Resected Weight Research Articles

The Complex Insurance Reimbursement Landscape in Reduction Mammaplasty

Reduction mammaplasty (RM) is generally thought of as a reconstructive procedure, frequently but variably reimbursed by third-party payers. The purpose of this study was to assess US plastic surgeons' opinions of and interactions with the insurance coverage environment surrounding the reimbursement of RM. The RM policies of 15 regional and nationwide health insurance carriers were analyzed. A survey regarding RM was distributed to all members of the American Society of Plastic Surgeons and subsequently analyzed. Most insurance carriers require a minimum resection weight, a minimum age, and a conservative therapy trial. A total of 757 surgeons responded to our survey. Seventy-six percent of the respondents believe that only some RM procedures should be covered by insurance. Sixty-four percent feel that symptoms are the most important factor in the surgeon's determination of medical necessity. Fifty-seven percent state that a breast resection weight of 500 g or greater is required for coverage in their region. Seventy-one percent believe that this weight should be less than 500 g per breast. If the surgeon estimates that he/she will remove 500 g per breast, the minimum weight for coverage, 61% of the surgeons would have patients sign a statement of liability for payment. If the intraoperative resection weight is inadequate, 45.6% would not remove additional tissue, risking nonpayment; 32.7% would complete the procedure and inform the patient that payment is out-of-pocket. Insurance reimbursement for RM varies in approval by carrier. Surgeons believe that signs and symptoms of macromastia determine medical necessity, whereas insurance carriers place a larger emphasis on resection weights.

Massive Panniculectomy in the Super Obese and Super-Super Obese

The incidence of obesity is on the rise in the United States and worldwide. Complications following panniculectomy are higher for super obese patients, often requiring readmission and additional interventions. In this study, the authors compare the outcomes of patients who underwent primary closure of their resection wounds to the outcomes of patients who underwent initial open wound management with a negative-pressure dressing. The records of all patients who underwent panniculectomy between 2007 and 2012 were reviewed. Of 14 patients with a body mass index greater than 50, nine underwent primary closure and five were treated with open wound management. A retrospective chart review was performed. There were no statistically significant differences in age or preoperative comorbidities, but body mass index was higher for the open wound management group (66.4 versus 58.9, p = 0.039). There were no statistically significant differences in mean operative time, resection weight, estimated blood loss, or hospital length of stay. The primary closure group had a 44 percent readmission rate and a 33 percent reoperation rate for wound complications. The open wound management group had no wound-related readmissions or secondary procedures for débridement. Open wound management in the massive panniculectomy patient reduces hospital readmission and secondary operations. This case series provides reasons to support the consideration of open wound management following massive panniculectomy in the super morbidly obese patient population.

Mid-term Results of Holmium Laser Enucleation of the Prostate (HoLEP) for the Treatment of Benign Prostatic Hyperplasia (BPH) by a Single Surgeon

ObjectivesHere the author report the mid-term clinical outcomes analysis with efficacy and safety of HoLEP. MethodsFrom May 2010 to September 2012, 270 consecutive patients treated with HoLEP were enrolled in this study. All patients was evaluated by digital rectal examination (DRE), transrectal ultrasonography (TRUS), serum PSA preoperatively. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and 1, 3, 6, 12, 24 months postoperatively. The perioperative data and complications were analyzed. All procedures of HoLEP was done by a single surgeon. ResultsThe mean patient age at the surgery was 67.5 years (45-82), and the mean PSA was 3.7 ng/mL (0.4-19.4). Mean operation time was 73.6 minutes (30-150). Mean prostate volume was 64.3 mL (20-150) and mean resected tisssue weight was 9.3 g (2-63). Mean catheter indwelling time was 2.7 day (1-6), and mean hospital stay was 3.2 day (1-7). The blood loss was minimal, so transfusion was not needed. The baseline data were IPSS; 23.0 (7-35), QoL score; 5.4 (4-6), Qmax (mL/s); 12.5 (1.2-16.5), PVR (mL); 59 (20-250). Postoperatively, IPSS and QoL scores and PVR decreased, and Qmax increased significantly. Intraoperative complication was minor capsular perforation (n = 5). Postoperative complications were acute urinary retention (n = 9), transient incontinence (n = 17), urinary tract infection (n=4), urethral stricture (n=4) and bladder neck contracture (n = 12). ConclusionsHoLEP showed statistical improvement of clinical parameters after 1 month operation and these results sustained for 24 months regardless of prostatic size.

