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PubMed1984

Clinical problems associated with dosimetry of 125-iodine for cancer of the prostate.

Dosimetry and clinical data for iodine-125 prostatic seed implants in 63 patients were retrospectively studied to evaluate the methods of calculating the effective implant activity. Our protocol called for 10 000 cGy to the periphery of the prostate from 125I and 4 000 cGy to the whole pelvis in 20 fractions from supervoltage. Most procedures used seed strengths of 20.35 to 21.09 MBq (0.55-0.57 mCi). The average number of seeds lost per patient was 2.1 without prior transurethral prostatic resection (TURP), and 5.6 with prior TURP. Specific precautions are recommended to minimize seed loss. In a 3 cm diameter gland with uniform seed distribution, the periphery received 10 000 cGy, while the central 2 cm diameter core received 20 000 cGy. Near the periphery there was a rapid decrease in dose averaging 1 390 cGy per millimeter radially. Because of this rapid fall-off, it may be misleading to specify the dose in cGy only. It is recommended that the total 125I activity per implant also be specified in the same way as mghr-of-radium-equivalent for cancer of the cervix. Recommended total activities needed for implantation in various prostate gland sizes are given.

Carcinoma↗
PubMed1984

[Spinal anesthesia with bupivacaine in lower urologic surgery. Our experience apropos of 500 cases].

Rachianesthesia was used for 500 lower urinary tract operations, including 50 repeat procedures, the anesthetic employed being bupivacaine. Patients were frequently hypertensive and presented cardiopathies, usually ischemic in origin. The surgical procedure generally involved transurethral prostate resection for adenoma or carcinoma, or endoscopic resection of a bladder tumor, and all patients received preventive heparin therapy using Kakkar's method. Induction of anesthesia occurs between 30 seconds and one minute after completing the injection a procedure lasting 2 to 5 minutes. Full anesthesia is obtained after 2 to 3 minutes, and is maintained during the mean operation period of 69 +/- 32 minutes by regular intraspinal injections of anesthetic. Results were perfect in 425 cases, 48 patients required additional sedatives, 23 a potent analgesic and 4 a general anesthetic after an operating time extending beyond 100 minutes heart rate remained fairly regular while diminishing slightly in frequency (an average of 4 beats/min). The fall in blood pressure was globally moderate (296 patients) and was unaltered in 204 cases. Hemodynamic modifications lasted for 3 à 4 minutes only and were corrected by appropriate therapy. Postoperative complications were mainly of the headache type (26 cases: 5%), but three patients developed angina from a coronary ischemic accident. Myocardial infarction was not observed, and no particularly incidents were reported in the 32 patients requiring repeat rachianesthesia. The simple execution and efficacy of this mode of anesthesia is emphasized, an additional need for general anesthesia being a rare event. The compound is well tolerated, hemodynamic modifications are moderate and neurological sequelae lacking. Rachianesthesia with bupivacaine appears to be among the methods of choice for lower urinary tract surgery.

Adolescent↗
PubMed1994

[Surgical treatment of prostate cancer].

Surgical treatment of prostatic carcinoma is used at the two extremities of the course of the disease. In the initial stage when the tumour is confined to the prostate, radical prostatectomy entails the best prognosis for cure by removal of the tumour, at the cost of slight morbidity, particularly the risk of subsequent impotence. However, the volume of the tumour often is greatly underestimated and the surgical excision does not reach healthy tissue in almost one out of two cases; in this case, it cannot be considered fully curative. Surgery has an important role in the metastatic phase, either as hormonal treatment (surgical castration) or with the aim of re-establishing urine flux (transurethral prostatic resection or urine derivation).

Humans↗
PubMed1994

[Transurethral microwave-thermotherapy in the treatment of benign prostatic hyperplasia].

