Complicaciones postoperatorias en pacientes con hiperplasia benigna de próstata según técnica quirúrgica

RESUMEN Introducción: La hiperplasia benigna de próstata tiene elevada prevalencia en mayores de 50 años. En quienes fracasa o es mal tolerado el tratamiento médico, se plantea cirugía. Objetivo: Analizar las complicaciones postoperatorias en pacientes operados por hiperplasia benigna de próstata, según diferentes técnicas. Métodos: Se analizaron 161 historias clínicas de pacientes de 60 o más años de edad, con diagnóstico de hiperplasia benigna prostática, intervenidos quirúrgicamente con las técnicas: adenomectomía abierta transvesical, retropúbica y endoscópica monopolar. Resultados: La variación de la hemoglobina ≥ 3mg/dl, con la técnica transvesical fue 17 % y con la retropúbica 27,3 %. El tiempo de sondaje vesical ≤ 4 días en la transvesical un 48,9 %; > 4 a < 7 días en la retropúbica en 59,1 % y ≤ 4 días en la endoscópica monopolar 68,5 %. La estancia hospitalaria ≥ de 5 días, en la transvesical 51,1 % y en la retropúbica 59,9 %; de 1 a < 3 días, con la endoscópica monopolar, 58,7 %. La infección del tracto urinario fue más frecuente con la transvesical (31,9 %), la infección del sitio operatorio (17 %); mientras que la orquiepididimitis fue más frecuente en la retropúbica (40,9 %). El síndrome posresección transuretral prostática monopolar, se presentó en el 17,4 % de los operados. Conclusión: La adenomectomía retropúbica fue la técnica quirúrgica con mayor frecuencia de complicaciones y la resección transuretral la de menor frecuencia. La retención aguda de orina por técnica retropúbica, fue la complicación más frecuente.

ABSTRACT Introduction: Benign prostate hyperplasia has a high prevalence in people over 50 years of age. In those who fail or is poorly tolerated medical treatment, surgery is considered. Objective: To analyze postoperative complications in patients operated on for benign prostatic hyperplasia, according to different techniques. Methods: 161 medical records of patients 60 years of age or older, with a diagnosis of benign prostatic hyperplasia, who underwent surgery with the techniques: open transvesical, retropubic and monopolar endoscopic adenomectomy were analyzed. Results: The variation of hemoglobin ≥ 3mg / dl, with the transvesical technique was 17% and with the retropubic one 27.3%. The time of bladder catheterization ≤ 4 days in the transvesical one 48.9%; > 4 to <7 days in the retropubic in 59.1% and ≤ 4 days in the monopolar endoscopic 68.5%. The hospital stay ≥ 5 days, in the transvesical 51.1% and in the retropubic 59.9%; from 1 to <3 days, with the monopolar endoscopic, 58.7%. Urinary tract infection was more frequent with transvesical (31.9%), surgical site infection (17%); while epididymo-orchitis was more frequent in retropubic (40.9%). Monopolar prostatic transurethral post-resection syndrome appeared in 17.4% of those operated on. Conclusion: Retropubic adenomectomy was the surgical technique with the highest frequency of complications and transurethral resection the least frequent. Acute retention of urine by retropubic technique was the most frequent complication.

The transvesical approach technique for robot-assisted radical prostatectomy for early stage prostate cancer / 中华泌尿外科杂志

