Endourologic procedures combined with other surgical and urologic interventions--early experience.

OBJECTIVES: To assess the feasibility of performing endourologic interventions combined with other operations during the same operative session. METHODS: Eighteen patients underwent simultaneous operations endourologically for upper urinary tract pathologic findings and other surgical and urologic indications. The operating time, technical feasibility, operative success, complications, hospital stay, and patient satisfaction were analyzed. RESULTS: The average patient age was 63 years (range 40 to 83). Five patients underwent percutaneous nephrolithotomy combined with either contralateral laparoscopic nephrectomy, contralateral open nephrectomy, radical retropubic prostatectomy, inguinal/umbilical hernia repair, transurethral resection of prostate, or cystolithotripsy. Thirteen patients underwent 15 retrograde endoscopic procedures (13 for stone disease and 2 for diagnostic purposes) that were combined with open contralateral nephrectomy, inguinal hernia repair, circumcision, closure of ileostomy, transurethral resection of bladder tumor, excision of lymphoma of thigh, drainage and sclerozation of hydrocele, or percutaneous gastrostomy. All procedures were successfully completed without complications. The average hospital stay was 5 days (range 3 to 6) in the percutaneous nephrolithotomy group and 2 days (range 1 to 5) in the retrograde endoscopic procedure group. The duration of hospitalization was related to the more complex operation; combining the procedures did not prolong it. The average follow-up was 11 months (range 3 to 24). All patients were highly satisfied because they were spared the need for more than one surgical session. CONCLUSIONS: Our results support the concept of performing simultaneous endourologic procedures and other operations during one surgical session. This approach obviates the need for repeated anesthesia, patient inconvenience, the psychological stress related to multiple operations, and reduces the total hospital stay.

Are indications for prostatectomy in octogenarians the same as for younger men?

Prostatectomy for benign hypertrophy of the prostate is usually performed to alleviate lower urinary tract symptoms (LUTS). We assessed indications for and risks of prostatectomy in men 80 years of age and compared them to those for younger men in order to determine whether indications for prostatectomy in octogenarians are different than these for younger men. Medical records of 171 men comprised of 84 patients >80 years of age (mean 84.4) and 87 patients <65 years of age (mean 60.6) who underwent prostatectomy for benign prostate hypertrophy were reviewed. Data regarding indications for surgery, American Society of Anesthesiologists system grade, anesthesia and surgery performed, duration of hospitalization and intrahospital postoperative complications were obtained. The respective indications for surgery in the very elderly and younger patients were: urinary retention with indwelling catheter in 46 (55%) and 34 (39%) (p < 0.04), LUTS in 32 (38%) and 52 (59%) (p < 0.005), and gross hematuria in 6 (7%) and 1 (1.2%). Transurethral prostatectomy was performed in 47 elderly patients (56%) and in 30 young patients (34.5%). The other patients in each group underwent open (suprapubic prostatectomy) surgery. The overall complication rate was significantly higher in the elderly group (39% vs 22%, p < 0.05), with major complications occurring only in this group. Indications for surgery were different for octogenarians than for younger men. Morbidity and mortality rates were significantly higher among the elderly men. Age appears to be an independent risk factor for complications associated with prostatectomy.