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  • 1.
    Fagerstrom, Tim
    et al.
    Karolinska Institute.
    Nyman, Claes R.
    Karolinska Institute.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Complications and Clinical Outcome 18 Months After Bipolar and Monopolar Transurethral Resection of the Prostate2011In: Journal of endourology, ISSN 0892-7790, E-ISSN 1557-900X, Vol. 25, no 6, p. 1043-1049Article in journal (Refereed)
    Abstract [en]

    Purpose: To compare bipolar resection with the conventional monopolar transurethral resection of the prostate (TURP) with respect to peri- and postoperative complications and long-term outcome. Patients and Methods: Patients with consecutive benign prostatic hyperplasia needing surgery (n = 185) from the hospitals waiting list were randomized to TURP using either a bipolar or a monopolar system. Peri-and postoperative parameters were monitored, complications were registered, and timed micturition/International Prostate Symptom Score (TM/IPSS) forms were collected at 3 and 6 weeks and at 6 and 18 months. Results: Bipolar surgery was followed by a 16% to 20% higher percentage of the patients reporting ongoing improvement (fractional IPSS change greater than2) at 3 and 6 weeks after the surgery (p less than 0.05). There were fewer readmissions in the bipolar group than in the monopolar (5 vs. 13, p less than 0.05). No differences between the groups with respect to hospital stay and catheter duration was recorded. Bipolar and monopolar TURP resulted in marked and sustained improvements of IPSS, bother score, and TM. Conclusions: Bipolar TURP, using the transurethral resection in saline (TURis) system, resulted in significantly fewer postoperative readmissions, faster postoperative recovery, and equally long-lasting good results in TM/IPSS and bother score, as in monopolar TURP.

  • 2.
    Fagerstrom, Tim
    et al.
    Karolinska Institute, Sweden .
    Nyman, Claes R
    Karolinska Institute, Sweden .
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Degree of Vaporization in Bipolar and Monopolar Resection2012In: Journal of endourology, ISSN 0892-7790, E-ISSN 1557-900X, Vol. 26, no 11, p. 1473-1477Article in journal (Refereed)
    Abstract [en]

    Purpose: To compare the in vitro degree of vaporization in bipolar and monopolar resection. less thanbrgreater than less thanbrgreater thanMaterials and Methods: Using either a bipolar system or a monopolar system, samples of chicken muscle and lamb kidney were resected in an isolated basin and then desiccated in an incubator. The percentual degree of vaporization for each sample was obtained as a difference between the total fresh weight of the sample and the calculated fresh weights of the resected tissue and remains. less thanbrgreater than less thanbrgreater thanResults: Reference samples showed that the water content was 73% in muscle and 77% in kidney. More muscle (mean 52%) than kidney (32%; P andlt; 0.0001) tissue was vaporized. The fraction of vaporized tissue was significantly higher in the bipolar technique. In muscle, the differences between monopolar and bipolar were 17% (P andlt; 0.05) and 26% (P andlt; 0.001), respectively, depending on the type of irrigation used. For kidney, the differences were 27% (P andlt; 0.01) and 34% (P andlt; 0.01), respectively. Further exploration of the degree of vaporization when using the bipolar resection showed that the choice of loop (P andlt; 0.0001), fluid (P andlt; 0.03), and tissue (P andlt; 0.0001) were all independently associated with the degree of vaporization. less thanbrgreater than less thanbrgreater thanConclusions: This study indicated that vaporization removes 50% more tissue than the weight of the resected tissue during conventional tissue resection. Bipolar standard loop resection resulted in a significantly higher degree of vaporization in both muscle and kidney than did monopolar technique. Bipolar resection worked satisfactorily in Ringers acetate.

  • 3.
    Källström, Reidar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Hjertberg, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Svanvik, Joar
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Impact of Virtual Reality-Simulated Training on Urology Residents Performance of Transurethral Resection of the Prostate2010In: Journal of endourology, ISSN 0892-7790, E-ISSN 1557-900X, Vol. 24, no 9, p. 1521-5128Article in journal (Refereed)
    Abstract [en]

    Background: There are today a number of VR-simulators for practicing the TURP procedure, but few data on the effect of training on surgical performance.

    Objective: To test if practicing the TURP procedure in a VR-simulator increases the skills and dexterity of urology residents when performing the procedure on patients. Design, setting and participants Twenty-four urology residents attended a five-day course on diagnosis and treatment of benign prostatic enlargement. Each of the residents did three video-recorded TURP procedures on patients.

    Intervention: Between two of the procedures the residents underwent criterion-based practice in a TURP simulator (PelvicVision).

    Measurements: The TURP procedure was peroperatively evaluated using objective structured assessment of technical skills (OSATS). The video-recordings of the procedures were analyzed on a minute to minute basis regarding the main action during that minute, if that action was successful, and errors.

    Results and Limitations: The participating residents rated patient safety as high, they believed they learned most from the real operations, and they gained knowledge about both the procedure and the instrumentation used. The mean practice time in the simulator was 198 minutes before reaching the criterion level. Comparison of the first and last TURP procedures showed an increase in autonomous operation time and in successful actions and a decrease in hemostasis time without increased blood loss. The proportion of residents believed able to perform a simple TURP procedure increased from 10% to about 75%. OSATSscores and self-evaluations were significantly improved. The scores increased significantly more with than without simulator practice. The patient follow-up showed no increased risks or poorer results regarding micturition.

    Conclusions: Practice in a simulator based environment improves the skills and dexterity of urology residents when performing the procedure on patients, without increased risks or poorer results for the patients.

  • 4.
    Li, longkun
    et al.
    Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
    Jiang, Chonghe
    Medical College of Hunan Normal University, Changsha, China.
    Song, Caiping
    Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
    Zhou, Zhansong
    Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
    Song, Bo
    Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
    Li, Webing
    Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
    Transurethral endoscopy technique with a ureteroscope for diagnosis and      management of seminal tracts disorders: a new approach2008In: Journal of endourology, ISSN 0892-7790, E-ISSN 1557-900X, Vol. 22, no 4, p. 719-724Article in journal (Refereed)
    Abstract [en]

    Purpose: To apply a transurethral endoscopic technique for examining and managing suspicious distal seminal tracts disorders with a ureteroscope.

    Patients and Methods: Sixteen patients with distal seminal tracts disorders underwent transurethral endoscopy through the distal seminal tracts using a semirigid ureteroscope. Of the 16 patients, 6 had suspected hemospermia, 4 spermatocele, and 6 male infertility.

    Results: The ejaculatory duct, seminal vesicle, and ampulla of the vas deferens were observed under direct vision with the ureteroscope. The vas deferens was investigated by cannulation with a guidewire or an epidural anesthesia catheter. Four patients received a diagnosis of spermatocele, four seminal vesiculitis, and three vas deferens obstruction. All patients received appropriate treatment. The remaining five patients had no anatomic disorders. All patients received careful postoperative observation and treatment, and were monitored for at least 3 months. Three patients had postoperative discomfort in the perineal region. There were no further complications.

    Conclusions: This new technique with the ureteroscope enables diagnosis and management of distal seminal tracts disorders through the normal anatomic tract. This endoscopic technique can be performed easily with minimal complications.

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