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Results for “Transurethral Resection of Prostate”

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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.

Aged↗

PubMed1977

Transurethral resection of prostate via perineal urethrostomy: follow-up report.

A controlled, prospective clinical study was undertaken to determine the incidence and cause of urethral strictures after transurethral resection. Patients were assigned to one of three groups. Group A consisted of patients in whom it was considered preferable 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 16.4 per cent of 85 patients in Group C and in 2.27 per cent of 88 patients in Group B; a statistically significant difference (p less than 0.01). It was concluded that strictures result from the trauma of the urethroscope via the entire urethra and not from the use of indwelling catheters. Perineal urethrostomy is the preferred route for prostatic resection and is mandatory whenever there is any question about the acceptability of the urethra to the resectoscope.

Follow-Up Studies↗

PubMed2005

Fluid absorption in endoscopic surgery.

Fluid absorption is an unpredictable complication of endoscopic surgery. Absorption of small amounts of fluid (1-2 litre) occurs in 5-10% of patients undergoing transurethral prostatic resection and results in an easily overlooked mild transurethral resection (TUR) syndrome. Large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Pathophysiological mechanisms consist of pharmacological effects of the irrigant solutes, the volume effect of the irrigant water, dilutional hyponatraemia and brain oedema. Other less widely known factors include absolute losses of sodium by urinary excretion and morphological changes in the heart muscle, both of which promote a hypokinetic circulation. Studies in animals, volunteers and patients show that irrigation with glycine solution should be avoided. Preventive measures, such as low-pressure irrigation, might reduce the extent of fluid absorption but does not eliminate this complication. Monitoring the extent of absorption during surgery allows control of the fluid balance in the individual patient, but such monitoring is not used widely. However, the anaesthetist must be aware of the symptoms and be able to diagnose this complication. Treatment should be based on administration of hypertonic saline rather than on diuretics. New techniques, such as bipolar resectoscopes and vaporizing instead of resecting tissue, result in a continuous change of the prerequisites for fluid absorption and its consequences.

Absorption↗

PubMed1987

Incidental adenocarcinoma in transurethral resections of the prostate. Partial versus complete microscopic examination.

Transurethral resection of prostate (TURP) for clinically benign prostatic enlargement is a common surgical procedure which often provides voluminous material for microscopic pathology examination. In about 15% of cases, prostate adenocarcinoma will be discovered incidentally in TURP tissue. Many of these incidental carcinomas are stage A1 and require no further clinical intervention, but a significant number of them are stage A2. The question in this study was to ascertain whether all or only a portion of tissue from routine clinically benign TURP specimens must be submitted in order to detect all clinically significant (stage A2) prostatic carcinomas. Results from this prospective study of 457 clinically benign TURPs in which all tissue was processed revealed 65 (14.2%) incidental carcinomas. Statistical analysis by number of blocks of tissue examined revealed that all A2 carcinomas and the large majority of A1 carcinomas would be detected by routine submission of eight blocks (average: 12.8 g) of prostate chips. This finding is in close accord with traditional practice of pathologists as published in a national survey.

Adenocarcinoma↗

PubMed2003

Management of symptomatic benign prostatic hyperplasia in southern Italy: a retrospective analysis of the Sicilian-Calabrian Society of Urology (SSCU) of 32,000 patients.

INTRODUCTION: The availability of new pharmacological and surgical options is responsible for important changes in the management of symptomatic benign prostate hyperplasia (BPH). The Sicilian-Calabrian Society of Urology performed a retrospective survey to assess the management of BPH in southern Italy in 1997 and 1998. PATIENTS AND METHODS: A 3-page questionnaire was sent to the 36 urological units of these two regions. The real number of patients treated was required. The numbers were checked with data obtained from the Health Regional Offices. RESULTS: Twenty-six urological units (72.3%) replied. Almost all patients underwent urinalysis, determination of serum prostate-specific antigen and creatinine levels, and renal and postvoid vesical echography. Uroflowmetry was performed in 69% and transrectal ultrasound in 56% of the patients. International Prostate Symptom Score or other symptom scores were used in 36% of the cases. Out of 31,558 patients with symptomatic BPH, 5,636 were surgically treated. Admission was due to acute urinary retention in 1,324 cases (23.5%). Transurethral resection of the prostate was the commonest procedure, accounting for 59.5% of the interventions. Open prostatectomy was performed in 1,804 patients (32%). Minimally invasive therapies accounted for less than 9% of the treatments. CONCLUSIONS: The present survey provides a picture of the current surgical practice in BPH in southern Italy in the late 1990s. Symptom scores are not routinely adopted. The low rate of transurethral prostate resections is in keeping with the worldwide decline. On the contrary, a high rate of open prostatectomies has been detected.

