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Results for “Transurethral Resection of Prostate”

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PubMed2000

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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PubMed2000

Transurethral vaporization-resection of the prostate versus standard transurethral prostatectomy: comparative changes in histopathological features of the resected specimens.

OBJECTIVES: Transurethral vaporization resection of the prostate (TUVRP) is a recent modification of the standard transurethral resection of the prostate (TURP). TUVRP uses a band electrode coupled to a high electrocuting energy to achieve simultaneous resection, vaporization and coagulation of the prostate. We evaluated the histopathological resection specimens of patients treated with TUVRP to see whether the higher energy used will result in thermal artifacts that will interfere with the pathological evaluation of the prostate, and compared the results to TURP specimens. MATERIAL AND METHODS: The histopathological specimens of 50 patients that underwent TUVRP or TURP were reviewed. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes or areas of stromal coagulative necrosis. Each identified pattern was awarded 1 point. The severity of cautery artifact was graded into mild, moderate or severe according to the sum of points in each specimen. RESULTS: Mild cautery artifact changes were noted in 1 patient who underwent TURP. Moderate changes were noted in 21 patients in each TURP and TUVRP groups while severe changes were noted in 4 and 3 patients undergoing TUVRP and TURP respectively. There were no statistically significant differences between the groups with regard to the severity of the cauterization- induced changes. CONCLUSIONS: The quality of histopathological specimens produced by TUVRP is similar to the standard TURP. It seems that the higher energy use in electrovaporization technique does not result in greater thermal injury to the tissues possibly because of the cooling effect of the irrigation fluids used intraoperatively.

Artifacts↗

PubMed1991

Transurethral resection of prostate prior to definitive irradiation for prostate cancer. Lack of correlation with treatment outcome.

From 1970 through 1983, 107 patients with newly diagnosed adenocarcinoma of the prostate were treated with radiotherapy with curative intent at Duke University Medical Center. Forty-five patients (42%) underwent transurethral resection of the prostate (TURP) for diagnostic and/or therapeutic purposes prior to beginning radiotherapy. Sixty-one patients (57%) were diagnosed by needle biopsy. TURP and needle biopsy groups were comparable (age, elevated acid phosphatase, early [A2, B] and late [C, D1] disease stages, and follow-up). TURP patients were more likely to have poorly differentiated tumors and were more often given concurrent hormonal therapy. Both univariate and multivariate analyses to study the effect of TURP on patients with prostate cancer treated with radiotherapy were done. We were unable to demonstrate any adverse impact of TURP on the outcome of radiation therapy for prostate cancer. This issue remains controversial and should be addressed in a prospective, randomized trial.

Actuarial Analysis↗

PubMed1991

Transurethral resection of prostate under sedation and local anesthesia (sedoanalgesia). Experience in 100 patients.

One hundred male patients (average age 68.2 yrs) with acute retention (n = 20) or with symptoms of outflow obstruction (n = 80) underwent transurethral resection of the prostate (TURP) under sedation (midazolam) and local anesthesia (lidocaine)--referred to as sedoanalgesia technique. Procedures lasted twenty-four minutes on average (range 15-35 min), and the weight of prostatic tissue resected ranged from 2-35 g (average 11.1 g). There were no complications related to the use of midazolam or lidocaine. The technique of sedoanalgesia proved safe and acceptable to all patients regardless of their pre-existing medical condition. Where the weight of prostate to be resected is estimated to be less than 40 g, TURP under sedoanalgesia proves an effective alternative to general or regional anesthesia.

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PubMed1995

The influence of preoperative concentrations of beta-endorphin and met-enkephalin on the duration of analgesia after transurethral resection of prostate.

beta-Endorphin (beta-EP) and methionine-enkephalin (M-EK) are endogenous peptides that play a role in the modification of pain perception and analgesia threshold. In order to understand more about pathophysiology of pain in association with neuroaxial blocks, we evaluated cerebrospinal fluid (CSF) concentrations of beta-EP and M-EK prior to spinal anesthesia (SA) in patients undergoing transurethral resection of prostate (TURP) to determine the correlation between preanesthesia concentrations and the duration of postoperative analgesia and opioid requirements. Twenty-five healthy patients undergoing TURP under SA were enrolled. beta-EP and M-EK were measured with a competitive radioimmunoassay. Mean preoperative beta-EP and M-EK concentrations were 153 +/- 44 and 38 +/- 5 pg/mL, respectively. Those with beta-EP concentrations > 153 pg/mL had significantly longer analgesia (P < 0.01), and lower utilization of morphine in the first postoperative day (P < 0.01). Moreover, patients with milder postoperative pain (visual analog scale score < 4/10) had significantly higher beta-EP concentrations (P < 0.01). A similar correlation was not found with M-EK values. These data suggest that preoperative CSF beta-EP, but not M-EK, concentrations correlate with the duration and quality of postoperative analgesia, as well as opioid requirements after spinal anesthesia.

