Addition of lidocaine to levobupivacaine reduces intrathecal block duration: randomized controlled trial / Adição de lidocaína à levobupivacaína reduz a duração do bloqueio intratecal: estudo clínico randômico / La adición de lidocaína a la levobupivacaína reduce la duración del bloqueo intratecal: estudio clínico aleatorizado

Background: The duration of the spinal block is a concern for anesthetists. Low dose intrathecal lidocaine has vasodilatory effects and increases the local anesthetic clearance from the intrathecal space. The aim was to investigate whether this effect of lidocaine can be used to increase the resolution of levobupivacaine spinal anesthesia. Method: After obtaining ethical approval and informed patient consent, 40 patients underwent transurethral prostate resection were studied. Patients were randomized into two groups and patients received either levobupivacaine 6.75 mg + 0.3 mL 2% lidocaine (Group L) or levobupivacaine 6.75 mg + saline (Group C). The main outcome measures were the difference between groups regarding the duration of the spinal block and PACU stay. Secondary outcome measures were the difference between groups in onset and resolution of the spinal block, adverse events and treatments were also investigated. Results: Spinal block resolved faster in Group L than Group C; 162.43 ± 39.4 min vs 219.73 ± 37.3 min (p = 0.000). PACU time was shorter in Group L (109 ± 49.9 min in Group L vs 148 ± 56.8 min in Group C) (p = 0.036). There was no difference between groups with respect to the incidence of adverse events and treatments. Groups were also similar regarding complications. PDPH and TNS were not observed in any group. Conclusion: Addition of low dose lidocaine to hyperbaric levobupivacaine reduces the duration of the intrathecal block provided by hyperbaric levobupivacaine. This technique can be used to reduce the spinal block duration for relatively short procedures like TUR-P. .

Justificativa e objetivo: a duração do bloqueio espinhal é uma preocupação para os anestesistas. Lidocaína intratecal em dose baixa tem efeito vasodilatador e aumenta a eliminação do anestésico local do espaço intratecal. O objetivo deste estudo foi analisar se esse efeito da lidocaína pode ser usado para aumentar a resolução da anestesia espinhal com levobupivacaína. Método: após obter aprovação do Comitê de Ética e consentimento informado, 40 pacientes submetidos à ressecção transuretral da próstata foram incluídos no estudo. Os pacientes foram randomizados em dois grupos e receberam6mgde levobupivacaína + 0,3 mL de lidocaína a 2% (Grupo L) ou6,75mgde levobupivacaína + solução salina (Grupo C). O desfecho primário foi a diferença entre os grupos em relação à duração do bloqueio espinhal e a permanência na sala de recuperação pós-anestésica (SRPA). Os desfechos secundários foram a diferença entre os grupos em relação ao início e à resolução do bloqueio espinhal; eventos adversos e tratamentos também foram investigados. Resultados: a resolução do bloqueio espinhal foi mais rápida no Grupo L do que no Grupo C: 162,43 ± 39,4 min vs. 219 ± 37,3 min (p = 0,000). O tempo na SRPA foi menor no Grupo L do que no Grupo C: 109 ± 49,9 min vs. 148 ± 56,8 min (p = 0,036). Não houve diferença entre os grupos em relação à incidência de eventos adversos e tratamentos. Os grupos também foram semelhantes no que diz respeito a complicações. Cefaleia pós-punção dural (CPPD) e sintomas neurológicos transitórios (SNT) não foram observados em nenhum grupo. Conclusão: a adição ...

