Schelin Sonny
Urology Section, Department of Surgery, Kalmar County Hospital, Kalmar, Sweden.
Scand J Urol Nephrol. 2009;43(1):63-7. doi: 10.1080/00365590802465061.
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.
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.
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.
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.
自20世纪70年代以来，经尿道前列腺切除术（TURP）一直是治疗梗阻性良性前列腺增生的金标准。在Core Therm（前列腺反馈治疗）之前，经前列腺注射甲哌卡因肾上腺素（ME）（卡波卡因 - 肾上腺素）已被用于麻醉腺体并减少前列腺内血流，从而减少经尿道微波热疗期间的不适、治疗时间和能量消耗。基于这一经验，研究了在TURP之前使用该技术以减少TURP手术期间的围手术期出血和失血情况。本文介绍了作者首次使用Schelin导管在TURP之前进行前列腺内ME浸润的临床经验。
在经前列腺注射0.5% ME后立即连续进行11例TURP手术。总共注入20 ml并使用Schelin导管技术浸润到右叶的两个象限（8点和11点）。然后使用改良的Nesbit技术切除右叶。为避免肾上腺素被冲洗掉，在切除左叶之前，再向左叶（1点和4点）浸润20 ml 0.5% ME。将总失血量、每克切除组织的出血量和手术时间与由同一位泌尿科医生进行的30例连续TURP手术的参考组进行比较，该参考组未进行任何前列腺内注射。所有患者（两组）均按照医院常规进行脊髓麻醉。
在TURP之前接受前列腺内ME注射的11例患者中，平均总失血量为108 ml（<20 - 302 ml），平均每克切除组织的出血量为4.8 ml（0 - 8.3 ml），平均手术时间为2.0分钟/克（1.5 - 3.0分钟）。平均切除体积为21.3克（15 - 37克）。在参考组中，平均总失血量为354 ml（67 - 1500 ml），平均每克切除组织的出血量为15.4 ml（5.9 - 44.4 ml），手术时间为2.2分钟/克。平均切除体积为23.6克（5 - 54克）。ME组的所有患者术后均通过利尿剂进行自我冲洗，无任何潜在出血迹象。ME组记录到1例晚期复发性出血。
这些首次临床经验表明，在TURP之前立即进行前列腺内ME浸润有几个可能的益处，例如围手术期出血和总失血量显著减少。手术时间缩短、视野改善、安全性提高、便于操作、可实现的切除体积增加以及完整切除也是可能的益处。
