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Sekar H, Palaniyandi V, Krishnamoorthy S, Kumaresan N. Post-transurethral resection of prostate urethral strictures: Are they often underreported? A single-center retrospective observational cohort study. Urol Ann 2021; 13:329-335. [PMID: 34759641 PMCID: PMC8525477 DOI: 10.4103/ua.ua_165_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/27/2020] [Accepted: 11/27/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Post-transurethral resection of prostate urethral stricture (PTS) is a well-documented delayed complication following transurethral resection of the prostate (TURP). The aim is to analyze various risk factors of PTS and see if the overall incidence is underreported. Materials and Methods A retrospective study was conducted in our institution between January 2017 and December 2018 in men who underwent TURP. Data obtained from the medical records department were analyzed. Statistical analysis was done using Fisher's exact test. A two-tailed P < 0.05 is considered statistically significant. Results Of the 447 men who underwent TURP, 57 developed PTS. Fifteen of 334 patients who underwent calibration before the procedure developed stricture compared to 42 of 137 without calibration (P < 0.01). There was a significantly lesser incidence of stricture with 24 Fr resectoscope compared with 26 Fr sheath (P < 0.04). Two patients with 24 Fr Foley and 30 of 35 (86%) patients with 22 Fr Foley catheter developed stricture of urethra. Distal bulbar urethra was the most common site of narrowing following TURP. Eighteen patients had Salvaris swab placed for traction and 12 patients required full-thigh traction, of which majority developed meatal stenosis. Conclusions TURP is one of the common surgical procedures performed by urologists. Meatitis and meatal stenosis, if included as complications of TURP, would increase the overall incidence of PTS. Factors such as the size of resectoscope sheath used, size of catheter inserted, placement of Salvaris swab traction, and preoperative calibration of urethra have a significant impact on the ultimate outcome.
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Affiliation(s)
- Hariharasudhan Sekar
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Velmurugan Palaniyandi
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sriram Krishnamoorthy
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Natarajan Kumaresan
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Abstract
For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.
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Affiliation(s)
- Jian-Wei Wang
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
| | - Li-Bo Man
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China
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Otaola-Arca H, Álvarez-Ardura M, Molina-Escudero R, Fernández MI, Páez-Borda Á. A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications. Int Braz J Urol 2020; 47:131-144. [PMID: 33047918 PMCID: PMC7712692 DOI: 10.1590/s1677-5538.ibju.2019.0766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/17/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is “rigorous” (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.
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Affiliation(s)
- Hugo Otaola-Arca
- Department of Urology, Clínica Alemana, Santiago, Chile.,Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,International Doctoral School, Universidad Rey Juan Carlos, Madrid, Spain.,Faculty of Medicine, Clínica Alemena-Universidad del Desarrollo, Santiago, Chile
| | - Manuel Álvarez-Ardura
- Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,International Doctoral School, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Mario I Fernández
- Department of Urology, Clínica Alemana, Santiago, Chile.,Faculty of Medicine, Clínica Alemena-Universidad del Desarrollo, Santiago, Chile
| | - Álvaro Páez-Borda
- Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,International Doctoral School, Universidad Rey Juan Carlos, Madrid, Spain
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Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N'Dow JMO, Chen C, Lam TBL. Reprint - Bipolar vs. monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction: A Cochrane review. Can Urol Assoc J 2020; 14:423-430. [PMID: 32569563 DOI: 10.5489/cuaj.6464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There remains uncertainty regarding the differences in patient outcomes between monopolar transurethral resection of the prostate (MTURP) and bipolar TURP (BTURP) in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). METHODS A systematic literature search was carried out up to March 19, 2019. Methods in the Cochrane Handbook were followed. Certainty of evidence (CoE) was assessed using the GRADE approach. RESULTS A total of 59 randomized controlled trials (RCTs) with 8924 participants were included. BTURP probably results in little to no difference in International Prostate Symptom Score (IPSS) at 12 months (mean difference -0.24, 95% confidence internal [CI] -0.39--0.09; participants=2531; RCTs=16; moderate CoE) or health-related quality of life (HRQOL) at 12 months (mean difference -0.12, 95% CI -0.25-0.02; participants=2004, RCTs=11; moderate CoE), compared to MTURP. BTURP probably reduces TUR syndrome (relative risk [RR] 0.17, 95% CI 0.09-0.30; participants= 6,745, RCTs=44; moderate CoE) and blood transfusions (RR 0.42, 95% CI 0.30-0.59; participants=5727, RCTs=38; moderate CoE), compared to MTURP. BTURP may carry similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01-4.06; participants=751; RCTs=4; low CoE), re-TURP (RR 1.02, 95% CI 0.44-2.40; participants=652, RCTs=6, I2=0%; low CoE) and erectile dysfunction (International Index of Erectile Function [IIEF-5]) at 12 months (mean difference 0.88, 95% CI -0.56-2.32; RCTs=3; moderate CoE), compared to MTURP. CONCLUSIONS BTURP and MTURP probably improve urological symptoms to a similar degree. BTURP probably reduces TUR syndrome and blood transfusion slightly postoperatively. The moderate certainty of evidence available for primary outcomes suggests no need for further RCTs comparing BTURP and MTURP.
