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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↗
PubMed2001

Disappearance of well-differentiated carcinoma of the prostate: effect of transurethral resection of the prostate, prostate-specific antigen, and prostate biopsy.

OBJECTIVES: To characterize the effect of prostate-specific antigen (PSA) and transurethral resection of the prostate (TURP) on the rate of diagnosis of well-differentiated (WD) prostate cancer (PCa) and PCa mortality. METHODS: All cases of PCa and rates of TURP at both Wilford Hall and Brooke Army Medical Centers between 1984 and 1995 were reviewed. Tumor grade was compared between prostate needle biopsy and TURP. The pattern of diagnosis was analyzed annually and for two time periods: pre-PSA (1984 to 1988) and post-PSA (1989 to 1995). RESULTS: The number of WD tumors fell by 50% over the period of study and was caused by a fall in number of TURPs as well as in WD tumors detected by TURP. PSA for early detection of PCa began in 1988, and within 5 years a more than 50% fall in the rate of metastatic disease was witnessed. These two events (PSA screening and fall in TURPs) led to an increase from 57% to 92% of tumors that were both clinically significant and potentially curable. CONCLUSIONS: These data help explain the fall in the rate of diagnosis of WD PCa. The resultant increase in the diagnosis of moderately and poorly differentiated PCa, coupled with the dramatic fall in the rate of diagnosis of metastatic PCa, may explain the reports of a fall in PCa mortality. If this observation is replicated in other populations, it may provide further impetus for a stronger recommendation for early detection with PSA and digital rectal examination.

Biomarkers, Tumor↗
PubMed1982

Transurethral resection of the prostate for chronic bacterial prostatitis.

Forty-nine patients with chronic bacterial prostatitis causing symptoms and receiving routine accepted treatment for many months or years, without permanent relief, were treated by transurethral prostatic resection (TURP). The purpose of the surgery was to remove the gland down to the true capsule (radical TURP). The patients' own appraisal of the results, the absence of symptoms and of infection, indicate 67% had a good result when assessed 1 year following surgery; 21% were improved and 12% received no benefit. Transurethral resection is recommended in selected cases and when the surgeon is able to remove all of the glandular tissue without causing large perforations through the true capsule. Acceptable results have been achieved in two-thirds of cases. There was no mortality and insignificant morbidity. Patients experiencing no benefit and those who were only improved but not cured were either poorly selected or infected prostatic tissue was not removed.

Adult↗
PubMed2001

[Metastatic liver tumor arising from prostate cancer following transurethral resection of the prostate--a report of two cases].

We herein present a report of metastatic liver tumor arising from prostate cancer following transurethral resection of the prostate (TUR) in two patients. The two patients were diagnosed as having moderately differentiated prostate adenocarcinoma, either stage C or B2, and underwent hormonal and/or radiation therapy. TUR was performed due to the patients' complaints of urinary outlet obstruction. Liver metastasis, without evidence of bone or pulmonary metastasis, was then noted 23 and 5 months later in the patients with stage C and B2 prostate cancer, respectively. It is possible that the process of TUR is related to the release of tumor cells from the prostate into the systemic circulation and involved in the development of liver metastasis.

Adenocarcinoma↗
PubMed1993

Patterns of irrigating fluid absorption during transurethral resection of the prostate as indicated by ethanol.

The absorption of irrigating fluid was measured by the ethanol method every 10 minutes during the course of 700 transurethral prostatic resections. The total blood loss was also measured using a photometer method. We found that ethanol determination is a convenient method of monitoring irrigating fluid absorption in daily practice. Absorption in excess of 150 ml. was detected in 46% of the operations. The volume of irrigant absorbed increased with the weight of the removed prostatic tissue, operating time and blood loss. The uptake of fluid usually started midway through the operation. Once absorption had started, there was an 87% probability that it would continue through the next 10 minutes with the exception of the last 10 minutes of surgery, when there was a 67% probability. A sudden decrease in arterial pressure coincided with the onset of fluid absorption 3.7 times more often than expected by chance. The absorption was no different in the 114 patients with a cancerous histology, compared to those with benign prostatic hyperplasia.

Absorption↗
PubMed1997

[Transitory blindness after transurethral resection of the prostate].

