Disorders of sodium balance: hyponatraemia can occur during transurethral resection of prostate.
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Humans↗
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Results for “Transurethral Resection of Prostate”
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[Transurethral microwave thermotherapy. A therapeutic option for high-risk patients with urinary retention secondary to benign prostatic hyperplasia].
Urinary retention secondary to benign prostatic hyperplasia is considered an absolute indication for surgical treatment of the prostate. Transurethral resection of the prostate is still considered the gold standard in terms of effectiveness. One of several new techniques for treatment of BPH is transurethral microwave thermotherapy (TUMT). Our first experiences with this technique in a group of patients with urinary retention were analysed retrospectively. In the short term 16 of the 25 treated patients were able to void spontaneously with acceptable bladder emptying (64%, 95% CI: 43-85). Later on, three of these initial successes received further treatments for BPH, two had a transurethral resection of the prostate and one was given medical therapy. No serious complication was seen except in one patient who developed a urethrorectal fistula which healed following conservative treatment. The success rate following TUMT was inferior to that of standard transurethral resection, but TUMT seems an acceptable alternative in patients with pronounced co-morbidity.
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Evaluation of uroflowmetry in different groups of patients after transurethral resection of prostatic adenoma.
One hundred patients after transurethral prostatectomy (TURP) were examined. The patients' age, presence or absence of urinary tract infection, time after TURP, and the size of adenoma were taken into consideration in the assessment of uroflowmetry. It was found that with the passage of time all parameters have improved. Comparison of the results of uroflowmetry performed in patients with large or small adenomas showed that TURP was successful in both groups. Infection was found to affect the volume of the bladder, but it had no significant influence on other uroflowmetry parameters or on residual urine. The age of the operated patients seemed to have no influence on the results of flowmetry after TURP.
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Bipolar electrosurgery for benign prostatic hyperplasia: transurethral electrovaporization and resection of the prostate.
PURPOSE OF REVIEW: The gold standard for surgical treatment of benign prostatic hyperplasia continues to be transurethral resection of the prostate, which is traditionally performed using a monopolar electrocautery system resulting in the possibility of certain well-recognized complications. This has led to the development of alternative surgical procedures such as vaporization of the prostate and most recently use of bipolar systems. The advantages of bipolar electrosurgery include the ability to use isotonic saline during surgery, reduced blood loss and less heat damage to the surrounding tissue. We have reviewed some of the technical aspects of the bipolar systems as well as their clinical use. RECENT FINDINGS: Bipolar electrovaporization of the prostate (Gyrus Medical Ltd, Cardiff, Wales) has been established for a few years and some data are available suggesting that the system is safe and effective, at least in the short term. The new technique of bipolar transurethral resection of the prostate has been studied in a small number of studies with promising results. SUMMARY: Bipolar transurethral resection is a novel approach in treatment of the prostate. A real paucity of clinical data is seen regarding the outcomes with this form of surgery. Although the generator and the resecting loop are different to the monopolar system, the resection technique is very similar which may be attractive to practising urologists. The need for large multi-centre studies in effectiveness of bipolar transurethral resection of the prostate is apparent.
Clinical Trials as Topic↗
Necrotising prostatic granulomas following transurethral resection--a case report.
Necrotising post surgical granulomatous prostatitis following transurethral resection of the prostate is a poorly recognized entity. It is often mistaken for other conditions like tuberculosis, allergic granulomatous prostatitis, etc. This case is being reported in order to increase the awareness of this condition. The relevant literature has also been reviewed.
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Bipolar transurethral resection of prostate in saline: preliminary report on clinical efficacy and safety at 1 year.