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Affiliation(s)
| | - Malo M F Scullion
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, ON, Canada
| | - Charalampos Mamoulakis
- Department of Urology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - James M O N'Dow
- Urology Department, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Changhao Chen
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
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Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N'Dow JMO, Chen C, Lam TBL. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 2019; 12:CD009629. [PMID: 31792928 PMCID: PMC6953316 DOI: 10.1002/14651858.cd009629.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is a well-established surgical method for treatment of men with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). This has traditionally been provided as monopolar TURP (MTURP), but morbidity associated with MTURP has led to the introduction of other surgical techniques. In bipolar TURP (BTURP), energy is confined between electrodes at the site of the resectoscope, allowing the use of physiological irrigation medium. There remains uncertainty regarding differences between these surgical methods in terms of patient outcomes. OBJECTIVES To compare the effects of bipolar and monopolar TURP. SEARCH METHODS A comprehensive systematic electronic literature search was carried out up to 19 March 2019 via CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, PubMed, and WHO ICTRP. Handsearching of abstract proceedings of major urological conferences and of reference lists of included trials, systematic reviews, and health technology assessment reports was undertaken to identify other potentially eligible studies. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared monopolar and bipolar TURP in men (> 18 years) for management of LUTS secondary to BPO. DATA COLLECTION AND ANALYSIS Two independent review authors screened the literature, extracted data, and assessed eligible RCTs for risk of bias. Statistical analyses were undertaken according to the statistical guidelines presented in the Cochrane Handbook for Systematic Reviews of Interventions. The quality of evidence (QoE) was rated according to the GRADE approach. MAIN RESULTS A total of 59 RCTs with 8924 participants were included. The mean age of included participants ranged from 59.0 to 74.1 years. Mean prostate volume ranged from 39 mL to 82.6 mL. Primary outcomes BTURP probably results in little to no difference in urological symptoms, as measured by the International Prostate Symptom Score (IPSS) at 12 months on a scale of 0 to 35, with higher scores reflecting worse symptoms (mean difference (MD) -0.24, 95% confidence interval (CI) -0.39 to -0.09; participants = 2531; RCTs = 16; I² = 0%; moderate certainty of evidence (CoE), downgraded for study limitations), compared to MTURP. BTURP probably results in little to no difference in bother, as measured by health-related quality of life (HRQoL) score at 12 months on a scale of 0 to 6, with higher scores reflecting greater bother (MD -0.12, 95% CI -0.25 to 0.02; participants = 2004; RCTs = 11; I² = 53%; moderate CoE, downgraded for study limitations), compared to MTURP. BTURP probably reduces transurethral resection (TUR) syndrome events slightly (risk ratio (RR) 0.17, 95% CI 0.09 to 0.30; participants = 6745; RCTs = 44; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 20 fewer TUR syndrome events per 1000 participants (95% CI 22 fewer to 17 fewer). Secondary outcomes BTURP may carry a similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01 to 4.06; participants = 751; RCTs = 4; I² = 0%; low CoE, downgraded for study limitations and imprecision), compared to MTURP. This corresponds to four fewer events of urinary incontinence per 1000 participants (95% CI five fewer to 16 more). BTURP probably slightly reduces blood transfusions (RR 0.42, 95% CI 0.30 to 0.59; participants = 5727; RCTs = 38; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 28 fewer events of blood transfusion per 1000 participants (95% CI 34 fewer to 20 fewer). BTURP may result in similar rates of re-TURP (RR 1.02, 95% CI 0.44 to 2.40; participants = 652; RCTs = 6; I² = 0%; low CoE, downgraded for study limitations and imprecision). This corresponds to one more re-TURP per 1000 participants (95% CI 19 fewer to 48 more). Erectile function as measured by the International Index of Erectile Function score (IIEF-5) at 12 months on a scale from 5 to 25, with higher scores reflecting better erectile function, appears to be similar (MD 0.88, 95% CI -0.56 to 2.32; RCTs = 3; I² = 68%; moderate CoE, downgraded for study limitations) for the two approaches. AUTHORS' CONCLUSIONS BTURP and MTURP probably improve urological symptoms, both to a similar degree. BTURP probably reduces both TUR syndrome and postoperative blood transfusion slightly compared to MTURP. The impact of both procedures on erectile function is probably similar. The moderate certainty of evidence available for the primary outcomes of this review suggests that there is no need for further RCTs comparing BTURP and MTURP.
