[Increased diuresis after transurethral prostate resection--a comparison between bumetanide and mannitol].
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Bumetanide↗
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Results for “Transurethral Resection of Prostate”
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[Transurethral prostate resection using a new resectoscope with continuous low pressure irrigation].
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Evaluation Studies as Topic↗
[Intraoperative urological complications in transurethral surgical interventions on the prostate for benign hyperplasia].
Wide clinical introduction of endoscopic methods in management of lower urinary tract (LUT) diseases is explained both by their high efficacy and relative safety. In spite of perfection of endourological tools, no large-scale clinical trials have been performed of late analyzing the rate of complications of endoscopic treatment of benign prostatic hyperplasia (BPH). A total of 5401 transurethral endoscopic operations were made in BPH patients. The spectrum of endoscopic operations made in the Research Institute of Urology (1991-2003) and Krasnodar Regional Hospital N 1 (1998-2003) covered the following operations: transurethral prostatic resection (5003-92.6%), transurethral prostatic incision (112-2.1%), transurethral rolling electrovaporisation of the prostate (119-2.2%), transurethral vaporizing resection of the prostate (107-1.98%), transurethral rotoresection of the prostate (60-1.1%). Overall number of intraoperative complications was 191 or 3.5%. Most frequent complications were closed and open perforation of the prostatic capsule (1.6 and 0.4%, respectively), a mechanical trauma of the prostate and urethra (0.3 and 0.15%, respectively), development of the syndrome of water intoxication (0.13%), intraoperative blood loss compensated by hemotransfusion (0.5%). Rare complications comprised injury of the ureteral ostia (0.09%), rupture of the urinary bladder (0.02%). Thus, transurethral endoscopic surgery is characterized by high safety, a trend to lowering of the number of intraoperative complications in transurethral endoscopic operations. Adherence to specification and TUR techniques leads to minimization of serious complications number.
Aged↗
The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic followup of transurethral resection of prostate for bladder outlet obstruction.
PURPOSE: Despite long-term symptomatic and uroflowmetry studies following transurethral prostate resection (TURP) there are sparse pressure flow data. Consequently there is minimal information to account for the long-term symptomatic failure and flow rate decrease seen with time following early improvements after surgery. MATERIALS AND METHODS: Men older than 45 years who were investigated at our department between 1972 and 1986, diagnosed with bladder outlet obstruction and elected surgical intervention were invited for repeat symptomatic and urodynamic assessment. Identical methods were used, allowing direct comparison of results. RESULTS: A total of 1,068 men were initially diagnosed with bladder outlet obstruction, of whom 428 (40%) died in the interim. Of the men who were followed 217 underwent TURP with a mean followup since surgery of 13.0 years. A significant, sustained decrease in the majority of symptoms and improvements of urodynamic parameters was seen. Long-term symptomatic failure and decreased flow rate were principally associated with detrusor under activity (DUA) rather than obstruction. Presentation predictive factors for the future development of DUA were decreased detrusor contractility and a lesser degree of obstruction. CONCLUSIONS: This unique long-term study provides valuable information on surgically treated bladder outlet obstruction. The association of long-term failure following surgery with DUA emphasizes the importance of pressure flow studies before repeat surgery. However, our faith in the long-term efficacy of TURP is justified.
Age Distribution↗
Double-blind randomized study of symptoms associated with absorption of glycine 1.5% or mannitol 3% during transurethral resection of the prostate.
