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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↗
PubMed1998

Sexual functions in patients with benign prostatic hyperplasia before and after transurethral resection of the prostate.

The purpose of this prospective study was to evaluate the sexual function of patients with benign prostatic hyperplasia (BPH) before and after transurethral resection of the prostate (TURP). The sexual functions of 155 patients with BPH were evaluated before TURP and 6 and 12 months afterwards. The mean age of the patients was 69 years (range 49-86 years). The only significant change in sexual function after TURP was improvement in early morning erections (P < 0.01). Sixty-eight per cent of the patients were satisfied with their sex life before TURP, 69% after 6 months and 67% after 12 months. The corresponding percentages of patients satisfied with their libido were 60%, 59% and 54%. Only 26% of the patients had completely satisfactory erections before TURP, while 22% had them 6 months later and 24% 12 months later. The proportion of fully impotent patients was 11% before the procedure, 13% after 6 months and 16% after 12 months. In 84% of the patients ejaculation was retrograde 6 months and 12 months after TURP. We conclude that TURP does not affect the sexual function of patients with BPH, with the exception of retrograde ejaculation.

Aged↗
PubMed2001

Comparison of ofloxacin and norfloxacin concentration in prostatic tissues in patients undergoing transurethral resection of the prostate.

BACKGROUND AND PURPOSE: To compare the concentrations of two fluoroquinolones, ofloxacin (OFLX) and norfloxacin (NFLX), in the prostate glands of patients who underwent transurethral resection of the prostate (TUR-P) after oral ingestion of both drugs for surgical prophylaxis. METHODS: Ten patients with clinical symptoms of benign prostatic hyperplasia undergoing TUR-P received 200 mg of both drugs per os simultaneously 2 hours before surgery. The concentrations of the drugs in the serum and prostate at the time of surgery were measured by high performance liquid chromatography. Patients' clinical characteristics were evaluated, including findings from transrectal ultrasonography of the prostate, prostate specific antigen concentration, renal function tests, and post-operative status. RESULTS: Two hours after administration, the mean serum concentration of OFLX was 4.14 +/- 0.64 mg/L (range 0.27-6.37) and of NFLX was 1.10 +/- 0.22 mg/L (range 0.02-2.1). The concentration of ORLX in prostatic tissue was 4.10 +/- 0.79 micrograms/g (range 1.70-6.37) and of NFLX was 2.22 +/- 0.57 micrograms/g (range 0.63-4.35). The ratio of the prostatic tissue concentration (P) to the serum concentration (S) was 2.11 for OFLX and 5.71 for NFLX. The concentrations of both drugs exceeded the minimum inhibitory concentration (MIC) for most gram-negative organisms, but NFLX may be unable to exceed the MIC90 of Enterobacter cloacae in some individuals. Leukocytosis and spiking fever developed after TUR-P in two of the 10 patients. CONCLUSIONS: Concentrations of OFLX were higher in both serum and prostatic adenoma tissues than those of NFLX (p < 0.001), while NFLX had better penetration into the prostate (P/S ratio) (p < 0.001). The results of this study indicated that the concentrations of both of these drugs exceeded the MIC for most gram-negative organisms.

Aged↗
PubMed2003

Long-term results of contact laser versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia with small or moderately enlarged prostates.

