Background: The prevalence of prostate enlargement increases with age in older men and is a prevalent clinical disease. The current study was conducted with the objective of comparatively evaluating the efficiency and safety of prostate resection techniques, thulium laser enucleation (ThuLEP) versus bipolar transurethral resection of prostate (TURP) for large prostate (>60 g) glands.
Aims and Objective: The aim of the study was to compare result of ThuLEP versus Bipolar TURP in Large Prostate (>60 g) – A Prospective Randomized Study.
Materials and Methods: In this prospective randomized controlled trial, symptomatic patients with BPH (benign prostatic hyperplasia) with a prostate gland >60 g indicated for surgery were included in the study. On the basis of the treatment, patients were grouped into Bipolar TURP and ThuLEP groups with 36 patients each. Demographics, patient characteristics, and laboratory investigations were recorded at baseline. Intraoperative parameters including operation time, blood loss, and complications were compared between groups. Uroflowmetry parameters were compared on days 7, 1, and 3 months of follow-up.
Results: Baseline patient characteristics were comparable between groups. Major variation in the mean operative time (88.69 vs. 96.11 min, P = 0.002), the volume of blood loss due to capsular or sinus perforation (0.51 vs. 0.28 L, P < 0.001), mean duration of postoperative catheterization (30.50 vs. 21.26 h, P < 0.001), and a mean number of hospital stays (38.42 vs. 29.06 h, P < 0.001) was noted between Bipolar TURP versus ThuLEP group. The post-void residual urine was significantly higher in bipolar TURP vs. ThuLEP at 1 week following surgery (P = 0.042) but was similar at 1- and 3-month follow-ups. AT 3 months, the mean residual prostate volume was considerably lower in ThuLEP group than the bipolar TURP group. All related complications were comparable between groups, mild and transient in nature, and disappeared within 1 month of follow-up.
Conclusion: The efficiency and safety of bipolar TURP and ThuLEP procedures for the management of large prostate are comparable. Due to the lower rate of blood loss, ThuLEP can be preferred in patients with coagulation disorders.
Background: Patients with non-muscle invasive bladder cancer (NMIBC) often have transurethral resection of the bladder tumor (TURBT). Inadequate TURBT, floating tumor cell implantation theory, and non-visualized microtumors are major factors for the recurrence of bladder cancer. According to guideline recommendations, after primary TURBT, there is a role of restage TURBT within 2–6 weeks in high-risk patients. The present study’s goal was to assess the role of restage TURBT in high-risk NMIBC.
Aims and Objectives: The aim of the study was to identify the group of patients with high-risk NMIBC who may skip the commonly performed restage TURBT operation.
Materials and Methods: In this prospective and observational study, biopsy-proven NMIBC patients with gross total painless hematuria secondary to urinary bladder mass from October 2017 to June 2019 were enrolled. Patients with high-risk disease will undergo restage TURBT after 2–6 weeks of primary TURBT. Residual/recurrent disease and tumor upstaging were recorded. To investigate the risk variables for tumor upstaging after restaging TURBT and residual/recurrent disease, logistic regression analysis was utilized.
Results: A total of 250 patients (deep muscle involvement, n = 237 and no muscle involvement, n = 13) with histopathologic ally-confirmed high-risk disease following re-TURBT were included in the final analysis. During re-TURBT, 18% of patients had residual or recurrent tumors. The presence of upper tract changes, presence of perivesical fat stranding and tumor size >3 cm, high-grade histopathology, and positive urine for malignant cytology had a higher risk of residual or recurrent disease. Histopathological specimens showing the absence of muscle in the primary TURBT specimen, the presence of recurrent/residual growth in restage TURBT specimen, and bladder tumor antigen increased the risk of upstaging.
Conclusion: Despite the low recurrence rate of tumors in restage TURBT, restage TURBT within 2–6 weeks of primary TURBT is an essential step for the accurate diagnosis among NMIBC patients. This further aids in deciding the subsequent treatment step in patients having upstaging and recurrent/residual tumors.
Background
Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience.
Methods
We performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up.
Results
There was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period.
Conclusion
The technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.
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