Justificación y objetivo: la duración del bloqueo raquídeo es una preocupación para los anestesistas. La lidocaína intratecal en dosis baja tiene un efecto vasodilatador y aumenta la eliminación del anestésico local del espacio intratecal. El objetivo de este estudio fue analizar si ese efecto de la lidocaína puede ser usado para aumentar la resolución de la anestesia raquídea con levobupivacaína. Método: después de obtener la aprobación del Comité de Ética y el consentimiento informado del paciente, fueron incluidos en el estudio 40 pacientes sometidos a resección transuretral de próstata. Los pacientes fueron aleatorizados en 2 grupos y recibieron 6 mg de levobupivacaína + 0,3 mL de lidocaína al 2% (grupo L) o 6,75 mg de levobupivacaína + solución salina (grupo C). El objetivo primario fue analizar la diferencia entre los grupos con relación a la duración del bloqueo raquídeo y la permanencia en la sala de reanimación postanestesia. El secundario fue la diferencia entre los grupos con relación al inicio y al término del bloqueo raquídeo. También se investigaron los eventos adversos y los tratamientos. Resultados: la resolución del bloqueo raquídeo fue más rápida en el grupo L que en el grupo C (162,43 ± 39,4 min vs. 219,73 ± 37,3 min [p = 0,000]). El tiempo en la sala de reanimación postanestesia fue menor en el grupo L que en el grupo C (109 ± 49,9 min vs. 148 ± 56,8 min [p = 0,036]). No hubo diferencia entre los grupos con relación a la incidencia de eventos adversos y tratamientos. Los grupos también fueron similares en lo que respecta a las complicaciones. No se observó en ningún grupo ni cefalea pospunción dural ni síntomas neurológicos transitorios. Conclusión: la adición de una ...

Clinical observation on analgesic effect of flurbiprofen for spastic pain after TUR-P / 局解手术学杂志

Objective To observe the analgesic effect and its complications of flurbiprofen axetil for spastic pain after transurethral re-section of prostate( TUR-P) . Methods 40 patients who were clinically diagnosed as benign prostatic hyperplasia and underwent TUR-P were randomly divided into the experimental group (n=20)and the control group(n=20). When the postsurgical spastic bladder pain happened, the patients in the experimental group received intravenous drip of flurbiprofen axetil 100 mg with saline 500 mL,and the patients in the con-trol group received intramuscular injection of pethidine hydrochloride 100 mg. If its effect is not good,100 mg bucinnazine hydrochloride were injected. Analgesia efficacy was assessed by visual analog scales( VAS) at 30 min,1 h,2 h,4 h,6 h and 8 h after medication. At the same time,the side-effects and complications were observed and recorded. Results There is no statistical difference between the experimental group and the control group at 30 min,1 h, and 2 h after medication(P>0. 05),but at 4 h,6 h and 8 h after medication,VAS score of the experimental group is obviously lower than that of the control group(P0. 05). Conclusion Intravenous drip of flurbiprofen axetil can be an ef-fective and safe way of curing postsurgical spastic bladder pain after TUR-P.

Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

La vaporización fotoselectiva del adenoma prostático con el ktp-láser (kalium-titanyl-phosphat) de 80 watt y la RTU-P de baja presión hidráulica / The photoselective vaporization of prostate adenoma with the 80 watt ktp-laser (kalium-titanyl-phosphat) and the low hydraulic pressure tur-p

El objetivo de este trabajo prospectivo es determinar la eficacia del método KTP-láser de 80 watt para la vaporización y ablación de la HPB sintomática. También se analizan los resultados al combinar el KTP-láser con la RTU-P y su repercusión sobre la hemoglobina. Material y Método: 300 pacientes con HPB sintomática fueron tratados entre agosto del 2004 y noviembre del 2006 con el KTPláser o combinado con RTU-P. La resección adicional fue efectuada en pacientes con adenomas grandes o por lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS. Resultados: 300 pacientes fueron tratados en 2 grupos. El grupo 1 (n: 50) con sólo tratamiento láser y pequeños adenomas, la hemoglobina se redujo un 3,2 por ciento y nadie requirió una transfusión. El grupo 2 (n: 250) con tratamiento combinado de KTP-láser y RTU-P en adenomas grandes, la hemoglobina se redujo en promedio 15,2 por ciento después de la intervención; 2 pacientes (0,8 por ciento) necesitaron una transfusión. Conclusión: El estudio pone de manifiesto, las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma sobre todo en próstatas de gran tamaño.

The objective of this prospective study is to determine the effectiveness of the 80 watt KTP laser method for the vaporization and ablation of the symptomatic BPH. Also the results when combining the KTP-laser with the TUR-P and their repercussion on the haemoglobin are analysed. Material and Method: 300 patients with symptomatic BPH were treated between august 2004and november 2006 with the KTP-Laser or combined with TUR-P. The additional Resection was carried out in those patients with great adenomas or to have accentuated middle lobule. The ablative effect was controlledat the end of the operation with TRUS (transrectal ultrasound). Results: 300 patients were treated in 2 groups. The group 1 (n: 50) just by laser treatment and small adenomas, the haemoglobin was reduced a 3.2 percent and nobody required a transfusion. Group 2 (n: 250) with combined treatment of KTP-laser and TURP in great adenomas, the haemoglobin was reduced in average 15,2 percent after the intervention; 2 patients (0,8 percent) needed a transfusion. Conclusion: Our study puts of open, the advantages to combine both surgical procedures to mainly obtain a better result in the ablation of the prostate adenoma in prostates of great size.

