Surgical Outcomes Research Articles

TheSAGES MASTERS program bariatric surgery pathwayselects 10 seminal publications on adjustable gastric banding.

Bariatric surgery is one of the clinical pathways of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program, and laparoscopic adjustable gastric banding (LAGB) is one of the three anchoring bariatric procedures. To improve surgeon lifelong learning, the Masters Program seeks to identify sentinel articles of each of the 3 bariatric anchoring procedures. In this article, we present the top 10 articles on LAGB. A systematic literature search of papers on LAGB was completed, and publications with the most citations and citation index were selected and shared with SAGES Metabolic and Bariatric Surgery Committee members for review. The individual committee members then ranked these papers, and the top 10 papers were chosen based on the composite ranking. The top 10 sentinel publications on LAGB contributed substantially to the body of literature related to the procedure, whether for surgical technique, novel information, or outcome analysis. A summary of each paper including expert appraisal and commentary is presented here. These seminal articles have had significant contribution to our understanding and appreciation of the LAGB procedure. Bariatric surgeons should use this resource to enhance their continual education and acquisition of specialized skills.

Case report: NSCLC with pulmonary embolism after treatment with almonertinib

Rationale: Almonertinib is the first independently developed third generation epidermal growth factor receptor tyrosine kinase inhibitors in China. It can be used not only for epidermal growth factor receptor (EGFR) sensitive mutation patients but also for T790M (+) resistant patients, and has better safety and survivability compared to the first and second generation EGFR-TKIs. The previous literature and case studies have reported significant treatment-related adverse reactions in non-small cell lung cancers patients treated with almonertinib, including elevated blood creatine phosphatase, prolonged cardiac QT interval, altered myocardial contractility, interstitial lung disease, eye disease, and hematological events. But there are few individual reports of pulmonary embolism events. Patient concerns: A 55-year-old female with no history of smoking visited a local hospital with mild cough and lower sacrococcygeal pain without obvious cause. Diagnosis: She was diagnosed with right lung adenocarcinoma with multiple bone metastases (T2bN1M1c, stage IVB) after image and histological examination, with EGFR 21 exon L858R sensitive mutation. Interventions: She initially underwent surgical treatment due to the discovery of a sacral tumor, and the pathology of the surgery indicated metastatic lung adenocarcinoma. Genetic testing results showed EGFR 21 exon L858R sensitive mutation. Combined with positron emission tomography/computed tomography imaging results and sacral tumor surgical pathology results, it was considered that the patient had lung adenocarcinoma with multiple bone metastases. Treatment plan: targeted treatment with almonertinib which is the third-generation EGFR-TKIs. After only 1 month of targeted treatment, chest enhanced computed tomography revealed pulmonary embolism imaging, combined with coagulation indicators, considering pulmonary embolism. As the thromboembolic site is located at the end of the pulmonary artery branch and imaging shows that tumor lesions are stable. Consider continuing targeted treatment with almonertinib and adjuvant oral anticoagulant therapy with rivaroxaban for treatment. Outcomes: Two months later, the patient’s condition was followed up and it was found that the imaging manifestations of pulmonary embolism disappeared, but the coagulation indicators remained in a hypercoagulable state. The patient’s treatment plan remained unchanged, and the patient was hospitalized for follow-up every 6 to 8 weeks to closely observe changes in the condition. Lessons: There are many reasons for the occurrence of hypercoagulable blood in tumor patients, and there are very few reports of treatment-related pulmonary embolism events in patients who are treated with almonertinib targeted therapy. It is particularly important to determine whether the hypercoagulable blood in such patients is related to targeted therapy drugs in clinical practice, as this will affect the clinical benefits of patients in epidermal growth factor receptor tyrosine kinase inhibitors treatment and the clinical indicators which need to pay more attention in follow-up observation, to avoid serious pulmonary embolism events and thus affect the patient’s survival status and quality of life.

Long-Term Quality of Life for Patients with Spina Bifida

Abstract Purpose of Review This review explores the literature that currently exists regarding quality of life for patients with spina bifida and assesses screening tools available for practitioners to assess these outcomes. Domains addressed include health related quality of life, relationships, bowel and bladder dysfunction, sexuality, pain, and mood. Recent Findings Several recent papers have assessed available questionnaires and reviewed findings of key quality of life domains, with varying results. Summary Historically, the literature has focused on surgical outcomes for patients with spina bifida. Though some authors have begun to explore quality of life for this patient population, particularly in the short-term, a paucity of quality, long-term studies exist that describe quality of life domains or offer potential targets for improvements in outcomes.

