Bipolar Saline TURP for Large Prostate Glands

The objective of this study was to evaluate the feasibility of bipolar transurethral resection of the prostate (TURP) in patients with very large prostate glands and significant comorbidities. Four patients with prostate glands >160 cc on preoperative volume measurement and ASA class three or higher underwent bipolar TURP with the Gyrus PlasmaKinetic system. Preoperative, operative, and postoperative parameters were studied. The results showed an average ASA class 3.25 (range: 3–4). The average preoperative prostate volume was 207.4 cc (range: 163–268). The average preoperative International Prostate Symptom Score (IPSS) and bother score was 31 and 6, respectively. Mean resection time was 163 min (range: 129–215). The weight of resected tissue and percentage of vaporized tissue was 80.8 g (range: 62–115) and 10.0% (range: 3.8–15.1), respectively. An average of 61L of saline was used (range: 48–78). The mean change in hemoglobin and serum sodium was 2.1 g/dl (range: 1.4–2.7) and 3.3 meq/l (range: 2–4), respectively. Postoperative catheter time averaged 76 h (range: 40–104). Mean length of hospital stay was 12 h (range: 4–24). The mean postoperative IPSS and bother score was 2.75 and 0.25, respectively. Bipolar TURP is a feasible alternative to simple open prostatectomy in high-risk patients with massive prostate adenomas. Prostate volume is reduced by approximately 10% due to vaporization.

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EFFECT OF DUTASTERIDE (5 ALPHA-REDUCTASE INHIBITOR) TREATMENT ON REDUCING BLOOD LOSS, IN PERIOPERATIVE PERIOD OF OPEN PROSTATECTOMY DONE IN LARGE PROSTATE.

10.36106/ijsr/5408179 ◽

2020 ◽

pp. 1-2

Author(s):

Rahul Goel

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Prostate Volume ◽

Holmium Laser ◽

Transurethral Resection Of Prostate ◽

Open Prostatectomy ◽

Perioperative Bleeding ◽

Free Material ◽

Large Prostate ◽

Medical Colleges

Objective- Open prostatectomy (OP) is still a very valid option in treatment of very large volume prostates in the absence of holmium laser enucleation ( holmium laser is a rarity and expensive in govt and self funded medical colleges), its main complication being intra and perioperative bleeding. Preoperative use of dutasteride has shown to decrease perioperative bleeding in TURP (transurethral resection of prostate), though till date OP being a standard procedure in large prostate management ,there is no study showing effect of dutasteride in perioperative bleeding in OP. The aim of this study was to evaluate whether pretreatment with dutasteride for 6 weeks before OP could reduce blood loss in surgery, as high watt holmium laser is still not available in most of the medical colleges ,treating patients for free . Material and Methods- Data of 218 patients who underwent OP for BPH (benign prostatic hyperplasia), were investigated retrospectively. Of 218 patients ,46 were pretreated with dutasteride for 6 weeks and the rest were not under dutasteride treatment. Age, prostate volume , prostate specific antigen(PSA) levels, coagulation profile, platelet count, pre and post operative hemoglobin(Hb) levels ,and blood transfusion history were recorded .Blood loss was estimated as follows : pre operative Hb(-) post operative Hb(+) amount of blood transfusion. The 2 groups were compared by independent samples t-test and a p value of 0.05 was considered significant. Results- The groups were similar in terms of age , prostate volume ,platelet counts, coagulation tests and post operative Hb levels. Preoperative Hb levels were lower in dutasteride group (13.4 vs 14.3,p=0.002) and amount of bleeding (-2.72g/dl vs.-1.93g/dl, p=0.01) was shown to be significantly lower in dutasteride group. Conclusion -Our result showed that pretreatment with dutasteride for 6 weeks before OP for very large prostates, reduces perioperative bleeding , and can be used in medical colleges where treatment is free ,instead of using holmium laser, though further prospective randomized trials would support the effectiveness of such treatment.