Adult↗

PubMed1992

Transurethral resection of prostate under TV monitoring (TV-TURP).

Since February 1987, we have used television monitoring as the main method for operative guidance during transurethral resection (TV-TURP). With this system, the surgeon watches the image on the TV monitor during TURP, and does not look through an endoscope. Seventy-one cases treated using TV-TURP were compared with 50 cases treated by conventional TURP without TV monitoring. The resection time per gram of tissue for TV-TURP was not significantly different from that of the conventional TURP. The other resulting data for TV-TURP were also statistically similar to those for conventional TURP. TV-TURP is an excellent method and not inferior to conventional TURP.

Aged↗

PubMed1984

Morbidity of radical perineal prostatectomy following transurethral resection of the prostate.

Radical prostatectomy in patients who have had prior transurethral resection of the prostate has been reported to result in significant morbidity. From 1974 to 1982, 30 patients who had had previous transurethral resection of the prostate underwent radical perineal prostatectomy for localized prostatic cancer. Operative time and blood loss were similar to a group of patients who had not had prior transurethral resection of the prostate. Over-all, 3 patients (10 per cent) had total incontinence and 3 (10 per cent) had stress incontinence requiring a pad or device. No patient undergoing radical prostatectomy less than 4 weeks or more than 4 months after transurethral resection of the prostate had postoperative incontinence. When radical perineal prostatectomy was performed between 4 weeks and 4 months after transurethral resection of the prostate the incidence of incontinence was 50 per cent. Five patients experienced prolonged perineal urinary drainage, all but 1 of whom healed spontaneously. Of the 6 patients with incontinence 3 had prolonged drainage. No patient had a rectal injury and there was no operative mortality. Two patients died without cancer and 1 has evidence of disease recurrence. We conclude that radical prostatectomy may be performed safely with acceptable morbidity following transurethral resection of the prostate and that if 4 weeks has elapsed since resection it might be advantageous to wait 4 months before performing radical surgery to lessen the risk of incontinence.

Aged↗

PubMed1986

The correlation of pretreatment transurethral resection of prostatic cancer with tumor dissemination and disease-free survival. A univariate and multivariate analysis.

A multivariate Cox's hazard function analysis was performed on the prognostic variables selected from 240 patients with localized carcinoma of the prostate who received external beam radiotherapy to analyze the association between the method of biopsy and disease-free survival. The patients received 4500 cGy to the pelvis followed by a 2-week treatment rest and then an additional 2000 cGy to the reduced prostatic volume. Median follow-up was 4 years (range, 1-9 years). The 5-year actuarial local control rate was 91%. There was no difference in local control relative to the method of biopsy (needle biopsy or transurethral resection of the prostate [TURP]). The 5-year actuarial risks of metastases were 28% and 48% for the needle biopsy and TURP groups, respectively (P less than 0.01). The 5-year disease-free survival for the needle biopsy and TURP groups were 55% and 42%, respectively (P less than 0.05). This difference maintained statistical significance for Stage C and Grade III tumors. A multivariate analysis demonstrated that "method of biopsy" was the third most powerful variable after serum acid phosphatase level and modified Broders' grade in predicting disease-free survival. Patients who had TURP had an almost twofold higher relative risk of disease progression than those who had needle biopsy. This study established the correlation of the method of biopsy with a lower probability of disease-free survival over and above the information obtained from the clinical stage, histologic grade, presence or absence of symptoms of obstruction, acid phosphatase level, and lymph node status. The association of TURP with tumor dissemination is discussed with reference to the mechanism of metastasis formation and prevention.

Biopsy, Needle↗

PubMed1990

[Video-guided TUR].

