Prostatic laser ablation versus transurethral resection of the prostate.
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Electrosurgery↗
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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↗
Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia.
OBJECTIVE: To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Forty-eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/TUIP; they were followed for 6 months and the outcome analysed on an intention-to-treat basis. RESULTS: At 6 months the symptom scores and maximum urinary flow rate (Qmax) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group (P > 0.05); the mean Qmax was 20.6 mL/s in the control group, 16.2 in the ILC group (P > 0.05 vs control) and 13.2 in the TUMT group (P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Qmax than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the 'well-known' complications of TURP occurred in the control group. Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the con-trol group were re-treated for BPH within the first 6 months. CONCLUSION: In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.
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Serum acid phosphatase elevation associated with transurethral resection syndromes.
In 6 patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia symptoms of post-transurethral prostate resection syndrome developed. Serum acid phosphatase determinations in the recovery room showed that all patients had high acid phosphatase levels although each had normal levels preoperatively. All patients showed a normal acid phosphatase level on the first postoperative day. The acid phosphatase elevations indicate significant intraoperative absorption of prostate tissue substances. The association of clinical symptoms with enzyme elevation suggests that the etiology of the confusing clinical syndromes following transurethral prostate surgery may be due to the intravenous absorption of not only irrigant solution but also tissue substances from the prostate gland.
Acid Phosphatase↗
Role of suprapubic drainage in the transurethral resection of prostate (TUR-P).
We assessed some clinical parameters and biochemical changes during TUR-P under suprapubic trocar aspiration system with suction. 18 patients underwent TUR-P with active aspiration and other 17 using Iglesias type resectoscope. The mean values of Sodium, Potassium and hematocrite did not differ significantly between the groups before surgery and 20 minutes after the beginning of resection. At the end of surgical intervention changes in hematocrit values were insignificant and blood electrolyte showed marginal statistical difference. The mean time of operation and resection in study group was 45.38 min and 37.31 min respectively, and in control group 56.25 min and 47.83 min respectively. Average weight of resected prostate tissue in study group was 67.92 g versus 58.75 g in control group. The time needed for the resection of 1 g prostate in a study group was 0.55 min versus 0.81 min in control group (p=0.05). The time needed for the removing of 1 g prostate tissue was 0.67 min and 0.96 min respectively (p<0.01). Our data supports that suprapubic trocar suction reduces the duration of the operation on the other hand, the mean time to remove one gram of prostate is much shorter comparing to conventional technique.
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Troponin T and N-terminal pro-brain natriuretic peptide changes in patients undergoing transurethral resection of the prostate.
PURPOSE: We investigated whether transurethral resection of the prostate (TURP) caused subclinical myocardial damage or cardiac dysfunction by measuring troponin T (Trop T) and N-terminal pro-brain natriuretic peptide (pro-BNP). MATERIALS AND METHODS: A total of 52 consenting patients took part in this study. All had a detailed medical history including cardiac history taken. On the day of the operation all patients had troponin T, pro-BNP, full blood count and urea, electrolytes and creatinine measured preoperatively. A preoperative and postoperative electrocardiogram was performed. Patients in renal failure were excluded from analysis. During the operations factors such as blood loss, operative time, tissue resected and fluid absorption were monitored. On postoperative day 1 all the previously mentioned tests were repeated. RESULTS: Mean patient age was 71 years (range 52 to 85). Eight patients had a history of associated cardiac problems. Mean preoperative and postoperative hemoglobin were 14.1 gm/dl (range 10.5 to 17) and 13.3 gm/dl (range 9.9 to 16.2), respectively. None of the patients had significant (greater than 1,000 ml) fluid absorption during TURP, which was calculated using ethanol tagged glycine. Mean blood loss measured with a photometer was 129.7 ml (range 0 to 1,800). Mean operative time was 28.4 minutes (range 5 to 50) and mean weight of prostatic tissue resected was 15.2 gm (range 1 to 47). Preoperative Trop T was less than 0.01 mcg/ml in all patients and mean pro-BNP was 39.2 pg/ml (range 0.5 to 866). Postoperative Trop T was less than 0.01 mcg/ml in all but 1 patient who experienced chest pain after TURP and had an increased Trop T (0.28 mcg/ml). Mean postoperative pro-BNP was 54.57 pg/ml (range 1 to 679). A total of 37 patients had an increase in pro-BNP which was still within the reference range for the age group. There were no significant electrocardiogram changes postoperatively. The Trop T changes were not statistically significant (Wilcoxon sign ranked test p = 0.31) although they may be clinically significant. CONCLUSIONS: Our study indicates that in patients with no prior cardiac history TURP does not cause myocardial damage indicated by nonincrease of Trop T. There are slight increases in pro-BNP after TURP in some patients although the exact clinical significance is uncertain.
