Conservation de l'ejaculation au cours de la resection transurethrale de prostate

Objective: To evaluate the role of partial prostatectomy in the management of bladder outlet obstruction due to benign prostatic hyperplasia (BPH) and to illustrate the indications and results with regard to micturition and preservation of antegrade ejaculation. Patients and Methods: Sixty-nine patients with a mean age of 53 years (range: 40 - 85 years) who had undergone partial prostatectomy for BPH were followed up between January 1997 and December 2002. Details on the quality of micturition and ejaculation of each patient were obtained via telephone calls after a period of at least 6 months following surgery. Results: As for micturition; good results were reported by 75;36(52/69) of the patients; while 23;19(16/69) and 1;45(1/69) of the patients reported satisfactory and unsatisfactory results; respectively. Antegrade ejaculation could be achieved in 97;1(67/69) patients. Conclusion: We conclude that partial prostatectomy as suggested by Hermabessiere3 is a technique which allows for the preservation of antegrade ejaculation. It is of special interest in the young patient; but can also be applied in the elder man

Scheduling tunneling TURP in carcinoma of the prostate

Objective Some patients with obstructing carcinoma of the prostate may fail to resume spontaneous voiding following bilateral orchidectomy. This group of patients would require an additional procedure in the form of limited transurethral resection of the prostate gland (tunneling TURP) to be able to resume spontaneous voiding. The objective of this study was to compare performing simultaneous tunneling TURP and bilateral orchidectomy on one hand with deferring channel TURP for at least one month after bilateral orchidectomy in cases where the patient has failed to resume spontaneous voiding on the other. Patients and Methods Forty-seven patients with obstructing carcinoma of the prostate were studied. Group I consisted of 22 patients who had simultaneous bilateral orchidectomy and tunneling TURP of the prostate; while Group II consisted of 25 patients who had tunneling TURP at least one month after bilateral orchidectomy. The groups were compared with regard to the ease of operation and postoperative management. Results Intra-operative bleeding; the need for repeated cleaning of the resection loop; the operating time and the hospital stay were significantly less in Group-II patients compared to Group I. Conclusion The results suggest that tunneling TURP when performed at least one month after bilateral orchidectomy allows enough time for a significant reduction of tissue friability; tissue adhesion to the resection loop; tumor circulation; intra-operative bleeding; operating time and postoperative hospital stay

Transurethral microwave thermotherapy (TUMT) in locally advanced carcinoma of the prostate

Objective Though systemic prostatic cancer disease eventually results in the patient's death; locally advanced disease may be associated with severe morbidity. The therapeutic options currently available include hormonal manipulation; radiotherapy or transurethral resection. Previous reports have suggested that local prostatic hyperthermia may have a dramatic effect on local and systemic malignant disease. This study aimed at evaluating the effect of transurethral microwave thermotherapy (TUMT) on locally advanced prostate cancer. Patients and Methods The study included 30 patients suffering from various degrees of bladder outlet obstruction secondary to advanced hormone-refractory prostate cancer. TUMT was delivered using the Prostalund machine (Lund Science - Sweden) weekly for 6 weeks. Transurethral heating was achieved via a Foley urethral catheter provided with microwave antenna; temperature sensors and cooling channels. The rectal temperature was monitored via rectal thermosensors mounted on a specially designed rectal probe. All the patients were evaluated before and after treatment; at 1 month; at 3 months and at 1 year. Results The mean pretreatment Boyarsky symptom score was 13.73 + 4.15. At 1 month; 3 months and 1 year follow up the mean Boyarsky symptom score was 8.73 + 4.14 (P=0.0001); 9.09+3.71 (P

Endoscopic transurethral resection of bilharzial ulcers in the urinary bladder. Single-center experience with 1000 patients

Objective To report on the results of endoscopic transurethral resection of chonic bilharzial ulcers of the urinary bladder at the Assiut University Hospital; Assiut; Egypt. Patients and Methods Between June 1995 and April 2001; 1000 patients (87.3males and 12.7females) with chronic bilharzial ulcers (78de novo and 22recurrent ulcers after previous open partial cystectomy) were treated by endoscopic transurethral electroresection (TUR) at our department. Single ulcers were diagnosed in 612 (61.2); double ulcers in 261 (26.1) and multiple ulcers in 127 (12.7) patients. Ulcers of a moderate diameter (1-2 cm) were present in 505 (50.5) patients. Electroresection was done until healthy fibers of the detrusor muscle or even the prevesical fat was reached. Results The mean duration of the resection was 19.8 minutes. Extraperitoneal bladder perforation was recorded in 11 patients (1.1). In all these patients conservation was successful. Intraperitoneal bladder perforation was recorded in 16 patients (1.6). In six out of these patients conservation was successful; while peritoneal drainage was necessary in the remaining cases. Conservative management was successful in 5 cases (0.5) of secondary haemorrhage. Hospitalization was one day in 920 patients (92). After six months 862 patients (86.2) were available for follow up. 745 (86.4) were symptom-free and 794 (92.1) reported complete healing of the resected ulcer at follow-up cystoscopy. Conclusion Endoscopic transurethral electroresection is a satisfactory modality for the treatment of bilharzial ulcers of the urinary bladder