PURPOSE: We studied which irrigating fluid, glycine 1.5% or mannitol 3%, is associated with the most favorable adverse effects profile when absorbed by the patient during transurethral resection of the prostate. MATERIALS AND METHODS: Irrigating fluid bags containing mannitol 3% or glycine 1.5%, both with added ethanol 1% as an indicator of fluid absorption, were used in a randomized double-blind fashion during 394 transurethral prostatic resections. The incidence of 13 symptoms was studied in 52 patients (13%) who absorbed more than 500 ml. fluid. RESULTS: The incidence of circulatory symptoms did not differ between the fluids but the risk of neurological symptoms, such as nausea, after transurethral prostatic resection was 4.8 times higher when glycine 1.5% was absorbed (p <0.04). An increase of 1,000 ml. in the volume of irrigant absorbed increased the overall risk for circulatory symptoms by a factor of 3.4 (p <0.03) and the risk of neurological symptoms by a factor of 4.4 (p <0.02). CONCLUSIONS: Absorption of mannitol 3% during transurethral prostatic resection is associated with fewer neurological symptoms than glycine 1.5%.
Absorption↗
[The development of transurethral resection in prostatic hypertrophy].
Some hitherto unknown facts on the development of transurethral prostate resection in a historical aspect are reported. Creation of the modern resectoscope from the first punch-instrument till nowadays is followed up in detail, quoting original sources from the literature. Each stage of development of transurethral resection is briefly discussed.
Europe↗
The efficacy of transurethral resection of the prostate in men with moderate symptoms of prostatism.
Transurethral resection of the prostate represents the operation most commonly performed by urologists in the United States. The objective of this study was to determine the efficacy of transurethral prostatectomy in men with moderate symptoms of prostatism. The efficacy parameters evaluated included peak urinary flow rate, obstructive and irritative symptom scores, and the global assessment by the patient of the voiding symptomatology. The mean peak urinary flow rate improved 108% after transurethral prostatectomy, and the mean obstructive and irritative symptom scores decreased 88 and 65%, respectively. The observed changes in urinary flow rates and symptom scores were statistically and clinically significant. Over-all, 84% of the patients indicated that the voiding symptoms were markedly improved after prostatic resection. Baseline urodynamic parameters were of no value for prediction of postoperative outcome. Several investigators recently reported their clinical experience with various pharmacological approaches for the treatment of symptomatic benign prostatic hyperplasia. Over-all, the degree of improvement in urinary flow rates and symptom scores achieved after transurethral prostatectomy exceeds all other therapeutic options that presently are available for the treatment of benign prostatic hyperplasia.
Aged↗
Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy.
One hundred patients with benign prostatic hypertrophy (BPH) were randomized to transurethral incision (TUIP) or transurethral resection of the prostate (TURP). The average prostate weight before operation was not more than 30.0 g. Indications for the operations were based on the disease history, physical examination, digital rectal examination, laboratory values, and pressure-flow examination. All operations were performed with patients under spinal anesthesia. TUIP was performed with a Collins knife, and TURP was performed with a resectoscope. Follow-up was performed 24 months after the operations. After treatment there were statistically significant daytime and nocturnal reduction in voiding frequencies of 2.9 and 1.7, respectively, after TUIP, and 2.0 and 1.5 after TURP. In both groups, there occurred significantly better maximal flow rate from 7.6 mL/s to 16.9 mL/s in group I and from 6.9 mL/s to 17.6 mL/s in group II. The mean values of linearized passive urethral resistance relation in both groups significantly decreased from 3.6 +/- 0.6 to 1.0 +/- 0.5 after TUIP and from 3.9 +/- 04 to 1.4 +/- 0.5 after TURP. The TUIP procedure is effective and safe for patients with a small number of complications.
Aged↗
Transurethral incision of prostate compared with transurethral resection of prostate in 132 matching cases.
In a prospective project during a 2-year period 132 patients with bladder outlet obstruction who were candidates for transurethral incision of the prostate were managed alternately by transurethral incision and transurethral resection of the prostate. Both operations were compared in matched patients. The results and complications favored transurethral incision, although there was no statistical significance except for the high incidence of bladder neck contracture after transurethral resection (p equals 0.028).
Adult↗
[The addition of ethyl alcohol to the irrigating fluid. Monitoring fluid absorption during transurethral resection of the prostate].