Objective:To investigate the feasibility and safety of the transvesical approach of robot-assisted radical prostatectomy.Methods:From June 2017 to May 2020, 41 patients underwent transvesical approach of robot-assisted radical prostatectomy. The patients’ mean age was 62.5(51-69)years. The mean prostate volume was 36.3(22.0-57.8)ml. The mean preoperative PSA value was 7.3(3.7-12.3)ng/ml. All preoperative Gleason score was less than or equal to 7 points and preoperative TNM stage ranged from T 2a to T 2b . All patients were diagnosed by prostate biopsy before surgery or pathological diagnosis after prostate enucleation. Robot-assisted radical prostatectomy through the longitudinal incision of the bladder neck was used. It was easy to identify and preserve the bladder neck during the operation. The bladder was opened with a small longitudinal incision, and the prostate was removed intrafascial. The pubic prostatic ligament and pudendal artery were fully preserved to achieve complete reduction of the anatomical structure. Results:All the operations were completed by robot-assisted radical prostatectomy with no transition to open surgery. The mean surgery time was 111.3(105-131)min. The mean estimated blood loss was 95.5 (50-220) ml. The mean postoperative hospital stay was 5.2(3-8)d. The time of postoperative catheter removal was 6.3(5-7)d. After 6 to 24 months of follow-up, 35 patients (85.4%, 35/41) received immediate recovery of continence, 4 patients had no urine leakage after 1 week, and 2 patients had no urine leakage after 1 month. All patients had regained continence 6-month postoperatively. No tumor biochemical recurrence (tPSA<0.2 ng/ml).Conclusions:The transvesical approach of robot-assisted radical prostatectomy was a safe and effective surgical technique, which was beneficial in early continence recovery, and also suitable for prostate cancer patients after prostate enucleation.

Effect of laparoscopic transvesical radical prostatectomy on sexual function and urinary control / 中华泌尿外科杂志

Urinary incontinence and sexual dysfunction are common complications after prostatectomy. The clinical data of 12 patients with low-risk localized prostate cancer treated in Shanghai Jiao Tong University Affiliated 6th People’s Hospital from November 2017 to November 2018 were analyzed retrospectively. All patients underwent transvesical laparoscopic radical prostatectomy. The recovery of urinary control and erectile function was satisfactory, with few complications and definite tumor control effect.

Transvesical Prostatectomy Versus Transurethral Resection ofProstate For Treatment of Benign Prostatic Hyperplasia More Than 100 Gms: A Randomized Control Trial

Purpose: To compare the functional effects and complicationsof transvesical prostatectomy (TVP) and bipolar transurethralresection of prostate (TURP) in patients with benign prostatichyperplasia (BPH) more than 100 gms.Method: Hundred and five patients participated at the SPMCMedical College, Bikaner, India with complaints of BPH withprostate size of 100-150 gm over study duration from June2015 to May 2018. Patients were grouped according to theireligibility for the two surgical procedures namely TVP (n=56)and bipolar TURP (n=49).Results: Of the total 105 patients, 56 (53.33%) patients weresurgically treated with TVP while the remaining 49 (46.67%)were managed with TURP. We did not observe any statisticallysignificant difference between the two groups with regards theIPSS, Qmax, residual urine volume. The numbers of postoperative complications were higher in TURP group (n=9) ascompared to TVP (n=3). Even the late complications such asstricture formation, need for redoing the surgery were higher inTURP group compared to TVP group.Conclusion: Open prostatectomy is a safer and more effectivesurgical treatment option for patients with BPH more than 100gms as compared to bipolar TURP. Even the reports of postoperative complications were higher in TURP group.

Iatrogenic vesicovaginal fistula repair-experience at Prince Hussein Urology and Organ Transplant Center

Background: Despite the advances in technology in urology practice, and the surgical approach in dealing with iatrogenic vesicovaginal fistula repair, the most important is to achieve continent rate with minimum morbidity.Methods: From January 2006 to December 2017, the medical records and operative notes of 52 female (mean age 37 year) who had undergone transabdominal transvesical operative repair of their vesicovaginal fistula (VVF) at this institution were reviewed retrospectively. CT urography and diagnostic cystourethroscopy were the modalities of diagnostic tools. Trans-abdominal, transvesical repair with omental flap interposition were performed within 4-6 months in all cases. Patients were evaluated at two to three weeks initially, then at three months interval and later annually.Results: In present study, the most common presentation of VVF was urine leakage through vagina. In two third of the patients the etiology was due to hysterectomy procedure, regarding the location of the fistula, 94.2% of the fistulas located high in the posterior wall of the urinary bladder (supratrigonal), with the mean size of 2.2cm (range 5-25mm). 49 patients had single fistula (94.2%). The mean operative time was 110 minutes (range 60-130 minutes) and the mean post-operative urethral catheterization was 21 days (range 17-24 days). Almost all patients were continent after a mean of five months.Conclusions: Iatrogenic VVF is one of the distressing complications of gynecological procedure; delayed transabdominal transvesical approach with omental flap interposition is associated with excellent and durable results with minor morbidity. Standardization of the technique is a key success in the outcome of the repair.

