Andre R. Campbell, MD; Robert C. Mackersie, MD; Alex Rodas, CCRC; Huub T. C. Kreuwel, PhD; Hobart W. Harris, MD. Objective: To compare outcome parameters for good- risk patients with .... the presence and concurrence of the principal author/surgeon.
Local Ablative Therapy and Partial Hepatectomy for Small. Hepatocellular Carcinoma .... zation was given. Operative mortality was defined as death within the.
Deficiency of the lysosomal enzyme glucocerebrosidase (OMIM #230800) leads to the accumulation of glucocerebroside in spleen, liver and bone marrow.1,2 In ...
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Wound infection was defined as the pres- ence of an abscess with .... altered the effect of dressing type on SPID, and vice versa. All tests were performed at a ...
varicocelectomy (OSV) and loupe assisted subinguinal varicocelectomy (LASV) using seminal and .... levels and microsurgical varicocele ligation resulted in a.
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Purpose: To make an objective controlled comparison of pain tolerance in transrectal ..... Collins GN: Nitrous oxide vs periprostatic nerve block with 1% lidocaine ...
From the State University of New York at Stony Brook, University Medical. Centes Stony Brook, NK Department of Emergency Medicine (AJS, JEH,. SMV. TWT. CFMC); and University of Ottawa, Ottawa, Ontario. Can- ada, Division of Emergency Medicine (JVQ).
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study, Barbagli et al. managed 57 patients with strictures between 2-3 cm with anastomotic urethroplasty with a long-term success rate of 87%. There was no incidence of chordee in their series. Similarly Elthaway et al. reported 98% success rate for bulbar strictures ranging from 0.5-4.0 cm (average 1.9 cm) over a mean follow-up of 50.4 months and Santucci et al. reported 95% success rates for excision and anastomosis of bulbar strictures ranging from 0.1-4.5 cm (mean 1.7 cm) over a mean follow-up of 70 months. These studies are important because they report long-term results to the tune of >90%. The verdict is thus clear that excision and anastomosis provides excellent results for bulbar urethral strictures of varied etiology for bulbar stricture lengths averaging 2 cm (range 1-4 cm). They also
reinforce the fact that these results can be achieved without having chordee as a complication.
REFERENCES 1. 2.
Pansadoro V, Emiliozi P. Internal urethrotomy in the management of anterior urethral strictures (long-term follow-up). J Urol 1996;156:73-5. Barbagli G, De Angelisb M, Romanob G, Lazzeri M. Long-term followup of bulbar end-to-end anastomosis: A retrospective analysis of 153 patients in a single centre experience. J Urol 2008;178:2470-3. Eltahawy EA, Virasoro R, Schlossberg SM, McCammon KA, Jordan GH. Long-term followup for excision and primary anastomosis for anterior urethral strictures. J Urol 2007;177:1803-6. Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty for bulbar urethral stricture: Analysis of 168 patients. J Urol 2002;167:1715-9.
Thulium laser versus standard transurethral resection of the prostate: A randomized prospective trial Deepak Dubey, K. Muruganandham Department of Urology, SGPGI, Lucknow, India
Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN. Thulium laser versus standard transurethral resection of the prostate: A randomized prospective trial. Eur Urol 2008;53:382-90.
In this prospective trial the authors randomized 100 consecutive patients to receive either a TURP (n = 48) or Thulium Laser Prostatectomy (n = 52). All patients were preoperatively assessed with subjective symptoms score, International Index of Erectile Function questionnaire, and complete urodynamic evaluation. Preoperative and perioperative parameters at 1-, 6-, and 12-months follow-up were also evaluated. All complications were recorded. TmLRP-TT was significantly superior to TURP in terms of catheterization time (45.7 ± 25.8 h vs. 87.4 ± 33.8 h, P < 0.0001), hospital stay (115.1 ± 25.5 h vs. 161.1 ± 33.8 h, P < 0.0001), and drop in hemoglobin (0.92 ± 0.82 g/dl vs. 1.46 ± 0.65 g/dl, P < 0.001), whereas it required equivalent time to perform (46.3 ± 16.2 vs. 50.4 ± 20.7 min, P > 0.05). TmLRP-TT and TURP resulted in a signiÞcant improvement from baseline in terms of subjective symptoms scoring and urodynamic Þnding, but no significant difference was found between the two groups. Late complications were also comparable. TmLRP-TT is an almost bloodless procedure with high efÞcacy and little perioperative morbidity. TmLRP-TT is superior to TURP in safety and is as efÞcacious as TURP in one-year follow-up. It is a promising technology in the clinical practice Þeld.
