Comparative Study Between Outcomes of Early Primary Endoscopic Realignment Versus Suprapubic Cystostomy With Delayed Reconstruction in the Management of Posterior Urethral Injury

Objectives: To compare the outcomes of early primary endoscopic realignment and suprapubic cystostomy with the outcomes of delayed reconstruction in the management of posterior urethral injury. Methods: This is a quasi-experimental prospective study Conducted in the Urology department Dhaka medical college and hospital from January 2009 to December 2010. Atotal of 60 consecutive patients were selected for this study and inclusion criteria, male patients and age 18years and above. Posterior urethral injury resulting in distraction defect and urethral injury with pelvic fracture. Group-A, 28 patients underwent early primary endoscopic realignment after initial suprapubic urinary diversion and Group-B, 32 patients underwent primary suprapubic urinary diversion and delayed urethral reconstruction after 3 months of injury. Results: After procedure 21(75%) out of 28 patients in Group-A developed stricture 12(42.9%) had simple and short segment stricture and 7(32.1%) had simple and long segment stricture, while in Group-B 12(37.5%) patients developed simple and short segment stricture. All of the patients in Group-A had minimum blood loss during operation. While, majority (81.3%) of patients in Group-B had a history of maximum blood loss. None of the patients in Group-A developed incontinence throughout the observations period (from removal of catheter to 9 months), while 15.6% of the patients in Group-B had incontinence at removal of catheter after anastomotic urethroplasty and at 3 month. The incontinence further increased to 18.8% at 6 and 9 months. Complaints of impotence were significantly less in Group-A than that in Group-B throughout the period of observation (14.3% vs. 37.5%, p = 0.042; 14.3% vs. 37.5%, p = 0.042 and 14.3% vs. 37.5%, p = 0.042). At removal of urethral catheter, stricture formation was observed and statistically there was no difference in Group-A and Group-B (14.3% vs. 21.9% in Group-B, p = 0.448). At month 3, stricture formation was significantly higher in Group-A than that in Group-B (42.9% vs. 15.6%, p = 0.020). At month 6, about 18% of patients in Group-A had stricture, but none of patients in Group-B was found so (p = 0.018). Conclusions: Early primary endoscopic realignment of traumatic posterior urethral disruption is a simple, less traumatic, safe, and rapid technique. It provides a low morbidity and less postoperative complications. Though recurrent stricture formation is higher but the strictures are simple and short and amenable to be corrected endoscopically. It may be considered as initial therapy in the management of posterior urethral distraction defect over suprapubic cystostomy with delayed reconstruction. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.29-35

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Prospective randomised study of cases of pelvic fracture urethral distraction defects managed by early alignment versus initial suprapubic urinary diversion with delayed urethroplasty

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202558 ◽

2020 ◽

Vol 8 (7) ◽

pp. 2426

Author(s):

Arun Kumar ◽

Gunjeet Kaur ◽

Krishna Kant Singh ◽

H. S. Pahwa ◽

Awanish Kumar ◽

...

Keyword(s):

Urinary Diversion ◽

Pelvic Fracture ◽

Randomized Study ◽

Stricture Formation ◽

Cutaneous Fistula ◽

Early Management ◽

Randomised Study ◽

Post Surgery ◽

Group A ◽

Group B

Background: In complex pelvic fracture urethral distraction defects (PFUDD), early management prevents incidence of devastating complications such as urinary incontinence, restenosis and urethra cutaneous fistula. The aim of the present study was to study the outcome of patients with PFUDD undergoing early alignment (either by rail roading or endoscopic) compared with initial suprapubic urinary diversion with delayed urethroplasty.Methods: This was a prospective randomized study done at KGMU, Lucknow; having PFUDD during the period from June 2014 to July 2017. Patients with PFUDD were randomized in to two groups. Group A included 22 patients and managed by supra pubic cystostomy followed by delayed urethroplasty. Group B included 23 patients and managed by primary alignment by rail-roading and early endoscopic alignment. Patients were followed up after 6 weeks, 3 months and 6 months for measuring the primary and secondary outcomes during follow up.Results: The most common age group that sustained pelvic fracture urethral distraction defects injury are male of 21-40 years. In group A, stricture was present in all patients at 6 weeks post-surgery. Open urethroplasty was done at 3 months in 60% and 10% patients at 6 months. In group B, stricture was present in 80% at 6 weeks, 40% at 3 months and 10% at 6 months. The incidence of ED in group A at 6 weeks, 3 months, was 25% patient which reduced to 20% at 6 months. In group B, ED was present in 30% patients 6 weeks, 3 months and which reduced to 25% at 6 months. No incontinence was observed in both groups.Conclusions: Primary realignment has significant benefits compared to SPC as realignment approach is associated with a 50%-55% decrease in stricture formation.

