-
Indian Journal of Urology 04/2012; 28(2):232-3.
-
[show abstract]
[hide abstract]
ABSTRACT: Open pyeloplasty is the standard treatment for ureteropelvic junction obstruction in children. The introduction of robotic surgical system has facilitated precise intracorporeal suturing and shortened the learning curve for minimal invasive procedures for the surgeons. There is sparse data over the outcomes of robot-assisted laparoscopic pyeloplasties in children. We describe our technique and outcomes of robotic pyeloplasty in children.
Operative data for all patients undergoing a robot-assisted procedure at our center is prospectively recorded in a database. We retrieved data of patients below the age of 16 years undergoing robot-assisted pyeloplasty between July 2007 to March 2011 and evaluated their operative parameters, recovery, and functional outcomes.
In the period under review, 34 pediatric patients (mean age 12 years, range 5-15 years) underwent robot-assisted laparoscopic pyeloplasty at our center. All patients underwent unilateral pyeloplasty but one patient underwent a simultaneous contralateral pyelolithotomy. The mean total operative time (range) was 105 minutes (75-190 minutes), average dissection time and the anastomosis time was 23 minutes (20-58 minutes) and 46.5 minutes (28-70 minutes) respectively. The mean blood loss was 30 mL. Follow-up of 36, 24, 18, 12, and 6 months was completed in 14, 21, 24, 28, and 31 patients respectively. Postoperatively, one patient had an omentum herniation through the camera port site and another had an ileocaecal volvulus. With a mean follow-up of 28.5 months (2-56 months), the success rate was 97% (32/33), whereas postoperatively one patient had deterioration of function.
Robot-assisted laparoscopic pyeloplasty is a safe and effective minimally invasive treatment modality in children.
Journal of endourology / Endourological Society 12/2011; 26(3):249-53. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the incidence and probability of recovery of erectile dysfunction after different types of one-stage urethroplasties for anterior urethral stricture disease.
Seventy-eight men undergoing single-stage anterior urethroplasty from January 1, 2008 to March 31, 2010 were followed prospectively. Patients were divided into 3 groups: group 1 (n=25)-penile substitution urethroplasty; group 2 (n=32)--primary excision anastomotic bulbar urethroplasty; and group 3 (n=21)--bulbar substitution urethroplasty. Patients willing to participate completed the International Index of Erectile Function (IIEF) preoperatively and then on subsequent follow-up visits at 3, 6, 9, 12, and 15 months after urethroplasty. Pre- and post-urethroplasty erectile functions were compared.
Our mean follow-up period was 15.50+2.389 months. The mean age (years) was similar among groups. The mean stricture length (cm) was 4.78±0.747, 2.95±0.658, and 6.13±0.981 in-groups 1, 2, and 3, respectively (P=.001). Mean preoperative IIEF score was 24.60±2.365 (similar among groups). Erectile dysfunction (ED) was found in 15 (20%) patients: 4/25 (16%), 9/32 (28%), and 2/21 (10%) in groups 1, 2, and 3, respectively. Mean postoperative decline (3 months) in IIEF score was 22.54±4.823. Overall, the decline was not significant among groups (P=.502.) Recovery of erectile function was seen in 75/78 (96%) men at a mean follow-up time of 5.63±2.59 months.
Anterior urethroplasty has a probability of causing ED in as much as 20% of patients. The type of urethroplasty has no significant effect on ED. Recovery of erectile function occurs within 6 months of urethroplasty.
Urology 05/2011; 78(1):78-81. · 2.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study is to evaluate the efficacy and safety of laser welding of vesicovaginal fistula (VVF) at our centre.
Between January 1, 2001 and January 3, 2010, eight patients underwent laser welding of vesicovaginal fistula. The mean age was 44 years (35-55). The VVF were primary (failing to heal following conservative management) in five and secondary (recurring following primary repair) in three cases. The mean fistula size was 3 mm (range, 2-4). Neodymium yttrium aluminium garnet (YAG) laser was used for the initial case, and in the remaining seven cases, holmium YAG laser was used for circumferential welding of the fistula. Following the procedure, a catheter was kept for 3 weeks. The mean hospitalisation period was 1 day. The mean follow-up is 47 months (2-110).
Seven patients were dry after catheter removal. In one patient, procedure was abandoned due to bleeding.
Laser welding of VVF is a simple, safe and efficacious procedure in a select group of patients.