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PubMed2001

[Transurethral resection of the prostate in the treatment of benign prostatic hyperplasia].

BACKGROUND AND OBJECTIVES: Transurethral resection of the prostate (TURP) represents a method of choice in surgical treatment of benign prostatic hyperplasia (BPH). The objective of this prospective study was to evaluate TURP mortality and morbidity rates. PATIENTS AND METHODS: In 1998 184 patients with lower urinary tract symptoms (LUTS) indicating the presence of BPH underwent one of the following surgeries: TURP 149 (81%), transurethral incision of the prostate 19 (10.3%), and open surgery (suprapubic transvesical prostatectomy) 16 (8.7%). From the group of 149 patients treated by TURP the following patients were withdrawn from the study: 7 (4.7%) patients with a finding of incidental carcinoma of the prostate and 14 (9.4%) patients who did not attend the postoperative follow-ups. RESULTS: 64 (50%) patients were treated for LUTS syndrome before TURP. TURP was applied in 69 (53.9%) cases for absolute indications. During the surgery and within one year after it, no mortality was recorded. Complications during the surgery were present in 13 (10.2%) patients, and within 24 h after the surgery in 38 (29.7%) patients. Early postoperative complications (up to 4 postoperative weeks) were recorded in 49 (38.3%) patients. Late postoperative complications within 3 month after the surgery occurred in 16 (12.5%) patients, within 6 months in 17 (13.3%) patients, and after 12 months in 17 (13.3%) patients. CONCLUSIONS: Although complications occur almost in 58% of patients, TURP still represents the standard treatment of LUTS indicating the presence of BPH. (Tab. 5, Fig. 2, Ref. 15.).

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PubMed1997

[Reduction of the weight of prostatic tissue during transurethral resection].

OBJECTIVE: To study the weight reduction of prostatic tissue removed during transurethral resection. METHOD: 22 hyperplastic prostate glands enucleated via a transvesical approach were resected in vitro, under conditions as close as possible to in vivo resection in 11 cases. The authors compared the weight of the enucleated prostates with the weight of fresh resection chips and the weight of chips fixed in Bouin solution. RESULTS: The weight of the chips was 28% lower than that of the prostates, while the weight of chips fixed in Bouin solution was 8% higher than that of the fresh chips. CONCLUSION: Transurethral resection causes a 28% loss of the weight of resected prostatic tissue and fixation in Bouin solution of these same chips increases their weight by an average of 8%.

Acetic Acid↗

PubMed2000

Transurethral resection of the prostate.

Transuretheral resection of prostate (TURP) is a common operation in most hospitals. The patients are elderly and usually have concomitant diseases such as diabetes, hypertension, cardiac and respiratory ailments that increase their perioperative risk. Perioperative morbidity and mortality approaches 20% and 1% respectively. Regional anesthesia, notably spinal anesthesia, offers many advantages over general anesthesia for TURP with some evidence of lower morbidity even though similar mortality rates and overall outcomes are reported for both groups. Procedure-specific complications include TURP syndrome, bladder perforation, primary fibrinolysis, bacteremia, and septicemia. All are associated with significant morbidity and mortality but amenable to early and aggressive therapeutic intervention.

Anesthesia↗

PubMed1979

Vasectomy with transurethral resection of prostate.

A retrospective study was made of 200 patients undergoing transurethral prostatectomy. Half of these patients received bilateral vasectomies. The vasectomized patients had a 5-percent incidence of epididymitis as compared with a 2-percent incidence in the nonvasectomized patients. Vasectomy failed to provide adequate protection against postoperative epididymitis and cannot be recommended as a routine procedure with a transurethral prostatectomy.

Epididymitis↗

PubMed2003

Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate.

BACKGROUND: Tramadol administered epidurally has been demonstrated to decrease postoperative analgesic requirements. However, its effect on postoperative analgesia after intrathecal administration has not yet been studied. In this double-blind, placebo-controlled study, the effect of intrathecal tramadol administration on pain control after transurethral resection of the prostate (TURP) was studied. METHODS: Sixty-four patients undergoing TURP were randomized to receive bupivacaine 0.5% 3 ml intrathecally premixed with either tramadol 25 mg or saline 0.5 ml. After operation, morphine 5 mg i.m. every 3 h was administered as needed for analgesia. Postoperative morphine requirements, visual analogue scale for pain at rest (VAS) and sedation scores, times to first analgesic and hospital lengths of stay were recorded by a blinded observer. RESULTS: There were no differences between the groups with regard to postoperative morphine requirements (mean (SD): 10.6 (7.9) vs 9.1 (5.5) mg, P=0.38), VAS (1.6 (1.2) vs 1.2 (0.8), P=0.18) and sedation scores (1.2 (0.3) vs 1.2 (0.2), P=0.89). Times to first analgesic (6.3 (6.3) vs 7.6 (6.2) h, P=0.42) and length of hospital stay (4.7 (2.8) vs 4.4 (2.2) days, P=0.66) were similar in the two groups. CONCLUSION: Intrathecal tramadol was not different from saline in its effect on postoperative morphine requirements after TURP.