Massive panniculectomy results in improved functional outcome

BackgroundPanniculus morbidus is a large abdominal apron found in morbidly obese patients. This condition creates a vicious cycle of weight gain and functional incapacity. Our study assessed the functional improvement in patients undergoing massive panniculectomy. MethodsA retrospective review of panniculectomies performed from 1994 to 2012 was conducted. Twenty-seven patients with resections >20 lbs were selected. Data on demographics, operative details, complications, and pre- and postoperative functional capacity (using the Steinbrocker Functional Classification) were collected. ResultsThe preoperative mean body mass index was 58 kg/m2, with a mean resection weight of 33 lbs. The overall complication rate was 74%. A statistically significant improvement in functional capacity (preop mean 3.7 vs postop mean 2.0; P < .0001) was identified. ConclusionsPanniculus morbidus is a functionally debilitating condition and massive panniculectomy is often the only treatment available. Our data suggest that massive panniculectomy is a viable option for patients functionally incapacitated by panniculus morbidus.

Experimental model to evaluate the effect of hydrothorax and lobar resection on lung compliance†

The objective of this study was to evaluate to what extent lung compliance is affected by the individual and combined action of lung resection and hydrothorax in an animal model. Anaesthetized and mechanically ventilated rabbits (weight range 2 ÷ 2.2 kg) were randomized in two groups: (i) experimental hydrothorax (from 2 to 8 ml) (n = 5) and (ii) right lower lobe lobectomy (n = 4) and right middle plus lower lobe resection (n = 2). To obtain lung compliance, we measured alveolar, oesophageal pressures and lung volume during slow inflation manoeuvres in control conditions and after hydrothorax or lung resection. Lung compliance was estimated as the change in lung volume divided by the change in transpulmonary pressure. Based on the changes in compliance of the whole lung, we calculated the corresponding changes in compliance of the right lung, which was directly exposed to unilateral hydrothorax and lobectomy. Average total lung compliance in the control was 3.3 ± 0.8 (SD) ml/cmH2O. Eight millilitres of hydrothorax significantly decreased (P < 0.001) lung compliance to 2.7 ± 0.7 ml/cmH2O and increased pleural liquid pressure at the bottom of the cavity from -1 cmH2O up to ∼ 2.5-3 cmH2O. Resection of the right lower lobe significantly decreased (P < 0.001) lung compliance to 1.75 ± 0.3 ml/cmH2O. Resection of the right middle plus lower lobes significantly decreased (P < 0.001) lung compliance to 1.52 ± 0.4 ml/cmH2O. Following hydrothorax, the decrease in right lung compliance (∼ 45%) was much greater than that expected based on the estimated decrease in right lung volume (20%). We attribute this difference to the fact that hydrothorax causes the lung to be exposed to positive, rather than sub-atmospheric, pressure, causing atelectasis. Following lobectomy, right lung compliance decreased by 62 and 80% for estimated decreases in lung volume of 30 and 60%. This difference could reflect inaccuracy in the estimate of lung volume reduction based on resected weight and/or surgical damage. We conclude that potential detrimental effects of hydrothorax and lobar resection decrease lung compliance and expose the lung to the risk of over-distension when a chest drain is applied.

