Resection Of Benign Prostatic Hyperplasia Research Articles

The Case Study of Pre-operative Transurethral Resection of Benign Prostatic Hyperplasia

Objective: The case study of pre-operative transurethral resection of benign prostatic hyperplasia
 Methods: The total of 987 patients with BPH in our hospital from September 2016 to December 2019 was selected, all of whom underwent TURP, and the rate and reason for reoperation of all patients were observed.
 Results: Among the 987 BPH patients, a total of 46 cases underwent resection, and the rate was 4.66%; compared with patients with one operation, the amount of postoperative wound bleeding was greater than that of patients with one operation, and the incidence of urethral stricture and bladder neck contracture was higher than that of patients with one operation. Statistically significant (P<0.05).
 Conclusion: The re-operation rate of BPH patients after TURP is low, but there are still some patients with recurrence. The main reasons Including urethral stenosis, residual glands, postoperative wound bleeding, and bladder neck contracture. At the same time, implementing targeted preventive measures in combination with the above reasons can effectively reduce the risk of repeated electrocardiography. Ratio of surgical resection and improved long-term prognosis.

Comparative analysis of laparoscopic retropubic simple prostatectomy combined with provisional clamping of internal iliac arteries, urethrocystoanastomosis and transurethral resection of benign prostatic hyperplasia

Aim. To provide comparative analysis of laparoscopic retropubic simple prostatectomy combined with provisional clamping of internal iliac arteries, uretherocystoanastomosis (LRP + CIIA + UCA) and transurethral resection of prostate (TURP) for surgical treatment benign prostatic hyperplasia (BPH).Materials and methods. 103 patients of age ³40 years old with refracted symptoms of urinary tract compression caused by BPH. The period of observation: from 2019 until the May 20, 2022; 48 and 51 patients were primary observed before and 6 months after LRP + CIIA + UCA and TURP. Criteria of inclusion: prostatic volume 60–80 cm3.Pre-operative treatment included such parameters as prostate-specific antigen level. Volume of prostate, volume of residual urine, urodynamic parameters, IPSS (International Prostate Symptom Score) + quality of life (QoL) scale result. Postoperative observation after 6 months included uroflowmetry, residual urine volume, evaluation of lower urinary tract symptoms and their influence on IPSS and QoL scale result. Efficacy of treatment of BPH is a summary of all earlier described parameters.Results. Symptomatic regression in patients who underwent LRP + CIIA + UCA and TURP was found among 15 (93.75 %) and 13 (81.25 %) patients relatively; complications distributed throughout 1, 2 and 3 classes by Clavien-Dindo criteria: after TURP – among 71.4, 22.9 and 5.7 % patients, after LPA + CIIA + UCA – among 35.4, 24.2 and 11.3 %, relatively. After 6 months maximal urine flow improved up to 22.7 ± 2.2 ml/seс, 16.8 ± 1.5 ml/seс, relatively.Conclusion. LRP + CIIA + UCA is effective for urodynamic and life quality improvement like TURP. LRP + CIIA + UCA has shown statistically significant advantages of such parameters as blood loss, bladder neck contractures and urethral strictures.

Robot-assisted aquablation for resection of benign prostatic hyperplasia: A series of cases

Robot-assisted aquablation for resection of benign prostatic hyperplasia: A series of cases

Transfusion rates after 800 Aquablation procedures using various haemostasis methods.

