“EFFECT OF PREOPERATIVE FINASTERIDE THERAPY ON PERIOPERATIVE BLOOD LOSS IN TRANSURETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA” – A PROSPECTIVE RANDOMIZED PLACEBO CONTROLLED STUDY Dissertation submitted to THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI - 32 in partial fulfillment of the requirements for the award of the degree of M.Ch (UROLOGY) BRANCH – IV GOVERNMENT KILPAUK MEDICAL COLLEGE & HOSPITAL CHENNAI – 600 010 AUGUST 2015
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“EFFECT OF PREOPERATIVE FINASTERIDE THERAPY ON PERIOPERATIVE BLOOD LOSS IN
TRANSURETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA” – A PROSPECTIVE RANDOMIZED PLACEBO
CONTROLLED STUDY
Dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI - 32
in partial fulfillment of the requirements for
the award of the degree of
M.Ch (UROLOGY) BRANCH – IV
GOVERNMENT KILPAUK MEDICAL COLLEGE & HOSPITAL
CHENNAI – 600 010
AUGUST 2015
CERTIFICATE
This is to certify that this dissertation entitled “EFFECT OF
PREOPERATIVE FINASTERIDE THERAPY ON PERIOPERATIVE
BLOOD LOSS IN TRANSURETHRAL RESECTION OF PROSTATE
FOR BENIGN PROSTATIC HYPERPLASIA” A PROSPECTIVE
RANDOMIZED PLACEBO CONTROLLED STUDY submitted by Dr.
NEELAKANDAN R appearing for M.Ch UROLOGY degree examination
in August 2015 is an original bonafide record of work done by him during the
academic period of August 2012 to July 2015 under my guidance and
supervision in partial fulfillment of requirement of the Tamil Nadu Dr.
M.G.R. Medical University, Chennai. I forward this to the Tamil Nadu Dr.
M.G.R. Medical University, Chennai, Tamil Nadu, India.
Prof. Dr MUTHULATHA N M.S, M.Ch., Professor and Head Of the Department, Professor of Urology, Department of Urology, Kilpauk Medical college, , Chennai - 600 010.
Prof. Dr SARAVANAN K M.S, M.Ch., Professor of Urology, Department of Urology, Govt. Royapettah Hospital Chennai - 600 020.
Prof. Dr R. NARAYANA BABU M.D, D.C.H The Dean,
Government Kilpauk Medical College, Chennai- 10
CERTIFICATE
This is to certify that this dissertation entitled “EFFECT OF
PREOPERATIVE FINASTERIDE THERAPY ON PERIOPERATIVE
BLOOD LOSS IN TRANSURETHRAL RESECTION OF PROSTATE
FOR BENIGN PROSTATIC HYPERPLASIA” A PROSPECTIVE
RANDOMIZED PLACEBO CONTROLLED STUDY submitted by Dr.
NEELAKANDAN R appearing for M.Ch UROLOGY degree examination
in August 2015 is an original bonafide record of work done by him during the
academic period of August 2012 to July 2015 under my guidance and
supervision in partial fulfillment of requirement of the Tamil Nadu Dr.
M.G.R. Medical University, Chennai. I forward this to the Tamil Nadu Dr.
M.G.R. Medical University, Chennai, Tamil Nadu, India.
Guide Prof. Dr. MUTHULATHA N
Professor and Head Of the Department Professor of Urology
Department of Urology Government Kilpauk Medical College
Chennai – 600 010.
DECLARATION
I, Dr. NEELAKANDAN R solemnly declare that this dissertation
“EFFECT OF PREOPERATIVE FINASTERIDE THERAPY ON
PERIOPERATIVE BLOOD LOSS IN TRANSURETHRAL
RESECTION OF PROSTATE FOR BENIGN PROSTATIC
HYPERPLASIA” A PROSPECTIVE RANDOMIZED PLACEBO
CONTROLLED STUDY was done by me in the Department of Urology,
Government Kilpauk Medical College and Government Royapettah Hospital,
Chennai, under the guidance and supervision of Prof. MUTHULATHA N,
Professor and Head Of the Department, Department of Urology,Govt.
Kilpauk Medical College, Chennai-10.
This dissertation is submitted to the Tamil Nadu Dr. M.G.R. Medical
University, Chennai-600032 in partial fulfillment of the University
requirements for the award of the degree of M.Ch., Urology.
Place : Chennai Date : 28-03-15
Dr NEELAKANDAN R
ACKNOWLEDGEMENT
I owe my thanks to THE DEAN Prof. NARAYANA BABU R
Govt.Kilpauk Medical College, Chennai, for permitting me to utilize the
facilities and conducting this study and the members of Ethical Committee
for their role.
I am extremely thankful to Prof. MUTHULATHA N, Professor and
Head of Urology, Govt.Kilpauk Medical College Chennai, and my guide, for
devising this study, valuable guidance, motivation, expert advice and help
rendered during the procedures and throughout this study
I am extremely grateful to Prof. SARAVANAN K, Professor of
Urology, Department of Urology, Govt. Royapettah Hospital , Chennai, for
his constant encouragement and guidance throughout the study and periodic
reviews.
I am extremely thankful to Prof. ILANGOVAN M and Prof.
GOVINDARAJAN R for their constant encouragement, valuable guidance,
motivation, expert advice and help rendered during the procedures and
throughout this study.
