Transurethral resection of the prostate stricture management.

For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.

Removal of a broken acupuncture needle in retroperitoneum by laparoscopy: a case report.

BACKGROUND: Acupuncture is a famous traditional medicine in China, but the complications caused by broken acupuncture needles have been rarely reported. It seems easy to remove the foreign matters usually, but things become difficulty in special issues. Here, we reported a recently encountered case to provide an important teaching point of treating a chronically retained broken needle in retroperitoneum. CASE PRESENTATION: A 42-year-old man presented with a chronically retained broken needle in his body after acupuncture therapy two years ago. However, due to the discomfort at the left back recently and ordinary inconvenience such as security check, he came to our hospital for minimally invasive surgery. He was introduced to our department because the broken needle had migrated from subcutaneous to adipose tissue in retroperitoneum during the two years. Considering the position of the broken needle, the patient was performed by laparoscopy in general anesthesia. The operation time was about 31 min and there were only three 7 mm incisions in the left lateral abdominal wall. The X-ray exam was performed to confirm that the broken needle was removed integrally. The patients begun normal activity at 6 h after surgery and was discharged on the second day after surgery. CONCLUSIONS: Acupuncture is widely used for pain treatment in China, but how to handle the complication of acupuncture needle broken in body are rarely reported. Laparoscopy will be the reasonable choice for treating needles broken in retroperitoneum.

Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis.

OBJECTIVE: The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi. METHODS: Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs) were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications. RESULTS: Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases). Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], P<0.0001) and reduced the expulsion time (standard mean difference =-0.39, 95% CI [-0.72, -0.05], P=0.02). Regarding safety, tamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008), and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications. CONCLUSION: On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi <10 mm in aspects of expulsion rate, expulsion time, and safety. Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy.