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Results for “Transurethral Resection of Prostate”

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PubMed1987

Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: a randomized study.

Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).

Humans↗

PubMed2004

Sexual function of LUTS patients before and after neodymium laser prostatectomy and transurethral resection of prostate. A prospective, randomized trial.

OBJECTIVE: To assess and compare the sexual function of patients undergoing transurethral resection of the prostate (TURP) or Nd:YAG laser treatment for lower urinary tract symptoms (LUTS) caused by obstructing benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: 98 LUTS patients with urodynamically confirmed bladder outlet obstruction were recruited. Patients were randomised to TURP and laser treatment, which was further divided to contact and hybrid treatments according to prostate size. The sexual function at baseline and at 1 year postoperatively was assessed from the Danish Prostate Symptom Score Sexual Function Questionnaire (DanPSS Sex) items concerned with erectile stiffness, ejaculatory volume and pain or discomfort on ejaculation. RESULTS: The sexual function data at 1 year was available for 83 patients. At baseline, a high prevalence of erectile dysfunction (86%), ejaculatory volume change (83%) and pain or discomfort on ejaculation (26%) was observed and considered problematic by 79%, 63% and 100% of men, respectively. An increase of total impotence in the TURP group was observed (p = 0.046). TURP decreased or totally eradicated the amount of ejaculate, which was the only difference found between the study groups (p < 0.001). Both laser and TURP treatments improved pain or discomfort on ejaculation. CONCLUSIONS: The prevalence of sexual dysfunction in patients with symptomatic infravesical obstruction caused by BPH is high and perceived mostly as bothersome. TURP, Nd:YAG contact or hybrid laser treatments did not increase erectile dysfunction but improved pain or discomfort on ejaculation. The only significant difference between these treatments in respect to sexual function was a higher incidence of decreased or absent ejaculate after TURP.

Aged↗

PubMed1998

A prospective, randomized 1-year clinical trial comparing transurethral needle ablation to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia.

PURPOSE: We assess the 1-year efficacy and safety of transurethral needle ablation of the prostate compared to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A prospective, randomized clinical trial of 121 men 50 years old or older with symptomatic BPH was performed at 7 medical centers across the United States. Of the men 65 (54%) were treated with transurethral needle ablation of the prostate and 56 (46%) underwent transurethral resection of the prostate. Mean and percentage changes from baseline and between cohorts for American Urological Association (AUA) symptom score, AUA bother score, quality of life score, peak urinary flow rate and post-void residual urine volume were measured at 1, 3, 6 and 12 months following treatment. Length of procedure, hospitalization, type of anesthesia, post-procedure catheterization, side effects and sexual function were compared. RESULTS: Transurethral needle ablation and resection resulted in a statistically significant improvement in AUA symptom, bother and quality of life scores, peak urinary flow rate and post-void residual. At 1-year followup, needle ablation and resection were equally effective in enhancing quality of life. Needle ablation had less effect on sexual function, with resection being associated with a greater incidence of retrograde ejaculation. Needle ablation could be performed as an outpatient procedure with local anesthesia while resection required anesthesia and hospitalization. Needle ablation was associated with markedly fewer side effects than resection. CONCLUSIONS: Compared to transurethral resection of the prostate, transurethral needle ablation of the prostate is an efficacious, minimally invasive treatment for symptomatic BPH that is associated with few side effects.

Catheter Ablation↗

PubMed2004

Safety and efficacy of transurethral resection of prostate glands up to 150 ml: a prospective comparative study with 1 year of followup.

PURPOSE: We investigated the safety and efficacy of transurethral resection of the prostate (TURP) for prostate glands between 70 and 150 ml. MATERIALS AND METHODS: We prospectively evaluated 113 patients treated with TURP for benign prostatic hyperplasia. A total of 57 patients with a prostate volume of less than 70 ml were assigned to group 1, while 56 with a prostate volume of between 70 and 150 ml were assigned to group 2. Preoperative parameters considered in each patient were prostate volume, International Prostate Symptom Score (I-PSS), urinary flow rate measurement (Qmax) and post-void residual urine volume (PVR). Operative time, resected tissue weight and all complications were recorded. All patients were evaluated 3 months and 1 year postoperatively. Preoperative, perioperative and postoperative data on the 2 groups were compared. RESULTS: Each group achieved significant improvement in I-PSS, Qmax and PVR. Operative time was significantly longer in group 2 but the complication rate was similar in the 2 groups. Group 2 resulted in better improvements in Qmax and I-PSS. At 1 year of followup PVR was significantly lower in group 1 than in group 2. Multivariate analysis revealed that only age was a significant independent predictor of complications, and only age and initial Qmax were independent predictive variables of outcome. CONCLUSIONS: TURP for large prostate glands is a safe procedure without showing a different complication rate compared with TURP for recommended volumes. Patients with a baseline prostate volume of greater than 70 ml seem to achieve better improvement in obstruction and symptoms.