I sincerely thank Prof THIYAGARAJAN K , Prof ILAMPARUTHI
C Prof PITCHAI BALASHANMUGAM K for helping me with his time
and advice during this study.
I am indebted to all my assistant professors Dr. LEELAKRISHNA P,
Dr JAYAGANESH R, Dr SENTHILVEL A, DR.JASON PHILIP D, DR.
EZHIL SUNDAR V AND Dr SIVASANKAR G for their support,
guidance and help without which it would had been difficult to carry out this
study. Help rendered by my senior and junior colleagues need special
mention.
I acknowledge the help by Mr EZHIL for the timely help rendered in
performing statistical analysis for this study.
The encouragement provided by my Late father and the support and
sacrifice of my mother and wife is inexplicable. The blessings of Almighty
without which this work would not have been possible is acknowledged with
humility and gratitude.
TABLE OF CONTENTS
SL. NO TITLE PAGE NO.
1. INTRODUCTION 1
2. AIM OF THE STUDY 6
3. REVIEW OF LITERATURE 7
4. MATERIALS AND METHODS 25
5. RESULTS & ANALYSIS 39
6. DISCUSSION 81
7. CONCLUSION 93
8. BIBLIOGRAPHY
ANNEXURE
1. PLAGIARISM CERTIFICATE 2. ETHICAL COMMITTEE,
APPROVAL FORM 3. PROFORMA 4. RANDOM TABLE 5. IPSS CHART 6. MASTER CHART
ABBREVIATIONS
I-PSS – INTERNATIONAL PROSTATE SYMPTOM SCORE
TURP – TRANSURETHRAL RESECTION OF PROSTATE
AUA – AMERICAN UROLOGICAL ASSOCIATION
GA / SA – GENERAL ANAESTHESIA / SPINAL ANAESTHESIA
PVP - PLASMA VAPORIZATION TECHNIQUE
GnRH – GONADOTROPIN RELEASING HORMONE
AR – ANDROGEN RECEPTOR
PLESS - PROSCAR (FINASTERIDE) LONG-TERM EFFICACY AND SAFETY STUDY
AUR – ACUTE URINARY RETENTION
VEGF – VASCULAR ENDOTHELIAL GROWTH FACTOR
MVD – MICROVASCULAR DENSITY
DRE – DIGITAL RECTAL EXAMINATION
PSA – PROSTATE SPECIFIC ANTIGEN
OD – ONCE A DAY
SD – STANDARD DEVIATION
DF - DIFFERENCE
PRE OP – PREOPERATIVE
POST OP – POST OPERATIVE
INTRODUCTION
INTRODUCTION
Benign prostatic hyperplasia (BPH) is an abnormal stromal and
glandular proliferation of the prostate gland and is a common benign tumor
found in men above 50 years of age. Most men who reach their average
expectancy will experience this condition in their life time1.
Like prostate cancer, BPH also very often occurs in the West
compared to Eastern nations, such as Japan, China, and Asian countries
like India. They are more common in blacks1.
BPH is characterised by the proliferation of the prostatic epithelial
and stromal cells within the prostatic transition zone, which results in
enlargement of the prostate gland which in turn leads to compression of
the prostatic urethra, and restriction of urinary flow2.
The incidence of BPH also increases with age, being 50% at 60
years and around 90% at 80 years of age (2).The patho-physiology and
aetiology of BPH is multi factorial and they are yet to be known3.
However proliferation of prostatic stromal cells is dependent on
androgens, the most important being Dihydro-testosterone(DHT). This
androgen is essential for early embryological development and growth of
the prostate gland3.DHT is synthesized from testosterone by the isoenzyme
2
5α-reductase, which has two subtypes - type1 and 2. 5α-reductase type 2 is
the main enzyme in the prostatic stroma that is responsible for conversion
of testosterone to DHT and maintains intra prostatic dihydero-testosterone
in sufficient level to cause prostatic hyperplasia4.
Bladder outflow obstruction (BOO) due to benign prostatic
hyperplasia (BPH) is the commonest urological condition affecting men
over 50 years of age and may produce voiding symptoms like frequency,
urgency, nocturia with or without incontinence and storage symptoms like
intermittency, poor stream, hesitancy, post-void dribbling. These
symptoms are collectively known as lower urinary tract symptoms
(LUTS)5.
Apart from BPH, there are plenty of urological diseases that present
with LUTS. So complete assessment of patients with LUTS is essential,
and involves detailed patient history, clinical examination which includes
per-rectal examination of prostate and also subjective assessment of
symptoms in the form of various questionnaires (I-PSS), ultrasound
abdomen, pelvis and uroflowmetry.
Management of patients with BPH is based on the clinical
symptoms and complications associated with BPH. The absolute
indications for surgical treatment are history of refractory urinary
3
retention, recurrent urinary tract infection, hematuria, azotemia and vesical
stone formation6-7.
The different modalities of treatment for BPH are as follows8:
· watchful waiting,
· medical management with alpha blockers or 5 alpha reductase
inhibitors
· minimally invasive and endoscopic procedures like TURP,
Transurethral needle ablation of prostate (TUNA),transurethral
28) Muzzonigro G, Milanese G, Minardi D, Yehia M, Galosi
AB,Dellabella M. Safety and efficacy of transurethral resectionof
prostate glands up to 150 ml: aprospective comparativestudy with 1
year of followup. J Urol 2004;172:611–5.
29) Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP) - MarkLynch,1 Seshadri,1 Kesavapillai,Subramonian,2 and Peter Thompson1Ann R Coll Surg Engl. 2010 Oct; 92(7): 555–558.
30) Blood loss during and after transurethral resection of prostate: a prospective study. Shrestha BM1, Prasopshanti K, Matanhelia SS, Peeling WB. Kathmandu Univ Med J (KUMJ). 2008 Jul-Sep;6(23):329-34
31) Management of Large (60 g) Prostate Gland: PlasmaKinetic Superpulse (Bipolar) versus Conventional (Monopolar) Transurethral Resection of the ProstateManish Bhansali Suresh Patankar, M.S., M.Ch., Sayten Dobhada, M.S., and Suparn Khaladkarjournal of endourology Volume 23, Number 1, January 2009.
32) Blood loss comparison during transurethral resection of prostate and high power GreenLight(™) laser therapy using isotopic measure of red blood cells volume. Bruyère F1, Huglo D, ChallacombeB, Haillot O, Valat C, Brichart N.
33) Factors influencing blood loss in transurethral resection of the prostate (TURP): auditing TURP.Kirollos MM1, Campbell N. Br J Urol. 1997 Jul;80(1):111-5
34) Does catheter traction reduce post-transurethral resection of the prostate blood loss? Walker EM1, Bera S, Faiz M. Br J Urol. 1995 May;75(5):614-7
35) Lee C, Kozlowski J M, Grayhack J T. Aetiology of benign prostatic hyperplasia. Urol Clin N Am1995; 22: 237–246
36) Walsh P C, Madden J D, Harrod M J et al. Familial incomplete male pseudohermaphroditism, type 2: decreased dihydrotestosterone formation in pseudovaginal perineoscrotal hypospadias. N Engl J Med 1974; 291: 944–949
37) Imperato-McGinley J, Guerrero L, Gautier T, Peterson R E. Steroid 5a-reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science 1974; 186: 1213–1215
38) Herr, H. W. The enlarged prostate: a brief history of its surgical treatment. BJU Int. 98, 947-952 (2006).Mercier, L. Recherches sur le traitement des maladies des organs urinaires. (Kessinger publishing, Paris, 185
39) McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003;349(25):2387–98.
40) Feneley M R, Span P N, Schalken J A et al. Aprospective randomized trial evaluating tissueeffects of finasteride therapy in benign prostatichyperplasia. Prostate Cancer Prostatic Dis 1999; 2
41) Marberger MJ, Andersen JT, Nickel JC, et al. Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention: combined experience from three large multinational placebo-controlled trials. Eur Urol. 2000;38:563–568.
42) The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group.Gormley GJ1, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD, Andriole GL, Geller J, Bracken BR, Tenover JS, et al.N Engl J Med. 1992 Oct 22;327(17):1185-91.
43) Clark RV, Hermann DJ, Cunningham GR, et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5α-reductase inhibitor. J Clin Endocrinol Metab. 2004;89:2179–2184
44) Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS).BJU Nickel JC1, Gilling P, Tammela TL, Morrill B, Wilson TH, Rittmaster RS
45) A comparative study of fixed dose of Tamsulosin with finasteride vs Tamsulosin with dutasteride in the management of benign prostatic hyperplasiaNK Mohanty, Uday Pratap Singh, Nitin K Sharma, RP Arora, Vindu Amitabh-indian journal of urology- Year : 2006 | Volume : 22 | Issue : 2 | Page : 130-134
46) The Effect of Finasteride on Microvessel Density and Expression of Vascular Endothelial Growth Factor and 5α-Reductase in Prostatic Hyperplasia Jae-Ho Hyun, Kun-Hyun Cho, Dong-Seok Han, Jin-Bum Kim and Young-seop Chang
47) S. J. Foley, L. Z. Soloman, A. W. Wedderburn et al., “Aprospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride,”Journal of Urology, vol. 163, no. 2, pp. 496–498, 2000.
48) O. L. ¨ Ozdal, C. ¨ Ozden, K. Benli, S. G¨okkaya, S. Bulut, and A.Memis¸, “Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): arandomized controlled study,” Prostate Cancer and Prostatic Diseases, vol.8,no.3,pp.215– 218, 2005
49) J. F. Donohue, H. Sharma, R. Abraham, S. Natalwala, D. R.Thomas, and M. C. Foster, “Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of the role of finasteride for decreasing operative blood loss,” Journal of Urology, vol. 168, no. 5, pp. 2024–2026, 2002.
50) L. Sandfeldt, D. M. Bailey, and R. G. Hahn, “Blood loss during transurethral resection of the prostate after 3 months of treatment with finasteride,” Urology, vol. 58, no. 6, pp. 972–976,2001.
