Rajiv Gandhi University of Health Sciences, Karnataka



Yüklə 46,18 Kb.
tarix14.06.2018
ölçüsü46,18 Kb.
#48465

SYNOPSIS
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

A STUDY OF EARLY CATHETER REMOVAL AFTER TRANSURETHRAL RESECTION OF PROSTATE”


Name of the candidate : Dr. Suhitha G.

Guide : Dr. H. Divakar Shenoy

Co-Guide : Dr. Manjunath Shetty

Course and Subject : M.S. (General Surgery)



Department of General Surgery,6

Father Muller Medical College,

Kankanady, Mangalore – 575002.
2008

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

Name of the candidate

And address

(in block letters)

DR. SUHITHA G.

P.G. RESIDENT

DEPARTMENT OF GENERAL SURGERY

FATHER MULLER MEDICAL COLLEGE

MANGALORE.

2

Name of the Institution

FATHER MULLER’S MEDICAL COLLEGE

3

Course of study and

Subject

M.S. (General Surgery)

4

Date of admission to course

01-05-08

5

Title of the Topic

A STUDY OF EARLY CATHETER REMOVAL AFTER TRANSURETHRAL RESECTION OF PROSTATE



6

BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study

Transurethral resection of the prostate (TURP) is a proven surgical technique that significantly improves lower urinary tract symptoms associated with Benign Prostatic Hyperplasia (BPH).

Conventionally, post TURP bladder irrigation is used for 12 to 24 hours and catheter removal with a voiding trial is recommended after 3 to 5 days. During the past decade, there have been several trials of early catheter removal with shortening of the post-operative irrigation period and the hospital stay. Early catheter removal on post operative day 2, on post operative day 1 and day case prostatectomy can be accomplished in selected patients if certain requirements can be satisfied.

This study is intended to explore the feasibility and safety of early catheter removal after transurethral resection of prostate as compared with conventional 3-5th day catheter removal.


7.


6.2 Review of Literature

In the current practice, there is pressure to reduce length of stay in the hospital, but this is balanced by a need to maintain acceptable standards of practice. Several studies support catheter removal early in the post operative course, typically within the first 24 hrs after TURP, in order to determine whether the number of hours between surgery and catheter removal could be safely reduced.

Mueller and colleagues1 in the study of reduction of length of stay and cost of TURP by early catheter removal demonstrated that hospital stay was reduced from 3.1 to 1.28 days in the study and control groups. Also, if this practice were adopted, the savings resulting from the reduction in hospital stay would be considerable.

Roderic, Roberta and Eugene2 in a prospective study of 200 patients undergoing TURP, reported that out of 156 patients whose catheters were removed on 1st post operative day, 152 of them went home on the same day and overall length of patient stay was 1.6 days.

Gorden3 in his study of TURP as a catheter free same day surgery found that mean duration of catheterization was 6.54 hours, 10 patients required repeat catheterization and was due to urethral discomfort in initiating micturition in 8 and post operative urinary tract infection in 2 patients. He concluded that TURP can be effectively managed in the day surgery setting with minimal morbidity.

A study of 431 patients conducted by Nakagawa and Toguri4 indicated the risk factors which delayed catheter removal where age, post operative bleeding and several comorbidiites like coronary artery disease, renal insufficiency and Alzeimers disease.
Chander and researchers5 in the study of TURP as catheter free day-care surgery demonstrated that TURP can be conducted as a day care surgery in relatively young patients (< 75 yrs) with moderate BPH (<50ml) and with no significant comorbidity.

A prospective study conducted in the national hospital of Srilanka, Colombo, confirms the safety of an irrigation free and early catheter removal policy after TURP in prostates weighing 25gms or less, with a significant reduction of post operative burden on the staff and budget.6

6.3 Objectives of the study

  • This is a comparative study using purposive or judgemental sampling method.

The objectives are:

  1. To assess the feasibility of catheter removal on the first day after TURP.

  2. Comparison of early removal of catheter with the conventional 3-5th day post-operative catheter removal.

Material and methods:

7.1 Source of data

A minimum of 100 patients undergoing TURP will be included in the study. The study period would be from July 2008 to July 2010.





