Suprapubic Transvesical Prostatectomy Research Articles

A Retrospective Operative and Early Outcome Comparison of Suprapubic Transvesical Prostatectomy and Transurethral resection of the Prostate.

BPH is the major cause of bladder outlet obstruction over the age of 40 years. Multiple surgical management options have been described of which STVP and TURP are the oldest and widely available procedures. The objective of this study is to describe and compare the intraoperative and early outcome situations of STVP and TURP. This is a hospital-based retrospective descriptive study that compares intraoperative and early outcomes of STVP and TURP in Menilik II Hospital from January 2017 to December 2019. The study samples were 72 STVP and 72 TURP patients. The mean duration of surgery in the STVP group was 97.8 minutes which is significantly longer than TURP group (66.15 minutes). Duration of post-op catheterization and hospital stay are significantly longer in STVP than TURP. The duration of surgery, length of hospital stays and post op catheterization are longer in STVP. There was no significant difference in intra-op and early complications from STVP and TURP.

Surgical Management and Post-Operative Outcomes of Urinary Outflow Obstruction: Experience of 50 Cases in Bangladesh

Background: Management of urinary outflow obstruction is very crucial.Objective: The purpose of the present study was to see the different management of urinary outflow obstruction with their post-operative outcomes.Methodology: This non-randomized clinical trial was conducted in the Department of Surgery at Rajshahi Medical College, Rajshahi, Bangladesh from September 1994 to December 1995 for a period of one year and three months. All the patients who were presented with bladder outflow obstruction and were admitted in the general surgical unit of the hospital were taken as study population. These patients were surgically managed in different procedures. The follow up was done to record the post-operative surgical outcomes.Result: A total number of 50 patients were recruited for this study. Benign enlargement of prostate was found in 13 cases of which 11(22.0%) cases were managed by suprapubic transvesical prostatectomy. Impacted urethral stone was found in 13 cases of which 4(8.0%) cases were managed by urethro-lithotomy followed by repair of urethra and indwelling catheter. Stricture urethra was found in 11 cases and all cases (100.0%) cases were managed by intermittent dilatation under general anesthesia. In 7 cases of rupture urethra, initially all patients were managed by suprabpublic cystostomy which was 7(14.0%) cases in number. All the 3 cases of carcinoma prostate were managed by prostatectomy and radiotherapy plus hormone therapy. A total number of 16 patients were managed by prostatectomy of which 1(2.0%) case was developed immediate postoperative hemorrhage which was managed by blood transfusion and continuous irrigation with normal saline. One patient developed postoperative clot retention due to blockage of Foley’s catheter, two patients developed postoperative incontinence, immediately after removal of the catheter. Out of 11 patients of impacted urethral stone, one developed urethral fistula and one developed UTI. Recurrent stricture urethra occurred in 3 patients. Seven patients with rupture urethra, 3 developed stricture urethra and 3 developed stricture urethra.Conclusion: In conclusion different surgical procedure are employed during the management of urinary outflow obstruction and immediate postoperative hemorrhage, postoperative clot retention, postoperative incontinence, urethral fistula, UTI and recurrent stricture urethra are the most common complication after surgical management of urinary outflow obstruction patients.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 84-88

A study of prostatic fossa packing: a modified technique in Freyer’s prostatectomy for achieving hemostasis

Background: Benign prostatic hyperplasia is one of the most common old age related benign tumor of urinary tract of men. Though now a day the gold standard treatment is only TURP, but this facility is still out of reach for majority of rural population of India. The rate of complications has come down heavily but still complete hemostasis remains a major concern for these patients.Methods: This present study was conducted at the center from March 2014 to December 2016, the aim of present study was to see the effectiveness of bladder packing on blood loss, complications and comfort of patient in the cases of Benign prostatic hyperplasia (BPH) admitted at in patient department of surgery.Results: A Total of 90 cases of BPH (Benign Prostatic Hypertrophy) were operated by Freyer’s suprapubic transvesical prostatectomy. All the patients presented with symptoms of BPH. A detailed clinical history and examination of all patients was recorded and AUA (American Urological Association), International Prostate Symptom Score (IPSS) was calculated. On table clear urine was confirmed with naked eyes and no Foley’s traction was given. After 72 hours of the surgery, pack was removed, saline irrigation was continued for 5 days. The patient was discharged on the 8th post-operative day after removal of stitches.Conclusions: The prostatic fossa packing technique without any traction is effective in control of postoperative bleed, it is an acceptable option where transurethral resection of prostate(TURP) is not available.