51) R. G. Hahn, T. Fagerstr¨om, T. L. J. Tammela et al., “Blood loss and postoperative complications associated with transurethral resection of the prostate after pre-treatment with dutasteride BJU International, vol. 99, no. 3, pp. 587–594, 2007
52) [Effect of dutasteride on reduction of intraoperative bleeding related to transurethral resection of the prostate].Boccon-Gibod L1, Valton M, Ibrahim H, Boccon-Gibod L, Comenducci A-Prog Urol. 2005 Dec;15(6):1085-9
53) R.Shanmugasundaram, J. Chandra Singh, Nitin S. Kekre- Does dutasteride reduce perioperative blood loss and postoperative complications after transurethral resection of the prostate? Indian J Urol. 2007 Jul-Sep; 23(3): 334–335.
54) Roehbon CG ,Benign prostatic hyperplasia-an over view-Review of urology 2005.7(9).
55) S. Haggstrom, N. Torring, K. Moller et al., “Effects of finasteride on vascular endothelial growth factor-a placebo-controlled randomized study in BPH patients,” Scandinavian Journal of Urology and Nephrology, vol. 36, no. 3, pp. 182–187, 2002.
56) J. D. McConnell, J. D. Wilson, F. W. George, J. Geller, F. Pappas,
and E. Stoner, “Finasteride, an inhibitor of 5ߙ-reductase, suppresses prostatic dihydrotestosterone in men with benign prostatic hyperplasia,” Journal of Clinical Endocrinology and Metabolism, vol. 74, no. 3, pp. 505–508, 1992
57) Pareek, M. Shevchuk, N. A. Armenakas et al., “The effect of finasteride on the expression of vascular endothelial growth factor and microvessel density: a possible mechanism for decreased prostatic bleeding in treated patients,” Journal of Urology, vol. 169, no. 1, pp. 20–23, 2003
58) Huan-Tao Zong1, Xiao-Xia Peng2, Chen-Chen Yang1 and Yong Zhang A systematic review of the effects and mechanisms of preoperative 5a- reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia; Asian J Androl. 2011 Nov; 13(6); 812–818.
59) O. L. Özdal, C. Özden, K. Benli, S. Gökkaya, S. Bulut, and A. Memiş, “Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study,” Prostate Cancer and Prostatic Diseases, vol. 8, no. 3, pp.215- 218- 2005
60) Liu XD, Yang YR, Lu YP, Zhang XH, Li FY et al. Preoperative finasteride of decreasing operative bleeding during transurethral resection of prostate. Chin J.Urol 2003; 24:694–6.
61) Sandfeldt L, Bailey DM, Hahn RG. Blood loss during transurethral resection of the prostate after 3 months of treatment with finasteride. Urology 2001; 58; 972–6
62) Hahn RG. Influence of variations in blood haemoglobin concentration on the calculation of blood loss and volumetric irrigating fluid balance during transurethral resection of the prostate. Br J Anaesth 1987; 59: 1223–9.
63) David A. Hochberg Jay B. Basillote,Noel A. Armenakas,Liliana, Vasovic, Maria Shevchuk,Gyan Pareek;Decreased Suburethral Prostatic Microvessel Density In Finasteride Treated Prostates: A Possible Mechanism For Reduced Bleeding In Benign Prostatic Hyperplasia –April 2002.167, Issue 4, Pages 1731–173; The journal of urology.
64) Memis A, Ozden C, Ozdal OL, Guzel O, Han O et al. Effect of finasteride treatment on suburethral prostatic microvessel density in patients with hematuria related to benign prostate hyperplasia. Urol Int 2008; 80: 177–80
65) Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified? BJU Int 1999;83:227–37.
66) Siavash Falahatkar, Gholamreza Mokhtari, Keivan Gholamjani MoghaddamBipolar transurethral vaporization: a superior procedure in Benign prostatic hyperplasia: a prospective randomized comparison with Bipolar TURP - Vol. 40 (3): 346-355, May - June, 2014 – international Brazilian Journal of urology.
67) Elmalik EM, Ibrahim AL, Gahli AM, et al. Risk factors in prostectomy bleeding. Eur Urol. 2000; 37: 199-204.
ANNEXURE
PROFORMA
“EFFECT OF PREOPERATIVE FINASTERIDE THERAPY ON PERIOPERATIVE BLOOD LOSS IN TRANSURETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC
HYPERPLASIA” – A PROSPECTIVE RANDOMIZED PLACEBO CONTROLLED STUDY
“EFFECT OF PREOPERATIVE FINASTERIDE THERAPY ON PERIOPERATIVE BLOOD LOSS IN TRANSURETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC
HYPERPLASIA” – A PROSPECTIVE RANDOMIZED PLACEBO CONTROLLED STUDY
Institution : Department of Urology,
Kilpauk Medical College, Chennai-600 010.
Name: Date :
Age : IP No :
Sex : Project Patient No :
The details of the study have been provided to me in writ ing and explained to me in my own language.
I confirm that I have understood the above study and had the opportunity to ask questions.
I understood that my partic ipation in the study is voluntary and that I am free to withdraw at any time, without giving any reason, without the medical care that will normally be provided by the hospital being affected.
I agree not to restrict the use of any data or results that arise from this study provided such a use is only for scientific purpose(s).
I have been given an information sheet giving details of the study.
I fully consent to partic ipate in the above study regarding Finasteride drug intake 2 weeks before surgery. Transurethra l resect ion of the prostate surgery (TURP) and to give the prostatic specimen for the investigation.