OBJECTIVE: Determining the therapeutic efficacy of transurethral microwave thermotherapy (TUMT) in benign prostatic hyperplasia (BPH). DESIGN: Prospective. SETTING: Department of Urology, University Hospital Nijmegen, the Netherlands. METHOD: In the outpatient clinic, 130 BPH patients (mean age: 65.9 years (SD: 6.9); mean prostatic volume 50.2 cm3 (SD: 18.4)) received TUMT in a single session lasting 60 min. The prostate was heated to above 45 degrees C by a microwave antenna in a urethral catheter, resulting in tissue necrosis. In the first year after treatment the Madsen symptom score, maximal flow, residual volume, prostatic volume and concentration of prostate-specific antigen in blood were collected. RESULTS: After 1 year 98 patients could be evaluated; of the other 32, 16 withdrew from follow-up, 10 underwent transurethral prostate resection and 6, other treatment. The maximal flow increased by 1.2 ml/s (SD: 4.0). The residual volume decreased by 15.8 ml (SD: 55.6). Symptom scores improved by 5.9 points (SD: 5.0). A 50% increase in symptom score was seen in 49.5% of all patients; 24.3% showed no improvement of complaints. There was no change in prostatic volume, whereas PSA concentration showed a transient increase in the first week after TUMT. Preliminary results after 6 months' follow-up of a randomised placebo-controlled study in 50 patients showed subjective and objective improvement of miction. CONCLUSION: TUMT results in distinct subjective improvement. Urodynamic findings show a less pronounced improvement.

Aged↗
PubMed1995

Geographic variation in rates of selected surgical procedures within Los Angeles County.

OBJECTIVE: We explore the contribution of income and ethnicity to geographic variation in utilization of surgical procedures. DATA SOURCES/STUDY SETTING: We assessed the use of eight procedures from 1986 through 1988 among residents of Los Angeles County using data from the California Discharge Dataset, the 1980 census, and other secondary sources. Procedures chosen for evaluation were coronary artery bypass grafting (CABG), coronary artery angioplasty, permanent pacemaker insertion, mastectomy, simple hysterectomy, transurethral prostate resection (TURP), carotid endarterectomy, and appendectomy. STUDY DESIGN: The amount of inter-zip code variation for each procedure was first measured using various estimates including the analysis of variance coefficient of variation (CVA). Population-weighted multivariate regression analysis was used to model variation in age- and gender-adjusted rates of procedure use among 236 residential zip codes. PRINCIPAL FINDINGS: Highest-variation procedures were coronary artery angioplasty (CVA = .392) and carotid endarterectomy (CVA = .374). The procedures with the lowest degree of variation were cardiac pacemaker implantation (CVA = .194) and hysterectomy (CVA = .195). Variation was significantly related to income (carotid endarterectomy) and either African American or Latino zip code ethnicity for all procedures except pacemaker implantation. For all procedures except appendectomy, the direction of the effect was toward fewer procedures with lower income. However, the effect of African American or Latino population ethnicity varied. CONCLUSIONS: In this large urban area both population ethnicity and socioeconomic status are significantly associated with the geographic utilization of selected surgical procedures.

Age Factors↗
PubMedDate not supplied

[Endoscopic cystolithotomy: hypogastric approach].

Vesical lithiasis is a relatively frequent problem, the solution of which has changed over the last few years driven by major technological evolution. Traditional open surgery has been outstaged by the new endoscopic techniques and extracorporeal lithotrity. Here, we present our endoscopic resolution protocol through a hypogastric puncture approach, using a conventional nephroscope, with or without the use of ultrasound. This technique has been applied to 39 patients obtaining a 97.4% success rate with minimal morbidity. This procedure is usually performed under local anaesthesia and ambulatory, using an urethrovesical catheter for 1 to 2 days. This approach offers certain advantages over the one through the urethra due to the difficulties of passage through the latter, and the inconvenience of working within a relatively narrow and rigid duct. It is faster and more efficient than extracorporeal lithotrity especially in the presence of very hard or very numerous calculi and, if necessary, can be complemented immediately with a prostate transurethral resection. In summary, this is a simple, efficient and safe technique, and it has become our choice therapy to resolve a vesical lithiatic condition in males.

Adolescent↗
PubMed1997

[Emphysematous cystitis: apropos of 2 cases].

