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PubMed1994

The use of ethanol-tagged mannitol in transurethral resection of the prostate does not alter the bleeding time in patients who absorb irrigation fluid.

To increase patient safety ethanol tagging of irrigation fluid is practised at several hospitals in Sweden to detect absorption of irrigation fluid during transurethral prostatic resection. Using this method it is found that almost half of the patients undergoing transurethral prostatic resections absorb irrigation fluid to some extent. Patients absorbing irrigation fluid bleed more than others. The phenomenon has been blamed on the open veins and sinusoides. Further, these patients are older, have larger prostates and longer operating times. To exclude an effect of ethanol-tagged irrigation fluid on the skin bleeding time this was measured before and after the operation in 57 patients. In 18 (32%) 160-1760 ml of irrigation fluid was absorbed, and in 9 patients over 480 ml. No difference in skin bleeding time emerged between absorbers and non-absorbers, and absorbers showed no differences in bleeding time between preoperative and postoperative values. There was a slight but insignificant decrease in the skin bleeding time after the operation in both absorbers and non-absorbers.

Absorption↗
PubMed1989

Electrical resistance of appliances as a cause of urethral stricture following transurethral resection of prostate.

We performed transurethral resection for prostatic hypertrophy on 128 patients, and encountered 6 causes of postoperative urethral stricture. As they occurred during a short period, we investigated the causes. An electrical check revealed electrical resistance of more than 10,000 omega in the electric cord of a resectoscope. When an unused loop was connected with three used cords (No. 1, 2 and 3) and a new cord, the resistances were 2,000, 5,000, 0.9 and 0.5 omega, respectively. Moreover, the respective resistances were 15,000, 1,150,000, 1.3 and 0.9 omega when a used loop was tested. These findings suggested that the excessive resistance resulted from the use of a worn cord and that the used loop caused the postoperative urethral stricture.

Electric Conductivity↗
PubMed2004

Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia.

PURPOSE: To our knowledge we report the first multicenter, prospective, randomized study comparing holmium laser enucleation (HoLEP) and transurethral prostate resection (TURP) for obstructive benign prostatic hyperplasia. MATERIALS AND METHODS: From January to October 2002, 100 consecutive patients with symptomatic obstructive benign prostatic hyperplasia were randomized at 2 centers to surgical treatment with HoLEP (52 in group 1) or TURP (48 in group 2). Patients in the 2 groups were preoperatively assessed by scoring subjective symptoms questionnaires. Preoperative and perioperative parameters were also evaluated, the latter at 1, 6 and 12 months of followup. RESULTS: At baseline all patients had obstruction (Schäfer grade greater than 2). At the 1, 6 and 12-month followups no statistically significant differences were observed between the 2 groups in terms of urodynamic findings and subjective symptom scoring. In the HoLEP group mean total time in the operating room +/- SD was significantly longer than for TURP (74 +/- 19.5 vs 57 +/- 15 minutes, p < 0.05), while catheterization time (31 +/- 13 vs 57.78 +/- 17.5 minutes, p < 0.001 and hospital stay (59 +/- 19.9 vs 85.8 +/- 18.9 hours, p < 0.001) were significantly shorter in the HoLEP group. Transient stress and urge incontinence were more common in the HoLEP group, although at the 12-month followup results were comparable. The overall complication rate was comparable in the 2 groups. Erectile function was also maintained in the followup period from baseline in each group, as expected. CONCLUSIONS: HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups.

Aged↗
PubMed2004

Holmium laser enucleation versus transurethral resection of the prostate. Are histological findings comparable?

PURPOSE: We investigated if an adequate histological diagnosis can be made from tissue after holmium laser enucleation of the prostate (HoLEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: We analyzed 40 HoLEP and 40 age matched TURP tissue specimens from patients who underwent 1 of the 2 procedures between January 2001 and August 2002. Each histological specimen was reviewed by a single pathologist. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. RESULTS: Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Tissue remaining following the procedure was estimated to be 36.3% of preoperative ultrasound volume after HoLEP and 52.8% after TURP (p <0.001). Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups. Tissue thermal artifacts induced by the laser were mostly due to coagulation. Thus, the alterations were similar to those after TURP. CONCLUSIONS: Tissue quality is altered after HoLEP and TURP. General prostatic architecture was maintained in the majority of HoLEP histological specimens. A moderately higher percent of prostatic tissue obtained by the Ho laser is lost by vaporization and coagulation. Nevertheless, these differences do not seem to alter pathologist ability to detect incidental prostate cancer and PIN.