Name of the Subject Signature Date
Name of the Invest igator
Signature Date
INFORMATION SHEET Title of the Project
“EFFECT OF PREOPERATIVE FINASTERIDE THERAPY ON PERIOPERATIVE BLOOD LOSS IN TRANSURETHRAL RESECTION
OF PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA” – A PROSPECTIVE RANDOMIZED PLACEBO CONTROLLED STUDY
❖ We are conducting a study on the above mentioned title
among patients attending Government Kilpauk Medica l College & Hospital, Chennai and for that your co-operation may be valuable to study.
❖ The privacy of the patients in the research will be maintained throughout the study. In the event of any publication or presentation resulting from the research, no personally identifiable information will be shared.
❖ Taking part in this study is voluntary. You are free to decide whether to participate in this study or to withdraw at any time; your decision will not result in any loss of benefits to which you are otherwise entitled.
❖ The results of the special study may be intimated to you at the end of the study period or during the study if anything is found abnormal which may aid in the management or treatment.
❖ You have prostate enlargement due to aging that cause urinary tract obstruction. During the Transurethral resection of prostate surgery (TURP) complication like bleeding can occur. To find out the role for Tab. Finesteride in reducing the TURP complications, I agree to take the Finasteride tablets before surgery and to send the prostatic resected specimen for the investigation.
Signature of Investigator Signature of Participant Date : Date :
S.NO
NAME AGE
GR
OU
P
DR
E G
RA
DE
USG
PR
OST
ATE
WEI
GH
T
pre
op
OPE
RA
TIN
G T
IME
(MIN
)
RES
ECTE
D T
ISSU
E W
EIG
HT
(G
MS)
USG
PR
OST
ATE
WT
POST
OP
PREO
P H
B
POST
OP
HB
PREO
P-PC
V
POST
OP-
PCV
PREO
P-Q
MA
X
POST
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QM
AX
INTR
AO
P C
ALC
ULA
TED
B
LOO
D L
OSS
CLO
T R
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TIO
N (
YES
=1,
NO
=2)
BLO
OD
TR
AN
SFU
SIO
N
(Y
ES=1
, NO
=2)
EXPL
OR
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ON
/
RET
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T (
YES
=1,
NO
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MV
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MV
D (I
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)
FAIL
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O=2
)
UTI
(CU
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E -1
,
NEG
ATI
VE
- 2)
PR
EOP
- IPS
S SC
OR
E (G
RA
DE
I (0
-7),
II
- (8
-19)
, III
-
(20-
35)
POST
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- IPS
S SC
OR
E (G
RA
DE
I (0
-7),
II -
(8-1
9), I
II -
(20-
35)
1 HABEEB REHMAN 65 A 2 55.9 45 20 30 11.0 10.5 32 31 10 14 175 2 2 2 18.41 20.22 2 2 II I
2 PONNUSAMY 78 A 2 41 40 25 18 10.8 10.5 31 30 11 14.2 132 2 2 2 20.62 13.4 2 2 III I
3 VISWANATHAN 56 A 2 39.1 40 25 20 11.5 10.0 31 29 10.5 14 132 2 2 2 21.24 14.98 2 2 II I
4 KANNIAPPAN 78 A 2 40.4 45 25 18 11.22 10.8 33 30 9 13.2 120 2 2 2 17.3 15.22 2 2 III I
5 GUNASEKARAN 53 A 2 41 40 20 15 12.5 10.0 32 29 8 15 214 2 2 2 14.42 16.4 2 2 II I
6 PREBAL 52 A 2 55.4 50 30 20 10.7 10.0 32 29 10 14.3 167 2 2 2 19.56 16.11 2 2 III I
7 RAMACHANDRAN 76 A 2 43.0 45 20 18 11.2 8.4 32 28 11.5 14.5 155 2 1 1 15.62 13.22 2 2 II I
8 LOGANATHAN 75 A 2 38.64 40 18 15 10.6 9.6 31 29 10.5 13.5 213 2 2 2 16.25 13.46 2 2 III I
9 SELVAM 67 A 2 41.5 47 19 20 12.4 9.6 30 29 11 14.5 198 2 2 2 14.56 20.62 2 2 II I
10 MANI 68 A 1 38.6 35 35 15 11.8 9.6 30 29 12 15.1 145 2 2 2 15.67 13.22 2 2 II I
