RESUMEN
OBJECTIVES: To evaluate whether the increased number of rectal perforations associated with contemporary transrectal ultrasound-guided, 12-core prostate biopsy, with a periprostatic block, is associated with a greater rate of postprocedural complications. METHODS: We prospectively studied 1000 patients undergoing contemporary transrectal ultrasound-guided prostate biopsy and compared the rates of complicated urinary tract infection and significant rectal bleeding with the rates in our previous report of complications using a then-standard, 6-core biopsy technique, without a periprostatic block. RESULTS: Three patients developed complicated urinary tract infections, two of which were with ciprofloxacin-resistant organisms. This was not a significant different statistically from our earlier report. Seven patients had significant rectal bleeding requiring endoscopic intervention. This rate also was not significantly different statistically from our earlier report. CONCLUSIONS: Our infection and rectal bleeding complications associated with contemporary transrectal ultrasound-guided prostate biopsy were low. We experienced a small, nonstatistically significant, increase in the complicated urinary tract infection rate and a small, nonstatistically significant, increase in the rectal bleeding rate in association with the transition from an eight-core, no periprostatic block, technique to the contemporary technique.
Asunto(s)
Biopsia con Aguja/efectos adversos , Hemorragia Gastrointestinal/etiología , Próstata/patología , Infecciones Urinarias/etiología , Anestésicos Locales , Bloqueo Nervioso Autónomo , Biopsia con Aguja/instrumentación , Biopsia con Aguja/métodos , Farmacorresistencia Bacteriana , Intervención Educativa Precoz , Epinefrina/uso terapéutico , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/prevención & control , Humanos , Asociaciones de Práctica Independiente , Lidocaína , Masculino , Estudios Prospectivos , Recto , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , Urología/organización & administraciónRESUMEN
PURPOSE: We evaluate the use of finasteride to control gross hematuria secondary to prostatic bleeding. MATERIALS AND METHODS: We reviewed retrospectively 42 patients treated with finasteride to treat gross hematuria. RESULTS: There were 28 evaluable patients who had taken finasteride for at least 6 months to control gross hematuria and hematuria ceased in 25 (91%). In 1 patient clot retention developed requiring transurethral resection of the prostate and 2 patients had 1 or more minor episodes of bleeding that resolved spontaneously. CONCLUSIONS: Finasteride appears to be an effective agent for controlling gross hematuria secondary to prostatic bleeding.
Asunto(s)
Inhibidores Enzimáticos/uso terapéutico , Finasterida/uso terapéutico , Hematuria/tratamiento farmacológico , Hemorragia/complicaciones , Enfermedades de la Próstata/complicaciones , Anciano , Anciano de 80 o más Años , Hematuria/etiología , Humanos , MasculinoRESUMEN
PURPOSE: We initiated a prospective study to verify or refute the complications of lymphocele formation and excessive blood loss associated with heparin prophylaxis in pelvic lymphadenectomy and radical prostatectomy. MATERIALS AND METHODS: A prospective study was completed on 579 men undergoing pelvic lymphadenectomy usually in association with radical prostatectomy. Patients were assigned to group 1 (given preoperative and postoperative subcutaneous heparin) and group 2 (no heparin). All patients were evaluated 2 to 3 weeks after surgery with ultrasound for pelvic lymphocele. RESULTS: There was no statistically significant difference in the number or size of pelvic lymphoceles or blood loss in group 1 versus group 2. CONCLUSIONS: The use of heparin prophylaxis to prevent thromboembolic complications in conjunction with pelvic lymphadenectomy and radical prostatectomy is not associated with increased blood loss or increased rate of lymphocele formation.
Asunto(s)
Pérdida de Sangre Quirúrgica , Fibrinolíticos , Heparina , Escisión del Ganglio Linfático , Linfocele/inducido químicamente , Complicaciones Posoperatorias/inducido químicamente , Prostatectomía , Contraindicaciones , Humanos , Linfocele/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios ProspectivosRESUMEN
PURPOSE: A retrospective review of a large group of transrectal ultrasound guided biopsies was performed to determine the symptomatic urinary tract infection rate associated with a consistent and defined antibiotic prophylaxis regimen. MATERIALS AND METHODS: A total of 4,439 biopsies was performed using an 18 gauge needle with ultrasound guidance. Patients were treated with 500 mg. ciprofloxacin twice daily for 8 doses beginning the day before biopsy. RESULTS: Of 5 symptomatic urinary tract infections noted 3 were complicated. CONCLUSIONS: These data demonstrate the low infection rate associated with this prophylaxis regimen.
Asunto(s)
Antiinfecciosos/uso terapéutico , Profilaxis Antibiótica , Biopsia con Aguja/efectos adversos , Ciprofloxacina/uso terapéutico , Próstata/patología , Infecciones Urinarias/prevención & control , Biopsia con Aguja/métodos , Humanos , Masculino , Persona de Mediana Edad , Próstata/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiologíaRESUMEN
PURPOSE: We assessed the use of combination bowel preparation before radical prostatectomy. MATERIALS AND METHODS: We reviewed 533 radical prostatectomies performed from 1984 to 1994. All patients underwent preoperative combination bowel preparation. The incidence, management and sequelae of rectal injury were determined. The literature addressing the management of rectal injuries was reviewed. RESULTS: Rectal injury occurred in 8 patients (1.5%). Injury was recognized intraoperatively and repaired primarily in 6 cases, and repair included colostomy in 2. Injury was recognized postoperatively as recto-urinary fistula in 2 cases and initial management was conservative. No fistula closed with conservative management. There were no pelvic abscesses and no deaths. CONCLUSIONS: Combination bowel preparation permits safe closure of rectal injury at radical prostatectomy without the necessity of routine colostomy. In the event of recto-urinary fistula, conservative management is not warranted.
Asunto(s)
Complicaciones Intraoperatorias/epidemiología , Prostatectomía , Recto/lesiones , Humanos , Incidencia , Complicaciones Intraoperatorias/terapia , MasculinoRESUMEN
Since 1989 we have used serum prostate specific antigen (PSA) levels as an indication for ultrasound guided systematic biopsies of the prostate. Realizing that the PSA level in part reflects prostatic glandular epithelial volume, we reviewed the accumulated data on our last 2,340 biopsies to determine if the quotient of PSA and prostatic volume, prostate specific antigen density, provided any further diagnostic information. There were evaluable data for 2,020 patients. Prostate specific antigen density levels are shown to have a strong correlation with the diagnosis of prostate cancer and provide a more reliable indication for ultrasound guided biopsy of the prostate than PSA alone.
Asunto(s)
Antígeno Prostático Específico/sangre , Próstata/patología , Neoplasias de la Próstata/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Biopsia , Servicios de Salud Comunitaria , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/sangre , UrologíaRESUMEN
A case of ureterosciatic hernia is presented with 3-dimensional computerized tomography reconstruction of the pelvis. The anatomical defect is defined. A total of 13 previously reported cases and the options for surgical repair are reviewed.
Asunto(s)
Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada por Rayos X/métodos , Enfermedades Ureterales/diagnóstico por imagen , Hernia/diagnóstico por imagen , Hernia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Ureterales/epidemiología , Obstrucción Ureteral/etiologíaRESUMEN
A few cases of the crush syndrome occurring postoperatively have been reported. We present a case of the crush syndrome involving the gluteal compartment secondary to prolonged duration of the patient in the right lateral decubitus position during a urological operation. A review of the literature demonstrates that prompt diagnosis is essential to avoid catastrophic results. The essentials of diagnosis, treatment and prevention are reviewed.