Continuous Bladder Irrigation Research Articles

Optimising postoperative care: Same-day discharge after transurethral resection of the prostate.

This study aims to assess the feasibility and safety of same-day discharge after transurethral resection of the prostate. Five years of records were retrospectively analysed. Length of stay categorised patients into Groups 1 (same-day discharge) and 2 (standard-length discharge). Logistic regression analysis was performed, controlling for clinicodemographic factors. Student's t-test compared continuous bladder irrigation and catheter dwell times. A total of 459 patients were identified between 2016 and 2021, 280 in Group 1 and 179 in Group 2, with median ages of 71.0 (interquartile range 36-92) and 72.0 (interquartile range 47-101) years (p = 0.067), respectively. Same-day discharge rates notably increased post-2018 (p = 0.025). Median prostate tissue resected in Group 2 was 7.1g (3.4-12.4g) and in Group 1 was 4.9g (2.4-10.2g; p = 0.034). While continuous bladder irrigation >1 hour was significantly lower in Group 1 than Group 2 (96.8% versus 27.4%; p = 0.0001), catheter dwell times were comparable (70.1 and 70.8 hours, respectively). Control-adjusted results showed a 40% reduction in emergency department representation odds for Group 1 compared with Group 2 (odds ratio = 0.60; 95% confidence interval = 0.37-0.99; p = 0.04). Length of stay was not significantly associated with hospital readmissions (p = 0.11). Continuous bladder irrigation for <1 hour in Group 1 was associated with a reduced emergency department representation (odds ratio = 0.43; 95% confidence interval = 0.197-0.980) but not readmission (odds ratio = 0.413; 95% confidence interval = 0.166-1.104). Same-day discharge post-transurethral resection of the prostate may be a viable and safe option for carefully selected patients.

Construction of early warning classification of risk in bladder spasm and its intervention plans guided by the rate adjustment card of continuous bladder irrigation after transurethral resection of the prostate (TURP): development and usability study

Construction of early warning classification of risk in bladder spasm and its intervention plans guided by the rate adjustment card of continuous bladder irrigation after transurethral resection of the prostate (TURP): development and usability study

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

ObjectiveTo evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.MethodsWe retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.ResultsAll patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100–145). Median estimated blood loss was 224 ml (IQR: 190–255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.ConclusionsUS-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

An intelligent continuous bladder irrigation monitoring and control system: Development and preliminary assessment

Abstract Objectives: To design an intelligent continuous bladder irrigation monitoring and control system and preliminarily assess its sensitivity of the early warning of flushing anomalies. Methods: According to the principle of bladder irrigation, an intelligent continuous bladder irrigation monitoring and control system was designed. The Amesim fluid simulation software was used to establish a parameterized simulation model for the bladder perfusion process and simulate the dynamic changes of bladder pressure and volume under different perfusion speeds to assess the sensitivity of the early warning of flushing anomalies. Results: The intelligent system consisted of 3 parts: the monitoring part (a flushing fluid inlet flow monitoring device, a flushing fluid outlet flow monitoring device, and a flushing fluid outlet color recognition sensor), the transition part (a control motherboard), and the regulation part (an alarm device, an electric control device for flushing fluid input speed, and a squeezing device for flushing waste fluid line). The data of the parameterized simulation model for the bladder perfusion process suggested that the sensitivity of the system was acceptable. Conclusion: The intelligent bladder irrigation system can automatically detect, report, and resolve signal abnormalities, thereby achieving the closed-loop management of bladder irrigation. The intelligent system might be used in clinical settings to reduce the burdens of nurses and promote patients’ recovery.

