Transurethral Procedures Research Articles

The Comprehensive Complication Index for Advanced Monitoring of Complications Following Endoscopic Surgery of the Lower Urinary Tract.

Purpose: To evaluate the Comprehensive Complication Index (CCI) for reporting complications in lower urinary tract transurethral procedures and compare it with the Clavien-Dindo classification (CDC). Materials and Methods: A total of 450 consecutive patients were included into the analyses [150 each of transurethral resection of bladder tumors (TURBT), transurethral resection of the prostate (TURP), and transurethral enucleation of the prostate using Tm:YAG, (ThuLEP)]. Complications were assessed according to the modified CDC. The CCI was calculated using a freely accessible online tool. Descriptive statistics and correlation analyses were applied to quantify operational differences and length of stay (LOS) between CDC and CCI. Sample size calculations for hypothetical clinical trials were contrasted for CDC and CCI application. Results: Overall n = 150 patients with complications (33.3%) within the first 60 days after operation were identified. Of these, n = 125 (83.4%) were minor complications up to CDC grade IIIa. Of patients with complications, n = 57 patients (12.6%) experienced more than one complication. Here, the cumulative CCI led to an upgrade of at least one CDC grade in 33 patients. Hence, in 22.0% of cases, the highest CDC grade underestimated the degree of complications. CCI showed higher correlation with LOS compared with CDC (all r > 0.2, all p-values ≤0.0001). Using CCI instead of CDC for sample calculation resulted in a strong reduction of the required number of patients for all three interventions (percentage of patient number decrease: -93.2% for TURBT, -71.8% for TURP, and -81.1% for ThuLEP). Conclusion: The CCI gives a more precise interpretation of the postinterventional complications of TURBT, TURP, and ThuLEP. CCI application may reduce the required sample size for clinical trials and will relieve their recruitment in the future.

Perioperative Hypothermia after Transurethral Surgeries: Is it Necessary to Heat the Irrigation Fluids?

ObjectiveTo investigate the role of heated irrigation fluids in the risk of hypothermia and related complications in patients undergoing transurethral procedures.MethodsThe medical records of all patients who underwent transurethral procedures between 2000 and 2016 at the VA Hospital were reviewed. Irrigation fluids have been heated to 42°C since 2013, as per the institutional policy (Group II). Prior to this date, room temperature solutions were used (Group I). The perioperative body temperature, use of warming devices, procedure length, and anaesthesia type were extracted from records and compared for both groups. In addition, demographic and anthropometric data, preoperative comorbidities, laboratory data, admission information and postoperative complications were obtained from the quality improvement database.ResultsThere were 1,363 patients in Group I and 269 patients in Group II. Perioperative temperature was decreased by 0.10°C in Group I compared to a temperature gain of 0.32°C in Group II (p<0.001). Three hundred and forty-eight (21%) patients undergoing transurethral procedures developed hypothermia <36°C. There was no difference in the incidence of postoperative mortality or complications between the normothermic and hypothermic patients.ConclusionThe replacement of room temperature solutions with warmed solutions for irrigation during transurethral procedures reduced the risk of temperature loss and hypothermia following these procedures. Available heating strategies effectively prevented the perioperative heat loss; however, such strategies did not affect the incidence of postoperative complications.

Benign Prostatic Hyperplasia: Clinical Manifestations, Imaging, and Patient Selection for Prostate Artery Embolization