Abnormalities Detection in Apert Syndrome using Hierarchical Clustering Algorithms

Craniosynostosis syndrome is a congenital condition occurring due to the abnormal development of the skull, leading to abnormalities in skull morphology. Apert syndrome is one of common craniosynostosis syndrome in Malaysia and this syndrome can be categorized as the severe craniofacial disorders. The abnormalities of skull morphological in Apert syndrome patient can be identified as outliers which are investigated in this study. This study presents a skull morphological analysis based on a case study involving six paediatric patients diagnosed with Apert syndrome, alongside 22 control patients aged 0 to 12 years, all of whom underwent treatment at the University Malaya Medical Centre (UMMC). The computerized tomography scan (CTSCAN) data is provided by UMMC recorded from year 2012 until 2020 and the data is measured using MIMICS software by taking the measurement of cranial angles. The clustering-based procedures will be applied to identify the abnormalities in skull angle dataset. There are 12 skull angles and these angles are analysed using hierarchical clustering algorithms for identifying the outliers or abnormalities. The objective is to detect the abnormalities and determine the skull angles that associated with Apert syndrome (AS) in Malaysia population using clustering-based procedure. The abnormalities in Apert syndrome datasets are successfully detected by the algorithms and this study found that there are skull angles with specific location of angles are associated with Apert syndrome. This study also found that the location of skull angles for patients age 0-24 months old and >24 months old are different. The findings of this study can assist the surgical team in directing additional focus towards specific regions of the skull during the planning of interventions. This guidance has the potential to optimize surgical outcomes and reduce the risk of potential complications.

The role of telehealth in the delivery of oral and maxillofacial surgery services at a level 6 hospital in New South Wales Australia during COVID-19 - the John Hunter Hospital experience: a commentary, review and cautionary tale for the future.

The objective of this article is to understand the uptake in use of Telehealth services during the COVID-19 pandemic as a way to provide compelling impetus for further research and promotion of Telehealth in general. A data review of Outpatient Department data from 2020 to 2023, as compiled by the Surgical Outcomes improvement Unit. Telehealth was widely adopted during the COVID-19 pandemic for clinicians to provide healthcare to patients whilst adhering to strict lockdown guidelines aimed at limiting exposure and spread of the respiratory virus. There has been minimal analysis, however, of the ethical and legal implications of telemedicine. Whilst it seems that access to care is improved via telehealth, there are subtle, inherent barriers intrinsic to it. There was a significant increase in the use of audio and audiovisual aids in the delivery of Oral and Maxillofacial Outpatient care during the COVID-19 period. Further analysis and improvements need to be made to the system before it can be considered as sufficient and adequate. Where there is rapid adoption of Telehealth in the delivery of Oral and Maxillofacial Surgery Services, there must be concurrent rigorous review and update of systems in order to address the key areas of patient safety and accuracy of treatment.

Assessment of Preoperative Anxiety Utilizing Amsterdam Preoperative Anxiety and Information Scale in Patients Undergoing Intracranial Tumor Surgery: An Exploratory Study

Abstract Background Preoperative anxiety in neurosurgical patients is high due to life-threatening illness and uncertainty of the surgical outcome. This study assessed preoperative anxiety and its influencing factors in patients undergoing intracranial tumor surgeries utilizing the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Methods One-hundred twenty patients, 18 to 65 years of age, of either sex, American Society of Anesthesiologists (ASA) grades I/II posted for elective craniotomy and tumor excision, were selected for the study. Various components of the APAIS were explained, and the level of anxiety and need for information were noted. The level of anxiety and depression by HADS (Hospital Anxiety and Depression Scale) score was also evaluated. Results The mean age was 38.00 ± 12.15 years. About 57.5% of the patients were male. Eighteen (15%) patients had an educational qualification of class 10, 60(50%) of 10 + 2, 36 (30%) were graduates, and 6 (5%) had a postgraduate qualification.The mean APAIS for total anxiety was 11.10 ± 1.79; the score for need for information was 6.28 ± 1.61. Mean total anxiety scores were higher in female patients (11.96 vs. 10.46, p < 0.001). Higher anxiety was observed in ASA status I patients (11.33 vs. 10.539 ASA I vs. II, p = 0.020). Significantly higher anxiety was observed in patients educated till class 10 (p = 0.012). A significantly higher need for information was observed in postgraduates (p = 0.012). Eighty (66.7%) patients had clinical anxiety, and 35 (29.2%) had clinical depression on the HADS score. Conclusion Neurosurgical patients have higher anxiety due to intracranial pathology, site of surgery, and unpredictability of outcome. Demographic and clinical variables do affect anxiety levels.