Surgical techniques and short-term outcomes of transvesical robot assisted radical prostatectomy / 中华泌尿外科杂志

Objective To introduce the technique and report our initial experience of transvesical robot assisted radical prostatectomy (TvRARP).Methods From April 2018 to August 2018,10 patients underwent TvRARP performed by a single surgical team were retrospectively reviewed.Preoperative data of patients [aged (58.6 ± 9.4) years,BMI (26.5 ± 3.1) kg/m2,tPSA (19.5 ± 4.1) ng/ml,biopsy Gleason score 6(6-7),prostate volume (33.4 ± 15.8) ml and IIEF-5 score 12 (10-16)] were collected.Preoperative study revealed 8 cases of cT1c,1 case of cT2a and 1 case of cT2b.All patients were continent preoperatively.During the surgical procedure,the bladder was opened,and a circumferential incision was then made around the internal urethral orifice.Initially,posterior dissection of bilateral vas deferens and seminal vesicles was performed,followed by posterior dissection towards apex.Lateral dissection of neurovascular bundles was performed before anterior dissection towards apex.The exposed urethra was transected and specimen was removed.Vesicourethral anastomosis and closure of bladder was performed in a standard way.Results All 10 cases were successfully performed robotically without conversion,transfusion or other major intraoperative or postoperative complications.Postoperative pathology confirmed 6 cases of pT2a,3 cases of pT2b and 1 case of pT2c [median Gleason score 6 (6-7)].One case was reported positive surgical margin.Operative time was (140.5 ± 35.5) mins.Estimated blood loss was (65.5 ± 35.5) ml.Urethral catheter was removed at 7 days postoperatively.Nine patients achieved urinary continence (0 pads) immediately after the removal of urinary catheter,while 1 patient returned to full continence at 2 weeks postoperatively.During a mean follow-up of 3 months (2-4 months),no biochemical recurrence was detected (tPSA ＜ 0.2 ng/ml).At 2 months postoperatively,IIEF-5 score was 11 (8-13) and no statistically difference was made compared with preoperative data (p ＞ 0.05).Conclusions Transvesical approach is a valid alternative of RARP in patients bearing localized low-risk prostate cancer.Tumor control and preservation of erectile function remains to be determined by long term follow-up.

Comparison of the clinical effects of transurethral plasmakinetic enucleation of prostate and suprapubic transvesical prostatectomy in the treatment of large volume benign prostatic hyperplasia / 中国综合临床

Objective To assess the clinical efficacy and safety of transurethral plasmakinetic enucleation of prostate (PKEP) and suprapubic transvesical prostatectomy (SPP) in the treatment of large volume benign prostatic hyperplasia (BPH).Methods A total of eighty patients with large volume BPH were selected in the First People''s Hospital of Xuzhou from March 2014 to December 2016,and they were randomly divided into two groups,the PKEP group and SPP group,with 40 cases in each group.The comparison was made between the two groups in terms of operation indicators,postoperative complications followed up for 6 months after surgery and other related curative effect indexes.Results In the SPP group,the intraoperative blood loss was significantly higher than that of the PKEP group ((215.7±10.4) ml vs.(75.6±9.2) ml,t=6.541,P0.05).But the catheterization time after operation,bladder irrigation time and length of hospital stay were significantly longer in the PKEP group than in the SPP group ((6.3±1.8) d vs.(2.4±0.6) d,(5.5±1.4) d vs.(1.3±0.6) d,(7.7±2.3) d vs.(3.1±0.7) d,t=4.357,2.542,2.975,P0.05).The rate of complication occurrence in the PKEP group were lower than that of the SPP group (P<0.05).Conclusion PKEP was effective in the treatment of BPH,with less bleeding loss,fewer complications and quick recovery.It can significantly improve the life quality of the patients and will be an ideal treatment for large volume BPH.