Benign prostatic hyperplasia (BPH) and it’s ayurvedic management

BPH Benign prostatic hyperplasia is a condition occurs in men after age of 50. It gives symptoms like frequency of micturation, hesistancy, urgency of micturation and nocturia . In modern sciences only alpha blocker, 5- Alpha-reductase inhibitors (5-ARIs) are used. if it not gives result the surgical option is preferred i.e. TURP Freyer’s suprapubic transvesical prostatectomy. Millions retropubic prostatectomy. To avoid the surgery and for getting satisfactory result & also reduce the price of treatment, ayurvedic view towards BPH treatment is useful .here researcher gathering the ayurvedic treatment for BPH or Vatshthila (mutraghat ).

Cystostomy-free open suprapubic transvesical prostatectomy: Is it a safe method?

Aim:To compare open suprapubic transvesical prostatectomy (OSP) without insertion of suprapubic cystostomy, OSP with insertion of cystostomy, and transurethral resection of the prostate (TURP).Patients and Methods:A total of 104 patients with an indication for prostatectomy were retrospectively assigned to TURP (group 1), OSP with cystostomy (group 2), and OSP without cystostomy (group 3). They were evaluated for length of the operation, length of hospital stay, post-operative complications, hemoglobin drop, changes of blood pressure, and intraoperative blood loss.Results:Mean age was 67.2 ± 8.7 in group 1, 73.3 ± 8.4 in group 2, and 74.0 ± 5.7 in group 3. Prostatic volume was 35.9 ± 13.8, 74.1 ± 33.8, and 74.3 ± 31.8 in groups 1, 2, and 3, respectively. There was no significant difference in prostatic volume between groups 2 and 3 (P = 0.99), but in group 1 it was lesser than groups 2 and 3 (P = 0.00). Length of the operation was 1.2 ± 0.2 in group 3 and 1.1 ± 0.2 in group 2, without a significant difference (P = 0.45). Length of hospital stay in group 3 (2.3 ± 0.4 days) was lesser than that in group 2 (2.6 ± 0.7) (P = 0.01). The amount of hemoglobin drop was 1.1 ± 0.9 in group 1, 1.1 ± 0.7 in group 2, and 1.4 ± 0.91 in group 3 without a significant difference between all groups. The amount of bleeding during operation was 173 ± 103 in group 2 and 161 ± 78 in group 3 (P = 0.98).Conclusion:OSP without insertion of cystostomy tube is a relatively safe method; however, larger studies are needed. It is also comparable to TURP in terms of postoperative efficacy and complications.

Open surgery in huge volume benign prostatic hyperplasia

The aim of this study is to evaluate the efficacy and safety of open surgical treatment for huge volume (> 150 ml) benign prostatic hyperplasia and summarize our clinical experiences. Between January 2001 and September 2010, surgeries for a total of 15 patients with huge volume benign prostatic hyperplasia were performed. Mean age of these patients was 71.8 ± 6.1 years. Mean prostate volume was 217.2 ± 90.6 ml (range: 150.1 to 471.7 ml). Follow-up was conducted one, three, six, and twelve months after the operation. The evaluation indicators included the maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), and quality of life (QoL). Results obtained are as follows: The mean weight of the surgically removed glands was 201.3 ± 87.5 g; the mean operation time was 65 ± 20.4 min; the mean hemoglobin loss during the operation was 1.4 ± 1.3 g/dl. One case of blood transfusion was observed. After catheter removal, all of the patients could urinate on their own. One month after surgery, the Qmax increased to 21.5 ± 4.6 ml/s (P < 0.001), and the IPSS and QoL decreased to 7.3 ± 2.5 and 2.4 ± 0.3 (P < 0.05), respectively. All the patients with lower urinary tract symptoms significantly improved during the 12-month follow-up period. Two patients had mild incontinence after the operations; however, their symptoms disappeared after three months. It is concluded that open suprapubic transvesical prostatectomy is a safe and effective treatment for patients with huge volume benign prostatic hyperplasia. Sufficient preoperative preparation is important for patient safety and reducing postoperative complications. Key words: Benign prostatic hyperplasia, huge volume prostate, surgical treatment.