The absorption of irrigation solution during transurethral prostatic resection may lead to the life-threatening condition of the so-called TUR syndrome. For a long time no early recognition procedure was easily and routinely available. This study was set up to investigate the effectiveness of ethanol as an early indicator of beginning absorption, as described by Hulten. Ethanol was therefore added to the irrigating fluid as a marker, and alcohol concentrations were measured in the exhaled breath. METHODS. For measurement of alcohol an Alcotest monitor 7110, Drägerwerk (Lübeck, FRG) was used. In preliminary experiments with 13 healthy volunteers the lowest amount of measurable i.v.-administered 2% Ringer-ethanol solution was found to be about 200 ml. The irrigating fluid used was a 2% ethanol-mannitol/sorbitol solution. RESULTS. The control of breath and blood alcohol levels in 10 patients undergoing transurethral bladder surgery showed that there was no absorption of alcohol across the internal bladder lining. Of 52 patients, who had to undergo transurethral prostatic resection, 23 had positive breath alcohol values of up to 0.81/1000. In 6 patients the blood alcohol levels only were elevated (max. 0.18/1000). In 23 other patients no increased blood or breath alcohol levels were detectable. The negative breath alcohol levels in 6 patients were most probably attributable to low breath volumes due to lack of cooperation caused by pre- and/or intraoperative sedation. There were no significant changes in central venous pressure, mean arterial pressure or heart rate even at the time of maximal alcohol levels, compared with initial values. These parameters thus cannot be used for the early recognition of beginning absorption. Simultaneous monitoring of serum sodium concentrations revealed significant decreases at the time of maximal breath alcohol levels. Yet, the first indication of beginning absorption was always a positive alcohol level. Serum sodium changes followed later with increasing alcohol levels. Sodium concentration did not drop before a positive alcohol level was measured in any of these cases. CONCLUSION. It was thus proven that the addition of ethanol to the irrigating fluid and monitoring of the patient's exhaled breath with the Alco-testmonitor is a simple, non-invasive system that can be routinely used for early detection of absorption during transurethral prostatic resection. Adequate adjustment of the further course of the operation was possible. The dreaded TUR syndrome did not develop in any of the patients monitored in this way.
Aged↗
Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up.
The aim of this study was to compare the clinical results of plasmakinetic resection of the prostate (PRP) with standard transurethral resection (TUR) of the prostate (TURP). A total of 240 patients (mean age 63.5; age range 52-90 years), with symptomatic benign prostatic hyperplasia were randomized into two groups and treated with two different techniques (TURP and PRP). We evaluated pre-operative, per-operative and post-operative (first and 12th months) findings of all patients. The mean catheterization time was 3 and 4.5 days in the PRP and standard TURP groups, respectively (P<0.001). We observed the improvements in maximum flow rates in PRP group were significantly higher than TURP group (P<0.001). TUR of the prostate using plasmakinetic energy seems to be a promising treatment alternative to conventional TURP. It has the advantages of low intraoperative and post-operative complications, short convalescence, excellent intraoperative hemostasis, absence of fluid absorption and TUR syndrome.
Aged↗
Internal urethrotomy of the prostatic urethra or transurethral resection in benign prostatic hyperplasia.
Transurethral resection of the prostate is the most common technique for the treatment of benign prostatic enlargement. The inconveniences of prostatic resection are retrograde ejaculation and bladder neck stenosis in small prostates. A randomized prospective trial was done to compare the results of conventional transurethral resection of the prostate in 22 patients and urethrotomy of the prostatic urethra in 27 with respect to postoperative retrograde ejaculation, persistent urinary symptomatology and maximal flow rates. After a mean followup of 25 months we concluded that internal urethrotomy of the prostatic urethra is the operation of choice in patients with a prostate of up to 30 gm.
Follow-Up Studies↗
A randomized prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia.