Catheter‐free discharge on first postoperative day after bipolar transurethral resection of prostate: Clinical outcomes of 100 cases

Our center has adopted a protocol for catheter-free first postoperative day discharge after bipolar transurethral resection of the prostate. We present the immediate, 1-month and 6-month outcomes of our first 100 cases following this protocol. All bipolar transurethral resection of the prostate patients followed the protocol regardless of indications and background comorbid conditions. Bladder irrigation was stopped in the evening after transurethral resection of the prostate, and the catheter was removed at 06.00 hours. All patients were discharged on the first postoperative day. They were reviewed at 1 month and 6 months with the International Prostate Symptom Score and uroflowmetry. The mean age of the study population was 70.8 years. A total of 40 patients had urinary retention and were on an indwelling catheter before transurethral resection of the prostate. A total of 14 patients had other surgeries in the same setting as the transurethral resection of the prostate. The mean resection weight was 32.7 g. The mean irrigation time and catheter time were 4.2 h and 15.0 h, respectively. The improvement in terms of International Prostate Symptom Score, quality of life score, peak flow rate and post-void residual volume was comparable with those reported in the literature for bipolar transurethral resection of the prostate. Similarly, early and late complication rates also compared favorably with the literature. The perioperative cost was significantly reduced. Catheter-free first postoperative day discharge after bipolar transurethral resection of the prostate is safe with good clinical outcomes and cost savings.

Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: Perioperative outcomes of a contemporary series

ObjectiveTo assess the perioperative morbidity of transvesical open prostatectomy (OP) and its predictors as a treatment for benign prostatic hyperplasia (BPH), and to update knowledge about the morbidity of OP using a standardised morbidity scale (Clavien), thus providing a platform for comparison with the newly developed techniques. Patients and methodsWe retrospectively review men with BPH who were treated with transvesical OP between April 2002 and December 2012. Preoperative patients’ data were reviewed for relevant variables. Operative details, the postoperative course, and 30-day relevant data were assessed. The study cohort was stratified based on the resected prostate weight, with group 1 having a resected weight of ⩽120g and group 2 >120g. ResultsThe review identified 163 patients. The mean (SD, range) duration of catheterisation after OP was 7.9 (2.2, 5–20) days and the duration of hospitalisation after OP was 8.1 (1.8, 5–15) days; both were significantly longer in group 2. All patients were able to void spontaneously by the first follow-up visit. Of 163 OP procedures, there were 106 perioperative complications in 69 (42.3%). Low-grade complications (grade ⩽2) included 38 (45.2%) and 53 (67%) in groups 1 and 2, respectively (P=0.8). High-grade complications (⩾3) included 3 (3.5%) and 12 (15.1%) in groups 1 and 2, respectively (P=0.02). The blood transfusion rate was 24.5%, the perioperative mortality rate was 1.2% and the re-admission rate within the first 30days after OP was 1.2%. High-grade complications were significantly associated with a greater resected prostate weight (odds ratio 1.08, 95% CI 1.001–1.17, P=0.046). ConclusionThe OP procedure is associated with a significant perioperative morbidity that correlated significantly with the resected prostate weight, especially for high-grade complications.

Level 2 Oncoplastic Surgery for Lower Inner Quadrant Breast Cancers: The LIQ-V Mammoplasty

Oncoplastic surgical techniques offer an option of breast conserving surgery for larger tumors with the use of glandular reshaping to prevent postoperative deformity. A technique for the excision of lower inner quadrant tumors via a V incision is described, the lower-inner quadrant-V (LIQ-V) mammoplasty, and the results of a pilot study are reported. Retrospective collection of pre- and postoperative data was collected from patients undergoing a LIQ-V mammoplasty for a LIQ tumor. Twenty-two patients were operated on between 2004 and 2011 at a mean age of 58 years. The mean follow-up was 55 months. The mean resection weight was 101 g for tumors ranging in size from 4 to 31 mm. The margins were clear in 95% of cases. There was one case of local recurrence and metastatic disease. The cosmetic outcome was judged as excellent in 68% of cases, and no patient required further ipsilateral or contralateral symmetrizing surgery. The deformity often associated with tumors of the LIQ is adequately addressed by this new technique. It has a complication rate comparable to other mammoplasty series and a high rate of clear resection margins. Many oncoplastic surgery techniques are based on inverted T mammoplasty, but these are not suited for all tumor locations. The LIQ-V mammoplasty is an adaptation of the standard techniques that best suit the LIQ. It is oncologically safe and provides disease-free margins, and although the resection volumes are large, the cosmetic outcome is not compromised.