Effect of Aike Mixture (艾可合剂) on the inflammatory infiltration in patients with chronic prostatitis type III A

To observe the effect of Aike Mixture (AKM) on prostatic inflammatory infiltration in patients with chronic prostatitis type III A (III A-CP/CPPS) and evaluate its anti-inflammatory action. METHODS METHODS: A total of 60 patients with III A-CP/CPPS suitable to operation and differentiated as Chinese medicine: Gan qi stagnancy syndrome type were selected. They were assigned with the random number table to two groups equally. Before operation, the patients in the treated group were administered with Proscar combined with AKM, but those in the control group treated with Proscar only. Suprapubic transvesical prostatectomy was performed two weeks later, and prostatic pathological examination was conducted. Grading of: inflammatory cell infiltration showed that the mean grade in the treated group was 0.78 ± 0.90 grades, which was significantly lower than that in the control group 1.68 ± 0.87 grades (P<0.05). However, the two groups were not different in the grades of fibroblast proliferation (1.50 ± 0.70 grades vs 1.62 ± 0.87 grades, P>0.05). AKM could suppress the inflammatory cell infiltration, be an effective and safe remedy for the treatment of IIIA-CP/CPPS of Gan-qi stagnancy syndrome type, and worthy for spreading in clinical use.

UP-3.053: Prospective Analysis of Efficacy and Safety of Suprapubic Transvesical Prostatectomy in Treatment of Benign Prostatic Hyperplasia Patients

UP-3.053: Prospective Analysis of Efficacy and Safety of Suprapubic Transvesical Prostatectomy in Treatment of Benign Prostatic Hyperplasia Patients

Study on correlation between MR spectroscopy and whole pathologic seetion in benign prostatic hyperplasia

Objective To investigate the metabolic characteristics,clinic values of different tissues in benign prostatic hyperplasia by correlating MR spectroscopy(MRS)with whole pathologic sections.Methods MRS presentation was studied in 16 patients with benign prostatic hyperphsia.The peak values of citrate,choline and creatine were measured,and the mtios of(choline+creatine)/citrate(cc/c)were obtained.After suprapubic transvesical prostatectomy,the specimens of whole pathologic sections were observed.The values of cc/c of different pathologic types were compared statistically with One.way-ANOVA and t test. Results MRS results were obtained in 578 units,which included 233 glandular tissue units.130 matrical tissue units.165 mixed tissue units and 50 tissue units around urethra.The ratios of (choline+creatine)/citrate of glandular,matrical.mixed tissues and units around urethra were 0.59±0.29.1.23±0.38.0.80±0.27 and 0.68±0.33(F=3.49.P＜0.05).The t tests were carried out between every two tissues.The t valUes between glandular tissues and matrical.mixed tissues were 19.60 and 7.09.P＜0.05:the t values between matrical tissues and mixed tissues.units around urethra were 13.22 and 9.42,P＜0.05;the t valUes between mixed tissues and units around urethra was 9.42,P＜0.05.Condusions,The ratios of cc/c ofthree prostate tissues were different in MRS.The metabolic characteristic of the units around urethra Was near to glandular units.MRS may be valuable to the distinctive diagnoses of prostate diseases. Key words: Prostatic hrparplasia; Magnetic regonance spectroscopy; Comparative study

Observation of post-prostatectomy incontinence :supra-pubic transvesical prostatectomy and transurethral resection of prostate

Objective To evaluate the morbidity of the post-prostatectomy incontinence of supra-pubic transvesical prostatectomy(SPP) and transurethral resection of prostate(TURP). Methods One hundred and thirtyfive patients were divided into two groups. 82 patients underwent SPP and 53 patients underwent TURP. We ob-served the morbidity and the time lasting of post-prostatectomy incontinence, the severity of post-prostatectomy in-continence as evaluated by Stamey incontinence grading system,patients who had more than one week postoperativeincontinence were received urodynamic tests,then we got the information of their incontinence types. Results We found that patients who underwent SPP had higher morbidity, severity and time lasting than those who underwent TURP. SPP group had much more morbidity of stress incontinence than TURP group, but the same morbidity of ur-gent incontinence after operation as the later. Conclusion TURP may be better than SPP in consideration of the post-prostateetomy incontinence. SPP group has more stress incontinence and it may be caused by complete resection of prostate and damnifieation of the mucous membrane of membranous urethra. Key words: Prostatectomy; Transurethral resection of prostate; Prostatic hyperplasia; Urinary incontinence

