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HPV na Prática Clínica

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Safety and efficacy of transurethral resection of the prostate under sedoanalgesia.

BJU Int 2000 Aug;86(3):220-2 (ISSN: 1464-4096)

Chander J; Gupta U; Mehra R; Ramteke VK [Find other articles with these Authors]
Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India MS.

OBJECTIVE: To assess the safety and efficacy of sedoanalgesia (local anaesthesia with sedation) in patients with benign prostatic hyperplasia (BPH) undergoing transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The study comprised 50 patients with BPH, two-thirds of whom were graded III-IV using the American Society of Anesthesiologists system. All patients had a topical instillation of lignocaine jelly 2% into their urethra, combined with 1% lignocaine (100-200 mg) with 1 : 400 000 adrenaline infiltration of the prostate via the perineal route. Sedation and anxiolysis were obtained with the intramuscular pethidine (0.5 mg/kg) and promethazine (1 mg/kg). Standard TURP was then carried out, with pain monitored during surgery using a visual analogue scale (VAS, maximum 10 points) and the amount of analgesic required after TURP recorded. The amount of prostatic tissue excised, duration of surgery, blood requirement, catheter interval, complications and hospital stay were recorded. The effectiveness of TURP was assessed by comparing symptom scores, uroflowmetry and postvoid residual volume before and after surgery. RESULTS: The mean intraoperative VAS was < or = 1 at any time during or after surgery; no patient required any postoperative analgesics. Only two patients complained of discomfort during the procedure and even they were comfortable after a supplemental dose of pethidine (12.5 mg). There were no conversions to general or regional anaesthesia. No blood transfusion was required in any patient. All patients began a normal diet 30 min after surgery and all were discharged within 48 h of surgery. There were no deaths; one patient had transient urinary incontinence and three had mild urinary tract infection. CONCLUSION: Sedoanalgesia was an effective, safe and simple alternative to general or regional anaesthesia for TURP in patients with BPH.

Transurethral Resection of the Prostate and Laser Prostatectomy under Local Anesthesia
[Record Supplied By Aries Systems]

Eur Urol 1998 Feb;33(2):202-205 (ISSN: 0302-2838)

Akalin Z; Mungan NA; Basar H; Aydo? anli L; Cengiz T [Find other articles with these Authors]
Department of Urology 1, Ankara Numune Hospital, Ankara, Turkey.

Abstract Objective: To perform transurethal resection of the prostate (TURP) and transurethral laser ablation prostatectomy (TULAP) under appropriate local anesthesia. Patients and Methods: A total of 54 patients were examined in this study. We carried out TURP in 42 and TULAP in 12 of them under local anesthesia with lignocaine chloride. Patient's discomfort was recorded by means of a four-point descriptive pain scale. Results: We had perfect pain control in the majority of the patients. Patients' acceptance was very high. No patient required conversion to general anesthesia. Complications due to local anesthesia were not observed. Conclusion: We believe that ours is a simple, safe and effective procedure.ular tissue ablation by HIFU. Despite the major drawback of this technique, i.e. that no tumor histology is obtained, we believe that transcutaneous HIFU followed by irradiation has the potential to be established as a minimally invasive treatment alternative to organ-preserving surgery for tumors in a solitary testis. [Copyright Information: (c)1998 by S. Karger AG, Basel].

Transurethral resection of the prostate and laser prostatectomy under local anesthesia.

Eur Urol 1998;33(2):202-5 (ISSN: 0302-2838)

Akalin Z; Mungan NA; Basr H; Aydoganli L; Cengiz T [Find other articles with these Authors]
Department of Urology 1, Ankara Numune Hospital, Turkey.

OBJECTIVE: To perform transurethal resection of the prostate (TURP) and transurethral laser ablation prostatectomy (TULAP) under appropriate local anesthesia. PATIENTS AND METHODS: A total of 54 patients were examined in this study. We carried out TURP in 42 and TULAP in 12 of them under local anesthesia with lignocaine chloride. Patient's discomfort was recorded by means of a four-point descriptive pain scale. RESULTS: We had perfect pain control in the majority of the patients. Patient's acceptance was very high. No patient required conversion to general anesthesia. Complications due to local anesthesia were not observed. CONCLUSION: We believe that ours is a simple, safe and effective procedure.

Nerve block in prostate surgery.

