Monopolar electrocautery, an alternative novel method of hemostasis during radical cystectomy: preliminary report

During radical cystectomy, local hemostasis is a critical factor for surgical success. It can be accomplished with a variety of techniques including mechanical compression, ligatures, auterization and laser. The aim of this work was to evaluate monopolar electrocautery alone for achieving hemostasis during radical cystectomy. In this prospective study 30 patients were scheduled for radical cystectomy over a period of 2 years at Al-Azhar University Hospitals using monopolar electrocautery as the only hemostatic tool. The parameters studied were: operative time, estimated blood loss and incidence of complications. The data were analyzed clinically and statistically. Monopolar electrocautery as the only hemostatic tool during radical cystectomy resulted in a short operative time [35 +/- 5 minutes]. The mean estimated blood loss was 150 +/- 50 ml. Intraoperative bleeding was encountered in 2 patients only and they received blood transfusion. The overall post-operative early [within the fi rst month] complication rate was low [13.3%] and all complications were managed conservatively. Monopolar electrocauterization is a safe method for achieving hemostasis during radical cystectomy, with a signifi cantly short operative time, low cost, low blood loss, a low cystectomy-related complication rate and a short hospital stay

Hand-assisted laparoscopic live-donor nephrectomy [HALDN] improves outcomes and results in increased kidney donation

Laparoscopic live-donor nephrectomy [LDN] has acquired an important role in the era of minimally invasive surgery. Modifications such as hand assistance may improve surgical outcomes with increase in organ donation. This study was performed to evaluate the impact of hand-assisted laparoscopic live-donor nephrectomy [HALDN] on kidney allograft function, peri-operative complications and organ supply. The results of 34 HALDON procedures carried out between July 2004 and January 2006 were evaluated retrospectively. Serum creatinine at discharge, length of hospital stay, estimated blood loss, operative time, warm ischemia time, use of analgesia and peri-operative complications were analyzed in donors and recipients. Also the number of volunteers of kidney donation was recorded. The mean values for donors and recipients subjected to the procedure were as follows: 1.2 and 1.3 mg/dL for creatinine at discharge, 2.7 and 7.4 days for length of hospital stay, and 77.8 and 98.2 mL for estimated blood loss, respectively. No major complications were encountered in the donors. Immediate dieresis after renal re-perfusion was observed in 97.1% of the recipients. Following implementation of the laparoscopic program the number of living kidney donors has increased by 90% compared to the mean of the previous 4 years. HALDN is a safe and minimally invasive procedure, giving the chance to use tactile sense to facilitate dissection, retraction and exposure, thus improving the outcome and resulting in excellent allograft function and significantly increased donation

Reduced dose of finasteride can equally be effective in patients with benign prostatic hyperplasia [BPH]

Finasteride is widely used for the treatment of benign prostatic hyperplasia [BPH]. Its therapeutic efficacy is believed to be mediated through selective inhibition of prostatic 5 alpha- reductase [type II]. The recommended dosage is 5 mg a day. However some studies have show effectiveness with lower doses. The aim of this study is to determine whether patients under 5mg Finasteride can maintain improvements in urinary obstruction when treated with 2.5 mg of finasteride daily for one year. 54 patients with benign prostatic hyperplasia, previously treated for at least one year with 5mg of finasteride, took 2.5 mg of finasteride daily for one year, Assessment included AUA flow rate, voided volume, or AUA symptom score after one year of finasteride 2.5 mg daily therapy. So, we can conclude that the daily dose of finasteride can be reduced to 2.5 mg daily without significant effect on subjective and objective measures of urinary obstruction in patients with BPH

Impact of lymph nodes involvement after radical cystectomy on patient survival

To evaluate the role of pelvic lymph node dissection [PLND] during radical cystectomy for bladder cancer as regards to the extent of nodal dissection and the necessary number of lymph nodes to be removed. Retrospective study was done on 198 patients with invasive bladder cancer treated with radical cystectomy and urinary diversion. Regional PLND include internal iliac, external iliac, and obturator nodes. The study evaluates the impact of pelvic lymph node involvement and the number of nodes removed during surgery on survival of patients. Lymph node metastases were detected in 54 patients [27.3%]. The average number of nodes removed in the node-positive and node-negative patients was 13.7 and 14.4 respectively. Although no difference was found in disease-specific survival in the node-negative patients when stratified by the number of nodes removed [13 or more versus less than 13], a significant survival advantage was found in the node-positive patients with 13 or more nodes removed versus less than 13 nodes removed. The patients with four or more positive nodes had a worse outcome than those with less than four positive nodes. However, even if the patients had less than four positive nodes, the survival of patients with less than 13 nodes removed was as poor as that of the patients with four or more positive nodes. In this series, the removal of 13 or more pelvic lymph nodes was essential for more accurate pathologic examination to predict patient outcome and contributed to an increased chance of survival