Functional and Radiological Outcomes of Surgically Treated Coxa-vara in Children.

Coxa vara is a condition in which the neck-shaft angle of the femur decreases below its normal value (<110 degrees) based on age. The deformity can be primarily caused by a congenital defect of the femoral neck cartilage or by secondary causes related to skeletal dysplasia, trauma, infection, and pathological bone disorders. The surgical treatment aims to restore the normal anatomy, thereby improving the mechanics and function of the hip joint. Generally, the HE angles should be corrected to <35 to 40 degrees, converting the shear forces into compressive forces. Our study aims to report the surgical outcome of coxa vara with various pathologies using radiographic measurement and functional scoring. Thirty-eight hips in 28 patients who underwent surgery for treatment of coxa-vara from 2013 to 2022 were included. Radiographic parameters like Hilgenreiner-epiphyseal angle and neck-shaft angle were assessed preoperatively and at the latest follow-up. Harris hip score was used for functional outcome. The mean age was 11.13 (5 to 18). The average follow-up was 48 (ranging from 24 to 96) months. The mean preoperative neck-shaft angle was 82 degrees, and the Hilgenreiner-epiphyseal angle was 71 degrees. At the latest follow-up, the mean neck-shaft angle was 127 degrees, and the Hilgenreiner-epiphyseal angle was 33 (P<0.001). The Harris hip score improved from 63 preoperatively to 92 at the latest follow-up (P<0.001). There was no recurrence of deformities at the mean follow-up of 37.87 months. Four complications occurred with k-wire fixation in whom revalgus osteotomy was done. Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to >110 degrees to prevent deformity recurrence. The majority of the patients reported improvement in hip function. However, a longer-term follow-up is required to determine further outcomes regarding the recurrence of the deformity.

Pituitary neuroendocrine tumors in elderly patients: clinical and surgical outcomes in a tertiary hospital

Pituitary neuroendocrine tumors in elderly patients: clinical and surgical outcomes in a tertiary hospital

Influence of elevated liver enzyme level on 30-day mortality rates in patients undergoing nonemergency orthopedic surgery

BackgroundThe effect of elevated preoperative liver enzyme levels on postoperative outcomes is a topic of concern to clinicians. This study explored the association between elevated preoperative liver enzyme levels and surgical outcomes in patients undergoing orthopedic surgery.MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program database, we obtained data on adult patients who received nonemergency orthopedic surgery under general anesthesia between 2011 and 2021.ResultsWe evaluated the data of 477,524 patients, of whom 6.1% (24 197 patients) had elevated preoperative serum glutamic oxaloacetic transaminase (SGOT) levels. An elevated SGOT level was significantly associated with 30-day postoperative mortality (adjusted hazard ratio, 1.62; 95% confidence interval, 1.39 to 1.90). We determined that the mortality rate rose with SGOT levels. The results remained unchanged after propensity score matching.ConclusionElevated preoperative SGOT levels constitute an independent risk factor for 30-day postoperative mortality and are proportionately associated with the risk of 30-day postoperative mortality.

How Effective is Transversus Abdominis Plane Block in Reducing Pain and Opioid Needs Following Bariatric Surgery?

How Effective is Transversus Abdominis Plane Block in Reducing Pain and Opioid Needs Following Bariatric Surgery?

Pediatric Canalicular Lacerations: Epidemiology and Surgical Outcomes.