J Urol 1996 Nov;156(5):1659-61 (ISSN: 0022-5347)

Tabet BG; Levine S [Find other articles with these Authors]
Department of Anesthesia, St. Luke's Hospital, Bluefield, West Virginia 24701, USA.
PURPOSE: We describe a novel technique for anesthetizing the prostate, which should be used for patients at risk undergoing prostate surgery with general, spinal or epidural anesthesia. MATERIALS AND METHODS: Local anesthesia to the prostatic plexus supplemented by monitored anesthesia care was performed on 40 patients with outflow obstruction secondary to an enlarged prostate. Of the patients 34 underwent transurethral resection of the prostate, 5 underwent visual laser ablation and 1 underwent transurethral electrovaporization. A 20 gauge spinal needle was inserted via a suprapubic approach toward the base and apex of the prostate, and guided by the left index finger inserted into the rectum. Lidocaine was injected into the prerectal space. Bulging of the rectal wall caused by the amount of lidocaine injected was appreciated. Insertion into the proper area was essential for a good anesthetic result. RESULTS: Adequate anesthesia levels could be obtained without major complications. All but 1 patient with poor bladder compliance were rendered free of a Foley catheter. There were no deaths. CONCLUSIONS: This technique has definite advantages for patients who are at risk for prostate surgery with general or spinal anesthesia.

Prospective multicenter study of transperineal prostatic block for transurethral needle ablation of the prostate.

Urology 2000 Dec 20;56(6):1052-5 (ISSN: 1527-9995)

Issa MM; Stein B; Benson R; Knoll LD; Fay R [Find other articles with these Authors]
Emory University School of Medicine, Atlanta, Georgia, USA.
The choice of anesthesia during thermal therapy of the prostate plays a significant role in the morbidity profile, patient convenience, and cost. We report 39 men with symptomatic benign prostatic hyperplasia who underwent transurethral needle ablation of the prostate under transperineal prostatic block. This method of local anesthesia proved safe, convenient, and satisfactory during the procedure.

The prostate anesthetic block for outpatient prostate surgery.

World J Urol 1998;16(6):378-83 (ISSN: 0724-4983)

Issa MM; Ritenour C; Greenberger M; Hollabaugh R; Steiner M [Find other articles with these Authors]
Department of Urology, College of Medicine, University of Tennessee, Memphis 38163, USA.
With the emergence of minimally invasive techniques for the treatment of benign prostate hyperplasia and the need to reduce health care costs, a simple and effective prostate anesthetic block may allow more procedures to be done in an outpatient or office setting. As based on neuroanatomy studies of the prostate, the perineal approach appeared to be the best way to anesthetize the prostate. This technique was used in 43 patients who underwent interstitial laser coagulation an outpatient or office setting. The perineal prostatic block was effective for pain control whether lidocaine or lidocaine/bupivacaine was used as determined by visual analog scale, linear pain scale, or global pain questionnaire. The use of intravenous (i.v.) sedation did not influence the efficacy of the prostate anesthetic block. Thus, the perineal prostate anesthetic block may be employed in patients undergoing minimally invasive surgery for benign prostatic hyperplasia in the outpatient/office location.

A prospective study of transperineal prostatic block for transurethral needle ablation for benign prostatic hyperplasia: the Emory University Experience.

J Urol 1999 Nov;162(5):1636-9 (ISSN: 0022-5347)

Issa MM; Perez-Brayfield M; Petros JA; Anastasia K; Labadia AJ; Miller LE [Find other articles with these Authors]
Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
PURPOSE: We evaluate the feasibility, effectiveness and role of transperineal prostate block in providing anesthesia during minimally invasive radio frequency thermal therapy of the prostate. MATERIALS AND METHODS: A total of 38 consecutive patients undergoing transurethral needle ablation for symptomatic benign prostatic hyperplasia were entered in this prospective study. All patients received transperineal prostatic block as the main method of anesthesia. A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concentration ratio) was used. Pain control during the instillation of transperineal prostatic block and transurethral needle ablation was assessed using a 10-point linear analog pain scale and questionnaire. RESULTS: Median patient age was 65.5 years (range 47 to 79), with 21% of men in the eighth decade of life. Median American Urological Association symptom score was 25.0 (range 14 to 35), bother score was 20.0 (11 to 28), quality of life score was 4.0 (3 to 6) and peak urinary flow rate was 8.9 cc per second (3.5 to 15.7). Median sonographic prostate volume was 35.0 cc (range 17 to 129). Median volume of anesthetic agent used was 40.0 cc (range 30 to 60) per case (1.1 cc solution per 1 cc prostate tissue). No adverse events were encountered. Median pain score was 3.3 (range 1 to 6) during instillation of transperineal prostatic block and 1.0 (0 to 6) during transurethral needle ablation. Transperineal prostatic block proved highly effective and was a satisfactory method of anesthesia during transurethral needle ablation as judged by postoperative questionnaire. No sedation, narcotic or analgesia was required. All procedures were performed in the outpatient cystoscopy suite or office setting without support of an anesthesia team or conscious sedation monitoring. CONCLUSIONS: Transperineal prostatic block is a safe, convenient, effective and satisfactory method of minimally invasive anesthesia for transurethral needle ablation of the prostate in an outpatient office setting. Elderly patients and those at high surgical risk can be treated safely using this approach. Considerable cost saving is seen secondary to omission of charges related to anesthesia team support, recovery room facility and conscious sedation monitoring.
: J Urol. 1999 Nov; 162(5):1648