ObjectiveTo determine if athermal methods are as effective in preventing blood transfusions as the use of cautery across various prostate volumes following prostate tissue resection for benign prostatic hyperplasia using Aquablation. Patients and methodsThe current commercial AQUABEAM robot that performs Aquablation therapy was first used in 2014. Since then numerous clinical studies have been conducted in various countries; Australia, Canada, Germany, India, Lebanon, Spain, New Zealand, United Kingdom, and the United States. All of the clinical trial data since 2014 were pooled with the early commercial procedures from France, Germany, and Spain to determine the effectiveness of haemostatic techniques in reducing the transfusion rate in patients after Aquablation.ResultsIn all, 801 patients were treated with Aquablation therapy from 2014 to early 2019. The mean (SD, range) prostate volume was 67 (33, 20–280) mL and 31 (3.9%) transfusions were reported. The largest contributing factor to transfusion risk was prostate size and method of traction. There was an increasing risk of transfusions in larger prostates when robust traction using a catheter‐tensioning device (CTD) without cautery was used, ranging from 0.8% to 7.8% in prostates ranging from 20 to 280 mL. However, when standard traction (taping the catheter to the leg, gauze knot synched up to the meatus, or no traction at all) was used and where the surgeon performed bladder neck cautery only when necessary, the risk of transfusion was 1.4–2.5% in prostates ranging from 20 to 280 mL.ConclusionsWhile the athermal subgroup with robust traction with a CTD had comparable transfusion rates for smaller prostates, the risk increased significantly as prostate volume increased. With standard traction methods and selective bladder neck cautery, the risk of transfusion was reduced to 1.9% across all prostate sizes.

Analysis of Present Status for Surgery of Benign Prostatic Hyperplasia in Korea Using Nationwide Healthcare System Data.

PurposeThere are no established statistical data available for the comparison of different surgical methods adopted for the resection of benign prostatic hyperplasia (BPH). This study investigates the present status related to BPH surgery in Korea for the past 8 years.MethodsNational-level data from the National Health Insurance Service and National Statistical Office were analyzed in this study. From 2010 to 2017, the trends of surgeries for BPH were reviewed according to the procedure code including transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), or high-power potassium titanyl phosphate (KTP), and this trend also analyzed by age, geographic distribution, and hospital type.ResultsOver the past 8 years, there was not much change in the total number of BPH-related surgeries (range, 10,393– 11,072). Although there was not much alteration in the number of conventional TURP (from 6,801 in 2010 to 6,645 in 2017), the number of HoLEP has dramatically increased (from 278 in 2010 to 3,805 in 2017). The number of HoLEP surgeries after 2011 exceeded the number of surgeries using KTP, and the gap is anticipated to rise. The number of surgeries by age group was most common in the 70s and the total number of surgeries is decreasing in all age groups; for HoLEP, the trend is steadily increasing over the age of 60 years. Most of the BPH surgeries were performed in metropolitan areas, such as Seoul, Gyeonggi-do, and Busan, and in larger hospitals compared to smaller hospital settings.ConclusionsThrough the data of the National Health Insurance Service, we could apprehend the present status of BPH-related surgery in Korea. Then, we could know about the trend according to several factors and we think these results will be valuable as academic references as well.

Comparison of the effects of two methods in the treatment of urinary incontinence after transurethral resection of prostate

Objective To compare the effects of ball of urethra suspension with Yiqi perturbation urine and subtract two methods in the treatment of urinary incontinence after transurethral resection of prostate. Methods From February 2012 to February 2017, 60 patients with urinary incontinence after transurethral resection of prostate in the Third People's Hospital of Shuozhou were selected.According to different therapeutic methods, the patients were divided into two groups, with 30 cases in each group.The control group was treated with ball of urethra suspension, the observation group was given Yiqi perturbation for urine.The incidence of urinary incontinence and degree of the two groups after treatment were observed.The incontinence duration, international prostate symptom score, residual urine volume, maximum urine flow rate and patients' quality of life scores were compared between the two groups. Results After treatment, the incidence rate of urinary incontinence in the observation group was 8.3%, which was significantly lower than 23.3% in the control group (χ2=10.28, P<0.05). The incontinence duration, international prostate symptom score, residual urine volume, maximum urinary flow rate in the observation group were (7.6±2.1)d, (21.2±3.4)points, (119.5±60.4)mL, (4.1±1.3)mL/s, respectively, which were better than those in the control group [(15.8±3.2)d, (5.6±1.5)points, (19.7±6.9)mL and (20.4±5.3)mL/s], the differences between the two groups were statistically significant (t=11.73, 22.99, 8.99, 22.99, all P<0.05). The quality of life scores in the observation group were better than those in the control group (all P<0.05). Conclusion Yiqi perturbation urine for urinary incontinence caused by transurethral resection of benign prostatic hyperplasia is better than the ball of urethra suspension, it can reduce the degree of postoperative incontinence, improve patients' quality of life. Key words: Urinary incontinence; Postoperative complications; Transurethral resection of prostate; Suburethral slings; Yiqi perturbation urine; Medicine, Chinese traditional; Controlled clinical trial

Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of the prostate for benign prostatic hyperplasia

To identify risk factors for urethral stricture and/or bladder neck contracture after transurethral resection of benign prostatic hyperplasia. We performed a retrospective analysis of 402 patients, which underwent a monopolar transurethral resection of the prostate in the urology clinic of Sechenov First Moscow State Medical University for prostatic hyperplasia during the period 2011-2014. Urethral stricture and (or) bladder neck contracture in the postoperative period were diagnosed in 61 (15.27%) patients; 34 patients (8.6%) had urethral stricture, 20 (4.97%) bladder neck contracture, and 7 (1.7%) had a combination of urethral stricture and bladder neck contracture. In 341 of cases (84.73%), no late postoperative complications were observed. A total of 106 of the 341 patients met the inclusion criteria, hence, containing all the information necessary for analysis such as the volume of the prostate, the duration of the surgery, the size of the endoscope, data on concomitant diseases, analysis prostatic secretion, and so on. Thus, two groups were formed. Group 1 (106 patients) is the control group in which urethral strictures and/or bladder neck contractures did not occur in the long-term postoperative period and group 2 (61 patients), in which was observed the formation of these complications. To calculate the statistical significance of the differences for categorical data, Fisher criterion was used. For quantitative variables, in the case of normal data distribution, an unpaired t-test or one-way analysis of variance was used; for data having a distribution different from normal, a Mann-Whitney rank test was used. Regression analysis established the significance of the influence of four factors on the development of scar-sclerotic changes of urethra and bladder neck: the tool diameter 27 Fr ( p < 0.0001), presence of prostatitis in past medical history ( p < 0.0001), prostate volume ( p = 0.003), and redraining of the bladder ( p = 0.0162). The relationship between the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, and repeated drainage of the bladder using the urethral catheter with the risk of developing scar-sclerotic changes in the urethra and/or bladder neck are statistically reliable and confirmed as a result of regression analysis.

Факторы риска развития стриктур уретры и/или контрактуры шейки мочевого пузыря после монополярной трансуретральной резекции гиперплазии предстательной железы

Факторы риска развития стриктур уретры и/или контрактуры шейки мочевого пузыря после монополярной трансуретральной резекции гиперплазии предстательной железы

Comparison of outpatient versus inpatient transurethral prostate resection for benign prostatic hyperplasia: Comparative, prospective bi-center study.

We compare the symptomatic relief with urodynamic parameter change and operative safety of the outpatient transurethral resection in saline (TURIS-V) technique with inpatient transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH). This prospective cohort comparison study enrolled patients who needed BPH surgery. Between January 2010 and June 2011, outpatient TURIS-V was performed at 1 centre and the results of the treatment were compared with inpatient TURP performed at a separate hospital. Preoperative characteristics, including prostate volume, were similar in both groups. Perioperative data and any treatment complications were recorded. The analysis compared postoperative outcomes, including a 6-month postoperative International Prostate Symptom Score (IPSS), a quality of life (QoL) evaluation and a record of any changes in uroflowmetry findings, between the 2 groups. In the TURIS-V patient group, 75 patients agreed to be in the study. Of these, 69 ultimately complete the study. In the TURP group, 76 patients agreed and 71 of these completed the study. Both study groups were well-matched for age, IPSS, QoL and uroflowmetry findings. The TURIS-V group experienced both shorter operation times (54.6 vs. 74.8 minutes) and shorter catheterization times (2.2 vs. 4.2 days) when compared to the TURP group. There were comparable improvements in the 6-month postoperative IPSS, QoL, and uroflowmetry findings between the 2 groups. There were also equally low incidence rates of procedural complications. Both TURIS-V and TURP relieve lower urinary tract symptoms in a similar way, with great efficacy and safety. Overall, TURIS-V had shorter operative and catheterization times compared to TURP. Notwithstanding the paper's limitations (non- randomized cohort comparison with possible selection or surgeon bias and small heterogeneous sample size), TURIS-V can be performed safely even in an outpatient setting.

