Benign Prostatic Hyperplasia: Conservative and Operative by J. E. Altwein, H. Baur (auth.), Prof. Dr. Gerhard Jakse,

By J. E. Altwein, H. Baur (auth.), Prof. Dr. Gerhard Jakse, Prof. Dr. Christian Bouffioux, Prof. Dr. Jean de Leval, Prof. Dr. Rudi A. Janknegt (eds.)

An severe dialogue has lately all started relating to present criteria within the prognosis and therapy of benign prosta­ tic hyperplasia (BPH). a couple of components have ended in this dialogue. In an expanding percentage of getting older males, for instance, BPH reasons so-called obstructive indicators that needs to be relieved via scientific or operative skill. This involves an incredible social and financial influence when it comes to future health charges. moreover, contemporary info point out the main usually played operation for BPH - transurethral resection of the prostate - is linked to the next danger of demise because of cardiac illness than open prostatectomy. moreover, reports utilizing the lately built means of uro­ dynamics to evaluate bladder outflow obstruction show that approximately 20% -30% of sufferers taken care of with transurethral resection or open prostatectomy are literally now not obstructed. which means those sufferers don't obtain the simplest treatment. ultimately, a number of new therapy been built, together with clinical deal with­ modalities have ment directed at endocrine pathways within the prostatic cells, balloon dilatation, spirals, transitority or everlasting stents, C). nd the appliance of warmth in hyperthermia or thermo­ treatment. The contributions to this quantity have been chosen from a symposium at the analysis and remedy of BPH. they're meant to supply a entire evaluate of the state-of-the-art in treating BPH. Aachen, Liege, Maastricht, September 1992 The Editors Contents improvement of Benign Prostatic Hyperplasia 1 J. E. Altwein and H. Baur Bladder Outflow Obstruction: Definition, medical program, and Grading in Benign Prostatic Hyperplasia. . . . . . .

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Example text

It is very interesting to see how close the shift of the tip of the linear PURR follows the lines of same detrusor strength when pre- and postoperative voiding studies are analyzed for the same patient (see Fig. 4). Defining Obstruction The most important step for the clinical application of an analytical concept such as the pressure/flow diagram is the question of how this diagram and the derived grading of outflow obstruction and detrusor contraction strength can be validated. This question is related to my introductory remarks and again points out the need for an extensive discussion of the rather vague and often obscure use of the term "obstruction" in urology.

The operator runs the risk of contracting bacterial infections such as tuberculosis or viral Video-Guided Transurethral Resection: Raising the Gold Standard 47 Fig. 4. Surgeon's contorted position during conventional TUR diseases such as AIDS or hepatitis B [10]. McNicholas et al. [14] reported a 46% rate of infection of the eye or face among surgeons operating on a total of 99 patients. Findings such as these led Davies and Harrison [3] to recommend that surgeons wear spectacles during TUR - a measure that becomes superfluous with video TUR.

For a cystostomy apply an 18-F catheter extravulnarily for temporary urine deviation. Close the prostate capsule with 110 chrom cat interrupted sutures (Fig. 8). Drain the periprostatic region with a 30-F silicon tube. Control complete hemostasis by irrigating the bladder via cystostomy. Secondary Treatment The 18-F cystostomy commonly remains in situ for 5 days. For all patients without cardiovascular risk factors induce a forced diuresis by generously substituting body fluid, thus irrigating the bladder physiologically.

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