scholarly journals Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

2015 ◽  
Vol 9 (11-12) ◽  
pp. 372 ◽  
Author(s):  
Mohamed A Elkoushy ◽  
Ahmed M Elshal ◽  
Mostafa M Elhilali
Keyword(s):  
Urinary Incontinence ◽  
Benign Prostatic Hyperplasia ◽  
Operative Time ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Complication Rates ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

<p><strong>Introduction:</strong> We assessed the change of patients’ profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time.</p><p><strong>Methods:</strong> We reviewed a prospectively maintained database of patients treated with laser for symptomatic BPH since March 1998. Patients were divided into 3 consecutive time-based groups: Group 1 for patients who underwent surgery before April 2004; Group 2, between April 2004 and March 2009; and for Group 3 from April 2009 to August 2014. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications.</p><p><strong>Results:</strong> A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (r = 0.62, p &lt; 0.001), total energy used (r = 0.47, p &lt; 0.001), and total operative time (r = 0.47, p &lt; 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, p 72 years), prostate volume (&gt;80 cc), operative time (&gt;95 minutes), and preoperative PSA (&gt;6 ng/dL) were significantly associated with postoperative urinary incontinence.</p><strong>Conclusions:</strong> Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (&gt;72 years), prostate volume (&gt;80 cc), operative time (&gt;95 minutes), and preoperative PSA (&gt;6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.

scholarly journals Fixation of Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Andrew Molloy ◽  
Samantha Whitehouse ◽  
Lyndon Mason
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Junior Staff ◽  
System Changes ◽  
Major Complication Rate ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Category: Trauma Introduction/Purpose: Ankle fractures are one of the most common fractures. Historically these have been frequently treated by non-specialists and junior staff. In 2011 we presented high malunion rates, which have been mirrored in other departments work. We present the results of system changes to improve the results of ankle fracture fixation Methods: Image intensifier films were reviewed on PACS and scored based on the criteria published by Pettrone et al. At least two blinded assessors assigned scores independently. Patients clinical data was collected from medical records. In 2011 we presented the results of fixation in 94 consecutive patients (Group 1) from 2009. Following this there was period of education in the department to allow change. 68 patients (Group 2) were then reviewed from a 7 month period in 2014 Multiple system changes were introduced in the department including; new treatment algorithms, dedicated foot and ankle trauma lists and clinics, and next day review of all intra-operative radiographs by independent attending. Prospective data was collected on 205 consecutive cases (Group 3) from 01/01/15 – 09/30/16 Results: Patients in group 1 had a malreduction rate of 33%. The major complication rate in this group was 8.5% (8 patients); with only one of these occurred in a correctly reduced fracture. These complications included 4 revision fixations, 2 deep infections and 1 amputation. Following the period of re-education, in Group 2, the mal-reduction rate deteriorated to 43.8%. In this group the major complication rate was 10.9%; including 6 revision fixations and 1 ankle fusion. In Group 3, following overall system changes, the malreduction rate was 2.4%. This result is statistically significant. The major complication rate fell to 0.98%; 1deep infection and 1 amputation (in a polytrauma patient with vascular injury). This result is again statistically significant. Conclusion: Our initial results show that very poor results are a consequence when sufficient attention is not given to what are frequently considered to be ‘simple’ fractures. In group 2 we demonstrated that soft educational changes (eg presentations, emails) are ineffective in improving results. We have demonstrated that hard (institutional system) changes in our department provided statistically significant improvements. These changes allowed the correct surgeon for the fracture in both determining the treatment plan and operating. With these changes, malreduction rates fell from 43.8% to 2.4% and major complication rates from 10.9% to 0.98%

scholarly journals Plasmakinetic vaporization versus plasmakinetic resection to treat benign prostatic hyperplasia: A prospective randomized trial with 1 year follow-up

