The risk and effectiveness of transurethral resection of prostate.

BACKGROUND: To advise a patient to have transurethral resection of prostate (TURP) needs information on the benefit and complications of the procedure. Quality assurance also needs present results to be compared with future ones. OBJECTIVES: The authors wanted to know: 1. Whether TURP can decrease theInternational prostate symptom score (IPSS) and improve the Quality of Life (QOL) scores concerning urination at 1.5 months post-operatively for at least 25 per cent of the pre-operative scores?; 2. What are the common medical diseases in this type of patient?; and 3. What are the mortality and immediate complications of TURPF? METHOD: This was a prospective, before-after design trial. All patients who came to have TURP at a tertiary care hospital were studied. IPSS and QOL scores were recorded before surgery and again when the patients came back to follow up at 1.5 months after discharge. Patients were evaluated for cardiopulmonary reserve and congestive heart failure. Anesthetic technique of choice was spinal anesthesia with 0.5 per cent bupivacaine. Anesthetic and surgical complications were recorded if the definitions were met. ANALYSIS: Pre-operative and 1.5 months post-operative scores were compared using paired t-test and 95 per cent confidence interval. RESULTS: During the 13 months there were 269 consecutive males who received TURP. The mean +/- SD age was 70.4 +/- 8.8 years (range 35-97). The mean difference between pre- and post-operative IPSS was 6.7 +/- 9.1 (95% CI 5.2-7.8). Quality of Life also improved, the mean difference between pre- and post-operative QOL was 3.2 +/- 1.6 (95% CI 2.9-3.5). Most patients had ASA class 2. Common pre-operative existing diseases were hypertension (31.6%), ischemic heart disease (18.2%), diabetes (15.6%), and COPD (7.1%). Anesthetic techniques were spinal block (77.3%), epidural block (5.9%), continuous epidural (11.2%), and general anesthesia (5.6%). Intra-operative complications were reported and T URsyndrome occurred in 1 patient (0.37%). There was one surgical death 3 days post-operation, due to septic shock probably from bowel perforation. CONCLUSION: The patients' symptoms and quality of life significantly improved, but there was 1 surgical death and 1 TUR syndrome among 269.

Scrotal flap penoplasty of the paraffinomas penis: 15 years of experience.

A two-stage scrotal flap penoplasty was carried out on a paraffinomas penis. In the first stage, total excision of the penile paraffin-containing skin was performed; The denuded penis was embeded in the subcutaneous tunnel of the scrotal sac. A scrotal skin flap for covering the penile shaft was separated after four months. During the past 15 years, a study was undertaken on 174 patients with an average age of 44 years (figure I). A satisfactory result was found in 148 patients, with 26 cases having required minor corrective surgery (table 1). Satisfactory sexual function was found in 168 patients, mildly painful intercourse in four patients and impotency in two cases (table 2). The post operative complications (table 3) were mild graft infection in 32 patients, partial graft necrosis in 11 cases redundant penile skin in 16 cases and tortious shape of the scrotum in 15 cases. All the patients presented to the hospital, complaining of abnormal penile shape and unsuccessful sexual intercourse.