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PubMed1992

[Urethral stricture after TURP and transvesical prostatectomy].

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.

Catheters, Indwelling↗

PubMed1992

[Incidental prostatic cancer--"wait and see" or radical prostatectomy?].

In a comparative and retrospective study, outcome was examined in two groups of patients with incidental carcinoma of the prostate (stage T1a). In the 47 patients in the first group the carcinoma was kept under observation for 2-10 years without the administration of any treatment. During the mean follow-up of 5 years, the disease progressed in 11 (23.4%) of these patients, and 4 of them died. The other group was made up of 20 patients who underwent radical prostatectomy. The clinical and pathological staging were quite different in this group than in the other: more advanced stages and higher grades were seen in 10 patients, and the specimens taken from 6 were found not to contain any tumour. After a mean follow-up period of 4.5 years, all these 20 patients are alive with no evidence of disease. The management of patients with T1a tumour is still a problem. Observation only will be followed by progression in 23% of cases, while radical prostatectomy actually constitutes overtreatment in 30%. In conclusion, we prefer to perform prostatectomy in all patients with T1a carcinoma who are young and have a good life expectancy.

Aged↗

PubMed1992

[Review of 36 trigono-cervico-prostatectomies, carried out for prostatic pathology].

Review of 36 trigone-cervix-prostatectomies, performed in our services. Studies made before and after the procedure. Indications for trigone-cervix-prostatectomies. Complications and results obtained. Trigone-cervix-prostatectomies as an alternative to prostate transurethral resection, in a highly selected group of patients, because of its simplicity and better results.

Aged↗

PubMed1992

Transvesical prostatectomy in Tikur Anbessa Hospital, Addis Ababa.

This is a retrospective study of a hundred and thirty patients with benign prostatic hypertrophy (BPH) treated at the Tikur Anbessa Hospital with suprapubic transvesical prostatectomy (STVP) from September 1984 to August 1988. The commonest presenting complaints were frequency of micturition noted in 113 (87%) patients and acute urinary retention in 102 (79%). The prostate was enlarged in all patients with an average weight of 70.0 gm in the 60 specimen weighed. Forty (31%) patients received two units of blood each. Sixty five (50%) developed immediate post operative complications and four patients died during the first post operative week giving a mortality rate of 3.0%. The duration of postoperative hospital stay was two to three weeks. It is concluded that transvesical prostatectomy is satisfactory modality of treatment for BPH in situations where facilities for transurethral prostatectomy (TUR) are not available as STVP can be accomplished with an acceptable morbidity and mortality.

Aged↗

PubMed1992

[Systematic morphometry of radical prostatectomy samples. A guideline for general practice].

The predictive value of quantitated tumor volume for the prognosis of the individual patient with prostate cancer has been established in analysis of more than 500 radical prostatectomy specimens at Stanford Medical Center. The Stanford technique for detailed tissue sectioning involves considerable time and expense plus computer planimetry. Therefore we have developed two simplified protocols which are suitable to routine diagnostic pathology. Histologic slides of 145 radical prostatectomy specimens, as evaluated by the Stanford technique, were reviewed and a selection of slides was made in a systematic fashion according to two protocols ("bilateral" and "parasagittal"). Tumor volume was estimated manually from this reduced sample of slides by comparing cancer areas to a millimeter grid. The bilateral protocol used an average of 11.7 slides per case (range 8-20), the parasagittal protocol used an average of 8.8 slides per case (range 6-15) versus an average of 26.2 slides per case (range 16-67) by the original Stanford technique. Volume estimates were within +/- 20% of true (computer) volume in 96% and 89% of cases, respectively. A simplified tissue sampling technique can yield accurate cancer volume determinations in radical prostatectomy specimens with reduced time and expense.

Histological Techniques↗

PubMed1979

[Antibiotic therapy after prostatectomy? (author's transl)].

This prospective study shows, that, neither an antibiotic prophylaxis of abacteriuric patients nor postoperative treatment of an asymptomatic urinary tract infection after transurethral prostatectomy have a significant influence on the clinical complications or the microbiologic results. After suprapubic prostatectomy complications in the control group were not significantly more frequent than in the group with antimicrobial prophylaxis. Patients with asymptomatic urinary tract infections before suprapubic prostatectomy had better clinical results, if they were treated with antibiotics as compared to a control group, although the difference control group was not significant. The correlation between consumption of antibiotics and development of resistant in pathogenic organisms forced us to use a more critical approach in the use of antimicrobial prophylaxis and therapy. This study shows clearly, that aseptic operations do not need an antibiotic protection and that faulty of asepsis cannot be corrected by antibiotics.

Anti-Bacterial Agents↗

PubMed1976

[The treatment of locally confined prostatic carcinoma: radiotherapy versus total prostatectomy (author's transl)].