Combined transgastricand transvesical approach for porcine partial nephrectomy and application of V-loc suture / 第二军医大学学报

Objective To perform partial nephrectomy via combined transgastric and transvesical approach in porcine and to use V-loc suture for suturing the renal defect, so as to further assess the safety and feasibility of combined transgastric and transvesical approach. Methods Three female pigs were used in this study. The transvesical access was established by incising the anterior wall of the bladder under ureteroscope, and a self-designed Trocar was inserted. Under the guidance of ureteroscopy, the transgastric accesswas established by a needle knife with cautery, and the gastroscope was introduced after balloon dilation. Under the guidance of gastroscope, laparoscopic ultrasonic scalpel was introduced via the bladder Trocar; the kidney artery and veinwere separated, the arteries were blocked and some lower part of renal parenchyma was resected; and the wound was closed by 2-0 V-loc suture which was introduced percutaneously. The specimens were collected from the bladder. Results Six partial nephrectomy procedureswere done in the 3 pigs. The first case was transferred to traditional laparoscopy due to incompleted blocking of the artery, bleeding and loss of vision. The rest 5 cases were successfully completed, with a mean operation time of 174 min(140-220 min), a warm ischemia time of 21 min (17-28 min), and with no significant bleeding. The average size of incised tissue was 1. 5 cm X1. 5 cm. Conclusion Partial nephrectomy via combined transgastric and transvesical approach is extremely difficult, but it can be done by using the V-loc suture and auxiliary needle laparoscopic instrument; however, its clinical prospect still needs further verification.

Transvesical approach laparoendoscopic single-site radical prostatectomy: for organ-confined prostate cancer: report of 8 cases / 中华泌尿外科杂志

Objective　To investigate the feasibility of applying transvescal approach laparoendoscopic single-site radical prostatectomy (TVSSLRP) and assess the oncological and functional outcomes.Methods　Eight patients with clinically localized prostate cancer (PCa) of low risk underwent TVSSLRP.Demographic data were accrued including patient age,body mass index (BMI),preoperative PSA level,the International Index of Erectile Function 5,biopsy Gleason score,clinical TNM stage and D'Amico risk classification.One surgeon performed all TVSSLRP procedures.A homemade triple-port was introduced percutaneouly into the bladder to establish pneumovesicum through a 4 cm incision.The major steps of the surgery were described as follows:initial incision was made along posterior margin of the bladder neck to expose bilateral vas deference and spermatic vesicle.After opening Denonvilliers' fascia and extending the space to lateral prostatic pedicles,an intra-fascial nerve sparing procedure was performed.The puboprastatic ligaments were then separated close to the prostate surface and the dorsal vein complex was cautiously swept off.Subsequently,careful apical dissection and urethral transection was sequentially conducted. To reduce the tension of vesico-urethral anastomosis,3 additional incisions parallel to vesio-urethral margin were created and a novel tension - reduced V-LocTM barbed polydioxanone sutures was used.　Results　All the operations were successfully performed and there was no conversion to standard laparoscopic approach or open surgery.The total operative time range was 75 - 180 min with mean time of 125 min.The blood loss was 85 -450 ml with mean 140 ml and no blood transfusion was required.The catheter was removed after a mean (range) of 14 (9 -16) days.No intra-operative complications occurred. No patient had positive surgical margins.The mean (range) hospital stay was 17 (13 -25) days after surgery. All the cases were continent after removal of the catheter.No cases demonstrated vesico-urethral stricture and biochemical recurrence on 12 - 18 months follow up postoperatively.　Conclusions　TVSSLRP is technically feasible for cases with organ-confined prostate cancer with good oncological and functional results.

