Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study.

Introduction: Bipolar transurethral resection of the prostate (B-TURP) is a commonly performed procedure, although it has not yet surpassed the gold standard monopolar TURP. The incidence and contributing factors to the development of urethral stricture following B-TURP are still a matter of debate and were analyzed in the present study. Methods: This prospective study evaluated patients who underwent B-TURP. Demographic characteristics, clinical data, and data on other specific investigations were analyzed. B-TURP was performed using an Olympus TURis bipolar system. Patients were followed up for 6 months with the International Prostate Symptom Score (IPSS), peak flow rate (Q-max), and residual urine estimation. Urethral stricture was defined as narrowing of the urethral lumen requiring instrumentation to improve the urinary flow rate. Results: A total of 352 patients were enrolled, with a mean age of 67 ± 8.6 years. The mean preoperative IPSS, prostate volume, and Q-max were 21 ± 4, 58.8 ± 31.7 cm3, and 8 ± 3 mL/sec, respectively. The mean meatal caliber was 28 ± 2 Fr. In 209 patients (59.4%), B-TURP was performed using a 24-Fr resectoscope, while in the remaining 143 (40.6%), a 26-Fr resectoscope was used. The mean resection times with the 24-Fr and 26-Fr resectoscopes were 36.5 ± 19.8 min and 63.5 ± 30 min, respectively. Urethral strictures were identified in 15 patients, with an incidence of 4.3%. Mean meatal caliber was significantly related to the risk of stricture formation (P = 0.001). Conclusions: The incidence of urethral stricture after B-TURP was 4.3%. We found that small meatal caliber was associated with an increased risk of urethral stricture following B-TURP.

Transurethral enucleation with bipolar energy for surgical management of benign prostatic hyperplasia: Our initial experience.

INTRODUCTION: Transurethral resection of the prostate has been considered as the gold standard for benign prostatic hyperplasia (BPH). LASER enucleation procedures have emerged as a size-independent gold standard. The flip side of LASER procedures is the initial cost of investment and a long learning curve. Transurethral enucleation with bipolar (TUEB) has emerged as an alternative prostatic enucleation procedure. We present our initial experience in TUEB. MATERIALS AND METHODS: Fifty patients with BPH and indications for surgery underwent TUEB from December 2014 to October 2015. Patients with prostate size >40 g were selected. All surgeries were done by a single urologist. Various parameters such as preoperative and postoperative International Prostate Symptom Score (IPSS) scores, Qmax (peak flow) scores, duration of surgery, duration of enucleation, drop in hemoglobin, postoperative pain scores, weight of morcellated tissue, and the incidence of stress urinary incontinence were measured. RESULTS: The mean age was 58 years and mean prostatic size was 84 g. Sixteen patients had refractory urinary retention. The mean IPSS score in remaining patients was 24.5. The mean preoperative maximal flow rate (Qmax) on uroflowmetry was 9.3 mL/s. The mean overall duration of surgery was 83 min. The mean drop in hemoglobin was 0.9 g/dl. The mean postoperative pain scores at 12 and 24 h after surgery were 2.1 and 1.3. The mean weight of morcellated tissue was 48 g. Twenty-six patients had de novo transient stress urinary incontinence after surgery. The mean IPSS score after TUEB was 8.3 showing significant improvement in all aspects of IPSS. The mean post-TUEB Qmax on uroflowmetry was 25 mL/s. CONCLUSIONS: TUEB is an effective surgical management of BPH. TUEB allows enucleation of large adenomas in a single sitting, mimicking conventional open enucleation of the prostate while having all the advantages of a minimally invasive surgery.

The "peritoneal scaffold" technique of extended pelvic lymph node dissection during radical prostatectomy: A novel technique.

INTRODUCTION: Laparoscopic or robotic-assisted laparoscopic radical prostatectomy (RALP) is a frequently used approach for localized carcinoma prostate. For intermediate and high-risk cancers, extended pelvic lymph node dissection (e-PLND), is often performed. Conventional e-PLND involves piecemeal retrieval of lymphatic tissue. We describe a novel technique of laparoscopic e-PLND, which involves en-masse removal of pelvic lymph nodes from each side, based on an overlying peritoneal scaffold. MATERIALS AND METHODS: Fifteen cases of intermediate and high-risk carcinoma prostate underwent laparoscopic radical prostatectomy (LRP) with peritoneal scaffold based e-PLND within a period of 1 year. We describe the surgical techqniue and outcomes in terms of operative time and lymph nodes retrieved. RESULTS: The mean operating times for "peritoneal scaffold" lymphatic dissection was 48 min (38-64). The total number of lymph nodes retrieved was 18 (14-22). There were no cases with postoperative lymph collection or hematoma. CONCLUSION: The "peritoneal scaffold" technique of e-PLND is a novel technique, which involves having a peritoneal scaffold to bind and hold all the lymphatic tissues together in its anatomical orientation during dissection. This enables complete retrieval of specimen during LRP and RALP.

Techniques in minimally invasive transperitoneal pyeloplasty: A compilation.

Context: Minimally invasive management (laparoscopic/robot assisted) is currently the standard of care for managing pelvi ureteric junction obstruction (PUJO). Open techniques of management of PUJO are well described in literature. However, there appears to be relative lack of description of minimally invasive techniques in the literature. Objective: This article is aimed at describing in detail, with images, the various techniques and modifications in laparoscopic or robot-assisted management of PUJO. Evidence Acquisition: A review of literature on PubMed was performed and all articles which detailed any technique of minimally invasive pyeloplasty were included. Evidence Synthesis: The various techniques of minimally invasive pyeloplasty as well as the authors' techniques are compiled and described in detail with intraoperative images. Conclusions: Operative techniques of minimally invasive pyeloplasty are not well described in literature. We have attempted to present a comprehensive resource of different techniques of minimally invasive pyeloplasty and the clinical scenarios in which they may be appropriate. This should prove to be a useful reference to the practicing urologist. Patient Summary: In this paper, we have compiled the various surgical techniques of treating obstruction at the PUJ of the kidney along with intraoperative photograph.