International Urogynecology Journal 03/2011; 22(8):981-4. · 1.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Study Type - Therapy (case series). Level of Evidence: 4.
To evaluate the efficacy and safety of using bipolar energy at low-power setting for transurethral resection (TUR) of bladder tumours.
In total, 108 patients (100 males and eight females) with superficial bladder carcinoma undergoing bipolar TUR of bladder tumours (B-TURBT) with the Gyrus(TM) Plasma kinetic Tissue Management System (Gyrus Medical Ltd, Cardiff, UK) were studied. The initial ten patients were operated at a default setting of 160 W cutting and 80 W coagulation. Subsequently, the current settings were modified to 50 W cutting and 40 W coagulation. The present study reports on the 98 patients who underwent TURBT with low-power settings. Tumour number, size, shape, location, operating time, hospital stay, blood loss, as well as intraoperative and postoperative complications, were all recorded .The resected tissues were examined by a pathologist who recorded grade, invasion of the muscularis propria and the presence of muscular invasion.
Out of the ten patients who were operated at the recommended default settings of 160 W cutting and 80 W coagulation, three patients had obturator jerks leading to two-bladder perforation. The results of 98 patients operated on at the low-power settings of 50 W cutting and 40 W coagulation are reported. Mean ± SD age was 56.34 ± 13.51 years. Tumours were multiple in 62 (63%) patients and single in 36 (37%) patients, with 68 (69%) in the lateral wall and six (6%) involving the ureteric orifice. Mean ± SD tumour size was 2.5 ± 0.81 cm with a mean ± SD resection time of 36.64 ± 16.5 min. The mean drop in haemoglobin was 0.94 ± 0.71 (0.20-4.0), with a mean ± SD (range) drop in haematocrit of 1.33 ± 1.29 (1-7). Five (5%) patients required blood transfusion as a result of preoperative low haemoglobin. Mean ± SD drop in sodium was 2.06 ± 0.66 mEq/L, with no patient developing TUR syndrome. None of the 98 patients developed obturator jerks and perforation at low-power settings. Complete resection was achieved in 94 (96%) patients. Mean postoperative hospital stay was 3 days.
TURBT using bipolar energy is safe and effective in the treatment of bladder tumours at power settings lower than the conventionally recommended settings. Lower power settings reduce the number of obturator jerks and perforations.
BJU International 12/2010; 108(4):553-6. · 2.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Access through the superior calix for percutaneous nephrolithotomy (PCNL) often breaches the diaphragm and is believed to have greater complications than access through other calices. We evaluated the safety and efficacy of a superior caliceal access in pediatric patients who were undergoing PCNL.
Operative and recovery data for pediatric patients (up to 16 years old) who were undergoing PCNL for renal calculi were prospectively entered into a database and reviewed. Patients with a superior calix puncture were compared with those in whom the superior calix was not punctured. Stone clearance was assessed by intraoperative fluoroscopy and postoperative radiography in all patients and ultrasonography and CT scan in selected cases.
Over a 2-year period, 26 pediatric patients (mean age 11.12 years; range 4-16 years) underwent 27 PCNLs. Stone bulk ranged from 200 to 1150 mm² (mean 656.03 mm²). Nine patients had staghorn stones. Thirteen patients (14 renal units) had primary superior calix access with 13 of these being supracostal (above the 12th rib). Four of these had staghorn calculus. All stones were fragmented using a pneumatic lithoclast. Second-look PCNL was necessary in two patients. Complete clearance was achieved in all except one patient in each group with superior and nonsuperior caliceal puncture. Hydrothorax developed in one patient with supracostal puncture necessitating tube drainage while abdominal collection developed in one in patient who underwent the nonsuperior calix approach. Both patients recovered with no sequelae.
The superior calix puncture is safe and effective in the pediatric population.
Journal of endourology / Endourological Society 11/2010; 24(11):1725-8. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recurrence of fistula is one of the very common complications of fistula repair. The disease has immense psychosomatic effect on the patients due to continuous leakage of urine. Management of recurrent vesico-vaginal fistula (VVF) repair poses a challenge to surgeons.