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The influence of transurethral resection of prostate on prognosis of patients with adenocarcinoma of the prostate treated by radical radiotherapy.
Results of 999 patients with carcinoma of the prostate treated with radical radiotherapy were evaluated to assess the impact of pre-treatment transurethral resection of the prostate. (TURP). A total of 427 patients had a needle biopsy and 541 patients had a TURP. In 31 patients the diagnostic procedure could not be ascertained. In patients with stage T1/T2 disease (411) no adverse effect on prognosis was observed following TURP compared with needle biopsy. In patients with stage T3/T4 disease (534) a significantly higher distant relapse rate and cause-specific mortality were observed after TURP but overall survival was similar after TURP and needle biopsy. A significant correlation was observed between the probability of TURP and poorly differentiated cancers. Multivariate analysis which evaluated the influence of age, T stage, histologic differentiation and TURP did not demonstrate diagnostic TURP to be a significant independent prognostic variate for patients with prostate cancer managed by radical radiotherapy.
Adenocarcinoma↗
Spinal clonidine fails to provide surgical anesthesia for transurethral resection of prostate. A dose-finding pilot study.
BACKGROUND AND OBJECTIVES: This study was designed to determine whether subarachnoid clonidine administration alone results in surgical anesthesia for transurethral resection of the prostate. METHODS: Blood pressure, heart rate, sedation, and sensory and motor blocks were assessed in 12 patients before and after lumbar subarachnoid injection of increasing doses of clonidine (three patients each received 75, 150, 300, and 450 micrograms doses). General anesthesia was induced at the request of the patient or surgeon, if conditions were unsatisfactory. RESULTS: Clonidine resulted in marked sedation within a mean of 19 minutes of spinal injection, and no motor block was observed. There was a 25% (range, 0-45%) reduction in mean arterial blood pressure. Although endoscopy was tolerated in all cases, general anesthesia was required when resection began, except in two patients who received 300 and 450 micrograms of clonidine, respectively. Postoperative analgesic requirements showed wide interindividual variability (mean, 6 hours; range 2-12 hours). CONCLUSIONS: Subarachnoid clonidine cannot be reliably used as the sole agent for spinal anesthesia, since general anesthesia is often required or deep sedation occurs. Increasing doses of clonidine do not prolong postoperative analgesia. Thus, clonidine could be used as a spinal analgesic but not as a spinal anesthetic.
Adrenergic alpha-Agonists↗
Hybrid laser treatment compared with transurethral resection of the prostate for symptomatic bladder outlet obstruction caused by a large benign prostate: a prospective, randomized trial with a 6-month follow-up.
OBJECTIVE: To compare the efficacy and safety of hybrid laser treatment, i.e. the combination of visual Nd-YAG laser ablation of prostate and contact Nd-YAG laser vaporization of prostate, with transurethral resection of the prostate (TURP) in the treatment of patients with symptomatic bladder outlet obstruction secondary to a benign high-volume prostate. PATIENTS AND METHODS: Forty-five symptomatic patients with hyperplastic prostates of >40 mL were randomized to undergo either hybrid laser treatment (21) or TURP (24). All patients were evaluated before and after treatment with a complex urodynamic assessment, and were accepted into the study only if they had infravesical obstruction in the pressure-flow study. In the hybrid method, Nd-YAG laser energy was first delivered by an 'adenoma-dependent' approach to all areas of the obstructing lateral lobe tissue through a side-firing gold-alloy tip fibre at 40 W for 90 s of 'burn'. The prostatic urethra was then opened and the median lobe vaporized using the a contact probe at 40 W. Patients were re-evaluated 3 and 6 months after treatment. RESULTS: Both treatments proved to be safe, and improved the subjective and objective outcome measures at 3 and 6 months compared with baseline values. After 3 months, there was a greater improvement in the TURP group in peak urinary flow rate (Qmax; P<0.01), mean urinary flow rate (Qave; P<0.01) and postvoid residual urine volume (P<0.05) than in the hybrid laser group. After 6 months, there was a greater improvement in the TURP group in detrusor pressure at Qmax (P<0.01), Qave (P<0.05) and prostate size (P<0.001) than in the hybrid laser group. In the pressure-flow study at 6 months, a higher proportion of patients (seven of 19) were still obstructed in the hybrid laser group than in TURP group (two of 21; P<0.05). TURP caused more intraoperative blood loss (P<0.001) and postoperative problems associated with bleeding; 38% of hybrid laser patients were discharged with a suprapubic catheter, whereas all TURP patients could urinate at discharge (P<0.01). The duration of bladder drainage was longer after hybrid laser treatment (P<0.001). CONCLUSION: The hybrid laser method was a safe but less effective treatment than TURP for benign prostatic enlargement in patients with prostates of >40 mL.