Recent data show that carcinoma of the prostate is not radioresistant. But not all prostatic cancers are radiosensitive. All information available in the literature on histologically proven local destruction of prostatic cancer tissue, all survival data and reported complications after radiation treatment are reviewed and discussed. The results of radical surgical treatment from various authors but mainly from the series of Belt and Schröder are used for comparison. From these data it is evident that total prostatectomy of stage B and C tumors is superior to radiation therapy as far as local eradication of tumor goes. Five- and ten-year actuarial survival rates are about identical for stage B disease but favor total prostatectomy in stage C patients. Sexual impotence, the most important lasting complication of total prostatectomy, is present in 23-47% of patients after radiotherapy. Urinary incontinence is not known after irradiation but reported after surgery. Long term damage of the lower urinary tract, the gastrointestinal system, or the lymphatics was reported in 2-24% of patients after radiotherapy. The indication for radiation treatment in stage D patients is very questionable. Exact surgical staging by iliac and obturator lymphadenectomy is desirable to rule out stage D disease in locally confined tumors. Radiation treatment is indicated in patients who are not willing to undergo surgery, who are unwilling to accept sexual impotence, or who are poor candidates for surgery from other reasons.

Cell Transformation, Neoplastic↗

PubMed1976

Prostatectomy in an 85-year-old hemophiliac.

Improved factor VIII preparations have made major surgery feasible for hemophiliac patients, as well as increasing their survival. In a hemphoiliac undergoing prostatectomy, the effects of local or systemic fibrinolysis and possible disseminated intravascular coagulation must be considered, in addition to the factor VIII deficiency. We successfully treated an octogenarian with benign prostatic hypertrophy and mild hemophilia during and after suprapubic prostatectomy by infusions of antihemophilic factor (factor VIII) concentrate. Cessation of infusion on the 15th day resulted in bleeding two days later. This ceased after resumption of antihemophilic factor infusion. Tests for abnormal fibrinolysis and fibrin split products gave negative results.

Aged↗

PubMed1977

Prostatectomy : its safety in an Australian teaching hospital.

A comparison of the results of prostatectomy in the same hospital after a 15-year interval has shown that there has been a significant reduction in the mortality (2-3 per cent versus 6-7 per cent). However, on reviewing the results of prostatectomy over the past 30 years it is evident that in spite of improved pre- and postoperative care the mortality and morbidity for high risk patients have remained constant. If the safety for this operation is to improve, it would seem that more care in patient selection is necessary and that other means of achieving urinary drainage will need consideration and evaluation in elderly men with significant cardiovascular and respiratory disease.

Aged↗

PubMed1977

The use of a silicone gel prosthesis in the treatment of post-prostatectomy incontinence.

Eighty-three patients with post-prostatectomy urinary incontinence were treated by silicone gel prostheses implanted over the bulbous urethra. The prosthesis provides continence by passively increasing the urethral resistance. Successful results were achieved in 72% of patients. The mechanism of post-prostatectomy incontinence and the development of anti-incontinence surgery is briefly reviewed.

Humans↗

PubMed1992

Fine-needle aspiration of a periurethral Teflon-filled cyst following radical prostatectomy.

Periurethral Teflon injections are being used increasingly for the treatment of urinary incontinence after radical prostatectomy. We report a case of a man who developed increasing obstructive urinary symptoms and stress incontinence following radical retropubic prostatectomy. Six months earlier, he had undergone periurethral Teflon injections. On transrectal ultrasound and magnetic resonance imaging, a 3.2-cm cystic lesion was noted at the prostatic bed near the bladder neck where the Teflon had been injected. Ultrasound-guided transperineal fine-needle aspiration of the cyst yielded a specimen with numerous birefringent crystalline Teflon particles. Although previous reports have described granulomatous tissue reaction, no multinucleated giant cells were present to suggest granuloma formation. To our knowledge, this is the first reported case of Teflon cyst formation following periurethral Teflon injections. The patient's history, imaging studies, cytopathology, and review of the literature are presented in this report.

Aged↗

PubMed1992

Pathologic changes occurring in the prostate following transurethral laser prostatectomy.

Serial gross and histopathologic examinations of the prostate following transurethral laser prostatectomy in the canine model demonstrated an immediate well-demarcated sphere of thermal necrosis measuring 2.7 cm in diameter, which, within 24 hours, had begun liquefaction and was showing multiple areas of cavitation. By the end of the 1st week, the areas of cavitation had coalesced to form a central cavity lined by a narrow layer of necrotic tissue clinging to the thin surviving peripheral belt of prostatic glandular parenchyma. At 3 weeks, the bluish-black discoloration resulting from breakdown of blood in the necrotic tissue had subsided, leaving masses of coagulonecrotic tissue within the central cavity. Within 5 weeks, the ectatic central cavity was lined by transitional epithelium. These postmortem pathologic observations confirm our surgical and clinical impressions of being able to satisfactorily perform an effective transurethral prostatectomy using neodymium:YAG (Nd:YAG) laser photoirradiation.