Surgical Outcomes of Gigantomastia Breast Reduction Superomedial Pedicle Technique

Reduction mammoplasty in patients with gigantomastia can prove a challenge for the plastic surgeon. Although several techniques have been described to reduce these very large breasts, they can often result in compromise of the nipple-areola complex (NAC), including necrosis, decreased sensation, and inability to breastfeed. The superomedial pedicle (SMP) reduction mammoplasty technique has been demonstrated as a safe and effective method of reduction in cases of mild to moderate hypertrophy. The aim of this study was to determine the risks of SMP in patients with gigantomastia (resection weight >1000 g/breast) at our institution. A retrospective study of all patients who underwent reduction mammoplasty with SMP technique by 8 surgeons at a single institution between 1999 and 2011 was performed. Patient demographics, preoperative breast measurements, and perioperative data were analyzed. Exclusion criteria were a reduction mammoplasty specimen weight of less than 1000 g. Our results show that 200 of 1750 patients who underwent SMP during the study period met the criteria. The average age at the time of the reduction was 39 years. The average body mass index was 36 kg/m. The average sternal notch to nipple distance was 35.5 cm for the right breast and 35.6 cm for the left breast. Average breast resection weight was 1277 g for the right and 1283 g for the left. Average NAC transposition was 11.25 cm for the right breast and 11.40 cm for the left breast. Twenty-one (10.5%) patients experienced partial necrosis of the NAC and 98% of the patients subjectively reported normal NAC sensation postoperatively. All patients exhibited good breast shape and projection postoperatively. Our study shows that SMP reduction mammoplasty in patients with gigantomastia is a safe and effective reduction mammoplasty technique and is associated with low risk for NAC necrosis with good breast shape.

Prospective outcome study of 106 cases of vertical mastopexy, augmentation/mastopexy, and breast reduction

Patient-reported data, including effects on patient satisfaction and quality of life, have not been rigorously studied in women treated with mastopexy and augmentation/mastopexy. This prospective outcome study evaluates and compares mastopexy (n=36), augmentation/mastopexy (n=47), and reduction (n=20) from the patient's perspective. Over a 5-year period, 125 consecutive women underwent vertical mammaplasties incorporating a medial pedicle. In-person interviews were conducted among 106 women at least 1 month after surgery (response rate, 84.8%). Questions were asked in six categories: patient data, indications, recovery, results, complications, and psychological effects. A follow-up study examined the incidence of subjective nipple numbness. The mean pain rating was 4.5 on a 1-10 scale. Both mastopexy (resection weight<300 g per breast) and reduction patients reported a significant reduction in physical symptoms after surgery (p<0.001). The mean result rating was 9.0 n a scale of 1-10. Expectations were met or exceeded in 91.5% of augmentation/mastopexy patients. The reported complication rate was 15.1%. The incidence of persistent nipple numbness was 10.6%. All procedures reduced breast self-consciousness (p<0.001). A correlation was found between the result rating and a lack of complications (p=0.01). All three breast procedures provide a high level of patient satisfaction (94.3%), improved self-esteem (89.3%), and improved quality of life (69.5%). Mastopexy patients report a symptomatic benefit in addition to correction of ptosis. Vertical augmentation/mastopexy provides a high level of patient satisfaction.

Comparison of Fluid Absorption between Transurethral Enucleation and Transurethral Resection for Benign Prostate Hyperplasia

Introduction: Although transurethral resection of prostate (TURP) remains the reference standard for benign prostate hyperplasia (BPH), the concern about complications promotes researchers to develop alternative surgical methods with fewer complications. In this study, we compared the safety and efficacy between the transurethral plasma kinetic enucleation of prostate (TUPKEP) and transurethral plasma kinetic resection of prostate (TUPKRP), mainly including absorption of irrigation fluid, the operation time, the weight of prostate tissue removed and severe complications. Methods: Sixty BPH patients were randomly and evenly assigned to the TUPKEP or TUPKRP group. The irrigation fluid used in both groups was 1% ethanol-containing saline solution. The ethanol concentrations in the subjects' end expiration were measured during operation. The volume of irrigation fluid absorbed was calculated accordingly. Results: No significant difference was found in operation time between two groups, whereas the weight of prostate tissue resection was significantly higher in the TUPKEP than that in the TUPKRP group. Conclusion: The study provides evidence for the safety, feasibility and effectiveness of both bipolar transurethral techniques. Further, compared to the TUPKRP group, the TUPKEP group has more efficient for resection of prostatic hyperplasia tissue, even though in terms of fluid absorption, no difference has been found in both groups. Ethanol monitoring is simple, safe and effective, which is beneficial for enhancing safety procedures.