PURPOSE: To determine the clinical efficacy and safety profile of the bipolar transurethral resection in saline (TURIS) system (Olympus Japan) in the treatment of men with benign prostate hyperplasia (BPH). PATIENTS AND METHODS: We prospectively evaluated 45 patients with a mean age of 66 years (range 50-87 years) who had clinically significant BPH and were treated with transurethral resection of prostate using the TURIS system beginning December 2003. Acute retention of urine was the indication in 49% of the patients. Patients had outpatient follow-ups at 1, 3, 6, and 12 months. RESULTS: A mean weight of 25.3 g of prostatic tissue was resected in a mean time of 42 minutes (range 15-75 minutes). The mean decrease in hemoglobin and sodium was 1.4 g/dL and 2.2 mmol/L, respectively. The mean follow-up period was 10 months. The mean International Prostate Symptom Score decreased from 22.6 preoperatively to 6.5 at 12 months and the mean Q(max) increased from 6.5 to 18.3 mL/sec at 12 months. Postoperative hemorrhage was seen in 6.6% of the patients, including 2 primary hemorrhages that necessitated blood transfusion (4.4%). Other complications were prolonged catheterization (11.1%), urinary-tract infection (8.9%), and bulbar urethral stricture (4.4%). CONCLUSIONS: This pilot study indicates that TURIS is a safe and efficacious treatment for BPH at 1 year.
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Mayo Clinic experience with the AS800 artificial urinary sphincter for urinary incontinence after transurethral resection of prostate or open prostatectomy.
The model AS800 artificial urinary sphincter was implanted in 56 patients with urinary incontinence after transurethral resection of the prostate and in 8 patients after open prostatectomy. Their ages ranged from fifty-three to eighty-seven years (mean, 70 years). At presentation, 92 percent had total incontinence and 8 percent had distressing stress incontinence. Fifteen patients (23%) had had previous radiation therapy. Bulbous urethral cuffs were used in 60 (94%) patients and vesical neck cuffs in 4 (6%). Follow-up questionnaires were mailed to assess satisfaction rate and degree of continence. Continence was significantly improved in 90 percent, and 87 percent of the patients were satisfied with their sphincters. Surgical revisions were required in 14 patients (22%). Cuff compression was inadequate in 9 patients, and erosion led to revision in 3 patients. At follow-up, 3 patients had had at least one component of the AS800 removed (complete device in 2 and cuff in 1).
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Detection and staging of prostatic carcinoma after transurethral resection or open enucleation of the prostate: accuracy of magnetic resonance imaging.
A total of 17 patients who had undergone transurethral (16) or open (1) enucleation of the prostate for presumed benign prostatic hyperplasia had prostatic adenocarcinoma: 10 on the basis of examination of the resected specimen (stage A) and 7 upon rectal examination performed 2 to 120 months after prostatectomy for benign prostatic hyperplasia (stage B). In all patients magnetic resonance imaging (MRI) of the prostate was performed before radical retropubic prostatectomy. Preoperative imaging was compared to pathological findings with respect to the presence, location and stage of singular or multiple prostatic carcinomas. Carcinomas were categorized according to the location within the prostate: whether on the right or left side, and whether in the peripheral zone (anterior, anterolateral or posterior) or the transition zone. The sensitivity of tumor detection for cancers originating in the peripheral zone was 81%. However, the sensitivity of detection decreased to 0% for tumors confined to the transition zone. Tumor staging was not compromised by previous prostatic enucleation or transurethral resection. MRI correctly identifies carcinomas originating in the peripheral zone but cannot detect those confined to the transition zone.
Adenocarcinoma↗
Transurethral resection of prostatic abscess under sonographic guidance.
Transrectal ultrasound may establish the diagnosis of prostatic abscess in an ambiguous clinical setting. Transurethral resection (deroofing) is the treatment preferred by many clinicians, yet intraoperative complete abscess obliteration may be difficult to confirm endoscopically. We report on a patient with a complex prostatic abscess endoscopically resected under transrectal ultrasound guidance. Adequacy of treatment was proved pathologically.
Abscess↗
Comparison of bipolar transurethral resection of the prostate with standard transurethral prostatectomy: shorter stay, earlier catheter removal and fewer complications.