Emphysematous cystitis is a rare infectious disease of the lower urinary tract. Its reputedly serious prognosis is related to treatment failures revealing ignorance concerning its pathophysiological mechanisms. Two cases of this disease were seen in our department, both in diabetic men over the age of 70 years with a history of prostatism. They presented to the emergency department with complete urinary retention and alteration of the general state and fever. Urine culture isolated Klebsiella pneumoniae in both cases. Treatment consisted of bladder drainage associated with adapted antibiotic therapy and control of diabetes. A suprapubic prostatectomy was subsequently performed in one case and transurethral prostatic resection was performed in the other case. The prognosis of this disease depends on early diagnosis and rapid introduction of effective treatment.

Aged↗
PubMed1998

Distribution of human herpesvirus 8 DNA in tumorous and nontumorous tissue of patients with acquired immunodeficiency syndrome with and without Kaposi's sarcoma.

Human herpesvirus 8 (HHV-8) DNA is present in virtually all Kaposi's sarcomas (KSs). Conflicting results, however, exist with respect to the presence of HHV-8 in nontumorous tissue samples. To define the specificity and predictive value of HHV-8 DNA detection in KS, we analyzed autopsy-derived tissue samples from patients with acquired immunodeficiency syndrome (AIDS) with and without KS for the presence of HHV-8 DNA, using single-step and nested polymerase chain reaction. Semiquantitative analysis of HHV-8 DNA was performed by endpoint dilution assays. HHV-8 DNA was detected in 41 (100%) tumor tissue samples of KSs. According to nested polymerase chain reaction results, HHV-8 DNA was also present in 16 (32%) of 50 nontumorous specimens of patients with AIDS patients with KS and in 3 (2.7%) of 113 specimens of patients with AIDS without KS; it was absent in 26 autopsy tissues and 15 transurethral resected prostatic specimens of patients without AIDS. By use of a second, unrelated primer set, the presence of HHV-8 DNA was confirmed in 12 (63.2%) of 19 nontumorous samples and detected in another 6 (17.7%) of 34 samples tested. Significantly higher titers of HHV-8 DNA were found in tumorous than in nontumorous tissues samples (1.9 x 10(4) vs. 1.2 x 10(2); P < .05). Specificity and positive predictive values for the diagnosis of KS by detecting HHV-8 DNA in a given tissue sample were 56 and 65.1% in patients with manifest KS and 97.4 and 100% in patients without previously known KS. An increased specificity and a positive predictive value were observed when the presence of KS anywhere in a given patient was considered (92.9 and 77.8%, respectively). In conclusion, the detection of HHV-8 DNA is a sensitive test for the diagnosis of KS. Its specificity, however, might be lower because HHV-8 can be detected in histologically unaffected tissue of patients with KS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The prognostic value of bladder contractility in transurethral resection of the prostate.

The contractility of the bladder as quantified by a parameter of approximated power per bladder surface area based on the Hill equation (Wmax) was calculated for 29 patients before and 3 months after transurethral resection of the prostate. There was no significant change in this parameter as a result of the operation. Patients who still had a significant amount of residual urine postoperatively had decreased contractility before and after surgery so that the postoperative condition could have been predicted preoperatively. In many patients a fading contraction was observed, that is detrusor contractility decreased during voiding, which gave rise to a significantly increased volume of residual urine. In most patients this pattern was restored to normal after relief of the obstruction, indicating that it was not related to structural changes in the detrusor muscle. A preoperative fading contraction had no predictive value towards the outcome of the operation.

Humans↗
PubMed1986

Reduction of heat loss during transurethral resection of the prostate.

A prospective trial was performed on 100 patients to determine whether using a reflective blanket (Space Blanket) and heated glycine 1.5% bladder irrigation solution would decrease the fall in body temperature associated with transurethral resection of the prostate under spinal anaesthesia. Patients who received a combination of reflective blanket and heated glycine 1.5% solution had their fall in body temperature significantly reduced when compared with those patients managed without a reflective blanket and/or heated 1.5% glycine. There was a marked decrease in the number of patients shivering and no increase in blood loss was seen when heated bladder irrigation solution was used.

Age Factors↗
PubMed1987

Randomized double-blind, placebo controlled safety study of a low molecular weight heparinoid in patients undergoing transurethral resection of the prostate.