Animals↗

PubMed1978

Post-prostatectomy incontinence.

Urinary continence is maintained by the smooth-muscled system of the "internal sphincter". The striated external sphincter is not primarily responsible for continence. One of the chief functions of the external sphincter is the initiation of voluntary micturition. Its other functions are: random interruption of the urinary stream, reflex control during an increase in intra-abdominal pressure (such as coughing, sneezing, larghing, lifting) complete emp;ying of the urethra after micturition and stabilization of the posterior urethra in the urogenital diaphragm. After prostatectomy an intact external sphincter is important in order to support the smooth-muscled system which continues to be primarily responsible for continence to function as efficiently as possible. In approximately 90% of all postprostatectomy incontinences the external sphincter is intact and this cames a good prognosis following our correcture surgery without the need for prostheses. Only in rare post-prostatectomy incontinence cases (aprox. 10%) is the external sphincter also injured. Incontinence surgery according to our method has not been satisfactory in these cases.

Electromyography↗

PubMed1978

Tumours of the urinary bladder accidentally diagnosed during prostatectomy.

By analysing 1472 prostatectomies, the authors have stated a coexistence of tumour of the bladder in 31 cases (2.11%). In 11 patients (0.75%) the tumours were accidentally diagnosed, as late as during the operation itself. Eight patients were operated transvesically. The tumour was diagnosed immediately after opening the bladder. The tumour was removed first and then the adenoma. Three patients were operated on according to Millin's method, their tumours having been detected only after enucleation of adenoma of the prostate. In five cases cancer of the bladder was diagnosed and in six papillary tumour of the bladder was found. The bladder cancers were treated by partial excision of the bladder or by deep electrocoagulation. The authors maintain that the small percentage of accidentally diagnosed tumours is no indication for a routine performance of cystoscopy in every case of adenoma of the prostate before intended prostatectomy.

Humans↗

PubMed1992

Prostatectomy in the very aged.

The number of very aged men who demand prostatectomy for benign disease is increasing. We have assessed surgery results in 79 patients operated during the last four years. Sixty-two underwent endoscopic and 17 open procedure. Mortality rate was 3.7%. Two patients died in the first week and one patient three weeks after surgery. Morbidity rate was 61% but did not significantly affect the final operative outcome. Operative success rate six weeks postoperatively was 87%, satisfactory for this age group. After detailed preoperative evaluation and postoperative care by specialized age care team, prostatectomy is safe, effective and involves low-cost treatment.

Age Factors↗

PubMed1975

Evolution of urinary flow rate with prostatectomy.

Urinary flow rate was studied before and after transurethral prostatectomy in 53 patients. An average of 43.8 percent improvement in maximum flow rate after transurethral prostatectomy was observed in this series. Improvement of maximum flow rate occurred in 71 per cent of patients. Half of the cases in which flow rate did not improve were chronic prostatitis. Uroflowmetry cannot be utilized as a quality index of a transurethral prostatic resection as long as the degree of detrusor deterioration is not assessed. There is a relationship between the degree of preoperative symptoms and the degree of postoperative urinary flow improvement. The degree of preoperative symptoms and urinary flow deviation are not related which suggests that uroflowmetry adds to the assessment of symptoms in the determination of the degree of obstruction. Patients presenting difficulty of urination have a greater chance to demonstrate urinary flow improvement after surgery than patients complaining of urinary frequency.

Animals↗

PubMed1977

Microscopic foci of cancer in prostatectomy for benign disease: diagnostic and surgical considerations.

A study of 66 patients in whom microscopic foci of prostatic cancer was found in prostatectomies done for benign prostatic hyperplasia revealed in 32 of the 66 cases (48%) that there were in retrospect abnormal rectal findings that should have suggested the possibility of neoplasia. Other abnormalities were elevated serum acid phosphatase (5 patients), asymmetrical enlargement of one lateral prostatic lobe at cystoscopy (7 patients), and unilateral hydroureteronephrosis (7 patients). Urinary retention was the presenting symptoms in 56% of the patients. Difficult enucleation was noted in 41% of the open prostatectomies. The importance of performing careful prostatic biopsy in any suspicious prostatic enlargement is again stressed.

Adenocarcinoma↗

PubMed1979

Reevaluation of vest technique of vesicourethral reconstruction in radical retropubic prostatectomy.

Vesicourethral reconstruction after radical retropubic prostatectomy was done by the Vest technique in 36 patients and by direct vesicourethral anastomosis in 100 patients. Complications resulting from the two methods of vesicourethral reconstruction were similar. Incontinence after radical retropublic prostatectomy appears not to be related to the method of vesicourethral reconstruction but occurs because of damage during surgery or postoperative scarring of the distal sphincteric mechanism.

Humans↗