The aim of this study was to report the epidemiology and surgical outcomes of canalicular lacerations in the pediatric age group. All pediatric patients who underwent repair of canalicular lacerations of any cause were included in this study. Age, sex, mechanism of trauma, and type of stent used were recorded. The study group consisted of 47 patients with a median age of 6.4 years (22mo-17y). Thirty of the patients were male (63.8%). The lower canaliculus was affected in 76.6% (n=36), the upper canaliculus in 40.4% (n=19), and both canaliculi in 17% (n=8). The most common cause of canalicular laceration was sharp objects (n=33, 70.2%). Canalicular laceration most commonly affects boys and especially involves the lower canaliculus. There was no difference in functional success between monocanalicular and bicanalicular stents. Prevention of canalicular lacerations should be the main focus.

Surgical outcomes in primary hyperparathyroidism: addressing factors predicting persistent or recurrent hyperparathyroidism

Surgical outcomes in primary hyperparathyroidism: addressing factors predicting persistent or recurrent hyperparathyroidism

An Analysis of the Impact of Intra-abdominal Pressure on Surgical Outcomes in Cases of Intestinal Obstruction: A Prospective Observational Study

An Analysis of the Impact of Intra-abdominal Pressure on Surgical Outcomes in Cases of Intestinal Obstruction: A Prospective Observational Study

Use of Anal Fistula Plug for Treatment of Fistula-in-ano: A Novel Technique?

Abstract Background: Fistula-in-ano is a chronic phase of anorectal suppuration characterized by purulent discharge. The conventional gold standard fistulotomy opens the entire track to heal with secondary intention. Anal fistula plug (AFP) is one of the newer modalities where the track is debrided from within and plugged with a biodegradable material made of porcine small intestinal submucosa. Materials and Methods: A total of 100 patients were enrolled in a randomized prospective study into two groups: conventional fistulotomy (CF) group and AFP group with 50 patients in each arm. The demography and surgical outcomes were assessed for postoperative pain, discharge and recovery, and failure. Results: All 100 patients included in the study had a history of anorectal suppuration which led to the residual anal fistula. Postoperative pain and analgesic requirements were equal in the two groups. The recovery period and return to work were shorter in the AFP group, and this difference was statistically significant. The success rate was 100% in the CF group as compared to 76% in the AFP group. There was no significant complication, failure, or recurrence in the CF group as against allergy (1), extrusion of plug (2), and failure/recurrence (9) in the AFP group. Conclusion: Our study shows that the application of bioprosthetic plugs may be an alternative option in a select group of patients. AFP has also shown to have a faster recovery with less morbidity and comparable success rates.

Talus-derived reference coordinate system for 3D calcaneal assessment: A novel approach to improve morphological measurements.

In 3D-analysis of the calcaneus, a consistent coordinate system aligned with the original anatomical directions is crucial for pre- and postoperativeanalysis. This importance stems from the calcaneus's key role in weight-bearing and biomechanical alignment. However, defining a reliable coordinate system based solely on fractured or surgically reconstructed calcanei presents significant challenges. Given its anatomical prominence and consistent orientation, the talus offers a potential solution to this challenge. Our work explores the feasibility of talus-derived coordinate systems for 3D-modeling of the calcaneus across its various conditions. Four methods were tested on nonfractured, fractured and surgically reconstructed calcanei, utilizing Principal Component Analysis, anatomical landmarks, bounding box, and an atlas-based approach. The methods were compared with a self-defined calcaneus reference coordinate system. Additionally, the impact of deviation of the coordinate system on morphological measurements was investigated. Among methods for constructing nonfractured calcanei coordinate systems, the atlas-based method displayed the lowest Root Mean Square value in comparison with the reference coordinate system. For morphological measures like Böhler's Angle and the Critical angle of Gissane, the atlas talus-based system closely aligned with ground truth, yielding differences of 0.6° and 1.2°, respectively, compared to larger deviations seen in other talus-based coordinate systems. In conclusion, all tested methods were feasible for creating a talus derived coordinate system. A talus derived coordinate system showed potential, offering benefits for morphological measurements and clinical scenarios involving fractured and surgically reconstructed calcanei. Further research is recommended to assess the impact of these coordinate systems on surgical planning and outcomes.

Hospital Volume for Rectal Cancer Resection Plays a Pivotal Role in Improving Outcomes: A Population-based Analysis.