Preventing superficial bladder cancer from recurrence by intravesical instillation with Brucea Javanica oil emulsion after TUR-Bt operation / 中国康复理论与实践

@# ObjectiveTo observe the effect of intravesical instillation of Brucea Javanica oil emulsion on recurrence of bladder cancer after transurethral resection of bladder tumor (TUR-Bt) operation.Methods187 patients with superficial bladder carcinoma after TUR-Bt operation were randomly divided into the group A (85 cases) and group B (102 cases). Patients of the group A were treated with instillation of Brucea Javanica oil emulsion; those of the group B were treated with mitomycin. A three-years following up was performed to observe the recurrence and side effects.ResultsAfter a 3-years following up, the recurrence rate of group A was 12.94%, lower than that of group B (34.31%). The side effects were seldom seen in the group A.ConclusionThe effect of intravesical instillation of Brucea Javanica oil emulsion to prevent the recurrence of bladder cancer after TUR-Bt operation is favorable.

A Case of a Tumor of the Follicular Infundibulum-like Change in Nevus Sebaceus / 대한피부과학회지

Cribier and Grosshans(1995) reported two cases of tumor of the follicular infundibulum(TFI) arising in nevus sebaceus for the first time. In 1961 Mehregan and Butler described a new benign adnexal neoplasm, which they called tumor of the follicular infundi4ulurn." Since then few observations have been published. The majority of the lesions are solitary. They appeared in adults, predominantly in wornen, on the face, arm, and neck. Histopathologically, the unique feature is a benign hyperplastic lesion that extends from the follicular infundibuluni. as an epithelial plate either with underlying elastic fiber network in TFI or without underlying elastic fiber network in TFI like change. A 52-year-old man has haf a solitary, well-defined, hairless, verrucous plaque on his right supra auricular area for about 10 years. It has seerned to increase gradually in size over the last year. The histologic findings shwed a plate-like growth of epithelial cells in the upper dermis extending parallel to the epidermis with multiple connections at the lower margin of the epidermis. The peripheral cell layer of ttie tumor plate showed palisading, and centrally located cells were pale staining. Many hair follicl s, mature sebaceous glands, ectopic apocrine glands, and inflammatory cell infiltrations were present in the dermis. However, there was no elastic fiber network beneath the epithelial cell plate. We believe our case is the first to be reported in Korea as TFI-like change in nevus sebaceus.

The Results of Benign Prostatic Hyperplasia Treatment by Transurethral Resection, Open Prostatectomy, and TUMT(Transurethral Microwave Thermotherapy) / 대한비뇨기과학회지

We noticed the treatment results of each of them after having treated the seventy-nine cases of benign prostatic hyperplasia with TUMT (N=32, Term ; 92.6-93.3), TUR-P (N=31, Term; 91.4-93.3), open prostatectomy (N=16, Term; 91.4-93.3). However, there was a difficulty to get to statistical reliability, for there was a little gap between the term of survey and the period of treatment of three groups. The results are following. In the TUMT, the maximal flow rate was improved from 8.2ml/s to 13.3ml/s and Madsen score dropped from 13.6 to 5.3, in the TUR-P they were 8.4ml/s to 16.5ml /s and 14.5 to 5.3 respectively, and in the open prostatectomy 6.8ml/s to 20.0ml/s and 15.8 to 5. 3 respectively. The degree of satisfaction of the patients themselves with each prescription was 46.9% in the TUMT. 67.7% in the TUR-P and 81.2% in the open prostatectomy. But 18.8% and l6.l% of the patients thought TUMT and TUR-P respectively ineffective. The conclusion is that open prostatectomy presented the better results than TUMT or TUR-P in the degree of satisfaction of patients and uroflowmetry during the survey period. And even though TUMT have presented lesser degree of satisfaction then TUR-P up to now, if the exact indications for the use of TUMT are found and the mechanical improvements undergo, then a number of benign prostatic hyperplasia cases seem to be treated in more safety and with lesser cost and time by TUMT instead of TUR-P.