Single-port Transvesical Robot-Assisted Simple Prostatectomy: Surgical Technique and Clinical Outcomes

BackgroundSurgical management of large prostatic adenomas can be performed via open, endoscopic, or robotic approaches. A low-profile single-port (SP) robot was built to work in confined areas (ie, the bladder) and regionalize surgery. ObjectiveTo describe the novel SP transvesical (TV) robot-assisted simple prostatectomy (RASP) and report clinical outcomes. Design, setting, and participantsSP TV RASP cases were performed in an academic hospital by two surgeons from 2019 to 2023. A total of 117 cases were performed, and data from patients with at least 12 mo of follow-up were analyzed. The inclusion criterion was severe obstructive urinary symptoms or catheter-dependent urinary retention due to large prostates with volume >80 ml. Surgical procedureThe procedure consisted of two main steps through a single 3-cm suprapubic incision: first, enucleation of the adenoma, and second, a 360° bladder mucosal flap reconstruction. No drains or continuous bladder irrigation was used routinely. MeasurementsIntraoperative parameters, pre- and postoperative uroflowmetry, and 1-yr clinical outcomes were assessed. We used descriptive statistics to analyze the data. Results and limitationsAll procedures were completed successfully without additional ports or conversions. The median console time and estimated blood loss were 107 min and 100 ml, respectively. Transfusion rate was 0%. Intraoperative complications included two suspected air emboli attributed to high insufflation pressures. There were no major postoperative complications. In total, 95.8% were discharged within the first 24 h, with a median length of stay and pain score of 5 h and 3/10, respectively. There was persistent improvement in the median International Prostate Symptom Score and flow rate after 1 yr. The median Sexual Score Inventory for Men score was 20 at 12 mo. Our study is limited by its retrospective nature and cohort size. ConclusionsSP TV RASP is a feasible alternative for the management of severe benign prostatic hyperplasia that promotes fast recovery and demonstrates 1-yr improvement in urinary function. Patient summarySingle-port transvesical robot-assisted simple prostatectomy is a minimally invasive alternative for the treatment of large benign prostatic growth. A single robotic arm goes through a small incision in the skin and bladder to extract the obstructive prostatic tissue. Afterward, reconstruction of the area is done to decrease bleeding and improve postoperative symptoms. We found that patients recover quickly and have excellent clinical results with a low risk of complications.

Analysis of flow rate of continuous bladder irrigation according to the height of the irrigation infusion set

This is a control volume analysis to examine the flow rate of irrigation fluid according to the size of indwelling catheter and the height of the fluid bag in consideration of the temperature of irrigation fluid and intra-bladder pressure during continuous bladder irrigation. In case of minimum bladder pressure with room temperature, the flow rates were − 0.045 to 0.993 cc/sec for 18Fr, − 0.053 to 1.176 cc/sec for 20Fr, − 0.055 to 1.227 cc/sec for 22Fr, and − 0.055 to 1.243 cc/sec for 24Fr. In case of maximum bladder pressure with room temperature, the flow rates were − 0.180 to 0.868 cc/sec for 18Fr, − 0.212 to 1.028 cc/sec for 20Fr, − 0.220 to 1.072 cc/sec for 22Fr, and − 0.223 to 1.086 cc/sec for 24Fr. In case of minimum bladder pressure with cold fluid, the flow rates were − 0.028 to 0.365 cc/sec for 18Fr, − 0.033 to 0.749 cc/sec for 20Fr, − 0.034 to 0.781 cc/sec for 22Fr, and − 0.035 to 0.791 cc/sec for 24Fr. In case of maximum bladder pressure with cold fluid, the flow rates were − 0.112 to 0.553 cc/sec for 18Fr, − 0.131 to 0.653 cc/sec for 20Fr, − 0.137 to 0.681 cc/sec for 22Fr, and − 0.139 to 0.689 cc/sec for 24Fr. This study is significant in that it utilized a fluid dynamics approach to provide basic data for continuous bladder wash care. Through the findings of this study, nurses can plan the exchange time of irrigation fluid and the pattern of urinary drainage when performing continuous bladder irrigation. It is also inferred that there may be an advantage in not having to calculate additional material costs for using an infusion pump for patients by determining the hourly injection rate of irrigation fluid based on the height of the infusion set's drop chamber.

