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PubMed1997

Transurethral needle ablation of the prostate: a urodynamic based study with 2-year followup.

PURPOSE: We evaluated the efficacy of transurethral needle ablation of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (BPH). This study was urodynamic based with 2-year followup to determine whether transurethral needle ablation of the prostate could reduce bladder outlet obstruction and, if so, whether the effect was durable. MATERIALS AND METHODS: A total of 47 patients with symptomatic BPH underwent transurethral needle ablation of the prostate under local anesthesia and intravenous sedation. All patients were evaluated subjectively using the American Urological Association symptom index and the quality of life score. Patients were evaluated objectively with uroflowmetry, post-void residual volume and pressure-flow studies. All patients underwent subjective and objective evaluation before treatment. Followup was conducted at 1, 3, 6, 12 and 24 months after treatment. Short and long-term complications were assessed. RESULTS: At 6-month followup there was 71% improvement in mean cases (22.4 to 6.6, 42 patients symptom index, p < 0.05), and 66% improvement in mean quality of life score (4.6 to 1.56, 42 patients, p < 0.05). Maximum flow rate, post-void residual volume and detrusor pressure at maximum flow rate also showed statistically significant improvements throughout the study. At 12-month followup there was a 55% increase in maximum flow rate (6.6 to 10.23 ml. per second, 29 patients, p < 0.05). A 37% reduction in mean detrusor pressure at maximum flow rate (92.4 cm. to 58 cm. water, 31 patients, p < 0.05) was recorded at 24-month followup, thus indicating that transurethral needle ablation of the prostate can lower bladder pressure-significantly. Post-void residual volume decreased from a pretreatment mean of 76.1 ml. to a mean of 36.9 ml. (31 patients, p < 0.05) at 24 months. Short-term complications (3 months) included transient posttreatment urinary retention in 8 patients (17%), duration 1 to 9 days, mild to moderate transient frequency dysuria all patients which resolved in more than 90% by 5 weeks and epididymitis in 1. A patient questionnaire was used to evaluate changes in sexual function and there were no reports of disturbances in erectile function or retrograde ejaculation. There were no long-term complications. However, 6 patients (12.7%) had persistent bothersome symptoms during the followup period and underwent transurethral prostate resection. Further analysis of this subset of patients with respect to pretreatment evaluation and transurethral needle ablation procedure did not reveal significant differences between them and patients with successful outcomes. CONCLUSIONS: Transurethral prostate resection is a safe and effective technique for treating lower urinary tract symptoms related to benign prostatic hyperplasia. The technique can be performed in the office as an outpatient, or as a same day surgical procedure, using topical anesthesia with intravenous sedation, if necessary. In the majority of patients subjective and objective improvements were sustained for the duration of this study, which included 2-year followup with pressure-flow studies.

Follow-Up Studies↗
PubMed1990

Transurethral resection of the prostate in the outpatient setting.

Transurethral resection of the bladder neck (8 patients) or prostate (142) was performed in the outpatient setting. Of the patients 5 required hospitalization for post-prostatectomy hemorrhage. This method has proved to be safe and cost-effective in the treatment of patients with outlet obstruction.

Adenocarcinoma↗
PubMed2000

A randomized study comparing high-energy TUMT to TURP: quality-of-life results.

PURPOSE: To evaluate the impact of high-energy transurethral microwave thermotherapy (TUMT) and transurethral prostatic resection (TURP) on quality of life (QoL) in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 147 patients with BPH were randomized to receive either high-energy TUMT treatment (Prostasoft 2.5) or a TURP and were followed for 1 year. All patients completed a QoL questionnaire to assess perception of urinary difficulties, sexual function, daily activities, psychological well-being, social activities and improvement in QoL. RESULTS: For almost all scales the standardized Cronbach's alpha was adequate. Between the various QoL scales there is a statistically significant correlation except for social well-being and sexual functions. There is also a significant correlation between the QoL scales and age, IPSS and Madsen. For the sexual functions there is only a correlation with age. A significant difference in improvement in favor of the TURP group was observed in general perception of urinary difficulties and activities of daily living. However, no difference between the groups was observed for the QoL scale measuring experienced improvement. The sexual function is not influenced by both treatment modalities. Both groups have a significant improvement in clinical outcome at all points of measurement. TURP has a better clinical outcome. CONCLUSION: Both TUMT and TURP have a significant positive effect on various aspects of QoL. In particular, perception of urinary difficulties and activities of daily living are positively influenced by both treatments. TURP, however, has a greater impact than high-energy TUMT.