A Histopathologic and Morphologic Study for Bladder Preservation in the Management of Invasive Bladder Tumors / 대한비뇨기과학회지

This study was designed to define the subgroup of patients with invasive bladder tumor who could be candidates for bladder preservation. Medical records of 50 patients with muscle invasive transitional cell carcinoma of bladder who underwent radical cystectomy in our hospital from March l983 to December l992 were reviewed. Tumor size, number, configuration, number of recurrence and grade at the time of TUR-B were compared to pathologic stage and lymph node status from radical cystectomy specimens. Pathologic stage such as P0, Pis, Pa, P1, P2 ( Group I) were defined to be superficially invasive tumor group in which bladder could possibly be preserved with TUR-B and P3a,P3b, P4(Group II) were defined to be deeply invasive tumor group in which bladder could not be preserved with TUR-B. The frequency of P0 and Group I of 50 cystectomy specimens were 8% and 46%. Among various factors evaluated, tumor configuration and size (less than 4cm) were the most significant ones discriminating superficially invasive from deeply invasive group(p<0.05). If bladder preservation modality using TUR-B is applied with this criteria, sensitivity, specificity. positive and negative predictive value were 57%, 74%, 65% and 67% respectively. In conclusion, papillary, small-sized tumors (less than 4cm) are likely to be superficially invasive and thus bladder preserving modality could be applied in this subgroup.

A Clinical Study about Operator's Skilled Experience in Transurethral Resection of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

A clinical observation was made on 261 cases of transurethral resection of benign prostatic hyperplasia (TURP) by the same operator, admitted during the period of 10 years from January 1984 to December 1993. The objective cases were divided by every 50 cases into 5 groups, and the operation results were compared in each group respectively. The results showed the tendency of increasing weight of resected prostatic tissue and decreasing operating time, consumed time for the resection of l gm of prostatic tissue, blood loss during operation, duration of postoperative gross hematuria and incidence of postoperatively complicated cases, as experiencing more TURP cases. The operation results were markedly improved and stabilized after experience of 150 cases of TURP. Our study suggests that TUR technique of the operator is improving step by step by accumulating experiences of TURP and the expert and stabilized skillful technique will be achieved after experience of more than 150 cases of TURP but the improvement of TUR technique may be accelerated by aid of better TUR instrument and teaching system.

Aspect of Recurrence in Superficial Bladder Tumor Treated by TUR / 대한비뇨기과학회지

Superficial bladder tumors are usually treated by TUR and the result of this treatment was known to have good prognosis. However, recurrence of the tumor after complete resection occurs in about 40-70% of the patients, a significant percentage of these recurrences showing a higher degree of malignancy. There are many factors affecting the recurrence and progression. Understanding the aspect of recurrence will help in the management of patients. So we studied to evaluate the relationship in 43 cases with superficial bladder tumors admitted to the Department of Urology, Inje college of Medicine, Pusan Baik Hospital during the period from April, l981 through March, l986. Thirty three patients were followed up for more than 3 Months. Following results were obtained: 1. No. of patients with recurrence was l8 (54.5 %). 2. Nine cases (50%) were recurred within 1 year and these patients had poor prognosis than patients recurred after 1 year. 3. The recurrence around the initial tumor site were 6 cases (33.3 %) and these patients had poor prognosis than recurrence at other site. 4. There was more significant increase of malignant progression and recurrence in multiple tumor or large tumor than solitary or small one. 5. There was significant increase of malignant progression and recurrence in initial high grade tumor than low grade tumor. 6. The recurrence rate was decreased in patients instilled adriamycin more than 4 times (45.5%, than less than 4 times (75%).