Holmium↗
PubMed1977

Complications of transurethral resection of the prostate.

A series of 632 patients undergoing one or more transurethral resections of the prostate gland at Wesley Pavilion of Northwestern Memorial Hospital is presented. Group characteristics, associated illnesses, and complications are reviewed and compared to an equally sized group of patients undergoing transurethral prostatic resection at the same hospital some twenty years earlier. This study has shown improvement in incidence of several complications, especially those related to infection and pyelonephritis, and urinary incontinence. Mortality rate has improved significantly and is likely due in great part to more comprehensive care of cardiovascular complications and control of infection. One can perhaps anticipate even further improvements in technique and results with the development of reliable fiberoptic instruments and improved lens systems which have been introduced to our institution since the period of time covered by this review.

Adult↗
PubMed1978

[Prevention of severe hypotension caused by epidural anaesthesia for transurethral resection of the prostate (author's transl)].

Severe art. hypotensions are one of the most frequent complications of epidural anaesthesia. In 62 geriatric patients undergoing transurethral prostatic resection two methods of prophylaxis for hypotension were investigated: 1. 500ml HES before epidural anaesthesia and supine position until operation. 2. Lithotomy position immediately after EDA without plasma substitute. Blood pressure, heart rate and necessity for the application of vasoactive substances show that the lithotomy position immediately after EDA is the statistically better method. The problem of plasma substitutes in transurethral prostatic resection will be discussed.

Aged↗
PubMed1992

[Prostatic cancer after transurethral resection for benign prostatic hypertrophy].

Five cases of prostatic cancer developed after transurethral resection of prostate for benign hypertrophy are reported. Duration of transurethral resection of prostate (TUR-P) to diagnosis of prostatic cancer ranged from one year and seven months to seven years and two months, on average four years and seven months and frequency of prostatic cancer after TUR-P was estimated at 1.2%. Four of five patients complained of macroscopic hematuria. The cystourethrogram showed the mass protruded in the dilated prostatic urethra or bladder-neck in four patients (80%), a remarkable finding, and four cases were at stage D. Risk of development of prostatic cancer is not decreased even after prostatectomy and prostatic carcinoma diagnosed after TUR-P often advances in stage. Therefore, periodical examinations of the patients who had a prior prostatectomy are very important.

Adenocarcinoma↗
PubMed1984

Hypothermia during transurethral resection of prostate.

Hypothermia during transurethral resection of the prostate has received relatively little attention in the urologic literature. Allen in 1973 found that with the use of room-temperature solutions the temperature drop was linear and time related up to 105 minutes. The study did not record temperatures beyond that time. In the present study, the temperatures of 16 patients were monitored for at least six hours after onset of surgery. Some patients were mildly hypothermic (35 degrees C or 95 degrees F), but the average patient's temperature continued to drop for three hours after onset of surgery. At this time, the mean nadir was 35.6 degrees C (96 degrees F). The pathophysiology of cold in the elderly with specific reference to the cardiovascular system is discussed. Warm solutions are recommended for TURP.

Body Temperature↗
PubMed1999

Is transurethral vaporization a remake of transurethral resection of the prostate?

PURPOSE: Transurethral resection of the prostate (TURP) is still the gold standard method to treat benign prostatic hyperplasia (BPH). Transurethral vaporization of the prostate (TUVP) is compared with the transurethral resection of benign prostatic hyperplasia. PATIENTS AND METHODS: Over a 10-month period, 78 patients presenting with moderate and severe symptomatic BPH were randomized into two groups. A total of 38 patients underwent TURP, and 40 men underwent TUVP. The protocol included urinary flow rate (Qmax), symptomatology evaluated by the International Prostatic Symptom Score (I-PSS), and an ultrasonographic estimate of the postvoiding residual volume (PVR). The TUVP was carried out using a regular loop with the electrical source set at 250 to 300 W in the pure cutting mode. The same technique was used in the TURP, but the electrosurgical unit was set at 50 to 80 W for cutting and 50 W for hemostasis. The mean follow-up was 17 months (range 11-23 months). RESULTS: The data showed significant improvement in the symptom score, maximum flow rate, and postvoiding residual urine volume after treatment (P<0.01) in both groups. Comparing the symptom score, there was no difference between the two techniques (P = 0.88), the same occurring with the PVR (P = 0.78). However, the Qmax was higher after TURP (P = 0.02). The amount of tissue resected showed no statistical difference between the two techniques (P>0.05). Operative time, postoperative irrigation, catheter removal, and hospital stay were better with TUVP (P = 0.001). There was a statistically significant difference (P = 0.003) when we compared the occurrence of retrograde ejaculation with TURP (32%) and TUVP (65%) The TUVP using a regular loop, in addition to the advantage of the equipment and technique already being familiar to urologists, is efficient and reduces capital expenditure. CONCLUSION: The TUVP is a remake of TURP, with higher energy offering better results.