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Correlation of prostate volume with 'International Prostate Symptom Score' and 'Benign Prostatic Hyperplasia-Impact Index' in benign prostatic hyperplasia

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v17i1.15174 ◽

2016 ◽

Vol 17 (1) ◽

pp. 6-10 ◽

Cited By ~ 2

Author(s):

D Gnyawali ◽

U Sharma

Keyword(s):

Benign Prostatic Hyperplasia ◽

Symptom Score ◽

International Prostate Symptom Score ◽

Prostate Volume ◽

Prostate Gland ◽

Prostatic Hyperplasia ◽

Prostate Hyperplasia ◽

Impact Index ◽

The Mean ◽

Severity Of The Disease

Introduction: Benign prostatic Hyperplasia is a common disorder and cause of morbidity in the ageing men. The evaluation symptoms and the bother associated with it are important for management. International Prostate Symptom Score (IPSS), Quality of life (QOL) and Benign Prostatic Hyperplasia Impact Index (BII) are practiced to quantify the severity of the disease. The size of prostate gland does not correlate with lower urinary tract symptoms. Correlation among above scoring is also not clear. Aim of the study is to evaluate correlation of prostate volume with International Prostate Symptom Score, Benign Prostatic Hyperplasia Impact Index and prostate size.Methods: Prospective study. Ninety-eight patients were included. Patients were assessed preoperatively with the International Prostate Symptom Score, Benign Prostatic Hyperplasia Impact Index and prostate volumes by trans abdominal ultrasound.Results: The mean age was 66.7 ± 7.3 years (50- 84) the mean IPSS, QOL, BII and prostate volumes were 23.6 ±6.0, 5.1 ± 0.9, 7.1±2.4 and 47.5±16.63 respectively. There was positive correlation between the IPSS and BII, IPSS and QOL and BII and QOL (rs= 0.89, 0.585 and 0.530 respectively) and no correlation between IPSS and BII with prostatic weight. (rs= -0.04 and -0.07 respectively).Conclusion: Management of the benign prostate hyperplasia should be considered on the bother symptoms and not on the size of the prostate.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 6-10

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Association between large prostate calculi and prostate cancer

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.3.181 ◽

2018 ◽

Vol 90 (3) ◽

pp. 181-183 ◽

Cited By ~ 1

Author(s):

Cem Yucel ◽

Salih Budak

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Volume ◽

Specific Antigen ◽

Future Research ◽

Detection Rates ◽

The Mean ◽

Total Psa ◽

The Relationship ◽

Large Prostate

Objective: We investigated the relationship between large prostate calculi and prostate cancer (PCa) risk. Materials and methods: The medical records of 340 patients who received a prostate biopsy at our institution between January 2015 and August 2016 were reviewed retrospectively. Of the patients, 82 had large prostatic calculi visualised by transrectal ultrasonography and 88 did not or had scarce prostatic calculi. We divided these patients into two groups: patients with large prostatic calculi (group 1) and patients without prostatic calculi (group 2). These groups were compared according to age, total prostate specific antigen (PSA) level, prostate volume, and final pathological diagnosis.Results: The mean age of all patients was 61.4 ± 6.2 years, the mean total PSA was 12.3 ± 17.4 ng/mL, the mean prostate volume was 41.7 ± 17.6 mL, and the overall cancer detection rate was 31.5%. The cancer detection rates were 41.3% and 22.6% in groups 1 and 2, respectively (p = 0.018). No significant differences in mean age, mean total PSA, or mean prostate volume were observed between the groups. Conclusions: In the present study, large prostatic calculi were associated with PCa. However, more study is needed to examine the relationship between large prostatic calculi and PCa in more detail. The effects of particularly large prostate calculi in the development of PCa will be a necessary focus of future research.

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The importance of surgical access in the treatment of patients with prostate cancer and abnormal prostate anatomy

Siberian Journal of Oncology ◽

10.21294/1814-4861-2021-20-6-32-40 ◽

2022 ◽

Vol 20 (6) ◽

pp. 32-40

Author(s):