Application of Research-Based Quality Control Circle in Setting a New Management Model and Complete Standardized Care for Continuous Bladder Irrigation After TURP

Objective: To explore the application of research-based quality control circle in setting a new standardized nursing management model for continuous bladder irrigation after transurethral resection of prostate (TURP) surgery, and to provide theoretical basis and evidence-based support for standardizing the nursing management model of continuous bladder irrigation after TURP in the Department of Urology. Methods: A quality control circle was established, focusing on the existing common problems of continuous bladder irrigation. The methods include implementing appropriate measures and other steps, and comparing the incidences of bladder spasms and urinary catheter obstruction, patient satisfaction, nurses’ awareness of relevant knowledge, nurses’ operational satisfaction, number of liquid pours (6000ml per flush), and number of open exposures before and after the activity. Results: Through this quality control circle activity, the incidence of bladder spasms in patients dropped from 42% to 14.3%; the incidence of urinary catheter obstruction dropped from 36% to 12.2%; patient satisfaction increased from 82% to 95.9%; nurses’ knowledge awareness rate increased from 74.2% to 96.8%; nurses’ operational satisfaction increased from 80.6% to 96.8%; the above differences are statistically significant (P &lt; 0.05). Moreover, the number of flushing liquid pours reduced from 5 times to 1 time, and the number of open exposures reduced from 5 times to 0 times. Circle members have improved their application of quality control circle methods, team spirit, and professional knowledge. Conclusion: The research-based quality control circle is suitable for setting a new standardized nursing management model for continuous bladder irrigation after TURP.

An Autonomous Continuous Bladder Irrigation System.

Introduction and Objective: Continuous bladder irrigation (CBI) is used in a variety of clinical settings, including post-transurethral surgery and the emergency department. Currently, CBI administration relies on nurses to diligently monitor and switch irrigation bags, as well as titrate the inflow rate based on effluent color. Inappropriate administration can result in discomfort to patients, clot urinary retention, repeat injury to the pathologic or surgical site, extended hospital stays, and even operative management. Our objective was to create an autonomous CBI system that decreases the incidence of disrupted irrigation flow and monitors the outflow to alert clinicians of critical events. Methods: 3D printing and off-the-shelf microcontrollers were used to design a device to fit the needs identified by stakeholders at our institution. An in vitro model of the bladder was created to test our design. The mechanical, electrical, and software subsystems were adjusted accordingly to meet our design requirements. Results: Our in vitro CBI model was able to simulate routine CBI administration with sudden bleeding. Bovine blood was used to simulate the bleeding events. A device was created that met identified stakeholder needs. Accurate detection of critical bleeding events, catheter blockage, and empty irrigation bags were achieved. The device responds to bleeding appropriately by increasing the irrigation rate. When the catheter is blocked, it stops the irrigation and alerts the nurse. Our system accurately titrated the irrigation rate to match a set outflow blood level parameter, conserving irrigation and minimizing nursing workload. Continuous monitoring of CBI effluent was recorded. Conclusions: We anticipate our device will decrease the cognitive load on nurses in busy clinical settings and improve workflow. Moreover, the detection of critical events will likely decrease patient morbidity. Continuous monitoring of the CBI outflow may prove to be a new clinical decision-making tool for ongoing hematuria. Clinical trial is pending.

A case of life-threatening hematuria.

A 66-year-old male with a past medical history of hypertension and benign prostatic hypertrophy, not on anticoagulation, presented with difficulty voiding and hematuria. He was seen at an outside hospital earlier in the day and received a straight catheterization for urinary retention, he was prescribed antibiotics for a urinary infection, and he was discharged home. Subsequently, after discharge, he developed hematuria with inability to void, prompting a visit to our emergency department (ED). On arrival, the patient was uncomfortable appearing, tachycardic with a heart rate of 116 beats per minute and a blood pressure of 114/67 mm Hg. His lower abdomen was tender to palpation. A point-of-care ultrasound (POCUS) of the bladder was performed. The ultrasound demonstrated a distended-appearing bladder containing a large area of layering mixed echogenicity with intrinsic turbulent Doppler signal (Video 1). The patient had a three-way Foley catheter placed in the ED for continuous bladder irrigation. He had a computerized tomography (CT) angiography of the abdomen and pelvis that did not reveal any active hemorrhage. He also had a CT urogram. Initially, the hematuria improved, however, following the abnormal ultrasound Doppler images, the patient was admitted to the urology service. Although he was admitted, his hemoglobin declined from 12 to 7.9 g/dL, and he suffered a cardiac arrest. The reason for the arrest was presumed to be from hemorrhagic shock. There was return of spontaneous circulation after initiation of massive transfusion protocol. He underwent cystoscopy showing an enlarged median prostate lobe with active extravasation, requiring embolization of the prostatic artery by interventional radiology (IR). Hematuria and urinary obstruction are common causes of ED visits with multiple underlying etiologies.1 Emergency physicians are tasked with the challenge of determining which patients can be managed as outpatients. In this case, gross hematuria from an actively bleeding prostate led to the hemorrhagic shock requiring multiple transfusions and need for IR embolization. The most common etiologies of prostatic hematuria are benign prostatic hyperplasia, iatrogenic urologic trauma, prostate cancer, and radiation therapy.2 In this patient, POCUS showed turbulent Doppler flow within the bladder (Figure 1A), which was concerning for active bleeding, and ultimately led to the patient's admission and emergent urologic consultation. Additionally, the POCUS also showed layering mixed echogenicities seen within the distended bladder, indicating a clot at various stages (Figure 1B). This case illustrates the importance of considering POCUS in patients with urinary retention and hematuria, especially in the setting of recent catheter placement.