Aged↗

PubMedDate not supplied

[The transurethral resection of prostatic adenoma].

The paper presents the analysis of 255 patients aged 39-89 yrs who sustained transurethral resection of prostatic adenoma between 1985 and 1988. The choice of the surgery technique depended on the direction of adenoma growth the weight of its tissue and the presence of associated diseases of the lower urinary tract. At present, the allowable weight of the removed tumor is increased from 30 to 60 g while the mean operation time is decreased from 50 +/- 10 to 35 +/- 5 minutes. The authors arrived at the conclusion that the aforementioned technique was of high performance and low-rate traumatism, thus widening the limits of the disease surgical treatment, decreasing the incidence of early (13.7 per cent) and late (2.7 per cent) complications and death rates (1.9 per cent). Besides, the duration of postsurgical hospital stay decreased (5 +/- 1.5 days in noncomplicated cases and 12 +/- 3 days in complicated ones).

Adult↗

PubMed1998

Post transurethral resection of prostate incontinence in previously radiated prostate cancer patients.

OBJECTIVES: This is a retrospective review evaluating the incidence of incontinence post transurethral resection of prostate (TURP) in patients who have had previous external beam radiation (XRT) for prostate cancer (PCA). MATERIALS AND METHODS: 1,230 patients underwent XRT for PCA between January 1985 and April 1996. From this group, 16 patients mean age of 67.8 years (range 48-84) at the time of XRT had a subsequent TURP for obstructive symptoms a median of 3.25 years later (range 3 months to 10.2 years). Patients have been followed post TURP for a median of 5.0 months (range 1 to 81 months). RESULTS: Nineteen percent (3) patients developed incontinence post TURP. An additional patient remained in retention and continued to suffer overflow incontinence. Incontinence was associated with a shorter time interval between XRT and TURP (13 months versus 55.3 months) and with a greater amount of prostatic resection (19 grams versus 11.4 grams) when compared to the continent group, but did not meet statistical significance. CONCLUSION: A high risk of incontinence post TURP in previously radiated patients was demonstrated. The association with a shorter time interval between procedures and the larger resection suggests that a conservative approach is warranted. Studies with the use of preop and post TURP urodynamics would be useful in further defining risk factors in this population.

Journal Article↗

PubMed2005

[Transurethral resection for prostatic adenoma larger than 100 ml--preoperative treatment with interstitial laser coagulation of the prostate plus chlormadinone acetate as a treatment maneuver for safer operations].

Between August 1985 and March 2004, we performed transurethral resection of the prostate (TURP) in 18 patients with benign prostatic hyperplasia (BPH) whose prostatic volume was larger than 100 ml. We divided the patients into two groups. Group A consisted of a total of 14 cases: 10 cases whose mean prostate volume was 114 ml (100 to 137 ml) and 4 cases whose prostate volume was not measured before TURP but whose mean resected prostatic tissue weight was 113 g (105 to 118 g). Group B consisted of 4 cases whose mean prostate volume was 110 ml (101 to 133 ml). Patients in group B underwent interstitial laser coagulation of the prostate (ILCP) followed by oral chlormadinone acetate (CMA) therapy (50 mg/day); TURP was performed 6 months later, once the prostate volume had shrunk to an average of 76 ml (66 to 91 ml). Mean resected weights and operation times were: group A, 93.1 g, 66.3 min; group B, 60.5 g, 55.7 min. There were 12 blood transfusion cases (85.7%; intraoperative) in group A, and 1 (25.0%; POD 1) in group B. Accordingly, this preoperative treatment was considered a safer method of TURP for BPH 100 ml or more. There were no cases of TURP syndrome or death in either group.

Aged↗

PubMed1996

[Mechanical autotransfusion also in transurethral resection of prostatic adenoma? Studies of preserved washed erythrocyte concentrates before possible retransfusion].

