Anesthesia in transurethral surgery

Transurethral resection (TUR) is a surgical operation generally performed in elderly patients, afflicted with polymorbidity and a high risk for anaesthesia. We studied 1351 transurethral resections during the years 1974-1984: 840 of these procedures were done under regional block--spinal as well as epidural--and 511 in general anaesthesia. Results and complications were related to the applied technique of anaesthesia. Considering that especially the very old patients belong to the regional anaesthesia group where general anaesthesia is known to be dangerous, the results of this study confirm definitely that regional anaesthesia is at present the most appropriate technique for TUR surgery.     

Characteristics of various electrodes for transurethral surgery

The characteristics of four electrodes for transurethral surgery were examined by resection experiments using porcine muscles. The electrodes were a loop type (uroloop, ENDO care), a roller type (STORZ), VAPOR CUT (STORZ) and WEDGE (Microvasive Co). With the stroke rate fixed at 1.2 cm/second and the electrical output changed to 200, 220, 240 W, the electrode was moved manually by 1 stroke for resection. Sections were weighed, histological changes on the cut surface were observed under a microscope and the excised + vaporized layer and desiccated layer were measured. A similar study was also made with the electrical output fixed at 200 W and the stroke rate changed to 0.6, 1.2, 2.4 cm/second. When the output was increased, the excised + vaporized layer and desiccated layer became deep with the roller-type. The excised + vaporized layer became deep and the desiccated layer tended to become deep with the UROLOOP and VAPOR CUT. No change in either layer was found with WEDGE. When the stroke rate was increased, both excised + vaporized layer and desiccated layer became shallow with VAPOR CUT, but only the desiccated layer became shallow with WEDGE. In conclusion, the proper output and stroke rate were considered to be 240 W and not more than 0.6 cm/second with the roller-type, 220-240 W and 0.6 cm/second with VAPOR CUT and 200 W and 1.2 cm/second with WEDGE.     

Antibiotic prophylaxis in transurethral surgery

In a prospective randomized double-blind study, perioperative prophylaxis with cefoperazone, a third-generation cephalosporin, in transurethral surgery was evaluated. Cefoperazone significantly lowered the urinary tract infection rate from 17 per cent to 0 per cent, five to seven days postoperatively. Results from the latest placebo-controlled studies concerning antibiotic prophylaxis in transurethral surgery are summarized, and the use of antibiotic prophylaxis is discussed and recommended.     

Evaluation of antiseptic use in plastic and hand surgery

Despite the growing complexity of plastic surgical cases, antiseptics available for preoperative preparation do not always prove effective. In addition to the varied sites of plastic surgery, there is a likelihood of considerable contamination with microorganisms since surgical gloves are frequently punctured during surgical procedures. With an aim to find a solution to all of these problems, a study was conducted in 2 stages. First, antimicrobial effects on the normal flora of hands of 4 different surgical handwashing procedures, which consist of scrubbing with 7.5% povidone-iodine (PI) scrub by using the sponge/brush, 7.5% PI scrub alone, 0.5% benzalkonium chloride (BC) solution, and 0.1% BC solution, were compared. In the second stage, bacteriological samplings were obtained from fingertips of the operating team during the surgical procedure. At the end of the study, the following results were obtained: (1) scrubbing with 7.5% PI detergent by using a scrub sponge was significantly more effective than without using a scrub sponge (P < 0.05). (2) There was no statistically significant difference in scrubbing when povidone-iodine detergent and 0.5% benzalkonium chloride solution (P > 0.05) were compared. (3) At the end of the surgery lasting 1-5 hours, hands were found to be cleaner than previously washed hands for preoperative preparation, which was considered a consequence of the sustained effect of PI. (4) There was a statistically significant difference between the cultures taken from the gloves at the end of the operation and from the hands after the gloves were taken off (P < 0.01). At the end of the operation, the gloves themselves were found to be extremely dirtier than the hands inside them. As a conclusion, bacterial escape due to glove perforation occurs from outside of the glove to the inside, contrary to the generally accepted concept.     