La résection transurétale de la prostate à l'hôpital Sanou Souro de Bobo-Dioulaso: à propos de 68 cas

Objectif Analyser la faisabilite et l'innocuite des resections transuretrales des prostates (RTUP) dans notre hopital. Patients et Methodes Une etude retrospective a ete faite couvrant la periode du 1er janvier 1994 au 31 decembre 2000. Soixante-huit dossiers ont ete retenus. L'analyse portait sur les resultats peroperatoires et post-operatoires immediats des resections. Resultats Le success de la technique etait de 88;20. Il y avait 11;80de complications peroperatoires. Le taux de conversion etait de 11;80. La duree moyenne de sejour hospitalier postoperatoire a ete de 6;7 jours. La mortalite operatoire a ete de 4;41. Conclusion La RTUP reste une technique a faire passer dans la routine car elle constitue un plus dans la gamme de nos prestations chirurgicales en urologie

Mortalite et morbidite precoces apres adenomectomie prostatique par voie transvesicale

Objectif Evaluer la mortalite et la morbidite precoces apres adenomectomie prostatique par voie transvesicale. Patients et Methodes Nous avons realise une etude descriptive pro-spective de Mars a Juin 1997. Quatre-vingt quatorze patients ont ete inclus. Tous les patients ont fait l'objet d'une evaluation clinique comportant un toucher rectal; ils ont egalement bene-ficie d'une echographie prostatique sus-pubienne. Le bilan pre-operatoire a comporte un dosage de la creatininemie et un bilan complet de l'hemostase. L'adenomectomie prostatique selon la technique de Hrynstchack a ete pratiquee chez tous les patients. Le suivi post-operatoire a consiste en un examen clinique quotidien; les patients ont ensuite ete revus a 1 mois puis a 3 mois. Les incidents et accidents per-operatoires et post-operatoires ont ete notes. Resultats La moyenne d'age de nos patients etait de 70;5 ans avec des extremes de 53 et 93 ans. Le volume moyen de la prostate mesure a l'echographie etait de 95;5 cc avec des extremes de 33 et 324 cc. Avant l'intervention; 54des patients etaient porteurs de sonde. Une cure simultanee de hernie a ete realisee dans 19des cas. La duree moyenne de l'intervention etait inferieure a une heure dans 63des cas. Aucun patient n'a ete transfuse en per-operatoire. Le delai moyen de port de sonde en post operatoire etait de huit jours avec des extremes de deux et 17 jours. La morbidite post-operatoire se resumait en un abces de paroi dans 19des cas; une fistule vesico-cutanee dans 15des cas et une orchiepididymite aigue dans 5des cas. Nous avons egalement note une pollakiurie dans 18des cas; une dysurie dans 8des cas et une imperiosite mictionnelle dans 3;2des cas. La mortalite a ete estimee a 2;14des cas. Conclusion Si la mortalite apres adeno-mectomie prostatique est faible; la morbidite reste elevee. Cette derniere; dominee par les complications infectieuses; est due aux larges indications de la chirurgie ouverte dans un environnement operatoire parfois precaire. C'est dire la necessite de developper la chirurgie par voie endoscopique

Transrectal ultrasound-guided biopsy : a prospective study of patients tolerance and complications

Objectives To determine the morbidity and patient tolerance of TRUS-guided biopsy from suspected malignant prostate or pelvic recurrence after radical cystectomy. Patients and Methods This prospective study comprised 113 patients who underwent TRUS-guided biopsy from the prostate or from pelvic recurrence following radical cystectomy. The patients' tolerance was assessed by scoring the severity of discomfort during the procedure and their acceptance was estimated by questionnaires following it. Results Most patients (56.6) experienced either no discomfort at all or only mild pain during the procedure. Intravenous sedation was needed in 31of the patients and general anaesthesia was necessary in two patients. Haematuria was the commonest complication (59.6) followed by rectal bleeding and haemospermia; which occurred in 36.7and 17.4of the patients; respectively. A vasovagal attack occurred in one patient. There was one major complication; a prostatic abscess which resulted in a temporary urethro-rectal fistula. Conclusion TRUS-guided core biopsy is safe with frequent minor but` very rare major complications. The majority of the patients tolerate the procedure with accepted discomfort but a considerable number of patients need sedation to complete the procedure effectively