AIM: Does cell-saving during transurethral resection of prostatic adenoma (TURP) provide autologous washed erythrocyte concentrates (AWECs) of the same haematological and bacteriological quality as that of established indications of a cell-saving device? Should the cell-saving device be used routinely in TURP? METHODS: 37 patients underwent TURP with written, informed consent. All patients had antibiotic therapy prior to surgery. Shed blood was processed by a cell-saving device. AWECs specimens were analysed for red blood count, electrolytes, LDH, extracellular haemoglobin, osmotic fragility, blood culture and bacterial concentration. In addition, data of urine cultures, adenoma cultures and adenoma histology were analysed. AWEcs were not retransfused. RESULTS: Haematological quality was shown to be comparable to that of established applications of a cell-saving device. However, 82% of the AWECs were contaminated with bacteria. Concentrations were as high as > 10(6) bacteria/ml. Isolated bacteria ranged from e. coli and pseudomonas to staphylococci, streptococci and candidae. Bacteria found in the urine cultures of patients with urinary tract infections could also be isolated in their AWECs. 16% of the patients had prostatic cancer not know preoperatively. Mass of resected adenoma and volume of AWEC did not correlate. CONCLUSIONS: In despite of good haematological quality we considered the rate of 82% bacterial and 16% tumour cell contamination of the AWECs unacceptable and, contrary to some literature data, we no longer use a cell-saving device in TURP.

Aged↗

PubMed2004

[Urodynamic analysis of urinary incontinence after transurethral resection of prostate].

OBJECTIVE: To investigate the value of urodynamic test in the diagnosis of postoperative incontinence after transurethral resection of the prostate(TURP). METHODS: Thirty-seven patients with urinary incontinence after TURP received urodynamic tests, including cystometry(CMG), pressure-flow study, rest urethral pressure profilometry(RUPP) and stress leak-point pressure (SLPP) measurement. Urethrocystography was taken when necessary. RESULTS: Of the 37 cases, 16 were diagnosed as motor urge urinary incontinence, 2 as sensory urge urinary incontinence, 17 as stress urinary incontinence and 2 as overflow urinary incontinence. CONCLUSION: Different types of urinary incontinence after TURP can be clearly distinguished by urodynamic tests, which provides objective basis for the choice of adequate treatment.

Aged↗

PubMedDate not supplied

[Immediate and late complications of transurethral resection of prostate].

300 patients with benign prostatic hyperplasia admitted in hospital between 1994 and 1998 were studied. The surgical procedure in 21 patients was TUIP (transurethral incision of prostate), in 18 patients was classic adenomectomy (open prostatectomy), in 58 patients classic TURP (transurethral resection of prostate) and in 203 patients TURP by low pressure (hypopressure). The immediate complications in those patients who underwent endoscopic procedures were bleeding in 18 patients, acute urinary infections in 20 patients, endotoxic shock in 5 patients, epididimytis in 9 patients, urine retention in 4 patients, obstruction of catheters in 10 patients, collection of washing liquid in perivesical space (Retzius) in 3 patients. The late complications were the following: bleeding--4 cases, imperative micturition--12 cases, vesicle neck sclerosis--3 cases, urethral orifice stenosis--16 cases, urethral stricture--3 cases, urinary retention--6 cases, abscess in perivesical space (Retzius)--1 case. After TURP in hypopressure, the complications were less frequent due to a better visualization a more rapid execution of the procedure.

Aged↗

PubMed1997

Motorised resection device for transurethral resection of the prostate: a laboratory evaluation.

Transurethral resection of the prostate is the most common method of relieving urinary outflow obstruction secondary to prostatic enlargement. However, this procedure can be responsible for various complications, including irrigant-fluid absorption and blood loss, both of which are strongly dependent on operation duration time. To reduce the latter, a new resection device has been designed for transurethral prostatectomy. The device basically consists of a rotating cutting loop controlled externally, with three degrees of freedom, to fit the adenoma shape. Its performance is assessed in vitro by drilling conical and semi-ellipsoidal cavities in agar gel models. The mean difference between the calculated and obtained cavity volumes is 3% (SD = 0.9%). The volume cutting rate, found to be independent of the type of cavity drilled, is equal to 2.9 +/- 0.3 cm3 min-1. The advantages of this motorised resection device prototype are reduction in operation duration and accuracy of the resected volume. In vivo resection of a 20 cm3 adenoma in less than 15 min can be expected.

Agar↗

PubMed2004

A randomized and prospective study on the value of antibiotic prophylaxis administration in transurethral resection of the prostate.