Aged↗
PubMed2005

Measurement of residual adenoma after transurethral resection of the prostate by transurethral enucleation technique.

OBJECTIVE: Transurethral resection of the prostate (TURP) leaves a lot of residual adenoma and has a high recurrence rate, but the residual adenoma weight has not been measured surgically. Using surgery we tried to measure the residual adenoma after TURP. MATERIAL AND METHODS: Total adenoma resection was performed via standard TURP in 64 cases with benign prostatic hyperplasia and the weight of the residual adenoma was measured by transurethral enucleation (TUE) of the prostate. RESULTS: Prostate volume averaged 37.4 ml and adenoma volume averaged 20.6 ml by TRUS. The average weight of the prostate removed by TURP was 9.8 g. After TURP residual adenoma was confirmed in all cases by TUE, and the average weight of the residual adenoma was 10.2 g. The total average prostate volume removed by TURP and TUE was 20.1 g. The average residual rate of the adenoma removed by TURP was 54.5%. CONCLUSION: TURP leaves about half of the adenoma. Therefore, TURP might be very difficult for complete resection of an adenoma.

Aged↗
PubMed2003

Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate.

Pseudohyperplastic prostatic adenocarcinoma is a recently described variety of adenocarcinoma that has been studied in core-needle biopsies and prostatectomy specimens. It is characterized by malignant glands that simulate benign hyperplastic glands with complex, medium to large-sized glands with papillary infoldings, luminal undulations, branching or cystic dilatations, and columnar cells with macronucleoli and nuclear enlargement. Our aim was to define frequency, tumor volume, and histologic features of pseudohyperplastic prostatic adenocarcinoma in transurethral resections of prostate. We studied 250 specimens from transurethral resections; 150 specimens were originally diagnosed as benign glandular hyperplasia, and 100 as conventional prostate adenocarcinomas. Of the 150 biopsies originally diagnosed as benign glandular hyperplasia, two (1.3%) had areas of pseudohyperplastic carcinoma. In both cases the neoplasm was limited to two chips and measured 3 and 4 mm in diameter, respectively. Both patients were asymptomatic 2 and 4 years after diagnosis. Of the 100 biopsies with adenocarcinoma, areas of pseudohyperplastic carcinoma were found in three cases. In the first two these areas were found in two fragments, and in the other case they were found in three chips, and measured 3, 4, and 6 mm, respectively. The clinical course in these cases was unfavorable, and two patients had metastasis. Main histologic findings included crowded glands (5/5), papillary projections (5/5), nuclear enlargement (5/5) macronucleoli (4/5) cystic glandular dilatation (4/5) straight luminal borders (4/5), pink amorphous secretions (4/5) nuclear hyperchromasia (3/5) and transition to small acinar pattern of adenocarcinoma (3/5). In conclusion, pseudohyperplastic prostate carcinoma is rare in transurethral resection specimens and is found in scarce chips. Frequency of false negative results in biopsies originally diagnosed as benign glandular hyperplasia was 1.3%. In biopsies diagnosed as carcinoma, this frequency was 3%. These patients had an adverse clinical course, apparently due to association with areas of conventional adenocarcinoma.

Adenocarcinoma↗
PubMed1992

Improved indication and followup in transurethral resection of the prostate using the computer program CLIM: a prospective study.

Analysis of preoperative and postoperative detrusor pressure-flow measurements with the aid of the IBM compatible software package CLIM in 29 patients who underwent transurethral prostatic resection indicated that CLIM supplies reliable obstruction parameters that are recommended for preoperative assessment and postoperative followup, and that approximately a third of the patients who present with prostatism are nonobstructed, suggesting that the indication for transurethral resection of the prostate is over assessed.

Adult↗
PubMed1988

[Transurethral resection of prostate weighing over 100G].

Transurethral resection of prostate was done on 11 prostates weighing over 100g among 1664 cases seen during the last 9 years. The largest prostate weighed 180g and needed 140 minutes for resection. From 400 ml up to 1,600 ml, mean 890 ml of blood were transfused in these patients. No severe complication or death occurred. In conclusion, a prostate weighing less than 200 g can be operated by transurethral resection.