7.2 Method of collection of data

100 symptomatic patients of benign prostatic hyperplasia attending to Department of Urology in Father Muller Medical College will be included in this study.

The patients will be evaluated as per the symptoms, routine investigations including renal function tests, urine analysis and culture, TRUS to evaluate prostate size and post void residual volume and pre-anaesthetic check.

TURP will be performed by urologists of FMMC with a 24F / 26F resectoscope with routine precautions to achieve maximum haemostasis. At the end of TURP, a 18F / 20F three-way foleys catheter will be placed and bladder will be irrigated with normal saline (0.9%). Volume of resected prostate will be measured.

Post operatively patients will be monitored for vital parameters, colour of catheter effluent and presence of clots. Catheter will be removed if the criteria for removal of catheter are met on post operative day 1. Patients who void satisfactorily would be discharged on post operative day 2 after a 24 hour observation period.

Factors such as patient age, grams of resected tissue, the length of post-operative stay, recatheterisation for the inability to void or bleeding, hospital discharge with a catheter, comorbid conditions and post operative complications will be compared for patients whose catheter would be removed 1 or more days postoperatively.




Inclusion criteria

  1. Symptomatic patients of BPH between age 50-80 years.

  2. Prostate volumes < 50ml as measured by transrectal ultrasonography.

  3. 1st post operative day – patients with normal vitals, adequate urine output, absence of clots, acceptable character of catheter effluent.

Exclusion criteria

  1. Patients with bleeding diathesis or on anticoagulant therapy.

  2. Significant medical illness that would increase the anaesthetic risk.

Data analysis

Data will be analysed for the statistical significance using chi square test and student ‘t’ test. A p value of < 0.05 will be considered significantly.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes. Transrectal ultrasonography to determine the volume of prostate and post void residual volume.

7.4 Has ethical clearance been obtained from your institution in case of 7.3

Yes.



8.

LIST OF REFERENCES

  1. Muellar M, Zeidman EJ, Desmond PM, Thompson IM, Optenberg SA, Wasson J. Reduction of length of stay and cost of transurethral resection of the prostate by early catheter removal. British Journal of Urology 1996; 78: 893-6.

  2. Roderic JC, Roberta AY, Eugene VC. The safety of over night hospitalization for transurethral prostatectomy: A prospective study of 200 patients. The Journal of Urology 1997; 157: 531-533.

  3. Gordon NSI: Catheter-free same day surgery transurethral resection of the prostate. J Urol 1998; 16: 1709-1712.

  4. Nakagawa T, Toguri AG: Early catheter removal following transurethral prostatectomy: A study of 431 patients. Med Princ Pract 2006; 15: 126-130.

  5. Chander J, Vanitha V, Lal P, Ramteke VK: Transurethral resection of the practice as catheter-free day-care surgery. British Journal of Urology 2003; 92: 422-425.

  6. Neville DP, Nandasena ACN: Early catheter removal after transurethral resection of prostate: Ceylon Medical Journal, 2002; 47: 105-108.



9.

Signature of the candidate:




10.


Remarks of the guide





11.

Name & Designation of

(in block letters)

11.1 Guide


    1. Signature






Dr. H. DIVAKAR SHENOY

Professor

Department of General Surgery

Fr. Muller Medical College

Mangalore – 575002.





    1. Co-guide (if any)



    1. Signature

Dr. MANJUNATH SHETTY

Associate Professor

Department of Urology

Fr. Muller Medical College

Mangalore – 575002.




    1. Head of Department



    1. Signature

Dr. P. SATHYARMURTHY AITHALA

Professor and HOD

Department of General Surgery

Fr. Muller Medical College

Mangalore – 575002.


12.

12.1 Remarks of the Chairman and Principal

12.2 Signature






Yüklə 46,18 Kb.

Dostları ilə paylaş:




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©www.genderi.org 2023
rəhbərliyinə müraciət

    Ana səhifə