CONTEXT: Antibiotic prophylaxis in transurethral resection of the prostate is a regular practice in urology. However, its prophylactic effect can be questioned when the antiseptic surgical technique is used. Nonetheless, urine culture-oriented antibiotic therapy is the gold standard for avoiding improper medication usage and bacterial resistance. OBJECTIVE: To study the efficacy of antibiotic usage in patients with negative urine cultures, who were submitted to transurethral resection of the prostate. TYPE OF STUDY: Prospective open labeled study. SETTING: Tertiary care referral hospital. PARTICIPANTS: 124 consecutive patients, who were randomly divided into two groups to receive antibiotic prophylaxis or not. MAIN MEASUREMENTS: Cultures from meatus, urine, irrigation and antiseptic fluid, and prostate tissue chips, were compared and analyzed for bacterial sensitivity to the antibiotic used, according to the surgeon's personal criteria. McLennan's test was used for statistical analysis. RESULTS: No statistically significant difference regarding clinical evolution was found between the groups that received or antibiotics or not. Statistical significance was found regarding the occurrence of positive urine cultures during the postoperative period for those not receiving antibiotics, but not in relation to fever, prostate chip culture or bacteremic episodes. Sixty-eight subjects (57.1%) presented positive prostatic tissue culture. There was no specific correlation between the recovered bacteria from the meatus, prostatic tissue chip and urine and the spectrum of the administered antibiotic. Six cases showed the same bacteria in the urine and prostatic tissue chip. Only fifteen cases (25%) in the antibiotic group showed the desired sensitivity directed to the collected bacteria. CONCLUSIONS: Antibiotic prophylaxis for patients whose urine is sterile is debatable in patients who are candidates for transurethral resection of the prostate. Most of the time, the antibiotic agent used is not specific for any of the bacteria recovered from the various sources analyzed.

Aged↗

PubMed2006

PlasmaKinetic Superpulse transurethral resection versus conventional transurethral resection of prostate.

PURPOSE: To compare the efficacy and safety of the PlasmaKinetic (PK) Superpulse system with that of conventional transurethral resection of the prostate (TURP) in terms of restoration of urinary flow and early postoperative course. PATIENTS AND METHODS: One hundred five men older than 45 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia (BPH) were randomized, 51 undergoing standard TURP with glycine as the irrigation fluid and 53 TURP with the PK Superpulse system with normal saline as irrigant. The operative time, intraoperative blood loss, catheter time, change in serum electrolytes (particularly sodium), and uroflowmetry and American Urological Association (AUA) Symptom Scores were compared. RESULTS: The blood loss as well as the catheter time observed in the PK Superpulse arm were significantly less than those in the conventional-TURP arm. The mortality rate was 0 in both the arms. The mean operative time was less in the PK Superpulse arm, although not significantly so. Hyponatremia was statistically insignificant. Significant changes were observed in the AUA Scores in both arms. CONCLUSION: The PK Superpulse system provides faster removal of tissue in a bloodless field with better views and a safer environment of saline irrigation with efficacy comparable to that of conventional TURP. However, further randomized trials with extended follow-up may be needed to better define the role of the PK Superpulse system in treating patients with symptomatic BPH.

Aged↗

PubMed2001

[A case of heparin-induced thrombocytopenia after transurethral resection of prostate during anticoagulant therapy].

A 66-year-old man had been receiving anticoagulant therapy for myocardial infarction with warfarin potassium (abbreviated as warfarin) 2 mg/day. Though he had been treated with tamsulosin hydrochloride 0.2 mg/day as diagnosis of benign prostatic hyperplasia, he experienced severe dysuria and wanted to undergo transurethral resection of the prostate. We decided to continue anticoagulant therapy because cardiologist judged that intermission of anticoagulant therapy could cause myocardial infarction. Warfarin 2 mg/day p.o. was replaced with heparin sodium (abbreviated as heparin) 5000 u x 2/day s.c. 6 days prior to surgery, and anticoagulant therapy was stopped on the day of surgery, but resumed on the following day. Purpura appeared around the extremities 18 days after the surgery. Although coagulation testing was normal, platelet counts had markedly been reduced (2,000/mm3). Platelet counts recovered to a level of 228,000/mm3 13 days after cessation of heparin. No other adverse effects were observed. Heparin-induced thrombocytopenia (abbreviated as HIT) was diagnosed clinically. We consider monitoring of platelets to be necessary because an increasing number of patients are on anticoagulant therapy in Japan, and accordingly, the use of heparin is likely to be increased.

Aged↗

PubMed1989

[Spinal anesthesia with bupivacaine for transurethral resection of prostate: effects of specific gravity, volume and dose].