Prostate artery embolization (PAE) has been shown to be safe and effective at treating lower urinary tract symptoms (LUTS), urinary retention, and hematuria caused by benign prostatic hyperplasia (BPH). To distinguish from other causes of these symptoms, a multidisciplinary evaluation by a urologist and interventional radiologist should include a complete history to screen for any nonprostate causes of LUTS. The International Prostate Symptom Score is a useful objective measure to quantify the patient's urinary complaints. A physical exam should be performed to evaluate a patient's candidacy for angiography, and baseline laboratory evaluation should ensure that the patient's coagulation and kidney function are adequate. In certain situations, patients may benefit from cystoscopy and urodynamic evaluation to ensure their symptoms are related to BPH. A review of the patient's imagining can be the most important component of the evaluation of a patient prior to PAE, because a patient's gland size is often a primary driver of what procedural options available are to him. Men with small glands (≤30 mL) can be treated with several of the available minimally invasive transurethral procedures, but larger glands (≥80-120 mL) may be limited to holmium laser enucleation of prostate, thulium laser enucleation of prostate, surgical prostatectomy, or PAE, depending on institutional practice patterns. Secondary considerations include medical comorbidities, the risks for sexual side effects, the risk for bleeding, and the possible adverse events associated with the procedure, which are all low for PAE. Most patients suffering from symptomatic BPH resulting in LUTS, retention, or hematuria will benefit from PAE.

Interstitial cystitis/bladder pain syndrome (IC/BPS)

As an orphan disease interstitial cystitis/bladder pain syndrome (IC/BPS) is afrequently underdiagnosed and inadequately treated disease of the urinary bladder, often after years of symptoms. Caused by an unknown etiology, ahigh variability of symptoms, a lack of biomarkers and agradual onset, IC/BPS is adiagnosis by exclusion and poses aspecial challenge to doctors and patients. In addition to conventional and complementary medical treatment, oral medication, intravesical and transurethral procedures are available as treatment options. Due to the invasiveness or irreversibility, however, interventional surgical procedures should only be used after careful consideration or as a last resort. In order to find asuitable individualized treatment, aclassification of the patients according to the severity and type of symptoms can be advantageous.

Relevance of intravesical pressures during transurethral procedures

Endourology has undergone fundamental changes over the last 2decades. Maintaining low intrarenal pressure (IRP) during upper urinary tract procedures is an established concept. However, researchers have not yet studied the concept of reduced intravesical pressures (IVPs) during transurethral (TUR) surgery as thoroughly. Low IVP is supposed to decrease complications as fluid retention, TUR syndrome, and incidence of fever. The study aims to give an overview of the contemporarily existing concepts and specify the term of low IVP to avoid TUR-related complications and optimize TUR-related results. A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were transurethral resection, transurethral enucleation, transurethral vaporization, pressure, fluid absorption, and TUR syndrome. Analyzed mean IVPs during TUR vary between 11 and 35 cmH2O but are mostly kept below 30 cmH2O. Mean maximum IVPs during TUR range from 20 to 55 cmH2O. Maximum IVPs seem to be lower when surgeons utilize continuous flow resection, and irrigation pressures are kept low. The results demonstrate a strong correlation between IVP levels and fluid absorption. IVP increase remains a neglected predictor of transurethral procedure complications, and endourologists should consider its intraoperative monitoring. Further research is necessary to quantify generated pressures and introduce means of controlling them.

Fixing tacks induced bladder erosion and recurrent stones following laparoscopic inguinal hernia repair: a case report

BackgroundHernia mesh erosion into the urinary bladder is a rare complication of hernioplasty, and mesh immigration is the most probable pathophysiology. There is no report describing mesh erosion induced by fixing tacks in inguinal hernia repair.Case presentationA 37-year-old man was admitted to our hospital with frequency, urgency and odynuria for 3 months. He received open right inguinal hernia repair in September 2014, and right laparoscopic hernioplasty for recurrence of the inguinal hernia in May 2015. In February 2019, he underwent a day-case transurethral cystoscopic operation for urethral and bladder stones. Cystoscopy revealed the existence of bladder stones and part of the eroded mesh on the right anterior wall, for which an open partial cystectomy was performed. The patient was followed up for 3 months postoperatively, during which no further mesh erosion or stone recurrence was detected by cystoscopy.ConclusionThis is the first case report describing mesh erosion into the urinary bladder by fixing tacks following laparoscopic inguinal hernia repair. In such a case, the eroded mesh and tacks need to be removed completely, but the effectiveness of a single transurethral procedure needs to be verified in more cases.

