Cardiovascular and hematological consequences of transurethral resection of the prostate [a clinical and experimental study]

A saline prostate extract was prepared from the prostatic tissue obtained during benign transurethral resection of the prostate [TURP] from several surgical specimens. Forty-eight adult male cats were studied. They were assigned into two main groups: Group A [n = 24] in which the cats were heparinized during the experimental procedure for measuring the blood pressure, ECG and serum Na; group B [n = 24] in which the cats were not heparinized and hemoglobin, hematocrit, platelet count, prothrombin time [Pt] and concentration [PC], activated partial thromboplastin [APTT], fibrinogen and fibrinogen degradation product [FDP] were measured at 0, 60, 90 and 120 minutes post infusion. Each of groups A and B were further subdivided into subgroups [six cats each] according to infusion: group 1C, saline 15 ml [control for group 1]; group 1, saline prostate extract 15 ml; group 2C, saline 0.5 L/kg [control for group 2]and group 2, glycine 0.5 L/kg. A 90-minute infusion interval was selected for the model to correspond with the maximal infusion period that occurred clinically. Twenty-five patients ASA class I or II were prospectively randomized to undergo TURP under spinal anesthesia. All patients had symptomatic benign prostatic hyperplasia. In conclusion, the experimental work proved that infusion of prostate tissue extract resulted in no statistical or clinical changes in MBP, HG, or ECG; so, it was suggested that glycine is responsible for the cardiovascular changes during TUR syndrome. On the other hand, infusion of prostatic tissue extract resulted in coagulation defects which may contribute to postoperative morbidity. However, the exact mechanism of coagulopathy still needs further investigations to be more specified. Meanwhile, because TURP is one of the most popular urology surgeries in elderly patients all over the world, a care must be taken especially when the size of the gland is over 30-35 g and the duration of surgery is more than 40 minutes

Orthotopic ileal bladder substitution [CAMEY II] following radical cystectomy using the linear-cutter stapling device

To evaluate the safety, efficacy and potential benefits of using the linear-cutter staplers in the ileal reanastomosis and ileal pouch reconstruction following radical cystectomy in patients with invasive carcinoma of the urinary bladder. We performed radical cystectomy and orthotopic ileal bladder substitution [Camey II] procedure in 20 patients with invasive carcinoma of the urinary bladder. In 10 patients the linear-cutter stapling device was used for the ileo-ileal reanastomosis and reconstruction of the pouch, while in the other 10 patients, the standard hand-suturing technique was used. The operative time and blood loss from the time of mobilization of the ileal segment to the time just before urethral anastomosis were calculated. Using the linear cutter-stapler in the ileo-ileal reanastomosis and ileal pouch reconstruction, saved approximately 1-1.5 hours of the operative time as mil as significant reduction of blood loss during this period. The leakage rate and hospital stay were less in patients with stapled pouch, but since most leakages were from the urethro-ileal anastomosis, the method used had no direct influence. The use of linear cutter staples in ileal reanastmosis and orthotopic ileal bladder substitution following radical cystectomy reduces significantly the operative time and blood loss without increased morbidity. The main question remains whether this equalizes the high cost of stapling devices

Ureteral meatotomy by endoscopic knife electrode in the management of large stones impacted in the intramural ureter

Transurethral meatotomy with knife electrode or Collings ' knife was done in 18 patients who either had a stone impacted in the intramural ureter and not suitable for ureteroscopic manipulations due to its large size [13] or when the dormia basket became impacted during attempts to extract the stone [5]. The stone was recurrent following open surgery in 10 of the 18 patients. This method resulted in successful endoscopic removal of the stones in all patients. Vesicoureteric reflux was detected in 10 patients at 1 month and in only 3 patients at 3 months. Follow up of these patients revealed no symptomatic upper tract infection or renal damage caused by this reflux. It was concluded that endoscopic ureteral meatotomy is recommended for the removal of impacted intramural ureteric stones not suitable for ureteroscopic manipulations or stones impacted in the dormia basket at the ureteric orifice, especially in recurrent cases