11 RENGANATHAN 80 A 3 54.9 50 25 20 11.9 10.6 32 30 10.5 13 100 2 2 2 15.89 17.45 2 2 III I
12 GOVINDARAJAN 64 A 2 46.9 45 28 18 12.4 10.2 32 31 11.7 16 110 2 2 2 18.45 13.08 2 2 II I
13 PONNUSAMY 65 A 2 56.8 50 25 18 11.7 9 31 28 12 17 160 2 1 2 20.22 14.42 2 2 III I
14 SIVARAMAN 70 A 2 43.7 43 30 15 10.3 9.6 30 29 11 13.1 229 2 2 2 13.4 15.6 2 1 III II
15 CHANDRASEKAR 55 A 2 44.5 50 24 18 11.4 9.8 31 29 10.3 13 175 2 2 2 14.98 18.41 2 2 III I
16 DASS 69 A 2 45.0 43 28 27 12 10.5 32 30 8.5 14.5 270 2 2 2 15.22 20.62 2 2 II I
17 KANNIAPPAN 62 A 2 41.54 42 22 19 12 9.6 30 29 9.7 15 100 2 2 2 16.4 13.22 2 2 III I
18 RAJAMANIKAM 75 A 1 37.5 35 35 17 12.5 10.0 32 29 11 13.3 190 2 2 2 16.11 15.87 2 1 III I
19 RAJAGOPAL 75 A 2 40.3 40 20 15 12 10.4 31 30 10.5 14 223 2 2 2 13.22 14.98 2 2 II I
20 BAKTHAVACHALAM 81 A 2 42.2 45 36 18 12.4 10.0 31 30 9 13.7 142 2 2 2 13.46 15.22 2 2 II I
21 FRANCIS 80 A 2 30.5 40 30 15 12.4 10.2 32 30 8 13 190 2 2 2 13.08 16.4 2 2 III I
22 KANNIAPPAN 50 A 1 35.0 40 30 15 11.0 10.0 33 30 10 14 169 2 2 2 16.25 18.41 2 1 II I
23 PARASURAMAN 61 A 3 66.6 65 40 20 12.4 10 31 29 11.5 14.5 235 2 2 2 14.56 20.62 2 2 II I
24 JONPRAKASH 68 A 2 37.9 40 30 15 11.0 10 32 29 10.5 13.5 175 2 2 2 15.67 17.98 2 2 II I
25 NARAYANAN 70 A 2 43.9 42 20 19 11.8 10 32 28 11 13.5 118 2 2 2 18.41 13.81 2 2 III I
26 RAMESH 45 A 2 44.8 46 22 18 12 8.6 30 27 11.7 16 175 1 2 2 20.62 16.56 2 2 III II
27 PONNAN 67 A 2 65.0 55 30 30 11.1 9.6 31 30 12 14 156 2 2 2 21.24 14.67 2 2 II I
28 PERUMAL 60 A 2 55.0 49 30 28 12.0 10 32 30 11 14.3 208 2 2 2 17.3 15.67 2 2 III I
29 BALASUBRAMANIYAN 68 A 2 43.0 50 20 15 11.5 11.0 33 32 10.3 13.6 189 2 2 2 14.42 24.4 2 2 II I
30 CHOTTILA 71 A 2 75.0 60 45 25 12.0 10.5 32 31 11 14 155 1 2 2 15.6 22.23 2 2 II I
31 PANCHACHALAM 63 A 1 40.0 45 15 16 11.5 10.5 32 31 12 13.4 157 2 2 2 18.41 19.06 2 2 III I
32 ARUMUGAM 55 A 2 65.0 60 35 20 11.7 10.5 31 30 10.5 15 143 2 2 2 20.62 19.56 1 2 III I
33 ANNAMALAI 55 A 1 37.0 47 20 15 12.5 10.0 31 30 11.7 14.1 158 2 2 2 13.22 24.01 2 2 III I
34 VEERAMANI 75 A 2 43.0 60 30 20 11.22 10.8 32 31 12 13.1 187 2 2 2 15.87 24.67 2 2 III I
35 VEERAMANI 75 A 2 54.5 50 25 20 12 10.0 31 29 9 15 220 2 2 2 13.08 16.87 2 2 III I
36 ANANDHAN 68 A 2 55.6 50 24 18 12.2 10.0 32 29 8 13 202 1 2 2 15.6 27.87 2 2 III I
37 TEYABAL 65 A 2 37.0 42 35 15 11.2 9.6 33 30 10 14.1 168 2 2 2 15.34 21.6 1 2 III I
S.NO
NAME AGE
GR
OU
P
DR
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RA
DE
USG
PR
OST
ATE
WEI
GH
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pre
op
OPE
RA
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(MIN
)
RES
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D T
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(G
MS)
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PR
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WT
POST
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PREO
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B
POST
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B
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N (
YES
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NO
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BLO
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N
(Y
ES=1
, NO
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EXPL
OR
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RET
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D (S
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UTI
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PR
