Objective: This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. Material and methods:A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed.Results: There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p= 0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. Conclusion:Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.
ObjectiveTo describe the surgical technique and report the early outcomes of a ‘minimum-incision’ endoscopically assisted transvesical prostatectomy (MEATP) for managing benign prostatic obstruction secondary to a large (>80 g) prostate.Patients and methodsIn a prospective feasibility trial, 60 men with large benign prostates underwent MEATP. The baseline and postoperative evaluation included the International Prostate Symptom Score (IPSS), a measurement of maximum urinary flow rate (Qmax), and the postvoid residual (PVR) urine volume. The adenoma was enucleated digitally through a 3-cm suprapubic skin incision, and haemostasis was completed with endoscopic coagulation of the prostatic fossa. Perioperative complications were recorded and stratified according to the modified Clavien–Dindo score.ResultsThe mean (SD, range) prostate weight estimated by ultrasonography was 102.9 (15.4, 80–160) g, the operative duration was 52 (8, 40–65) min, the haemoglobin loss was 2.1 (1, 0.4–5) g/dL, the catheterisation time was 5.2 (1.3, 4–9) days, and the hospital stay was 6.2 (1.4, 5–10) days. There were 21 complications recorded in 16 (27%) patients, and most (86%) were of grades 1 and 2. The most frequent complications were bleeding requiring a blood transfusion (8%), and prolonged drainage (5%). There was a significant improvement at 3 months after surgery in the IPSS (8.6 vs. 21.6, P < 0.001), Qmax (19.5 vs. 7.7, P < 0.001), and PVR (15.8 vs. 83.9 mL, P < 0.001).ConclusionMEATP is feasible, safe and effective. Comparative studies and long-term data are required to determine its role in the surgical treatment of large-volume BPH.
Background: Little light has been shed on erectile functions following bipolar vaporization of the prostate. Patients and Methods: A prospective study was conducted that included 100 cases with a history of endoscopic prostatic surgery. Cases were allocated into two groups: group I included 50 patients who were subjected to the conventional monopolar transurethral resection of the prostate (TURP), and group II included 50 patients who were subjected to bipolar vaporization of the prostate. All patient were assessed 3 and 6months after the operation.Severity of benign prostatic hypertrophy symptoms and erectile function were reassessed using International Prostate Symptom Score and International Index of Erectile Function-5 (IIEF-5), respectively. Results: Although all patients in both groups demonstrated significantly lower IIEF-5 scores 3months postoperatively (P<0.0001), the percentage of IIEF-5 score reduction was insignificantly different between both groups. No significant differences were found at the 6-month follow-up. The erectile fraction (EF) in group II (bipolar vaporization group) was slightly better, yet insignificantly different from group I. The incidence of complications (TURP syndrome, bladder perforation, intraoperative bleeding, postoperative bleeding, and postoperative urinary tract infection) in group I (monopolar TURP) was significantly higher than the incidence in group II (bipolar vaporization). Among the study variables, it seems that diabetes mellitus and hypertension and development of postoperative complications (especially intraoperative bleeding, capsular perforation, and urinary tract infection) were significantly associated with development of postoperative erectile dysfunction (ED). Conclusion: No significant difference was found regarding sexual function following monopolar TURP and the bipolar vaporization of the prostate. However, the bipolar TURP is safer with less complications.
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