Is TURP out?
| July-September 2008 |
The advent of modern laser technology continues to offer a serious threat to the current gold standards for treating BPH, viz. TURP/Open prostatectomy. In a randomized trial comparing TURP with HoLEP, Tan et al. demonstrated that HoLEP is superior to TURP in improving urodynamic bladder obstruction along with shorter catheterization time and decreased blood loss. In a recent randomized trial,  HoLEP showed better outcomes as compared to open prostatectomy for adenomas larger than 100 g over a long-term follow-up of Þve years. However, the learning curve for HoLEP is steep, which has prevented many urologists from accepting this technique. KTP green light laser has also demonstrated equivalence to TURP in a prospective clinical trial, albeit with a follow-up of only six months. Similarly KTP laser prostatectomy has been found to be equally effective and safe as compared to open transvesical prostatectomy in a randomized prospective trial. In this statistically well-powered randomized prospective trial the authors have compared Thulium laser prostatectomy (ThLRP) to TURP. Over a follow-up of 12 months, they reported equal efÞcacy of the two techniques and decreased
Indian Journal of Urology
catheterization time, blood loss and hospital stay in favor of the Thulium laser. Unlike KTP, ThLRP retrieves prostatic tissue for biopsy, has a shorter learning curve than HoLEP. The operative technique most closely resembles TURP as compared to other lasers. Before this technique becomes widely accepted, we await experience from other centers with longer follow-up. However, it is becoming increasingly evident that TURP is facing genuine competition and might be replaced as the gold standard in minimally invasive surgery of the prostate.
Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser
enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 2003;170:1270-4. 2. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 2008;53:160-6. 3. Bachmann A, Schürch L, Ruszat R, Wyler SF, Seifert HH, Müller A, et al. Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): A prospective bi-centre study of perioperative morbidity and early functional outcome. Eur Urol 2005;48:965-72. 4. Alivizatos G, Skolarikos A, Chalikopoulos D, Papachristou C, Sopilidis O, Dellis A, et al. Transurethral photoselective vaporization versus transvesical open enucleation for prostatic adenomas >80 ml: 12-mo results of a randomized prospective study. Eur Urol 2007 Nov 29 [Epub ahead of print].
Follow-up after pyeloplasty: How long? T. J. Nirmal, J. C. Singh Department of Urology, Christian Medical College, Vellore, India. E-mail: [email protected] van den Hoek J, de Jong A, Scheepe J, van der Toorn F, Wolffenbuttel K. Prolonged follow-up after paediatric pyeloplasty: Are repeat scans necessary? BJU Int 2007;100:1150-2.
SUMMARY This was a retrospective study of 138 patients who underwent a successful dismembered pyeloplasty over an eight-year period. Patients were divided into three groups based on the duration of follow-up with renal scans. Group one (138) had a renal scan at a mean of nine months after surgery and the split renal function (SRF) before and after surgery was compared. Group two (35) had a second scan at 3.5 years after surgery and group three (29), in addition, had another scan at 5.5 years. The SRF of the scan after surgery and the late scan at 3.5 and 5.5 years were compared. A change in SRF of greater than 5% was considered signiÞcant. The mean (range) SRF was marginally better in all three groups at follow-up. Repeat renal scans at 3.5 and 5.5 years after surgery showed stable SRF, even if the renal function was already diminished. Of 138 patients, only Þve had a signiÞcant deterioration in SRF to less than 40%. Hence, the authors have concluded that repeat renal scans in a Þve to seven-year period after pyeloplasty don’t seem to be justiÞed, as most renal units remain stable.
COMMENTS Dismembered Anderson-Hynes pyeloplasty is a successful treatment for ureteropelvic junction (UPJ) obstruction with success rates as high as 98%. Long-term data in adults 429
has shown Þve to 15-year durability of success. For these reasons, dismembered pyeloplasty remains the Þrst line surgical procedure for the majority of pediatric urologists. DeÞning a true UPJ obstruction in the pediatric population remains difficult. Serial ultrasounds, measurement of resistive index (RI) using duplex ultrasonography and intravenous urography are few of the various modalities used. Radionuclide renography is one of the modalities with objective measurements. Calculation of SRF and assessing wash out curves is important in the diagnosis and followup. However, there are only a few reports in children on how long these patients need follow-up. Also, little is known about the long-term renal function on consecutive renal scans, especially whether loss of renal function in the absence of obstruction might progress with time. The authors have attempted to answer some of these questions. Apart from the retrospective design, one of the major drawbacks of this study is that the majority of the patients with an immediate postoperative SRF more than 40% were discharged from follow-up assuming that their renal function would remain stable. Hence, only 29 of the 138 patients had follow-up scans at a mean of 5.5 years. O’Reilly et al. performed a repeat renal scan in 24 patients at 6-19 years after surgery and concluded that the results