A prospective comparative study on the operative outcomes between monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: An institutional experience

Background: Benign prostatic hyperplasia (BPH) is a common disease in elderly men. Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the treatment of bladder outlet obstruction due to BPH. Its modification, bipolar TURP (B-TURP), promises to overcome its most prominent drawbacks, such as bleeding and dilutional hyponatremia. Aims and Objectives: This study aims to study the feasibility, effectiveness, and safety of B-TURP over M-TURP. Materials and Methods: A total of 110 patients with BPH were prospectively randomly assigned to undergo B-TURP (55) or M-TURP (55). Patient characteristics of the two groups were similar. Hemoglobin was measured preoperatively and postoperatively. IPSS, maximal flow rate, and post-void residual urine volume were assessed preoperatively. Duration of surgery, mean weight of resected tissue, mean irrigation fluid used, mean drop in hemoglobin, mean change in sodium, and mean post-operative irrigation used were also compared. Results: Duration of resection time was significantly shorter in M-TURP (P=0.0034). The mean change in sodium and mean post-operative irrigation used were significantly lower in bipolar group with P<0.05 and 0.0024, respectively. The mean drop in post-operative hemoglobin concentration (P=0.0916) was statistically insignificant. There was one instance of the transurethral resection (TUR) syndrome in the M-TURP group whereas no TUR syndrome occurred in the B-TURP group. Conclusion: B-TURP and M-TURP are effective and safe techniques for the surgical treatment of BPH. B-TURP definitely reduces the incidence of dilutional hyponatremia and post-operative irrigation use making it a competitor to replace M-TURP as the new gold standard.

Hyponatremia in Acute Heart Failure in Relation to Hematocrit Levels: Clinical Relevance and Prognostic Implication

Background: Hyponatremia is the most common electrolyte abnormality found in hospitalized patients with acute heart failure (AHF) and is related to poor prognosis. This study sought to evaluate: (1) the different prognostic impact of dilutional versus depletional hyponatremia, evaluating short- and long-term outcome; (2) the relationship between both types of hyponatremia and intravenous furosemide dose, renal function changes, and persistent congestion at discharge. Methods: This retrospective single-center study included 233 consecutive patients with a primary diagnosis of AHF. Hyponatremia was defined as serum sodium < 135 mEq/L, which could be either dilutional (hematocrit < 35%) or depletional (hematocrit ≥35%). Persistent congestion was defined as a congestion score ≥2 at discharge. Patients were followed 180 days for occurrence of death or rehospitalization for AHF. Results: Hyponatremia was present in 68/233 patients with 27 cases classified as dilutional hyponatremia versus 41 as depletional. The proportion of patients with persistent congestion was higher in the dilutional hyponatremia group, but similar in the depletional hyponatremia group (52 vs. 81 vs. 58%; p = 0.02). After adjustment for important baseline characteristics, dilutional hyponatremia was significantly associated with the risk of death or rehospitalization for AHF at 60 days (HR 2.17 [1.08–4.37]; p = 0.03) and 180 days (HR 1.88 [1.10–3.21]; p = 0.02). In contrast, depletional hyponatremia was only significantly associated with the same endpoint at 180 days (HR 1.64 [1.05–2.57]; p = 0.03). Conclusions: Low hematocrit levels in AHF patients with hyponatremia characterize a population that is more difficult to decongest and has poor clinical outcome. In contrast, patients with hyponatremia but normal hematocrit are better decongested and have better short-term outcome.

HYPONATREMIA

Background objective: Hyponatremia is not uncommon complication of livercirrhosis and may affect hospital mortality. This study was aimed to determine frequency andoutcome of hyponatremia in liver cirrhosis patients. Patients and Methods: The cirrhotic subjectswere assessed for hyponatremia while outcome measured in relation to hyponatremia and itsseverity. Data was analyzed in SPSS 16.0 and frequencies as well as percentages calculatedfor hyponatremia. Results: Out of one hundred liver cirrhosis patients, 65% were males and35% females. Mean age ±SD of overall cirrhotic subjects was 40.79±7.83. Hyponatremia wasidentified in 72% (51% males and 21% females) patients. The mean ± SD for sodium levelin overall population was 129.73±8.35 while 119.92±3.61 in hyponatremic cirrhotic patients.Conclusion: Dilutional hyponatremia is a frequent finding in liver cirrhosis patients.

LIVER CIRRHOSIS

Liver cirrhosis results from prolonged, widespread but patchy hepato-cellularnecrosis due to various reasons. Objectives: To determine the frequency and severity ofhyponatremia in patients with liver cirrhosis. Study Design: Descriptive case series study.Period: Six months. Setting: Liaquat University Hospital Hyderabad. Methods: The cirrhoticsubjects were assessed for hyponatremia and its severity. The data was analyzed in SPSS 16and the frequency and percentage was calculated for hyponatremia and statistically p -value≤0.05 was considered as significant. Result: Sixty five percent males and thirty five percentfemales of liver cirrhosis were studied. The mean age ± SD of overall cirrhotic subjects was40.79±7.83. The hyponatremia was identified in 72% (51 males and 21 females) patients. Themean ±SD for Na+ level in overall population was 129.73±83.51 while it was 119.92±3.61 inhyponatraemic cirrhotic subjects. The sodium level in male and female hyponatraemic cirrhoticpatients was 121.73±8.63 and 118.92±3.31. Conclusions: Dilutional hyponatremia is frequentin patients with liver cirrhosis.