Comparative outcomes of plasmakinetic versus monopolar transurethral resection of benign prostatic hyperplasia: 7 years' results.

We compared results from the standard monopolar or the bipolar plasmakinetic method for the transurethral resection of the prostate (TURP) due to benign prostatic hyperplasia (BPH) at 4 and 7 years after surgery (medium to long term). A retrospective analysis was performed on the complete data from 124 patients who were alive and had 7 years of regular follow-up. Of those 124 patients with BPH, 65 (52%) underwent monopolar TURP (M-TURP) and 59 (48%) underwent plasmakinetic TURP (P-TURP). During the follow-up period, the International Prostate Symptom Score (IPSS), the maximal flow rate (Qmax) measured using uroflowmetry and the prostate specific antigen (PSA) values were recorded. Patients in whom alpha blockers were administered due to the growth of postoperative adenoma and who had been operated on due to urethral stricture, bladder neck contracture or a growing adenoma were also noted and recorded. There was no statistically significant difference between M-TURP and P-TURP groups in any pre-operative or post-operative follow-up parameter at 4 or 7 years post-surgery. Specifically, PSA, IPSS and Qmax values; urethrotomies performed; alpha-blocker use; and the frequency of re-operations were statistically insignificant (p>0.05). Our study demonstrated that when medium-to long-term results are compared, P-TURP and M-TURP appear to result in similar IPSS scores, Qmax values, complication rates and retreatment rates. Larger prospective studies are required to corroborate these results.

A Report on Major Complications and Biochemical Recurrence After Primary and Salvage Cryosurgery for Prostate Cancer in Patients With Prior Resection for Benign Prostatic Hyperplasia: A Single-center Experience

To report on biochemical recurrence (BCR) and major complications in patients with prior prostate resection that underwent cryosurgery (CS) for prostate cancer. The Columbia University Urologic Oncology database identified patients that underwent CS after resection. Patient demographics, surgical details, prostate volume, prostate-specific antigen (PSA) levels, biopsy results, major complications, and BCR were recorded. Prior resection for benign prostatic hyperplasia was identified in 32 patients who underwent CS. Median age was 70.7 years (range 54.9-83.1 years). Median prostate volume before and after resection was 40 (range 30-90) and 20 cm(3) (range 9-54), respectively. Median time from resection to CS was 50.4 months (range 0-178.1 months). Twenty-one (16 full and 5 focal gland ablations) and 11 patients underwent primary and salvage CS, respectively. Median prostate-specific antigen at CSwas 5.9 ng/mL (range 0.1-18.4 ng/mL), with a median nadir post-CS of 0.1 ng/mL (range 0.04-12.2 ng/mL). Median follow-up was 41.2 months (range 8.9-154.2 months). According to Stuttgart and Phoenix definitions, 11 and 10 patients, respectively, experienced BCR. Three patients underwent further CS for disease recurrence. Overall complications were rare and minor. Patients with smaller glands postresection (<20 cc(3)) experienced a similar incidence of BCR as those with larger glands after CS in all the settings. Although no patients experienced major complications after primary CS, 18% (2/11) had grade III or higher complications in the salvage setting. Postresection gland volume was not associated with BCR. Further research is needed to evaluate functional and oncological outcomes in postresection patients after CS because they are considered high-risk for major complications.

Transurethral Resection of Prostate Abscess: Is It Different from Conventional Transurethral Resection for Benign Prostatic Hyperplasia?

