Transurethral Resection of the Prostate - Detroit Medical Center
Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. To investigate the effectiveness and reliability of the combination of optical mechanical cystolithotripsy OMC and transurethral prostatectomy TURP for the treatment of bladder calculi and obstructive benign prostatic enlargement BPE. The records of a random selection of 97 patients with obstructive BPE who were treated with TURP only in the same period were used as OMC TURP control.
The operative duration time, the length of hospital stay, the duration of urethral catheterization, outcome and complications of the procedures for each patients were reviewed. The postoperative mean peak flow rates were Bladder stones may be primary or secondary, according to the aetiology.
Primary, i. Secondary bladder calculi are commonly associated with BOO, including that from prostatic enlargement, bladder neck contracture, urethral stricture, or in bladder dysfunction such as OMC TURP diverticulum, cystoceles and neurogenic bladder diseases [ 1 2 3 ]. Urinary infection promotes the formation of struvite stones and some bladder stones may OMC TURP formed on foreign bodies, e.
The surgical treatment of bladder stones OMC TURP evolved significantly during the last 50 OMC TURP. It is clear that infravesical obstruction should be corrected to eliminate any predisposing condition for vesical calculous disease. OMC TURP open surgery may be the best available method for very large stones and for patients with large prostates, it may not be suitable for small or moderate obstructive BPE; TURP is the standard surgical treatment for this condition.
An endourological procedure simultaneously removing both the infravesical obstruction and OMC TURP stones may be ideal for such patients. Therefore, combined therapy for infravesical obstruction and bladder stones has been recommended by some, having the advantage of a single anaesthesia, a shorter hospital stay and cost effectiveness [ OMC TURP 14 15 16 17 18 19 ].
In this paper we report our experience in the management of bladder calculi with optical mechanical cystolithotripsy OMC combined with TURP to correct BOO, and investigate whether this combination causes additional morbidity. Preoperatively, any infections were treated with appropriate antibiotics. The patients who had malignant disease or had no postoperative assessments were excluded from the study.
Indications for TURP were determined by cystoscopy after the uroflow study and an assessment of residual urine. OMC TURP antimicrobial prophylaxis was given to all patients. Under a spinal or general anaesthesia cystoscopy was performed initially to assess the number and size of the stones, and any associated pathology OMC TURP as tumours and BPE. The urethra was adequately dilated using Van Buren sounds.
OMC was then performed using the largest dimension of the Storz cystolithotrite, after lubricating and passing it through the urethra into the bladder.
Stones were then visualized, grasped and crushed. If there was a bladder neck contracture or median lobe enlargement, TURP was performed before lithotripsy.
The resected prostatic tissues OMC TURP weighed. If there was a residual stone in bladder or an impacted urethral stone, a silicon Foley catheter was left indwelling for 4 weeks, and OMC repeated. The patients were followed up 15 days after treatment and then every 3 months. The uroflow study was repeated in patients undergoing TURP after 3 months and retrograde urethrography performed in patients with persistent obstructive symptoms.
OMC TURP demographic findings and the distribution of the patients are listed in Table 1. Nineteen patients treated with OMC alone had neurogenic bladder dysfunction.
A bladder diverticulum with a large neck was diagnosed in eight OMC TURP with OMC TURP neck OMC TURP and neurogenic bladder dysfunction. A distal ureteric stone was diagnosed in six patients with BPH and in one patient with OMC TURP neck contracture. A unilateral simple stenotic ureterocele with a stone in it was found in three patients and treated with OMC TURP incision using a Bugbee electrode.
OMC was OMC TURP for incomplete fragmentation or residual stones in two patients and for urethral stone impaction in two who underwent the combined procedure. Severe bleeding from the bladder and prostate requiring blood transfusion was identified in three patients who underwent the combined procedure. Blood transfusions were also required in two patients who underwent TURP alone. Bladder mucosal tearing and severe bleeding, caused by a small bladder capacity, was noted in one patient who underwent OMC OMC TURP, and was treated with continuous bladder irrigation and blood transfusion.
In one patient with bladder neck contracture, the penile urethra was injured during the removal of the lithotrite; it was repaired by open surgery, and managed with OMC TURP urethral catheter and cystostomy drainage for 3 weeks Fig. The complications of the procedures are also shown in OMC TURP 1.
Differences between the mean duration of indwelling catheterization and mean resected prostatic tissue weight were not significant. Neurogenic bladder dysfunction was the second most frequent cause. To prevent new stone formation and to facilitate the elimination of the stone fragments, infravesical obstruction and bladder stones were treated simultaneously; OMC and TURP have been used simultaneously OMC TURP 40 years.
The mean resected prostatic tissue weight and Q max of the present patients who underwent TURP alone were not statistically different from those who underwent the combined procedure. Therefore, the combination did not change the effectiveness of these procedures. In the present study, only the mean duration of catheterization after TURP alone was longer than those reported previously. Nseyo et al. The complication OMC TURP of combined procedure was significantly higher than OMC TURP of TURP alone, although the risk was also twice that for OMC alone.
These results support attempts OMC TURP develop newer and less OMC TURP lithotripsy techniques. Transurethral electrohydraulic lithotripsy, ultrasonic lithotripsy and shockwave lithotripsy SWL have been combined with TURP for the treatment of bladder stones [ 4 5 6 7 8 9 10 11 12 ]. Bhatia and Biyani reported residual bladder stones in two of 43 patients treated with SWL alone [ 19 ].
Ikari et al. The complication and mortality rates were 3. Volume 84Issue 1. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the OMC TURP matches an existing account you will receive an email with instructions to retrieve your username. BJU International. Free Access. Tools Request permission Export citation Add to favorites OMC TURP citation.
Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Objectives To investigate the effectiveness and reliability of the combination of optical mechanical cystolithotripsy OMC and transurethral prostatectomy TURP for the treatment of bladder calculi and obstructive benign prostatic enlargement BPE.
Introduction Bladder stones OMC TURP be primary or secondary, according to the aetiology. Results The demographic findings and the distribution of the patients are listed in Table 1. Figure 1 Open in figure viewer PowerPoint. Philadelphia: Saunders, ; Google Scholar.
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