Evaluation of a blood gas and chemistry monitor for use during surgery

An observational study was performed to evaluate a new blood gas and chemistry monitor (GEM-6 Diamond Sensor Systems, Ann Arbor, Michigan) in nine patients during cardiac surgery. Paired blood samples were analyzed by the instrument under test and by standard clinical laboratory instruments. The differences between the measurements of the new and the standard instruments are summarized as follows (mean +/- standard deviation, units of measure, number of samples): pH (-0.039 +/- 0.02, 154); PCO2 (2.63 +/- 1.8 mmHg, 154); venous PO2 (-2.0 +/- 3.0 mmHg, 72), hematocrit (4.7 +/- 2.7%, 98), potassium (0.18 +/- 0.13 mmol, 100), and ionized calcium (0.195 +/- 0.11 mmol, 100). Because the differences in arterial PO2 measurements were markedly heteroscedastic, a logarithmic transformation was employed, which upon retransformation gave the test instrument's 95% confidence limits as within 5.1% below to 46% above the nominal value on 82 samples. However, on the 14 samples having nominal values below 165 mmHg (the upper limit of the calibrated range of the GEM-6) the 95% confidence limits were from 5.4% below to 23.6% above the nominal reading. No failures of the test instrument occurred during the evaluation, and quality control standards run before, midway through, and again after sampling from each patient all gave readings within the manufacturer's tolerance. For all variables except hematocrit and ionized calcium, this instrument matches the values from the laboratory well enough over the clinically important range to supplant it for intraoperative monitoring purposes.     

Retinal tolerance of an implantable light source for use during vitrectomy surgery.

To assess for the possible development of a phototoxic lesion, we exposed five Dutch belted rabbit retinas to constant illumination with an implantable "chandelier" light source at maximal intensity for 1 hour. No clinically apparent lesion developed in any of the experimentally treated eyes by 48 to 72 hours posttreatment. Light and electron microscopic examination failed to reveal any of the characteristic changes of retinal phototoxicity. A control eye treated with a 20-minute exposure to a standard endoiluminator probe at maximal intensity held 2 mm from the retinal surface demonstrated typical light and electron microscopic phototoxic abnormalities, whereas a retina similarly treated with a 5-minute exposure was normal. We have confirmed that a standard endoilluminator probe can create a phototoxic lesion in the experimental setting. Furthermore, no phototoxicity from the sustained retinal exposure to a fixed, implantable light source for a clinically relevant duration could be demonstrated.     

Accurate obturator nerve block in transurethral surgery

Twenty-two patients with ureteral stones underwent twenty-four-hour urinary excretion studies of calcium, phosphorus, and uric acid before and after stone elimination from the urinary tract. Comparison of pre- and post-stone elimination studies showed no significant differences suggesting that the presence of stones in the urinary tract has little influence on the twenty-our-hour urinary excretion of calcium, phosphorus, and uric acid.     

经尿道电气化术联合电切术治疗前列腺增生症(附122例报告)

目的 :探讨良性前列腺增生症 (BPH)的有效治疗方法。方法 :联合应用经尿道前列腺电气化术(TUVP)和经尿道前列腺电切术 (TURP)治疗BPH患者 12 2例 ,平均年龄 72 .3岁 ,其中Ⅰ度增生 8例 ,Ⅱ度增生5 1例 ,Ⅲ度增生 37例 ,Ⅳ度增生 2 6例。结果 :手术操作时间 30～ 15 0min ,平均 74.2 9min。 1例 (0 .8% )术中输血40 0ml,2例 (1.6 % )术后输血 2 0 0～ 40 0ml。发生 1例 (0 .8% )电切综合征。术后平均留置导尿管 5d。随访 1～10个月 ,国际前列腺症状评分 (IPSS)由术前 (2 9.8± 1.5 )分降至术后 2个月 (10 .9± 1.0 )分 (P <0 .0 1) ,排尿通畅 ,并发症少。结论 :TUVP与TURP联合应用治疗BPH具有二者的优点 ,出血少 ,能切除更多前列腺组织 ,并发症少 ,疗效显著     

经尿道汽化电切加电切术治疗前列腺增生症(附256例报告)