Assessing the association between hospital surgical volume (SV) and outcomes after rectal cancer surgery (RCS), using national population-based data. For RCS, the association of higher SV with improved short- and/or long-term outcomes remains controversial. National cancer registry data and administrative data were used to select patients diagnosed with stage I-III rectal cancer in 2009-2018 and who underwent RCS. The average annual SV of RCS was categorised as low (<15; LV), medium (15-29; MV) or high (≥30; HV). The association between SV and 90-day and 1-year excess postoperative mortality (90DPM and 1YEPM) and 5-year observed survival (5YOS) was evaluated. From the 11,519 patients , RCS was performed in LV (4,088; 36%), MV (2,795; 24%) or HV (4,636; 40%) hospitals. Observed 90DPM was significantly better in HV (2.3% 95%CI[1.9,2.8]) than in LV (3.7% 95%CI[3.2,4.4]) and MV (3.5% 95%CI[2.9,4.3]) with adjusted OR 1.4, P<0.0001. Continuous regression analysis showed significantly higher 90DPM in annual SV <35 compared to ≥35 (OR 1.6 95%CI[1.21,2.11]; P=0.0009). Observed 1YEPM was significantly better in HV (2.9% 95%CI[2.2,3.6]) compared to LV (4.7% 95%CI [3.9,5.6]) with adjusted excess HR 1.31 95%CI[1.00,1.73] and P=0.05, and to MV (5.0% 95%CI[4.0,6.1]) with adjusted excess HR 1.45 95%CI[1.09,1.94] and P=0.01. The 5YOS was significantly better in HV (75.9% 95%CI[74.6,77.2]) than in LV (70.3% 95%CI[68.8,71.8]) and MV (71.5% 95%CI[69.7,73.2]) with adjusted HR 1.4 in both LV and MV versus HV, P≤0.003. This population-based study identified robustly superior outcomes at 90-days, 1-year and 5-years after RCS in hospitals with higher volumes.

Intra- and interobserver agreement in computed tomography localization of primary nonhematopoietic hepatic masses and comparison with surgical and histopathological outcomes in 21 cats.

Computed tomography (CT) is commonly used in the staging of hepatic masses and for liver lobectomy planning. Mass location is an important factor in determining the feasibility of resection, including surgical technique and the likelihood of surgical complications. The objectives of this retrospective descriptive cross-sectional, observer agreement, method comparison study were to assess the reliability of CT in correctly determining the hepatic division and lobar site of origin of feline primary nonhematopoietic hepatic masses, compared with surgically confirmed locations. Furthermore, it provides an overview of the types and locations of liver masses found in a cohort of cats. Pre- and postcontrast CT images of 21 cats were independently and simultaneously reviewed by two observers. Intra- and interobserver agreements and descriptive statistics on demographic and histological diagnoses were calculated. Based on surgical assessment, it was found that masses most frequently originated from the left hepatic division (13/24, 54%). The most frequent lobar origins were the left lateral (8/24, 33%), left medial (5/24, 21%), and right medial lobes (5/24, 21%). No masses were found originating from the right lateral lobe. CT correctly determined hepatic division and lobar origin in 76% of cases, with good-to-excellent intra- and interobserver agreement. The hepatic division had higher agreements overall for both observers. Most of the masses were benign (17/21, 81%), and the most prevalent histological diagnoses were biliary cystadenoma (11/21, 52%) and hepatocellular adenoma (6/21, 29%). Findings suggest that postcontrast CT is a reliable method for correctly determining hepatic mass division and lobar origin in cats.

Postoperative Activity Restrictions After Slings: A Randomized Controlled Trial.