Do repeated transurethral procedures under general anesthesia influence mortality in patients with non-invasive urothelial bladder cancer? A Danish national cohort study

Purpose: To investigate the effect of repeated transurethral procedures under general anesthesia on overall mortality in patients with non-invasive bladder cancer.Materials and methods: All Danish residents with non-invasive papillary urothelial carcinoma or primary urothelial carcinoma in situ diagnosed between 1 January 2000 and 1 January 2011 were included and followed until death or 31 March 2017. All transurethral procedures under general anesthesia, intravesical instillation therapy, recurrences and progression to invasive disease or cystectomy were recorded during follow-up. Associations between treatments and overall mortality were evaluated using multivariable regression analysis adjusted for age, gender, comorbidities and socioeconomic status. The effect of disease progression on mortality was removed by censoring patients at the time of progression or cystectomy.Results: Risk of death increased with the number of transurethral procedures under general anesthesia for Ta low- and high-grade tumors compared to patients who had only one procedure; after eight or more procedures the risk of death increased by 28% and 83%, respectively. There was no similar relationship for carcinomas in situ. In total, 36–52% of procedures under general anesthesia did not identify urothelial neoplasia.Conclusions: Repeated transurethral procedures under general anesthesia appear to be associated with increased risk of death in patients with primary non-invasive papillary urothelial carcinoma. Furthermore, a substantial number of procedures were without findings of neoplasia, indicating that too many patients are admitted for transurethral procedures under GA. Attempts should be taken to reduce unnecessary transurethral procedures under GA, e.g. by improved outpatient diagnosis of urothelial neoplasia.

Urethral Strictures after Transurethral Surgery: Treatment and Histological Issues

Introduction. The development of upper and lower urinary endoscopic surgery has brought about an increase in the number of urethral strictures after transurethral procedures. Material and methods . A retrospective analysis was performed involving the treatment results of 72 patients with urethral strictures after transurethral surgery in 2011-2016. All the patients underwent standard examination, including US, residual urine analysis, uroflowmetry, retrograde and micturating urethrography, IPSS and QoL questioning and general clinical tests. Results and discussion . The median of observation comprised 28 months. Bulbous urethra appeared to be the most frequent localisation of urethral strictures (87.5 %). The median stricture length was 2 cm with the mean maximum urine flow rate equal to 5.9 ± 2.7 mL/s. The median IPSS score counted 25 points. The type and number of surgical procedures were as follows: internal optic urethrotonomy (29), anastomotic urethroplasty (18), single-stage skin flap urethroplasty (3), single-stage urethroplasty using buccal mucosa graft (17), multiple-stage urethroplasty using buccal mucosa graft (1), meatotomy (1), single-stage navicular fossa urethroplasty using buccal mucosa graft (1). Internal optic urethrotonomy was to be effective in 52 % cases, while other surgical procedures showed 89 % effectiveness. The pathomorpho-logic studies revealed severe inflammation without signs of stroma fibrosis within urethral strictures. Conclusion. Transurethral endoscopic procedures appear to be the main causative factor (in 54 % cases) for iatrogenic urethral strictures.

GreenLight Laser photoselective vapo-enucleation of the prostate with front-firing emission versus plasmakinetic resection of the prostate for benign prostate hyperplasia.