Benign Prostatic Hyperplasia: 5-Year Experience / 대한비뇨기과학회지

Three hundred and ninety patients with benign prostatic hyperplasia managed at Seoul National University Hospital during a 5 year period from 1981 to 1985 were analyzed retrospectively. Most patients experienced urinary retention(60.3%) or had significant residual urine(l2.O %). Azotemia was found in 41 patients(10.5%) and bacteriuria in 67 patients(l7.2%). Intravenous pyelography was performed routinely in most of patients but it did not contribute significantly for the management. 217 transurethral(55.6%), 124 suprapubic(31.8%), and retropubic resections(12.6%) were done according to size of prostate, patient`s general condition and surgeon`s preference by 27 operators including 20 senior residents. The mean weight of resected tissue was 14.5gm in TUR and 36.1gm in open resection. The mean perioperative transfusion was l.2 pints in TUR and 2.2 pints in open resection. Overall morbidity of prostatectomy was l7.4% and there was no difference between TUR and open resection. Excessive bleeding was the major complication which developed in 6.9% of TUR and 6.4% of open resection. Initial azotemia, bacteriuria and old age over 80 years did not increase the operative morbidity. In TUR, 30gm or more of resceted adenoma and/or 90min or more of resection time increased the morbidity significantly. Prophylactic antibiotics decreased the postoperative urinary tract infection. The antibiotics were continued until 5~7 days after removal of catheter, and an additional antibiotics were not necessary even in the presence of microscopic pyuria which persistence for longer time. In 351 patients(90.9%), voiding problem was improved but in 39 patients(10%), it was persisted. Uroflowmetry was useful to evaluated the outcome of the resection. Maximum improvement in the flowrate was found 3 month postoperatively and the result was same in the patients with TUR and open resection.

Clinical Observation on Bladder Tumor / 대한비뇨기과학회지

A clinical observation was made on 236 cases of bladder tumor admitted to the Department of Urology, Presbyterian Medical Center during the period from August, 1970 through July, 1980 and the following results were obtained. 1. Among 236 cases of in-patients, 188 cases were male and 48 female with 4:1 ratio. 2. Main age distribution was between 40 and 70 years, showing the highest incidence in 60 to 69 years (33. 1%). 3. The clinical manifestation included hematuria (81.4%), dysuria (27. 6%), frequency(24. 6%) and other symptoms. 4. The tumors were located in the base and lateral wall of bladder (67%) mainly. 5. On I. V. P. findings, 135 cases(57. 2%) were normal, 40 cases (17. 0%) showed unilateral hydronephrosis and 14 cases (6.0%) bilateral hydronephrosis. 5. Of 235 cases of bladder tumor, 181 (76.6%) were transitional cell carcinoma, 10 cases (4.3%) of squamous cell carcinoma and 4 cases of adenocarcinoma (1. 7%). 7. On treatment of bladder tumor, T. U. R. was performed on 122 cases, total cystectomy 57. radiation therapy 33 and thio-TEPA bladder instillation 28.

Clinical Observation on 235 Cases of T. U. R / 대한비뇨기과학회지

Clinical observation was made on 223 cases of T. U. R. who had been admitted to the Dept. of Urology during the period of 7 years from September. 1971 through July, 1978 and on 12 cases of T. U. R. who had metastatic bladder tumors from cervical carcinoma of the uterus. 1. Among total 1.759 in-patients. T. U. R. was performed on 223 cases (12.7 %) and on 12 cases who had metastatic bladder tumor from cervical carcinoma of the uterus. 2. Age distribution was between 23 and 89 years and the sixth decade was most common. 3. Among 235 cases, 180 were male and 55 female with the ratio of 3.3:1. 4. Major diseases were bladder tumors (64.68 %), B. P. H. (18.72 %), and Prostatic carcinomas (9.36 %). 5. Average operation time for T. U. R. was 73.5 min, (Bladder tumor), 71 min. (B.P.H.), and 64.5 min. (prostatic Ca.) respectively. 6. Average weight of tissue resected was 11.7 gm. (bladder tumor), 16 gm (B.P.H.), and 11.5 gm (prostatic Ca.). 7. Duration of indwelling catheter was 3.5 days (bladder tumor), 6.5 days (B.P.H.), and 5.7 days (prostatic Ca.). 8. Average duration of hospital stay after T. U. R. was 10.8 days (bladder tumor), 14.5 days (B.P.H.), and 14 days (prostatic Ca.). 9. Poet-operation complication were listed as : bleeding (14 cases), infection (12 cases), fluid absorption toxicity (4 cases), and extrapolation (2 cases) 10. Spinal anesthesia was performed on 90 % of patients.