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- IPS
S SC
OR
E (G
RA
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I (0
-7),
II
- (8
-19)
, III
-
(20-
35)
POST
OP
- IPS
S SC
OR
E (G
RA
DE
I (0
-7),
II -
(8-1
9), I
II -
(20-
35)
38 KASINATHAN 55 A 2 54.5 60 35 20 10.6 9.6 31 29 11.5 14.5 190 2 2 2 17.98 21.12 2 2 III I
39 SUBRAMANI 78 A 1 43.0 46 19 17 12.2 9.6 31 29 10.5 13.5 180 2 2 2 13.81 18.97 2 2 III II
40 ZITARAM 50 A 2 31.3 40 19 15 11.5 9.6 30 28 11 14.5 170 2 2 2 13.56 25.89 2 2 II I
41 MARIMUTHU 70 A 2 43.2 55 40 15 12.5 10.0 32 30 11.5 14.5 230 2 2 2 14.67 22.87 2 2 III I
42 CHINNASAMY 72 A 1 35.5 40 25 15 12.3 9.8 32 29 10.5 13.5 154 2 2 2 15.67 23.98 2 2 III I
43 MARIAPPAN 63 A 1 45.0 45 30 15 12.5 10.0 31 29 11 14.5 226 2 2 2 14.76 23.45 2 2 III I
44 SITARAMAN 67 A 1 40.0 35 35 15 10 9.7 32 28 11.7 15.2 210 2 2 2 15.96 21.54 2 2 III I
45 VENKATESAN 50 A 2 48.0 65 38 15 12.0 10.0 32 31 12 14.1 120 2 2 2 18.98 20.76 2 2 II I
46 JEYARAMAN 65 A 1 37.5 45 35 18 11.6 9.5 32 31 11 16 198 2 2 2 16.87 24.56 2 2 III I
47 PALANI 60 A 2 41.6 40 21 18 12.5 9.8 31 30 10.3 13.6 236 2 2 2 17.98 21.63 2 2 III I
48 NACHIAPPAN 66 A 1 39.3 40 25 14 12.2 10.5 31 30 11 14.5 145 2 2 2 19.98 26 2 2 II I
49 KALIMUTHU 72 A 2 43.4 50 28 26 11.8 10.5 32 31 12 14.6 189 2 2 2 21.12 19.56 2 2 III I
50 GOPALAN 59 A 3 56.5 60 42 13 11.4 9.7 31 29 10.5 15 150 2 2 2 14.22 26.87 2 2 III I
51 GUNALAN 58 B 1 33.5 45 18 17 12 9.5 30 29 11.7 12.5 213 2 2 2 24.4 23.56 2 2 II I
52 SWAMIINATHAN 65 B 3 72.0 65 43 20 12.6 9.6 31 28 11.5 12.4 240 2 2 2 22.23 21.87 2 2 III I
53 TIKKARAM 74 B 1 31.0 45 20 15 12.5 10 31 30 10.5 15.5 330 2 2 2 19.06 24.76 2 2 II I
54 RAJENDRAN 63 B 2 57.0 55 40 15 12 9.4 32 28 11 13.6 265 2 2 2 19.56 26.76 2 2 III I
55 RAMACHANDRAN 75 B 1 31.0 50 15 18 12.2 9.6 32 29 12 14.5 220 2 2 2 24.01 20.43 2 2 II I
56 NANDHA KUMAR 75 B 2 50.0 60 35 30 12.4 9.5 32 30 10.5 12.4 321 2 2 2 18.95 19.76 2 1 III I
57 THANGARAJ 65 B 1 32.0 45 16 15 12.1 9.8 31 30 11.7 14.5 280 2 2 2 16.87 22.01 2 2 III II
58 PENICILLIAIYA 70 B 2 69.0 65 40 25 11.2 9.6 32 29 12 14 223 2 2 2 17.98 25.9 1 2 II I
59 NARAYANAN 64 B 2 53.0 65 30 23 12 9.6 31 29 11 13 156 2 2 2 21.6 22.45 2 1 III I
60 THIRUKUMAR 70 B 2 50.0 55 35 15 11.2 8.6 32 27 10.3 14 270 1 1 1 21.12 22.56 2 2 II I
61 RAMASAMY 74 B 2 54.0 58 34 20 10.8 9.8 31 28 8.5 12 230 2 2 2 18.97 26.98 2 2 II I
62 PARI 75 B 1 45.3 58 30 14 12.3 8.6 31 27 9.7 13.4 260 1 1 2 21.67 24.65 2 2 II II
63 KUPPUSAMY 76 B 2 55.0 60 35 20 10.6 9.4 31 26 11 13.5 257 2 2 2 18.98 24.65 2 2 III I
64 KRISHNAN 72 B 2 44.5 50 30 15 12.7 9.6 30 27 10.5 14.5 180 2 2 2 22.87 25.78 2 2 II I
65 SADAYAN 55 B 2 43.0 45 20 22 11.2 8.6 32 27 12 11.7 240 2 1 2 23.98 25.78 2 2 III I
66 CHAKRAVARTHI 63 B 1 33.6 40 20 13 12.3 9.4 31 27 11 14.2 280 2 2 2 23.45 24.78 2 1 III I
S.NO
NAME AGE
GR
OU
P
DR
E G
RA
DE
USG
PR
OST
ATE
WEI
GH
T
pre
op
OPE
RA
TIN
G T
IME
(MIN
)
RES
ECTE
D T
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E W
EIG
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(G
MS)
USG
PR
OST
ATE
WT
POST
OP
PREO
P H
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POST
OP
HB
PREO
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N (
YES
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NO
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BLO
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TR
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N
(Y
ES=1
, NO
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EXPL
OR