OBJECTIVE: To evaluate the long-term results of contact laser vaporization (CLV) of the prostate and transurethral resection of the prostate (TURP) in patients with symptomatic bladder outflow obstruction (BOO) caused by benign prostatic hyperplasia (BPH) with prostates smaller than 40 ml. MATERIAL AND METHODS: A total of 52 patients with lower urinary tract symptoms (LUTS) and urodynamically confirmed BOO caused by BPH with glands smaller than 40 ml were treated by means of CLV or TURP in a randomized trial. Changes in symptom score, urodynamics and prostate volume were evaluated during a 4-year follow-up period. RESULTS: A total of 42 (81%) of the patients were available for review at 4 years. The re-operation rate was 1/26 for each treatment. A sustained improvement in median Danish Prostate Symptom Score was seen in the laser group from 18 (range 5-54) to 5 (0-34) and in the TURP group from 18 (4-46) to 4 (0-18) (p<0.001 for both). A sustained improvement in maximum urinary flow rate was also seen in the laser group from 8.3 (4.8-19.6) ml/s to 14.3 (10.1-33.6) ml/s (p<0.001) and in the TURP group from 8.6 (5.0-15.9) ml/s to 16.1 (7.7-39.6) ml/s (p<0.01), without differences between the study groups. Median detrusor pressure at maximum urinary flow rate decreased significantly after both treatments, in the CLV group from 64 (32-112) cmH2O to 38 (18-65) cmH2O and in the TURP group from 57 (40-137) cmH2O to 28 (9-44) cmH2O (p<0.001 for both), and at 48 months was significantly higher in the laser group (p<0.01). At 4 years, 7/22 (32%) of the laser patients and 2/20 (10%) of the TURP patients were urodynamically obstructed. Post-void residual at 48 months was significantly lower in the TURP group than in the CLV group. Median prostate volume was smaller after TURP at 6 and 48 months (p<0.05). CONCLUSIONS: Long-term data of CLV and TURP treatments for BPH with small or moderately enlarged prostates indicate no significant difference in the relief of symptoms or in the rate of re-operations. However, the number of patients in this study was small and consequently the power to detect differences between the study groups was low. Regarding most objective outcome parameters, long-term follow-up revealed a slight advantage of TURP over CLV.

Aged↗
PubMed2004

[Efficacy of pretreatment with Serenoa repens on bleeding associated with transurethral resection of prostate].

AIM: Aim of the study is to evaluate the efficacy of a pretreatment with lipidic-sterolic extract of Serenoa repens (Permixon) to reduce bleeding during transurethral resection of prostate (TURP) in patients with benign prostatic hyperplasia. METHODS: This is a monocentric, randomised versus control group study. We enrolled 108 patients, randomised either in the experimental group or in the control one. Patients in the experimental group received a pretreatment with Serenoa repens (320 mg/die of Permixon) for at least 8 weeks before the TURP procedure. In the control group patients did not receive any medical treatment before the intervention. RESULTS: Out of 108 enrolled patients, 88 were evaluated per protocol. In the pretreated group the perioperative bleeding was significantly lower than in the control one (respectively 124 vs 287 ml) and the need of transfusion decreased remarkably. Moreover, in the pretreated group, the duration of postoperative catheterization (respectively 3 vs 5 days) and the evaluated hematological parameters (red cells 4.5 vs 4 million, hemoglobin 13.4 vs 11.9 g, hematocrit 40% vs 35%) were significantly lower than in the control group. CONCLUSION: The pretreatment with Serenoa repens, before TURP procedure, improves the efficacy of the procedure itself and reduces the risk of complications, in particular perioperative bleeding and duration of postoperative catheterization.

Aged↗
PubMed1989

Preoperative use of 5-fluorouracil to reduce operative bleeding in transurethral resection of prostate.

We report results of a preliminary study on the preoperative use of 5-fluorouracil (5-FU) to reduce bleeding in transurethral resection of prostate. The average amount of blood lost for each case in the 5-FU group (30 cases) was calculated to be 10.16 mL/g, while the average for the control group was 15.12 mL/g. A blood loss of about 5 mL/g in the 5-FU group was less than in the control group. In addition, the reduction of bleeding was apparent in cases where the removed prostate weighed more than 10 g, and was especially marked in those cases where the removed prostate weighed 20-29 g. A pathologic examination of the 5-FU-treated prostate revealed atrophy of the glandular tissue, hyperplasia of the connective tissue, marked dilatation of the lumen of some of the acini which indicated exhaustion of glandular secretion, a decrease in the number of blood vessels, and formation of lymphoid follicles. All of the test group, with the exception of one whose white blood cell count once dropped to 2,700/mm3, did not show any side effects.

Aged↗
PubMed1986

Safety and efficacy of intravesical aminocaproic acid for bleeding after transurethral resection of prostate.

There appears to be no clinically significant difference in blood loss or transfusion requirements after transurethral resection of the prostate (TURP) when intravesical 0.5% aminocaproic acid is compared with 0.9% sodium chloride irrigation in patients during the first three days after surgery. This is probably because early post-TURP bleeding is due to inadequate hemostasis or perforation of the prostatic capsule, and not excessive local or systemic fibrinolysis. However, we suggest that intravesical aminocaproic acid might be a useful alternative to systemic antifibrinolytic therapy in patients with delayed, recurrent, excessive post-prostatectomy bleeding, which is thought to be due to fibrinolysis. Since aminocaproic acid is not systemically absorbed after bladder instillation, intravesical administration causes few side effects and does not necessitate screening patients for disseminated intravascular coagulation prior to treatment.

