Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study.

To assess the efficacy and morbidity of the holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia. The study included 60 (55%) and 49 (45%) patients who underwent laser and bipolar enucleation of the prostate respectively. According to the perioperative data, except for length of hospital stay and enucleated prostate weight, all the remaining parameters were similar between the groups. There were significant differences between the preoperative and the postoperative third and 12th month voiding parameters in both groups. In the laser group, the maximum urine flow rate value was better than the bipolar group at the postoperative third and 12th months. However, we did not find any statistically significant difference between the groups in terms of the serum prostate-specific antigen level, International Prostate Symptom Score and postvoid residual urine volume at the postoperative third and 12th months. Our results show that both laser and bipolar techniques are effective minimally invasive surgical treatment options for men with benign prostatic hyperplasia. When compared to bipolar technique, laser technique provides shorter hospital stay, more prostatic tissue enucleation and better maximum urine flow rate values.

Comparison of different postoperative pain managements in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.

PURPOSE: We compared the effects of local levobupivacaine infiltration, intravenous paracetamol, intravenous lornoxicam treatments on postoperative analgesia in patients submitted to transperitoneal laparoscopic renal and adrenal surgery. MATERIALS AND METHODS: Sixty adult patients 26 and 70 years who underwent laparoscopic renal and adrenal surgery were randomized into three groups with 20 patients each: Group 1 received local 20 mL of levobupivacaine 0.25% infiltration to the trocar incisions before skin closure. In group 2, 1g paracetamol was given to the patients intravenously 30 minutes before extubation and 5 g paracetamol was given intravenously in the 24 postoperative period. In group 3, 8 mg lornoxicam i.v. was given 30 minutes before extubation and 8 mg lornoxicam i.v. was given in the 24 postoperative period. In the postoperative period, pain scores, cumulative tramadol, and additional pethidine consumption were evaluated. RESULTS: Postoperative pain scores significantly reduced in each group (p < 0.05). Although pain levels of the groups were not significantly different at 1, 2, 4, 8, 12 and 24 hours postoperatively, cumulative tramadol consumptions were higher in group 1 than the others. (Group 1 = 370.6 ± 121.6 mg, Group 2: 220.9 ± 92.5mg, Group 3 = 240.7 ± 100.4 mg.) (p < 0.005). The average dose of pethidine administered was significantly lower in groups 2 and 3 compared with group 1 (Group 1: 145 mg, Group 2: 100mg, Group 3: 100mg) (p = 0.024). CONCLUSIONS: Levobupivacaine treated group required significantly more intravenous tramadol when compared with paracetamol and lornoxicam groups in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.

Comparison of different postoperative paın managements in patients submitted to transperitoneal laparoscopic renal and adrenal surgery

ABSTRACTPurpose:We compared the effects of local levobupivacaine infiltration, intravenous paracetamol, intravenous lornoxicam treatments on postoperative analgesia in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.Materials and Methods:Sixty adult patients 26 and 70 years who underwent laparoscopic renal and adrenal surgery were randomized into three groups with 20 patients each: Group 1 received local 20mL of levobupivacaine 0.25% infiltration to the trocar incisions before skin closure. In group 2, 1g paracetamol was given to the patients intravenously 30 minutes before extubation and 5g paracetamol was given intravenoulsy in the 24 postoperative period. In group 3, 8mg lornoxicam i.v. was given 30 minutes before extubation and 8mg lornoxicam i.v. was given in the 24 postoperative period. In the postoperative period, pain scores, cumulative tramadol, and additional pethidine consumption were evaluated.Results:Postoperative pain scores significantly reduced in each group (p < 0.05). Although pain levels of the groups were not significantly different at 1, 2, 4, 8, 12 and 24 hours postoperatively, cumulative tramadol consumptions were higher in group 1 than the others. (Group 1 = 370.6 ± 121.6mg, Group 2: 220.9 ± 92.5mg, Group 3 = 240.7 ± 100.4mg.) (p < 0.005). The average dose of pethidine administered was significantly lower in groups 2 and 3 compared with group 1 (Group 1: 145mg, Group 2: 100mg, Group 3: 100mg) (p = 0.024).Conclusions:Levobupivacaine treated group required significantly more intravenous tramadol when compared with paracetamol and lornoxicam groups in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.

Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion.

We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5-10 mm diameter were randomly divided into three groups. Group 1 (n = 25) received tamsulosin 0.4 mg/d; group 2 (n = 25) received nifedipine 10 mg/day p.o and group 3 (n = 25) received diclofenac sodium 50 mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16-68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (pgroup1-3 = 0.004, pgroup2-3 = 0.048 and pgroup1-2 = 0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408 mg in groups 1, 2 and 3, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p = 0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.