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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↗
PubMedDate not supplied

[Sacral anesthesia in transurethral resection of the prostate].

Block anesthesia has some advantages in transurethral surgery over general anesthesia. 48 patients were operated under sacral anesthesia and 47 patients under peridural anesthesia. Anesthesia-induced complications were compared to those published in the literature. It was found that in transurethral prostatic resection sacral anesthesia is more simple and cost-effective than peridural anesthesia.

Aged↗
PubMed1992

Transurethral laser resection of the prostate.

Transurethral laser resection of the prostate was performed on 25 patients for the management of bladder outlet obstruction secondary to prostatic hyperplasia. All of the patients in our series were treated on an outpatient basis and the majority of these under IV sedation. Patient selection was limited to older, high-risk patients who were poor surgical candidates for transurethral resection of the prostate or suprapubic prostatectomy because of underlying medical problems. Successful results were noted in 20 of the 25 cases (80%). Five procedures were unsuccessful because the patients were unable to spontaneously void after laser resection. Transurethral laser resection of the prostate utilizing the contact laser system is an acceptable alternative to transurethral resection of the prostate in advanced age, high-risk patients with small gland volumes.

Age Factors↗
PubMed1994

[Urethral strictures following transurethral resection of the prostate].

A series of 147 patients subjected to transurethral prostate resection (TUPR) are followed up for seven years with a special reference to urethral strictures development. The patients' age varies from 52 to 78 years, with an 18-month average postoperative observation term. The methods of diagnosis used comprise uroflowmetry, retrograde urethrography and urethrocystoscopy. Obstruction of the lower urinary ways and urethral strictures are documented in 16 cases (10 per cent). Usually, post-TUPR strictures occur within one to three months after the operation. A brief literature survey on the incidence rate of this complication, reported by other authors, along with a comparative assessment of the results, is done. The likely underlying causes involved, and the prophylactic measures against the complication are discussed.

Aged↗
PubMed1997

The impact of systematic prostate biopsy on prostate cancer incidence in men with symptomatic benign prostatic hyperplasia undergoing transurethral resection of the prostate.

PURPOSE: We determined the impact of 1 or more systematic (4 to 6 cores) needle biopsies of the prostate on the incidence of prostate cancer in men undergoing transurethral resection of the prostate for symptomatic benign prostatic hyperplasia (BPH) with elevated serum prostate specific antigen (PSA) and/or suspicious digital rectal examination. MATERIALS AND METHODS: Records were reviewed retrospectively for 85 consecutive men 54 to 85 years old who underwent transurethral resection of the prostate for symptomatic BPH. Of the men 56 (66%) had at least 1 prior benign systematic prostate biopsy. RESULTS: Cancer was detected in the transurethral resection specimen in 5 of 29 men (17.2%) who had no prior prostatic biopsy and in 9 of 56 (16.1%) who had at least 1 prior benign biopsy. Among the latter group the probability of cancer being present in the transurethral resection specimen was not related to the number of prior biopsies, PSA concentration or PSA density. Of the cancers detected in men with at least 1 prior benign biopsy 89% were clinical stage T1b or greater. CONCLUSIONS: Clinically relevant prostate cancers may be detected in a significant proportion (more than 15%) of men undergoing transurethral resection of the prostate for symptomatic BPH despite prior screening with serum PSA, digital rectal examination and 1 or more systematic needle biopsies of the prostate.

Aged↗
PubMed1993

Fluid absorption and circulating endotoxins during transurethral resection of the prostate.

Recent publications report increased cardiovascular morbidity and mortality after transurethral prostatic resection (TURP). Repeated breath-ethanol monitoring with a new infrared device permits a highly sensitive peroperative registration of fluid absorption. A prospective study in 52 patients revealed surprisingly high rates of intravascular fluid loads without clinical manifestations. Only 4 patients developed clinical signs of the TUR syndrome. Immunological work-up in 41 patients demonstrated circulating endotoxins and significant rise of endogenous tumour necrosis factor (TNF) in 3 of these patients. In 11 patients transient endotoxins could be detected during resection under prophylactic parenteral antibiosis. In the face of less invasive approaches to benign prostatic hyperplasia, close intraoperative monitoring and antibiotic coverage should be demanded as a routine procedure during TURP. Elective surgery should be delayed until appropriate antibiotic therapy has been given.

