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Special Conditions: Management of Concomitant Urological Pathology and the Comorbid Patient

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The Big Prostate

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Abstract

Life expectancy continues to increase and as a result more frail, elderly and co-morbid patents are undergoing surgery (Brodak et al. Clin Interv Aging. 10:379–85, 2015). This is acutely seen in the management of men with prostatic disease. Urologists are increasingly encountering the older man with larger (>100 cc) prostates and concurrent and multiple co-morbidities. Urological diseases such as bladder and renal stones, bladder tumours and benign prostatic enlargement often necessitate concurrent or staged operative management. The grossly enlarged prostate can hinder or obstruct progress in the initial operation due to mass effect and bleeding. Identification and planning is key for successful outcomes in these men. Ensuring that the right equipment is available is a critical step before the cystoscopic inspection of the lower urinary tract has even started.

This chapter will discuss tips and tricks when encountering the big prostate in common endourological procedures and how to negotiate this in order to get a successful surgical outcome. In addition this chapter highlights the importance of patient selection, identification of high-risk groups and how medical optimisation preoperatively can improve outcomes in elderly men with the very large prostates undergoing endourological procedures. Patient factors have been shown to be stronger predictors of mortality than the type of surgery (Story et al. 65(10):1022–30, 2010).

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Author information

Authors and Affiliations

  1. The Stone Unit, Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK

    Jonathan Makanjuola BSc (Hons), AKC, FRCS (Urol) & Matthew Bultitude M.Sc., F.R.C.S. (Urol.)

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  1. Jonathan Makanjuola BSc (Hons), AKC, FRCS (Urol)
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  2. Matthew Bultitude M.Sc., F.R.C.S. (Urol.)
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Correspondence to Jonathan Makanjuola BSc (Hons), AKC, FRCS (Urol) .

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Editors and Affiliations

  1. University College London & University College London Hospital, London, United Kingdom

    Veeru Kasivisvanathan

  2. Guy’s and St Thomas’s Hospitals NHS Foundation Trust, London, United Kingdom

    Ben Challacombe

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Makanjuola, J., Bultitude, M. (2018). Special Conditions: Management of Concomitant Urological Pathology and the Comorbid Patient. In: Kasivisvanathan, V., Challacombe, B. (eds) The Big Prostate. Springer, Cham. https://doi.org/10.1007/978-3-319-64704-3_13

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  • DOI: https://doi.org/10.1007/978-3-319-64704-3_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64703-6

  • Online ISBN: 978-3-319-64704-3

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