Does intraprostatic vasopressin prevent the transurethral resection syndrome?

OBJECTIVE: To determine whether intraprostatic vasopressin (IPVP) prevents the transurethral resection (TUR) syndrome during prostatectomy. PATIENTS AND METHODS: The study comprised 36 consecutive patients (mean age 68 years) with prostates clinically assessed as >/= 20 g who underwent standard transurethral prostatectomy (TURP). Ten units of vasopressin in 0.5 mL were diluted with 9.5 mL isotonic saline and injected into the prostate transrectally before TURP. Blood samples were taken before and immediately after TURP to measure serum sodium concentration and free haemoglobin levels. The TURP irrigant used was cooled, boiled water maintained at 70-80 cmH2O pressure during resection. Twenty patients had alcohol added to the irrigant and their breath alcohol assessed at 10-min intervals during TURP. All patients had their pulse rate, blood pressure and sensorium monitored continuously. Extreme care was taken to avoid and/or identify capsular damage during resection. RESULTS: The mean weight of tissue resected was 36 g and the mean resection time 24 min. There was no significant change in clinical variables during TURP. In 19 patients the breath alcohol changes were insignificant. Changes in free haemoglobin were not significant, but the levels decreased after TURP in four patients, caused by the dilution consequent on the infusion of 800-1000 mL isotonic saline during surgery. Serum sodium concentrations showed only insignificant decreases, except in one patient whose breath alcohol suggested the absorption of 500 mL of irrigant. This patient's serum sodium concentration decreased by 9 mmol/L; 1 L of 5% dextrose was infused during the procedure and capsular damage was recognized early during TURP. CONCLUSION: Insignificant volumes of irrigant entered the circulation of the patients during TURP with water irrigation and IPVP. The greatest risk factor for fluid entry during TURP is capsular damage. IPVP decreases bleeding and therefore improves visibility, so allowing the early identification of capsular damage. IPVP seems therefore to be of help during TURP by decreasing bleeding and allowing insignificant volumes of irrigant to enter the vasoconstricted vessels; it appears to prevent the TUR syndrome.     

Is transurethral vaporization a remake of transurethral resection of the prostate?

PURPOSE: Transurethral resection of the prostate (TURP) is still the gold standard method to treat benign prostatic hyperplasia (BPH). Transurethral vaporization of the prostate (TUVP) is compared with the transurethral resection of benign prostatic hyperplasia. PATIENTS AND METHODS: Over a 10-month period, 78 patients presenting with moderate and severe symptomatic BPH were randomized into two groups. A total of 38 patients underwent TURP, and 40 men underwent TUVP. The protocol included urinary flow rate (Qmax), symptomatology evaluated by the International Prostatic Symptom Score (I-PSS), and an ultrasonographic estimate of the postvoiding residual volume (PVR). The TUVP was carried out using a regular loop with the electrical source set at 250 to 300 W in the pure cutting mode. The same technique was used in the TURP, but the electrosurgical unit was set at 50 to 80 W for cutting and 50 W for hemostasis. The mean follow-up was 17 months (range 11-23 months). RESULTS: The data showed significant improvement in the symptom score, maximum flow rate, and postvoiding residual urine volume after treatment (P<0.01) in both groups. Comparing the symptom score, there was no difference between the two techniques (P = 0.88), the same occurring with the PVR (P = 0.78). However, the Qmax was higher after TURP (P = 0.02). The amount of tissue resected showed no statistical difference between the two techniques (P>0.05). Operative time, postoperative irrigation, catheter removal, and hospital stay were better with TUVP (P = 0.001). There was a statistically significant difference (P = 0.003) when we compared the occurrence of retrograde ejaculation with TURP (32%) and TUVP (65%) The TUVP using a regular loop, in addition to the advantage of the equipment and technique already being familiar to urologists, is efficient and reduces capital expenditure. CONCLUSION: The TUVP is a remake of TURP, with higher energy offering better results.     

Bipolar transurethral resection of prostate: a new reference standard?