A. V. Zyryanov ◽

A. S. Surikov ◽

A. A. Keln ◽

A. V. Ponomarev ◽

V. G. Sobenin

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Blood Loss ◽

Comparison Group ◽

Prostate Volume ◽

Robotic Prostatectomy ◽

Study Group ◽

Open Prostatectomy ◽

Large Prostate ◽

Blood Loss Volume

Background. The increased volume of the prostate in patients with confirmed prostate cancer (pc) is observed in 10 % of cases. The limitations of external beam radiotherapy and brachytherapy associated with large prostate volume and obstructive symptoms define radical prostatectomy (Rp) as the only possible treatment for prostate cancer in these patients. The purpose of the study was to determine the importance of the surgical approach in radical prostatectomy in patients with abnormal anatomy of the prostate. Material and methods. The study group consisted of patients with a prostate volume of more than 80 cm3 (n=40) who underwent a robot prostatectomy. The comparison group was represented by patients also selected by the prostate volume ≥ 80 cm3, who underwent classical open prostatectomy (n=44). The groups were comparable in age and psa level. The average prostate volume in the study group was 112.2 ± 26 cm 3(80–195 cm 3). The average prostate volume in the comparison group was 109.8 ± 18.7 cm3 (80–158 cm 3) (р>0.05). Both groups had favorable morphological characteristics. Results. The average surgery time difference was 65 minutes in favor of the open prostatectomy (p<0.05). The average blood loss volume in the study group was 282.5 ± 227.5 ml (50–1000 ml). The average blood loss volume in the group with open prostatectomy was 505.7 ± 382.3 ml (50–2000 ml). Positive surgical margin in the robotic prostatectomy was not detected, at 6.9 % in the group with open prostatectomy (p<0.05). According to the criterion of urinary continence, the best results were obtained in the group of robotic prostatectomy (p<0.05). Overall and relapse-free 5-year survival did not show a statistically significant difference. Conclusion. The use of robotic prostatectomy in a group of patients with a large prostate volume (≥ 80 cm3) allows us to achieve better functional and oncological outcomes.

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HUBUNGAN ANTARA DERAJAT INTRAVESICAL PROSTATIC PROTRUSSION DENGAN Q MAX, VOLUME PROSTAT, DAN INTERNATIONAL PROSTATE SYMPTOM SCORE PADA PASIEN BPH DENGAN LUTS TANPA KOMPLIKASI

Indonesian Journal of Urology ◽

10.32421/juri.v16i2.336 ◽

1970 ◽

Vol 16 (2) ◽

Author(s):

Musa As'ari ◽

Sabilal Alif ◽

Adi Santoso ◽

Widodo J P

Keyword(s):

Symptom Score ◽

International Prostate Symptom Score ◽

Prostate Volume ◽

Rank Correlation ◽

Volume Measurement ◽

Ball Valve ◽

Spearman Rank Correlation ◽

Valve Mechanism ◽

Spearman Rank ◽

Male Patients

Objective: The prostate volume is an objective due to BPH diagnosed, however it is not always concerned with the LUTS degree. LUTS is a syndrome of BOO which marked by obstructive and irritable symptoms. The ball valve mechanism in bladder neck results in increasing of BOO. The aim of this study is to prove the relation of intravesical prostatic protrussion (IPP) with prostate volume, Q max, and international prostate symptom score (IPSS) in non complicated BPH LUTS patients. Materials and method: This research is an analysis observational that involved 85 male patients aged 50 to 91 years old (average 63,98 years old) in Urology Outpatient Clinic RSUD Dr. Soetomo, starting November 2007 until April 2008. Such IPSS evaluation, prostate volume measurement, uroflowmetry examination, and IPP examination with TAUS were applied to all of these patients. Results: The calculation shows the increasing of IPP degree followed by the decreasing of Q max value, where Spearman rank correlation indicates r=-0,465 with p=0,001 (smaller than 0,05), which shows the relation between IPP and Q max. In Spearman rank correlation, with the IPP degree increasing followed by IPSS value increasing indicates r=0,456 and p=0,001, which is smaler than 0,05. Also shows the increasing of IPP degree followed by prostate volume increasing, with r=0,230 and p=0,034 is smaller than 0,05 in Spearman rank correlation. Conclusion: The research reveals a connection between IPP degree and Q max, where the higher IPP degree the lower Q max value, the higher IPP degree the bigger IPSS value, and the higher IPP degree the bigger prostate volume.

