ABSTRACT
BACKGROUND AND PURPOSE: Today, urologists around the world are encountering greater numbers of larger prostate glands, probably because of an initial trial of pharmacotherapy. The present study was performed to assess the safety and efficacy of bipolar transurethral resection of large prostate glands using the PlasmaKinetic (PK) Superpulse System. PATIENTS AND METHODS: This single-blind, randomized study included 70 patients with prostate gland >60 g seen on three-dimensional transrectal ultrasonography. Patients were randomized 1:1 using envelopes into either a PK Superpulse transurethral resection of the prostate (TURP) group or conventional TURP group, and underwent the procedure accordingly. Perioperative and postoperative parameters included operative time, blood loss, need for blood transfusion, clinical transurethral resection (TUR) syndrome, and duration of catheterization and hospitalization. Of 70 patients, 67 were followed for a minimum of 9 months, and data were analyzed using SPSS software. RESULTS: Both groups were comparable in terms of preoperative parameters, which included American Urological Association Symptom Score, Qmax, gland size, and postvoid residual. A statistically significant difference between the two groups was found in terms of perioperative blood loss, change in serum sodium, and duration of catheterization. These complications were significantly less in the PK Superpulse group, with an obvious reduction in the duration of hospitalization in that group. CONCLUSION: The PK Superpulse System can be used as safely and effectively in the resection of the large gland (>60 g) as it has been reported to be in the resection of small and medium-sized glands. By using physiologic saline (0.9% NaCl) as irrigation fluid, it eliminates any danger of TUR syndrome and thus eliminates the conventional time limit of resection. PK Superpulse TURP is a promising treatment modality in the management of large prostate glands. It has all the features of gold-standard monopolar TURP, along with added safety and efficacy. It is ready to be included in the urologist's armamentarium.
Subject(s)
Prostate/surgery , Transurethral Resection of Prostate/methods , Follow-Up Studies , Humans , Male , Middle Aged , Perioperative CareABSTRACT
BACKGROUND: Medical management of urinary calculus disease is a challange for modern science. In the present trial Ayurvedic drug "Herbmed," which is made up of varuna (Crataeva nurvala) and banana stem (Musa paradisiaca) was assessed to see reduction and/or expulsion of urinary calculi and also to assess the role of these drugs to reduce pain during expulsion. MATERIALS AND METHODS: In this prospective randomized, double-blind, placebo control trial, total 77 patients with calculi more than 5 mm were included. All patients were evaluated either by X-ray KUB or USG KUB for 3 months. All patients were divided into two groups: group A included patients with calculi 5-10 mm (n = 31) and group B with calculi > 10 mm (n = 30) with either active treatment or placebo in both the groups. All patients were asked to keep a record of number of pain episodes, while severity of pain was measured on a visual analogue scale (VAS). RESULTS: In group A, there was 33.04% reduction in the size of calculi in the active arm while there was a 5.13% increase in the same group in the placebo arm (p = 0.017). In the other group B, there was an 11.25% reduction in the active arm and a 1.41% reduction in the same group with placebo. In the active arm there was statistically significant lower VAS as compared to the placebo arm in the form of the highest VAS (p = 0.008), average VAS (p = 0.001) and VAS at the first episode of pain (p < 0.0001). CONCLUSIONS: Our preliminary experience suggests that the Ayurvedic formulation "varuna and banana stem" has promise for the management of upper urinary-tract calculi, especially renal calculi. It helps to dissolve renal calculi and facilitate their passage. In addition, it also helps in reduction of pain due to renal/ureteric calculus disease. A larger phase III study with a longer follow-up is required.
