Methods of Haemostasis and Restore of Bladder-urethral Segment During Retropubic Prostatectomy in Patients with Benign Prostatic Hyperplasia

The objective: to estimate methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia. Materials and methods. Analysis of methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia was performed. Results. Open retropubic prostatectomy (like transbladder prostatectomy) was recommended by European Association of Urology (EAU, 2020) as operation of first choice for surgical treatment big size prostatic hyperplasias. The authors gave such prevalences of retropubic prostatectomy over trans-bladder: operation is performed under visual control that gives haemostatic control of prostatic cavity and removing all parts of nodules; the bladder is not drainaged that avoids disuria in postoperative period, decreases postoperative bed-time and increases comfort for patients; urethra is cut by scissor in apical part of prostate that is prophylaxis tearing of urethra, trauma of exernal sphincter, stricture of memranaceas urethra and urine incontinence after operation; reconstruction of bladder-urethral segment is performed that is prophylaxis of stricture of bladder neck; surgeon can performed simultaneous hernioplasty and retropubic prostatectomy in case of inquinal hernia and benign prostatic hyperplasia. Arterial and venous blood supplying of bladder and enlarged prostate were wrote. Places of arterial and venous bleeding after cutting of prostatic capsule and removing nodules, prophylaxis suturing of arterial and venous bleeding places were noted. Original own methods of restoring of bladder-urethral segment and haemostasis of prostatic cavity by using two or three П-like catgut sutures were shown. For simplifying operation and decreasing time of performing operation and increasing haemostasis of prostatic cavity authors recommended performing passing haemostatic sutures throught prostatic capsule only once and linking of sutures on muscle peaces from rectus muscle (or pyramidal muscle). In case of absent bleeding from prostatic cavity the simplify method of bladder neck trigonisation by using two П-like catgut sutures or two V-like catgut sutures on bladder neck for prophylaxis of bladder neck stenosis was recommended (proximal trigonisation of bladder neck in prostatic cavity). Review of haemostatic merhods of prostatic cavity during retropubic prostatectomy was shown. Conclusion. Analysis of methods of haemostasis and restore of bladder-urethral segment and own original methods during retropubic prostatectomy in patients with benign prostatic hyperplasia allow improve haemostasis of prostatic cavity, prophylaxis of bladder neck and urethra stenosis, decrease intraoperative bleeding and period of operation.

Tumor contact length: A novel multiparametric MRI predictor of prostate cancer outcomes.

61 Background: Multiparametric MRI (MP-MRI) can visualize prostate tumors. MP-MRI characteristics (extraprostatic extension (ECE), tumor volume, etc.) can be predictive of final pathologic findings such as lymph node (LN) involvement, pathological ECE (pECE), and biochemical recurrence (BCR). These are pivotal in the decision-making process regarding treatment. Tumor contact length (TCL) is defined as the length of cancer in contact with the prostatic capsule. We evaluated the ability of MP-MRI determined TCL in predicting pECE, BCR and LN in patients undergoing radical prostatectomy. Methods: All patients who underwent a 3T MP-MRI at the NCI from 2007 to 2015 were retrospectively classed into no ECE, suspicious ECE (sECE) and frank ECE (fECE) based on MP-MRI findings. sECE was defined as tumor with capsular bulge on MRI while fECE was clear capsular obliteration and tumor extension beyond the prostatic capsule. Demographic data was obtained on patients with fECE and sECE on MP-MRI with the presence of pECE, LN, and BCR status following radical prostatectomy from a single surgeon (PP) experience. Chi-Square and Wilcoxon rank sum test were used to compare proportions and continuous variables respectively. Logistic regression was used to determine the predictive ability of TCL. Statistical significance was defined as p-value ≤0.05. Results: Of all 1,260 patients who underwent MP-MRI, we focused on 146 who had sECE (68) or fECE (78) on MP-MRI. Mean age was 60 years and median prostate specific antigen was 11.7 ng/ml. Logistic regression analysis showed that MP-MRI determined TCL was predictive of ECE (p=0.01), LN status (p=0.0001) on final pathology and BCR (p=0.05) during follow up. Patients with pECE had a longer median MP-MRI TCL (2.8 cm) compared to those without pECE (2.4 cm), p=0.04. When analyzed individually, fECE correlated with pECE (p=0.05) while s ECE did not correlate with pECE (p=0.11). Although, not statistically significant, the median MP-MRI TCL for sECE with pECE was still longer than in sECE with no pECE in the sub-group analysis. Conclusions: Longer TCL on MP-MRI can indicate presence of ECE, LN involvement at final pathology as well as predict BCR on follow up.

It Suddenly Occurred: Extensive Subcutaneous Emphysema after Bipolar Transurethral Resection of Prostate

Subcutaneous emphysema is a very rare and good-natured complication after transurethral resection of prostate (TURP). It has been reported as colon perforation, diverticulitis, and bladder perforation associated complication previously. We report the first case of a wide subcutaneous emphysema due to microperforations of prostatic capsule, without a bladder perforation after TURP. Any sign of clinic situation should lead to ceasing of the procedure immediately; otherwise, it can cause a life-threatening problem of abdominal compartment syndrome.