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[Transurethral resection of the prostate under local transurethral anesthesia. Apropos of 18 cases].
The authors have used this method in 14 patients with a total of 18 transurethral resections under local anaesthesia. This technique is reserved for patients unsuitable for general anaesthesia or loco-regional anaesthesia and in whom prostatic resection is essential. The mean mass resected is 10 g, but with experience, it should be possible to resect 20 to 30 g. The technique is simple and the results are comparable to those of standard transurethral resections, apart from the fact that these patients are usually particularly elderly or fragile subjects.
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Outpatient transurethral resection of the prostate at a urological ambulatory surgery center.
Transurethral resection of the prostate has been the standard treatment for patients with benign prostatic hyperplasia, and it has traditionally required 2 to 7 days of hospitalization. Since 1991 we performed outpatient transurethral resection of the prostate at a urological ambulatory surgery center on 125 select patients. Standard resection techniques were used with particular attention to hemostasis, since bladder irrigation was stopped before patients were discharged home. Transfer to a hospital was required for 3 patients because of hematuria, 1 for fever and suspected bacteremia, and 1 for cardiac dysrhythmia. No patient required hospitalization after he was discharged from the ambulatory surgery center. Outpatient transurethral resection of the prostate can be performed safely with excellent patient satisfaction and cost-effectiveness. Alternative treatment modalities for benign prostatic hyperplasia should be evaluated against outpatient transurethral resection of the prostate before they are broadly embraced.
Adult↗
[Multifactor analysis of bladder neck contractures after transurethral resection of prostate].
OBJECTIVE: To analyse different factors related to the occurrence of bladder neck contracture (BNC) and to find possible ways of reducing this complication. METHODS: All putative factors and the numbers of BNC cases were studied with statistical analyses in 1,017 cases that had undergone transurethral resection of the prostate (TURP). RESULTS: The morbidity of BNC after TURP was significantly higher than that of open operations. Small size of the prostate, longer time of operation, higher power in resection and prostatitis were factors of BNC. CONCLUSION: Properties of the prostate and electrical current injuries of resection are the primary factors of BNC. The selection of patients and techniques of TURP are most important in decreasing the morbidity of BNC.
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Urodynamic assessment and quantification of prostatic obstruction before and after transurethral resection of the prostate: standardization with the aid of the computer program CLIM.
The clinical manifestations of benign prostatic hypertrophy (BPH) are ascribed entirely to the infravesical obstruction. Therefore relief of symptoms is pursued by surgical removal of obstruction, i.e. prostatectomy. On the other hand, it is generally accepted that the conventional clinical signs and symptoms do not correlate with obstruction as urodynamically defined. In the present study, objective obstruction and detrusor contractility parameters were calculated from detrusor pressure and flow rate measurements in 22 patients before and after transurethral resection of the prostate (TURP) using the computer program CLIM. The results indicate: (1) that CLIM supplies reliable obstruction and contractility parameters for preoperative assessment and follow-up in patients with BPH and (2) that greater than 25% of the patients, who underwent TURP, were objectively not obstructed. These findings form strong arguments for including CLIM parameters in the preoperative assessment to perform a TURP.
Diagnosis, Computer-Assisted↗
Pretreatment transurethral resection of prostate cancer and disease-free survival.
