Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined

Introduction: Controversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary. Methods: Patients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence. Results: Patients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07–1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p<0.01) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking. Conclusions: A simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.

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Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis

Neurosurgical FOCUS ◽

10.3171/2016.5.focus1637 ◽

2016 ◽

Vol 41 (3) ◽

pp. E7 ◽

Cited By ~ 13

Author(s):

Mingliang He ◽

Leping Ouyang ◽

Shengwen Wang ◽

Meiguang Zheng ◽

Anmin Liu

Keyword(s):

Systematic Reviews ◽

Operative Time ◽

Meta Analysis ◽

Catheter Insertion ◽

Cochrane Library ◽

Number Needed To Treat ◽

Shunt Failure ◽

Peritoneal Catheter ◽

Significant Difference ◽

Mini Laparotomy

OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25–0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8–23), operative time was shorter (mean difference [MD], −12.84; 95% CI −20.68 to −5.00; p = 0.001), and blood loss was less (MD −9.93, 95% CI −17.56 to −2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD −1.77, 95% CI −3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.

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Comparison of nephroscopy and cystoscopy used in the treatment of bladder stones: a systematic review and meta-analysis of randomized controlled trials

BMC Surgery ◽

10.1186/s12893-021-01461-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liping Gou ◽

Zhenghao Wang ◽

Ye Zhou ◽

Xiaofeng Zheng

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Operative Time ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Bladder Stones ◽

Randomized Controlled ◽

Significant Difference

Abstract Background A systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscopy and cystoscopy in transurethral cystolithotripsy (TUCL) for bladder stones (BS). Methods The PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases were searched up to January 2021 for studies assessing the effect of different types of endoscopes among patients who underwent TUCL. The search strategy and study selection process were in accordance with the PRISMA statement. Results Five randomized controlled trials were included in the meta-analysis. The results showed no difference in stone-free rate (RR = 1.00, CI = 0.98–1.02, p = 1.00) between the two groups and nonsignificant heterogeneity (I2 = 0%, p = 1.00), and all patients were rendered stone free. Use of the nephroscope significantly shortened the operative time compared with the cystoscope group (RR= − 26.26, CI = − 35.84 to − 16.68, p < 0.00001), and there was significant heterogeneity (I2= 87%, p < 0.00001). There was no significant difference in mean urethral entries (RR = 0.66, CI = − 0.71 to − 2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = − 0.07 to 0.23, p = 0.31) or total complication rate (RR=1.37, 95% CI = 0.47–4.00, p = 0.56) between the two groups. Conclusions In conclusion, this systematic review demonstrates that both nephroscopy and cystoscopy have high stone clearance efficiency, low rates of complications and short hospitalizations. The mean urethral entries depend on the treatment method for large stone fragments. However, the use of nephroscopy can significantly reduce the operative time.

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Effect of preoperative prostate volume on the improvement of lower urinary tract symptoms in patients with benign prostatic hyperplasia undergoing transurethral resection of prostate

Journal of Nephropathology ◽

10.34172/jnp.2020.18 ◽

2019 ◽

Vol 9 (2) ◽

pp. e18-e18

Author(s):

Behzad Lotfi ◽

Sajjad Farazhi ◽

Mohammadreza Mohammadi Fallah ◽

Mansour Alizadeh ◽

Rohollah Valizadeh ◽

...