BackgroundAlthough the conventional, monopolar transurethral resection of the prostate (TURP) has proven to be an effective and relatively safe treatment for patients with benign prostatic hyperplasia (BPH), many new endoscopic technologies have been introduced to treat BPH. With the development of laser, there are several alternative transurethral procedures embracing laser therapies. Herein, this study sought to explore the efficacy, safety and follow-up of GreenLight laser photoselective vapo-enucleation of the prostate (PVEP) with front-firing emission compared with plasmakinetic resection of the prostate (PKRP) used to surgically manage BPH.MethodsData from patients who underwent either GreenLight laser PVEP or PKRP were retrospectively collected from March 2013 to May 2018. Perioperative data from both groups were compared.ResultsTotally, 43 and 45 patients were included in the PVEP and PKRP groups, respectively. No significant difference was observed in excision efficiency ratio (resected prostate weight/operation time) between the two groups (P=0.372). The efficiency ratio of the first 20 PVEP procedures (0.36±0.09 g/min) was significantly lower than that of the second 23 PVEP procedures (0.45±0.18 g/min) (P=0.042). The PVEP group experienced a shorter duration of catheterization, postoperative hospital stay and irrigation time than the PKRP group (P<0.001, P=0.001 and P<0.001, respectively). There was no statistically significant difference between the two groups (P=0.937) in terms of overall postoperative complications. Three months after surgery, the international prostate symptoms (IPSS) score, quality of life (QOL) score, postvoid residual (PVR) volume and maximum urinary flow rate (Qmax) were decreased in both groups (P<0.001 for all) and were comparable between both groups (P=0.635, 0.662, 0.671 and 0.924, respectively).ConclusionsGreenLight laser PVEP with front-firing emission was safe and effective modality in treating patients with BPH with short-term follow-up. PVEP was associated with shorter catheterization and postoperative hospital stay time compared with PKRP.

MP41-11 OUTCOMES AND TECHNIQUE FOR EXTRAPERITONEAL ROBOTIC YV-PLASTY FOR RECURRENT BLADDER NECK STENOSIS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-11 OUTCOMES AND TECHNIQUE FOR EXTRAPERITONEAL ROBOTIC YV-PLASTY FOR RECURRENT BLADDER NECK STENOSIS Nadim Abo Youssef, Fabian Obrecht*, Jan Brachlow, Christian Padevit, and Hubert John Nadim Abo YoussefNadim Abo Youssef More articles by this author , Fabian Obrecht*Fabian Obrecht* More articles by this author , Jan BrachlowJan Brachlow More articles by this author , Christian PadevitChristian Padevit More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To demonstrate the outcomes and the technique of robot assisted Y-V (RAYV) plasty bladder neck reconstruction with preferable extraperitoneal approach for recurrent bladder neck stenosis (BNS). METHODS: We present our results and the technique of 22 patients who underwent RAYV March 2016 to July 2019 in our department. 22 cases of BNS emerged after transurethral resection of the prostate. The indications were residual volume, dysuria and attenuated urinary stream. Following an extraperitoneal approach with a three arm Da Vinci Si system, the perivesical space is cleaned. The bladder neck is located and the ventral part of the prostate is exposed. An anterior longitudinal incision is performed starting from the bladder neck over the ventral vesico-prostatic junction down through the stenotic area to the external sphincter. The incision is enlarged to an inverted Y-shaped opening and an indwelling catheter is inserted. The tip of the V-shaped bladder flap is brought to the base of the inverted Y and closed with a running barbed suture. RESULTS: 22 patients with BNS underwent RAYV (table 1). All patients had undergone at least 2 transurethral procedures for the initial treatment. No conversion to open surgery had to be performed. The median operative time (skin to skin) was 133 min (range 69-180), the estimated blood loss was median of 5 (range 0-200) ml. There were no intraoperative and four patients with Clavien Dindo III as postoperative complications. The transurethral indwelling catheter was removed after 8 (4-25) days. The hospitalization period was median 5 (3-14) days, as patients preferred to leave the hospital without an indwelling catheter. Most of the patients showed six weeks postoperative a significant improvement of dysuria and residual volume as well as an increasing uroflowmetry (table 2). There was no recurrence of BNS with a median follow-up of 19.4 (2-42) months. CONCLUSIONS: The extraperitoneal robotic YV-plasty is a feasible and minimally invasive approach for recurrent bladder neck stenosis. Still, long-term results must confirm the efficacy in the future. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e598-e599 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nadim Abo Youssef More articles by this author Fabian Obrecht* More articles by this author Jan Brachlow More articles by this author Christian Padevit More articles by this author Hubert John More articles by this author Expand All Advertisement PDF downloadLoading ...

Applications of electromotive drug administration in urology.