Adenocarcinoma↗
PubMedDate not supplied

[Antibiotics in transurethral resection of the prostate in patients with low risk of infectious complications: randomized prospective comparative study].

OBJECTIVES: To compare the rate of infectious complications using 2 antibiotic schemes in prostatic transurethral resection of the prostate (TUR-P) of patients at low risk, in order to reduce the use of antibiotics in this kind of patients. Secondarily, try to weigh the influence of clinical background, intraoperative complications and postoperative outcome on the development of such complications. METHODS: A comparative, prospective, randomized, open study was designed including 95 patients with sterile urine without indwelling catheter, subjected to TUR-P during one year. Group 1 received cefazolin 1 gr. i.v. preoperative and every 8 hrs. during the first day (3 doses) followed by ciprofloxacin 250 mg. oral every 12 hrs until the catheter was removed (therapeutic dose). Group 2 received cefazolin 1 gr. i.v. preoperative and at 8 hrs postoperative (2 doses) followed by nitrofurantoin 100 mg. oral every night until the catheter was removed (prophylactic dose). Five patients were excluded after randomization (5.3%) and all the remainders completed follow up. RESULTS: Ninety patients are analyzed, 45 in each group. Both groups were well matched with regard to clinical background, surgical and postoperative parameters and complications. Fever (axillary temperature equal or over 37.5 degrees C) was present in 2% of Group 1 and 11% of Group 2 (p = 0.091). Postoperative early or late bacteriuria (colony count > 100,000 CFU/mL) was present in 2% of Group 1 and in 13% of Group 2 (p = 0.049). Postoperative urinary infection (bacteriuria + clinical infection) was present in 2% of Group 1 and in 16% of Group 2 (p = 0.026). A statistical association was found between fever and postoperative urinary infection in all patients (p = 0.029) and between purulent secretion during prostatic tissue cutting and fever in Group 2 (p = 0.01). CONCLUSION: Patients in Group 1 (cefazolin-ciprofloxacin) presented significant less postoperative urinary infection than those in Group 2 (cefazolin-nitrofurantoin) represented by less postoperative bacteriuria frequency. This was possibly due to different antimicrobial activity and dosage of used drugs. Fever was statistically related to postoperative urinary infection.

Administration, Oral↗
PubMed2004

Experimental comparison of high power (80 W) potassium titanyl phosphate laser vaporization and transurethral resection of the prostate.

PURPOSE: Perioperative hemorrhage is still the major complication of standard transurethral prostate resection (TURP). Potassium titanyl phosphate (KTP) laser vaporization using 80 W is a novel technique that promises instant hemostatic tissue ablation. In this ex vivo investigation we compared the hemostatic properties of the 2 procedures. MATERIALS AND METHODS: Ex vivo, blood perfused porcine kidneys were used to verify the hemostatic efficacy of KTP laser vaporization and TURP-like tissue resection. Bleeding could be exactly quantified in relation to tissue ablation for the 2 techniques. In addition, specimens were examined microscopically. RESULTS: KTP laser vaporization demonstrated highly significantly decreased bleeding as compared to conventional tissue resection for a standardized ablation volume of 16 cm tissue (2.1 vs 23.3 ml per minute, p <0.0001). Tissue ablation was more rapid in the resection group (20 vs 100 seconds, p <0.001). Histological examinations revealed larger coagulation zones for the KTP group compared to conventional tissue resection (0.9 vs 0.6 mm, p <0.01). CONCLUSIONS: Ex vivo, 80 W KTP laser vaporization is a virtually bloodless ablative procedure, giving rise to hemostasis that is highly superior to conventional TURP-like tissue resection. However, the novel procedure is considerably more time-consuming.

Animals↗
PubMed1977

Accuracy of transurethral resection of the prostate versus transrectal needle biopsy in the diagnosis of prostatic carcinoma.

Transurethral prostatic resection for obstructive uropathy often yields malignant tissue in a significant number of patients with prostatic carcinoma. A comparison of the diagnostic accuracy of transurethral prostatectomy and transrectal prostatic biopsy in 139 patients who had both procedures demonstrated no significant difference. It is suggested that patients with obstruction and suspected prostatic carcinoma, who are not candidates for curative treatment, should have transurethral prostatectomy to relieve the obstruction and to confirm the diagnosis simultaneously.

Biopsy, Needle↗