2014 ◽  
Vol 8 (9-10) ◽  
pp. 595 ◽  
Author(s):  
Mert Ali Karadag ◽  
Kursat Cecen ◽  
Aslan Demir ◽  
Ramazan Kocaaslan ◽  
Fatih Altunrende
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Statistical Difference ◽  
Preoperative Evaluation ◽  
Operation Time ◽  
Maximum Flow ◽  
Prostatic Hyperplasia ◽  
Group 2 ◽  
Hemoglobin Drop ◽  
Group 1

Introduction: We evaluate the efficacy and outcomes of plasmakinetic vaporization (PKVP) and plasmakinetic resection (PKR) to treat benign prostatic hyperplasia (BPH).Methods: A total of 183 patients with BPH underwent plasmakinetic prostatic surgery between 2008 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine, Turkey. After clinical and preoperative evaluation, the patients were randomized to PKRP or PKVP groups sequentially by using computer-generated numbers. Group 1 included 96 patients treated with PKR. Group 2 included 87 patients treated with PKVP. Patients in both groups were compared in terms of hemoglobin drop, operation time, catheter duration, reobstruction, incontinence and recatheterization.Results: When we compared the maximum flow rates (Qmax values) at the 12th month, there was no statistical difference between 2 groups. Group 1 had a mean Qmax value of 17.92 ± 3.819 and Group 2 had a 18.15 ± 3.832 value (p > 0.05). There was a statistical difference between the groups in terms of hemoglobin drop, catheter duration and operation time. The mean catheter duration in Group 1 was 3.74 ± 1.049 days, and in Group 2 it was 2.64 ± 0.849 days (p < 0.05). Operation time was statistically longer in Group 2 (PKVP) and hemoglobin drop was statistically higher in Group 1 (PKR).Conclusion: PKVP for BPH is safe and effective. When compared with PKRP, it provides a significantly shorter catheter duration and less bleeding due to hemostasis control with similar IPSS and Qmax improvements after 1 year.

Role of Frameless Stereotaxy in the Surgical Treatment of Cerebral Arteriovenous Malformations: Technique and Outcomes in a Controlled Study of 44 Consecutive Patients

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1108-1118 ◽  
Author(s):  
Stephen M. Russell ◽  
Henry H. Woo ◽  
Seth S. Joseffer ◽  
Jafar J. Jafar
Keyword(s):  
Blood Loss ◽  
Arteriovenous Malformations ◽  
Operative Time ◽  
Controlled Study ◽  
Frameless Stereotaxy ◽  
Complication Rates ◽  
Cerebral Arteriovenous Malformations ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE To describe a frameless stereotactic technique used to resect cerebral arteriovenous malformations (AVMs) and to determine whether frameless stereotaxy during AVM resection could decrease operative times, minimize intraoperative blood losses, reduce postoperative complications, and improve surgical outcomes. METHODS Data for 44 consecutive patients with surgically resected cerebral AVMs were retrospectively reviewed. The first 22 patients underwent resection without stereotaxy (Group 1), whereas the next 22 patients underwent resection with the assistance of a frameless stereotaxy system (Group 2). RESULTS The patient characteristics, AVM morphological features, and percentages of preoperatively embolized cases were statistically similar for the two treatment groups. The mean operative time for Group 1 was 497 minutes, compared with 290 minutes for Group 2 (P = 0.0005). The estimated blood loss for Group 1 was 657 ml, compared with 311 ml for Group 2 (P = 0.0008). Complication rates, residual AVM incidences, and clinical outcomes were similar for the two groups. CONCLUSION Frameless stereotaxy allows surgeons to 1) plan the optimal trajectory to an AVM, 2) minimize the skin incision and craniotomy sizes, and 3) confirm the AVM margins and identify deep vascular components during resection. These benefits of stereotaxy were most apparent for small, deep AVMs that were not visible on the surface of the brain. Frameless stereotaxy reduces the operative time and blood loss during AVM resection.

scholarly journals Outcome Comparison of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Patients in Karawang General Referral Hospital