PURPOSE OF REVIEW: Transurethral resection of prostate is the gold standard for the surgical management of benign prostate hyperplasia. Bipolar devices allow transurethral resection of prostate with saline irrigation, which lessens water intoxication and negates the need for diathermy pad and unwanted stimulation of the obturator nerves and cardiac devices. Several randomized clinical trials compare the various bipolar devices with conventional monopolar ones. For this review, we search all peer-reviewed published literature databases and present the evidence from them to substantiate its advantages and disadvantages. RECENT FINDINGS: Of the various types of bipolar devices, Gyrus has the longest clinical experience. Bipolar transurethral resection of prostate overcomes the shortcomings of bipolar transurethral prostate vaporization, which includes the absence of histology, postop irritative urinary symptoms and nondurable clinical outcomes. With bipolar transurethral resection of prostate, there is lesser bleeding which leads to shorter resection time and lower fluid absorption. This also enables shorter cathterization time and hospital stay. Transurethral resection syndrome has not been observed. SUMMARY: Bipolar transurethral resection of prostate has demonstrated similar clinical efficacy as monopolar transurethral resection of prostate with shorter catheterization and hospital stay. It eliminates the occurrence of transurethral resection syndrome and minimizes bleeding risk. Long term outcomes from these randomized clinical trials will determine the durability of its clinical efficacy and incidence of urethral strictures.     

The lipid story in chronic kidney disease: a long story with a happy end?

Cardiovascular (CV) morbidity and mortality increase with the severity of kidney disease, reaching 30 times higher mortality rates in dialysis patients compared with the general population. Although dyslipidemia is a well-established CV risk factor in the general population, the relationship between lipid disorders and CV risk in patients with chronic kidney disease (CKD) is less clear. Despite the clear evidence that statins reduce the risk of atherosclerotic events and death from cardiac causes in individuals without CKD, the use of statins in patients with kidney disease is significantly less frequent. For a long time, one of the explanations was the lack of a prospective, randomized, controlled study designed specifically to CKD patients. After recent publication of the data from Study of Heart and Renal Protection trial, given the safety and potential efficacy of statins, this lipid-lowering treatment should be administered more frequently to individuals with CKD stage 1–4, as well as those undergoing dialysis.     

Is a second transurethral resection necessary for newly diagnosed pT1 bladder cancer?

PURPOSE: We evaluated the potential benefit of a second transurethral resection in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Between January 2001 and May 2003, 80 patients with stage T1 bladder cancer were included in this protocol in which all patients prospectively received second TUR within 2 to 6 weeks following the initial resection. Patients with incomplete resections were excluded from study. The pathological findings of the second TUR were reviewed. RESULTS: Of the 80 patients who underwent second resection, 18 (22.5%) had macroscopic tumors before resection. However, with the addition of microscopic tumors, overall residual disease was determined in 27 (33.8%) patients. Of the 27 patients 7 had pTa, 14 had pT1, 3 had pT1+pTis and 3 had pT2 disease. Residual cancers were detected in 5.8%, 38.2% and 62.5% in G1, G2 and G3 tumors, respectively. The risk of residual tumor directly correlated with the grade of the initial tumor (p = 0.009). CONCLUSIONS: Although second TUR dramatically changed the treatment strategy in a small percentage of cases, we strongly recommend performing second TUR in all cases of primary pT1 disease, especially in high grade cases.     

The elephant man—A tragic syndrome

In 1884, Sir Frederick Treves first described a patient known as The Elephant Man because of grotesque facial and bodily deformities, presumably due to von Recklinghausen's neurofibromatosis. Because of these extreme deformities and disfigurements, this unfortunate man, although he was otherwise healthy, was socially ostracized and unable to live a normal life.This report concerns three modern examples of individuals whose great difficulty in enjoying life with other members of society was due to their peculiar appearances. Two of the patients suffered from neurofibromatosis and the third from multiple congenital nevi.A case is made for using the term elephant man syndrome for those who are made so ugly by certain congenital conditions that they are unable to function happily.A plea is made for plastic surgeons to apply their skills in these cases despite the excessive time and effort required, since aesthetic surgery here may be life-saving surgery.Hearts so touch'd, so pierced, so lost as mine. E're such a soul regain its peaceful state, How often must it love, how often hate How often hope, despair, resent, regret, Conceal, disdain—do all things but forget. Alexander PopePresented at the Annual Meeting of the American Society for Aesthetic Plastic Surgery, Inc., March 12, 1973Theodore F. Wilkie, the senior author of this paper, unfortunately passed away in 1977 before he could see the fruition of his work with the publication of this paper. His obituary was written in a previous issue of Aesthetic Plastic Surgery, volume I, page 319, in 1977 by Verner V. Lindgren.     

