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Guo RQ, Meng YS, Yu W, Zhang K, Xu B, Xiao YX, Wu SL, Pan BN. Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis. Asian J Androl 2017; 20:62-68. [PMID: 28440263 PMCID: PMC5753556 DOI: 10.4103/aja.aja_6_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.
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Affiliation(s)
- Run-Qi Guo
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
| | - Yi-Sen Meng
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
| | - Wei Yu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
| | - Kai Zhang
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
| | - Ben Xu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
| | - Yun-Xiang Xiao
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
| | - Shi-Liang Wu
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
| | - Bai-Nian Pan
- Department of Urology, Peking University First Hospital and Institute of Urology, National Research Center for Genitourinary Oncology, Beijing 100034
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Nash DB. Ahead of the curve. Popul Health Manag 2013; 16 Suppl 1:S1. [PMID: 24070242 DOI: 10.1089/pop.2013.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David B Nash
- Jefferson School of Population Health , Philadelphia, Pennsylvania
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Liu H, Harris KM, Weinberger S, Serxner S, Mattke S, Exum E. Effect of an employer-sponsored health and wellness program on medical cost and utilization. Popul Health Manag 2013; 16:1-6. [PMID: 22823180 PMCID: PMC3883086 DOI: 10.1089/pop.2013.1691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The objective of this study was to examine the impact of PepsiCo's health and wellness program on medical cost and utilization. The authors analyzed health plan and program data of employees and dependents 19-64 years of age, who had 2 years of baseline data (2002 and 2003) and at least 1 year of data from the intervention period (2004 to 2007), resulting in a sample of 55,030 members. Program effects were measured using a difference-in-difference approach based on a multivariate regression model with an individual-level random effect. In its first year, the program was associated with a relative increase in per member per month (PMPM) cost ($66, P<0.01); a relative reduction in PMPM costs of $76 (P<0.01) and $61 (P<0.01) was seen in the second and third year, respectively. Over all 3 years, the program was associated with reduced PMPM costs of $38 (P<0.01), a decrease of 50 emergency room visits per 1000 member years (P<0.01), and a decrease of 16 hospital admissions per 1000 member years (P<0.01). The disease management component reduced PMPM costs by $154 (P<0.01), case management increased PMPM costs by $2795 (P<0.01), but no significant effects were observed for lifestyle management over the 3 intervention years. The implementation of a comprehensive health and wellness program was associated with a cost increase in the first year, followed by a decrease in the following years. These results highlight the importance of taking a long-term perspective when implementing such programs and evaluating their effectiveness.
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Affiliation(s)
- Hangsheng Liu
- The RAND Corporation, Boston, Massachusetts 02116, USA.
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Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel M, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. Therapie des benignen Prostatasyndroms (BPS). Urologe A 2009; 48:1503-16. [DOI: 10.1007/s00120-009-2067-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rassweiler J, Schulze M, Stock C, Teber D, De La Rosette J. Bipolar transurethral resection of the prostate ‐ technical modifications and early clinical experience. MINIM INVASIV THER 2009; 16:11-21. [PMID: 17365673 DOI: 10.1080/13645700601159410] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of the study was to update the current modifications of transurethral resection of the prostate (TURP) using bipolar high frequency current and to report on our first own clinical experience. Based on a Medline search covering the period from January 2000 to September 2006 and our clinical experience with three different devices (VISTA-ACMI, Gyrus, Storz), the technical basis of these modifications was described. In addition, an analysis of the actual outcome (handling, complications, morbidity) of bipolar TURP (n = 124) compared to a parallel series of monopolar TURP (N = 148) was carried out. Recently, five different modifications of bipolar resection devices (ACMI, Gyrus, Olympus, Storz, Wolf) have been introduced. Experimental and clinical data were available for four of these modifications (VISTA-ACMI, Gyrus, Olympus, Storz). The devices differ in terms of modification of the passive electrode (two loops, single loop, resectoscope sheath). Bipolar technology allows the use of 0.9% sodium chloride (instead of glycine) as irrigant. In all bipolar devices, a slight prolongation was noted for initiation of the cut, with the VISTA showing the poorest cutting behaviour. Finest apical dissection could be performed with the Storz device. Phase III-studies comparing bipolar and monopolar TURP showed advantages for bipolar concerning the rate of TUR-syndrome/fluid absorption, bleeding, catheter time, whereas the resection speed was similar. In two studies using two different devices (Gyrus, Olympus) a higher rate of urethral strictures was detected. We conclude that TURP still represents the reference standard in the management of benign prostatic hyperplasia. Initial data suggest that bipolar technology is safe and effective. It may offer some advantages with respect to the reduction of TUR-syndrome, less conductive trauma (i.e. tissue charring), cheaper irrigation solution, and a shorter catheter time. In addition to already existing phase III-studies, larger randomized mulit-institutional trials will have to substantiate these advantages.
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Affiliation(s)
- Jens Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Germany.