Absorption↗
PubMed2001

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features].

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Humans↗
PubMed2004

[Systematic prostate biopsy before transurethral resection of the prostate].

PURPOSE: With the aim of evaluating the clinical significance of systematic prostate biopsy before transurethral resection of the prostate (TUR-P), clinical data were reviewed retrospectively in patients who had underwent prostate biopsy prior to scheduled TUR-P. PATIENTS AND METHODS: Between July, 1994 and June, 2000, TUR-P was scheduled in a total number of 456 patients with clinically diagnosed benign prostatic hyperplasia (BPH). RESULTS: In 218 (47.8%) out of 456 cases, prostatic biopsy was conducted prior to TUR-P due to abnormally elevated serum prostate specific antigen (PSA) levels of 4.0 ng/ml or more, revealing only 22 (10.1%) cases of prostatic cancer. Between these 22 cases with biopsy proven prostatic cancer and 189 cases with BPH confirmed both by biopsy and following TUR-P, statistically significant differences were noted in age (p < 0.05), prostate volume (p < 0.0001) and PSA density (p < 0.01). CONCLUSION: Considering the low positive rate of preoperative prostatic biopsy, it might be suggested that a considerable number of biopsy could be avoided in patients with clinically diagnosed BPH. Based on the results obtained from this study, prostatic biopsy might be unnecessary before TUR-P for those with prostate volume greater than 60 ml or PSA density less than 0.15.

Age Factors↗
PubMed1999

Factors influencing morbidity in patients undergoing transurethral resection of the prostate.

OBJECTIVES: Transurethral resection of the prostate (TURP) has become the primary method to relieve bladder outlet obstruction for patients with benign prostatic hyperplasia (BPH). Data from 3861 consecutive patients with BPH who underwent TURP from 1971 to 1996 at our hospital were retrospectively analyzed. METHODS: The patients were classified into two groups comprising 1930 patients who underwent TURP from 1971 to 1985 (early group) and 1931 patients who underwent TURP from 1985 to 1996 (late group). Risk factors associated with blood transfusions and perioperative complications were analyzed in these patients. RESULTS: Mortality, morbidity, and blood transfusions were noted in 5 (0.1 %), 516 (13.4%), and 507 (13.1%) patients, respectively. The blood transfusion and morbidity rates decreased over the 25-year period (P <0.001, chi-square test for trends), which was reflected in a decrease in these rates in the late group (6.1% and 9.5%, respectively) compared with those of the early group (20.2% and 17.2%, respectively). Postoperative bleeding and morbidity were closely related to prostatic gland size and operating time. The most significant differences for the risk of a blood transfusion were related to resection time, the amount of tissue resected, age, and the decade (1970s, 1980s, or 1990s) in which the surgery was performed (P <0.0005), whereas resection time was significantly correlated with morbidity (P <0.0005). As risk factors for each complication, the time of surgical resection, the decade of surgery, and the amount of tissue resected directly correlated with the incidence of extravasation and hemostatic procedures (P < or =0.003), whereas the incidence of postoperative epididymitis positively correlated with a preoperative vasectomy and a closed drainage system (P <0.0005). CONCLUSIONS: Since the 1970s, the rates of blood transfusions and morbidity have decreased for patients undergoing TURP. Advances in techniques, instrumentation, and surgical and perioperative management, including anesthesia, have made TURP a relatively safe procedure, and it remains an effective means for treating patients with BPH.

Aged↗
PubMed1993

A comparison between intermittent and continuous transurethral resection of the prostate.