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Short Segment versus Long Segment Posterior Pedicle Screws Fixation for Treatment of Thoracolumbar Burst Fracture: A Comparative Prospective Study

Asian Journal of Medical Research ◽

10.47009/ajmr.2020.9.2.or1 ◽

2020 ◽

Vol 9 (2) ◽

pp. 1-6

Author(s):

Arvind Singh ◽

Shiv Kumar Bali ◽

Subhajit Maji ◽

Kaustubh Ahuja ◽

Nagaraj Manju Moger ◽

...

Keyword(s):

Blood Loss ◽

Burst Fracture ◽

Thoracolumbar Spine ◽

Posterior Fixation ◽

Short Segment ◽

Kyphosis Correction ◽

Duration Of Surgery ◽

Group A ◽

Group B ◽

Anterior Column Reconstruction

Background: The surgical treatment of unstable burst fracture (TLICS >4) of the thoracolumbar vertebrae remain controversial. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. Subjects & Methods: In this prospective study, we included 32 patients with Burst fracture AO type A3, A4 of Thoracolumbar spine (T10-L2), who underwent posterior pedicle screw fixation for Burst fracture Thoracolumbar spine. A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior column reconstruction(n=4) with cage, Whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B). Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. Results: The operative time Group A (159.85 min 22.5) was significantly shorter than Group B (198.7 31.5). Blood loss was significantly less in Group A (478 ml 259.3) than Group B (865ml 275.7). Kyphosis Correction loss at 6th month follow up in Group A (subgroup A1: 10.7deg 6.2, subgroup A2: 7.1deg 7.4 and subgroup A3: Subgroup A3: 6.1deg 5.2) was higher than that of group B (6.2deg 6.3). Complication (surgical site infection) occurred in Two patients in group B. There was no significant difference in terms of improvement in functional and neurological outcomes among both groups. The functional outcomes as per the SCIM and ODI score at 6th month follow up in group A: 74.7 +-22.29, 31.5+-13.73 respectively, and group B: 73.8+-26.07, 26.7+-17.9, respectively. Conclusion: Short-Segment Posterior Fixation (SSPF) is a significantly decreased duration of surgery and blood loss compare with Long-Segment Posterior Fixation (LSPF). Loss of kyphosis correction in Short-Segment Posterior Fixation (SSPF) may be decreased with index screws or anterior column reconstruction.

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Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0125-4 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Mohamed I. Refaat ◽

Amr K. Elsamman ◽

Adham Rabea ◽

Mohamed I. A. Hewaidy

Keyword(s):

Patient Satisfaction ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Technique ◽

Decompression Surgery ◽

Microsurgical Decompression ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

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Effectiveness of a Gelatin–Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study

Global Spine Journal ◽

10.1177/21925682211008835 ◽

2021 ◽

pp. 219256822110088

Author(s):

Kazunori Nomura ◽

Munehito Yoshida ◽

Motohiro Okada ◽

Yosuke Nakamura ◽

Kenichi Yawatari ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Retrospective Cohort ◽

Spinal Canal Stenosis ◽

Lumbar Spinal Canal Stenosis ◽

Canal Stenosis ◽

Postoperative Drainage ◽

Group A ◽

Group B ◽

Lumbar Spinal

Study Design: Retrospective cohort study. Objectives: To investigate the effectiveness and safety of a gelatin–thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). Methods: This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. Results: The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B ( P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). Conclusions: The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.

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Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04307-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Bing-xin Kang ◽

Hui Xu ◽

Chen-xin Gao ◽

Sheng Zhong ◽

Jing Zhang ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Trial ◽

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Randomized Controlled ◽

Group A ◽

Total Knee ◽

Group B ◽

D Dimer

Abstract Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P < 0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900025013).

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Surgery for thoracolumbar junction (T12-L1) tuberculosis a multicentre, retrospective study

10.21203/rs.2.13914/v1 ◽

2019 ◽

Author(s):

Yanping Zeng ◽

Peng Cheng ◽

Jiulin Tan ◽

Zhilin Li ◽

Yuan Chen ◽

...

Keyword(s):

Blood Loss ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

Surgical Techniques ◽

Operation Time ◽

Thoracolumbar Junction ◽

Group A ◽

The Mean ◽

Group B ◽

Approach Group

Abstract Purpose A multicentre, retrospective study was conducted to evaluate the safety and efficacy of different surgical techniques for thoracolumbar junction (T12-L1) tuberculosis. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 257) from January 2005 to January 2015 were collected and reviewed. A total of 45 patients were operated on by an anterior approach (Group A), 52 by a combined anterior and posterior approach (Group B) and 160 by a posterior approach (Group C). Anti-tuberculosis therapy was performed both before and after surgery. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Results All three surgical approaches achieved bone fusion, pain relief and neurological recovery. The mean loss of correction in group A at last follow-up was higher than in groups B and C (P < 0.05), and the difference between groups B and C was not significant (P > 0.05). The mean operation time and blood loss in group B were greater than in groups A and C. Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only approach is superior to the anterior-only approach in the correction of kyphosis and maintenance of spinal stability. The posterior-only approach is recommended because it achieves the same efficacy as the anterior-only or combined approach but with shorter operation times, less trauma and less blood loss. Keywords Spinal tuberculosis; Thoracolumbar junction; Three approaches.