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Park KS, Cho YS, Joo KJ. Potassium-Titanyl-Phosphate Laser Photoselective Vaporization of the Prostate in Patients with Benign Prostatic Hyperplasia with Detrusor Underactivity: Influence on Detrusor Pressure. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.12.1193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kyung Seo Park
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sam Cho
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Joong Joo
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Orth M. [Benign prostatic hypertrophy and the benign prostatic syndrome]. ACTA ACUST UNITED AC 2008; 37:315-21. [PMID: 18618632 DOI: 10.1002/pauz.200700275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Matthias Orth
- Vinzenz von Paul Kliniken gGmbH, Marienhospital Stuttgart, Institut für Laboratoriumsmedizin, Adlerstr. 7, 70199 Stuttgart.
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Yang SW, Yu JH, Sung LH, Chung JY, Noh CH. The Effectiveness of Transurethral Resection of the Prostate Combined with High Power Potassium-titanyl-phosphate (KTP) Laser Vaporization for Patients with a Prostate Volume Greater than 45cc. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.11.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Seung Wan Yang
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ji Hyeong Yu
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Luck Hee Sung
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Yong Chung
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Choong Hee Noh
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Hamann MF, Wild C, Seif C, Hautmann S, Jünemann KP, Braun PM. Funktionelle Ergebnisse nach Laservaporisation der Prostata mit dem KTP-Laser. Urologe A 2007; 46:521-4, 526-7. [PMID: 17372716 DOI: 10.1007/s00120-007-1311-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment for bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH) impairs the quality of life. The potassium tintanyl phosphate (KTP) vaporisation of the prostate offers promising modalities in treatment of BOO. We prospectively determined the impact of KTP-lasertherapy on voiding function, quality of life and sexual function. PATIENTS AND METHODS So far a total of n=123 patients complaining of symptomatic BPH were treated with an 80 watt Laser. N= 40 of them agreed to participate in the study and were evaluated prospectively. Preoperative pressure-flow-studies verified significant bladder outlet obstruction in all cases. Disease specific quality of life and sexual function were assessed using the International Prostate Symptom Score (IPSS) and International Inventory of Erectile Function (IIEF). Three months after treatment follow-up video-urodynamics were carried out to determine changements in pressure flow and bladder function. RESULTS All patients showed significant improvement after a hospital stay of 4,9 days. The maximum flow rate increased from 9,1 ml/sec preoperatively to 20,2 ml/sec and the amount of residual urine decreased from 98 ml preoperatively to 17 ml immediately after removal of the catheter. Urodynamics after the follow up period showed that the maximum urinary flow improved from 9.7 ml/s preoperatively to 17,6 ml/s and the volume of residual urine decreased from a median of 127.5 ml preoperatively to 45 ml postoperatively. The IPSS and IIEF decreased from a median of 20,4 preoperatively to 8,16 and from a median of 14 preoperatively to 12,7 respectively. The pressure-flow study verified the desobstruction and showed a decline in detrusor pressure at maximum flow from 76,66 cm H2O to 33,79 cm H2O. The urethral opening pressure sank from 75.86 cm H2O preoperatively to 37,51 cm H2O postoperatively. CONCLUSION The potassium tintanyl phosphate (KTP) vaporisation of the prostate is a promising new method in the treatment of benign prostatic hyperplasia as shown by the data. Beside its low perioperative and postoperative morbidity due to a high hemostatic property it offers a good tissue debulking effect.
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Affiliation(s)
- M F Hamann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105 Kiel.
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Verger-Kuhnke AB, Reuter MA, Epple W, Ungemach G. [The low hydraulic pressure transurethral resection of the prostate results in 340 patients with great adenomas]. Actas Urol Esp 2007; 30:896-904; discussion 904. [PMID: 17175929 DOI: 10.1016/s0210-4806(06)73555-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION the transurethral resection of prostate TURP is the elective treatment for the small and medium adenomas. In this study they analyse the effectiveness, the results and the postoperative morbidity in the resection of the great adenomas. PATIENTS AND METHOD We study 340 patients with great adenomas and symptomatic infravesical obstruction that were operated with the low hydraulic pressure RTUP between August of 1999 and June of 2006. RESULTS Average Age of the patients 69 years (range 51-89). Prostate volume by TRUS, 107 ml (70-204). PSA 7,94 ng/ml (0,71-26,4). Weight of the resected fragments: 74,5gr. (50-160), time of the intervention 65 min. (35-155), postoperative urethral catheterisation 1.7 days (1-8), suprapubic derivation 6.5 days (5-15), the duration of hospital stay after surgery were 8 days (7-16), peak flow pre-op. 11.2 ml/sec. (5-15,7), post-operative 19.7 ml/sec. (7-41,3). There were no cases of TURP syndrome in this group. Operative complications: Urinary infection without fever (bacteria >100.000) 95 patients (27.9%), bladder derivation by preoperative urinary retention 53 patients (15,6%). 18 patients (5,3%) with postoperative urinary retention. 11 patients (3,2%), with infection and fever >38 degrees C. 7 patients (2%) with postoperative bladder bleeding, 2 patients (0,6%) with urethral lesion. 1 patient (0.3%), with massive scrotal hematoma (after vasectomy). Control of the pre and post operative hemoglobin: Hemoglobin pre-op 15 g/dl (12-19,3), hemoglobin post-op 11,5 g/dl (7,6-16,4), difference of (- 3,5g/dl) 23,3%. In only 29 patients (8.5%) it was necessary to carry out a sanguineous transfusions (heterolog) of 2 to 4 EC (500 ml), the TRUS was 125 ml, weight of the fragments 90 gr. (52-140), the hemoglobin pre-op was 14,72g/dl and post-op of 8,8g/dl with a difference of (- 5,92g/dl) 40.2%. CONCLUSIONS The video assisted low hydraulic pressure TURP, is an effective method in the surgical treatment of great prostate adenomas. The severe postoperative complications are little, and in 311 patients (91.5%) it was not necessary sanguineous transfusion. The stationary treatment and the urethral catheterisation is smaller in comparison with the open adenomectomy.