Video-TUR has become a very important new technique in urology, causing far less discomfort than conventional techniques for the surgeon. A mini-chip camera (Olympus OTVS-2) is attached to the lens system of a continuous-flow resectoscope (Olympus). A television monitor (Sony PVM 1442) provides reliable guidance for the cutting loop when resection is necessary for the treatment of benign hypertrophy or carcinoma of the prostate or carcinoma of the bladder. To maintain a good intravesical flow system, which is very important for a clear field of view, a suprapubic cystostomy should be placed. The surgeon sits in a comfortable position with both eyes on the screen so that eye-strain, back pain and mental stress can be reduced. The excellent depth perception is due to a 50-times enlargement by the camera, so that tissue-orientated TUR is possible. Even when it is not possible to place the patient in an optimal position, because of scrotal hernia or coxarthrosis, TUR can still easily be performed. In 120 transurethral prostate resections and 30 transurethral bladder tumour resections, the video technique has proved comfortable for the surgeon and safe for the patient. Video-TUR has been helpful in the presentation of this technique in urologic teaching. TUR of the prostate has been freed from much of its mystique, since the procedure can be watched while it is in progress. The video technique has opened up a new epoch in endourology, whose importance cannot yet be realized.

Humans↗

PubMed1993

Negative repeat transurethral resection of prostate fails to identify patients with stage A1 prostatic carcinoma at lower risk of progression: a long-term study.

Stage A1 (low-grade and low-volume) adenocarcinoma is associated with a low likelihood of progression. Repeat transurethral resection has been used to identify patients at increased risk (residual cancer noted) as well as those at low risk of progression (no residual cancer noted). We recently evaluated the ability of this technique to define a low-risk patient population. We reviewed the records of 24 patients who underwent repeat transurethral resection after they were identified as having Stage A1 prostatic cancer on initial resection (Gleason score < 5, tumor volume comprising < 5% of the resection specimen). Despite no evidence of residual carcinoma on repeat resection, 3 patients (13%) progressed at a mean follow-up of seven years (2 locally, 1 locally and distantly). We conclude that repeat resection does not effectively evaluate the risk of progression and that other techniques including transrectal ultrasonography and serial prostate-specific antigen measurements should be similarly evaluated.

Adenocarcinoma↗

PubMed1989

Symptom analysis and uroflowmetry 7 years after transurethral resection of the prostate.

The long-term result after transurethral resection of the prostate is not well documented. From 1981 to 1983, 84 consecutive consenting patients completed detailed symptom analysis and urodynamic examination before transurethral resection of the prostate. These studies were repeated 3 and 12 months postoperatively. Of the 84 patients 44 were interviewed at 86 months: 75% reported improvement compared to preoperative symptoms. In addition, 23 patients underwent uroflowmetry at 7 years. For this group the maximum urine flow rate remained virtually unchanged from 1 to 7 years postoperatively). When uroflowmetry results from all patients undergoing testing at the various followup intervals are considered, the maximum urine flow rate was 9.5 ml. per second preoperatively, 17.0 ml. per second at 3 months and 19.6 ml. per second at 1 year. Of the 44 patients 7 (16%) underwent repeat transurethral resection of the prostate.

Aged↗

PubMed2001

The 2-year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy vs transurethral resection of the prostate.

OBJECTIVE: To assess the 2-year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy of the prostate (IRFT) vs transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Patients with lower urinary tract symptoms (LUTS) and urodynamic evidence of bladder outlet obstruction (BOO) were randomized to undergo IRFT or TURP and were followed up using the International Prostate Symptom Score (IPSS) and urodynamic assessment for 2 years. RESULTS: At 2 years there was a clinically relevant reduction in the IPSS in the IRFT (20 to 9) and TURP groups (22 to 4). There was also a statistically significant reduction in the detrusor pressure at maximum urinary flow in both groups, but the reduction in the IRFT group was probably not sufficient to explain the observed symptomatic improvements solely from a reduction in BOO. CONCLUSION: IRFT can produce a sustained improvement in LUTS for at least 2 years. However, such improvements are unlikely to be entirely the result of a reduction in BOO. The effects of radiofrequency energy may, at least partly, be independent of any thermal effect and depend instead on neuromodulation of lower urinary tract nerves.