The prognosis and safety of continuous saline bladder irrigation in patients after transurethral resection of bladder tumors: a systematic review and meta-analysis of comparative study.

The prognosis and safety of continuous saline bladder irrigation (CSBI) after transurethral resection of bladder tumor (TURB) as an alternative method needs to be explored. A literature review and meta-analysis were performed by searching PubMed, EMBASE, Cochrane Library databases and original references of the included articles. PRISMA checklists were followed. We used the GRADEpro GDT to assess the certainty of evidence from the results of our meta-analysis. A total of eight articles including 1600 patients were studied. The results indicated that patients received CSBI after TURB had no statistical differences compared to the control group in the recurrence-free survival and progression-free survival. However, the CSBI group showed significant improvements compared to the control group in terms of the number of recurrences during follow-up and the period to first recurrence except for the number of tumor progression during follow-up. Furthermore, patients treated with CSBI did not show an inferior effect than those treated with immediate intravesical chemotherapy (IC) in respects of recurrence-free survival, progression-free survival, the number of recurrences during follow-up, the number of tumor progression during follow-up and the period to first recurrence. But the immediate IC group had a higher incidence than the CSBI group in terms of macrohematuria, micturition pain, frequency of urination, dysuria, retention and local toxicities. Patients treated with CSBI after TURB showed a significant improvement compared to the control group in terms of the number of recurrences during follow-up and the period to first recurrence. However, compared to immediate IC, CSBI did not show an inferior effect except for lower incidence of adverse reactions.PROSPERO registration number CRD42021247088.

Single-Port Robotic Transvesical Simple Prostatectomy Step by Step

We detail the instruments required to perform a single-port robotic transvesical simple prostatectomy, as well as the surgical technique to perform this operation using the single-port robot. A 3-cm transverse incision is made three fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The roll wound retractor rolling ring is inserted into the bladder lumen, with the access port, SP Short Entry Guide, and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mm Hg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc, but is usually removed en lobe. A vesicourethral mucosal advancement flap is performed with 3-0 V-Loc suture from apex to base at 3-o-clock and 9-o-clock; a double-arm 3-0 V-Loc suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. Prostatic adenoma specimens can be removed from the SP Access Port directly or removed from the bladder using the robotic camera for observation. The cystotomy is closed in two layers with 3-0 Vicryl suture. The patient is observed for 2 hours on continuous bladder irrigation to determine ambulatory discharge eligibility. Follow-up is in 3 to 7 days for trial of void. Disclosure: Portions of this video and title were presented at the AUA 2023 in the form of a video abstract and as an AUA Core Curriculum video. https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000003288.06 Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. There are no commercial associations during the past 3 years that might create a conflict of interest in connection with the video. Runtime of video: 7 mins 37 secs

Shared Experiences

Shared Experiences

Clinical Efficacy of Neoadjuvant Intravesical Mitomycin-C Therapy Immediately Before Transurethral Resection of Bladder Tumor in Patients With Nonmuscle-invasive Bladder Cancer: Preliminary Results of a Prospective, Randomized Phase II Study. Letter.