2019 ◽  
Vol 13 (3) ◽  
pp. 69
Author(s):  
Ramlan Halimi ◽  
Achmad Rizky Herda Pratama
Keyword(s):  
Quality Of Life ◽  
Benign Prostatic Hyperplasia ◽  
Transurethral Resection ◽  
Prostatic Hyperplasia ◽  
Transurethral Resection Of Prostate ◽  
Significant Difference ◽  
Prostate Size ◽  
Group 2 ◽  
Group 1

Background: Benign Prostatic Hyperplasia (BPH) is the most common pathological condition in man that causes Lower Urinary Tract Syndrome (LUTS). The most popular therapeutic modality for BPH is Transurethral Resection of Prostate (TURP). This study describes the TURP outcome in BPH patient with prostate size > 75 grams compared to < 75 grams in Karawang General Referral Hospital.Methods: We performed a retrospective review of clinical outcome from BPH patient with LUTS who underwent TURP procedure between January 2017 – April 2018. Data was taken through patient medical records and processed descriptively to describe complications, quality of life, and clinical laboratory data. Qualitative data compared with Chi-Square test.Results: During this study, we evaluated 40 patients, 20 patients with prostate size > 75 grams (group 1) and 20 patients with prostate size < 75 grams (group 2). Mean age in group 1 was 65.6 ± 9.9 years and in group 2 was 65.3 ± 10.2 years. International Prostate Symptom Score (IPSS) after TURP between group 1 and group 2 showed a significant difference, while incomplete emptying was found mostly in group 2 (p < 0.05). There was no significant difference in Quality of Life Score between group 1 and group 2 (p > 0.05). From laboratory results, we found a reduction of hemoglobin in both groups with p-value < 0.05 or no significant difference.Conclusions: Transurethral Resection of Prostate (TURP) procedure for patient with prostate size > 75 grams is safe and effective with lower complications and there is no significant difference compared to patient with prostate size < 75 grams.

scholarly journals Effect of Renal Function on Success and Complications of Percutaneous Nephrolithotomy

2021 ◽  
pp. 68-73
Author(s):  
Serkan Yarimoglu ◽  
Mehmet Erhan Aydin ◽  
Murat Sahan ◽  
Omer Koras ◽  
Onur Erdemoglu ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones. Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success. Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3. The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310). Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL. Keywords: Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates

scholarly journals Randomized, controlled trial of laser vs. bipolar plasma vaporization treatment of benign prostatic hyperplasia

2017 ◽  
Vol 11 (6) ◽  
pp. 194 ◽  
Author(s):  
Thomas A.A. Skinner ◽  
Robert J. Leslie ◽  
Stephen S. Steele ◽  
J. Curtis Nickel
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Diode Laser ◽  
Controlled Trial ◽  
Prostatic Hyperplasia ◽  
Laser Vaporization ◽  
Symptom Improvement ◽  
Complication Rates ◽  
Surgical Team ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Team Satisfaction

Introduction: Prostate vaporization technology is becoming a standard of care for treatment of moderate, symptomatic benign prostatic hyperplasia (BPH). We compared two transurethral prostatevaporization technologies with respect to cost, efficiency, efficacy, safety, and surgical team satisfaction.Methods: Fifty-five patients meeting standardized symptom criteria for BPH were randomized to either Olympus Plasma ButtonTM or Biolitec EVOLVE® diode laser vaporization. Primary outcome of cost with secondary outcomes of clinical efficacy, resection time, surgical team satisfaction, and safety were analyzed. Followup was carried out at six and 12 weeks. Patient factors included baseline, as well as six- and 12-week International Prostate Symptom Score (IPSS) with quality of life (QoL) scores. We recorded surgical team satisfaction with a Likert-style survey investigating ease of set-up, reliability, efficiency, and ability to reach desired endpoint. All complications or side effects detected within three months and the resulting management were included in the cost analysis.Results: Mean cost per patient was $3418 for the Olympus group and $4564 for Biolitec (p<0.05). Surgical vaporization time was significantly less for the Olympus group, 24.3 vs. 33.5 minutes(p<0.05). Surgical and nursing staff preferred the Olympus device (p<0.05). IPPS symptom improvement and complication rates were similar between groups. Patients in the Biolitec arm had more intraoperative bleeding episodes requiring conversion to monopolar transurethral resection of the prostate (TURP) (three vs. none).Conclusions: In a head-to-head randomized trial, Olympus Plasma Button transurethral vaporization was more cost-effective, faster, and preferred by surgical staff when compared to Biolitetec Diode Laser vaporization. Both devices showed similar safety and efficacy.