OBJECTIVE: To describe a case of transient blindness post-TURP, a complication of the foregoing procedure. METHODS/RESULTS: The patient developed transient blindness following transurethral prostatic resection, ascribable to the resorption of the irrigation fluid (1.5% glycine), since this condition coincided with high serum glycine levels and its metabolites. CONCLUSION: The toxicity of glycine resorption during TURP is attributed to its metabolization to ammonia. Hyperammonemia encephalopathy causes inhibition of the brain neurotransmitters at different levels of the CNS, as well as in the retina. High intraocular concentrations of glycine affect the retinal amacrine cells, causing transient histological changes.

Absorption↗
PubMed1995

Prostatic histology in secondary transurethral resection of the prostate.

Human benign prostatic hyperplasia consists of 3 major components, stromal and glandular tissue, and glandular lumen. To our knowledge morphometric analysis of prostatic tissue from patients who have undergone a secondary transurethral resection of the prostate has never been reported. Quantification of these histological components might aid in selecting treatment for patients with recurrent urinary symptoms following transurethral resection of the prostate. Transurethral resection specimens from 13 consecutive patients who had undergone prostatectomy twice were stained by the Masson trichrome method. Quantitative morphometric analysis was performed using computer image analyzing software. The mean total area was 15.9%, 15.4% and 68.7% for glandular lumen, and glandular and stromal areas, respectively, in the initial transurethral resection specimens and 13.3%, 14.1% and 72.6%, respectively, for secondary transurethral resection of the prostate. There was no significant difference among the 3 morphometric components in the 2 prostatectomy specimens with respect to percent area, within subject variability and skewness (all p values > or = 0.38). Our study confirms previous findings that the majority of initial transurethral resection specimens are predominantly stroma. Furthermore, our study indicates that the percent distributions between initial and secondary transurethral resection of the prostate with respect to the 3 major histological components are not different, suggesting that the stromal, glandular and glandular lumen content of an initial transurethral resection specimen is representative of the recurrent prostatic tissue.

Aged↗
PubMed1983

The "shrinkage" of the prostate during transurethral resection.

Fresh hyperplastic prostate glands from 19 patients who underwent open prostatectomy were weighed and their volume measured. After a simulated transurethral resection the weight and the volume of the pieces were determined. The volume of each enucleated specimen was plotted against the volume after electroresection. The regression coefficient was 0.8039. Similarly, the regression coefficient for the weight was 0.7864. Therefore a diminution in volume and weight of approximately 20% can be expected after electroresection. The specific weight close to one remained unchanged. The supracollicular distance was an unreliable indicator of the size of the prostate.

Humans↗
PubMed1980

Coma from hyponatremia following transurethral resection of prostate.

Even though hyponatremia may occur following transurethral resection of the prostate (TURP), only 14 patients of a large TURP population deteriorated to a comatose state as a result of hyponatremia. These patients were generally older, with larger prostates, and longer resection times than the average for transurethral resection of the prostate. They also consistently had serum sodium levels postoperatively of near 120 mEq./L. or below. It was noted that obtundation can occur immediately or be delayed several hours. Even though no deaths occurred, awareness of the possibility of post-TURP hyponatremia and prompt treatment with hypertonic saline were shown to reduce morbidity significantly.

Aged↗
PubMed1997

Lack of correlation between blood fibrinolysis and the immediate or post-operative blood loss in transurethral resection of the prostate.

OBJECTIVE: To evaluate whether the activation of the extrinsic tissue-type plasminogen activator-related fibrinolysis is implicated in the blood loss in patients with benign prostatic hyperplasia, undergoing transurethral prostatic resection (TURP). PATIENTS AND METHODS: TURP was performed in 24 men and the operative and post-operative blood loss determined. The activation of the tissue-type plasminogen activator-related fibrinolysis was followed using new sensitive and specific assays, and the changes related to the blood loss. Measurements of the plasma concentrations of free tissue-type plasminogen activator (t-PA) activity, tissue-type plasminogen activator (t-PA) antigen, plasminogen activator inhibitor (PAI) activity, plasminogen activator inhibitor 1 (PAI-1) antigen, plasminogen (Plg) activity, plasminogen (Plg) antigen, alpha 2-antiplasmin (alpha 2-AP), D-dimer and fibrin degradation products (FbDP) were all determined and the area under the curve (AUC) for each of these quantities correlated with the blood loss. RESULTS: TURP was followed by a marked activation of the fibrinolytic system. There was an immediate increase in systemic t-PA activity and t-PA antigen, coinciding with a significant drop in PAI activity. Post-operatively, PAI activity and PAI-1 antigen increased. The formation of plasmin was indicated by a fall in the plasma concentration of Plg activity and Plg-antigen and alpha 2-AP but which increased significantly at the end of the study period. Increased systemic fibrinolytic activity was further confirmed by a marked increase in fibrin D-dimer and FbDP. There was no correlation between the AUC in the operative period of any of the fibrinolytic variables and the measured blood loss. In the post-operative period, t-PA antigen (P = 0.004), PAI activity (P = 0.043), PAI-1 antigen (P = 0.016) and alpha 2-AP (P = 0.047) all correlated with the post-operative blood loss, while there was no correlation between fibrin D-dimer or FbDP and blood loss. CONCLUSION: The fibrinolytic system is activated during and after TURP, but the increased activity is not of pathophysiological importance for the blood loss.