Keyword(s):

Urinary Tract ◽

Benign Prostatic Hyperplasia ◽

Transurethral Resection ◽

Lower Urinary Tract ◽

Prostate Volume ◽

Prostatic Hyperplasia ◽

Urinary Tract Symptoms ◽

Significant Difference ◽

Lower Urinary

Introduction: Benign prostate hyperplasia, pathophysiology contributes to bladder outlet obstruction due to functional obstruction caused by gland size enlargement resulting in the lower urinary tract symptoms (LUTS). Objectives: To determine the correlation of the prostate volume with surgical outcomes and postoperative LUTS in patients with benign prostatic hyperplasia (BPH) undergoing transurethral resection of the prostate (TURP). Patients and Methods: Patients with BPH who were refractory for medical treatment enrolled in the study. Patients divided into three groups with attention to their prostate volume conducted by transabdominal ultrasonography. To evaluate patients’ LUTS, the International Prostate Symptom Score (IPSS) questionnaire was filled for all patients preoperatively and during the first and third months follow up sessions. Results: In the current study, mean age of the patients was 66.92 ± 1.08 years. Of 111 patients, eight patients (7.2%) had prostate volume less than 30 cc, 59 patients (53.2%) had prostate volume between 30-60 cc, and 44 patients (39.6%) had prostate volume more than 60 cc. During first month postoperative, mean decrease in IPSS scores in patients with prostate volume less than 30 cc, prostate volume between 30–60 cc and prostate volume more than 30 cc were 27.72 ± 3.53, 27.32 ± 3.37 and 27.45 ± 2.87, respectively. The ANOVA test showed no significant difference between the groups (P= 0.93). Mean decrease in IPSS score during third month postoperative, had no significant difference between the three groups, too (P=0.71). Symptoms alleviation observed in 94.6% and 95.5% of the patients, during first and third months follow-up, respectively. Conclusion: There was no correlation between the IPSS scores decrease and patients’ symptoms recovery and preoperative prostate volume in patients with BPH who underwent TRUP.

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Can Liposomal Bupivacaine Be Safely Utilized in Elective Spine Surgery?

Global Spine Journal ◽

10.1177/2192568218755684 ◽

2018 ◽

Vol 9 (2) ◽

pp. 133-137 ◽

Cited By ~ 5

Author(s):

Luke Brown ◽

Tristan Weir ◽

Scott Koenig ◽

Mark Shasti ◽

Imran Yousaf ◽

...

Keyword(s):

Relative Risk ◽

Length Of Stay ◽

Urinary Retention ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Fusion Surgery ◽

Liposomal Bupivacaine ◽

Lumbar Decompression ◽

Increased Risk ◽

Significant Difference

Study Design: Single-blinded prospective randomized control trial. Objectives: To compare the incidence of adverse events (AEs) and hospital length of stay between patients who received liposomal bupivacaine (LB) versus a single saline injection, following posterior lumbar decompression and fusion surgery for degenerative spondylosis. Methods: From 2015 to 2016, 59 patients undergoing posterior lumbar decompression and fusion surgery were prospectively enrolled and randomized to receive either 60 mL injection of 266 mg LB or 60 mL of 0.9% sterile saline, intraoperatively. Outcome measures included the incidence of postoperative AEs and hospital length of stay. Results: The most common AEs in the treatment group were nausea (39.3%), emesis (18.1%), and hypotension (18.1%). Nausea (23%), constipation (19.2%), and urinary retention (15.3%) were most common in the control group. Patients who received LB had an increased risk of developing nausea (relative risk [RR] = 1.7; 95% confidence interval [CI] = 0.75-3.8), emesis (RR = 2.3; 95% CI = 0.51-10.7), and headaches (RR = 2.36; 95% CI = 0.26-21.4). Patients receiving LB had a decreased risk of developing constipation (RR = 0.78; 95% CI = 0.25-2.43), urinary retention (RR = 0.78; 95% CI = 0.21-2.85), and pruritus (RR = 0.78; 95% = 0.21-2.8) postoperatively. Relative risk values mentioned above failed to reach statistical significance. No significant difference in the hospital length of stay between both groups was found (3.9 vs 3.9 days; P = .92). Conclusion: Single-dose injections of LB to the surgical site prior to wound closure did not significantly increase or decrease the incidence or risk of developing AEs postoperatively. Furthermore, no significant difference was found in the hospital length of stay between both groups.

