Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: A meta-analysis

Objective:To find out whether warm bladder irrigation fluid can decrease the occurrence of perioperative hypothermia,blood loss and shiver in patients treated with benign prostatic hyperplasia(BPH).Method:A comprehensive literature review and meta-analysis that included randomized controlled trials(RCTs)related to temperature of irrigation fluid in the perioperative treatment for BPH was taken by researchers.The relevant literature were searched in Chinese database,such as Retrieval Chinese Journal Full-text Database,VIP Journal Database,Wanfang database,as well as in English search engine and database,including Embase,Cochrane and Medline till January 2018.The study quality was assessed by recommended standards from Cochrane Handbook(version 5.1.0).Results:A total of 28 RCTs and 3858 patients were included.The results showed that the incidences of shiver(risk ratio[RR]Z 0.32,95%confidence interval[CI]:0.28e0.36,p<0.001,I^2 Z 0%)and hypothermia(RR Z 0.36,95%CI:0.21e0.59,p<0.001,I^2 Z 67%)in the group of warm irrigation fluid were lower than the group having room-temperature fluid.Room-temperature irrigation fluid group caused a greater drop in body temperature compared to warm irrigation fluid group(p<0.001,I^2 Z 96%).We performed a narrative descriptive statistics only because of substantial heterogeneity.Conclusions:Warm bladder irrigation fluid can decrease the drop of body temperature and the incidence of hypothermia and shiver during and after the operation for BPH.Warm irrigation fluid should be considered as a standard practice in BPH surgeries.

Endoscopic surgery for intraventricular hemorrhage:A comparative study and single center surgical experience

BACKGROUND Intraventricular hemorrhage is a neurosurgical emergency,and a dangerous condition associated with high morbidity and mortality.Previously,hematoma evacuation is generally executed by external intracranial drainage(EVD)or surgical evacuation.Nowadays,endoscopic evacuation is emerging as a good alternative because it brings relatively less invasion and injury.However,successful endoscopic evacuation requires skilled manipulation of endoscopic devices and the evidence supporting its efficacy differs in different reports.AIM To improve the technique usage and provide more evidence of endoscopic evacuation efficacy,we summarize our surgical experience and compared the outcomes of the endoscopic evacuation with EVD using real-world data.METHODS We retrospectively studied 96 consecutive patients with intraventricular hemorrhage who underwent either endoscopic surgery(n=43)or non-endoscopic surgery(n=53)for hemorrhage evacuation between November 2013 and September 2019 in our center.Patients’conditions prior to and after the operation were evaluated and analyzed to assess the efficacy of the operation.The consciousness status improvement and perioperative in-hospital parameters in the two types of operation groups were assessed and compared.RESULTS Patients in the endoscopic and non-endoscopic groups presented with a similar state of consciousness,with a comparable Glasgow Coma Scale(GCS)index.The average operation time of the endoscopic group was longer than that of the nonendoscopic group(median 2.42 h vs 1.08 h,P<0.001).Although the endoscopic group was older and had a baseline Graeb score that indicated more severe hemorrhage than the non-endoscopic group(Graeb median:Endoscopic group=9 vs non-endoscopic group=8,P=0.023),the clearance rate of hematoma was as high as 60.5%.Both the endoscopic and non-endoscopic groups showed an improved GCS index after surgery.However,this improvement was more marked in patients in the endoscopic group(median improvement of GCS index:Endoscope group=4 vs non-endoscopic group=1,P<0.001).Additionally,the endoscopic group had a lower Graeb score than the non-endoscopic group after the operation.The intensive care unit stay of the endoscopic group was significantly shorter than that of the non-endoscopic group(median:endoscopic group=6 d vs non-endoscope group=7 d,P=0.017).CONCLUSION Endoscopic evacuation of intraventricular hemorrhage was generally an effective and efficient way for hemorrhage evacuation,and contributed remarkably to the improvement of consciousness in patients with intraventricular hemorrhage.

Bipolar Transurethral Prostate Resection: A Study of 112 Cases

Background: With the advancement of technology, prostate resection can be performed nowadays using endoscopic techniques, which include monopolar and bipolar transurethral prostate resection. This study aimed to evaluate the results of bipolar transurethral prostate resection in a single urology center in Cameroon. Materials and Methods: This was a retrospective study carried out over two years (2015-2017) involving 112 patients with symptomatic prostate diseases who underwent transurethral prostate resection with the help of a bipolar Olympus generator. Results: The ages of the participants ranged from 44 years to 85 years, with a mean age of 64.41 ± 9.5 years. Fifty-six (50%) patients presented with only obstructive symptoms, five (4.46%) had only irritative symptoms, twenty (17.86%) presented with both obstructive and irritative symptoms, eight (7.14%) presented with macroscopic hematuria, seven (6.25%) with urinary tract infections, and sixteen (14.29%) with acute urinary retention. Digital rectal examination was unremarkable in 74 (66.07%) findings and was positive in 38 (33.93%) patients. The median prostate diameter was 70 [59 - 86.5] mm. The mean preoperative IPSS was 24.46 ± 5.68. The mean surgery duration was 77.61 ± 23.87 minutes. The mean volume of irrigation fluid used during surgery was 24.84 ± 6.40 ml. The differences between the preoperative and postoperative mean IPPS score, maximum urine flow rate, and quality of life were statistically significant (all P Conclusion: Bipolar transurethral prostate resection is a viable alternative to open surgery or laparoscopic surgery for large prostate glands. This technique is also associated with a reduction in prostate-related morbidity.