Partial spleen resection with a radiofrequency needle device—a pilot study

Introduction

Total splenectomy leads to an immunocompromised state, with an increased lifetime risk of infection. The lifetime risk of developing overwhelming postsplenectomy infection is 5 %, with a mortality rate of approximately 50 %. In addition to vaccination and antibiotic prophylaxis, partial splenectomy is believed to improve patient safety.

Methods

We performed partial splenectomy in seven patients using a radiofrequency (RF) technique with Habib® needles. In seven patients, an open access partial splenectomy was performed. In three patients, a partial splenectomy was performed simultaneously with intraabdominal tumour resection. In two patients, the upper pole of the spleen was removed due to tumours of the spleen. In one patient, a large symptomatic splenic cyst was resected and in another patient, a partial splenectomy was performed due to trauma. RF was applied using Habib® needles (AngioDynamics, Manchester, GA, 31816, USA).

Results

The partial splenectomy procedures were easy and safe in all seven patients. The RF application with the Habib® needles led to primary haemostasis. The blood loss was less than 50 ml in all cases. After a minimum follow-up of 1 year, there were no cases of infections or other adverse events related to the previous partial splenectomy.

Conclusion

In our experience, partial splenectomy with Habib® needles is easy to perform and safe for the patient. Thus, radiofrequency resection is a good alternative to total splenectomy in many patients and reduces the risk of postsplenectomy infections.     

John Orlando Roe—Not Jacques Joseph—The father of Aesthetic Rhinoplasty

By a careful analysis of numerous medical articles, this article emphasizes that John Orlando Roe (1848–1915), an otolaryngolotist from Rochester. New York, was the true father of aesthetic rhinoplasty-in contrast to the claims that incorrectly assign this role to Jacques Joseph of Berlin.Says Wells: A skillfull dissembler may disguise, in a degree, the expression of the mouth; the hat may be slouched over the eyes; the chin may be hidden in an impenetrable thicket of beard; but the nose will stand out and make its sign in spite of all proportions. It utterly refusses to be ignored, and we are, as it were, complelled to give it our attention [36]Presented at the XVIth Dalinde Medical Seminar on Aesthetic Surgery, Mexico City-Cuernavaca, March 18, 1986     

Is there a correlation between the outcome of transurethral resection of prostate and preoperative degree of bladder outlet obstruction?

To compare the impact of transurethral resection of prostate (TURP) on symptom scores and maximal flow rates (Qmax) in patients with equivocal bladder outlet obstruction (BOO) and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index (BOOI) greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual volume (PVR) check and transrectal ultrasound were performed. 20相似文献   

Tumor cytoreduction results in better response to androgen ablation—a preliminary report of palliative transurethral resection of the prostate in metastatic hormone sensitive prostate cancer

ObjectivesTo investigate the oncologic influence of transurethral resection of the prostate (TURP) as a cytoreductive surgery in metastatic hormone sensitive prostate cancer (mHSPC), in the setting of continuous complete androgen blockade (CAB).Materials and methodsMedical histories of 146 consecutive Chinese males with newly diagnosed mHSPC, registered in our institution in 2006 and 2007, were reviewed. All of these patients received CAB as initial systematic therapy. Demographics and cancer control outcomes from 39 mHSPC patients who underwent TURP for a relief of bladder outlet obstruction were compared with those of the other 107 who received CAB only when they were still hormone-sensitive. Median follow-up was 15 months (3 to 27 months).ResultsAge at diagnosis, baseline PSA, and biopsy Gleason score were comparable between the 2 groups. Patients who underwent a TURP had lower PSA nadir (median 0.15 ng/ml vs. 0.82 ng/ml, P = 0.015) and longer time to PSA nadir (11.2 months vs. 6.4 months, P < 0.001). More patients in the non-TURP group developed hormone refractory prostate cancer (P = 0.007). The TURP group had a tendency towards longer disease-specific survival and overall survival (24.4 months vs. 24.1 months and 24.4 months vs. 22.9 months, respectively), though this did not reach statistical significance.ConclusionsTURP resulted in a better and more prolonged response to hormone therapy in mHSPC, with a trend towards positive influence in disease specific survival and overall survival. To date, our preliminary report is the first study regarding long-term survival of cytoreductive surgery in mHSPC, and further investigations are warranted.