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  • Author: Chanatee Bunyaratavej x
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Open access

Thasinas Dissayabutra, Wattanachai Ungjaroenwathana, Chanatee Bunyaratavej, Kriengsak Prasopsanti and Piyaratana Tosukhowong

Abstract

Background: The transurethral resection syndrome TUR syndrome is the most serious complication following transurethral resection of prostate (TURP).

Objective: We compared 5% dextrose in water with sterile water as an irrigating solution and evaluated postoperative intravascular hemolysis.

Methods: A prospective, randomized, controlled trial of 41 benign prostatic hypertrophy (BPH) patients who underwent TURP. The differences between preoperative and postoperative free plasma hemoglobin were measured by using a spectrophotometric method to determine the degree of intravascular hemolysis. Serum glucose and electrolytes were measured preoperatively and postoperatively. Signs and symptoms of TUR syndrome were recorded. Prostatic tissues were weighed. Volumes of irrigating fluid were recorded.

Results: Free plasma hemoglobin was significantly increased in the sterile water group (n = 21) and higher than in the 5% dextrose in water group (n = 20) (p < 0.001). The postoperative plasma glucose was higher in the 5% dextrose in water group (p = 0.007). None of patients developed a TUR syndrome. There was no difference in other serum electrolytes between both groups.

Conclusion: Intravascular hemolysis can be prevented by using 5% dextrose in water instead of sterile water. No correlation between hemolysis and TUR syndrome was found in TURP patients with postoperative stable serum sodium.

Open access

Non Wongvittavas, Kamol Panumatrassamee, Julin Opanuraks, Manint Usawachintachit, Supoj Ratchanon, Kavirach Tantiwongse, Chanatee Bunyaratavej, Apirak Santi-ngamkun and Kriangsak Prasopsanti

Abstract

Background: Radical nephrectomy is the treatment of choice for large renal cell carcinoma (RCC).

Objectives: To describe the complications after radical nephrectomy for suspected or proven RCC and analyze the risk factors.

Materials and methods: We retrospectively reviewed medical records from 110 patients who underwent radical nephrectomy for RCC in our institution between January 2007 and December 2013. The clinicopathological data of all patients were recorded and complications were graded using modified Clavien classification. Univariate and multivariate analysis was made of the predictive factors for complications.

Results: Fifty postoperative complications occurred in 34 patients (31%) within 30 days, including 11% transfusion related complications. There were 22% minor complications (6% grade 1, 16% grade 2) and 9% major complication (5% grade 3, 2% grade 4, and 2% grade 5). The most common complications were transfusion-related, re-laparotomy because of bleeding, and prolong ileus. In univariate analysis, pathological T-stage (P = 0.001), American Society of Anesthesiologists (ASA) score (P = 0.007), tumor size (P = 0.01), and tumor diameter >4 cm (P = 0.03) were significant predicting factors. Major Charlson comorbidity index (CCI >2) was the only significant factor for major complications (P = 0.04). In multivariate analysis, ASA score was a significant independent predictor for overall complications (odds ratio 4.83, P = 0.01).

Conclusions: ASA score was a significant predictive factor for overall postoperative complications. Comorbidities was also a predictor for major complications in radical nephrectomy. Preoperative risk stratification for complications should be considered during decision-making and for proper counseling of patients.