Purpose. To present our experience of prostate abscess management by modified transurethral resection (TUR) technique. Methods. Seventeen men with prostate abscess undergoing TUR between 2003 and 2011 were retrospectively analyzed. Details of demography, surgical procedures, complications, and followup were noted. Results. With a mean age of 61.53 ± 8.58 years, all patients had multifocal abscess cavities. Initially, 6 men underwent classical TUR similar to the technique used for benign prostatic enlargement (group 1). Next, 11 men underwent modified TUR (group 2) in which bladder neck and anterior zone were not resected. The abscess cavities resolved completely, and no patient required a second intervention. One patient in group 1 and three in group 2 had postoperative fever requiring parenteral antibiotics (P = 0.916). Three patients in group 1 had transient urinary incontinence, whereas none of the patients in group 2 had this complication (P = 0.055). Four and five men in group 1 and 2 reported retrograde ejaculation, respectively (P = 0.740). Conclusion. The modified technique of prostate resection edges over conventional TURP in the form of reduced morbidity but maintains its high success rate for complete abscess drainage. It alleviates the need for secondary procedures, having an apparent advantage over limited drainage techniques. Use of this technique is emphasized in cases associated with BPH and lack of proper preoperative imaging.

Unusual Increased β-Globulins in an Elderly Patient

A 90-year-old man who had a history of transurethral prostate resection for benign prostatic hyperplasia was admitted for left hip pain. A hip radiography examination revealed a large osteolytic lesion in the left greater trochanter, and a bone scintigraphy evaluation showed increased activity in the same area. Because of the patient's history, metastasis from prostate carcinoma was suspected, and bone biopsies were performed the same week. Ten days later, the patient was hospitalized in the emergency department after a fall that fractured the femoral neck. At admission, plasma sodium, chloride, and potassium concentrations were all within their respective reference intervals. The plasma concentration of total protein was 5.0 g/dL (50 g/L) [reference interval, 6.0–8.0 g/dL (60–80 g/L)], and that of albumin was 1.5 g/dL (15 g/L) [reference interval, 3.0–4.5 g/dL (30–45 g/L)]. The albumin-corrected calcium concentration was 10.8 mg/dL (2.69 mmol/L) [reference interval, 9.0–10.6 mg/dL (2.25–2.65 mmol/L)]. Hematology tests showed mild normocytic (mean corpuscular volume, 95.1 fL; reference interval, 80–97 fL]), aregenerative [reticulocyte count, 54 × 103/μL (54 × 109/L); reference interval, 25–80 × 103/μL (25–80 × 109/L)] anemia, with a low hemoglobin concentration [9.9 g/dL (99 g/L); reference interval, 13.0–17.0 g/dL (130–170 g/L)] and leukopenia [2.5 × 103/μL (2.5 × 109/L); reference interval, 4.0–10.0 × 103/μL (4.0–10.0 × 109/L)]. The plasma creatinine value was 1.1 mg/dL (97 μmol/L) [reference interval, 0.71–1.20 mg/dL (62–106 μmol/L)], and the urea nitrogen concentration was 35.0 mg/dL (12.5 mmol/L) [reference interval, 7.8–19.6 mg/dL (2.8–7.0 mmol/L)]. The urine protein value was 540 mg/24 h (reference interval, 0–150 mg/24 h). Urine protein electrophoresis (UPEP)4 showed the presence of an unusual spike in the β region (Fig. 1A). We measured an increased urine concentration of free κ light chain …