Single-port laparoscopic transvesical prostatectomy in pigs / 第二军医大学学报

Objective: To assess the feasibility of the single-port laparoscopic transvesical prostatectomy in pigs, and to summarize the technique difficulties, so as to lay a foundation for future clinical application. Methods: Six uncastrated male pigs were used in this study. The skin stomas were made through bladder exstrophy and the TriPort system was inserted into the bladder. Radical prostatectomy was performed as did in human using laparoscopic instruments through the TriPort system after inflating the bladder. The bladder and abdomen were closed after vesicourethral anastomosis, and the prostate specimens were removed through the skin stoma. Results: The first three procedures failed due to inappropriate positioning of TriPort system, limited space of bladder, and the high tension of vesicourethral anastomosis. The other 3 procedures were successful, with the periods used being 190 min,160 min, and 110 min. The whole prostates were resected completely, and the completeness of the urinary tract was recovered using interrupted suture (6 sutures). Conclusion: The single-port laparoscopic transvesical prostatectomy is a feasible procedure, but there are technical difficulties. Further experiments are needed on human cadavers before clinical application.

Reserved sutures for incision closure of transvesical natural orifice transluminal endoscopic surgery in pigs / 第二军医大学学报

Objective: To close the incision of transvesical natural orifice transluminal endoscopic surgery (NOTES) with reserved sutures in pigs, and to assess the feasibility and safety of the technique, so as to lay a foundation for future clinical application. Methods: Five female pigs were inserted with self-made Trocar into the bladder under general anesthesia. Guided by ureteroscope, the needle passed the top wall of the anterior bladder and reached the abdominal wall, with two suture ends reserved for closure, one at the abdominal wall and the other in the urethra (out of Trocar). After finishing the transvesical NOTES, we pulled the suture end at the abdominal wall to the bladder and knotted outside the Trocar; then we dragged the urethra suture end to make the knot on the abdominal wall locating on the lateral wall of bladder, and then the urethral suture was knotted in Trocar and the knot was pushed to the bladder wall using a knot pushing device; finally the bladder incision was closed. The closure of the bladder incision was observed and tested with water filing method. Results: The first two cases failed due to the overweight and large size of the pigs, or because the bladder incision was to close to the bladder neck, or due to the poor quality of the suture. The procedures were successful in the following 3 pigs, with the operation time periods being 45 min, 30 min, and 25 min, and with satisfactory closure. Conclusion: Reserved suture for incision closure of transvesical NOTES procedure is safe and feasible; the technique is easy to perform and needs no special surgery devices; and it deserves further study.

The diagnosis, treatment and prevention of dysuria within 6 months after suprapubic transvesicle prostatectomy / 中国综合临床

Objective To summarize the diagnosis,treatment and prevention of dysuria within 6 months after the suprapubic transvesical prostatectomy. Methods Twenty-four cases were retrospectively reviewed,including the data on the diagnosis, treatment and prognosis. Results Twenty-one of the 24 cases had received surgery. There were 9 cases with bladder neck stricture,9 cases with posterior urethra stricture and 3 cases with of remnant glands. Nine cases received transurethral bladder neck incision, 9 received open surgery ( bladder neck,posterior urethral incision) and 3 received transurethral resection of the prostate (TURP) plus bladder neck incision. The other 3 diagnosed as detrusor weakness were conservatively treated by indwelling catheter and they were improved one months later. None of these patients was readmitted into hospital for dysuria within 6 months after treatment. Conclusion The recurrence of dysuria post prostatectomy mostly ( 75% ) occurred within 6 months after surgery. A majority of these patients need a second surgery. To avoid a second surgery for postoperative dysuria, much attention should be paid to the operating technique and postoperative management.