To review all published evidence regarding the use of Electromotive Drug Administration (EMDA) for the management of urological conditions, focusing on efficacy and safety, and highlighting areas that require further study. The PubMed and Medline databases were searched up to July 23, 2019. All studies reporting the use of EMDA to enhance the intravesical administration of therapeutic drugs for urological conditions were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. Thirty-two studies were included. The use of EMDA has been reported in the following urological conditions: (1) nonmuscle-invasive bladder cancer (NMIBC); (2) overactive bladder; (3) bladder pain syndrome; (4) radiation cystitis; (5) detrusor acontractility; and (6) for analgesia prior to transurethral procedures. Overall, most studies are nonrandomized trials with small numbers of patients. The use of EMDA is reported to be safe and effective in all these conditions, with the highest level of evidence in NMIBC in the neoadjuvant and adjuvant setting. However, the low overall quality of evidence limits the conclusions that can be reached. The use of EMDA to improve the efficacy of intravesical treatments is promising, but the low overall quality of the evidence base has limited its widespread use. Future studies should compare EMDA to passive diffusion and current standard of care in large, randomized, and long-term studies to determine the efficacy, safety, and cost-effectiveness of this modality.

Is Primary Realignment Appropriate for the Initial Management of Straddle Injuries to the Bulbar Urethra?

ObjectiveTo compare the clinical courses of patients with straddle injuries to the bulbar urethra based on the initial management strategy for urinary drainage, mainly suprapubic tube placement (SPT) and primary realignment (PR), and to examine whether PR has a beneficial effect on subsequent urethroplasty with regards to surgical and patient-reported outcomes. MethodsWe reviewed the clinical courses of 126 patients with bulbar urethral stricture following straddle injuries who underwent delayed urethroplasty between August 2010 and April 2019. Patients were categorized as being initially treated with SPT (82 patients) or PR (44 patients). Stricture was considered complicated if preoperative urethrography or cystoscopy revealed iatrogenic scarring or a stricture away from the injury site. ResultsThe percentage of patients who experienced delayed transurethral treatment at least once before referral was significantly higher in patients treated with PR than in those treated with SPT (25/44, 56.8% vs 16/82, 19.8%, P < .0001). Although there was no difference in stricture length in both cohorts, the fraction of patients with complicated stricture was significantly higher in patients treated with PR than in those treated with SPT (15/44, 34.1% vs 14/82, 17.1%, P = .003). There was no significant difference in the selected type of urethroplasty, operative time, blood loss, success rate, postoperative maximum urinary flow rate, voiding symptoms, or erectile function between the 2 groups. ConclusionPR does not facilitate delayed urethroplasty and had no beneficial effect on urethroplasty outcome. PR might lead to delayed transurethral procedures, resulting in increased risk of complicated strictures.

Clinical value of suprapubic Trocar puncture lithotripsy in the treatment of benign prostatic hyperplasia and bladder stones

Objective To evaluate the clinical value of suprapubic Trocar puncture lithotripsy in the treatment of benign prostatic hyperplasia and bladder stones. Methods From February 2016 to August 2018, 60 patients with benign prostatic hyperplasia and bladder stones in the Second Hospital of Pujiang County were randomly selected.The patients were divided into transurethral prostatic bipolarplasma electrotomy group(control group, 30 cases) and transurethral prostatic bipolar excision procedure combined with suprapubic Trocar puncture cystinolithotomy group(study group, 30 cases) according to the operation methods.The operation time, stone extraction time, removal of bladder fistula time, catheter extraction time, success of one stone extraction, postoperative complications of the two groups were statistically analyzed. Results The operation time, stone removal time, bladder fistula removal time and catheter removal time of the study group were significantly shorter than those of the control group(t=6.965, 4.541, 3.365, 3.306, all P<0.05). The success rate of the first stone extraction in the study group was 100.0%(30/30), which was significantly higher than 86.7%(26/30) in the control group (χ2=12.83, P<0.05). The incidence rate of postoperative complications in the study group was 10.0%(3/30), which was significantly lower than 23.3%(7/30) in the control group(χ2=13.34, P<0.05). Conclusion Suprapubic Trocar puncture lithotripsy has high value in the treatment of benign prostatic hyperplasia and bladder stones. Key words: Urinary bladder calculi; Prostatic hyperplasia; Transurethral resection of prostate; Cystostomy; Cystotomy; Postoperative complications