1738 PATIENT WITH SMALL RESECTED PROSTATE WEIGHT IN TRANSURETHRAL RESECTION OF THE PROSTATE IS ASSOCIATED WITH A HIGHER INCIDENCE OF NEUROLOGICAL COMORBIDITIES íV A NATION-WIDE STUDY

INTRODUCTION AND OBJECTIVES: Transurethral resection of the prostate (TURP) is a standard procedure for relieving prostate obstruction to improve lower urinary tract symptom (LUTS). However, some patients have persistent LUTS following TURP and we suspect some neurological co-morbidities might contribute to LUTS. We conducted this study to investigate the prevalence of some neurological disorders in patients receiving TURP. METHODS: The subset of the National Health Insurance Research Database (NHIRD) of Taiwan contains data of all medical benefit claims and covers most Taiwan populations. According to ICD codes-9, all patients received TURP from 2006 to 2009, with diagnostic codes, 600.X-602.X. All patients with diagnosis of genitourinary cancer before TURP were excluded. The patients were also excluded if the diagnosis of prostate cancer was recorded in one month after operation. Different benefit claims were submitted to National Health Insurance according to different resected prostate weight. Therefore we could subdivide patients into three groups, small group ( 15 grams), medium group (15 50 grams), large group ( 50 grams). We determined the incidence of neurological diagnostic codes of cerebrovascular event (CVA) (430,431,432.X,433, 434.X,436-438), Parkinsonias disease (332.X), spinal stenosis (724.0X, 723.0), herniation of intervertebral disc (HIVD) (722.0X-722.2X,722.4X-722.7X), which were claimed within one year before TURP. The difference between these three groups was analyzed. RESULTS: Among the total population of 22.8 millions, 33905 patients received TURP for BPH from 2006 to 2009. The patientias number of each subgroups were 14511 (42.8%) in small group, 16487 (48.6%) in medium group, and 2907 (8.6%) in large group. The number of patients with CVA, Parkinson disease, spinal stenosis, and HIVD diagnosed before TURP in each subgroup was shown in the Table 1. The incidence of every neurological disorder is significantly higher in smaller resected weight group than in medium and large group. CONCLUSIONS: This study found that the incidence of neurological comorbidity is significantly higher in patients with smaller weight resected by TURP. It implies that neurological comorbidity significantly contribute to male LUTS.