Experimental nephrectomy via combined transgastric and transvesical approach in porcine / 第二军医大学学报

Objective: To assess the feasibility of nephrectomy via combined transgastric and transvesical approach in a porcine model, and to summarize our experience. Methods: Three female pigs were used in this study. The transvesical access was established using ureteroscope. The vesical hole was enlarged with the dilator of ureteroscope sheath and a self-designed Trocar was inserted. The gastroscope was inserted through a hole on gastric wall, which was made using a needle knife and dilator under ureteroscopy. The ultrasound knife, scissor and clips were introduced via the Trocar, and the nephrectomy was completed under the guidance of gastroscope. Results: The six kidneys of the three pigs were successfully resected, with the operation time being (132±10.5) min, without noticeable hemorrhage or complications. Mild hemorrhage occurred after ultrasonic ligation in the first nephrectomy, and was managed by clips. Clips were used to block the vessels before resection for the remaining five kidneys. Conclusion: Our method via combined approach is technically feasible for nephrectomy in a porcine model, but the kidneys have not been taken out and the puncture wounds on the bladder and gastric wall have not been closed, so further study is still needed.

Prostatectomia aberta: modificações da técnica de Freyer e retirada precoce da sonda: [carta ao editor] / Opened prostatectomy: modified technical Freyer's prostatectomy and very soon catheter removal: [letter to the editor]

Introdução e objetivos: Prostatectomia transvesical (PTV) é uma operação simples e fácil de ser realizada. Sua principal indicação é no grande adenoma prostático associado ou não à patologia vesical. Realizamos algumas modificações técnicas que permitiram um maior controle do sangramento, alta hospitalar no terceiro dia de pós-operatório e sem sonda vesical. Material e métodos: Entre 2001 e 2005, 102 pacientes com grandes adenomas prostáticos foram submetidos à prostatectomia transvesical suprapúbica modificada pelo mesmo cirurgião. A idade média dos pacientes foi 67,8 anos (59 a 82 anos). O peso médio do adenoma foi 81,5g. A abertura da bexiga na sua região fúndica é pequena o suficiente para passar dois ou três dedos ou um espéculo vaginal tamanho médio. A bexiga é fechada por uma sutura contínua. O fio de categute, por não ultrapassar as camadas da bexiga, evita a comunicação da luz vesical com o espaço de retzius, favorecendo a cicatrização rápida da mucosa vesical. Hemostasia mais eficaz foi obtida com a realização de pontos em ?X? pegando parte da cápsula a partir do colo vesical e aplicados às 3, 5, 7 e 9 horas. Resultados: As modificações descritas permitiram a retirada da sonda no terceiro dia de pós-operatório. Não houve aumento das complicações. Foi diminuído o custo hospitalar e amenizado o sofrimento do paciente com o menor tempo de uso da sonda. Conclusões: A seleção adequada do paciente associada às modificações técnicas adotadas resolveram os dois maiores problemas da PTV: maior tempo de internação e uso da sonda vesical.

Seminal Vesicular Cyst Causing Recurrent Epididymitis / 대한비뇨기과학회지

A case history is presented of a seminal vesicular cyst which caused recurrent epididymitis in a young boy. Seminal vesicular cyst is an uncommon disorder and is usually asymptomatic. Endoscopic cannulation of the cyst has been found to be the most useful diagnostic test. At first, the patient was managed by dilation of the orifice of ejaculatory duct in order to facilitate drainage. However, he suffered from incontinence and sustained retrovesical cystic mass. We therefore excised the seminal vesicular cyst by transvesical approach.

The effects of perineal exercises on continence of urine in patient undergoing suprapubic transvesical prostatectomy or transurethral prostatectomy.

The purpose of this study was to test the effects of perineal exercises on ability to control urination; i.e., continence of urine in patients undergoing suprapubic transvesical prostatectomy or transurethral prostatectomy. The study was conducted in surgical ward Mahidol Bampen 2, Siriraj Hospital. The quasi-experimental design was used as the method of procedure. The 30 subjects were equally assigned into one control and one experimental group. The experimental group patients received an extra treatment; i.e., systemically organized nursing instructions on period exercises for both pre and post operative phases. The control group patients received no extra treatment, only what was routinely provided in the ward. A Patient Continence Status Checklist (PCSC) was specially designed for this study. It uses a nominal scale to evaluate patients at their first voiding after the removal of urethral catheter or suprapubic cystostomy tube. It was found that the number of continent patients were significantly higher in the experimental group than in the control group (p<.01). This indicated that the experimental group patients showed higher ability to control urination than the control group patients.