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RELATIONSHIP OF PERIURETHRAL FIBROTIC IN BPH PATIENT WITH LUTS AND URINARY RETENTION

Indonesian Journal of Urology ◽

10.32421/juri.v24i2.378 ◽

2017 ◽

Vol 24 (2) ◽

Author(s):

Zamroni Zamroni ◽

Sunaryo Hardjowijoto ◽

Soetojo Soetojo

Keyword(s):

Urinary Retention ◽

Prostate Volume ◽

Basal Membrane ◽

Transitional Epithelium ◽

Test Results ◽

Prostate Hyperplasia ◽

Urinary Tract Symptoms ◽

Significant Difference ◽

Average Patient ◽

Relationship Of

Objective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material & methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p>0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p>0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p>0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients.

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A clinico pathological study and management of benign enlargement of prostate

International Surgery Journal ◽

10.18203/2349-2902.isj20180992 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1275 ◽

Cited By ~ 1

Author(s):

Ashish Mor ◽

Surender Mohan Sharma ◽

Sujoy Mukherjee ◽

Rishi Jindal

Keyword(s):

Urinary Retention ◽

Acute Urinary Retention ◽

Prostate Volume ◽

Stone Formation ◽

Prostate Gland ◽

Digital Rectal Examination ◽

Pathological Study ◽

Significant Relation ◽

Residual Urine ◽

Severe Group

Background: Benign prostatic hyperplasia (BPH) is the non-malignant enlargement of the prostate gland. Prolonged obstructions may eventually lead to acute urinary retention, recurrent urinary tract infection, hematuria, bladder calculi, and renal insufficiency.Methods: Hundred cases of benign enlargement of prostate were studied from November 2015 to 2016. Patients diagnosed as benign enlargement of prostate by clinical digital rectal examination, investigation like USG were included in this study. Patients with urinary retention due to strictures and urolithiasis, carcinoma were excluded.Results: Mean age of presentation was 64.4, and 34% were found to be in severe group of IPSS grading. There was a significant co-relation between the PVRU and prostate volume. There were 16% cases of acute urinary retention, 2% cases presented with bladder stones. Benign enlargement of prostate, IPSS score, Post voidal residual urine has a weak correlation with the increasing age as observed.Conclusions: Benign enlargement of prostate is a disease of elderly with peak incidence in the 5th and 6th decade of life, BPH has co-relation with inguinal hernia, AUR which is 16%. There was no correlation between the age of the patient and the severity of symptoms with respect to IPSS score. There was no correlation between the age of the patient and the severity of symptoms with respect to IPSS score. In present study there was a statistically significant relation were found between prostate volume and post voidal residual urine. Large amount of residual urine is the indication for surgery because it predisposes to infections and stone formation.

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Neither operative nor nonoperative approach is superior for treating displaced midshaft clavicle fractures: a partially blinded randomized controlled clinical trial

The Bone & Joint Journal ◽

10.1302/0301-620x.103b4.bjj-2020-1636.r1 ◽

2021 ◽

Vol 103-B (4) ◽

pp. 762-768

Author(s):

Ilija Ban ◽

Morten Tange Kristensen ◽

Kristoffer Weisskirchner Barfod ◽

Jacob Eschen ◽

Thomas Kallemose ◽

...

Keyword(s):

