The prostate anesthetic block for outpatient prostate surgery

Issa, Muta M.; Ritenour, Chad W.M.; Greenberger, Mark; Hollabaugh, Robert S.; Steiner, Mitchell S.

doi:10.1007/s003450050085

Cited by 34 publications

(8 citation statements)

References 11 publications

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“…The nerve fibers course along the branches of the inferior vesical artery and dorsal vein of the penis to form bilateral neurovascular bundles and are the main sensory supply of the prostate (52, 53). These bundles straddle the posterolateral aspect of the prostate at 5 and 7 o'clock positions, in the angle formed by the seminal vesicle with the base of prostate (54). The branches decussate extensively and ramify between the capsule and the Denonvilliers' fascia (Fig.…”

Section: Introductionmentioning

confidence: 99%

Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know

Nazir

2014

Korean J Radiol

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Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.

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Section: Introductionmentioning

confidence: 99%

Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know

Nazir

2014

Korean J Radiol

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“…In some aspects ILC seems to offer an advantage over TURP; blood loss is minimal and the risk of TUR syndrome is eliminated, as saline rather than glycine is used as the irrigant. Furthermore, the possibility of administering ILC under local anaesthesia is an attractive option because patients undergoing surgery for BPH are elderly and often have significant comorbidity [8,9]. However, direct comparisons of ILC and TURP in randomized trials are lacking.…”

Section: Introductionmentioning

confidence: 99%

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

2002

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Objective To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH). Patients and methods Forty-eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/ TUIP; they were followed for 6 months and the outcome analysed on an intention-to-treat basis. Results At 6 months the symptom scores and maximum urinary flow rate (Q max ) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group ( P > 0.05); the mean Q max was 20.6 mL/s in the control group, 16.2 in the ILC group ( P > 0.05 vs control) and 13.2 in the TUMT group ( P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Q max than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the 'well-known' complications of TURP occurred in the control group.Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the control group were re-treated for BPH within the first 6 months. Conclusion In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.

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“…In 1984, Orandi emphasized the importance of using local anesthesia for urological endoscopic surgeries such as transurethral incision and resection of the prostate, visual urethrotomy, ureteral meatotomy, and resection of primary and recurrent bladder tumors [8] . In a similar study, Issa et al [13] performed transperineal prostatic block in 43 patients who underwent interstitial laser coagulation of the prostate in either an outpatient or office setting. These authors confirmed that the majority of their patients tolerated the procedure, concluding that perineal prostatic block is a safe, economical, and effective anesthesia technique for minimally invasive prostate surgeries.…”

Section: Discussionmentioning

confidence: 99%

Performing 180-Watt GreenLight® Laser Prostatectomy using Periprostatic Block

Çakır¹

2018

Haydarpasa Numune Med J

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Introduction: GreenLight® photoselective vaporization of the prostate (PVP) is an effective minimally invasive surgical treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS). This study aimed to assess the feasibility of using local anesthesia during the 180-Watt GreenLight® PVP procedure in patients who are unsuitable for general or regional anesthesia. Methods: The study involved 52 patients who underwent PVP using the 180-Watt GreenLight® system at our institution under periprostatic block between December 2013 and August 2015. All patients completed International Prostate Symptom Score (IPSS) and underwent uroflowmetric evaluation to determine maximum flow rate (Qmax). Post-void residual urine and prostate volumes were measured by transpubic and transrectal ultrasonography, respectively. Before the operation, 20 ml of bupivacaine hydrochloride (5 mg/ml) was injected into the prostate capsule through the perineum using a 22 G Spinocan® needle under the guidance of an index finger inserted into the rectum. Following the procedure, each patient was assessed for pain using the visual analog scale (VAS), and all patients were followed up 3 months after surgery. Results: Mean patient age was 74.88±7.16 years. All operations were successfully completed without the need to convert to general anesthesia. PVP resulted in a significant improvement in IPSS (28.6±3.83 vs. 10.73±2.62, p<0.0001) and Qmax (6.88±1.1 vs. 23.87±2.8, p<0.0001). Mean operative time, indwelling catheter duration, and length of hospital stay were 57.13±15.32 min, 1.25±0.44 days, and 1.37±0.56 days, respectively. No severe perioperative complications were recorded. The majority of patients did not exhibit any evidence of pain during the procedure (46 of 52 patients had a VAS of 0), and the mean VAS score was 0.40±1.27. Discussion and Conclusion: Periprostatic block appears to be a feasible and safe alternative to general or regional anesthesia during PVP using a 180-Watt GreenLight® system. This type of anesthesia may be preferred for use in elderly patients with BPH/LUTS who cannot tolerate general and/or regional anesthesia due to comorbidities.

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The prostate anesthetic block for outpatient prostate surgery

Cited by 34 publications

References 11 publications

Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know

Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

Performing 180-Watt GreenLight® Laser Prostatectomy using Periprostatic Block

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