OBJECTIVES: To compare the safety and efficacy of laser ablation of the prostate, one of the minimally invasive treatments available for men with benign prostatic hyperplasia, to transurethral resection of the prostate (TURP). METHODS: A prospective randomized study of 100 men with benign prostatic hyperplasia, with 50 patients in each treatment arm, was conducted. All patients met the entry criteria: age older than 45 years, no history of carcinoma of the prostate, a peak flow rate less than 15 mL/s, medical therapy failure, and the ability to undergo regional or general anesthesia. All patients underwent a preoperative evaluation consisting of the American Urological Association (AUA) symptom score, uroflowmetry, pressure-flow study, transrectal ultrasound for prostate volume, and serum prostate-specific antigen determination. Patients underwent either TURP or laser ablation of the prostate using the potassium titanyl phosphate (KTP)/neodymium: yttrium-aluminum-garnet laser. Patients were seen for follow-up at 1, 3, 6, and 12 months. RESULTS: The mean age was 68.2 years (range 45 to 90) for the laser group and 67.4 years (range 54 to 82) for the TURP group. The mean AUA symptom score was 22 for the laser group and 21 for the TURP group. The mean peak uroflow rate was 7.6 +/- 3.4 mL/s for the laser group and 6.5 +/- 4.0 mL/s for the TURP group. At 12 months of follow-up, the mean AUA symptom score had decreased to 7 (-69.5%) for the laser group and to 3 (-80.9%) for the TURP group. The mean peak uroflow rate increased to 15.4 mL/s (+ 107.8%) for the laser group and to 16.7 mL/s (+ 150.7%) for the TURP cohort. Seventy-five percent of the laser group had a 50% or greater decrease in their individual AUA symptom score compared with 93% of the TURP group. Sixty-five percent of the laser cohort had a 50% or greater increase in their peak uroflow rate compared with 75% of the TURP cohort. CONCLUSIONS: Laser prostatectomy produced improvements in the peak flow rate and symptom score similar to those produced by TURP. The patients who underwent laser treatment required a longer period to reach maximum improvement, which probably reflects the lack of tissue debulking at the time of surgery. Further improvement in laser technology will be required to produce more immediate results.
Aged↗
Effect of cystoscopy, prostate biopsy, and transurethral resection of prostate on serum prostate-specific antigen concentration.
To assess the effect of cystoscopy, prostate biopsy, and transurethral resection of the prostate (TURP) on the serum prostate-specific antigen (PSA) concentration, 101 patients were evaluated. For cystoscopic examination, 69 men were randomized in a prospective manner to one of three groups: flexible cystoscopy, rigid cystoscopy, and a control cohort. The median change in serum PSA was 0.1 ng/mL following flexible cystoscopy, 0.05 ng/mL after rigid cystoscopy, and 0.05 ng/mL for the control group, in which two serum PSA determinations were obtained without an intervening cystoscopy. The differences between the three groups were not statistically significant. The effect of prostate biopsy and TURP was examined in 32 men. Prostate biopsy caused an immediate elevation in the serum PSA level, with a median increase of 7.9 ng/mL (p < 0.0001). Similarly, TURP produced an elevation in the serum PSA concentration, with a median change of 5.9 ng/mL (p < 0.001). The median time required for the serum PSA value to return to a stable level after prostate biopsy was fifteen days (range: 5-21 days) for men with prostate cancer and seventeen days (range: 3-30+ days) for men without cancer, and eighteen days (range: 12-30+ days) for men who underwent TURP. These findings indicate that a serum PSA determination after either a flexible or a rigid cystoscopy is accurate and reliable. Both biopsy and TURP cause an immediate increase in the serum PSA level, which usually returns to a stable, baseline level within three weeks. However, because in some patients the serum PSA still remained elevated after four weeks, it is recommended that a serum PSA determination not be obtained for at least six weeks after either a prostate biopsy or TURP.
Aged↗
[Clinical study on prostatic cancer detected incidentally by transurethral resection of the prostate].