You have accessJournal of UrologyLetters to the Editor1 Apr 2023Clinical Efficacy of Neoadjuvant Intravesical Mitomycin-C Therapy Immediately Before Transurethral Resection of Bladder Tumor in Patients With Nonmuscle-invasive Bladder Cancer: Preliminary Results of a Prospective, Randomized Phase II Study. Letter. Ashish Ranjan, Ankit Misra, Sanjoy Kumar Sureka, and Uday Pratap Singh Ashish RanjanAshish Ranjan Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India More articles by this author , Ankit MisraAnkit Misra * E-mail Address: [email protected] Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India More articles by this author , Sanjoy Kumar SurekaSanjoy Kumar Sureka Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India More articles by this author , and Uday Pratap SinghUday Pratap Singh Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003363AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail J Urol. 2023;209(1):131-139. To the Editor: We read with great interest the study investigating the novel role of intravesical mitomycin-C (MMC) in nonmuscle-invasive bladder cancer (NMIBC) in a neoadjuvant setting.1 Single, immediate, post-transurethral resection of bladder tumor (TURBT) instillation of MMC is the standard protocol in NMIBC.2 It primarily reduces the recurrence risk by eliminating viable residual tumors and preventing reseeding of the free-floating cancer cells.3 However, fear of extravasation and its associated serious complications has led to its low practical compliance worldwide.4 This study has demonstrated the use of neoadjuvant intravesical MMC for NMIBC with promising therapeutic efficacy, better tolerability, and low significant adverse effects. Although the dose and schedule of neoadjuvant MCC followed in the study were convenient for the patient, we would like to know the scientific basis for using 2 doses at a specific interval. The writers mention a preliminary study for deciding on 2 doses of neoadjuvant MMC, but no reference has been given. Do the authors feel that the control group should have received a single immediate post-TURBT MMC per the standard? Were any morphological or radiological criteria considered before administering the neoadjuvant therapy? The rationale of giving MMC post-TURBT is only to give it to patients with superficial disease on resection. Would it not be an overtreatment and waste of resources on those that eventually come out as muscle invasive? MMC concentration in tumor and normal tissue was measured to know about uptake, but is there any standard concentration in the postoperative instillation setting to which it was matched? Moreover, it would be interesting to know the method used to detect the concentration of MMC in the tissue. Would continuous saline irrigation used during the TURBT have diluted the effect of MMC on the tissue? Multifocal tumors were more in the control arm (24, 63%) than in the intervention arm (15, 46%). Was this difference statistically significant? This could have a bearing on better recurrence-free survival in the intervention arm and more progression in control. Lastly, we appreciate the authors' focus on an important area in NMIBC treatment. REFERENCES 1. . Clinical efficacy of neoadjuvant intravesical mitomycin-C therapy immediately before transurethral resection of bladder tumor in patients with nonmuscle-invasive bladder cancer: preliminary results of a prospective, randomized phase II study. J Urol. 2023; 209(1):131-139. Link, Google Scholar 2. . Trial-based cost-effectiveness analysis of an immediate postoperative mitomycin C instillation in patients with non–muscle-invasive bladder cancer. Eur Urol Open Sci. 2022; 37:7-13. Crossref, Medline, Google Scholar 3. . Continuous saline bladder irrigation in reducing recurrence and progression when compared to immediate mitomycin-C instillation post-resection of bladder tumor: a short communication. Asian Pac J Cancer Prev. 2022; 23(1):171-175. Crossref, Medline, Google Scholar 4. . Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection with transurethral resection alone in patients with stage pTa-pT1 urothelial carcinoma of the bladder: which patients benefit from the instillation?Eur Urol. 2016; 69(2):231-244. Crossref, Medline, Google Scholar Submitted December 19, 2022; accepted February 2, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 4April 2023Page: 677-678 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashish Ranjan Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India More articles by this author Ankit Misra Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India * E-mail Address: [email protected] More articles by this author Sanjoy Kumar Sureka Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India More articles by this author Uday Pratap Singh Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India More articles by this author Expand All Submitted December 19, 2022; accepted February 2, 2023; published 000. Advertisement Advertisement PDF downloadLoading ...

