The Efficacy of Bipolar Transurethral Resection of the Prostate in Patients with Large Prostates(>80g) and Analysis of the Postoperative Results Based on the Resection Ratio / 대한비뇨기과학회지

PURPOSE: We evaluated the efficacy of bipolar transurethral resection of the prostate(TURP) in patients with large prostates(>80g) and determined the postoperative results based on the transitional zone resection ratio. MATERIALS AND METHODS: Thirty patients with benign prostatic hyperplasia (BPH)>80g(group 1) and 76 patients with BPH between 30g and 80g (group 2) were evaluated. The evaluation before TURP included the International Prostate Symptom Score(IPSS), maximum urinary flow rate (Qmax), post-void residual urine(PVR), and transrectal ultrasonography. The operative time, weight of resected tissue, change in serum hemoglobin, and complications were noted. After TURP, patients were reassessed for the IPSS, Qmax, and PVR at 6 months. In group 1, subgroup analysis of the postoperative symptom scores was performed based on the ratio of the resection volume(RV) to the transitional zone volume(TZV). RESULTS: In patients with large prostates, the operative times were prolonged, and the weights of resected tissues were higher. However, there were no statistically significant differences between the two groups with respect to hemoglobin changes, postoperative hospital stays, or complications. The postoperative clinical parameters were markedly improved in both groups. Severe bleeding necessitated blood transfusion, and the TURP syndrome did not occur in any patients. The symptom score improved more as the RV/TZV increased. CONCLUSIONS: Bipolar TURP is an effective and safe surgical treatment method, even in patients with large prostates. Considering that the complications associated with bipolar TURP are very rare, surgeons should aim to perform a complete resection of the enlarged transitional zone to ensure a good postoperative result.

Efficacy of Bipolar Transurethral Resection of the Prostate: Comparison with Standard Monopolar Transurethral Resection of the Prostate / 대한비뇨기과학회지

PURPOSE: We wanted to assess the efficacy of bipolar transurethral resection of the prostate (TURP) compared with standard monopolar TURP. MATERIALS AND METHODS: All 25 patients with symptomatic benign prostatic hyperplasia (BPH) who underwent TURP from July 2004 to June 2005 were retrospectively reviewed. Thirteen consecutive patients underwent standard monopolar TURP and 12 underwent bipolar TURP using the Gyrus PlasmaKinetic system. RESULTS: The mean weight of resection was 29.7g for the bipolar TURP and 22.5g for the monopolar TURP. The operative time was shorter (82.5 vs 98.1 minutes, respectively), the estimated blood loss was less (252 vs 268cc, respectively) and the mean post-operative hospital stay was shorter (5.3 vs 5.7 days, respectively) in the bipolar TURP group. However, these differences were not statistically significant. The acute complications were significant hyponatremia in one patient and clot retention in one patient after monopolar TURP, but no complications occurred after bipolar TURP. The maximal flow rate increased from 6.4 to 14.7ml/sec in the bipolar TURP group, and it increased from 6.7 to 15.2ml/sec in the monopolar TURP group. CONCLUSIONS: Compared to monopolar TURP, bipolar TURP can be easily and safely used for treating symptomatic BPH with less morbidity.

A case of hepatopleural fistula complicated by transcatheter arterial chemoembolization for hepatocellular carcinoma with liver abscess / 대한내과학회지

Pleural complication is extremely rare among the complications of lung following transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma. We report a case of hepatopleural fistula complicated by TACE. A 50-year-old male was admitted to the hospital because of aggravation of cough and chest pain. Fifty five days before admission, a liver abscess had developed and treated by percutaneous drainage. A hepatocellular carcinoma had been diagnosed as a cause of liver abscess. Forty five days before admission, TACE had been performed for the hepatocellular carcinoma. Thirty days after TACE, dry cough and right pleuritic chest pain developed. After admission, serial CT scans of thorax and abdomen showed the pleural effusion containing the lipiodol from the liver through hepatopleural fistula. Chest tube insertion with a urokinase instillation was performed for the treatment of empyema caused by hepatopleural fistula.