Early postoperative outcomes of patients undergoing prostatectomy for benign prostatic hyperplasia at Kenyatta National Hospital, Nairobi

To describe early postoperative complications of prostatectomy. A descriptive prospective study. Kenyatta National Hospital between 6th October 2003 and 21st June 2004. Eighty five men undergoing prostatectomy for the relief of lower urinary tract obstruction due to benign prostatic hyperplasia. Procedures included suprapubic transvesical prostatectomy, retropubic prostatectomy and transurethral resection of the prostate (TURP). Co-morbidity, intra-operative and early postoperative complications, need for re-operation, 30-day mortality, duration of postoperative catheterisation, and duration of postoperative hospital stay. Eighty five patients were included in the study and their age range was 46-85 years (mean 66 years). Sixty nine (81%) of the patients underwent open prostatectomy, and sixteen (19%) underwent TURP. Twenty six patients had co-existing medical conditions, the most common being hypertension (29%) and diabetes mellitus (13%). The most common intra-operative complication during prostatectomy was haemorrhage which occurred in ten patients (11.8%). One patient had perforation of the bladder during transurethral resection and required a laparotomy to repair the bladder. Wound sepsis was the most common postoperative complication following open prostatectomy (35%, n = 69), and an association was found between wound sepsis and diabetes mellitus. Complications common to both open prostatectomy and TURP were urinary tract infection (15%), clot retention (10%), pyrexia (10%) and pneumonia (8.2%). Three patients (4.4 %) required re-operation due to complications related to wound sepsis. The duration of postoperative catheterisation ranged from 1-14 days (mean 6.66 days) while postoperative hospital stay ranged from 3-24 days (mean 8.16 days). There was no postoperative mortality at 30 days. Open prostatectomy is the most performed procedure for the relief of lower urinary tract obstruction due to benign prostatic hyperplasia at Kenyatta National Hospital. Wound sepsis is the commonest early postoperative complication and the presence of diabetes mellitus significantly increases the risk of development of wound sepsis.

1737: Early and late Complications to Suprapubic Transvesical Prostatectomy for benign Prostate Enlargement

You have accessJournal of UrologyModerated Poster 54, Wednesday, May 23, 2007 10:00 am - 12:00 pm1 Apr 20071737: Early and late Complications to Suprapubic Transvesical Prostatectomy for benign Prostate Enlargement Lone Boegesvang, and Kari J. Mikines Lone BoegesvangLone Boegesvang More articles by this author , and Kari J. MikinesKari J. Mikines More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31925-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1737: Early and late Complications to Suprapubic Transvesical Prostatectomy for benign Prostate Enlargement." The Journal of Urology, 177(4S), pp. 577–578 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 577-578 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Lone Boegesvang More articles by this author Kari J. Mikines More articles by this author Expand All Advertisement Loading ...

Complications and Early Postoperative Outcome After Open Prostatectomy in Patients With Benign Prostatic Enlargement: Results of a Prospective Multicenter Study

We prospectively analyzed the complications and immediate postoperative outcome of open prostatectomy for benign prostatic hyperplasia to provide reference data for emerging techniques, such as holmium laser enucleation of the prostate and laparoscopic prostatectomy. A total of 902 patients with a mean +/- 1 SD age of 71.3 +/- 6.8 years were evaluated while undergoing open prostatectomy in Bavaria, Germany from January 1, 2002 to December 31, 2003. We prospectively analyzed 54 parameters concerning preoperative status, surgical details, complications and immediate outcome. Mean operative time was 80.8 +/- 34.2 minutes. Mean prostate size was 96.3 +/- 37.4 ml. Average enucleated tissue was 84.8 +/- 44.0 gm. Incidental carcinoma of the prostate was found in 28 of 902 patients (3.1%) and the mortality rate was 0.2%. The overall complication rate was 17.3%. The most relevant complications were bleeding requiring transfusion in 68 cases (7.5%), urinary tract infection in 46 (5.1%) and surgical revision due to severe bleeding in 33 (3.7%). Patients had an average International Prostate Symptom Score of 20.7 +/- 7.6 preoperatively. Mean urinary peak flow rate increased significantly to 23.1 +/- 10.5 ml per second from a baseline of 10.6 +/- 6.4 ml per second (p <0.0001). Post-void residual volume decreased to 17.5 +/- 34.8 ml from a baseline of 145.1 +/- 152.8 ml (p <0.0001). Open prostatectomy showed a satisfactory early postoperative outcome with a complication rate that was within the expected range compared to that in the recent literature. It represents an important option in the treatment of patients with significant benign enlargement of the prostate for surgeons with no access to modern techniques, such as holmium laser enucleation of the prostate or laparoscopy.

