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ResumenAntecedentesEn la actualidad el manejo quirúrgico del crecimiento prostático obstructivo tiende a ser cada vez más favorable a las técnicas mínimamente invasivas, sin embargo, la cirugía abierta se sigue realizando frecuentemente.ObjetivoReportar los resultados obtenidos con la adenomectomía transvesical abierta en un solo centro en pacientes con crecimiento prostático obstructivo resistentes a tratamiento médico con próstatas>80g.Material y métodosSe realizó un estudio retrospectivo de 139 pacientes sometidos a adenomectomía transvesical abierta de enero de 2007 a diciembre de 2013. Se tomaron en cuenta variables pre-, trans- y postoperatorias.ResultadosLa edad media fue de 70 años, volumen prostático medio 119.5g, IPSS preoperatorio 18, Qmáx preoperatorio medio 8.6ml/s, el 71% portadores de sonda, media de sangrado transoperatorio 800ml, duración media de la cirugía 120min, el 51% requirió transfusión, estancia hospitalaria media 6 días, el 53% presentó complicaciones, la mayoría Clavien II, peso medio del adenoma 85g, IPSS medio postoperatorio 3, Qmáx postoperatorio medio 15ml/s, y el 18% desarrolló esclerosis de cuello vesical.DiscusiónLos resultados obtenidos son similares a lo reportado en la literatura, con disminución en los síntomas del tracto urinario inferior y mejoría en la dinámica miccional posterior al procedimiento, sin embargo la morbilidad transoperatoria a expensas de sangrado y transfusiones es superior a la informada aunque no se reportó mortalidad.ConclusiónLa adenomectomía transvesical abierta sigue siendo un procedimiento eficaz y resolutivo para el manejo del crecimiento prostático obstructivo en pacientes con próstatas>80g en centros con experiencia en México.AbstractBackgroundCurrent surgical management of obstructive prostate hyperplasia tends to increasingly favor minimally invasive techniques. However, open surgery is still frequently performed.AimsTo report the results with open transvesical adenomectomy at a single center in patients with medical treatment-refractory obstructive prostatic hyperplasia with prostates larger than 80 g.MethodsA retrospective study was conducted on 139 patients that underwent open transvesical adenomectomy within the time frame of January 2007 to December 2013. Preoperative, intraoperative, and postoperative variables were taken into account.ResultsMean patient age was 70 years, mean prostate volume was 119.5 g, mean preoperative IPSS was 18, and mean preoperative Qmax was 8.6ml/s. Seventy-one percent of the patients had a catheter, mean intraoperative blood loss was 800 ml, and mean surgery duration was 120 min. Fifty-one percent of the patients required transfusion, mean hospital stay was 6 days, and 53% of the patients presented with complications, the majority of which were classified as Clavien II. Mean adenoma weight was 85 g, mean postoperative IPSS was 3, mean postoperative Qmax was 15 ml/s, and 18% of the patients developed bladder neck contracture.DiscussionOur results were similar to those reported in the literature, with reduced lower urinary tract symptoms and improved micturition dynamics after the procedure. However, intraoperative morbidity related to blood loss and transfusions were greater than that reported in the literature, but there were no deaths.ConclusionsIn Mexico, open transvesical adenomectomy continues to be an effective and efficacious procedure for the management of obstructive prostate hyperplasia in patients with prostates larger than 80 g, when performed in centers with experience in this surgery. |