Group I-12 patients with recurrent VVF, having robotic repair from August 2006 to June 2008, were included in the present study. Group II-20 patients matched in all possible parameters with recurrent VVF having open surgical repair in the past were taken as controls. Patients in both the groups were evaluated by assessing relevant clinical details; performing urine routine examination and culture, renal function test, three swab test, ultrasonogram-kidney, ureter, and bladder radiograph, intravenous urogram (to look for upper tract and rule out uretero-vaginal fistula), and urethro-cystoscopy. The details were retrospectively recorded from the case sheets.
In group I, 100% were successfully managed as compared with 90% in group II, but it was not statistically significant (p > 0.05). Mean blood loss was significantly less (p < 0.05) in group I compared with group II (mean 88 vs. 170 mL). The mean hospital stay also was significantly less (p < 0.05) in group I in comparison with group II (mean 3.1 vs. 5.6 days). None of the patients had complications in group I compared with group II, but it was not significant.
The present study suggests that robotic VVF repair is a better option for recurrent fistulas in view of its reduced morbidity, without compromising the results.
Journal of endourology / Endourological Society 11/2010; 24(11):1779-82. · 1.75 Impact Factor
-
Indian Journal of Urology 07/2010; 26(3):463.
-
[show abstract]
[hide abstract]
ABSTRACT: To present our experience and outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for pelvi-ureteric junction obstruction (PUJO).
This was a prospective study of 85 consecutive patients who had RALP for PUJO at our institute from July 2006 to December 2008. The preoperative evaluation included intravenous urography (IVU) and diuretic renography. The type of pyeloplasty was decided based on the size of the pelves, presence of crossing vessel, level of ureteric insertion and the length of obstruction. All surgery was done through a transperitoneal approach using four or five ports. The follow-up comprised IVU and renal dynamic scintigraphy. Relevant data were collected and analysed for perioperative morbidity, complications and long-term functional outcomes.
In all, 86 RALPs were performed, including one bilateral, 41 right-sided and 43 left-sided cases. The mean operative time was 121 min, including an anastomosis time of 47 min. The mean estimated blood loss was 45 mL. The drain was removed within 48 h. The mean hospital stay was 2.5 days. Three patients had stents that migrated upwards, and prolonged drainage. The success rate was 97% (82/85) with a mean follow-up of 13.6 months.
RALP is highly effective for managing PUJO, with low morbidity, quick recovery and a durable success rate.
BJU International 10/2009; 105(7):980-3. · 2.84 Impact Factor
-
Journal of endourology / Endourological Society 05/2009; 23(4):595-7. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the success rate of redo anastomotic urethroplasty and to compare it with primary anastomotic urethroplasty.
We compared 52 patients with post-traumatic posterior urethral strictures (group 1, mean age 24.6 years, range 10-62) who had undergone redo urethroplasty with 66 patients (group 2, mean age 22.6, range 6-71) who had undergone primary anastomotic urethroplasty. Mean stricture length was 2.0 cm (1-4.5) and 2.5 cm (1.5-6), respectively. All of the patients in group 1 had a stricture located at the bulboprostatic anastomotic site. In group 2, 43 (65.2%) had a bulbomembranous stricture and 23 (34.8%) had a prostatomembranous stricture.
Mean operative time was 140 (100-240) and 90 min (75-200) in group 1 and 2, respectively. Mean blood loss was 180 (80-900) and 125 mL (50-700), respectively. Mean hospital stay was comparable (6.6 days vs 5.5 days) between the two groups. Mean follow up was 54 months (10-144) for group 1 and 62 months (12-122) for group 2. Corporal separation, inferior pubectomy, a transpubic approach and urethral rerouting were required in 22 (42.3%) and 12 (18.2%), 7 (13.5%) and 3 (4.5%), 12 (23%) and 5 (7.6%), 2 (3.8%) and nil patients in group 1 and 2, respectively. An excellent or acceptable outcome was achieved in 42 (80.8%) and 57 (86.4%), 8 (15.4%) and 7 (10.6%) patients, respectively. Two patients in each group failed.
Previously failed end-to-end urethroplasty does not alter the success rate of redo end-to-end urethroplasty.
International Journal of Urology 09/2008; 15(10):885-8. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To analyze the feasibility and outcome of retroperitoneoscopic nephrectomy for benign nonfunctioning kidneys and compare it with open simple nephrectomy.