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Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

Author(s):

Perruchoud ◽

Vuilleumier ◽

Givel

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Average Length ◽

Length Of Hospital Stay ◽

Healing Time ◽

Incision And Drainage ◽

The Mean ◽

Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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A cluster-controlled clinical trial of two prophylactic silicone sacral dressings to prevent sacral pressure injuries in critically ill patients

Wound Practice and Research ◽

10.33235/wpr.27.1.21-26 ◽

2019 ◽

pp. 21-26 ◽

Cited By ~ 1

Author(s):

Monica Stankiewicz ◽

Jodie Gordon ◽

Joel Dulhunty ◽

Wendy Brown ◽

Hamish Pollock ◽

...

Keyword(s):

Clinical Trial ◽

Intensive Care ◽

Similar Efficacy ◽

Care Patient ◽

Controlled Clinical Trial ◽

Cost Difference ◽

Increased Risk ◽

Pressure Injury ◽

Risk Patients ◽

The Mean

Objective Patients in the intensive care unit (ICU) have increased risk of pressure injury (PI) development due to critical illness. This study compared two silicone dressings used in the Australian ICU setting for sacral PI prevention. Design A cluster-controlled clinical trial of two sacral dressings with four alternating periods of three months' duration. Setting A 10-bed general adult ICU in outer-metropolitan Brisbane, Queensland, Australia. Participants Adult participants who did not have a sacral PI present on ICU admission and were able to have a dressing applied for more than 24 hours without repeated dislodgement or soiling in a 24-hour period (>3 times). Interventions Dressing 1 (Allevyn Gentle Border Sacrum™, Smith & Nephew) and Dressing 2 (Mepilex Border Sacrum™, Mölnlycke). Main outcomes measures The primary outcome was the incidence of a new sacral PI (stage 1 or greater) per 100 dressing days in the ICU. Secondary outcomes were the mean number of dressings per patient, the cost difference of dressings to prevent a sacral PI and product integrity. Results There was no difference in the incidence of a new sacral PI (0.44 per 100 dressing days for both products, p = 1.00), the mean number of dressings per patient per day (0.50 for both products, p = 0.51) and product integrity (85% for Dressing 1 and 84% for Dressing 2, p = 0.69). There was a dressing cost difference per patient (A$10.29 for Dressing 1 and A$28.84 for Dressing 2, p < 0.001). Conclusions Similar efficacy, product use and product integrity, but differential cost, were observed for two prophylactic silicone dressings in the prevention of PIs in the intensive care patient. We recommend the use of sacral prophylactic dressings for at-risk patients, with the choice of product based on ease of application, clinician preference and overall cost-effectiveness of the dressing.

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Effect of Surgical Versus Pharmacological Decompression of Ludwig’s Angina on Airway Compromise among Nigerian Patients

Journal of Dentistry and Oral Sciences ◽

10.37191/mapsci-2582-3736-2(1)-024 ◽

2020 ◽

Author(s):

Ekaniyere EB

Keyword(s):

Length Of Hospital Stay ◽

Surgical Decompression ◽

Airway Compromise ◽

Inclusion Criteria ◽

Hospital Stays ◽

Ludwig’S Angina ◽

The Mean ◽

The University ◽

Ludwig's Angina ◽

Gender Type

Background: Even though the decompression of the cellulitis phase of Ludwig’s angina (LA) by surgical or pharmacological approach is well documented, it is unclear which approach is more effective. Objective: We aim to compare the outcome of treatment between surgical versus pharmacological decompression in patients with LA. Subjects and Methods: A retrospective cohort study was designed. Data were collected from the case notes of patients that met the inclusion criteria from 2004 to 2018 at the University of Benin Teaching Hospital, Nigeria.The data were age, gender, type of decompression approach, length of hospital stay (LOS) and airway compromise. Result: A total of 62 patients comprising 37(59.7%) surgical decompression group and 25(40.3%) pharmacological decompression group were studied. Thirty-six (58.1%) males and 26 (41.9%) females were studied. Their mean age and standard deviation were 40.6 years and 11.9 years respectively. The mean length of hospital stays between the pharmacological and surgical decompression groups were 8.05 days and 13.8 days respectively. The incidence of airway compromise in the surgical decompression group was 19.9% lower than that of the pharmacological decompression group (P=0.47), which was not significant. The type of decompression approach also failed to influence the incidence of airway compromise (P = 0.41). Conclusion: The use of surgical versus pharmacological decompression does not significantly alter the incidence of airway compromise in the management of LA. The Patients that had surgical decompression had a shorter stay in the hospital as compared to those who had pharmacological decompression. This was not statistically significant.

