Intravesical rupture of bladder during transurethral prostatic resection.
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An 80-year-old patient suffering from prostatism underwent repeated transurethral prostatic resection. Histologic examination of the prostatic tissue that was removed at the time of the second operation disclosed a granuloma with fibrinoid necrosis combined with necrotizing vasculitis. Only four cases of granulomatous prostatitis and vasculitis have been reported in the literature:two were generalized vasculitis, while in the two other instances, the vasculitis was confined to the prostate. We report an additional case of granulomatous prostatitis combined with vasculitis localized in the prostate.
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One hundred patients were prospectively randomised into two groups to receive either a single dose of 1 g ampicillin and 80 mg gentamicin pre-operatively or no antibiotic prophylaxis. The incidence of breakage in the continuity of the closed drainage system was documented. All patients with urinary tract infection (UTI), catheterisation, clinical prostatic carcinoma, neurogenic bladder and bladder tumours were excluded. UTIs, bacteraemia and fever were noted. There were 7 late exclusions. The incidence of UTI in the control and antibiotic groups was 16 and 17% respectively. No blood cultures were positive. There were no significant differences in the incidence of fever between the two groups. A break in the closed drainage system occurred in 13 patients. Fifteen of the 93 developed UTI. A break in the closed drainage system occurred in 7 of the 15 patients (40%) with UTI. Of the 78 patients without UTI, 8 had a break (10%). This difference was highly significant. We recommend that less emphasis be placed on prophylactic antibiotics and more on avoiding breakage of the closed system in the prevention of UTI after transurethral resection of the prostate (TURP) in the low risk situation.
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The objective of the study was to investigate the reliability of patients' recollected pre-intervention symptom status and the impact of those symptoms compared with contemporary pre-operative reports, and to test the stability of recollected views. In design (A) a self-completed symptom questionnaire was administered before (contemporary) and 3 months after (recollected) surgery. In design (B) a self-completed symptom questionnaire on recollected pre-operative symptoms was administered 12 and 14 weeks after surgery. Setting (A) comprised the twin consultant urological unit in the Chesterfield and North Derbyshire Royal Hospital NHS Trust, and setting (B) a sample from the National Prostatectomy Audit of 5281 patients. The subjects were 77 consecutive patients scheduled for transurethral resection of the prostate (TURP), and 170 consecutive respondents undergoing TURP. The main outcome measures were the difference in group mean scores for The American Urological Association (AUA) Symptom Index, Impact Index (a score of symptom impact), and 14 constituent questions; association assessed using Pearson's correlation coefficient; agreement assessed using weighted Kappa statistics. Complete paired data sets were available for 58 (75%) men for the Symptom Index, and for 61 (79%) men for the Impact Index. Pre-operative mean Symptom Index scores for contemporary and recollected were similar, as were mean scores for the Impact Index. However, only poor to fair levels of association and agreement were obtained for the Symptom Index (r = 0.6, kappa (w) = 0.3) and Impact Index (r = 0.6, kappa (w) = 0.3). Results for the constituent questions were similar.(ABSTRACT TRUNCATED AT 250 WORDS)
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One hundred patients with benign prostatic hypertrophy were treated by transurethral prostatic resection by the Mauermayer method. Average resection time was 67.5 minutes and average weight of resected tissue was 26.2 g. Incidence of intraoperative and postoperative complications were within reasonable range and no serious complication including death occurred. Preoperative and postoperative uroflowmetric examinations were carried out on 61 patients and a significant improvement of urinary flow was demonstrated. The Mauermayer method is a safe and effective method of prostatic resection.
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