From January 1998 to December 2006, 505 retroperitoneoscopic nephrectomies were performed. In the same time period, 112 open nephrectomies were also performed. In the retroperitoneoscopic group, the mean age was 39 years (range 15-74 years); 204 (40.4%) were men and 301 (59.6%) were women. Forty in this group had a history of surgery. Thirty-six patients had a pyonephrotic kidney; 33 of these patients had undergone percutaneous nephrostomy preoperatively. The cause of the nonfunctioning kidney was ureteropelvic junction obstruction in 198 patients, calculus disease in 193 patients, genitourinary tuberculosis in 48 patients, renal dysplasia in 19 patients, anomalous kidney in 20 patients, and renovascular hypertension in 16 patients. In 11 patients, there were other causes for the nonfunctioning kidney.
Retroperitoneoscopic nephrectomy was performed in 476 (94.2%) patients. Conversion to open nephrectomy was necessary in 25 patients. The mean operative time was 85 minutes (range 45-240 min) in the retroperitoneoscopic group and 70 minutes (range 35-120 min) in the open group. The mean blood loss was 110 mL (range 30-600 mL) in the retroperitoneoscopic group and 170 mL (range 70-500 mL) in the open group. Four (0.8%) patients in the retroperitoneoscopic group needed a blood transfusion, whereas 5 (4.5%) patients in the open group had a blood transfusion. The hospital stay in the retroperitoneoscopic group was 3 days (range 1-7 d) and was 5 days (range 3-12 d) in the open group.
Retroperitoneoscopic nephrectomy, although technically challenging, is becoming a gold standard for patients with nonfunctioning kidneys caused by benign conditions.
Journal of Endourology 05/2008; 22(4):693-8. · 1.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To report our experience with laparoscopic radical cystectomy and extracorporeal urinary diversion for high-grade muscle invasive bladder cancer in a consecutive series of 48 patients with 3 years of follow-up.
From June 1999 to April 2006, 48 patients (42 men and 6 women; mean age 59 years, range 24 to 80) with bladder cancer underwent laparoscopic radical cystectomy and bilateral pelvic lymph node dissection at our institution. Urinary diversion was done extracorporeally through the specimen extraction incision.
The mean operating time was 310 minutes, and the mean blood loss was 456 mL. In 1 patient, conversion to open surgery was required because of severe hypercarbia. Three major complications were observed intraoperatively (rectal injury in 2 and external iliac vein injury in 1 patient). However, all these complications were managed laparoscopically, with completion of the procedure laparoscopically. The mean hospital stay was 10.2 days (range 7 to 25). One patient died in the postoperative period of severe lower respiratory tract infection and septicemia. Histologic examination showed organ-confined tumors (Stage pT1/pT2/pT3a) in 34 patients (71%) and extravesical disease (pT3b/pT4) in 14 (29%). Of the 48 patients, 12 (25%) had lymph node involvement. The mean number of nodes removed was 14 (range 4 to 24). At a mean follow-up period of 38 months (range 10 to 72), 35 patients were alive with no evidence of disease (disease-free survival rate 73%).
The results of our study have shown that laparoscopic radical cystectomy is a safe, feasible, and effective alternative to open radical cystectomy. Extracorporeal urinary diversion through a small incision decreases the operating time, while maintaining the benefits of laparoscopic surgery. The 3-year oncologic efficacy was comparable to that of open radical cystectomy.
Urology 02/2008; 71(1):41-6. · 2.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We present the outcomes of a large series of patients treated with radical cystectomy and pelvic lymphadenectomy for transitional cell carcinoma of bladder.
A total of 502 patients underwent radical cystectomy (RC) for bladder cancer from 1992 till December 2006. Of these, 432 patients with primary transitional cell carcinoma of bladder underwent RC with bilateral pelvic lymphadenectomy with a curative intent. The clinical course, pathologic characteristics and long-term clinical outcomes were evaluated in this group of patients.
The median follow-up was 62 months. There were 30 (6.9%) perioperative deaths and 111(25.7%) early complications. The recurrence-free survival (RFS) and overall survival (OAS) were 66% and 62% at five years and 62% and 40% respectively at 10 years. The RFS and OAS were significantly related to the pathological stage and lymph node status with increasing pathological stage and lymph node positivity associated with higher rate of recurrence and worse OAS (P < 0.001). A total of 145 patients (33.5%) developed bladder cancer recurrence. Of these, 40 (27.6%) developed local pelvic recurrence and 105 patients (72.4%) developed distant recurrence. The median time to local and distant recurrence was 12 and 16 months respectively.