UNLABELLED: Authors from Detroit assess the use of the bipolar TURP against the monopolar technique; there were relatively few patients, reflecting the decreasing requirement for TURP in the USA. In addition, the amount of resected tissue was not particularly large, almost certainly a reflection of the decreasing size of resected prostatic tissue in that country. They found the bipolar TURP to have many advantages over standard monopolar TURP, and these are described. Acute urinary retention is a common urological emergency, and authors from London found that it had a measurable impact on the health-related quality of life of patients who develop this problem. They describe particularly how painful a condition it is, and that it had a significant economic burden. OBJECTIVE: To assess bipolar transurethral prostatectomy (TURP) using the Gyrus system (Gyrus Medical, Maple Grove, MD) compared with a standard monopolar TURP. PATIENTS AND METHODS: All 43 patients undergoing TURP from November 2000 to August 2002 were reviewed retrospectively; the 1.5-year observation period allowed for the detection of late complications. In all, 18 consecutive patients had standard and 25 had bipolar TURP. RESULTS: The resection was 18 g for standard and 15 g for the Gyrus TURP (part of the Gyrus chips are vaporized during resection). The Foley catheter was removed sooner (1.8 vs 3.2 days) and the hospital stay was less in the Gyrus group (1.2 vs 2.1 days). Acute complications occurred in a third of the standard group and four (16%) of the Gyrus group. Long-term complications were comparable, at two each in the standard and Gyrus groups. Four patients (15%) with small glands went home on the day of surgery, needing no bladder irrigation after Gyrus TURP. CONCLUSION: Few innovations in TURP technique have been described in the past few decades but comparing Gyrus to standard TURP showed that the former allows earlier removal of the urinary catheter and earlier discharge from hospital, while decreasing complications. The Gyrus system also has other benefits; it allows coagulation of tissue during resection, resulting in excellent intraoperative visualization, and normal saline is used as the irrigant fluid, reducing the potential for TUR syndrome. The shorter stay after Gyrus TURP can result in cost savings of up to $1200/patient/day at our institution.
Adult↗
Informed consent: an evaluation of patients' understanding and opinion (with respect to the operation of transurethral resection of prostate).
The ability of patients to understand and recall information given prior to obtaining written consent was assessed in 55 patients who were due to undergo the operation of transurethral resection of prostate. The patients were also asked their opinion on informed consent. Most patients knew the position of the prostate and the purpose of the operation. Some aspects of the postoperative management and complications were less well remembered. In particular, 18% of the patients could not remember the possibility of retrograde ejaculation despite efforts to emphasize this. Of the patients who returned their questionnaires, 41% did not mind what happened to them provided they were made better; 54% trusted their doctor to do the right thing and did not think detailed explanation was important; 62% felt that consent forms are to protect the doctor's right; still most patients felt that consent forms were necessary. Sub-groups comparison showed no relationship between patients' attitude and their ability to recall information.
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[Radical transurethral resection of prostate for spinal cord bladder: its therapeutic effects and urodynamic evaluations].
89 spinal cord injury patients who had voiding disturbance and were refractory to conservative therapy, were treated by radical transurethral resection of prostate (radical TUR-P). We evaluated the therapeutic effects of this procedure using clinical, urographic and urodynamic studies. 80 of 89 cases attained satisfactory voiding parameters after radical TUR-P. Postoperative incontinence was not seen and in some cases incontinence was improved. The vesicoureteral reflux was abolished in 15 of 23 refluxing ureters and ameliorated in 3 ureters. Hydronephroureters were normalized in 9 of 10 cases. Urodynamically, vesical compliance was increased after radical TUR-P. Detrusor hyperreflexia was suppressed in 6 of 15 cases. Detrusor sphincter dyssynergia was abolished or suppressed in 25 of 31 dyssynergic patients. By referring to the neuroanatomy and physiology of the denervated urethra, why radical TUR-P works was ascribed to its possible "sympathectomy" effect.
Adult↗
[Transurethral microwave irradiation and resection of prostate].
Transurethral microwave irradiation followed immediately by TURP was carried out in 120 BPH patients with a self-designed transurethral microwave irradiator. To relieve obstruction partial resection of the prostate was made to form a smooth prostatic tract. Moreover, regression of the residual prostatic tissue caused by hyperthermia also occurred. The success rate was 96.7%, The procedure, simple, safe and effective, is especially suitable for high risk patients. The extent of thermal distribution of 2450 MHz microwave and its destructive effects were investigated. The surgical technique of combined transurethral microwave irradiation and resection of prostate and its complications are discussed.
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Streptococcus faecalis disc space infection following transurethral resection of prostate.