03:09 PM Abstract No. 4 Prostatic artery embolization with 100- to 300-μm particles to treat lower urinary tract symptoms attributable to benign prostatic hyperplasia: a single-center analysis of 2-year outcomes

To present medium-term safety and efficacy data for prostatic artery embolization (PAE) using 100- to 300-μm particles to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). 74 patients who underwent PAE with 100μm-300μm particles from April 2014 through August 2018 were retrospectively reviewed. Exclusion criteria were dementia preventing symptom evaluation and technical failure. Subjects (n=60, mean age=71.4, mean Charlson comorbidity index=3.3, mean prostate gland volume (PGV)=183mL) had a mean pre-procedure International Prostate Symptom Score (IPSS) of 21.5, mean Quality of Life score (QOL) 4.3, and mean post-void residual (PVR) 163mL. After PAE, subjects were evaluated at 1, 3, 6, 12 and 24 months. Comparisons to baseline values used T-tests (PGV, PVR) or Wilcoxon signed rank tests (IPSS, QOL). Adverse events were recorded using the Clavien-Dindo classification. One month after PAE, mean IPSS dropped from 21.5 to 7.7 (↓64%) and mean QOL improved from 4.3 to 1.8 (↓58%) (n=42, P<0.001 for both). At 3 months, there was further improvement: mean IPSS was 6.2 (↓71%) and mean QOL 1.1 (↓74%); also mean PVR was 64mL (↓61%) and mean PGV 62mL (↓66%) (n=34, P<0.001 for all). At 6 months, results were sustained with mean IPSS of 6.3 (↓71%), mean QOL 1.1 (↓74%), mean PVR 61mL (↓63%), and mean PGV 75mL (↓59%) (n=41, P<0.001 for all). At 12 months, mean IPSS was 6.7 (↓69%), mean QOL 1.0 (↓77%), mean PVR 64mL (↓61%), and mean PGV 71mL (↓62%) (n=29, P<0.001 for all). At 24 months (n=8), mean IPSS was 7.8 (↓64%, P<0.001), mean QOL 0.6 (↓86%, P<0.001), mean PVR 89mL (↓45%, P=NS), and mean PGV 44mL (↓76%, P=NS). Two significant adverse events occurred: one urinary tract infection (grade 2) and one case of painful necrotic tissue that was transurethrally resected (grade 3B). Ten (17%) self-limited grade 1 adverse events occurred. PAE with 100- to 300-μm particles produced sustained significant improvements in LUTS, PVR, and PGV in the range of transurethral procedures. Safety was similar and efficacy superior to most PAE series using larger size particles. PAE is a viable option for patients who are not good surgical candidates.

Specific characteristics of urethral strictures in a developing country (Brazil).

Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil. This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient. The mean age was 52.13 ± 16.9years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39years old group (42.8%), idiopathic in the 40-59years old group (32.4%) and iatrogenic in patients over 60years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%). In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.

Effects of Warmed Fluid Irrigation Intervention and Forced- Air Warming Intervention on Hypothermia in Transurethral Operation Under Spinal Anesthesia

Background/Objectives: The purpose of this study was to investigate an effective nursing intervention for prevention of hypothermia and thermal discomfort in patients undergoing transurethral procedure under spinal anesthesia.Method/Statistical Analysis: A total of 63 patients were randomly assigned to one of 3 groups. During the procedure, the warmed fluid irrigation group received warm irrigation fluid at 37°C, while the forced-air warming group received forced-air warming by means of Bair Hugger set at 38°C. The control group received room-temperature irrigation fluid.Findings: Body temperature measured immediately after the procedure showed a significantly higher in the warmed fluid irrigation group than in the control group. The level of thermal discomfort on arrival at the recovery room was significantly lower for the warmed fluid irrigation group than for the other two groups.Improvements/Applications: The present results suggest that warmed fluid irrigation is more effective than forced-air warming for preventing hypothermia and thermal discomfort during a transurethral procedure under spinal anesthesia.