Aged↗
PubMed2002

Combined cystolithotomy and transurethral resection of prostate: best management of infravesical obstruction and massive or multiple bladder stones.

OBJECTIVES: To investigate the results of combined suprapubic cystolithotomy followed by transurethral resection (TUR) of the prostate (TURP) or TUR of the bladder neck in patients with infravesical obstruction and massive or numerous bladder stones. We also reviewed the medical literature and compared the success, morbidity, and mortality rates of the treatment modality presented here and the nonsurgical modality of transurethral lithotripsy and resection of the prostate or bladder neck. METHODS: Through a 10-year period, 20 men with benign prostatic hyperplasia or bladder neck obstruction and massive or numerous bladder stones underwent cystolithotomy for stone clearance followed by TURP or TUR of the bladder neck. A second group of 20 randomly selected men who underwent TURP alone was studied retrospectively for time of surgery, number of days of postoperative indwelling catheter use, and hospital stay. RESULTS: No deaths occurred. All stones were successfully evacuated (100% stone-free rate). The operative time and number of days of postoperative indwelling catheter use and hospital stay were notoriously shorter in the present series compared with the transurethral lithotripsy and TURP modality. A single case of fever (5% complication rate) occurred in each group. When comparing the data of the present series with a group of 20 men who underwent TURP only, no differences were found in the times of postoperative indwelling catheter use and hospital stay. Cystolithotomy performed before TURP prolonged the total time of surgery an average of 18.4 minutes. CONCLUSIONS: In the era of endoscopic and minimally invasive surgery, a small suprapubic cystostomy followed by TURP is still the treatment of choice in cases of infravesical obstruction and very large or numerous bladder stones. The procedure is quick and easy to perform and bears a low morbidity rate compared with transurethral lithotripsy and TURP. A small cystotomy does not prolong the time of indwelling catheter use and hospital stay.

Aged↗
PubMed1997

Diagnostic value of additional systematic prostate biopsies in patients undergoing transurethral resection of the prostate.

OBJECTIVES: There are patients with obstructive voiding symptoms and suspicious screening parameters in whom prostate cancer (PC) cannot be excluded prior to transurethral resection of the prostate (TURP). The goal of our study was to assess the diagnostic value of systematic biopsies of the peripheral zone of the prostate performed during TURP. METHODS: Between 1990 and 1995, 132 patients (average age 69.5 +/- 7.4 years) with at least one suspicious screening parameter underwent a TURP and additional systematic prostate biopsies. Pathology reports were reviewed to verify whether PC was present in the TURP chips or in the biopsy cores. RESULTS: Histologic examination found benign prostatic hyperplasia in 52, prostatitis in 53, and PC in 27 patients. PC was detected only with TURP in 11 patients (40.8%). In 15 patients (55.6%), both TURP and prostate biopsies showed PC. There was only 1 patient (3.7%) with a positive biopsy in whom the examination of the resection chips did not detect PC. In patients with negative digital rectal examination and intermediate prostate-specific antigen levels, prostate-specific antigen density was not able to differentiate between benign and cancerous lesions. CONCLUSIONS: There seems to be a subgroup of patients where systematic and repeated prostate biopsies fail to detect PC prior to TURP. Although the increase in the detection rate through additional prostate biopsies of the peripheral zone is limited, we would recommend these biopsies in addition to TURP, especially if patients are eligible for further curative treatment options.

Adult↗
PubMed1987

Factors influencing the osmolality and the concentrations of blood haemoglobin and electrolytes during transurethral resection of the prostate.

Twenty patients undergoing transurethral resection of the prostate (TUR) were followed every 10 min intraoperatively as well as 1 and 2 h postoperatively with measurements of blood haemoglobin concentration (B-Hb), serum sodium (S-Na), serum potassium (S-K), serum osmolality (S-osmol), blood loss, central venous pressure and volumetric determination of the irrigating fluid absorption. Changes in B-Hb correlated well with the sum of acetated Ringer solution given and intravascular irrigating fluid absorption. A transient decrease in S-Na of 1-4 mmol/l followed absorptions less than 300 ml. With larger intravascular absorptions, three stages of dilutive changes in S-Na and B-Hb are described. Extravascular absorptions resulted in mild blood parameter changes at various times after their occurrence. Absorption of irrigating fluid was associated with an increase in S-K. S-osmol decreased in conjunction with some absorptions, although the irrigating fluid was isotonic. Postoperative analyses of blood parameters gave only limited information about intraoperative complications. The only consistent pattern was associated with intravascular irrigating fluid absorption.