Adult↗

PubMedDate not supplied

[Transurethral radiofrequency thermal destruction as the method of choice in patients with benign prostatic hyperplasia with a high degree of surgical risk and the presence of a cystostoma (or pronounced infravesical obstruction with preserved micturition)].

The authors employed transurethral radiofrequency thermodestruction (TRT) in 27 BPH patients with infravesical obstruction and grave somatic status excluding radical surgery. 17 of them had cystostomic drainage. A single procedure was not long and ran without general anesthesia. In patients able to urinate objective and subjective improvement was recorded, in those with cystostomic drainage suprapubic fistula was eliminated in 10 patients. In some cases TRT produced the results comparable to transurethral resection of the prostate. TRT complications comprise mainly infection and inflammation (11.1%). By efficacy and safety TRT occupies an intermediate position between thermotherapy and prostatic transurethral resection. This method is alternative in BPH patients with cystostoma and severe associated diseases.

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PubMed1999

Randomized trial of safety and efficacy of transurethral resection of the prostate using contact laser versus electrocautery.

The aim of this study was to prospectively evaluate the safety and efficacy of contact laser ablation of the prostate (CLAP) vs. transurethral resection of the prostate (TURP) in symptomatic benign prostatic hypertrophy (BPH). During a 1-year period (1995-1996), 37 males 50 years of age or older were randomized to either CLAP using Nd:YAG laser treatment or TURP. Patients with Qmax <15 mL/s, American Urological Association (AUA) symptom score >12, and postvoid residual (PVR) >125 mL were enrolled. Patients were excluded if they had prior surgical treatment for BPH or known conditions that could affect bladder function. Comparisons of preoperative and postoperative symptom scores, Qmax, PVR, total catheter time, hospital stay, complications, and hematocrit changes were performed. A 2:1 randomization was used, which resulted in 26 CLAP and 12 TURP patients. One-year follow-up data were available for 21 CLAP and 7 TURP patients. The mean prostate volume, age, AUA symptom score, and Qmax were not significantly different between the two arms. Significant differences in favor of CLAP were shorter catheter time (27.2 vs. 40.4 hours; p < .05) and shorter hospital stays (28.5 vs. 60.0 hours; p < .05). The only other significant difference between the two arms was a lower AUA symptom score in favor of TURP at 1 year (4.7 vs. 8.4; p < .05). Qmax, PVR, and postoperative hematocrit were similar between the groups. The only complications included recatheterizations, which occurred more frequently in the TURP patients (25% vs. 14%). CLAP appears to be slightly less effective in AUA symptom score reduction; however, it is equally safe and is superior for shortening catheter time and hospital stay compared to TURP.

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PubMed2004

Can prostate stents be used to predict the outcome of transurethral resection of the prostate in the difficult cases?

PURPOSE OF REVIEW: Endoprosthesis has been used to maintain luminal patency in several different diseases and is well established in cardiovascular and gastrointestinal pathologies. The usefulness and application in prostatic pathology and benign prostatic hyperplasia are not as clear. This report reviews the development of overactive bladder in patients with bladder outlet obstruction due to benign prostatic hyperplasia. It also describes a new application of prostatic stents in patients with combined overactive bladder and bladder outlet obstruction. RECENT FINDINGS: Over the last few decades, interest has been focused on the pathology of overactive bladder due to bladder outlet obstruction. Persistent outlet obstruction can certainly induce overactivity in some cases. However, the significance of preoperative identification of the latter problem is still an open issue, and it is obviously of vital importance to find instruments to identify parameters of prognostic significance. Different prostatic stents have been used for a variety of purposes. Recent studies have demonstrated that prostatic stents are effective in relieving obstruction and urinary retention. However, the role of prostatic stents in bladder outlet obstruction is still not clear when compared with other minimally invasive options. By using a prostatic stent to simulate transurethral resection of the prostate, the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder has been possible to assess before the operation. However, larger controlled clinical studies are needed to corroborate the value of the test. SUMMARY: Prostatic obstruction can induce severe overactive bladder in some cases. A prostatic stent to relieve outflow obstruction and to simulate transurethral resection of the prostate decreases the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder because very high risk patients can be excluded from surgery. The stent test indicates that patients who do not leak and experience reduced symptoms when they are relieved of their outlet obstruction can be advised to have a transurethral resection of the prostate.