V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY

You have accessJournal of UrologyCME1 Apr 2023V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY Andreia Cardoso, Sara Anacleto, Catarina Laranjo Tinoco, Ricardo Matos Rodrigues, Ana Sofia Araújo, Mariana Capinha, Vera Marques, João Pimentel Torres, Carlos Oliveira, Miguel Mendes, and Emanuel Carvalho-Dias Andreia CardosoAndreia Cardoso More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mariana CapinhaMariana Capinha More articles by this author , Vera MarquesVera Marques More articles by this author , João Pimentel TorresJoão Pimentel Torres More articles by this author , Carlos OliveiraCarlos Oliveira More articles by this author , Miguel MendesMiguel Mendes More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder leiomyomas (BL) are rare benign tumors, with roughly 250 cases reported worldwide. Surgical excision is the recommended treatment, classically through open partial cystectomy. As alternatives, minimally invasive approaches, such as laparoscopic (lap), robot-assisted and transurethral (TU) resection (TUR), are arising. In parallel, TU cystorraphy has been reported for vesicovaginal fistulas or traumatic perforations. Thus, to the best of our knowledge, we report the 1st Human Natural Orifice Transluminal Endoscopic Surgery (NOTES) with a purely TU approach for BL enucleation and cystorraphy, without transvesical access, gas insufflation, neither extracorporeal knot tying. METHODS: A 68-year-old woman presented an incidental 22mm lesion on the left posterolateral bladder wall on MRI, highly suspicious for BL. After cystocopic confirmation of a submucosal lesion, TUR was proposed. We performed a pioneer NOTES with total TU BL enucleation and cystorraphy using: 30° lens, white light only, saline irrigation, 26Ch resectoscope, operative cystoscope, Collin’s knife and standard resection loop, bipolar energy, 5mm lap needle holder and 3-0 V-Loc 23cm length suture. RESULTS: BL complete enucleation was done with bipolar energy on Collin’s knife and standard resection loop. Then, V-Loc suture was completely placed inside the bladder through the operative cystoscope, and with the lap needle holder inserted through it, a total intravesical cystorraphy with single hand continuous suture was performed. Operative time was 40min. Patient was discharged on the next day, with bladder catheter for 5 days. There were no complications. CONCLUSIONS: TUR has been used for BL, but without cystorraphy, which is a limitation for bigger or more profound infiltrative lesions. Cystorraphy techniques combining TU, transperitoneal and/or transmural bladder access were reported. A purely TU cystorraphy recently reported required extracorporeal sliding knot techniques, so, it was only possible in women. Thus, our approach may be the most minimally invasive possible for the safest treatment of BL. We combined several techniques aiming to reach an ideal one. Using only regular material, a single urethral route, and no gas insufflation, we achieved a quick and safe procedure, with no need for continuous bladder irrigation and short catheterization. Yet, it requires advanced skills such as single hand lap suturing. Our technique seems also feasible in small bladder perforations, fistulas, or other lesions (e.g.: endometriosis). Additionally, with total intravesical suture, it may also be viable in men. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreia Cardoso More articles by this author Sara Anacleto More articles by this author Catarina Laranjo Tinoco More articles by this author Ricardo Matos Rodrigues More articles by this author Ana Sofia Araújo More articles by this author Mariana Capinha More articles by this author Vera Marques More articles by this author João Pimentel Torres More articles by this author Carlos Oliveira More articles by this author Miguel Mendes More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-03 COMBINATION PROSTATIC ARTERY EMBOLIZATION PRIOR TO AQUABLATION® FOR BENIGN PROSTATIC HYPERTROPHY: A PROPENSITY SCORE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP51-03 COMBINATION PROSTATIC ARTERY EMBOLIZATION PRIOR TO AQUABLATION® FOR BENIGN PROSTATIC HYPERTROPHY: A PROPENSITY SCORE ANALYSIS Sandeep Bagla, Anthony Sare, Abin Sajan, Pratik Desai, and Inderjit Singh Sandeep BaglaSandeep Bagla More articles by this author , Anthony SareAnthony Sare More articles by this author , Abin SajanAbin Sajan More articles by this author , Pratik DesaiPratik Desai More articles by this author , and Inderjit SinghInderjit Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aquablation has been previously reported with a 10% bleeding risk and a 6% requiring transfusion rate. The purpose of this study was to demonstrate the feasibility and safety of Prostatic Artery Embolization (PAE) before Aquablation® in patients with Benign Prostatic Hypertrophy (BPH). METHODS: A retrospective chart review identified 148 patients treated with Aquablation® for BPH from May 2018 to June 2021. Patients were divided into two groups: Aquablation® alone (n=56) vs. combination PAE and Aquablation® (n=89). Patient demographics, pertinent laboratory values, operative reports, and the hospital courses between the two groups were reviewed. After propensity score matching for age and prostate gland size, outcomes were compared between Aquablation alone vs combination therapy. RESULTS: PAE was technically successful in 89/89(100%) combination patients and all 89 patients underwent successful Aquablation® within a median time of 2 days. Compared to Aquablation® alone, PAE prior resulted in significant reduction in hospital length of stay (34.4±23.5 vs 13.8±26.1 hours, p<0.001). Additionally, PAE before Aquablation® resulted in 16 times (p=0.001) less likely use of perioperative hemostatic measures (balloon traction, cautery). Patients without prior PAE were 7.8 times more likely (p<0.001) to require >2 hours of post-operative continuous bladder irrigation. Patients with Aquablation® alone were also more likely to return to the operating room within 30 days of the procedure (p<0.001). Lastly, the incidence of persistent hematuria at 2 or 4 week followup was 3.2 times higher in the Aquablation® alone group (p<0.001) compared to the combination group. There were no major PAE related adverse events reported in the combination arm. CONCLUSIONS: Combination PAE and Aquablation® resulted in a reduction in length of hospital stay, intraprocedural hemostastatic maneuvers, and less post-operative bleeding complications than patients undergoing Aquablation® monotherapy for treatment of BPH. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandeep Bagla More articles by this author Anthony Sare More articles by this author Abin Sajan More articles by this author Pratik Desai More articles by this author Inderjit Singh More articles by this author Expand All Advertisement PDF downloadLoading ...