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Affiliation(s)
- Cameron Edwin Alexander
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Malo MF Scullion
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
- European Association of UrologyArnhemNetherlands
| | - Yuhong Yuan
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1280 Main Street WestRoom HSC 3N51HamiltonONCanadaL8S 4K1
| | - Charalampos Mamoulakis
- University General Hospital of Heraklion, University of Crete Medical SchoolDepartment of UrologyHeraklion, CreteGreece
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal InfirmaryUrology DepartmentForesterhillAberdeenScotlandUKAB25 2ZN
| | - Changhao Chen
- Sun Yat‐Sen Memorial Hospital, Sun Yat‐Sen UniversityDepartment of Urology107 Yan‐Jiang RoadGuangzhouChina
| | - Thomas BL Lam
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
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Tan GH, Shah SA, Ali NM, Goh EH, Singam P, Ho CCK, Zainuddin ZM. Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate. Investig Clin Urol 2017; 58:186-191. [PMID: 28480344 PMCID: PMC5419110 DOI: 10.4111/icu.2017.58.3.186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to determine the urethral stricture (US) rate and identify clinical and surgical risk factors associated with US occurrence after transurethral resection of the prostate using the bipolar Gyrus PlasmaKinetic Tissue Management System (PK-TURP). MATERIALS AND METHODS This was an age-matched case-control study of US occurrence after PK-TURP. Retrospective data were collected from the hospital records of patients who had a minimum of 36 months of follow-up information. Among the data collected for analysis were prostate-specific antigen level, estimated prostate weight, the amount of prostate resected, operative time, history of urinary tract infection, previous transurethral resection of the prostate, and whether the PK-TURP was combined with other endourological procedures. The resection rate was calculated from the collected data. Univariate and multivariate analyses were performed to identify clinical and surgical risk factors related to US formation. RESULTS A total of 373 patients underwent PK-TURP between 2003 and 2009. There were 13 cases of US (3.5%), and most of them (10 of 13, 76.9%) presented within 24 months of surgery. Most of the US cases (11 of 13, 84.6%) occurred at the bulbar urethra. Multivariable logistic regression analyses identified slow resection rate as the only risk factor significantly associated with US occurrence. CONCLUSIONS The US rate of 3.5% after PK-TURP in this study is comparable to contemporary series. A slow resection rate seems to be related to US occurrence. This should be confirmed by further studies; meanwhile, we must be mindful of this possibility when operating with the PK-TURP system.