Aged↗
PubMed1989

The use of distilled water as an irrigating fluid in patients undergoing transurethral resection of the prostate.

Thirty patients undergoing transurethral resection of the prostate using distilled water as an irrigating fluid were studied. There was no significant change in the serum concentration of the variables studied (preoperatively compared to postoperatively) as possible indicators of haemolysis or absorption of irrigating water such as sodium, potassium, albumin, total protein, creatinine, uric acid, urea, haemoglobin, haematocrit and haptoglobin. The mean value of plasma haemoglobin (P-Hb), observed immediately postoperatively and reflecting the magnitude of haemolysis, was delta 294.8 mg/l. There was a good correlation between P-Hb and the inflowing irrigating distilled water (r = 0.69). The P-Hb variation (delta) correlated with resection time and with the weight of the resected prostate (r = 0.54 and r = 0.52, respectively). A good correlation was also found between resection time and delta body weight which reflects the amount of water absorbed (r = 0.67) and between delta body weight and the inflowing irrigating water (r = 0.61). Our study shows that distilled water can be used as an irrigating fluid quite safely. The advantages of distilled water outweigh the disadvantages which can be avoided easily if proper attention is given.

Absorption↗
PubMed1988

[The results of transurethral resection of the prostate].

The results of transurethral resection of the prostate (TUR-P) performed on 465 clinical cases diagnosed as benign prostatic hypertrophy or prostatic carcinoma at our Hospital during the recent seven years are reported. Various factors which seem to influence the results of TUR-P were reviewed.

Aged↗
PubMedDate not supplied

[Transurethral electroresection of prostatic adenoma under transrectal ultrasonic control].

The aim of the study was to improve the results of transurethral prostatic resection (TUPR) by introduction of intraoperative transrectal ultrasonic investigation (TRUSI) and to determine topographic-anatomic features of the prostate, intraorgan relations of adenomatous nodes and surgical prostatic capsule on-line in TUPR. A total of 64 patients with prostatic adenoma (PA) of the second degree aged 52-79 participated in the study. All of them have undergone TUPR. The patients were divided into two study groups (15 patients with volume of the prostate 36.5-78.6 cm3 and 17 patients with prostate size 80-4-141.2 cm3) in which TRUSI was performed and two control groups (n = 14, size 34.9 to 79.2 cm3 and n = 18, size 81.7-130.8 cm3, respectively) who have not undergone intraoperative TRUSI. PA clinical symptoms were similar in all the groups. Intraoperative TRUSI was conducted in 3 stages (in the beginning, middle and end of surgery) in two planes--transverse and sagittal. Postoperative complications required repeated endoscopic interventions in 2 and 4 patients of groups 2, 3 and 4, respectively. Control TRUSI on day 7 after TUPR registered mean volume of the prostate to be 19.3 +/- 1.4 cm3 in group 1, 39.8 +/- 2.1 cm3 in group 2, 28.1 +/- 1.6 cm3 in group 3, 47.7 +/- 3.2 cm3 in group 4. Maximal flow rate 1 month after TUPR was, on the average, 21.4 +/- 1.4 ml/s, 18.8 +/- 1.1 ml/s, 18.3 +/- 1.6 ml/s and 15.5 +/- 1.2 ml/s in groups 1, 2, 3 and 4, respectively. Thus, intraoperative TRUSI provides information which helps the surgeon to orient in the course of surgery and minimize the threat of perforation of the prostatic capsule; minimizes intraoperative complications and enhances efficacy of radical transurethral electroresection of prostatic hyperplasia improving long-term outcomes of the operation.

Aged↗
PubMedDate not supplied

[Incidental prostatic cancer].