Should continuous bladder irrigation be recommended when single instillation of intravesical chemotherapy cannot be used after transurethral resection in low-risk non-muscle invasive bladder cancer?

Reducing the recurrence rate in patients with low-risk non-muscle invasive bladder cancer patients is a critical concern in the urologic community. The gold standard treatment is single instillation (SI) of intravesical chemotherapy after transurethral resection of bladder tumor (TURBT), but unfortunately, it is underused. Continuous bladder irrigation (CBI) after TURBT is an alternative strategy to SI for the prevention of bladder tumor implantation and recurrence. The aim of this review was to present the evidence that supports CBI after TURBT when SI is not possible.

Impact of intravesical administration of tranexamic acid on gross hematuria in the emergency department: A before-and-after study

IntroductionLocal applications of tranexamic acid (TXA) have been effective in treating various hemorrhagic conditions. In patients with gross hematuria, the main treatment in the emergency department (ED) is continuous bladder irrigation (CBI). However, CBI has no pharmacological effects except blood clot removal from dilution. The aim of this study was to evaluate the impact of the intravesical TXA injection before CBI. MethodsThis study was a before-and-after, retrospective, and single-center study. The target population was hematuria patients who received CBI via a 3-way Foley catheter. As the intervention procedure, 1000 mg of TXA was injected through the Foley catheter and after 15 min, the Foley catheter was declamped and CBI started. Since the intervention started in March 2022, the patients from March 2022 to August 2022 were assigned to the after group and the patients from March 2021 to August 2021 were assigned to the before group. The primary outcomes were the length of stay in the ED and duration of Foley catheter placement. The secondary outcomes were the admissions and the revisits for CBI within 48 h after discharge. ResultsThe numbers of patients in the before group and after group were 73 and 86, respectively. The median length of stay in the ED was shorter in the intervention group than in the group not treated with TXA (274 min vs. 411 mins, P < 0.001). The median duration of Foley catheter placement was also shorter in the intervention group than not treated with TXA (145 min vs. 308 mins, P < 0.001). The revisits after ED discharge were lower in the after group than in the before group (2.3% vs. 12.3%, P = 0.031). There was a trend for lower admissions in the TXA treatment group than before group (29.1% vs. 45.2%, P = 0.052). ConclusionAfter the TXA intervention, reduction in the length of stay in the ED, the duration of Foley catheter placement, and the revisits after ED discharge was observed.