Relative Risk ◽

Operative Treatment ◽

Initial Treatment ◽

Controlled Clinical Trial ◽

Number Needed To Treat ◽

Dash Score ◽

Randomized Controlled ◽

Significant Difference ◽

Nonoperative Group

Aims To compare the functionality of adults with displaced mid-shaft clavicular fractures treated either operatively or nonoperatively and to compare the relative risk of nonunion and reoperation between the two groups. Methods Based on specific eligibility criteria, 120 adults (median age 37.5 years (interquartile range (18 to 61)) and 84% males (n = 101)) diagnosed with an acute displaced mid-shaft fracture were recruited, and randomized to either the operative (n = 60) or nonoperative (n = 60) treatment group. This randomized controlled, partially blinded trial followed patients for 12 months following initial treatment. Functionality was assessed by the Constant score (CS) (assessor blinded to treatment) and Disability of the Arm, Shoulder and Hand (DASH) score. Clinical and radiological evaluation, and review of patient files for complications and reoperations, were added as secondary outcomes. Results At 12 months, 87.5% of patients (n = 105) were available for analysis. The two groups were well balanced based on demographic and fracture-related characteristics. At six weeks of follow-up a significant difference in DASH score (p < 0.001) was found in favour of operative treatment. The functionality at 12 months of follow-up based on CS and DASH was excellent in both groups (CS > 90 points and DASH < 10 points) with no significant difference (p = 0.277 for DASH and p = 0.184 for CS) between the two groups. The risk of symptomatic nonunion was significantly higher in the nonoperative group (p = 0.014), with a relative risk of 9.47 (95% confidence interval (CI) 1.26 to 71.53) in this group compared to the operative group. The number-needed-to-treat to avoid one symptomatic nonunion was 6.2. Initial treatment and age were factors significantly associated with nonunion in a logistic analysis. There were 26% in both groups (n = 14 in operative group and n = 15 in nonoperative group) who required secondary surgery, with most indications in the nonoperative group mandatory due to nonunion compared to most relative indications in the operative group requiring intervention due to implant irritation. Conclusion Superiority was not identified with either an all-operative or all-nonoperative approach. The functionality at short term (within six weeks) seems igreater following operative treatment but was not found at one year. The risk of nonunion is significantly higher with nonoperative treatment. However, an all-operative approach to lower the nonunion risk may result in unnecessary surgery and is not recommended. Cite this article: Bone Joint J 2021;103-B(4):762–768.

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Short-term surgical outcomes after Monopolar- versus Bipolar Transurethral Resection of the Prostate

QJM ◽

10.1093/qjmed/hcab110.003 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Ramadan ◽

mohammed shoeb ◽

Mohamed Shabayek

Keyword(s):

Transurethral Resection ◽

Surgical Outcomes ◽

Operative Time ◽

Perioperative Complications ◽

Controlled Study ◽

Transurethral Resection Of Prostate ◽

Short Term ◽

Intraoperative Bleeding ◽

Significant Difference

Abstract Background Transurethral resection of prostate (TURP) is currently the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), as this procedure results in the best improvement in symptoms and urine flow rate (1). Aim of the Work to compare between the two techniques used for transurethral resection of the prostate; Monopolar versus Bipolar resection as regards short term surgical outcomes, perioperative complications and early changes in quality of life.. Patients and Methods Randomized controlled study with simple randomization (1:1) of 80 patients with BPH candidate for transurethral resection of the prostate, 40 patients underwent M-TURP, and other 40 patients underwent B-TURP, their age mean age of paients included in our study 57-61 years old, mean prostate size 68-71 gm. Results Comparing intra-operative data in monopolar and bipolar TURP groups, our study reported that there was statistically significant decrease in volume of irrigation and operative time in B-TURP group in comparison to M-TURP group. although intra-operative complications; bleeding, electrolytes disturbance, fever and LUTS were lower in BTURP group; however, did not reach statistically significant. In M-TURP group ,there was statistically significance increase in change Hb, and time of post-oprative irrigation, IPSS in compared to B-TURP group. While in respect to PVR, time of catheterization and hospital stay, there was no statistically significant difference data among the two studied groups. Conclusion Bipolar TURP represents a promising endoscopic treatment for patients with BPH with decrease in volume of irrigation and reduced operative time, and less incidence of TUR syndrome, intraoperative bleeding, and postoperative complications .However, further investigations are needed with larger, preferably randomized multicentric controlled trials to confirm the results of this study in the future.