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Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016728 ◽

2020 ◽

pp. neurintsurg-2020-016728

Author(s):

Joshua S Catapano ◽

Andrew F Ducruet ◽

Stefan W Koester ◽

Tyler S Cole ◽

Jacob F Baranoski ◽

...

Keyword(s):

Hospital Stay ◽

Hospital Costs ◽

Length Of Hospital Stay ◽

Diagnostic Procedures ◽

Femoral Access ◽

Catheter Size ◽

The Mean ◽

The Difference ◽

Procedure Type ◽

Angiographic Findings

BackgroundTransradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.MethodsElective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.ResultsOf the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).ConclusionNeuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

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Correlation of intravesical prostatic protrusion with severity of lower urinary symptoms among patients with benign prostatic hyperplasia

African Journal of Urology ◽

10.1186/s12301-020-00102-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Babatunde K. Hamza ◽

Muhammed Ahmed ◽

Ahmad Bello ◽

Musliu Adetola Tolani ◽

Mudi Awaisu ◽

...

Keyword(s):

Flow Rate ◽

Bladder Outlet Obstruction ◽

Peak Flow ◽

Prostate Volume ◽

Outlet Obstruction ◽

Peak Flow Rate ◽

The Mean ◽

Benign Prostate ◽

Intravesical Prostatic Protrusion ◽

Lower Urinary

Abstract Background Benign prostate hyperplasia (BPH) is characterized by an increase in the number of epithelial and stromal cells in the periurethral area of the prostate. Lower urinary tract symptoms (LUTS) often develop as a manifestation of bladder outlet obstruction (BOO) due to benign prostate enlargement. When the prostate enlarges, protrusion into the bladder often occurs as a result of morphological changes of the gland. Prostatic protrusion into the bladder can be measured with ultrasound as intravesical prostatic protrusion (IPP). There are studies that have shown IPP as a reliable predictor of bladder obstruction index (BOOI) as measured by pressure flow studies. IPP is thereby reliable in assessing the severity of BOO in patients with BPH. The severity of symptoms in patients with BPH can be assessed through several scoring systems. The most widely used symptoms scoring system is the International Prostate Symptoms Score (IPSS). The aim of this study is to determine the correlation of IPP with IPSS in men with BPH at our facility. Methods The study was a cross-sectional observational study that was conducted at the Division of Urology, Department of Surgery, in our facility. The study was conducted on patients greater than 50 years LUTS and an enlarged prostate on digital rectal examination and/or ultrasound. All consenting patients were assessed with the International Prostate Symptoms Score (IPSS) questionnaire, following which an abdominal ultrasound was done to measure the intravesical prostatic protrusion (IPP), prostate volume (PV) and post-void residual (PVR) urine. All the patients had uroflowmetry, and the peak flow rate was determined. The data obtained were entered into a proforma. The results were analyzed using Statistical Package for Social Sciences (SPSS) software package version 20. Results A total of 167 patients were seen during the study period. The mean age was 63.7 ± 8.9 years, with a range of 45–90 years. The mean IPSS was 18.24 ± 6.93, with a range of 5–35. There were severe symptoms in 49.1%, while 43.1% had moderate symptoms and 7.8% had mild symptoms. The overall mean IPP was 10.3 ± 8 mm. Sixty-two patients (37.1%) had grade I IPP, 21 patients (12.6%) had grade II IPP and 84 patients (50.3%) had grade III IPP. The mean prostate volume and peak flow rate were 64 g ± 34.7 and 11.6 ml/s ± 5.4, respectively. The median PVR was 45 ml with a range of 0–400 ml. There was a significant positive correlation between the IPP and IPSS (P = 0.001). IPP also had a significant positive correlation with prostate volume and post-void residual and a significant negative correlation with the peak flow rate (P < 0.01). Conclusion Intravesical prostatic protrusion is a reliable predictor of severity of LUTS as measured by IPSS, and it also shows good correlation with other surrogates of bladder outlet obstruction.

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