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

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.

scholarly journals Holmium laser prostatectomy in a tertiary Italian center: A prospective cost analysis in comparison with bipolar TURP and open prostatectomy

2020 ◽  
Vol 92 (2) ◽  
Author(s):  
Riccardo Schiavina ◽  
Lorenzo Bianchi ◽  
Marco Giampaoli ◽  
Marco Borghesi ◽  
Hussam Dababneh ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Prostate Volume ◽  
Indirect Costs ◽  
Holmium Laser ◽  
Transurethral Resection Of Prostate ◽  
Open Prostatectomy ◽  
Global Cost ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Objective: To assess the economic impact of Holmium laser enucleation of prostate (HoLEP) in comparison with transurethral resection of prostate (TURP) and open prostatectomy (OP). Methods: Between January 2017 and January 2018, we prospectively enrolled 151 men who underwent HoLEP, TURP or OP at tertiary Italian center, due to bladder outflow obstruction symptoms. Patients with prostate volume ≤ 70 cc and those with prostate volume > 70 cc were scheduled for TURP or HoLEP and OP or HoLEP, respectively. Intraoperative and early post-operative functional outcomes were recorded up to 6 months follow up. Cost analysis was carried out considering direct costs (operating room [OR] utilization costs, nurse, surgeons and anesthesiologists’ costs, OR disposable products costs and OR products sterilization costs), indirect costs (hospital stay costs and diagnostics costs) and global costs as sum of both direct and indirect plus general costs related to hospitalization. Cost analysis was performed comparing patients referred to TURP and HoLEP with prostate volume ≤ 70 cc and men underwent OP and HoLEP with prostate volume > 70 cc respectively. Results: Overall, 53 (35.1%), 51 (33.7%) and 47 (31.1%) were scheduled to HoLEP, TURP and OP, respectively. Both TURP, HoLEP and OP proved to effectively improve urinary symptoms related to BPE. Considering patients with prostate volume ≤ 70 cc, median global cost of HoLEP was similar to median global cost of TURP (2151.69 € vs. 2185.61 €, respectively; p = 0.61). Considering patients with prostate volume > 70 cc, median global cost of HoLEP was found to be significantly lower than median global cost of OP (2174.15 € vs. 4064.97 €, respectively; p ≤ 0.001). Conclusions: Global costs of HoLEP are comparable to those of TURP, offering a cost saving of only 11.4 € in favor of HoLEP. Conversely, HoLEP proved to be a strong competitor of OP because of significant global cost sparing amounting to 1890.82 € in favor of HoLEP.

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

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.

scholarly journals The effect of short-term use of finasteride versus cyproterone acetate on perioperative blood loss with monopolar transurethral resection of prostate

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Shabieb A. Abdelbaki ◽  
Adel Al-Falah ◽  
Mohamed Alhefnawy ◽  
Ahmed Abozeid ◽  
Abdallah Fathi
Keyword(s):  
Blood Loss ◽  
Transurethral Resection ◽  
Cyproterone Acetate ◽  
Histopathological Examination ◽  
Microvascular Density ◽  
Controlled Study ◽  
Control Group ◽  
Transurethral Resection Of Prostate ◽  
Perioperative Bleeding ◽  
And Control

Abstract Background Perioperative bleeding is the most common complication related to transurethral resection of prostate; the aim of the study was to compare the effect of pre-operative use of finasteride versus cyproterone acetate (CPA) on blood loss with monopolar TURP. Methods This prospective randomized controlled study was conducted on (60) patients with BPH underwent monopolar TURP between July 2019 and July 2020. Patients were distributed into three equal groups; CPA group: 20 patients received cyproterone acetate 50 mg tab BID for two weeks before TURP, finasteride group: 20 patients received single daily dose of finasteride 5 mg for two weeks before TURP, control group: 20 patients received no treatment before TURP, all patients underwent monopolar TURP, and then histopathological examination of the resected tissues was done with assessment of the microvascular density of the prostate. Results Our study showed that there was significant decrease in intraoperative blood loss and operative time in CPA and finasteride groups in comparison with control group (p = 0.0012) (p < 0.0001), respectively, significant decrease in post-operative Hb and HCT value in finasteride and control groups in comparison with CPA group (p < 0.01), significant increase in specimen weight in CPA group compared to other groups (p < 0.01), and there was also significant decrease in microvascular density in CPA group in comparison with other groups (p < 0.01). Conclusion Cyproterone acetate is more effective than finasteride in decreasing perioperative bleeding with TURP by decreasing microvascular density of the prostate.

scholarly journals Bipolar Saline TURP for Large Prostate Glands

2007 ◽  
Vol 7 ◽  
pp. 1558-1562 ◽  
Author(s):  
David S. Finley ◽  
Shawn Beck ◽  
Richard J. Szabo
Keyword(s):  
International Prostate Symptom Score ◽  
Prostate Volume ◽  
Length Of Hospital Stay ◽  
Volume Measurement ◽  
Open Prostatectomy ◽  
Risk Patients ◽  
Resected Tissue ◽  
Feasible Alternative ◽  
The Mean ◽  
Large Prostate