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Affiliation(s)
- Guan Hee Tan
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurayub Md Ali
- Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Eng Hong Goh
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Praveen Singam
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Zulkifli Md Zainuddin
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Cui Y, Chen H, Liu L, Chen J, Qi L, Zu X. Comparing the Efficiency and Safety of Bipolar and Monopolar Transurethral Resection for Non-Muscle Invasive Bladder Tumors: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2016; 26:196-202. [PMID: 26799841 DOI: 10.1089/lap.2015.0507] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of bipolar and monopolar transurethral resection of bladder tumor (TURBT) procedures for non-muscle invasive bladder cancer (NMIBC) patients. MATERIALS AND METHODS We searched for all studies investigating bipolar TURBT and monopolar TURBT for NMIBC patients in PubMed, Web of Knowledge, and the Cochrane Central Search Library. A systematic review and meta-analysis were performed. Efficacy was assessed by catheterization time, resection time, pathology, and recurrence rate. Safety was assessed by obturator nerve reflex, bladder perforation, hemoglobin decrease, and transfusion. RESULTS Our searches identified eight studies. Bipolar TURBT is associated with decreased resection time, catheterization time, and hemoglobin changes. There were no statistically significant differences between bipolar TURBT and monopolar TURBT for rates of obturator nerve reflex, bladder perforation, and transfusion. The grade of cautery artifact had no different between the two procedures or even was lower in the bipolar arm. There was no significant difference in recurrence rate when comparing the two procedures. CONCLUSIONS This systematic review indicates that the bipolar technique is more efficacious and safer for NMIBC patients. More large-scale, multicenter, randomized controlled studies are needed before final clinical recommendations can be made.
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Affiliation(s)
- Yu Cui
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, China
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Abdallah MM, Badreldin MO. A short-term evaluation of the safety and the efficacy of bipolar transurethral resection of the prostate in patients with a large prostate (>90 g). Arab J Urol 2015; 12:251-5. [PMID: 26155365 PMCID: PMC4487266 DOI: 10.1016/j.aju.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of bipolar transurethral resection of the prostate (TURP) in patients with a large prostate (>90 g), as a significant recent modification of TURP is the incorporation of bipolar technology, which uses the same technique as monopolar TURP but with normal saline as the irrigant. PATIENTS AND METHODS Forty patients with a prostate of >90 g and who were considered at risk for monopolar TURP were treated by bipolar TURP. The operative duration, resection time, resected tissue weight, resection rate, resection ratio, amount of irrigation fluid used, the decrease in intraoperative haemoglobin level, haematocrit and serum sodium levels, and the blood loss were recorded. The follow-up data were analysed. RESULTS The mean (SD) operative duration was 116.3 (25.52) min, the resection time was 106.5 (25.69) min, the resected volume was 78.9 (20.58) g, the decrease in haemoglobin levels was 1.67 (0.46) g/dL, the mean serum sodium decline was 2.60 (0.68) mmol/L, and the blood loss was 532 (101.2) mL. The blood loss/g of resected tissue was 6.85 (0.70) mL. The mean (SD) postoperative bladder irrigation time was 2.0 (0.32) days, the catheterisation time was 3.25 (0.55) days and the postoperative hospital stay was 3.25 (0.55) days. CONCLUSION Bipolar technology makes it possible to use TURP to treat patients with very large prostates and who are at risk when treated by the standard monopolar technology, with a satisfactory safety profile and with favourable efficacy.
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Affiliation(s)
- Mohamed M Abdallah
- Urology Department, Menoufiya University Hospital, Menoufiya University, Egypt
| | - Mohamed O Badreldin
- Urology Department, Menoufiya University Hospital, Menoufiya University, Egypt
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Mamoulakis C, Sofras F, de la Rosette J, Omar MI, Lam TBL, N'Dow JMO, Ubbink DT. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd009629.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Charalampos Mamoulakis
- University Hospital of Heraklion, University of Crete Medical School; Department of Urology; Heraklion Crete Greece
| | - Frank Sofras
- University Hospital of Heraklion, University of Crete Medical School; Department of Urology; Heraklion Crete Greece
| | - Jean de la Rosette
- Academic Medical Center, University of Amsterdam; Department of Urology; Amsterdam Netherlands
| | - Muhammad Imran Omar
- University of Aberdeen; Academic Urology Unit; Health Sciences Building (second floor) Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - Thomas BL Lam
- University of Aberdeen; Academic Urology Unit; Health Sciences Building (second floor) Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal Infirmary; Urology Department; Foresterhill Aberdeen Scotland UK AB25 2ZN
| | - Dirk T Ubbink