Diathermy↗
PubMed2003

5-year outcome of a prospective randomized trial to compare transurethral electrovaporization of the prostate and standard transurethral resection.

OBJECTIVES: To update our prospective randomized trial comparing the safety, efficacy, and durability of transurethral electrovaporization of the prostate (TUVP) using the VaporTrode with standard transurethral resection of the prostate (TURP). METHODS: A total of 104 patients, taken from the waiting list for surgery for benign prostatic hyperplasia were randomized to TUVP (52 patients, mean age 67.5 years) or TURP (52 patients, mean age 70.2 years). In each group, 51, 47, and 40 patients completed 1, 2, and 3 years of follow-up, respectively. Of the 104 patients, 27 TURP and 26 TUVP patients completed 5 years of follow-up. RESULTS: Both groups were comparable in terms of the mean preoperative International Prostate Symptom Score, quality-of-life score, maximal urinary flow rate, and postvoid residual volume. The follow-up data at 5 years showed a significant and maintained improvement in the mean International Prostate Symptom Score (TUVP: 5.9 +/- 6.3 versus TURP: 8.6 +/- 7.1, P = 0.16), quality-of-life score (TUVP: 1.1 +/- 1.2 versus TURP: 1.7 +/- 1.4, P = 0.09), and mean maximal urinary flow rate (TUVP: 21 +/- 9 mL/s versus TURP: 17.9 +/- 13.1 mL/s, P = 0.17), with decreases in the mean postvoid residual volume (TUVP: 27.3 +/- 44.3 mL versus TURP: 10.7 +/- 13.1 mL, P = 0.08). Two patients in each group (4%) developed urethral strictures. Two TURP patients (4%) developed bladder neck strictures compared with one TUVP patient (2%). In each arm, 7 patients (13%) underwent reoperation during a 5-year period (approximate reoperation rate: 3% in each arm per year). Postoperatively and during 3 years of follow-up, impotence was reported in 17% of the TUVP group and 11% of the TURP group (P = 0.49); retrograde ejaculation was reported in 72% of the TUVP group and 89% of the TURP group (P = 0.47). CONCLUSIONS: Our 5-year follow-up results confirm that TUVP is as effective as standard TURP in the treatment of moderate-size benign prostatic hyperplasia. The reoperation rate and long-term complication rate are comparable and the initial improvement has been maintained during a 5-year period for most patients in both groups.

Adenocarcinoma↗
PubMed2003

Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months.

PURPOSE: To compare the efficacy and safety of transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) during an 18-months follow-up. PATIENTS AND METHODS: A series of 59 patients older than 40 years were included in this study. The entry criteria were prostate size <70 g, maximum urinary flow rate (Q(max)) <15 mL/sec, International Prostate Symptom Score (IPSS) >13, and no suspicion of prostate cancer according to the clinical or laboratory findings. Of the patients, 26 (44%) were treated with TUNA and 33 (56%) with TURP. At 3 and 18 months of follow-up, Q(max), postvoiding residual volume (PVR), IPSS, and the quality of life (QOL) score were compared with the baseline values. The results were also compared in patients undergoing TUNA v TURP. RESULTS: Improvements in Q(max), PVR, IPSS, and QOL score were statistically significant for both groups at 3 and 18 months of follow-up. The increase in the mean Q(max) of the TURP group was higher than that in the TUNA group, whereas no significant differences were found in the two groups regarding improvements in IPSS and QOL score. There were no complications associated with the TUNA procedure, while 16 retrograde ejaculation, 4 erectile impairment, 2 urethral stenosis, and 1 urinary incontinence cases were observed after TURP. CONCLUSIONS: The TUNA procedure is an effective and safe minimally invasive treatment with negligible adverse effect for selected patients with symptomatic BPH compared with TURP. It should be considered as an alternative treatment option for younger patients who want to preserve sexual function.

Adult↗
PubMed1987

Incidence of serum acid phosphatase elevation after transurethral prostatectomy.

Serum acid phosphatase levels were measured in 402 patients after transurethral resection of the prostate for benign adenoma. All patients had normal preoperative serum acid phosphatase levels (less than 0.8 IU/L) and the tissue specimen was histologically benign in all patients. Ninety-three patients (23%) showed normal postoperative serum acid phosphatase levels, while 309 (77%) showed postoperative elevation of serum acid phosphatase. One hundred forty-eight patients (37%) had postoperative levels higher than 5 IU/L. Significant elevation of serum acid phosphatase may follow transurethral prostate resection in patients having no evidence of malignancy.