Laparoscopic Millin with Full Vesicourethral Anastomosis—Implications for Hematuria and Ejaculation

Clinical History: A 64-year-old man presented lower urinary tract symptoms (LUTS) and two acute urinary retentions in 6 months, despite having taken dutasteride and tamsulosin. Physical Examination: Digital rectal examination: unsuspicious, enlarged, and inflamed prostate. Diagnosis: Ultrasonography 90 mL prostate, Qmax 3 mL/sec, total prostate-specific antigen (PSA) 5.7 ng/mL, and PSA density 0.06 ng/mL2. Benign prostatic obstruction was diagnosed. Intervention: We started a standard four-port extraperitoneal transcapsular laparoscopic simple prostatectomy (LSP). After adenoma complete removal, including middle lobe and prostatic urethra, we performed our modification, adding a reconstructive step to the standard procedure: a continuous vesicourethral anastomosis (VUA), using a 5/8 circle needle, with 3-0 absorbable unidirectional barbed suture. Prostatic capsule was closed traditionally. Follow-Up/Outcomes: Hematuria was residual and continuous bladder irrigation (CBI) was removed on day 1. Urethral catheter (UC) was maintained for 6 days. At seven weeks, patient presented without LUTS and with antegrade ejaculation, the status that he maintains after 12 months, without complications. Therefore, simply adding VUA to LSP, we may achieve the absence of significant postoperative LUTS and hematuria, obviating CBI need, and even preserve antegrade ejaculation. The success of this case reflects this technique worldwide feasibility, even in large prostates with middle lobe and impossible urethra preservation, without requiring extraordinary material and allying surgical steps already known. We are routinely performing and attempting to improve this technique. We aim to eliminate CBI and remove UC sooner, and to evaluate the possible risk of VUA stricture, or treatment implications on eventual future prostate cancer, in a starting randomized study, but we believe that its advantages may outweigh the risks. No competing financial interests exist. Runtime of video: 5 mins 0 secs Authors' Contributions: All authors contributed to the design of the study, are accountable for all aspects of the study, and have approved the final article for publication. Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Prior abstract presentations: UROtech22, May 26–28, 2022, Istanbul, Turkey; 6th AIM ACELAS—Algerian Community of Endourology and Laparoscopic Surgery—INTERNATIONAL MEETING, September 29–October 1, 2022, Algiers, Algeria.

No bladder irrigation versus continuous bladder irrigation after HoLEP: a propensity score matching analysis

PurposeIn this study, the feasibility of a no bladder irrigation strategy after transurethral holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH) was studied.MethodsFrom August 2021 to December 2021, the clinical data of 62 patients who received no bladder irrigation after HoLEP (Group A) were studied. The control group contained the clinical data of 150 patients in the same therapy group (from January 2021 to July 2021) who received continuous bladder irrigation after HoLEP (Group B). The baseline was consistent after using the propensity score matching (PSM) method, and the differences between groups were compared. The pre- and postoperative complications, international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR) of the two groups were compared, accompanied by a follow-up evaluation of surgical effects.Results47 pairs of patients were successfully matched by PSM. There was no statistically significant difference in the intraoperative conditions and the incidence of early postoperative complications between the two groups (P > 0.05). Before and one month after the surgery, significant differences were also found in the IPSS, QOL, Qmax, and PVR of both groups (P < 0.05). Within one month after the surgery, no statistically significant difference was found in IPSS, QOL, Qmax, PVR, or the incidence of early postoperative complications between the two groups (P > 0.05).ConclusionFor appropriately selected patients according to the exclusion criteria, the no bladder irrigation strategy after HoLEP for BPH is safe and effective.

A prospective randomized study comparing short-time with long-time continuous saline bladder irrigation after transurethral resection in non-muscular invasive bladder cancer

A prospective randomized study comparing short-time with long-time continuous saline bladder irrigation after transurethral resection in non-muscular invasive bladder cancer