OBJECTIVE: To evaluate the incidence of incidental prostate cancer and PSA ability to predict its presence. MATERIAL AND METHOD: Retrospective study of 862 patients undergoing prostate surgery between 1994 and 1997, both inclusive. Digital rectal examination provided no suspicion of neoformation. Mean age was 68 +/- 7.5 years. Mean PSA, 8.3 +/- 10 ng/ml (Hybritech). 15% patients had previously undergone at least one ultrasound-guided biopsy in the peripheral area. 55% patients underwent retropubic surgery and the remaining 45% prostate transurethral resection. Ultrasound prostate volume for both patient groups was 107 +/- 63 cc and 45 +/- 25 cc, respectively. RESULTS: Incidental cancer was found in 6% patients; 65% were T1a and 35% T1b. Mean PSA concentration in cancer patients was almost significantly (p = 0.05) higher than in patients with BPH. Patients with PSA > 10 ng/ml presented a significantly higher incidence of cancer (p = 0.02). Patients with previous prostate biopsy showed a cancer incidence rate of 12% versus 5% patients with no previous biopsy (p = 0.001). CONCLUSIONS: Incidence of incidental prostate cancer was 6%. PSA was not a good predictor of incidental cancer. Patients with PSA > 10 ng/ml, showed higher incidence of cancer. Younger patients with PSA > 10 ng/ml, and at least one negative biopsy of the peripheral area should undergo biopsy of the transitional area prior to surgery.

Aged↗
PubMed2001

Consensus development of a histopathological classification system for chronic prostatic inflammation.

OBJECTIVE: To develop a standardized histopathological classification system for chronic prostatitis (standardized description of prostatic inflammatory infiltrates) based on a literature review, extensive prospective evaluations in two recognized prostatitis research centres and widespread consensus of international urological centres identified as having major expertise or interest in chronic prostatitis. METHODS: Relevant articles for review were identified by a Medline search undertaken by the Cochrane Review Group in Prostate Diseases and Urologic Malignancies, and cross-checking bibliographies of retrieved studies, reviews, book chapters and abstracts of the American Urological Association and International Prostatitis Collaborative Network Annual Meetings. Initial drafts were based on classification systems independently developed by the Prostatitis Research Centers at Queen's University in Canada and University of Washington in the USA. A collaborative draft was distributed to 20 urological/pathological clinical centres who participated in the North American Chronic Prostatitis Collaborative Research Network and First International Prostatitis Collaborative Network. A consensus classification system was then distributed to the participating panel for acceptance. RESULTS: The literature review identified a reasonably consistent description of inflammatory infiltrate locations and patterns that were further incorporated into the draft based on the Queen's University and University of Washington proposals. Eighteen (90%) of the identified Prostatitis Centers participated in the revision of the draft and the final consensus process. The final consensus document classifies prostatic inflammation according to its extent and grade/severity in each tissue compartment (location). Conclusion The consensus of the expert panel was that this classification system can be used in the evaluation of prostatic inflammation in prostate biopsies, transurethral resected prostate chips or prostatectomy specimens. A standardized accepted framework to describe histopathological prostate inflammation will prove useful in evaluating prostate disease.

Chronic Disease↗
PubMed2004

Transurethral resection of prostate (TURP) through the decades--a comparison of results over the last thirty years in a single institution in Asia.

INTRODUCTION: This study was conducted to evaluate the results and complications of transurethral resection of prostate (TURP) over the last 30 years in our institution. MATERIALS AND METHODS: This retrospective study encompasses 3 different eras: 168 patients in the late 70s, 175 patients in the late 80s and 283 patients in the late 90s. All the patients had at least 18 months of follow-up. RESULTS: The mean age from the 1970s, the 1980s and 1999 were 68.8 years, 69.2 years and 69.4 years respectively. The proportion of patients operated on for acute retention fell from 78.6% (132) in the 1970s, to 54% (96) in the 1980s, and 43% (122) in 1999. The mean resection time was 44.8 minutes in 1989 and 41.8 minutes in 1999. The mean weight of prostate resected was 22.1 g in the 1970s, 24.2 g in 1989 and 22.2 g in 1999. 44% (74) required blood transfusion in the 1970s, with 11% (19) in 1989 and 4% (11) in 1999. There were 2 deaths (acute myocardial infarction and pneumonia) in the 1970s, 1 (pneumonia) in 1989 and no mortality in 1999. There were 4 patients with TURP syndrome in the 1970s, 3 in 1989 and 1 in 1999. The incidence of postoperative urinary tract infection (UTI) was 25% (42) in the 1970s, 16% (29) in 1989 and 6% (17) in 1999. CONCLUSIONS: As expertise and experience in TURP progress, the complication rates fall, as evidenced by the lower rates of transfusion, TURP syndrome and postoperative UTI in the later series.

Aged↗