OPEN PROSTATECTOMY

Objectives: To study the morbidity of open prostatectomy. To assessthe frequency of complications after open prostatectomy. Study design: Descriptive cross sectional. Setting: SurgicalUnit-IV, DHQ Hospital, Faisalabad. Duration: 01-01-2003 to 31-12-2003 (One Year). Subjects: Patients of bladderoutlet obstruction due to benign prostatic hyperplasia (PBH) were operated by open surgery (Transvesical or retropubicprostatectomy). Results: Open prostatectomy was performed in 54 cases. In 38 cases, suprapubic transvesicalprostatectomy was performed, while in 6 cases, retropubic prostatectomy was done. Our youngest patient was 42 yearsold and oldest 90 years. Mean age was 62 years. In our study, the most common complications were wound associatedseen in 7(12.96%) cases. They included cellulites in 3(5.56%) cases, stitch abscess in 1(1.85%) cases, seroma in1(1.85%) cases, and abscess in 2(3.70%) cases. Other complications were bleeding in the form of reactionaryhaemorrhage/clot retention in 2(3.70%) cases and secondary haemorrhage in 3(5.56%) cases. Urinary fistula was seenin 5(9.26%) cases while retrograde ejaculation in 6(11.11%) cases, stricture urethra in 3(5.56%) cases, urinaryincontinence in 4(7.41%) cases and urinary tract infection in 5(9.26%) cases. Epididimo-orchitis, deep vein thrombosisand osteitis pubis were not seen in our study. The average duration of hospital stay was 6 days. Most cases weredischarged within five days of operation, while stitches were removed on the eighth postoperative day. Conclusions:The morbidity of open prostatectomy is higher than transurethral resection (TURP), as TURP is better procedure dueto lower complication rate, short hospital stay, cost effectiveness and better tolerated by old and unfit patients,presenting with small fibrotic prostate. Open prostatectomy is still a good option for BPH where TURP facilities are notavailable.

Do Prostatic Infarction, Prostatic Inflammation and Prostate Morphology Play a Role in Acute Urinary Retention?

Objective: To investigate whether there is a role of prostatic infarction, prostatic inflammation and prostate morphology in acute urinary retention (AUR) etiology. Methods: Ninety-eight consecutive male patients who were admitted to our clinic with either AUR or lower urinary tract symptoms (LUTS) were involved in the study. Patient age ranged from 43 to 88 years (median age 70). Group 1 consisted of 53 (54%) patients with AUR, and Group 2 consisted of 45 (46%) patients with LUTS. In Group 1 and Group 2, 58.4% (n:31) and 62.2% (n:28) of the patients underwent transurethral prostate resection, 41.6% (n:22) and 37.8% (n:17) of the patients underwent suprapubic transvesical prostatectomy, respectively. Each patient was asked about the factors: smoking habits, taking previous general anesthesia and preexisting cardiovascular disease such as hypertention and atherosclerotic coronary vascular disease which may lead to AUR via prostatic infarct. Prostatic infarction, prostatic inflammation and prostatic morphology were examined in the patients’ specimen. Results: Mean age, median serum prostate-specific antigen (PSA) level, and prostatic inflammation ratio were significantly higher in Group 1. There were not significant differences between the groups regarding prostate volume, prostatic infarction ratio and a type of prostatic morphology. In the present study, except for taking previous general anesthesia and preexisting cardiovascular disease, only prostatic inflammation was found important contributory factor on AUR. AUR risk was 3.03 times higher in the patients with prostatic inflammation (95%CI 1.28–7.15) ( p = 0.01). Conclusions: No significant effect of prostatic infarction was found on occurence of AUR which was more frequent in elderly patients. Prostatic inflammation may have an important risk factor in AUR etiology. Additionally, serum PSA levels were higher in AUR group. No association was found between a type of prostatic morphology and AUR.