The clinical results reported from this large group of patients demonstrate that radical cystectomy provides good survival results for invasive bladder cancer patients with low incidence of pelvic recurrence.
Indian Journal of Urology 01/2008; 24(1):54-9.
-
[show abstract]
[hide abstract]
ABSTRACT: We present our experience with the perioperative, functional and oncological outcomes of radical cystectomy in patients with bladder cancer and obstructive uremia.
From 1998 to June 2006, 58 patients with bladder cancer, and concomitant obstructive uropathy and azotemia presented to our institution. Mean +/- SD serum creatinine at presentation was 9.2 +/- 4.5 mg% (range 2.4 to 16.5). Radical cystectomy, bilateral pelvic lymphadenectomy and urinary diversion were performed after stabilizing renal function with and without percutaneous nephrostomy in 28 and 8 patients, respectively. Various preoperative variables were evaluated for predicting long-term treatment failure and renal deterioration. Mean followup was 34 months.
Mean serum creatinine at surgery was 1.85 mg%. An ileal conduit was used in 32 patients and cutaneous ureterostomy was used in 4. One patient died of chest infection in the perioperative period. All patients had muscle invasive disease, while 15 had positive lymph nodes. At the mean followup 15 patients (41.6%) were free of disease and 21 had treatment failure. Of the factors evaluated pathological tumor stage, grade and lymph node involvement predicted the long-term oncological outcome, while serum creatinine greater than 2.5 mg% at surgery and ileal conduit diversion predicted long-term renal deterioration.
Patients with bladder cancer who have obstructive uremia usually present with locally advanced disease. Radical cystectomy is not associated with additional morbidity, provided that patients are adequately prepared before surgery by optimizing renal function. An adequate number of these patients achieve long-term disease-free survival after radical cystectomy. As the urinary diversion of choice, an ileal conduit appears to be safe in patients with serum creatinine less than 2.5 mg% at surgery.
The Journal of Urology 11/2007; 178(4 Pt 1):1206-11; discussion 1211. · 3.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Radical nephrectomy with tumor thrombectomy in patients with renal cell carcinoma and level I to III thrombus extension is directly associated with an improved prognosis. However, radical surgery in patients with level IV thrombus extension is associated with high perioperative mortality, even if long-term survival is possible. In this report, we describe an alternative technique of vena caval and intraatrial tumor thrombectomy to decrease perioperative mortality and morbidity.
A cohort of 6 patients aged 46, 50, 53, 56, 54, and 52 years underwent radical nephrectomy with tumor thrombectomy from the vena cava and right atrium under mild hypothermic cardiopulmonary bypass and intermittent cross-clamping of the supraceliac abdominal aorta. Intraatrial tumor thrombectomy was performed on a beating, perfused heart in 4 patients and a hypothermic, cardioplegia-perfused heart in 2 patients.
There were no early or late deaths. The aortic cross-clamp time was 12 and 15 minutes for patients 5 and 6, respectively. The cumulative hepatic and renal ischemic time was 16 minutes (range, 14 to 22 minutes) at 32 degrees C. The mean cardiopulmonary bypass time was 53.3 +/- 8.9 minutes (range, 40 to 65 minutes). At a mean follow-up of 43 +/- 24.6 months (range, 10 to 70 months), all patients are active and remain disease-free.
We conclude that radical nephrectomy and tumor thrombectomy in patients with level IV thrombi can be safely performed with cardiopulmonary bypass, mild hypothermia. and intermittent supraceliac abdominal aortic occlusion, avoiding potential hematologic, hepatic, renal, neurologic, and septic complications associated with circulatory arrest.
The Annals of thoracic surgery 06/2007; 83(5):1731-6. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Shockwave lithotripsy (SWL) is a safe and efficacious modality for pediatric urolithiasis. Recent reports claim good results even with larger stone burdens, irrespective of stone location. We reviewed the outcomes of SWL in the pediatric population at our center to assess the impact of stone burden and location and the age of the child on the stone-free rate.
Records of 106 patients <or=16 years of age (mean age 10.9 years) treated with SWL for stones with a surface area of 20 to 600 mm2 (mean 124.17 mm2) from July 1989 to June 2004 were reviewed. Metabolic abnormalities were present in 20.7% of the patients. All procedures were performed using the Siemens Lithostar, and stone clearance was assessed 3 months after SWL. Complications and the need for re-treatment and ancillary procedures were noted, and the impacts of stone size and location and the age of the child on stone clearance were assessed.