Lymphoepithelioma-like carcinoma of the prostate

In this report, we summarized the clinicopathologic features of 5 cases of lymphoepithelioma-like carcinoma of the prostate, a rare variant of prostate cancer characterized by a malignant epithelial component densely infiltrated by lymphoid cells. In all 5 patients, there were obstructive symptoms and elevated prostate-specific antigen; one patient had also hematuria. Their ages ranged from 69 to 82 years (mean age, 76 years). The initial diagnosis of lymphoepithelioma-like carcinoma of the prostate was made on transurethral resection in 3 cases and radical prostatectomy in 2 others. In one case the diagnosis of lymphoepithelioma-like carcinoma admixed with conventional acinar adenocarcinoma was an unexpected finding at time of transurethral resection for benign prostatic hyperplasia. Three patients had clinical stage T3 tumors and another had stage T4 disease; stage T1b was present in the remaining case. Microscopically, all tumors contained lymphoepithelioma-like carcinoma, which comprised 10% to 90% of the entire tumor. All cases were associated with adenocarcinoma, either as the sole pattern in 5 cases or with an additional ductal component in 3 cases. One case had additional features of adenosquamous carcinoma. The lymphoepithelioma-like carcinoma component was characterized by indistinct cytoplasmic borders and a syncytial growth pattern. The stroma was densely infiltrated by lymphoid cells admixed with some plasma cells and neutrophils; one case had a prominent infiltration of eosinophils. Immunohistochemical staining demonstrated that lymphoepithelioma-like carcinoma was positive for prostate-specific antigen, prostate acid phosphatase, alpha-methylacyl coenzyme A racemase, and epithelial membrane antigen; several cytokeratins (AE1/AE3, 7, 8, and 20 [rare cells]) were also immunoreactive. The mean Ki-67 labeling index was 53% (range, 40%-70%), and the p53 expression in all cases was low (10%-20%). The lymphoid component was mainly composed of T with a minor subset of B cells, admixed with some dendritic cells and histiocytes as seen by S100 and CD68 immunoreactivity. Latent membrane protein 1 immunostaining and in situ hybridization for Epstein-Barr virus were negative in all 5 lymphoepithelioma-like carcinoma cases. DNA ploidy of lymphoepithelioma-like carcinoma tumors gave DNA histograms with aneuploid peaks. DNA ploidy of the concurrent adenocarcinoma gave DNA aneuploid peaks except in one DNA diploid case. Four patients died of disease from 8 to 26 months; one patient was lost to follow-up. In summary, lymphoepithelioma-like carcinoma of the prostate arise in aggressive prostate cancers at advanced clinical stage. Morphologic recognition and distinction from other prostatic lesions and tumors with prominent lymphoid stroma is critical for its clinical management.

Is the minimally invasive treatment as good as transurethral resection for benign prostatic hyperplasia?

Despite the development of new technologies, transurethral resection of the prostate (TURP) is still considered the gold standard for surgical treatment of the benign prostate hyperplasia (BPH). In general, new minimally invasive treatments have not demonstrated better outcomes than TURP in evidence based medicine trials published to date, and should be reserved for patients who prefer to avoid surgery, who are unsuitable candidates for surgery or who no longer respond favorably to medication. TUMT and TUNA appears to be more effective than medical therapy but less effective than TURP. Both treatments can be given under topical anesthesia or local prostatic or perineal block. Efficacy of transurethral vaporization appears similar to TURP, but the studies are short-term and the glands operated on are relatively small. In patients with small prostates, the transurethral incision of the prostate can also be a good option, associated with less morbidity than TURP. Bipolar resection of the prostate is similar to TURP in effectiveness, but the data are inconclusive regarding blood loss, length of catheterization and hospital stay. Long-term comparative trials are needed to determine if the minimally invasive therapies are superior to standard TURP.

Methicillin-resistant Staphylococcus aureus endocarditis after transurethral prostatic resection

We report the first case, to our knowledge, of methicillin-resistant Staphylococcus aureus endocarditis complicating transurethral prostatic resection for benign prostatic hyperplasia. The patient had been catheterized preoperatively because of urinary retention and, postoperatively, developed pyrexia with persistent methicillin-resistant S. aureus-positive blood cultures. The cause remained elusive, despite extensive investigations (including echocardiography), until he developed embolic phenomena pathognomonic of infective endocarditis 1 month into treatment with intravenous vancomycin.

Dermatitis sistémica de contacto por tetracaínas

We report the case of a 71-year-old-man with dermatitis in the groin area. Forty-eight hours previously, he had undergone transurethral resection for benign prostatic hyperplasia. During the prostatectomy, the probe was lubricated with a urological ointment containing the topical anesthetic, tetracaine. The patient had previously experienced severe pruritus and fissures in the perianal area after using antihemorrhoidal ointments. Biopsy and patch testing with the standard series and lubricant ointment showed positive reactions to this lubricant, called “urological lubricant” (UL) (+ + +) with caine mix (+ + +). The patient was diagnosed with systemic contact-type dermatitis due to caine mix. The dermatitis improved with topical steroids and oral antihistamine agents.