Transurethral resection of the prostate (TUR-P) was performed on 463 consecutive patients with clinically diagnosed benign prostatic hyperplasia (BPH) between April 1994 and June 2000. Pathological examinations of resected prostatic tissues revealed prostatic cancer in 15 (3.2%) of them. Eight (53.3%) of them were in stage A1, and 7 (46.7%) in stage A2. Between 15 cases with prostatic cancer and those with BPH, clinical features including age, serum prostate specific antigen (PSA) levels, prostatic volume, PSA density (PSAD), and resected prostatic tissue weight were compared. As a result, age was the only parameter related with prostatic cancer with a statistically significant difference. The higher the age, prostate cancer was found more frequently. Postoperatively, radical prostatectomy and antiandrogen therapy were performed in 1 and 9 cases, respectively. The remaining 5 cases are being followed with no treatment for prostatic cancer, and have shown no findings suggesting recurrence. These 15 cases are all living disease-free at present. It seems of importance to explain preoperatively the possible detection of prostatic cancer in association with TUR-P, particularly for elderly patients aged 80 years or older.
Adenocarcinoma↗
Transurethral electrovaporization of the prostate versus transurethral resection of the prostate: a prospective randomized study.
We evaluated the safety, efficacy and complications of two treatment modalities of benign prostatic hyperplasia (BPH): transurethral electrovaporization of the prostate (TVP) versus transurethral resection of the prostate (TURP) in a randomized prospective trial. A total of 40 consecutive patients with symptomatic BHP was randomized to undergo TVP or TURP. International prostate symptom score, peak urinary flow rate and post-void residual urine volume were measured at baseline and 1, 3, 6 months. Other parameters evaluated included operative time, operative blood loss, sexual functional changes and postoperative catheterization time. Symptom scores improved at all follow-up intervals compared with pretreatment values for both groups. For TVP and TURP groups scores decreased from 20.6 (12-27) to 0.6 (0-3) and from 21.5 to 3.9 (1-9) and peak urinary flow rates increased from 5.1 ml/sec to 21.4 ml/sec and 4.6 ml/sec to 17.7 ml/sec at 6th month respectively. There were no major complications in the TVP group while in the TURP group 5 (25%) patient required repeat catheterization secondary to clot retention. Two patient (12.5%) in TVP group and 12 patient (70.5%) in TURP group reported retrograde ejaculation. In conclusion the results indicate that TVP is effective as standard TURP in the treatment of BPH. TVP seems more beneficial than the TURP as far as the intra and post operative morbidity is concerned.
Aged↗
CT features of perirectal fascia thickening after transurethral resection of prostatic adenoma.
Thickening of the perirectal fascia (PRF) has been described as a CT sign of local extension of pelvic cancers. It has been observed also after radiation therapy and various pelvic surgical procedures. To demonstrate prospectively its nonspecificity, we systematically looked for such thickening before and after consecutive uneventful transurethral prostatic resections in 17 patients presenting with benign adenomas and in one patient with an unexpected prostatic carcinoma. In six patients (33%) obvious PRF thickening appeared on postoperative CT. Thus, this cause of fascial thickening must be considered when evaluating pelvic cancers.
Fascia↗
"TUR syndrome" after transurethral resection of the prostate using suprapubic drainage.
In a retrospective study of 522 consecutive patients who were subjected to transurethral resection of the prostate with suprapubic trocar technique, six patients were suspected of having transurethral prostatic resection syndrome. The majority of the transurethral resections were performed by surgical or urological trainees. Only two patients fulfilled the criterion for TUR syndrome caused by absorption of irrigating fluid and defined as an electrolyte dilution corresponding to a plasma sodium level below 120 mmol/l. In the present paper the symptomatology and treatment of TUR syndrome are outlined with reference to the literature. The trocar technique clearly has minimized the risk of TUR syndrome, which emphasizes the value of the method.
Aged↗