目的　探讨良性前列腺增生症(BPH)的有效治疗方法。方法　采用经尿道前列腺汽化电切(TUEVAP)加经尿道前列腺电切术(TURP)联合治疗BPH患者256例。结果　手术时间20～125min,平均62min。29例(11.3%)术中需输血200～600ml,均为Ⅲ°增生者。切除前列腺组织重量8～120g,平均38g。无电切综合征发生。术后3～5d拔除导尿管,排尿均通畅。180例随访6个月～2年,IPSS由术前28.8±2.0下降至术后7.2±0.3(P<0.01),最大尿流率由术前平均(5.1±0.4)ml/s升至术后(16.7±1.8)ml/s(P<0.01)。B超复查124例,38例(30.7%)仍有剩余尿10～40ml,平均18.2ml。术后继发性出血12例(4.7%),尿道狭窄8例(3.1%),暂时性尿失禁3例(1.2%)。结论　TUEVAP加TURP联合治疗BPH可综合两者的优点,疗效显著,并发症少,安全性高,是治疗BPH的有效方法。     

Evaluation of the safety of recent surgical microscopes equipped with xenon light sources

Although recent surgical microscopes for neurosurgery are equipped with xenon light sources to obtain bright fields of vision, the safety of a xenon beam, which has strong energy intensity in a long ultraviolet light, for cortical neurons has not been evaluated. Cranial windows were made in the parietal bones of gerbils. The skull of each gerbil was covered with warmed saline (0.5 mm in depth) to maintain the brain temperature. Ultraviolet irradiation (365-nm) was performed for 30 minutes at energy levels of 9.6, 4.4, 1.3, and 0.3 mwatts/cm(2), and neuronal damage was observed in 90 +/- 4%, 42 +/- 23%, 9 +/- 6%, and 0 +/- 0% of pyramidal cells in the parietal cortex 24 hours later. With the use of a logistic regression curve, the energy level causing 50% of neuronal damage was estimated to be 5.4 mwatts/cm(2). By increasing the thickness of the saline layer over the skull surface (1 mm and 2 mm), neuronal damages were significantly attenuated (21 +/- 18% and 10 +/- 8%, respectively, 4.4 mwatts/cm(2). Because the highest energy levels of 365-nm ultraviolet rays emitted from surgical microscopes measured in the present study (0.379 mwatts/cm (2)) were much closer to the dose causing 0% damage than to the dose causing 9% damage, the risk of neuronal injury occurring during microsurgery could be negligible. However, care should be taken in patients who take medicine classified as photosensitizing agents, such as diphenylhydantoin, which are thought to concentrate ultraviolet energy. The use of saline over the cortical surface may be beneficial for reducing the detrimental effects of 365-nm ultraviolet light.     

Evaluation of transurethral application of alprostadil for erectile dysfunction in Indonesians

Aim: To evaluate the efficacy and safety of transurethral application of alprostadil (MUSE.) for the treatment of erectile dysfunction in Indonesians. Methods: Twenty erectile dysfunction patients aged between 32 - 74 years old were recruited in this study. The inclusion criteria were as follows: 1 ) adult males 18 years or older with a subjective complaint or erectile dysfunction, 2) to provide written informed consent, 3) to agree not to use other forms of treatment for erectile dysfunction, 4) fulfill the screening laboratory values. Part 1, eligible patients were titrated in the clinic starting with a dose of 250 μg and proceed in a stepwise manner to 500μg and 1000μg on separate clinic visits until they identified a dose that produced a satisfactory response. The interval between each in-clinic titration was 2-3 days. Each in-clinic titration dose was evaluated at 15 min intervals over a one hour period for erection assessment, blood pressure and pulse. Part 2, patients used MUSE at home for three months at the dose identified during the inclinic titration. Monthly interim visits were required for patient follow-up and drug distribution. At the end of the study, patients had another laboratory (except testosterone, only assayed in screening procedure) and physical examination. Results: The etiology of erectile dysfunction was psychological in 5 patients and organic in 15 patients. The 65% of the patients achieved the erection scale of 4 or 5 either in the clinic or at home, 10% achieved the scale of 4 at home, but not in the clinic, and 25 % only achieved the scale of 2 or 3 with the highest dose of 1000μg either in the clinic or at home. No significant differences were found in biochemical examination before and after the study. The 60 % of the patients who achieved erection scale 4 or 5 continued to use MUSE until the end of the study, while 40 % of them complained of pain at the time of MUSE application, during erection and/or during intercourse. They withdrew from the study. Conclusion: Transurethral application of alprostadil (MUSE) is effective and safe to produce erection sufficient for intercourse in erectile dysfunction of various etiologies. Pain during application, erection and intercourse is a common side effect and a cause of withdrawal.