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Endoscopic surgery of the prostate and bladder can be accomplished safely, efficiently, and economically, using outpatient or abbreviated-stay procedures. Local anesthetics rather than more traditional spinal or general techniques may also be used. Guidelines and techniques are described.
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A total of 342 benign prostatic hypertrophy patients were treated at the Department of Urology, Kaohsiung Medical College Hospital from January 1972 to December 1988. Median duration of operating time was 74.4 minutes, 67 patients (20%) required a blood transfusion and the mean volume of blood per patient transfused was 1019.4 ml. Median post-operative catheter management was 7 days and the median post-operative ward time was 8.6 days. Two patients (0.5%) had a bladder lesion with peritoneal perforation and required a secondary operation for bladder suture. Secondary hemorrhaging return for treatment of clotting was seen in 11 cases (3.2%). Stress incontinence was noted in 11 cases (3.2%). Anterior urethral stricture was noted in 9 cases (2.6%), impotence occurred in only one case (0.3%) and TUR syndrome in 2 (0.6%). There were two post-operative deaths, for a mortality rate of 0.6 percent. The causes of death were sepsis in one patient and acute renal failure in the other.
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Twenty-two patients with bladder outflow obstruction and a past history of cerebrovascular accident are described. Sixteen patients regained normal micturition control. Poor results occurred in the more handicapped patients, especially in those with additional neurological problems. Patients who present with bladder outflow obstruction should be treated surgically. To determine those patients who will have a poor result full clinical and neurological assessment must be made, together with urodynamic studies. In order to improve these results a team approach is required between the urologist, geriatrician, nurse and physiotherapist.