Abstract:

Iatrogenicinjury to the lower urinary tract, specifically the ureter and bladder, is a potential risk of any pelvic surgery. According to the available literature, the incidence of injury to the ureter ranges from 0.5-2.5% for routine pelvic operarions. In actuality, the incidence of ureteral injury during pelvic surgery may even be higher, as many cases are not reported, not detected or are asymptomatic. Injury to the bladder during pelvic surgery most commonly occurs in the form of inadverant laceration or placement of sutures through the bladder wall. Previous pelvic surgery, including Cesearean section, hysterectomy and bladder suspension procedures, and gynecologic conditions such as malignancy, endometriosis and pelvic inflammatory disease increase the risk for bladder trauma.

Authors:

Janine K. Jensen, M.D., Donald R. Ostergard, M.D., University of California at Irvine, Irvine, CA

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Abstract:

With the increasing longevity of the population, the incidence of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH) is expected to increase. Transurethral resection of the prostate (TURP) is currently considered the standard surgical treatment for this disease. However, TURP is an invasive procedure associated with some morbidity and, rarely, mortality. During the past several years, several alternative treatments for BPH have emerged. Visual laser ablation of the prostate (VLAP)is one of the more attractive choices among these alternatives. The use of laser energy to treat BPH has several advantages over TURP. Laser energy causes coagulation of the blood vessels, thus minimizing blood loss and fluid absorption. VLAPis an outpatient procedure performed under direct vision utilizing a standard or continuous-flow cystoscope. The technique ofVLAP is relatively easily learned and has a much shorter learning curve than that ofTURP. To date, clinical trials have confirmed the efficacy and safety of VLAP and the minimal associated morbidity. In the short-term follow-up, improvement in both subjective (symptom score) and objective (urinary flow rate) factors is similar to that after TURP. Although the results obtained with this laser technology are exciting and encouraging, further study and long-term follow-up are needed to confirm the durability of these results.

Authors:

William J. Glenski, M.D., Reza S. Malek, M.D., David M. Barrett M.D., Mayo Clinic, Rochester, MN

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Abstract:

Benign Prostatic Hyperplasia (BPH) is a pathological description of an aging process that affects a great majority of men. Classically, obstructive and irritative symptoms such as frequency, nocturia and weak urinary stream are described as "prostatism". Microscopically, BPH can be described as hyperplasia of stromal and epithilial cellular element which can macroscopically present as a gross adenomatous enlargement of the prostate gland. Thus, treatment of BPH is aimed at alleviating symptoms of prostatism and associated morbidities of prostatic obstruction.

Authors:

Alexis E. Te, M.D., Columbia University, New York, NY

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