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PubMed1989

[An electromyographic study of detrusor sphincter dyssynergia in neurogenic vesical dysfunction. Part 2. Changes after radical transurethral resection of prostate and response to alpha-adrenergic stimulation].

The relevance of the type of detrusor sphincter dyssynergia (DSD) and motor unit analysis as examined by simultaneous recordings of electromyography (EMG) of the external urethral sphincter (EUS) and bladder pressure was discussed in the first report. In this report, they were analysed similarly before and after radical transurethral resection of the prostate (TUR-P) to see how it was effective in relieving DSD. Furthermore, the response of the EUS to alpha-adrenergic stimulation was examined by analyzing its motor unit activity. Radical TUR-P was performed in 18 cases. After radical TUR-P, there was an improvement in the type of DSD (3 cases) or in its sub-types (8 cases), associated with decrease in residual urine rate in 16 cases. EUS responded to alpha-adrenergic stimulation with an increase in the frequency of pre-existing motor units and recruitment of new motor units. After radical TUR-P,EUS was similarly activated when stimulated with alpha-adrenergics. These data indicated that radical TUR-P was effective in relieving DSD by suppressing or abolishing abnormal continence reflex. Moreover, alpha-adrenergic activation of EUS also seemed to suggest a possible sympathetic role in the genesis of DSD, although exact mode of its involvement in the somatomotor innervation of the EUS remains to be settled.

Adrenergic alpha-Agonists↗

PubMed1976

Transurethral resection of prostate via perineal urethrostomy. Prospective study.

A controlled, prospective clinical study was undertaken to determine the incidence and cause of urethral strictures after transurethral resection. Patients were assigned to 1 of 3 groups. Group A consisted of patients in whom it was considered preferable for various reasons to perform prostatic resection through perineal urethrostomy; therefore, these were excluded from randomization. All other patients were randomized using a sealed-envelope method into Group B who underwent resection via perineal urethrostomy and Group C who underwent resection via the entire urethra. Strictures occurred in 6 of 42 patients in Group C postoperatively while patients in Group B remained free of strictures. This difference was statistically significant (p less than 0.05). It was concluded that strictures which occur result from the use of the resectoscope through the entire urethra and not from the use of indwelling catheters, and that performing prostatic resection via perineal urethrostomy is valuable in preventing the occurrence of such strictures.

Follow-Up Studies↗

PubMed1978

Do we overtreat patients undergoing transurethral resection of the prostate?

Two hundred unselected patients undergoing transurethral resection of the prostate have been surveyed. The routine use of endotracheal intubation, muscle relaxants, intermittent positive pressure respiration, intravenous fluids and postoperative sedation was avoided whereever possible. The results of this survey are presented and indicate that such measures can be omitted from the management of patients undergoing transurethral resection of the prostate with no significant increase in morbidity or mortality and, indeed, morbidity and mortality may be decreased by their exclusion.

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PubMed1986

Reduction of post-operative bleeding after transurethral resection of the prostate by local instillation of fibrin adhesive (Beriplast).

A method for instilling a two-component fibrin adhesive into the prostatic cavity after transurethral resection of the prostate is described. In a prospective, controlled study, 30 consecutive patients undergoing transurethral prostatectomy (TURP) were randomised either to receive treatment with the local instillation of fibrin adhesive into the prostatic cavity or to a control group that received no special treatment post-operatively. There were no complications either during application of the fibrin adhesive or in the follow-up period. Post-operative blood loss was significantly reduced in the fibrin group (P less than 0.01).

Fibrin↗

PubMed1991

Benign prostatic hypertrophy.

By age 75, between 10 and 25 percent of men require intervention for problems caused by benign prostatic hypertrophy. Symptoms of bladder outlet obstruction include hesitancy, terminal dribbling, postvoid fullness and double voiding. Symptoms of bladder irritability include frequency, urgency, dysuria and nocturia. Urinary retention, hydronephrosis, azotemia and worsening obstructive symptoms are indications for treatment. In addition to catheter drainage or surgical resection, new treatment options include the use of alpha-adrenergic blockers and antiandrogens, as well as balloon dilatation of the prostate. Transurethral resection of the prostate remains the mainstay of treatment, providing effective relief in 85 percent of patients. Since only the enlarged portion of the prostate is removed, prostatic cancer or recurrence of benign prostatic hypertrophy is possible.

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