In preparation for an efficacy study, the effect of the low molecular weight heparinoid Org 10172 on postoperative blood loss was assessed in a randomized double-blind, placebo controlled study in patients undergoing transurethral resection of the prostate (TURP). Org 10172 and placebo were given twice daily as i.v. injection for three postoperative days starting one hour preoperatively. Three doses of Org 10172 (800, 1600, and 2400 anti-Xa units b.d.) were evaluated against placebo in three consecutive patient blocks respectively. Each block consisted of 20 patients, 15 receiving Org 10172 and 5 patients placebo. The study was discontinued after 9 patients of the third block had completed the protocol because of excessive urinary blood loss. Data analysis showed a dose-dependent increase in postoperative haemoglobin loss, this was not significant for the 800 anti-Xa units b.d. dosage but was significant in those patients treated with 1600 (p less than 0.05) and 2400 anti-Xa units b.d. (p less than 0.01). It was concluded that the heparinoid Org 10172 caused a dose dependent increase in urinary blood loss following TURP.

Aged↗
PubMed1996

Dextran 70 and blood loss during transurethral resection of the prostate.

BACKGROUND: Dextran is an effective plasma expander but also a potential anticoagulant. This article attempts to establish the clinical significance of any increased intra-operative blood loss associated with the use of dextran 70 during transurethral resection of the prostate (TURP). METHODS: The blood loss was measured in used irrigating fluid by a photometer in 800 patients undergoing TURP. In 154 of them, 500-1,000 ml of 6% dextran 70 was given for volume replacement. A regression model was used to test for interactions between the use of dextran and the operative parameters that correlated independently with the blood loss. RESULTS: The bleeding varied between 10 and 3,825 ml (median 323). Operative parameters correlating to the blood loss were: weight of the prostatic resectate, operating time, irrigating fluid absorption, and systolic arterial blood pressure. The result of this regression analysis indicated that dextran did not increase the blood loss. Neither did the prostatic weight and operating-time-corrected blood loss increase when dextran was infused. CONCLUSION: There was no indication that dextran 70 given within the recommended dose range increases the blood loss during TURP.

Aged↗
PubMed1998

Infection after transurethral resection of the prostate: variation among centers and correlation with a long-lasting surgical procedure. Association pour la Recherche en Anesthésie-Réanimation.

OBJECTIVES: The purpose of this study was to analyze the risk factors of postoperative infection following transurethral resection of the prostate (TURP). METHODS: 857 consecutive patients scheduled for TURP were included in a French multicenter prospective study (12 surgical centers). For each patient, data were collected and analyzed as risk factors of postoperative infection. Statistical analysis used the chi 2 test or Student's test for univariate analysis, then stepwise logistic regression for multivariate analysis. RESULTS: The incidence of post-TURP infection was 21.6%: urinary tract infection (19.3%) and bacteremia and/or septic shock (2.3%). Multivariate analysis documented three independent risk factors of postoperative infection: preoperative bacteriuria (p < 0.003), duration of surgical procedure > 70 min (p < 0.01) and the surgical center (p < 0.00001). CONCLUSION: The duration of the surgical procedure is an important postoperative risk factor of infection and there is a major difference between centers in terms of postoperative risk of infection. Further studies are needed to explain this last phenomenon.

Aged↗
PubMed1984

'Cardiac' enzymes after transurethral resection of the prostate.

Postoperative serial determinations of serum total creatine kinase (CK) and the CK-B subunit (by immunoinhibition), and of total lactate dehydrogenase (LD) and isoenzyme LD-1 (by immunoprecipitation), were performed in 16 and 9 patients, respectively, after uncomplicated transurethral resection of the prostate (TURP). Total CK remained unchanged. An early, modest increase in serum CK-B activity, accompanied by an unusually high CK-B/total CK relation, correlated significantly with duration of operation and amount of tissue resected. A slight, early elevation of the total LD level was not accompanied by an increase in LD-1. If the possibility of small increases in CK-B and LD from the prostate is taken into consideration, routine criteria for diagnosing myocardial damage may be applied after TURP.

Aged↗
PubMed1996

[Cardiac arrest during transurethral resection of the prostate].

Due to the development of anesthetic drugs and techniques, and the progress of monitor system. The rate of cardiac arrest during anesthesia has declined during the last decades. We report two cases of sudden cardiac arrest which happened during transurethral resection of the prostate, and discuss the mechanism, treatment, and the methods of prevention.

Adult↗