The case of a 65-year-old diabetic patient who developed L5/S1 disc space infection caused by Streptococcus faecalis is reported. The patient had a history of a fall followed by transurethral resection of prostate within 2 weeks before presentation. Parenteral vancomycin administered for 6 weeks aborted the infection. The patient made good recovery. This is the first reported case of Streptococcus faecalis primary intervertebral disc space infection. The importance of prophylactic antibiotics during urosurgical operations in diabetic patients is stressed.
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Three-dimensional stereotactic posterior ischiorectal space computerized tomography guided brachytherapy of prostate cancer: a preliminary report.
PURPOSE: A 3-dimensional (D) stereotactic posterior ischiorectal space computerized tomography (CT) guided approach is presented for brachytherapy of localized prostate adenocarcinoma. MATERIALS AND METHODS: During the last 2 years 130 patients 49 to 90 years old (median age 71) with clinical stage A, B or C adenocarcinoma have been treated by this method. The initial prostate specific antigen profile was range 0.9 to 143 ng./ml., mean, 16.25 and median 13.0. Range of initial prostatic volume was 30 to 156 cm.3, with a (median 62 and mean 65). Of the patients 15% had signs and symptoms of urinary obstruction, that is with residual urine greater than 100 cc and significant nocturia and frequency. Transurethral resection of the prostate defects were present in 20% of the patients. Volume and treatment planning is performed by CT. Placement of the after loading needles is accomplished with a 3-D stereotactic system mounted on a CT table. The prescribed dose is 12,000 cGy. for 103Palladium seeds and 16,000 for 125I. The dosage is achieved by spacing the after loading needles 10 mm. apart with the seeds averaging 10 mm. apart from center to center. RESULTS: Prostate specific antigen levels decreased to less than 2 ng./ml. in 95% of the patients including those at high risk 6 to 24 months after the procedure. Except for treatment related transient symptoms of urethritis and proctitis, there have been no complications. No patients had incontinence, acute infection, hemorrhage or radiation damage to the rectum. No patients required post-implant transurethral resection of the prostate. There was significant clinical improvement in patients with obstructive uropathy. CONCLUSIONS: The 3-D stereotactic CT guided posterior ischiorectal space approach for brachytherapy is not limited by prostate size, transurethral prostatic resection defects or public arch interference, and it allows for needle verification and correction if necessary. Initial clinical and biochemical results in patients treated with this method are promising.
Adenocarcinoma↗
Collagen injection therapy for post-prostatectomy incontinence.
PURPOSE: Post-prostatectomy incontinence has an incidence of 5 to 12% and greatly affects quality of life. Since the approval of glutaraldehyde cross-linked collagen there is a renewed interest in injectable urethral bulking agents. We investigated the long-term efficacy and prognostic criteria for transurethral collagen injection therapy for men with post-prostatectomy incontinence. MATERIALS AND METHODS: From November 1993 to May 1995, 62 men with post-prostatectomy incontinence (54 after radical prostatectomy and 8 after transurethral resection of the prostate) were treated with collagen via a transurethral approach. Median followup was 29.0 months from the date of the last injection procedure. RESULTS: Social continence was defined as dry or minimal leakage requiring at most 1 pad daily with activity. Of 62 patients 38.7% achieved social continence and 8.1% became totally dry. The success rate was 35.2 for radical prostatectomy versus 62.5% for transurethral prostatic resection patients. Of the patients who achieved social continence with at least 1-year followup 23 (60.9%) remained so with no further treatment. At 2-year followup 21 patients (42.8%) maintained social continence. The success rate was 27.3% for those who wore a penile clamp or condom catheter before treatment (3 of 11 patients), and only 21.4% for those who underwent transurethral incision of a bladder neck contracture (3 of 14). A median of 4 injection procedures and 20.0 ml. collagen were required to achieve social continence. CONCLUSIONS: Transurethral collagen injection therapy is a reasonable treatment option for post-prostatectomy incontinence in select patients in whom more conservative therapy has failed. However, patients who have required a penile clamp, experienced continuous leakage or undergone transurethral incision of a bladder neck contracture are unlikely to respond well to this treatment.
Activities of Daily Living↗
Re: Transurethral resection of the prostate versus transurethral electrovaporization of the prostate: a blinded, prospective comparative study with 1-year followup.
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Electrosurgery↗
Prostatic laser ablation versus transurethral resection of the prostate.
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Electrosurgery↗