Systemic stress responses in patients undergoing surgery for benign prostatic hyperplasia

To determine differences in systemic stress responses in patients undergoing three different types of surgery for benign prostatic hyperplasia (BPH), evaluated by measuring levels of stress variables, i.e. cortisol; acute-phase reactants, i.e. C-reactive protein (CRP) and fibrinogen; and antioxidants, i.e. total antioxidant status (TAS) and superoxide dismutase (SOD). The study included 80 patients who fulfilled the inclusion criteria for surgery for BPH. Based on an ultrasonographic estimate of the prostate volume before surgery, all patients were allocated to one of three groups; group 1, prostate < or = 30 g and treated with transurethral incision of the prostate (TUIP); group 2, prostate 30-80 g, treated with transurethral resection of the prostate (TURP); and group 3, prostate >80 g, treated with a suprapubic transvesical prostatectomy (TP). Blood samples were taken from each patient on the day before and the day after surgery, and the acute-phase reactants and antioxidants measured; cortisol concentrations were also measured in 24-h urine samples the day before and 3 days after surgery. There were significantly higher levels of cortisol, CRP and TAS, and significantly lower levels of fibrinogen and SOD in all study groups after surgery than before. Surgery and associated conditions, e.g. excitement, fear, blood loss, etc., lead to traumatic and oxidative stress, followed by a strong systemic stress response during and after surgery. Low fibrinogen levels after surgery had a different pattern from the other acute-phase reactants, as a result of increased fibrinolytic activity after TURP and TP. The extent of the systemic stress response correlated fairly well with the degree of tissue damage, which differed in the three groups. Suprapubic TP caused the most tissue trauma and triggered the strongest systemic stress response. This response was moderate after TURP, while TUIP (a minor intervention) caused the least stress. Specific changes in stress markers could be used to improve surgery for BPH. Whether there is a benefit of antioxidant therapy during surgery for BPH should be evaluated in further studies.

Suprapubic transvesical prostatectomy in a rural Kenyan hospital.

To evaluate the effectiveness, safety and complications of suprapubic transvesical prostatectomy in a rural Kenyan hospital. A prospective audit of suprapubic transvesical prostatectomy. Africa Inland Church, Kijabe Hospital, Kijabe, Kenya. One hundred and six men with lower urinary tract obstruction, clinically due to benign prostatic hyperplasia, undergoing suprapubic transvesical prostatectomy. Suprapubic prostatectomy. Age, presentation, comorbidity, type of anaesthesia, pathology, bladder irrigation time, Foley time, post-operative stay, complications-mortality, blood transfusion rate, return to theatre for bleeding, incontinence, urine leak, urinary retention. One hundred and six men entered the study with a mean age of 72.8 years. Seventy eight per cent were in retention and 25% had significant medical problems. Spinal anaesthesia was used in 94%. The mean prostate weight was 70.4 g and 11% had carcinoma. The Foley's catheter was removed at a mean of 4.2 days after surgery and the mean post-operative stay was 6.0 days. The 30 day mortality was 0.9%, the blood transfusion rate was 4.7%, the return to theatre for bleeding rate was 0.9% and 4.7% of patients developed a urine leak. Suprapubic transvesical prostatectomy, performed under spinal anaesthetic, by general surgeons in rural Kenya, is a safe and effective way of managing benign prostatic hyperplasia and its complications.

A PROSPECTIVE STUDY OF THE SAFETY AND EFFICACY OF SUPRAPUBIC TRANSVESICAL PROSTATECTOMY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