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.

scholarly journals Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA 

2020 ◽  
Author(s):  
Huiping Wei ◽  
Qiuping Xiao ◽  
Jianfeng He ◽  
Tianji Huang ◽  
Wantang Xu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Elderly Patients ◽  
Tranexamic Acid ◽  
Topical Application ◽  
Control Group ◽  
Specific Method ◽  
Intertrochanteric Fractures ◽  
Perioperative Blood Loss ◽  
Perioperative Bleeding

Abstract Background: The specific method and dose of tranexamic acid (TXA) topically applied for intertrochanteric fractures have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically administered via our protocol for perioperative bleeding management in elderly patients with intertrochanteric fractures who underwent proximal femoral nail anti-rotation (PFNA).Methods: A retrospective comparative analysis was performed. The TXA group was composed of 82 patients with topical use of TXA, and the control group was composed of 82 patients without TXA use during the PFNA procedure. Intraoperative, total and hidden amounts of blood loss, drainage volumes, postoperative blood transfusion volumes and complications were compared between the two groups.Results: The intraoperative, total and hidden amounts of blood loss and the drainage volumes were significantly lower in the TXA group than in the control group (P=0.012, P<0.01, P<0.01, P=0.014, respectively). The volume and rate of blood transfusion in the TXA group were significantly lower than those in the control group (P<0.01). There were no significant differences in complications between the two groups (P>0.05).Conclusion: Topical application of TXA offers an effective and safe option for reducing perioperative blood loss and transfusion in elderly patients with intertrochanteric fractures undergoing PFNA.

scholarly journals P107 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: a systematic review and meta-analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Amanda Koh ◽  
Alfred Adiamah ◽  
Dhanny Gomez ◽  
Sudip Sanyal ◽  
Amanda Koh
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Tranexamic Acid ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Thromboembolic Events ◽  
Intraoperative Blood Loss ◽  
Perioperative Bleeding ◽  
Perioperative Blood Transfusion

Abstract Introduction Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA) in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery. Method A comprehensive search of Pubmed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model. Results Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies. Conclusion TXA reduces intra-operative blood loss without an increase in complications.

scholarly journals 842 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: A Systematic Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Koh ◽  
A Adiamah ◽  
S Sanyal
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Tranexamic Acid ◽  
Weighted Mean Difference ◽  
Thromboembolic Events ◽  
Intraoperative Blood Loss ◽  
Mortality And Morbidity ◽  
Perioperative Bleeding ◽  
Perioperative Blood Transfusion

Abstract Introduction Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA), in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery. Method A comprehensive search of PubMed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model. Results Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies. Conclusions TXA reduces intra-operative blood loss without an increase in complications.

scholarly journals Transvesical Prostatectomy after Transurethral Resection- Need for Retention of Skills for Open Prostatectomy: A Case Report

2021 ◽  
Vol 3 (4) ◽  
pp. 1-2
Author(s):  
Balantine U. Eze ◽  
Anthony C. Nevo ◽  
Chijioke C. Anekpo ◽  
Sunday G. Mba
Keyword(s):  
Transurethral Resection ◽  
Gold Standard ◽  
Bladder Outlet Obstruction ◽  
Acute Urinary Retention ◽  
Outlet Obstruction ◽  
Prostatic Hyperplasia ◽  
Transurethral Resection Of Prostate ◽  
Open Prostatectomy ◽  
Common Cause ◽  
Large Prostate

Benign prostatic hyperplasia is a common cause of bladder outlet obstruction BPH. Transurethral resection of prostate (TURP) remains the gold standard of surgical therapy but have limitations in handling large prostates. We report a case of a patient with a large prostate that had TURP, later developed acute urinary retention and subsequently had transvesical prostatectomy with a good outcome. There is need for retention of skills for open prostatectomy despite the crave for acquisition of endoscopic/ minimally invasive skills.

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

2020 ◽  
pp. 1-6
Author(s):  
Kadir Omur Gunseren ◽  
Serkan Akdemir ◽  
Mehmet Cagatay Çiçek ◽  
Ali Yıldız ◽  
Murat Arslan ◽  
...  
Keyword(s):  
Prostate Volume ◽  
Operation Time ◽  
Holmium Laser ◽  
Open Prostatectomy ◽  
Prostate Weight ◽  
Total Operation Time ◽  
Simple Prostatectomy ◽  
Laser Enucleation ◽  
Rapid Removal ◽  
Holmium Laser Enucleation

<b><i>Introduction:</i></b> To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. <b><i>Methods:</i></b> Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. <b><i>Results:</i></b> HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. <b><i>Conclusion:</i></b> LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

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