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Affiliation(s)
- A B Verger-Kuhnke
- Reuter Klink, Servicio de Urología, Hospital Karl-Olga, Hospital Escuela Dependiente de la Universidad de Ulm, Stuttgart Alemania.
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Jonas U, Gabouev AI, Herrmann TRW, Höfner K, Michel MC, Alschibaja M, Hartung R. Benigne Prostatahyperplasie. Urologe A 2006; 45 Suppl 4:134-44. [PMID: 16912878 DOI: 10.1007/s00120-006-1139-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- U Jonas
- Medizinische Hochschule, Carl-Neuberg-Strasse 1, 30625 Hannover.
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Reich O, Seitz M, Gratzke C, Schlenker B, Bachmann A, Stief C. Benignes Prostatasyndrom (BPS). Urologe A 2006; 45:769-80; quiz 781-2. [PMID: 16788796 DOI: 10.1007/s00120-006-1039-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Today, the surgical treatment of the benign prostatic syndrome (BPS) often follows a course of drug treatment. Besides conventional transurethral resection of the prostate (TURP), which has represented the standard therapeutic option for decades, and its in part significant modifications ("vaporizing resection"; bipolar resection), much of the interest has shifted to alternative instrumental procedures like transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA) or several laser techniques. By reviewing the current literature, preferably from randomized controlled trials, these different procedures are critically assessed. Moreover, the present role of open prostatectomy is discussed.
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Affiliation(s)
- O Reich
- Urologische Klinik und Poliklinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, 81377 , München,
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Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol 2006; 50:969-79; discussion 980. [PMID: 16469429 DOI: 10.1016/j.eururo.2005.12.042] [Citation(s) in RCA: 786] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 12/19/2005] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To update the complications of transurethral resection of the prostate (TURP), including management and prevention based on technological evolution. METHODS Based on a MEDLINE search from 1989 to 2005, the 2003 results of quality management of Baden-Württemberg, and long-term personal experience at three German centers, the incidence of complications after TURP was analyzed for three subsequent periods: early (1979-1994); intermediate (1994-1999); and recent (2000-2005) with recommendations for management and prevention. RESULTS Technological improvements such as microprocessor-controlled units, better armamentarium such as video TUR, and training helped to reduce perioperative complications (recent vs. early) such as transfusion rate (0.4% vs. 7.1%), TUR syndrome (0.0% vs. 1.1%), clot retention (2% vs. 5%), and urinary tract infection (1.7% vs. 8.2%). Urinary retention (3% vs. 9%) is generally attributed to primary detrusor failure rather than to incomplete resection. Early urge incontinence occurs in up to 30-40% of patients; however, late iatrogenic stress incontinence is rare (<0.5%). Despite an increasing age (55% of patients are older than 70), the associated morbidity of TURP maintained at a low level (<1%) with a mortality rate of 0-0.25%. The major late complications are urethral strictures (2.2-9.8%) and bladder neck contractures (0.3-9.2%). The retreatment rate range is 3-14.5% after five years. CONCLUSIONS TURP still represents the gold standard for managing benign prostatic hyperplasia with decreasing complication rates. Technological alternatives such as bipolar and laser treatments may further minimize the risks of this technically difficult procedure.
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Affiliation(s)
- Jens Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Germany.
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Kim HG, Lee BK, Paick SH, Lho YS. Efficacy of Bipolar Transurethral Resection of the Prostate: Comparison with Standard Monopolar Transurethral Resection of the Prostate. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.4.377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyeong Gon Kim
- Department of Urology, Konkuk University College of Medicine, Seoul, Korea
| | - Byung Ki Lee
- Department of Urology, Konkuk University College of Medicine, Seoul, Korea
| | - Sung Hyun Paick
- Department of Urology, Konkuk University College of Medicine, Seoul, Korea
| | - Yong Soo Lho
- Department of Urology, Konkuk University College of Medicine, Seoul, Korea
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