Factors Affecting De Novo Urinary Retention after Holmium Laser Enucleation of the Prostate

Objective Patients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP. Materials and Methods 336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups. Results The mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498–0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004–0.383) or a transfusion (OR 0.144, 95% CI 0.027–0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05). Conclusions De novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.

The status and ecology of the American alligator (Alligator mississippiensis) in Par Pond, Savannah River site

Par Pond is a man-made 1120 ha cooling reservoir located on the Savannah River Site near Aiken, South Carolina. From 1972-1978 a detailed study on the status of the alligator in Par Pond was conducted by Tom Murphy (unpub. MS thesis Univ. of GA, 1977). Murphy estimated that approximately 110 alligators inhabited Par Pond with an adult (> 1.8 m) to juvenile (< 1.8 m) ratio of (1.8:1), an overall sex ratio of 3.2:1, and an average of only 2.3 nests/yr. The purpose of this study (1986-1989) was to determine the current population size and structure, determine how the population has changed in the last 15 years and to examine growth and survival of juvenile alligators. Data were collected by monthly night-time eyeshine counts aerial surveys, capturing animals, and locating and following the fate of nests. There was a strong positive correlation between water temperature and the number of alligators observed during eyeshine counts. Both eyeshine counts and aerial surveys were highest in spring and varied seasonally. A total of 184 different non-hatchling and 157 hatchling alligators were captured between May 1986 and November 1988. Population estimates and size distributions based on capture data indicate that over the last 15 years the population has increased from approximately 110 to 200 alligators, and the size distribution has shifted from one dominated by large adults to one that has a higher proportion of juveniles. The current sex ratio (2.6:1) is not significantly different from that reported by Murphy (1977, 3.2:1). However, the average number of nests/yr has increased from 2.3 to 4.0. Data on juvenile growth and survival show that the growth rate of hatchlings (32.9 cm/yr total length) is greater than that of animals age 1-3 (21.6 cm/yr total length) and survival of all ages is variable between years and between clutches. Results from this study indicate that from 1972-988 the population has increased ac an average exponential rate of 6 % per year. If conditions in Par Pond do not change, the population size should continue to increase.