123 transurethral resections of the prostate were studied. The operations were randomized to either continuous or intermittent technique. The first 64 operations were performed using an irrigating fluid pressure head of 65 cm (measured from the top of the operating table). In the rest of the operations an 80 cm pressure head was used. In this way four groups were obtained comprising 30 to 31 patients, differing from each other in respect of irrigating technique. Isotonic 5% mannitol solution was used as an irrigating fluid. The irrigating fluid absorptions were calculated from the plasma mannitol levels determined immediately postoperatively. The use of a trocar significantly lessened the average absorbed fluid volume, while there was no significant difference between the groups of high and low irrigating fluid pressure head. The intraoperative bleeding, the decrease in serum sodium, the resection time and resection rate did not differ significantly between the four groups.

Aged↗
PubMed1996

The use of ethanol as a marker to detect and quantify the absorption of irrigation fluid during transurethral resection of the prostate.

During transurethral resection of the prostate (TURP), the irrigation fluid is often absorbed by the circulatory system and/or the region around prostate occasionally resulting in severe signs and symptoms. Instant detection and qualification of absorption of irrigation fluid have not been possible earlier. A method involving tagging of the irrigation fluid with ethanol for detection and quantification of absorbed irrigation fluid by measurement of ethanol in expired breath (EB) has been developed. The validity of measuring EB ethanol to detect and quantify absorption of irrigation fluid was studied in 13 patients undergoing TURP. The EB ethanol was compared with three other methods: I. Isotope tagging of the irrigation fluid and detection of absorbed fluid using a scintillation detector placed over large blood vessels. 2. Measuring changes in serum-sodium every 10 min. 3. Regular interval monitoring (RIM) of the difference between volume used for irrigation and volume recovered from patients every 10 min. The method of measuring EB ethanol was found to be highly valid. The possibility of detecting absorption and the incidence of absorption using EB ethanol in the clinical routine was studied in 192 patients undergoing TURP. Half of them absorbed irrigation fluid, 25% absorbed more than 400 ml. The proportion of patients absorbing irrigation fluid was the same for both experienced and inexperienced resectionists. Clinical assessment of absorption of irrigation fluid was performed by the resectionists and the supervising nurses in 118 patients undergoing TURP. Prerequisites for massive absorption were found by the resectionist in 8/9 patients. The resectionist falsely indicated absorption in 22 patients. The nurses correctly indicated 3/9 patients and falsely indicated 4 patients. To investigate the method measuring EB ethanol to detect absorption of irrigation fluid during general anaesthesia, 20 patients underwent TURP and EB ethanol was compared with the RIM method. There was a good correlation between the methods. Elevated pressure in the bladder and the prostatic fossa is a prerequisite for absorption of irrigation fluid. Detection and quantification of absorbed irrigation fluid by EB ethanol was used for comparing 102 patients operated on with and without a pressure warning device alarming at 1.5 kPa in the bladder. using the device reduced both the volume of absorbed irrigation fluid, and the number of patients absorbing irrigation fluid. Both ethanol per se and haemodilution by absorbed irrigation fluid may have impacts on the coagulation system. To investigate the influence of absorption of ethanol tagged mannitol on bleeding time, measurements were performed before and after TURP in 57 patients. No difference in bleeding time was found among patients who absorbed irrigation fluid as compared with those who did not. In conclusion, measurement of ethanol in EB for detection and quantification of absorbed irrigation fluid is a highly valid method when compared with three other methods. Absorption of irrigation fluid was found in 50% of the patients undergoing TURP. Clinical assessments of absorption of irrigation fluid are unreliable. EB ethanol can be used in patients during general anaesthesia. Using a pressure warning device decreases the volume of absorbed irrigation fluid, as well as the number of patients absorbing it. Absorption of ethanol tagged mannitol as irrigation fluid has no influence on bleeding time.

Absorption↗
PubMed2006

Association between the presence of bacterial 16S RNA in prostate specimens taken during transurethral resection of prostate and subsequent risk of prostate cancer (Sweden).