Emprego de sistemas robóticos na cirurgia cardiovascular

O desenvolvimento de sistemas roboticos para cirurgia teve inicio na decada de 80, por solicitacao do exercito norte-americano, que antevia a possibilidade de realizar operacoes em teatros de guerra, distantes do local onde estava o cirurgiao. Entretanto, o primeiro uso em humanos so ocorreu anos mais tarde, numa resseccao transuretral de hiperplasia benigna de prostata. Cirurgioes cardiacos foram logo atraidos pela tecnica robotica devido a possivel aplicacao com reduzido carater invasivo; esperava-se menor trauma cirurgico e reducao da dor, morbidade, tempo de internacao e custo do procedimento. Atualmente, de forma restrita e em casos selecionados, robos sao usados para revascularizacao do miocardio e implante de marcapasso em cirurgias cardiacas totalmente endoscopicas; podendo tambem constituir apoio visual na retirada de arteria toracica interna, reconstrucao valvar mitral e correcao de defeitos congenitos. Utilizando o robo auxiliar AESOP® para controle do videotoracoscopio, com controle vocal por meio do sistema HERMES®, temos realizado disseccao da arteria toracica interna, implante de eletrodo ventricular esquerdo e abordagem de defeitos congenitos na cirurgia de correcao. Apesar do entusiasmo cientifico inicial com a cirurgia robotica, ainda nao existe evidencia clara de superioridade desta tecnica em relacao a operacao convencional, em termos de resultado. Isto se aplica tambem ao custo, pois o investimento inicial na aquisicao de sistema cirurgico completo (console, controle de video, instrumental) provavelmente e compensado apos muitos procedimentos e longo intervalo. Mas e certo que a cirurgia robotica tera um lugar no futuro, possibilitando aprendizagem, telepresenca e realizacao de procedimentos pouco invasivos, embora complexos.

The correlation between urodynamics and morphology in men with benign prostatic hyperplasia

We have the impression that the degree of obstruction was stronger in the patients with a middle lobe of hyperplastic nodule than in those without such a lobe in patients with benign prostatic hyperplasia. In the present study, we compared the data from a pressure-flow study (PFS) and a presence of a middle lobe. A transurethral resection for benign prostatic hyperplasia was performed in 2,439 patients, 798 underwent PFS. The PFS findings and the presence of a middle lobe were compared with the following parameters, namely, the bladder detrusor function, the degree of obstruction, the post-voided residual volume, the maximum flow rate, the prostate volume and the resected volume. In the pressure-flow study, the rate of the normal bladder detrusor function was higher in the patients with a middle lobe than in those without such a lobe (71.9 versus 53.3%). The degree of obstruction was also stronger in the patients with a middle lobe than in those without in the patients with a normal bladder detrusor function (89.0 versus 79.4%). Then in the patients with a middle lobe, the quantity of the post-voided residual volume was greater, however, the maximum flow rate was lower. Most patients with a middle lobe demonstrate an improved voiding ability after underwent a transurethral resection.

Modified bulbar urethral sling procedure for the treatment of male sphincteric incontinence.

Urinary incontinence secondary to intrinsic sphincter deficiency is a debilitating condition for the patient and an ordeal for the urologist. Because of the complexity of reconstructive surgical techniques and the prohibitive cost of the prosthetic devices used, there is a need for a simple procedure. We herein report our experience in managing urinary incontinence secondary to sphincteric incompetence in nine consecutive patients using a modified bulbar urethral sling procedure over a period of 2 years. In eight patients, the incontinence followed open prostatectomy or transurethral resection for benign prostatic hyperplasia, and one patient had incontinence following fulguration of posterior urethral valves. Our procedure uses bolsters that are suspended from the rectus fascia, and a hammock made of a folded Dacron patch is placed beneath the bulbospongiosus muscle to form a sling. All patients were continent postoperatively, with only mild stress leakage in the erect posture, during a mean follow-up of 12.2 months (range 6-22 months) and required one or two improvised pads per day to remain continent during the daytime. Persistent perineal infection necessitated removal of the sling in one patient. One patient required clean intermittent catheterization for a short period postoperatively. This modified bulbar urethral sling procedure is a simple yet effective method to treat sphincteric deficiency of any cause.