We investigate the safety and efficacy of suprapubic transvesical prostatectomy, and the change in bladder wall thickness after surgery. We conducted a prospective 1 center study of 32 consecutive patients who underwent transvesical prostatectomy from December 1996 to March 1997 for benign prostatic hyperplasia with large prostate volume, who were followed for 1 year. Pressure flow study and transrectal sonography were performed at baseline and repeated at 6 months. Bladder wall thickness was measured at baseline and regular intervals postoperatively. A morbidity questionnaire was completed during the first 6 weeks after surgery. An average of 63 gm. prostate adenoma were enucleated at surgery. An indwelling catheter was required for an average plus or minus standard deviation of 5.4 +/- 2.6 days after treatment. The International Prostate Symptom Score decreased from 19.9 +/- 4.4 to 1.5 +/- 2.7 and the quality of life score decreased from 4.9 +/- 1.0 to 0.2 +/- 0.4 at year 1, respectively. Maximum flow rate improved from 9.1 +/- 5.3 to 29.0 +/- 8.9 ml. per second. Residual urine decreased from 128 +/- 113 to 8 +/- 18 ml. Before surgery 30 patients had obstruction and 2 were in the equivocal zone of the International Continence Society nomogram. At 6 months after prostatectomy 30 patients did not have obstruction, and 2 who were subsequently operated on for bladder neck sclerosis were equivocal and had obstruction, respectively. No patient had significant postoperative bleeding and no heterologous blood transfusions were required. There were 4 men who had urinary tract infection and 1 who had wound infection. A slight decrease in erectile function was observed 6 weeks postoperatively, and no change in patient libido and quality of sex life was reported. The total complication rate was 31.3%. The bladder was unstable in 7 men before and 3 after surgery. A significant decrease in bladder wall thickness was observed from 5.2 +/- 0.7 at baseline to 2.9 +/- 0.9 mm. at year 1 postoperatively. Our study confirms the excellent clinical outcome of transvesical prostatectomy, and rapid improvement of most subjective and objective parameters during the 4 weeks after surgery. Bladder hypertrophy appears to be significantly reduced after prostate surgery. The urodynamic results in patients who underwent open surgery probably represent the maximum obtainable relief of obstruction and should be considered the reference standard to which all other treatments, including transurethral resection, should aspire.

HOLMIUM LASER VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE: A RANDOMIZED PROSPECTIVE TRIAL WITH 1-YEAR FOLLOWUP

The high-powered holmium:YAG laser can be used for incision, ablation and resection of the prostate. The technique of holmium laser resection of the prostate is compared to transurethral prostatic resection for surgical management of benign prostatic hyperplasia in this prospective randomized study. A total of 120 urodynamically obstructed cases were randomized to holmium laser or transurethral prostatic resection. All eligible patients were assessed preoperatively and at 3 weeks, and 3, 6 and 12 months postoperatively with an American Urological Association symptom score, peak urinary flow rate, and questionnaires concerning sexual function and continence. Preoperative pressure flow study, ultrasound prostate volume assessment and post-void residual volume measurement were repeated at the 6-month visit. All complications were noted. Holmium laser and transurethral resections resulted in significant improvements in symptom score, quality of life score, peak urinary flow rate and post-void residual urine measurements. Operating time was significantly longer in the holmium group but nursing contact time, catheter time and hospital stay were significantly less compared to the transurethral prostatic resection group. Urodynamic results were equivalent at 6 months. There were fewer side effects in the holmium group. Effects on continence, potency and symptoms were similar with 1-year followup. Holmium and transurethral resections of the prostate appear to be equivalent in surgical management of bladder outflow obstruction due to benign prostate hyperplasia. Perioperative morbidity was less in the holmium group.

Morbidity of radical retropubic prostatectomy following previous prostate resection

A total of 153 patients with prior prostate surgery underwent a radical retropubic prostatectomy for carcinoma of the prostate. Ninety-seven patients had undergone transurethral resection of the prostate (TURP), and 56 patients had undergone suprapubic transvesical prostatectomy (SPP). In 115 patients, the diagnosis of malignancy was made at the time of transurethral resection or enucleation. No perioperative deaths occurred and no patient suffered rectal injury or ureteral transection. Operative time and blood loss were similar between the TURP and SPP groups and were not different in a group of patients who had not had prior prostate surgery. Early and late complications occurred in eight patients (5.2%), of whom seven had had previous TURP. Complete urinary control was achieved in 96% (147) of the patients; stress incontinence was present in 4% (6 patients); and no patient was totally incontinent. Postoperative complications and the occurrence of stress incontinence were not related to the time elapsed between the previous prostate surgery and the radical prostatectomy. Sexual function was preserved in 32 (71%) of the 45 patients in whom we performed a nerve-sparing radical prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 77 (67%) of the stage A patients. Twenty-nine (25%) of the stage A and 13 (34%) of the stage B patients had pathological evidence of disease extension beyond the confined prostate. Follow-up was 6-92 months, with a mean of 32 months. Four patients died of prostatic cancer, two patients died without cancer, and five have evidence of disease progression; 142 (93%) are alive without evidence of disease. Although radical prostatectomy sometimes is more difficult after previous prostate surgery, operative complication rates, patient morbidity, and the opportunity for surgical cure are not different from those seen in patients with no history of previous prostate operations.