Transurethral resection of the prostate after intraprostatic injections of mepivacain epinephrine: a preliminary communication.
OBJECTIVE
Transurethral resection of the prostate (TURP) has been the gold standard for treatment of obstructive benign prostatic hyperplasia since the 1970s. Intraprostatic injections of mepivacain epinephrine (ME) (Carbocain-Adrenalin) before Core Therm (Prostalund feedback treatment) have been used to anaesthetize the gland and reduce the intraprostatic blood flow, thereby reducing discomfort, treatment time and energy consumption during transurethral microwave thermotherapy. As a result of this experience, use of this technique before TURP, to reduce perioperative bleeding and blood loss during TURP surgery, was investigated. This paper presents the author's first clinical experiences using the Schelin Catheter to add intraprostatic infiltrations of ME before TURP.


METHODS
Eleven consecutive TURP operations were performed immediately after intraprostatic injections of 0.5% ME. Altogether, 20 ml was injected and infiltrated into the two quadrants (8 and 11 o'clock) in the right lobe using the Schelin Catheter technique. Then the right lobe was resected using a modified Nesbit technique. To avoid washout of epinephrine another 20 ml of 0.5% ME was then infiltrated in the left lobe (1 and 4 o'clock) just before resection of the left lobe. Total blood loss, bleeding per gram of resected tissue and operating time were compared with a reference group of 30 consecutive TURP operations, without any intraprostatic injections, performed by the same urologist. All patients (both groups) had spinal anaesthesia according to the hospital routine.


RESULTS
In the 11 patients receiving intraprostatic ME before TURP mean total blood loss was 108 ml (<20-302 ml), mean bleeding/g resected tissue was 4.8 ml (0-8.3 ml) and the mean operating time was 2.0 min/g (1.5-3.0 min) Mean resected volume was 21.3 g (15-37 g). In the reference group mean total blood loss was 354 ml (67-1500 ml), mean bleeding/g resected tissue was 15.4 ml (5.9-44.4 ml) and operating time was 2.2 min/g. Mean resected volume was 23.6 g (5-54 g). All patients in the ME group underwent postoperative self-irrigation by diuretics without any signs of latent bleeding. One late recurrent bleeding was registered in the ME group.


CONCLUSIONS
These first clinical experiences indicate several possible benefits when using prostate infiltrations of ME immediately before TURP, such as significantly less perioperative bleeding and total blood loss. Reduced operation time, improved visibility, improved safety, facilitated education, increased achievable resection volumes and complete resections are also possible benefits.
Schelin
Sonny
S
Urology Section, Department of Surgery, Kalmar County Hospital, Kalmar, Sweden. sonny.schelin@telia.com
D000779:Anesthetics, Local / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004837:Epinephrine / Q000008:administration & dosage*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000379:methods*; D014521:Urethra; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008619:Mepivacaine; D004837:Epinephrine