The Effect of Tobacco Use on Incision Healing in Total Ankle Arthroplasty: A Review of 114 Patients

2019 ◽  
Vol 13 (1) ◽  
pp. 27-31 ◽  
Author(s):  
James M. Cottom ◽  
Steven M. Douthett ◽  
Kelly K. McConnell ◽  
Britton S. Plemmons
Keyword(s):  
Wound Complication ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Group 3 ◽  
Former Smokers ◽  
Group 2 ◽  
Never Smokers ◽  
Group 1

The purpose of this study was to compare wound complication rates after total ankle replacement in 3 groups of patients based on tobacco status. The total cohort was divided into 3 groups based on tobacco history. Group 1 included patients who were actively tobacco users. Group 2 included patients with a history of tobacco user. Group 3 served as the control group and included patients who had never used tobacco. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by 1 surgeon. Patient demographics, tobacco history, and postoperative wound complications were recorded. A total of 114 patients with tobacco history were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. Group 1 included 11 active smokers. Group 2 included 38 former smokers, and group 3 had a total of 65 never smokers included. The average follow-up was 28 months for group 1 (range 10-55 months), 34.1 months for group 2 (range 12-60 months), and 32.8 months for group 3 (range 11-60 months). The wound complication rate was noted to be statistically significant when comparing active smokers to never smokers using Fisher’s exact test ( P = .0223). When comparing former smokers with never smokers, the difference in wound complication rate did not reach statistical significance ( P = 0.7631). All patients underwent at least 1 concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement wound healing complication rates are significantly higher in active tobacco users. There was no significant difference in wound healing complications when comparing former tobacco users versus never tobacco users. Levels of Evidence: Level III: Retrospective comparative study

Comparison of three different modalities for the treatment of bladder calculi by size

2021 ◽  
pp. 039156032110204
Author(s):  
Ali Yıldız ◽  
Hakan Anıl ◽  
İbrahim Erol ◽  
Kaan Karamık ◽  
Hakan Erçil
Keyword(s):  
Operative Time ◽  
Operation Time ◽  
Ureteral Stones ◽  
Stone Size ◽  
Postoperative Stay ◽  
Bladder Stones ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

Purpose: Treatment recommendations for kidney or ureteral stones are based on stone size; however, this is uncertain for bladder stones. This study aims to determine the best approach to bladder stones based on their size. Materials and methods: We retrospectively analyzed 401 patients with bladder stones. Patients were divided into three different groups according to stone size (11–20 mm, 21–30 mm, 31–40 mm as groups 1, 2, and 3 respectively). Patients had transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), and open cystolithotomy (OCL) performed. Results: Stone fragments were removed completely in all patients. When catheter time, postoperative stay, and hematocrit decrease values were compared, the results were significantly higher for OCL in all three groups ( p: 0.001). When the relationship between stone sizes and operation time is evaluated, TUCL had shorter operation times (34.1 ± 10.6 min) in group 1. However, TUCL had longer operation times in group 2 and group 3 compared to OCL and PCCL. Conclusion: TUCL may be preferable due to better postoperative outcomes and shorter operative time for ⩽2 cm stones. As the stone size increases, PCCL is more favorable in terms of operation time.

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