The overall stone-free rate was 87% (complete clearance 72%; insignificant [<3-mm] residual fragments 15%). The re-treatment rate was 58%, and the efficiency quotient was 47. Whereas stone size correlated strongly with the stone-free rate (Mann-Whitney U test x = 0.004; chi-square test P = 0.02), patient age and stone location did not have a significant impact.
Extracorporeal shockwave lithotripsy is an effective modality to treat pediatric upper urinary-tract calculi, especially when the stone burden is <200 mm2. Larger stone burdens are associated with poorer results, necessitate more ancillary procedures, and have a higher complication rate.
Journal of Endourology 03/2007; 21(2):141-4. · 1.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Renal lymphangiomatosis is a rare developmental malformation resulting in the development of cystic masses in the peri-pelvic or peri-renal areas. We report our experience in the management of this rare anomaly. Herein, we also describe the successful laparoscopic ablation of an uncommon subcapsular variant of renal lymphangiomatosis, which failed percutaneous drainage.
International Urology and Nephrology 02/2007; 39(2):365-8. · 1.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The increased use of fluoroscopy during percutaneous nephrolithotomy (PCNL) places the urologist and operating room personnel at an occupational risk for measurable radiation exposure. We evaluated the degree of radiation exposure received by the patient and operating room personnel at our endourology facility during PCNL.
The incident radiation dose to the patient and the urologist during 50 consecutive PCNL procedures was monitored using lithium fluoride thermo-luminescent dosimeter chips (TLD chips). A hand held radiation survey meter was used to measure the radiation in air at different positions occupied by various operating room personnel. The approximate distances of the various personnel from the X-ray tube were also measured.
PCNL was performed upon 35 males and 15 females. The average time for the procedure was 75 minutes (range: 30-150 min). The mean fluoroscopy screening time during the procedure was 6.04 min (range 1.8-12.16 min) with a mean fluoroscopy tube potential of 68 kVp and a mean tube current of 2.76 mA. The mean radiation exposure dose to the patient was 0.56 mSv (SD +/- 0.35), while the mean incident radiation exposure to the finger of the urologist was 0.28 mSv (SD +/- 0.13).
The various operating room personnel are within safe radiation dose limits during PCNL. Efficient fluoroscopy further reduces the radiation scatter. All occupational personnel should 'achieve as low as reasonably achievable' dose by adhering to good practices.
International Urology and Nephrology 02/2006; 38(2):207-10. · 1.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the safety and efficacy of two alternatives for surgically treating symptomatic benign prostatic hyperplasia (BPH), i.e. transurethral vapour resection of the prostate (TUVRP) and holmium laser enucleation of the prostate (HOLEP), with transurethral resection of the prostate (TURP), the standard surgical therapy, as treating large prostates is associated with greater morbidity, and to date there is no simultaneous comparison of these three methods.
We prospectively randomized 150 patients (50 in each group) with BPH and glands of >40 g to undergo either TURP, TUVRP or HOLEP. The evaluation before treatment included urine culture, serum prostate specific antigen (PSA) level estimation, the International Prostate Symptom Score (IPSS), peak urinary flow rate (Q(max)), and transabdominal ultrasonography to estimate prostate size and postvoid urine residue (PVR). The operative duration, blood loss, resected tissue weight, change in levels of haemoglobin and serum sodium, nursing contact time, duration of catheterization, and complications were noted. After surgery patients were reassessed for the IPSS, Q(max) and PVR at 6 months and 1 year.
The patients in all three groups had comparable characteristics before surgery. The mean operating duration and intraoperative irrigant used for TUVRP was less than for HOLEP or TURP, and blood loss with HOLEP and TUVRP was less than with TURP (all P < 0.001). Postoperative irrigation, nursing contact time, and catheter duration were significantly less for HOLEP than TURP or TUVRP, and for TUVRP than TURP. At follow-up, patients in all groups had a significant improvement from baseline in IPSS, Q(max,) and PVR, but the differences between the groups were not significant at 6 months or 1 year.
HOLEP and TUVRP are both acceptable alternatives to TURP for treating large prostate glands, with less perioperative morbidity and comparable efficacy at 6 months and 1 year.
BJU International 02/2006; 97(1):85-9. · 2.84 Impact Factor