Transurethral procedures in the treatment of benign prostatic hyperplasia: A systematic review and meta-analysis of effectiveness and complications.

Background:With the progress of surgical techniques and instruments, various minimally invasive surgical therapies were developed to treat benign prostatic hyperplasisa (BPH). However, the efficacy and safety of different transurethral procedures for the treatment of BPH are still undefined.Method:A systematic search was performed for all randomized controlled trials (RCTs), which compared the transurethral procedures for BPH from 1995 to 2016. The clinical baseline characteristics, International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), maximum flow rate (Qmax), short-term and long-term complications were analyzed using RevMan and ADDIS software.Result:Eighty-eight randomly controlled trials and fifteen procedures were included in the network meta-analysis. HoLEP greatly inproved PVR. TmLRP had the best efficacy in improving QoL score. Diode laser vaporization of prostate was superior in improving IPSS and Qmax. Diode laser through vaporization required the shortest time in catheterization, while Nd:YAG was the longest procedure. For the hospitalization time, TUR was the longest and HoLEP was the shortest. TmLRP was related to the lowest postoperative hemoglobin decrease. TmLEP had the least rates of occurrence of hematuria, reoperation and erectile dysfunction. HoLEP was the best choice to reduce the incidence of recatheterization, urinary retention, urinary tract infection, stress urinary incontinence and retrograde ejaculation. The complications such as blood transfusion, urethral stricture, bladder neck contracture were relatively rare in the patients who underwent diode laser vaporization of prostate.Conclusion:Compared with other transurethral procedures, thulium, holmium and diode lasers were associated with better efficacy and fewer complications.

The Impact of Common Urologic Complications on the Risk of a Periprosthetic Joint Infection.

Periprosthetic infections after total hip arthroplasty (THA) or total knee arthroplasty (TKA) are substantial complications, and there are conflicting reports of their association with urologic complications. Our objective was to determine whether urinary tract infection (UTI) and acute urinary retention (AUR) are significant risk factors for joint infections after THA or TKA. We performed a population-based, retrospective cohort study of patients who were ≥66 years old when they underwent an initial THA or TKA between April 2003 and March 2013. Investigated exposures included a UTI presenting for treatment within 2 years after joint replacement, as well as AUR within 30 days after THA or TKA. The primary outcome was joint infection requiring hospital admission following THA or TKA (which had to occur within 2.25 years after THA or TKA for the UTI exposure or 120 days for the AUR exposure). A total of 113,061 patients met the inclusion criteria and had arthroplasties (44,495 THAs and 68,566 TKAs) during the study period. The median age was 74 years (interquartile range [IQR], 70 to 79 years). Of those patients, 28,256 (25.0%) had at least 1 UTI and they were more likely to be older and female; to have had previous antibiotic exposure, cystoscopy, or urinary retention; and to have atrial fibrillation. Most of those UTIs were coded as nonspecific UTI, and the patient was seen for outpatient treatment in a non-emergency department setting. A total of 2,516 patients (2.2%) had AUR within 30 days of the procedure. Those patients were more likely to be older and male, to have medical comorbidities, to have had previous transurethral procedures or cystoscopy and previous urology visits, and to have received a general anesthetic during their procedure. A total of 1,262 patients (1.1%) had joint infection requiring hospital admission. In multivariate Cox regression analysis, UTI was associated with an increased risk of joint infection (hazard ratio [HR], 1.21 [95% confidence interval (CI), 1.14 to 1.28]; p < 0.01). However multivariate analysis did not demonstrate an association between AUR and joint infection (HR, 0.99 [95% CI, 0.60 to 1.64]; p = 0.98). UTI was associated with increased risk of hip or knee periprosthetic joint infection, whereas AUR was not a significant risk factor. Timely and appropriate treatment of symptomatic UTIs in this patient population may be important to prevent periprosthetic joint infection. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Surgical Management of Fossa Navicularis and Distal Urethral Strictures.