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Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20211817 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1507

Author(s):

Amit Yadav ◽

Lakshman Agarwal ◽

Sumit A. Jain ◽

Sanjay Kumawat ◽

Sandeep Sharma

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Abdominal Surgery ◽

Wound Infection ◽

Skin Incision ◽

P Value ◽

Wound Area ◽

Significant Difference ◽

Group A ◽

Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

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ELECTIVE MIDLINE LAPAROTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1869 ◽

2011 ◽

Vol 18 (01) ◽

pp. 106-111

Author(s):

ARSALAN SIRAJ ◽

ATHAR ABBAS SHAH GILANI ◽

MUHAMMAD FAROOQ DAR ◽

Sohail Raziq

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Wound Infection ◽

Visual Analogue Score ◽

P Value ◽

Midline Laparotomy ◽

Pain Scores ◽

Group A ◽

Insignificant Difference ◽

Group B

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.

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SUBLINGUAL MISOPROSTOL FOR PREVENTION OF POSTPARTUM HAEMORRHAGE – A RANDOMISED CONTROL TRIAL

10.36106/7030894 ◽

2021 ◽

pp. 56-57

Author(s):

Anupama Anupama

Keyword(s):

Caesarean Section ◽

Blood Loss ◽

Outcome Measures ◽

Post Partum ◽

Randomised Control Trial ◽

Study Group ◽

Sublingual Misoprostol ◽

Group A ◽

Post Partum Haemorrhage ◽

Group B

Aim – The aim of the study was to study the effect of sublingual misoprostol for prevention of PPH. Materials and Methods – This was a prospective, randomized, double blind, placebo controlled study. Inclusion criteria were women aged 20-40 years with 38-40 weeks of gestation who underwent elective caesarean section. Exclusion criteria were women have risk factors for post-partum haemorrhage, active thromboembolic disease and intrinsic risk for thrombosis. Participants were randomly assigned to misoprostol group or group A (n=50) and placebo group or group B(n=50). Group A received 400µg of sublingual misoprostol after delivery of the baby, group B received placebo tablet at the same time. Primary outcome measures were blood loss from delivery of the placenta to the end of the caesarean section to 2 hours postpartum, haemoglobin estimation was done in all patients pre operatively and 24 hours post operatively and the change in concentration was noted. Secondary outcome measures were need for additional uterotonics, use of additional surgical interventions to control post-partum haemorrhage. Result – Blood loss from both placental delivery to the end of caesarean section and from end of caesarean section to 2 hours postpartum were signicantly lower in the study group. (p<0.0001). Change ifn haemoglobin concentration in study group was also signicantly less than in the control group. (p<0.0001). Total amount of Oxytocin required was signicantly less in the study group (p=0.01). The number of women requiring other oxytocics (inj. Methyl ergometrine, inj. Carboprost) was signicantly less in study group (p=0.0078). Conclusion – Sublingual misoprostol has been found to be effective in preventing PPH.

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“A PROSPECTIVE STUDY: ROLE OF TRACTION ON FOLEY’S CATHETER IN TURP PATIENTS”

10.36106/8221806 ◽

2021 ◽

pp. 27-29

Author(s):

Prashant Lavania ◽

Ankush Gupta ◽

Rahul Chaudhary

Keyword(s):

Blood Loss ◽

Early Discharge ◽

Common Condition ◽

Medical College ◽

Duration Of Hospital Stay ◽

Group A ◽

Foley’S Catheter ◽

Group B ◽

A Prospective Study

INTRODUCTION: Benign prostatic hyperplasia (BPH) is the most common condition affecting men those are 50 years of age and above.TURP is still the widely used technique for management of BPH. TURPwith advent of newer technologies in diathermy and visual scope, has turned into a relatively safe one. AIM:To study role of catheter traction on blood loss and complications in patients with TURP. MATERIALS AND METHODS: This study was done among patients of BPH admitted in the Department of Surgery at S.N. Medical College, Agra during the period from January 2019 to February 2020. Total 60 cases were enrolled in the study and divided into two groups. Group A(30 patients) with traction on catheter after TURPand Group B(30 patients) without traction on catheter. DISCUSSION: Blood loss and irrigation uid was signicantly less in the group with traction on foley's catheter. Duration of hospital stay and complications were also lesser in group with traction. CONCLUSION: Traction on foley's catheter post TURP is effective in managing BPH with the merits of higher safety due to less blood loss and early discharge.

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