Aged↗
PubMed2003

Management of inguinal hernia with benign prostatic hyperplasia: simultaneous inguinal hernioplasty with transurethral resection of prostate.

BACKGROUND: Elderly patients frequently suffer from inguinal hernia and benign prostatic hyperplasia. When these two occur together, it becomes important to decide which surgery should be done first. METHODS: Data was maintained prospectively for 35 patients undergoing simultaneous transurethral resection of prostate (TURP) and inguinal mesh hernioplasty at our hospital between May 2000 and December 2002. The results were analyzed to determine whether the performance of the two operations simultaneously was a viable option in such a patient category. RESULTS: In 33 patients unilateral hernioplasty, and in 2, Stoppa's mesh repair (for bilateral hernia) was performed along with simultaneous TURP by two independent operating teams. There was no significant increase in operating time or post-operative stay when the two procedures were performed together. There were no major in-hospital complications. On follow up, all the patients have remained well, with no recurrence of hernia. CONCLUSIONS: Combining mesh hernioplasty and TURP is a better option because of low wound infection and hernia recurrence rates. Combining these two also saves the patient of having to undergo another hospital admission and surgery, besides the significant cost savings.

Adult↗
PubMed2004

An unusual pathological finding of chronic lymphocitic leukemia and adenocarcinoma of the prostate after transurethral resection for complete urinary retention: case report.

BACKGROUND: We describe a patient who underwent transurethral resection of the prostate for urinary obstructive symptoms and had histological findings of adenocarcinoma of the prostate with prostatic localization of chronic lymphocitic leukemia (CLL). The contemporary presence of CLL, adenocarcinoma of the prostate and residual prostatic gland after transurethral resection has never been reported before and the authors illustrate how they managed this unusual patient. CASE PRESENTATION: A 79-years-old white man, presented with acute urinary retention, had a peripheral blood count with an elevated lymphocytosis (21.250/mL) with a differential of 65.3% lymphocytes and the prostate-specific antigen (PSA) value was 3.38 ng/mL with a percent free PSA of 8.28%. The transrectal ultrasound (TRUS) indicated an isoechonic and homogenic enlarged prostate of 42 cm3 and the abdomen ultrasound found a modest splenomegaly and no peripheral lymphadenophaty. The patient underwent transurethral resection of the prostate and had a pathological finding of adenocarcinoma in the prostate with a Gleason Score 4 (2+2) of less than 5% of the material (clinical stage T1a), associated with a diffused infiltration of chronic lymphocitic leukemia elements. CONCLUSIONS: The incidental finding of a prostatic localization of a low-grade non-Hodgkin's lymphoma does not modify eventually further treatments for neither prostate cancer nor lymphoma. The presence of a low-grade and low-stage lymphoma, confirmed by a hematological evaluation, and the simultaneous evidence of an adenocarcinoma after transurethral resection of the prostate for acute urinary retention do not require any immediate treatment due to its long-term survival rate and the follow-up remains based on periodical PSA evaluation and complete blood count.

Adenocarcinoma↗
PubMed2006

Intravesical Explosion during Transurethral Resection of Prostate - a reminder.

Intravesical explosion during transurethral resection of the prostate (TURP) is an extremely rare but dreaded complication and results in rupture of the bladder. It is believed that intravesical explosion occurs due to formation of explosive gases in the bladder during TURP and its admixture with air. A case of intravesical explosion during TURP resulting in bladder rupture at our institution is described. Though the management of this catastrophe is relatively straightforward, it has the potential for dire consequences. We emphasize that, despite its rare occurrence, it is preventable and suggest measures to avoid it.

Humans↗
PubMed2005

Comprehensive study of bladder neck contracture after transurethral resection of prostate.