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Endoscope-Assisted Reduction of Zygoma Arch Fractures

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1631018 ◽

2021 ◽

pp. 205-213

Author(s):

A. M. Khattab ◽

A. M. Gamea ◽

M. H. Hamad

Keyword(s):

Surgical Technique ◽

Blood Loss ◽

Risk Reduction ◽

Outcome Measures ◽

Operative Time ◽

Maxillofacial Surgery ◽

Controlled Study ◽

Number Needed To Treat ◽

Open Approach ◽

Significant Difference

Aims: To compare the effectiveness of the endoscope-assisted approach with the open surgical technique for reduction of zygoma arch fractures. Study design: Randomized controlled study. Place and Duration of Study: Maxillofacial surgery unit, Otolaryngology department, Tanta University hospital, Tanta, Egypt, between April 2019 and October 2020. Methodology: We included 18 patients (15 men, 3 women; age range 16-63 years) with fracture of zygoma arch. Ten cases were operated by the endoscope-assisted approach while the other 8 cases were operated by the open surgical technique. Operative time, intraoperative blood loss, adequacy of reduction and any complications were recorded and documented. Results: The endoscope assisted group showed a statistically significant lower risk of complications with risk reduction rate of 67.5%. In other terms, the number needed to treat was 1.5, that is to say we must treat 1.5 patients with the endoscope-assisted method to prevent 1 adverse event that would have happened with the traditional open approach. Other outcome measures of operative time and blood loss showed no statistically significant difference (P value equals .25 and .52 respectively). The outcome of rate of inadequate reduction has quite wide 95% CI (-19.38 to 19.38) that reflects imprecision due to lack of events. Conclusion: The endoscope-assisted method showed statistically significant superiority in the domain of incidence of complications risk reduction (67.5%). No statistically significant difference was recorded in other outcome measures. Thus, the endoscope assisted approach for the zygoma arch fracture is in our opinion a better option than the traditional open incision approach.

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Comparison of GreenLight 180-W XPS laser vaporization versus transurethral resection of the prostate: Outcomes of a single regional center

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.3.169 ◽

2020 ◽

Vol 92 (3) ◽

Author(s):

Daniele Mattevi ◽

Lorenzo Luciani ◽

Rosa Spina ◽

Claudio Divan ◽

Stefania Cicuto ◽

...

Keyword(s):

Transurethral Resection ◽

Functional Outcomes ◽

Prostate Volume ◽

Specific Antigen ◽

Perioperative Outcomes ◽

Laser Vaporization ◽

Regional Center ◽

Significant Difference ◽

Single Centre Study

Background: To evaluate the intermediate perioperative outcomes, rate of complications and functional data after XPS 180-W Greenlight photoselective laser vaporization (PVP) compared with transurethral resection of the prostate (TURP) in a prospective non-randomized single centre study. Methods: We analyzed a prospectively-maintained database collecting data on 100 patients undergoing surgical treatment of BPH (50 consecutive PVP and 50 consecutive TURP). All complications, recorded and graduated according to the Clavien Dindo system and the clinical, operative, perioperative variables were compared. The functional outcomes, International Prostate Symptom Score (IPSS), max flow rate (Qmax) and Prostate Specific Antigen (PSA), were recorded preoperatively and at 1 year of follow up. Results: Age, prostate volume, use of anticoagulants or antiplatelets, ASA score and operative time were comparable in the two groups. The reduction in the hemoglobin levels (0.46 vs 1.8 g/dL), the catheterization time (1.2 vs 3.2 days), the hospital stay (1.7 vs 3.8 days) and rate of transfused patients (0 vs 8%), were significantly lower for PVP. Transient re-catherization (6 vs 26%) was significantly lower for PVP. The IPSS and Qmax at 1 year showed no significant difference. The rate of repeat TURP/PVP was higher in the TURP group (0 vs 10%). Reduction of PSA, that reflects the major reduction of prostate volume, was statistically greater in PVP group respect TURP group (p = 0.001). Conclusions: PVP has advantages in terms of perioperative safety and major complications than TURP. Functional outcomes at 1 year of follow-up were comparable.

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