1967 SMALL RESECTED PROSTATE WEIGHT IS ASSOCIATED WITH A HIGHER REOPERATION RATE FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE íV A STUDY ON 33905 PATIENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (I)1 Apr 20131967 SMALL RESECTED PROSTATE WEIGHT IS ASSOCIATED WITH A HIGHER REOPERATION RATE FOLLOWING TRANSURETHRAL RESECTION OF THE PROSTATE íV A STUDY ON 33905 PATIENTS Alex Tong Long Lin, Chih Chieh Lin, Hsiao Jen Chung, Eric Yi Hsiu Huang, Kuang Kuo Chen, and Tzeng Zi Chen Alex Tong Long LinAlex Tong Long Lin Taipei, Taiwan More articles by this author , Chih Chieh LinChih Chieh Lin Taipei, Taiwan More articles by this author , Hsiao Jen ChungHsiao Jen Chung Taipei, Taiwan More articles by this author , Eric Yi Hsiu HuangEric Yi Hsiu Huang Taipei, Taiwan More articles by this author , Kuang Kuo ChenKuang Kuo Chen Taipei, Taiwan More articles by this author , and Tzeng Zi ChenTzeng Zi Chen Taipei, Taiwan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2386AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral resection of the prostate (TURP) is a well accepted procedure for relieving prostate obstruction to improve lower urinary tract symptom (LUTS). We conducted this nation-wide study to investigate as if the resected prostate weight is a predictive factor for reoperation of TURP, transurethral incision of bladder neck (TUIBN), and urethrotomy. METHODS The subset of the National Health Insurance Research Database (NHIRD) of Taiwan contains data of all medical benefit claims and covers most Taiwan populations. According to the ICD codes-9, all patients with diagnostic codes, 600.X-602.X, and received TURP from 2006 to 2009. All patients with genitourinary cancers before TURP were excluded. The patients were excluded if the diagnosis of prostate cancer was recorded in one month after TURP. Owing to different benefit claims for different resected prostate weight, we could subdivide patients into three subgroups, small group (< 15 grams), medium group (15∼50 grams), large group (>50 grams). After first TURP, we recorded the incident rate and interval to following procedures. The relative risk between groups was further compared. RESULTS Among the total population of 22.8 millions, 33905 patients received TURP. The patient's number of each subgroups were 14511 (42.8%) in small group, 16487 (48.6%) in medium group, and 2907 (8.6%) in large group. The patients' number of reoperation in each subgroup (small, medium, large) were 663 (4.6%), 452 (2.7%), 90 (3.1%), respectively. The patients' number of receiving TUIBN in each subgroup were 183 (1.3%), 86 (0.5%), 5 (0.2%). The patients' number of receiving urethrotomy in each subgroup were 696(4.8%), 459 (2.8%), 63 (2.2%). The mean intervals of first TURP to reoperation of TURP, TUIBN, and urethrotomy were 1.39, 1.09, and 1.02 years, respectively. Relative risk of further surgical procedures after first TURP between each subgroup was detailed in the table 1. In the table, smaller group revealed higher risk to receive further surgical procedures. CONCLUSIONS This study found that a smaller resected weight could be a predictive factor for further procedures, reoperation, TUIBN, and urethrotomy after TURP. It's necessary to strictly evaluate the indication of TURP for patients with a smaller prostate. Table 1. The relative risk between groups was further compared by logistic regression model Odds Ratio 95% CI p value Reoperation Small v.s. Large 1.4 1.2-1.8 0.002 Medium v.s. Large 0.9 0.7-1.1 0.23 TUIBN Small v.s. Large 6.7 2.8-16.4 < 0.001 Medium v.s. Large 2.9 1.2-7.2 0.02 Urethrotomy Small v.s. Large 2.2 1.7-2.9 < 0.001 Medium v.s. Large 1.3 1.0-1.7 0.07 Adjust with demography Factors: age, urbanized level, geographic location © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e807-e808 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Tong Long Lin Taipei, Taiwan More articles by this author Chih Chieh Lin Taipei, Taiwan More articles by this author Hsiao Jen Chung Taipei, Taiwan More articles by this author Eric Yi Hsiu Huang Taipei, Taiwan More articles by this author Kuang Kuo Chen Taipei, Taiwan More articles by this author Tzeng Zi Chen Taipei, Taiwan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

2180 COMPARISON OF THULIUM:YTTRIUM-ALUMINUM-GARNET (REVOLIX®) PROSTATECTOMY WITH MORCELLATOR(PIRANHA®) AND WITHOUT MORCELLATOR FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

and prostate size of Thulium VapoEnucleation of the prostate (ThuVEP) for symptomatic benign prostatic obstruction (BPO). METHODS: A prospective evaluation of 687 patients was done. ThuVEP was performed using a 2 m Tm:YAG laser; the resected tissue was then morcellated within the bladder. Prostate size was 40g in 196 (group A), 40 to 79g in 336 (group B), and 80g in 155 (group C) patients, respectively. Patient data and the immediate outcomes were analyzed. RESULTS: The mean prostate sizes were 27.94 6.77, 54.38 10.54, and 109.8 28.31 gm for group A, B, and C (p 0.001). Laser energy, operation time, enucleation time, morcellation time, enucleation (resected weight/enucleation time) efficiency, operation efficiency (resected weight/operation time), percentage of resected tissue (resected weight/preoperative prostate volume), and resected weight differed significantly among the groups (p 0.001). Haemoglobin (Hb) loss (g/dL) differed significantly between group A (1.09 1.02), B (1.28 1.27), and C (1.62 1.49) (p 0.001). The overall correlation between Hb loss and prostate size in all patients was however very weak (r 0.13) and was below the level of significance (r 0.2). The median postoperative catheter time was 2 days in all groups. At discharge, peak urinary flow rates and post-voiding residual urine volumes improved significantly (p 0.001) compared to baseline without differences between group A, B, and C. The most relevant complications were acute urinary retention (8%), urinary tract infection (4.66%), secondary apical resection (2.91%), and bleeding requiring transfusions (2.03%). There were no differences in the occurrence of complications between group A, B, and C. The mortality rate for ThuVEP was 0%. CONCLUSIONS: Perioperative morbidity and micturition improvement was not associated with prostate size in ThuVEP. Therefore, ThuVEP is a size-independent treatment modality of BPO.