The investigation was carried out in 80 patients scheduled for transurethral resection of prostate (TUR-P). All patients were ASA I or II, and received no premedication. Before anesthesia, elastic bandages were applied to both lower extremities and 6 mL/kg of G/S (5% Glucose in 0.9% saline solution) was administered by intravenous infusion. The patient was placed in the lateral position and dural puncture was performed at the L3-4 interspace using a standard midline approach with a 23 gauge spinal needle. The patients were allocated randomly to four groups, each group consisting of 20 patients. Three mL of 0.5% Bupivacaine was administered in group A; 3 mL of 0.5% Bupivacaine with 1 mL 10% G/W (Glucose water) in group B; 2 mL of 0.5% Bupivacaine with 1 mL 10% G/W in group C and 3 mL of 0.5% Bupivacaine in 8% glucose in group D. Assessment of the sensory and motor blockade and measurement of arterial pressure and heart rate were performed after injection. All data were analyzed by ANOVA. A p value of less than 0.05 was considered statistically significant. The results showed that the duration of analgesia with plain Bupivacaine was shorter than with hyperbaric Bupivacaine (2.59 +/- 0.81 h vs 3.12 +/- 0.72 h, P less than 0.05). The maximum cephalad spread of analgesia was lower with plain Bupivacaine (T 9 +/- 2 vs T 7 +/- 2, P less than 0.05). Patients receiving either 3 mL or 4 mL of hyperbaric bupivacaine were similar in regard to duration and maximum cephalad spread of analgesia, but the effect on the cardiovascular system was more severe in the group receiving 4 mL.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1991

Transurethral-resection zone prostate cancer detected at cystoprostatectomy. A detailed histologic analysis and clinical implications.

The authors identified incidental adenocarcinoma of the prostate in serial cross-sections of prostates from 61 of 100 patients having cystoprostatectomy for bladder cancer. In 20 patients, cancer foci were in the prostatic region accessible to transurethral resection (TUR). Eight of these 20 patients had stage A1 disease (less than or equal to 3 foci); in six of these patients all foci were located at or within the transition-zone boundary only. Twelve patients had stage A2 disease (greater than 3 foci); in none were more than three foci at or within the transition-zone boundary. Among the 20 patients, 84 tumor foci were distributed as follows: 62% in the peripheral zone, 10% in the transition zone, 3% in the central zone, and 25% in the transition zone boundary. The authors' data suggest that Stage A prostate cancer, like larger clinically detectable cancers, is multifocal, multizonal, and similarly distributed with respect to the urethra. No case of Stage A1 disease would have been reclassified as Stage A2 by repeat TUR of the entire transition zone and transition zone boundary. The authors' results confirm those of previous studies that report a high incidence of residual carcinoma in regions not accessible to TUR in patients with presumptive Stage A1 disease and suggest that ultrasonography and ultrasonographically guided biopsies, rather than repeat TUR, may more accurately define the extent of Stage A disease in some patients.

Adenocarcinoma↗

PubMed2002

Is there a difference in early perioperative morbidity in transurethral resection of prostate (TURP) versus TURP with cystolitholapaxy and TURP with inguinal herniorrhaphy?

Objective of this study is to determine the difference in early peri-operative morbidity of transurethral resection of prostate (TURP) and if it is combined with inguinal hernia repair and mechanical and/or pneumatic fragmentation of bladder calculus. All patients undergoing TURP, cystolitholapaxy (CLL), inguinal hernia repair (IHR) or any combination between January 1997 and December 1999 were identified using ICD 9CM coding and indexing system. Overall 1273 patients were identified, charts were reviewed for demographics, pre-operative parameter, intra-operative data and early peri-operative morbidity. In the three year period, 19 patients had TURP and inguinal herniorrhapy (IHR), 17 patients had TURP and cystolitholapaxy (CLL), 2 patients had TURP+IHR+CLL performed simultaneously; in the same period 346, 815, 74 patients had TURP, IHR, and CLL alone respectively. All the groups were matched for age, presentation and Co-morbidities. There was significant difference in the operating time between the different groups. Complications were not significantly different in the TURP, IHR, CLL, TURP+IHR, and TURP+CLL. In conclusion, mean operative time for TURP+IHR is increased by a fraction of 168.3 for TURP+CLL by 109.8 and TURP+IHR+CLL is 202.1 over TURP alone, with no significant difference in morbidity between TURP and TURP+IHR and TURP+CLL.

Aged↗

PubMed1993

Electroencephalographic changes from hyponatremia during transurethral resection of the prostate.

A patient undergoing transurethral resection of the prostate suffered hyponatremia during the perioperative period. Electroencephalography demonstrated diffuse slowing although the patient was not clinically encephalopathic. The serum sodium level may indicate a trend toward development of the transurethral resection syndrome but the sodium level does not necessarily parallel metabolic changes in brain tissue. Consequently, electroencephalography may aid in the early diagnosis and treatment of encephalopathy during the early phases of the transurethral resection syndrome.

Central Nervous System Diseases↗