title: Urapidil in the preoperative treatment of pheochromocytomas: a safe and cost-effective method.
abstract: BACKGROUND
  Surgery for pheochromocytoma may lead to uncontrolled catecholamine secretion with severe hypertension and cardiac failure. Perioperative α1-receptor-blockade with orally administered phenoxybenzamine or intravenous urapidil therefore is a standard procedure in the treatment regime prior to surgery.
  
  
  METHODS
  Medical records of 30 patients who underwent surgery for pheochromocytoma during the years 2002-2011 were retrospectively analyzed. We investigated the difference in the clinical course of patients undergoing surgery for pheochromocytoma with either phenoxybenzamine or urapidil pretreatment with special regard to the intraoperative course and length of hospital stay and costs.
  
  
  RESULTS
  Nineteen (16 female, 3 male) patients (63 %) received a preoperative α-block with orally administered phenoxybenzamine. Eleven patients (6 female, 5 male) (37 %) were treated with intravenous urapidil for 3 days prior to surgery. Intraoperative episodes of hypertension or hypotension did not differ significantly. The median total hospital stay in phenoxybenzamine-treated patients was 17 days in contrast to 11 days in the urapidil group (p = 0.0087). Patients who received i.v. pretreatment spent significantly fewer days in the hospital prior to operation [median: 3 days (range: 3-7 days) versus 9 days (range: 3-21 days); p = 0.0001]. The reduction in the number of days in the hospital in the urapidil group led to a significantly elevated revenue per day (<euro>637.49/day versus <euro>412.50/day; p = 0.001).
  
  
  CONCLUSIONS
  Perioperative treatment with the selective α1 blocker urapidil remains a simple and cost effective method in the treatment regime of patients with pheochromocytoma.
authors: Department of General and Visceral Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. nils.habbe@kgu.de
authors: Nils
authors: N
authors: Habbe
authors: Florian
authors: F
authors: Ruger
authors: Jorg
authors: J
authors: Bojunga
authors: Wolf Otto
authors: WO
authors: Bechstein
authors: Katharina
authors: K
authors: Holzer
mesh_terms: D000284:Administration, Oral; D000310:Adrenal Gland Neoplasms / Q000191:economics / Q000601:surgery*; D000315:Adrenalectomy; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D005858:Germany; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D007275:Injections, Intravenous; D007431:Intraoperative Complications / Q000517:prevention & control*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010643:Phenoxybenzamine / Q000191:economics / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000191:economics / Q000601:surgery*; D010879:Piperazines / Q000191:economics / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D010879:Piperazines; D010643:Phenoxybenzamine; C015568:urapidil
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