515 Is the resected prostate weight a predictive factor of the need for continual medication or reoperation for lower urinary tract symptom after transurethral resection of the prostate? A study by applying nation-wide population based database

515 Is the resected prostate weight a predictive factor of the need for continual medication or reoperation for lower urinary tract symptom after transurethral resection of the prostate? A study by applying nation-wide population based database

Risk Factors of Infectious Complications after Transurethral Prostate Surgery in Patients with Preoperative Sterile Urine

Purpose To determine the risk factors of infectious complications after transurethral surgery of the prostate in patients with sterile urine. Materials and Methods A total of 183 patients who underwent transurethral resection of the prostate or holmium laser enucleation of the prostate were reviewed. All patients had urinalyses and urine cultures preoperatively, on the day of catheter removal, and at two weeks postoperatively. Patients were divided into two groups according to whether preoperative urinalysis showed sterile urine (group I, n=99) or not (group II, n=84). Clinical parameters were compared between the two groups. Univariate and multivariate logistic regression were used for estimation of infectious complications after surgery in group I. Results Compared with group II, group I showed younger age, fewer post voided residuals, low prostate specific antigen levels, short-term duration of oral antibiotic therapy, and low incidence of infectious complications (p<0.05). In univariate analysis in group I, age, diabetes mellitus (DM), prostate volume, resection weight, and duration of oral antibiotic therapy showed an association with infectious complications (p<0.05). Factors showing independent association with infectious complications in group I were DM (odds ratio [OR], 7.31; 95% confidence interval [CI], 1.83-29.0; p=0.005), resection weight (OR, 1.03; 95% CI, 1.01-1.06; p=0.039), and duration of oral antibiotics (OR, 0.64; 95% CI, 0.43-0.94; p=0.025). Conclusions Kinds of antibiotics showed no effect on infectious complication, therefore, second generation cephalosporin is recommended for reduction of antibiotic resistance. Clinicians should be aware of the high risk for infectious complication in patients with DM and who underwent large volume resection of the prostate.

Plasties mammaires de réduction en ambulatoire : étude prospective de faisabilité

The French Ministry of Health and its regional agencies decided on December 27th, 2010 to develop the ambulatory surgery in the purpose to eliminate 48,000 beds of surgery in France. This evolution, which results from Anglo-Saxon countries, is inevitable in front of the financial deficit of our health insurance. Like the Canadian plastic surgeons, who were forced to it for 7 years, we wanted to study the feasibility of an ambulatory care of the reduction mammaplasties in a hospitalo-university department. Between January and June, 2012, 25 patients, of less than 65 years old, were operated for a reduction mammaplasty scheduled in ambulatory. None presented particular anesthetic risk. All lived unless 1h of the hospital, went out accompanied, were revised the day after the intervention, then in a usual way. Our criterias of evaluation were the following ones: global satisfaction of the care in ambulatory, weight of glandular resection, postoperative complications, rate of readmission. The average age of the patients was 32 years (19-56 years). The average weight of resection was 400g by breast (140-1000g). Twenty patients went out on evening (80%). Among them, 19 (95%) expressed their satisfaction and would accept again this intervention in ambulatory. No major complication arose in this series. Five other patients saw their release repelled by the anaesthetists for the following motives: score of Aldrete lower than 9, pain not relieved by the analgesic (I or II), nausea and uncontrollable vomitings. This first clinical study realized in France, confirms that when certain conditions are filled, the reduction mammaplasty can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care.

Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/postpregnancy

It is well known that the risk of complications after abdominal contouring surgery is high. Sparse data in published reports exist, suggesting that complication rates are higher in postbariatric patients compared with patients who have lost weight by dieting. The aim of this study was to analyse the incidence of complications after abdominoplasty in postbariatric patients compared with in patients who have not had weight loss surgery. The aim was also to identify predictive factors associated with the development of postoperative complications. This study retrospectively analysed 190 consecutive patients operated on with abdominoplasty due to abdominal tissue excess from January 2006 to December 2008 at Sahlgrenska University Hospital. Variables analysed were sex, age, max body mass index (BMI), delta BMI (max BMI minus preoperative BMI), preoperative BMI, method of weight reduction, resection weight, and complications. The early complication rates were significantly higher in postbariatric patients (48%) than in patients who had not had weight loss surgery (29%). Resection weight was significantly higher for patients with early local complications compared with patients without early local complications. Max BMI, delta BMI, or preoperative BMI had no influence on the incidence of complications. In conclusion, this study confirms in a fairly large sample that the complication rate after abdominoplasty seems to be higher in postbariatric patients compared with patients who have not had weight loss surgery. However, no predictive factors could be identified explaining these differences. Further studies need to be conducted to identify predictive factors for the occurrence of complications after abdominal contouring surgery.

ASPS Clinical Practice Guideline Summary on Reduction Mammaplasty

In May of 2011, the Executive Committee of the American Society of Plastic Surgeons approved an evidence-based guideline on reduction mammaplasty developed by the American Society of Plastic Surgeons Health Policy Committee. The guideline addresses six clinical questions: procedural efficacy as noted by relief of symptoms, resection weight, the impact of body mass index on surgical complications, use of prophylactic antibiotics, use of drains, and effect on quality of life. The evidence indicates that resection volume is not correlated directly to the degree of postoperative symptom relief. Increased breast resection weight may increase the risks of complication. The evidence is inconclusive on whether increased body mass index is associated with increased risk of complications. Perioperative antibiotics may reduce the risk of infection associated with reduction mammaplasty, and in standard reduction mammaplasty procedures without liposuction, the use of drains is not beneficial. Reduction mammaplasty has been shown to improve quality of life.

Therapeutic Mammaplasty for Breast Cancer: Oncological and Aesthetic Outcomes

Therapeutic mammaplasty (TM) for breast cancer is a widely practiced oncoplastic technique. Patient selection criteria and method of margin assessment are not clearly established. The aim of our review was to analyse oncological and aesthetic outcomes over a 7 year period. We conducted a retrospective review of 251 breast cancer patients who underwent TM from 2002 to 2009 at the Netcare Breast Care Centre, Johannesburg. Primary chemotherapy was used to downsize large tumours. Intraoperative margin assessment was performed. Statistical analysis was performed using Kaplan-Meier estimates. Cosmetic outcomes were assessed by an independent review panel using photographic material. Mean tumour size was 15.4 mm. Mean resection weight was 237 g. Sixty-four (25.5 %) patients received primary chemotherapy. Mean margin taken was 15 mm. The back-to-theatre rate was 2 % (5 cases). A total of 222 patients underwent bilateral procedures. Contralateral occult disease was identified in six cases (2.4 %). The early (<2 months) complication rate was 3.2 %. Late complications were related to adjuvant radiotherapy (20.7 %). Mean follow-up was 50 months. The recurrence rate was 4 %. Five of six patients with locoregional recurrence had DCIS at initial surgery. The mortality rate was 3.2 %. The overall survival rate was 96.4 % and the metastasis-free survival rate was 94.6 %. Acceptable aesthetic results were achieved in 96 % of the patients. Primary chemotherapy allowed for TM in patients with large tumours. Intraoperative margin assessment decreased reoperation rate. Contralateral matching procedures resulted in histological detection of occult disease. TM is an oncologically appropriate and cosmetically favourable technique.