- Academic Medical Centre, University of Amsterdam; Quality Assurance & Process Innovation, and Department of Surgery; J1b-215 Academic Medical Centre Meibergdreef 9, PO Box 22700 Amsterdam Netherlands 1100 DE
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Mamoulakis C, Schulze M, Skolarikos A, Alivizatos G, Scarpa RM, Rassweiler JJ, de la Rosette JJ, Scoffone CM. Midterm Results from an International Multicentre Randomised Controlled Trial Comparing Bipolar with Monopolar Transurethral Resection of the Prostate. Eur Urol 2013; 63:667-76. [DOI: 10.1016/j.eururo.2012.10.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
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Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int 2013; 112:109-20. [DOI: 10.1111/j.1464-410x.2012.11662.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andreas Skolarikos
- Second Department of Urology; Sismanoglio Hospital; University of Athens Medical School; Athens; Greece
| | - Michael Schulze
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn; Germany
| | - Cesare M. Scoffone
- Department of Urology, San Luigi Hospital; University of Turin; Orbassano; Turin; Italy
| | - Jens J. Rassweiler
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn; Germany
| | - Gerasimos Alivizatos
- Second Department of Urology; Sismanoglio Hospital; University of Athens Medical School; Athens; Greece
| | - Roberto M. Scarpa
- Department of Urology, San Luigi Hospital; University of Turin; Orbassano; Turin; Italy
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Reply by the authors. Urology 2013; 81:472. [PMID: 23374839 DOI: 10.1016/j.urology.2012.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 10/20/2012] [Accepted: 10/22/2012] [Indexed: 11/24/2022]
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Bipolar Transurethral Resection of the Prostate Causes Deeper Coagulation Depth and Less Bleeding Than Monopolar Transurethral Prostatectomy. Urology 2012; 80:1116-20. [DOI: 10.1016/j.urology.2012.07.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/05/2012] [Accepted: 07/17/2012] [Indexed: 11/19/2022]
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Khorrami M, Hadi M, Javid A, Izadpahani MH, Mohammadi Sichani M, Zargham M, Alizadeh F. A Comparison Between Blind and Nerve Stimulation Guided Obturator Nerve Block in Transurethral Resection of Bladder Tumor. J Endourol 2012; 26:1319-22. [DOI: 10.1089/end.2012.0037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mazaher Hadi
- Department of Urology, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Amir Javid
- Department of Urology, Isfahan University of Medical Sciences, Esfahan, Iran
| | | | | | - Mahtab Zargham
- Department of Urology, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Farshid Alizadeh
- Department of Urology, Isfahan University of Medical Sciences, Esfahan, Iran
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15
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[Surgical treatment of male lower urinary tract symptoms (LUTS)]. Urologe A 2012; 51:1297-306; quiz 1307. [PMID: 22940718 DOI: 10.1007/s00120-012-2959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) comprises a variety of treatment modalities. Transurethral resection of the prostate (TURP) is considered the gold standard. In the last decade various new techniques have emerged with encouraging functional results. However, long-term data are missing in order to evaluate the efficacy and safety. This review aims to describe new widely available techniques and to assess the underlying evidence.
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Laser prostatectomy of lower urinary tract symptoms due to benign prostate enlargement: a critical review of evidence. Curr Opin Urol 2012; 22:22-33. [PMID: 22123291 DOI: 10.1097/mou.0b013e32834dd0ed] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Different transurethral prostatic laser systems are available. In 2011, new Oxford evidence levels (LoEs) were published with significant changes compared with the former version. They are easier to use and incorporate more clinical aspects. Randomized trials of laser systems used before 2002, except Holmium laser, were not included in this critical evidence analysis, as these techniques are not in clinical use any more. RECENT FINDINGS Twenty-five [18 Holmium enucleation of the prostate (HoLEP) and seven photoselective vaporization of the prostate (PVP)] randomized trials covering transurethral electroresection of the prostate or HoLEP, PVP or Thulium laser enucleation were identified. According to evidence levels, there is a large gap in terms of long-term follow-up. The majority of randomised controlled trials are of low quality. Typically with HoLEP, many articles were published covering the same patient population (LoE II). Only one randomised controlled trial was published with Tm:YAG prostatectomy (LoE II) and none with diode lasers (980-1340 nm, LoE IV-V). Large cohort studies (LoE III-IV) provide additional evidence for PVP and HoLEP, typically for subgroups. SUMMARY In 2011, higher evidence on HoLEP and PVP has been published. Evidence levels for HoLEP and PVP are comparable with meta-analysis (LoE II). However, evidence that laser prostatectomy is better than transurethral electroresection of the prostate in terms of efficacy is lacking (LoE II). All lasers are safer in terms of perioperative bleeding (LoE II).