OBJECTIVE: To study bacterial 16S RNA in archival prostate samples from 352 patients with benign prostate hyperplasia (BPH) and evaluate whether the presence of bacterial DNA was different in those who later developed prostate cancer (n = 171) and in the matched controls that did not progress to cancer (n = 181). METHODS: 16S DNA PCR followed by cloning and sequencing the positive samples. RESULTS: In 96/352 (27%) of the prostate tissue specimens 16S RNA were detected. Sequence analysis revealed Propionibacterium acnes as the predominant microorganism (23% of 16S RNA positive patients). The second most frequent isolate-Escherichia coli was found in 12 (12%) patients. The other isolates included Pseudomonas sp. (3 patients), Actinomyces sp. (2), Streptococcus mutans (1), Corynebacterium sp. (2), Nocardioides sp. (1), Rhodococcus sp. (1) Veillonella sp. (2). In P. acnes positive samples 62% exhibited severe histological inflammation versus 50% in the bacteria-negative group (p = 0.602). The presence of P. acnes in the prostate was associated with prostate cancer development (OR 2.17, 95% CI 0.77-6.95). CONCLUSIONS: This study has revealed P. acnes as the most common bacteria in the prostate in BPH. Further studies are needed to clarify its role in contributing to the development of prostatic inflammation and prostate cancer.

Aged↗
PubMed2000

Diagnosis of prostate adenocarcinoma using transurethral resection of the prostate after multiple negative transrectal biopsies and persistently elevated prostate-specific antigen level.

We report a case of prostate cancer diagnosis by transurethral resection of the prostate in a man who underwent more than 50 needle biopsies by three different physicians for an increasing prostate-specific antigen level. Radical prostatectomy resulted in removal of an organ-confined tumor (T2aN0M0), and a short follow-up revealed an undetectable prostate-specific antigen level.

Adenocarcinoma↗
PubMed1996

Evaluation of bladder contractility in men undergoing transurethral resection of the prostate.

OBJECTIVE AND METHODS: We analyzed preoperative and postoperative urodynamic parameters in 26 patients who underwent transurethral prostatic resection with the aid of a computer program. The parameters URA, W and Wmax were evaluated: URA affords a monitoring of the removal of obstruction, while Wmax and W function monitor changes in detrusor contractility, which appear significant after prostatic resection in obstructed patients. RESULTS: Many patients had a fading contraction, that is detrusor contractility decreased during micturition: in most of them the removal of obstruction restored this pattern to normal. CONCLUSION: Evaluation of these parameters is recommended for preoperative assessment and postoperative follow-up.

Follow-Up Studies↗
PubMed1991

[Long-term follow up of transurethral resection of the prostate--a review of 137 patients].

For assessing the long-term outcome of patients after transurethral prostatic resection (TUR-P), telephone interview in terms of the urinary symptom and the sexual function was conducted on 191 cases who underwent TUR-P in Hokkaido University Hospital from 1982 to 1988. Adequate replies were obtained from 137 patients (71.7%), whose mean age was 70.2 years old and mean follow up period was 4.8 years. Subjective urinary symptoms, which are mainly classified as dysuria, frequency and incontinence, were improved in 114/120 (95.0%), 99/108 (91.7%), and 20/21 (95.2%) respectively. Overall symptom-free rates of dysuria, frequency, and incontinence were 85.1% (114/134), 86.6% (116/134), and 90.3% (121/134). Morbidity of incontinence following TUR-P was only 6/134 (4.5%). There was one deaths (0.7%) at 2 weeks after TUR-P, but was not attributable to the operative procedure itself. Although 82 cases (59.9%) had risk factors such as the cardiovascular disease, malignancy or other systemic disorders, they did not jeopardize the postoperative course nor were attributed to the mortality. Uninhibited contraction and/or vesical denervation supersensitivity on perioperative cystometrogram were found in 53/84 (63%). These urodynamic abnormalities were not considered to be postoperative urinary symptoms. Postoperatively, the decrease in libido was noted in 12/63 (19%), but its causal relation to the procedure was obscure in most of the patients. We believe TUR-P can offer a satisfactory outcome in the majority of the patients with minimum risk.

Aged↗