Sakıp ERTURHAN, Haluk ŞEN, Ahmet ERBAĞCI, Ünsal ÖNER, Pirbudak ÇÖÇELLİÜ Lütfiye, Özkan Gülşen TANRIVERDİ

Transüretral rezeksiyon girişimlerinde bipolar ve monopolar rezektoskop kullanımının hemodinami ve serum elektrolitlerine etkisi

Çalışmamızda, spinal anestezi altında transüretral prostat rezeksiyonu uygulanan hastalarda monopolar, ve bipolar rezektoskop kullanımının hemodinami, serum elektrolitleri,üretral kateter, süresi ve hastanede kalış süresi üzerine olan etkilerinin karşılaştırılması amaçlandı. Fakülte Etik Kurul onayı ve hasta onamı alındıktan sonra, 60 hastayı rastgele iki gruba ayrıldı. Çalışma grubunda bipolar. (Grup B) (n=30), kontrol grubunda monopolar (Grup M)(n=30) rezektoskop ile TUR-P uygulanması planlandı. Tüm olgulara spinal anestezi uygulandı. .Operasyon süresince 5 dakika arayla kan basıncı, kalp atım hızı ve solunum sayıları izlendi. Operasyon öncesi, operasyonun 30. dk'sında, operasyon bittikten 1 ve ' 24 saat sonra; serum Na+, K+, Cl', hemoglobin ve hematokrit düzeyleri ' ölçüldü. Üretral kataterizasyon ve hastanede kalma süreleri kaydedildi. Grup M'deki olgularda kontrol değerine göre 25. ve 3O.dk'larda kari basıncında, belirgin düşmeler olduğu gözlendi. (p

The effects of bipolar and monopolar resectoscope on hemodynamic and plasma elctrolytes in transurethral resection procedures

In our study, we compared the effects of monopolarm and bipolar resectoscope use on hemodynamics, serum electrolytes, and length of hospital stay of patients who is undergoing TUR-P with spinal , anesthesia. After approval of the Faculty Ethical Committee and the written consent of the patients, 60 patients are randomly allocated into two groups that is planned to perform TUR-P with bipolar resectoscope (Group B)(n=30) group and monopolar resectoscope (Group M)(n=30), respectively. Spinal anesthesia had been performed to alj patients. Blood pressure, heart rate and respiratory rate were monitorized with five minutes periods during the operation. Serum Na K+, Cl", Hb ve Hct values measured before the operation, at 30. , minute of the operation, 1., 24. h after the operation. Urethral catheterization time and length of hospital stay had been recorded. In Group M , blood pressure of the patients at 25th and 30th minutes had been decreased significantly comparison to the control values (p

PDF

___

l.Glynn PJ, Campion EW, Bouchard GR, Silbert JE. The development of benign prostatic hyperplasia among volunteers in the normative aging study. Am J Epidemiol. 1985;121:78-90.
2. Near DE. Transurethral prostatectomy. Br J Surg. 1994;81:484-5.
3. Tkocz M, Prajsner A. Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy. Neurourol Urodyn. 2002;21:112-6.
4.Yang Q, Peters TJ, Donovan JL, Wilt TJ, Abrams P. Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomised controlled trials. J Urol. 2001;165:1526-32.
5. Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified? BJU Int. 1999;83:227-37.
6. Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG, et al. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. New Engl J Med. 1995;332:75-9.
7. Morgan GE, Mikhail MS, Murray MJ, Larson CP. Anesthesia for genitourinary surgery. Morgan E, Mikhail MS, Murray JM, Larson C, eds. Clinical Anesthesiology, 3rd ed. USA: McGraw-Hill Companies. 2002;36:692-707.
8. Kayhan Z. Boşaltım Sistemi ve Anestezi. Klinik Anestezi. 2. baskı. İstanbul: Logos Yayıncılık; 1997;27:340-54.
9. Gravenstein D. Transurethral resection of the prostate (TURP) syndrome: A review of the pathophysiology and management. Anesth Analg. 1997;84:438-46.
10. Mebust WK, Holtgrewe HL, Cockett AT. Transurethral prostatectomy-immediate and postoperative complications: A operative study 13 participating institutions evaluating 3885 patients. J Urol. 1989;141:243-7.
11. Jensen V. The TURP syndrome. Can J Anaesth. 1991;38:90-6.
12. Borboroglu PG, Kane a, Ward JF, Roberts JL, Sands JP. Immediate and postoperative complications of transurethral prostatectomy in the 1990s. J Urol. 1999; 162:1307-10.
13. Concato J, Horwitz RI, Feinstein AR, Elmore JG, Schiff SF. Problems of comorbidity in mortality after prostatectomy. JAMA. 1992;267:1077-82.
14. Roos NP, Wennberg JE, Malenka DJ. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia. N Engl J Med. 1389;320:1120-4.
15. Hammadeh MY, Madaan S, Singh M, Philp T. A 3- year follow-up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy. BJU Int. 2000;86:648-51.
16. Loh SY, Chin CM. A demographic profile of patients undergoing transurethral resection of the prostate for benign prostate hyperplasia and presenting in acute urinary retention. BJU Int. 2002;89:531-3.
17. Boyle P, Robertson C, Vaughan ED, Fitzpatrick JM. A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia. BJU Int. 2004;94:83-8.
18. Dawkins GP, Miller RA. Sorbitol-mannitol solution for urological electrosurgical resection: A safer fluid than glycine 1.5% Eur Urol. 1999;36:99-102.
19. Hahn RG. Smoking increases the risk of large scale fluid absorption during transurethral prostatic resection. J Urol. 2001;166:162-5.
20. Erturhan S, Erbagci A, Seckiner I, Yagci F, Ustun A. Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up. Prostate Cancer Prostatic Dis. 2007;10:97-100.
21. Dincel C, Samli MM, Güler C, Demirbaş M, Karalar M. Plasma kinetic vaporization of the prostate: clinical evaluation of a new technique. J Endourol. 2004; 18:293-8.
22. Singh H, Desai MR, Shrivastav P, Vani K. Bipolar versus monopolar transurethral resection of prostate: randomized controlled study. J Endourol. 2005; 19:333-8.
23. Ho HS, Yip SK, Urn KB, Fook S, Foo KT, Cheng CW. A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system. Eur Urol. 2007;52:517-22.
24. Botto H, Lebret T, Barre P, Orsoni JL, Herve JM. Luga gne PM. J Endourol. 2001;15:313-6.
25. Fung BT, Li SK, Yu CF, Lau BE, Hou SS. Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate. Asian J Surg. 2005;28:24-28
26. Helke C, Manseck A, Hakenberg OW, Wirth MP. Is transurethral vaporesection of the prostate better than standard transurethral resection? Eur Urol. 2001;39:551-7.
27. Hammarsten J, Lidqvist K, Sunzel H. Urethral stricture following transurethral resection of the prostate. The role of the catheter. Br J Urol. 1989;63:397-400.
28. Hart AJ, Fowler JW. Incidence of urethral stricture after transurethral resection of prostate. Effects of urinary infection, urethralflora and catheter material and size. Urology. 1981;18:558-91.