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Mamoulakis C, Sofras F, de la Rosette J, Omar MI, Lam TBL, N'Dow JMO, Ubbink DT. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Zhu G, Xie C, Wang X, Tang X. Bipolar plasmakinetic transurethral resection of prostate in 132 consecutive patients with large gland: three-year follow-up results. Urology 2011; 79:397-402. [PMID: 22035765 DOI: 10.1016/j.urology.2011.08.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/15/2011] [Accepted: 08/27/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the safety, efficacy, and medium-term durability of bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia in a prospective study. METHODS From March 2007 to May 2008, 132 consecutive patients underwent PK-TURP at our institution. All patients were assessed perioperatively and followed up at 1, 3, 6, 12, 18, 24, and 36 months postoperatively. The parameters included the International Prostate Symptom Score, quality of life scores, maximal urinary flow rates, transrectal ultrasonography, postvoid residual urine volume, and serum prostate-specific antigen level. RESULTS The mean patient age was 64.55±4.03 years. The prostate volume was 79.66±12.36 g. The operative time was 78.83±17.41 minutes, and the resected weight was 58.12±7.29 g. The catheterization time was 69.00±17.99 hours, and the hospital stay was 117.00±17.99 hours. The decrease in hemoglobin and sodium was 1.55±0.48 g/dL and 1.57±0.38 mmol/L, respectively. A significant improvement occurred in the maximal urinary flow rate (22.34±3.1 mL/s), International Prostate Symptom Score (2.90±1.60), and quality of life (1.12±0.60) at the 3-year follow-up compared with baseline (P<.001). Of the 132 patients, 6 (4.5%) required reoperation. CONCLUSION PK-TURP represents an effective surgical intervention for the treatment of bladder outlet obstruction for large prostates. Furthermore, the functional results at 3 years demonstrated durability. Therefore, the PK-TURP technique could play an important role in the surgical treatment of patients with symptomatic benign prostatic hyperplasia with a large prostate gland.
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Affiliation(s)
- Guangbin Zhu
- Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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19
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Yang SJ, Song PH, Kim HT. Comparison of deep biopsy tissue damage from transurethral resection of bladder tumors between bipolar and monopolar devices. Korean J Urol 2011; 52:379-83. [PMID: 21750747 PMCID: PMC3123812 DOI: 10.4111/kju.2011.52.6.379] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/16/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose Bipolar energy has recently been used for transurethral resection of bladder tumor (TURBT). Although this modality is thought to be safe, there are some controversies concerning the pathologic accuracy of the biopsy specimens. We compared clinical efficacy, safety, and pathologic characteristics of deep biopsy specimens between bipolar and monopolar devices. Materials and Methods From January 2002 to June 2007, a total of 115 patients underwent TURBT with deep biopsy with the use of bipolar (bipolar group, n=64) or monopolar (monopolar group, n=51) devices. We retrospectively analyzed tumor size, tumor number, urine cytology, perioperative blood loss (postoperative changes in hemoglobin levels), complications, duration of catheterization, duration of hospitalization, pathologic stage, WHO grade, deep biopsy specimen thickness, and grade of thermal damage. Results There were no statistical differences in tumor size, tumor number, urine cytology, complications, duration of hospitalization, pathologic stage, or WHO grade between the two groups. Postoperative changes in hemoglobin levels were significantly lower in the bipolar group (p=0.038), and the duration of catheterization was shorter in the bipolar group (p=0.026). The deep biopsy specimen thickness was significantly thinner in the bipolar group (2.25±0.94 mm vs. 3.02±1.39 mm, p<0.05). The grade of thermal damage was not statistically different between the two groups (p=0.862). Conclusions In terms of clinical efficacy and safety, bipolar TURBT is comparable to monopolar TURBT, having advantages in perioperative blood loss and duration of catheterization. In addition, pathologic changes in deep biopsy after bipolar and monopolar TURBT are similar. Bipolar TURBT can be properly used for bladder tumors without pathologic error.
