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Biomedical subjects

Alan McNeill

Publications and source records attributed to Alan McNeill.

7 recordsLinked to original sources
PubMed2006

Complications of endoscopic extraperitoneal radical prostatectomy (EERPE): prevention and management.

Endoscopic extraperitoneal radical prostatectomy (EERPE) is a further advancement of minimal invasive surgery as it overcomes the limitations of laparoscopic (transperitoneal) RPE by the strictly extraperitoneal route of access combining the advantages of minimal invasive surgery with the advantages of an extraperitoneal procedure. Endoscopic extraperitoneal radical prostatectomy has many advantages but is not without complications. The aim of this review article is to describe the most common complications of this procedure. Complications associated with endoscopic extraperitoneal radical prostatectomy are: vascular injury--bleeding--haematoma, bowel injury, lymphocele, injury to the bladder--ureter, port site hernia, anastomotic leakage--stricture, obturator nerve injury--paralysis, gas embolism, catheter blockage, and miscellaneous like perineal pain, pubic osteitis, infection- urosepsis. The present review paper focuses on the identification and management of these complications The incidence of most complications directly correlates with the surgeons' experience, and the various complications are related to technical errors rather than to the technique itself. The laparoscopist performing endoscopic/ laparoscopic radical prostatectomy should be aware of all these complications. He should be able to recognise promptly, treat efficiently, and ideally prevent these complications.

Endoscopy↗
PubMed2006

Anaesthetic considerations for endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy.

We focus on the anaesthesiology and requirements for minimally invasive procedures for treating localized prostate cancer. The management of anaesthesia for laparoscopic and endoscopic radical prostatectomy (RP) can be more complex than expected. Numerous groups, especially early in their experience, have had problems (e.g. hypercarbia) with the anaesthesiology of the procedure. Co-operation between the surgeon and the anaesthesiologist is of paramount importance for a safe and effective laparoscopic or endoscopic RP. Nevertheless, the relative anaesthetic equipment and trained personnel should be available before embarking on such technically proficient procedures.

Anesthesia↗
PubMed2005

The economic impact of using alfuzosin 10 mg once daily in the management of acute urinary retention in the UK: a 6-month analysis.

OBJECTIVE: To calculate the economic consequences of using alfuzosin 10 mg once daily for managing acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS: We examined whether alfuzosin use during hospitalization for AUR and for 6 months after a successful trial without catheter (TWOC) is cost effective compared to placebo and immediate prostatectomy, from the perspective of patients managed in the National Health Service (NHS) in the UK. A decision-analysis model was developed to estimate the costs of various treatment options within the first 6 months after a first episode of AUR. Clinical data were obtained from a large randomized clinical trial comparing alfuzosin 10 mg with placebo, and from published reports. Cost data were obtained from both NHS and resource-use data gathered during the clinical trial. A Monte Carlo analysis, allowing variability in all uncertain variables of the model, was used to calculate the uncertainty surrounding the results. RESULTS: Treating patients with alfuzosin during initial hospitalization for AUR and in the first 6 months after a successful TWOC generates a cost-saving of pounds 349 relative to placebo. Savings related to immediate prostatectomy were pounds 892; both savings were significant (P < 0.05). Alfuzosin treatment was associated with a lower rate of prostatectomy after discharge from hospital after a successful TWOC. CONCLUSION: Treatment with alfuzosin 10 mg once daily before and after a successful TWOC has both clinical and economic benefits. It decreases the need for emergency surgery for BPH and reduces treatment costs in the first 6 months.

Adrenergic alpha-Antagonists↗
PubMed2004

Quantitative morphometric analysis of individual resected prostatic tissue specimens, using immunohistochemical staining and colour-image analysis.

OBJECTIVE: To develop a method for obtaining morphometric measurements representative of individual chips from transurethral resection of the prostate (TURP). MATERIALS AND METHODS: In all, 232 sections were cut in pairs from 25 TURP chips, collected from four patients undergoing TURP for benign prostatic hyperplasia. Individual tissue chips were processed, embedded in paraffin wax and pairs of neighbouring sections cut from the specimens at intervals of 300 microm throughout the thickness of the specimen. Of each pair, the epithelial tissue (ET) of one and the smooth muscle (SM) of the other section were stained immunohistochemically with anti-prostate-specific antigen and anti-SM myosin, respectively. Proportions of ET and SM within the sections were measured with colour-image analysis and calculated within the TURP chips using all pairs of sections cut from the specimen, and the first pair of sections only. The differences between the sets of results were analysed using descriptive statistics. RESULTS: From each TURP chip, 3-7 pairs of sections were cut; for both ET and SM within each chip the differences between the results calculated using data from all pairs of sections and the first pair alone were small, as were the distributions of these differences within each prostate. CONCLUSIONS: Morphometric measurements from one section from a processed TURP chip, as opposed to serial sections, can be used to reliably assess the morphology of tissue within that specimen. This permits a considerable saving of resources when undertaking morphometric image analysis of resected prostatic tissue specimens.

Aged↗