Catheter Ablation↗

PubMed1997

The early postoperative morbidity of transurethral resection of the prostate and of 4 minimally invasive treatment alternatives.

PURPOSE: We compared the early postoperative morbidity of transurethral resection of the prostate to minimally invasive treatment alternatives with respect to the objective rate of complications and subjective morbidity assessed by a patient addressed diary-type questionnaire. MATERIALS AND METHODS: Parameters evaluated preoperatively were the International Prostate Symptom Score (I-PSS), free flow study, post-void residual, transrectal ultrasonography and a pressure-flow study. The patients underwent transurethral resection (28), transrectal high intensity focused ultrasound (20), visual laser ablation (15), transurethral needle ablation (15) and transurethral electrosurgical vaporization (17) of the prostate. On the day of hospital discharge the patients received the questionnaire and were asked to answer daily 7 questions concerning micturition status. After 6 weeks the questionnaire was returned and an I-PSS, uroflowmetry and post-void residual were obtained. RESULTS: Preoperatively, there was no statistically significant difference regarding the I-PSS, peak flow rate, prostate volume and degree of bladder outlet obstruction. After 6 weeks the peak flow rate improved most prominently after transurethral electrosurgical vaporization (+ 13.2 ml. per second), transurethral resection of the prostate (+ 12.3 ml. per second) and visual laser ablation (+ 11.1 ml. per second). The I-PSS decreased most significantly after transurethral resection (-14.1) and transurethral electrosurgical vaporization (-8.4). There was no difference regarding the rate of adverse events within the first 6 weeks postoperatively in the 5 treatment arms. Mean duration of catheter drainage plus or minus standard deviation was 3.7 +/- 1.2 days after transurethral resection of the prostate, 6.8 +/- 1.7 days after high intensity focused ultrasound, 7.8 +/- 1.5 days after visual laser ablation, 2.0 +/- 0.4 days after transurethral needle ablation and 3.3 +/- 0.8 days after transurethral electrosurgical vaporization. Analysis of the questionnaire revealed that the daytime frequency, degree of hematuria and incontinence were comparable for all 5 procedures within the first 6 weeks postoperatively. Postoperative dysuria was greatest after visual laser ablation and transurethral electrosurgical vaporization. Regarding the degree of nocturia, there was no improvement after visual laser ablation, while the remaining 4 procedures yielded a significant and comparable decrease. The most significant subjective improvement in uroflowmetry was reported after transurethral resection of the prostate and transurethral electrosurgical vaporization. Regarding the global quality of life question, the patients were generally more worried after visual laser ablation and transurethral needle ablation compared to the other 3 procedures. CONCLUSIONS: The overall morbidity of transurethral resection of the prostate within the first 6 weeks postoperatively is equivalent to that of the 4 minimally invasive treatment alternatives evaluated in our study. When comparing the 4 minimally invasive procedures, no dramatic differences were notable, although visual laser ablation seems to be associated with a greater degree of morbidity as assessed by this questionnaire.

Aged↗

PubMed1992

Comparison of the cost-effectiveness of various therapies for common prostatic disorders.

Diseases of the prostate currently represent a major health problem worldwide. As the age of the male population increases in the future, so will the number of patients suffering from these disorders and the cost for treatment increase. Currently, benign prostatic hyperplasia (BPH) and prostate cancer are common in men over 50 years of age. In men after puberty, prostatic infections (prostatitis) are common. Each condition carries with it controversy regarding the most cost-effective treatment. Treatment for these disorders can include surgical intervention, drug therapy, or no treatment at all. In the United States, surgery is the usual treatment of BPH in men over 65 years of age, but most patients with BPH are asymptomatic and require no intervention. Aside from acute urinary retention or backpressure that compromises renal function, the indications to perform surgery are questionable. While some alpha-adrenergic antagonists are used to temporarily relieve symptoms, many patients with BPH will eventually require surgery. Transurethral resection of the prostate is the surgical treatment of choice in selected patients with BPH, accounting for over 90% of surgery performed in this area. The risk-to-benefit ratio for this procedure is favourable and cost-saving steps can be taken by the physician. Open prostatectomy, both suprapubic and retropubic, is performed to treat large prostates. However, both hospital stay and overall morbidity is higher for open prostatectomy than for transurethral prostatic resection. Radical prostatectomy and radiotherapy are commonly performed to treat patients with cancer of the prostate. For patients with the early stages of the disease, administering no treatment is also acceptable. Each therapeutic method has its advocates, and overall survival rates are similar for all treatments. Radiotherapy, however, is less expensive. We review the magnitude of these diseases, therapies available and relevant cost-effectiveness studies. When this sort of scientific information is not taken into account, the physician's decision of which therapy to choose is sometimes blinded by the prejudices and fears of the patient.