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Affiliation(s)
- So Jun Yang
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
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20
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Ubee SS, Philip J, Nair M. Bipolar technology for transurethral prostatectomy. Expert Rev Med Devices 2011; 8:149-54. [PMID: 21381907 DOI: 10.1586/erd.10.90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bipolar electrosurgical technology has gained worldwide attention with various companies introducing devices, such as the Gyrus PlasmaKinetic™ Tissue Management System (Gyrus ACMI, MN, USA) and the Olympus(®) UES-40 Surgmaster generator (Olympus, Tokyo, Japan), which is aimed at minimizing the morbidity of standard monopolar transurethral resection of the prostate (TURP), whilst also maintaining efficacy and durability. The Gyrus PlasmaKinetic System effectively controls bleeding, resulting in a clear operative field; it greatly reduces risk of transurethral resection syndrome, thus providing a new option among minimally-invasive surgical treatments for benign prostatic hyperplasia. In a meta-analysis of head-to-head comparisons between the monopolar and bipolar TURP, the operation times, transfusion rates, retention rates after catheter removal and urethral complications did not differ significantly. Irrigation and catheterization duration was significantly longer with monopolar TURP.
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Affiliation(s)
- Sarvpreet S Ubee
- Department of Urology, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
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Fagerström T, Nyman CR, Hahn RG. Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate. J Endourol 2011; 25:1043-9. [PMID: 21568691 DOI: 10.1089/end.2010.0714] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To compare bipolar resection with the conventional monopolar transurethral resection of the prostate (TURP) with respect to peri- and postoperative complications and long-term outcome. PATIENTS AND METHODS Patients with consecutive benign prostatic hyperplasia needing surgery (n=185) from the hospital's waiting list were randomized to TURP using either a bipolar or a monopolar system. Peri- and postoperative parameters were monitored, complications were registered, and timed micturition/International Prostate Symptom Score (TM/IPSS) forms were collected at 3 and 6 weeks and at 6 and 18 months. RESULTS Bipolar surgery was followed by a 16% to 20% higher percentage of the patients reporting ongoing improvement (fractional IPSS change >2) at 3 and 6 weeks after the surgery (p<0.05). There were fewer readmissions in the bipolar group than in the monopolar (5 vs. 13, p<0.05). No differences between the groups with respect to hospital stay and catheter duration was recorded. Bipolar and monopolar TURP resulted in marked and sustained improvements of IPSS, bother score, and TM. CONCLUSIONS Bipolar TURP, using the transurethral resection in saline (TURis) system, resulted in significantly fewer postoperative readmissions, faster postoperative recovery, and equally long-lasting good results in TM/IPSS and bother score, as in monopolar TURP.
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Affiliation(s)
- Tim Fagerström
- Section of Urology, Södersjukhuset, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
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Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ. Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJU Int 2011; 109:240-8. [DOI: 10.1111/j.1464-410x.2011.10222.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mamoulakis C, de la Rosette JJ, Ubbink DT. Re: Burke et al.: Systematic Review and Meta-analysis of Transurethral Resection of the Prostate Versus Minimally Invasive Procedures for the Treatment of Benign Prostatic Obstruction (Urology 2010;75: 1015-1022). Urology 2010; 75:1235-6; author reply 1236-7. [DOI: 10.1016/j.urology.2009.11.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 11/22/2009] [Accepted: 11/24/2009] [Indexed: 11/15/2022]
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Mamoulakis C, Ubbink DT, de la Rosette JJ. Bipolar versus Monopolar Transurethral Resection of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol 2009; 56:798-809. [DOI: 10.1016/j.eururo.2009.06.037] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 06/27/2009] [Indexed: 11/25/2022]
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25
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Bipolar transurethral resection of the prostate: what did we learn, and where do we go from here? Eur Urol 2009; 56:796-7. [PMID: 19660854 DOI: 10.1016/j.eururo.2009.07.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/21/2009] [Indexed: 11/19/2022]
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Four-Year Outcome of a Prospective Randomised Trial Comparing Bipolar Plasmakinetic and Monopolar Transurethral Resection of the Prostate. Eur Urol 2009; 55:922-9. [DOI: 10.1016/j.eururo.2009.01.028] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 01/14/2009] [Indexed: 11/19/2022]
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