OBJECTIVES: To test the validity of transurethral resection of the prostate (TURP) plus transurethral incision (TUI) of bladder neck as an alternative to TUI of the prostate, a nonrandomized and retrospective study was done to review comprehensively the incidence of, severity of, and risk factors for bladder neck contracture (BNC) in patients with benign prostatic hyperplasia who underwent transurethral surgery. METHODS: The evaluation parameters included age, prostate-specific antigen level, urinalysis and uroflowmetry findings, voided volume, presence of vesical stones and urinary retention, surgical type, adenoma weight, and perioperative morbidities. RESULTS: Of the 1470 patients studied, 1135 (77.2%) were eligible for analysis. At a mean follow-up of 37.9 months, 110 patients (9.7%) had developed BNC. The adenoma weight, blood transfusion, and postoperative maximal and mean flow rate in patients with BNC were significantly less than in patients without BNC. The incidence of BNC in the TURP group was greater than that in the TURP plus TUI group (12.3% versus 6%, P = 0.000). BNC was completely prevented using TURP plus TUI if the adenoma weight was greater than 30 g. However, in the TURP group, 4% of patients developed BNC even with an adenoma weight greater than 50 g. Multivariate analyses showed that adenoma weight and surgical type were significant risk factors for BNC. Patients with associated vesical stones were less prone to develop BNC. CONCLUSIONS: TURP plus TUI provides a pathologic diagnosis, and with minimal morbidity, it can be an alternative to TUI of the prostate in selected patients. Personal diathesis may play a role in the pathogenesis of BNC.

Aged↗
PubMed2005

Bipolar versus monopolar transurethral resection of prostate: randomized controlled study.

BACKGROUND AND PURPOSE: Transurethral resection of prostate (TURP) using bipolar electrocautery and physiologic saline is a new technical advancement in the field of surgical management of benign prostatic hyperplasia. The purpose of this study was to assess the efficacy and safety of this new technique and to compare the results with those of conventional monopolar TURP. PATIENTS AND METHODS: This study included 60 patients who were randomized 1:1 to bipolar (group 1) or monopolar (group 2) TURP. Bipolar TURP was performed with the Vista CTR resectoscope and generator (ACMI Corp.). Preoperatively, patients were assessed by symptom score, uroflow, and transrectal sonography, and the two groups were comparable with regard to these measures and age. The preoperative and postoperative parameters studied included resection time, amount of tissue resected, irrigant amount, blood loss, fluid absorption, and change in serum sodium and hemoglobin. Postoperatively, patients were assessed for symptoms, symptom score, and uroflow rate at 1 and 3 months. RESULTS: There was no difference in resected tissue amount, irrigant amount, fluid absorption, duration and amount of postoperative irrigation, or fall in hemoglobin. The mean resection rate was 0.61 g/min in group 1 and 0.74 g/min in group 2. Serum Na dropped by 4.6 Eq/L in group 2, whereas it fell only 1.2 mEq/L in group 1 (P < 0.001). Improvement in symptom and QoL scores and Q(max) were similar in the two groups. Postoperative dysuria was less common with bipolar resection. CONCLUSION: Bipolar resection of the prostate is as effective as monopolar TURP. Moreover, it does not lead to any change in serum Na and causes less postoperative dysuria.

Aged↗
PubMed1996

Proliferative response of human prostate tumour xenografts to surgical trauma and the transurethral resection of the prostate controversy.

Transurethral resection of the prostate (TURP) as an excisional procedure involving multiple incisions into the prostate does not differentiate between palpably benign prostate tissue and microscopic foci of well-differentiated adenocarcinoma. The impact of TURP on the progression of such 'latent' or 'incidental' tumours unique to the prostate gland has been a focal point of a continuing controversy. In studies designed to develop preclinical evidence that would lend support to, or detract from, either side of the TURP controversy, surgical trauma-induced stimulation of in situ tumour growth was extended to include human prostate tumour tissue PC-3, DU-145 and H-1579, albeit as xenografts in athymic nude males. A significant proliferative response of prostate tumours implanted directly in, adjacent to, or distant from, a freshly induced surgical wound, could be inhibited by a somatostatin analogue (Lanreotide) applied topically to the surgical site. This preclinical model supports TURP as a risk factor for biopsy or therapeutic surgical intervention procedures in benign prostatic hypertrophy (BPH), a risk factor that increases with the stage of disease in undetected cancers. It also suggests a potential clinical benefit that might be derived by applying Lanreotide directly to the surgically traumatised genitourinary area by simple irrigation of the urethra and bladder during or shortly post TURP.

Adenocarcinoma↗