Restricting activity after midurethral slings is an unproven practice. The objective of this study was to evaluate the effect of postoperative activity restriction on satisfaction and outcomes after slings. This was a multicenter, 2-arm, noninferiority randomized controlled trial. Patients aged 18-85 years undergoing treatment with a midurethral sling were randomized 1:1 to postoperative activity restriction or liberal activity. Restrictions included avoidance of strenuous exercise and heavy lifting. The liberal group was allowed to resume activity at their discretion. Our primary outcome was satisfaction with postoperative instruction at 2 weeks. Secondary outcomes included surgical failure, mesh exposure rates, and other adverse events. In total, 158 patients were randomized with 80 to the liberal group and 78 to the restricted group. At 2 weeks, 54 (80.6%) of patients in the liberal group and 48 (73.9%) of patients in the restricted group were satisfied. We found statistical evidence supporting the hypothesis that postoperative liberal activity instruction is noninferior to activity restriction with regard to patient satisfaction (P = 0.0281). There was no significant difference in strenuous activity at 2 weeks (P = 0.0824). The liberal group reported significantly more moderate activity at 2 weeks (P = 0.0384) and more strenuous activity at 6 weeks and 6 months (P = 0.0171, P = 0.0118, respectively). The rate of recurrent or persistent stress incontinence for liberal versus restricted groups was 18.52% versus 23.53% (P = 0.635). There were no statistically significant differences in complication rates. Postoperative liberal activity was noninferior to activity restriction with regard to patients' satisfaction. There was no evidence supporting a statistically significant association between postoperative instruction and negative surgical outcomes.

Surgery Outcomes of Prolene Suture Gonioscopy Assisted Transluminal Trabeculotomy (GATT)– up to 4 years follow-up and Prognostic Factors

Precis: Long-term success was achievable after GATT. GATT performed at early stage of glaucoma had better surgery outcomes. Trabeculoplasty may compromise surgery success. Purpose: To evaluate the long-term effectiveness of prolene suture gonioscopy assisted transluminal trabeculotomy (GATT) and identify factors that may affect surgical outcomes. Patients and Methods: This is a retrospective cohort study of adult patients with prolene suture GATT performed by a single surgeon at one medical center. Results: Of the 145 eyes from 124 patients studied, intraocular pressure was reduced from 22.1±7.8 to 15.1±3.2 and 15.1±3.5 mmHg, and the number of glaucoma medications was reduced from 3.2±1.1 to 1.3±1.4 and 1.4±1.5 at postoperative years 3 and 4, respectively. 93 and 71 eyes completed a 3 and 4-year follow-up, with 44% of the eyes at year 4 remaining medication free. Compared to eyes with combined GATT/cataract extraction (CE), eyes with GATT alone had significantly more preoperative medications and a higher reoperation rate (31% vs. 16.5%). Eyes with prior trabeculoplasty had a higher reoperation rate (28.8%) than those without (16.1%). Kaplan-Meier survival analysis revealed that GATT/CE eyes without trabeculoplasty had a longer median time to failure (48 mo) than GATT/CE eyes with trabeculoplasty (18 mo), and GATT eyes with or without trabeculoplasty (9 mo and 12 mo, respectively). Conclusion: Prolene suture GATT successfully reduced IOP. Eyes with more preoperative medications responded less well to GATT. Prior laser trabeculoplasty was associated with poorer outcomes. Further study is needed to verify these findings.

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

PurposeThe primary aim of the study was to evaluate if en-bloc vs. non en-bloc made a difference to intra-, peri- and post-operative surgical outcomes of anatomical endoscopic enucleation (AEEP) in large (> 80 cc) and very large prostates (> 200 cc). The secondary aim was to determine the influence of energy and instruments used.MethodsData of patients with > 80 cc prostate who underwent surgery between 2019 and 2022 were obtained from 16 surgeons across 13 centres in 9 countries. Propensity score matching (PSM) was used to reduce confounding. Logistic regression was performed to evaluate factors associated with postoperative urinary incontinence (UI).Results2512 patients were included with 991 patients undergoing en-bloc and 1521 patients undergoing non-en-bloc. PSM resulted in 481 patients in both groups. Total operation time was longer in the en-bloc group (p < 0.001), enucleation time was longer in the non en-bloc group (p < 0.001) but morcellation times were similar (p = 0.054). Overall, 30 day complication rate was higher in the non en-bloc group (16.4% vs. 11.4%; p = 0.032). Rate of late complications (> 30 days) was similar (2.3% vs. 2.5%; p > 0.99). There were no differences in rates of UI between the two groups. Multivariate analysis revealed that age, Qmax, pre-operative, post-void residual urine (PVRU) and total operative time were predictors of UI.ConclusionsIn experienced hands, AEEP in large prostates by the en-bloc technique yields a lower rate of complication and a slightly shorter operative time compared to the non en-bloc approach. However, it does not have an effect on rates of post-operative UI.