الفهرس | Only 14 pages are availabe for public view |
Abstract This prospective study was designed to evaluate the efficacy,safety and outcome of Rotoresection as a modality for prostatic ablation in comparison to the gold standard surgical procedure: TURP. The study comprised 60 patients with BPH presented to urology outpatient clinic of Benha university hospital from january 2003 to february 2004 with lower urinary tract symptoms, randomly divided into two groups (RRP and TURP) according to the procedure assigned with a non-significant difference as regards the age and preoperative I-PSS, quality of life index, prostatic volume and voiding cytometric parameters. The mean resection time in TURP group was 47±5.6 min, while in RRP group was 32.8±12.9 min, there was a significant (P<0.05) shortening of the resection time in RRP group in comparison to resection time in TURP group. The mean irrigate volume used during TURP was 11.2±2.7 liter, while in RRP the mean irrigate volume used was 9.3±2.8 liter. There was a significant (P<0.05) increase in the irrigate volume used during TURP in comparison to volume used during RRP. The duration of postoperative catheterization was 2.3±0.9 days in patients underwent TURP. while was 1.6±0.6 days in 101 __________________ s.-lIIm,_-’- __ patients underwent RRP with a significant (P<O.05) prolongation of the duration of PO catheterization in TURP group. Patients included in both groups showed a significant decrease of hemoglobin concentration in comparison to their preoperative measures, however, the decrease is also significant in patients underwent TURP in comparison to those underwent RRP. Urine analysis and culture were performed one month postoperative for all the study participants. In 8 patients, 3 in RRP and 5 in TURP groups, pyuria was detected on microscopic examination (pus> 5/HPF). Preoperative I-PSS and quality of life index of patients included in both groups showed a non-significant (P>O.05) difference, while showed progressive significant (P<O.05) decrease in both groups throughout the follow-up period in comparison to the preceding score in the same group and to the preoperative ones with a non-significant difference between both groups. Furthermore,the mean preoperative Q-max was 8.3±2.3; and 7.9±2.5 in patients underwent TURP and RRP; respectively, 6- months after surgery,the mean Q-max became 24.8±10 in TURP group and 25.7±8.8 in RRP group with a significant (P<O.05) increase in postoperative measures in comparison to their preoperative measures In addition,the mean PVR volume was significantly (P<O.05) decreased 6-months postoperatively in both groups. 189 -----------------_ •...,,----- Three patients in RRP group, two developed hematuria on the 7th and 10th days after discharge and the third had urine retention two days after catheter removal. Both were managed conservatively by urethral catheter fixation for 3 days, antibiotics, anti-inflammatory, drugs and hemostatics, After catheter removal all voided spontaneously with Qmax 24, 22 and 20 ml/sec, respectively. Three patients; 2 in TURP group (6.6%) and one in RRP group (3.3%) had mild degree of stress incontinence, both were managed conservatively. Four patients; 3 in TURP group (10%) and only one in RRP group (3.3%), developed bladder neck contracture, 6 months postoperatively and all were managed by BNI. Out of the obtained results, it could be concluded that Rotoresection as an endoscopic modality for prostatic ablation in cases of PBH is effective with shorter duration of surgery, decreased amount of irrigate, decreased intra and postoperative bleeding and provided acceptable range of postoperative complications. It is a safe procedure with better preservation of patient hemodynamic parameters and shorter hospitalization period and could achieve patient’s satisfaction. |