Urethral reconstruction has evolved in the last several decades with the introduction of various techniques including fasciocutaneous skin flaps and buccal mucosal grafts. However, distal urethral strictures have continued to be a reconstructive challenge due to tendency for adverse cosmetic outcomes, risks of glans dehiscence or fistula formation, and stricture recurrence. The surgical options for treatment of distal urethral strictures have changed throughout the years; however, there is no one universally accepted technique for their treatment. The current trend for treatment is shifting away from multi-staged procedures or the use of local skin flaps to single-stage transurethral procedures that utilize buccal mucosa with glans preservation. This chapter will describe the evolution of distal urethral stricture treatments tracking gradual improvements and modifications over time. The different interventions include transurethral approaches, such as dilations and visual urethrotomy, meatotomy, and meatoplasty/urethroplasty techniques including genital skin flaps and single- and double-stage repairs with buccal mucosal grafts.

MP10-15 THE IMPACT OF COMMON UROLOGIC COMPLICATIONS ON THE RISK OF A PROSTHETIC JOINT INFECTION

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2018MP10-15 THE IMPACT OF COMMON UROLOGIC COMPLICATIONS ON THE RISK OF A PROSTHETIC JOINT INFECTION Nahid Punjani, Brent Lanting, Andrew McClure, Jennifer Winick-Ng, and Blayne Welk Nahid PunjaniNahid Punjani More articles by this author , Brent LantingBrent Lanting More articles by this author , Andrew McClureAndrew McClure More articles by this author , Jennifer Winick-NgJennifer Winick-Ng More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.361AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prosthetic infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) are significant complications, and there are conflicting reports of their association with urologic complications. The purpose of this study is to determine if urinary tract infection (UTI) and acute urinary retention (AUR) are significant risk factors for joint infections after THA or TKA. METHODS This study is a population-based retrospective cohort study of all patients greater than 66 years of age undergoing a THA or TKA in Ontario, Canada between April 1, 2003 and March 31, 2013 (n = 113,061). Cases were reviewed for post-operative UTI requiring presentation to the emergency department or hospital admission within 2 years of joint replacement, as well as acute urinary retention within 30 days of THA/TKA. The primary outcome is joint infection requiring hospital admission following THA and TKA. We hypothesized that both UTI and AUR would increase the risk of subsequent joint infection after arthroplasty. RESULTS A total of 113,061 patients met inclusion criteria and had arthroplasties during the study period (44,495 with THA and 68,566 with TKA). Median age was 74 (IQR 70-79). A total of 28,256 (25.0%) had at least one UTI, and were more likely to be older, female, have previous antibiotic exposure, cystoscopy or retention, and have atrial fibrillation. A total of 2,516 (2.2%) patients had AUR within 30 days of procedure, and were more likely to be older, male, have medical comorbidities, previous transurethral procedures or cystoscopy, previous Urology visits and a general anesthetic during their procedure. A total of 1,262 (1.1%) patients had joint infection requiring hospital admission at a median of 86 days (IQR 21-377). In multivariate Cox regression analysis, UTI was associated with an increased risk of joint infection (HR 1.21, 95% CI 1.14-1.28, p<0.01). However multivariate analysis did not demonstrate an association with AUR and joint infection (HR 0.99, 95% CI 0.60-1.64, p=0.98). CONCLUSIONS UTI is associated with increased risk of peri-prosthetic joint infection of THA or TKA, whereas acute urinary retention is not a significant risk factor. Timely and appropriate treatment of symptomatic UTIs in this patient population may be important in prevention of prosthetic joint infection. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e122-e123 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nahid Punjani More articles by this author Brent Lanting More articles by this author Andrew McClure More articles by this author Jennifer Winick-Ng More articles by this author Blayne Welk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...