Data from the American College of Surgeons' national survey on prostate cancer were analyzed to determine whether recurrence-free survival differs between those patients diagnosed by transurethral resection of the prostate (TURP) and those diagnosed by needle biopsy. Only patients who received radiation therapy as treatment were included in this analysis. There were 461 patients diagnosed by TURP and 541 patients by needle biopsy. Disease free survival was calculated according to the state and tumor differentiation. Except in stage B1, none of the groups showed a statistically significant difference in recurrence-free survival between the two diagnostic procedures. The results of this analysis suggest that the disease-free survival of patients with radiation-treated prostate cancer diagnosed by TURP and needle biopsy are similar.
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Incidence and morphology of concurrent primary carcinomas of the urinary bladder and prostate in transurethral resection specimens.
A retrospective morphologic investigation was conducted to determine the incidence of concurrent primary carcinomas of the urinary bladder and prostate gland and to identify their patho-histologic features using transurethral resection specimens. The study was based upon 1281 cases with the initial diagnosis of a benign or malignant epithelial or mesenchymal tumor of the bladder. In 294 of the patients (23.0%), transurethral resection specimens were also available from the prostate. The incidence of double carcinomas (n = 52) was found to be 4.2% of all vesical carcinomas reviewed (n = 1228) and 17.7% of only those cases with biopsies available from both organs. Of the coexisting bladder carcinomas, 81% represented papillary transitional cell carcinomas grades 1 and 2. These were associated in 78.6% of the cases with well and moderately differentiated carcinomas (grades 1 and 2) of the prostate gland, showing either a uniform glandular or a pluriform glandular and cribriform pattern of growth. Half of the concurrent cancers of the bladder were noninvasive and 19.2% had infiltrated only the lamina propria. Thus, the great majority of coincidental vesical and prostatic carcinomas proved to be well and moderately differentiated and by far the majority of the bladder carcinomas exhibited a low stage. Since there was no typical association of particular histologic carcinoma types coexisting with each other and because the extent of local spread was unremarkable, it is impossible to predict the occurrence of double carcinomas of the urinary bladder and prostate on morphologic grounds.
Adenocarcinoma↗
Comparison of epsilon aminocaproic acid and normal saline for postoperative bladder irrigation following transurethral resection of prostate.
A prospective, randomized, double-blind trial of bladder irrigation with a 0.5% solution of epsilon aminocaproic acid (EACA) versus normal saline plus placebo was undertaken in 75 patients undergoing transurethral resection of the prostate for benign or malignant disease. Systemic absorption after irrigation with EACA was not detectable. No significant advantage, however, was demonstrated for the EACA solution over normal saline irrigation in measured postoperative blood loss, irrigant volume, hours of catheterization, or length of hospital stay.
Aminocaproates↗
The role of internal urethrotomy in the prevention of urethral stricture following transurethral resection of prostate.
Urethral stricture is the commonest late complication of transurethral prostatectomy. Although internal urethrotomy is widely practised to prevent structures, there are no reports of any controlled trials of the procedure. A prospective trial of internal urethrotomy, using the Otis urethrotome, in 210 consecutive transurethral prostatectomies is presented. Patients were divided into 2 groups, those undergoing urethrotomy before TUR ("Trial group") and those undergoing TUR without urethrotomy ("Control group"), and they were followed for a minimum of 6 months. The incidence of stricture in the control group was significantly greater than in the trial group (P less than 0.01). Analysis of all other variables revealed no difference between the 2 groups and it is concluded that internal urethrotomy does prevent stricture formation and that it should be undertaken routinely before transurethral resection.
Humans↗
Holmium laser resection v transurethral resection of the prostate: results of a randomized trial with 2 years of follow-up.
BACKGROUND AND PURPOSE: The holmium laser (2140 nm) can be used to ablate, resect, and enucleate the enlarged prostate. The 2-year results of a randomized trial comparing holmium laser resection of the prostate (HoLRP) and transurethral resection (TURP) are presented. PATIENTS AND METHODS: The 120 patients were randomized to either TURP (N = 59) or HoLRP (N = 61). The patients were reviewed at 1, 3, 6, 12, 18, and 24 months postoperatively. Eighty six (72%) of the patients were available for review at the 2-year mark. RESULTS: At 2 years, there was no significant difference between the two groups in AUA Symptom Score, peak flow rate (Qmax) value, or quality of life score. Adverse events, including reoperations, incontinence, and loss of erectile potency, were also similar. CONCLUSIONS: The HoLRP and TURP procedures result in similar clinical outcomes at 2 years.
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