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ON
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RET
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MV
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FAIL
UR
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ID (Y
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UTI
(CU
LTU
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POSI
TIV
E -1
,
NEG
ATI
VE
- 2)
PR
EOP
- IPS
S SC
OR
E (G
RA
DE
I (0
-7),
II
- (8
-19)
, III
-
(20-
35)
POST
OP
- IPS
S SC
OR
E (G
RA
DE
I (0
-7),
II -
(8-1
9), I
II -
(20-
35)
67 KUMAR 55 B 2 60.0 65 25 18 12.5 9.6 31 29 11 13.6 180 2 2 2 21.54 28.41 1 2 II I
68 PACHAIAPPAN 67 B 2 60.0 65 30 20 12.4 9.6 31 28 11 14.5 270 2 2 2 20.76 26.78 2 2 III I
69 VELAVAN 70 B 2 49.4 60 20 20 11.8 8.5 31 28 12 14 289 2 2 2 24.56 27.89 2 2 III I
70 KANNAIYAN 58 B 2 55.0 60 26 30 12.3 8 31 27 10.5 13 223 1 1 1 21.63 22.78 2 2 III I
71 HARIKRISHNAN 65 B 3 70.0 70 50 18 11 8.7 33 28 11.7 13.8 157 2 2 2 20.67 23.56 2 2 II II
72 DASTHAGIRI 66 B 2 48.1 50 24 30 12.2 9.5 31 27 11.5 14.3 220 2 2 2 19.56 25.89 2 2 III I
73 MURUGESAN 53 B 1 35.3 46 20 20 11.9 9.6 31 27 10.5 16 210 2 2 2 26.87 22.56 2 2 II I
74 SWAPANMANDAL 53 B 1 38.5 48 18 17 11.8 8.4 31 28 11 11.6 225 2 2 2 22.56 24.98 2 1 II I
75 AROKIYAM 64 B 1 40 50 20 25 11.2 9.4 33 26 12 14.5 240 2 2 2 21.87 25.44 1 2 III II
76 BASKARAN 64 B 2 49 55 20 25 11.3 9.6 33 28 10.5 10.3 221 1 2 2 24.76 28.56 2 2 III I
77 SELVARAJ 67 B 2 32.5 45 18 20 11.6 9 31 27 11.2 12.2 133 2 2 2 17.76 22.56 2 2 II I
78 ALAPPAN 73 B 2 39.9 50 25 20 12.6 8.4 31 27 11 14 289 2 2 2 20.43 27.98 2 2 II I
79 EZHUMALAI 63 B 2 40.55 55 20 35 12.5 8.6 33 28 12 11.5 298 2 2 2 19.76 21.54 2 2 III I
80 SELVARAJ 62 B 2 46.4 50 25 19 12.7 8.2 31 29 10.5 12.5 100 2 2 2 22.01 23.75 2 2 II I
81 SUBRAMANI 82 B 2 30.8 40 17 20 12.5 9.6 33 28 11.7 15 312 2 2 2 18.9 24.56 2 2 II I
82 VASU 78 B 2 44.7 45 23 17 12.2 9.7 31 29 11 9.7 134 2 2 2 22.45 26.76 2 2 III I
83 RANGANATHAN 62 B 2 45.9 58 25 20 12.5 9.6 33 28 9 14.5 267 2 2 2 19.56 19.56 2 2 III II
84 DURAISAMY 80 B 2 45.9 52 20 14 10.1 9.5 30 28 8.7 10.4 189 2 2 2 26.87 26.87 2 1 II I
85 SAMINAHAN 55 B 2 42.1 45 22 16 11.5 8 33 27 7.5 12.5 168 1 1 1 22.56 22.56 2 2 II I
86 BALASUBRAMANIYAN 60 B 2 43.2 53 15 15 12.4 9.8 31 29 8.5 9.4 110 1 2 2 21.87 24.22 1 2 III I
87 baskaran 64 B 2 32.67 40 16 17 11.9 10.2 33 30 9 12.2 130 2 2 2 21.54 25.78 2 2 III I
88 ARUNACHALAM 62 B 2 50.6 65 26 20 12.5 9 30 28 8 15.3 345 1 2 2 20.76 22.76 2 2 II I
89 SUNDARAM 72 B 2 43.5 45 20 25 12.6 9.4 30 27 8.9 15 130 2 2 2 24.56 25.76 2 2 III I
90 BAKTHAN 61 B 2 46.7 55 20 18 12.6 9 30 27 8.3 13.6 234 2 2 2 21.87 23.98 2 2 III I
91 NATESAN 78 B 2 48.8 60 20 18 12.0 9.8 34 28 9.4 11.5 125 2 2 2 24.76 24.87 2 2 III I
92 VELMURUGAN 55 B 2 33.6 42 15 16 12.4 8.2 31 27 10.7 11.2 213 1 1 2 17.76 22.56 2 2 III I
93 ARUMUGAM 75 B 2 48.9 50 20 19 12 8.6 33 27 8.5 10.8 190 1 2 2 20.43 25.78 2 2 II I
94 VARADHAN 60 B 2 30.0 40 15 15 12.6 9.8 31 29 10.1 14 178 2 2 2 19.76 21.12 2 2 III I
95 SUBRAMANI 65 B 2 36.7 48 18 20 12.5 8.6 31 29 11 15 234 2 2 2 23.45 24.1 2 2 III II
96 JAYAPAUL 50 B 2 46.5 49 23 20 12.5 9.4 34 27 11.7 11.4 317 2 2 2 21.54 24.4 2 1 III I
97 GANESH 48 B 2 33.0 40 18 20 12.4 9.6 31 28 11 14.5 145 2 2 2 20.43 22.23 1 2 II I
98 SADAYAPPAN 46 B 1 40.0 50 22 25 11.2 8.6 32 27 10.5 12.4 156 2 2 2 20.76 24.67 2 2 III I
99 PONMUTHAN 66 B 2 58.0 65 20 24 12.5 9.8 32 29 11 12.1 190 2 2 2 20.78 25.56 2 2 III I
100 PERUMAL 61 B 3 60.0 70 30 20 12.6 9.6 31 28 12 13.4 220 2 2 2 21.67 24.01 2 2 III I