Catheterization↗

PubMed2000

Are there acid base changes during transurethral resection of the prostate (TURP)?

UNLABELLED: Acid base status during transurethral resection of the prostate (TURP) has been almost neglected. We therefore measured the acid base status and interpreted the observed changes according to the Stewart approach. The Stewart model focuses more on the influence of serum electrolyte concentrations on acid base changes than does the conventional Henderson-Hasselbalch approach. In 20 patients undergoing TURP, the following variables were determined: PaO(2), PaCO(2), pH(a), actual bicarbonate, standard base excess, serum concentration of sodium, potassium, chloride, lactate, and total protein. A study group (n = 11) and a control group (n = 9) were built, depending on the maximal amount of fluid absorption estimated with the aid of ethanol concentration monitoring in the expired gas. The study group developed a mild acidosis with a decrease in pH from 7.41 to 7.37 (P = 0.037), compared with a very discrete pH decrease from 7.44 to 7.42 in the control group. We found that moderate irrigant absorption during TURP leads to a specific metabolic acidosis. We speculate that larger amounts of irrigant absorption may cause a more severe metabolic acidosis. As the constellation of independently pH regulating variables appears to be typical for TURP, this acidosis could be named "TURP-acidosis." IMPLICATIONS: We measured acid base status in 20 patients undergoing transurethral resection of the prostate comparing a larger fluid absorption group with a minor or no fluid absorption group. We postulate the development of a typical metabolic transurethral resection of the prostate-acidosis caused by irrigant absorption.

Acid-Base Imbalance↗

PubMed2004

Prostate brachytherapy can be performed in selected patients after transurethral resection of the prostate.

PURPOSE: To evaluate urinary function and bother after prostate brachytherapy (PB) in patients who have had prior transurethral resection of the prostate (TURP). METHODS AND MATERIALS: A total of 171 patients with stage T1a-T2b prostate cancer, Gleason score <or=7 who underwent prior TURP received PB at a single institution. In January 2002, all 171 patients were mailed the University of California-Los Angeles Prostate Cancer Index and International Prostate Symptom Score sheet. One hundred patients (60%) returned completed surveys. Time of TURP before implant ranged from 2 to 300 months (median, 6.5 years). Mean patient age was 74 +/- 5.2 years, follow-up time after implant ranged from 6.1 to 50.9 months (median, 25 months). RESULTS: The mean urinary function score and bother score for the entire study group was 83.5 +/- 19.5 and 82.5 +/- 23.7, respectively. Multivariate analysis revealed higher pretreatment International Prostate Symptom Scores to have significant negative impact (p = 0.001) on urinary function and bother scores. CONCLUSION: With accurate ultrasound identification of the urethral defect and precise dosimetry, brachytherapy can be performed in selected patients who have had prior TURP with resultant low impact on urinary function and bother scores.

Aged↗

PubMed1986

Does transurethral resection of prostatic carcinoma promote tumor spread?

122 patients with prostatic carcinoma treated by radiation therapy were reviewed. An actuarial analysis was done on survival comparing patients treated by transurethral resection (TURP) prior to radiation to those diagnosed by needle biopsy. Survival rates were not significantly different between groups. TURP was also without effect on interval free of distant or local recurrence. Survival and time to distant or local recurrence were analyzed by tumor stage and grade. A multivariate analysis with the Cox model was made by which the effects of TURP and tumor grade and stage were examined simultaneously. TURP was without effect on survival rates and interval to distant or local recurrence after adjustments had been made for the effects of stage and grade.

Actuarial Analysis↗