Acid Phosphatase↗
PubMed1994

[Semi-radical transurethral resection of the prostate for small benign prostatic hyperplasia].

The conventional method of transurethral resection of the prostate (TUR-P) is often not beneficial for small benign prostatic hyperplasia (BPH) because of a high frequency of postoperative bladder neck contracture (BNC). Herein, we examined the usefulness of semi-radical transurethral resection of the prostate (semi-radical TUR-P) from the view points of improvement of peak flow rate, the frequency of postoperative BNC and incidental carcinoma of the prostate in 79 cases of small BPH (group A) and 101 cases (group B) of large BPH in which less than 10 g for more than 10 g of the internal glands was resected, respectively. The bladder neck was resected carefully to avoid over resection which may cause BNC in small BPH cases. Satisfactory results were obtained in both groups, that is, the improvement of the peak flow rate from 7.03 +/- 3.79 ml/sec to 13.9 +/- 7.32ml/sec and from 4.96 +/- 2.88 ml/sec to 15.2 +/- 8.30 ml/sec, and the frequency of BNC were 2.53% (2/79) and 1.98% (2/101) in groups A and B, respectively. The frequency of incidental carcinoma of the prostate were 15.2% (12/79) and 17.8% (18/101) in groups A and B. We conclude that semi-radical TUR-P is a favorable maneuver for small BPH because of satisfactory improvement in peak flow rate with low frequency of postoperative BNC and its superiority in screening test for incidental carcinoma of the prostate.

Aged↗
PubMed1988

[Autologous retransfusion of washed erythrocytes in transurethral resection of prostatic adenomas. Preliminary report].

Red blood cells were concentrated from the irrigation fluid used during prostatic resection in 30 patients by means of a cell saver system. The resulting units of packed red cells were analysed for quality and possible contamination. Average blood loss during the procedure was 645 ml, and an average of 580 ml of packed red cells was harvested and retransfused in 25 patients. Retransfusion was well tolerated and no adverse reactions were seen. Our positive clinical experience with the method and the ease of application suggest that it can probably be recommended as a routine procedure during transurethral resection of the prostate.

Aged↗
PubMed1982

Nosocomial Pseudomonas aeruginosa urinary tract infections.

Two separate outbreaks of Pseudomonas aeruginosa urinary tract infections (UTIs) were associated with cystoscopy or transurethral prostate resection. The first outbreak was identified after routine bacteremia surveillance demonstrated four cases of P aeruginosa septicemia in a three-month period. A six-month retrospective review of the microbiology records identified 14 cases of P aeruginosa UTI associated with urologic surgery instrumentation. The outbreak terminated after the implementation of two major control measures: (1) replacement of hexachlorophene solution with an iodophor solution for preparing patients and cleaning instruments before disinfection, and (2) weekly gas sterilization of cystoscopy instruments. The second outbreak, consisting of 11 cases of P aeruginosa UTI after transurethral resection of the prostate gland, occurred in a 187-bed community hospital. All available patient isolates were serotype 011, and culture of a rubber adaptor attached to the resectoscope also yielded growth of that serotype. The outbreak promptly terminated when the rubber adaptor was sterilized between cases.

Aged↗
PubMed2005

[Therapeutic efficacy of bipolar plasmakinetic technique compared with transurethral resection on benign prostate hyperplasia].

OBJECTIVE: To evaluate the effect and safety of transurethral prostatectomy with the bipolar plasmakinetic technique (PKRP) compared with the transurethral resection (TURP) in the treatment of benign prostate hyperplasia (BPH). METHOD: Four hundred BPH patients with matched lesions were divided into 2 groups: 200 patients, aged 74.1 (58-91), underwent transurethral prostatectomy with PKRP, and 200 patients, aged 73.8 (56-90), underwent TURP. RESULT: In the PKRP group the average IPSS decreased from 27.1 +/- 4.5 preoperatively to 11.3 +/- 3.4 postoperatively 6 months after (P < 0.01), the. average maximum flow-rate Q (max) increased from 6.1 +/- 2.4 ml/s preoperatively to 18.6 +/- 3.5 ml/s postoperatively (P < 0.01), and the average residual urine (RU) reduced from 102.3 +/- 43.3 ml preoperatively to 22.6 +/- 16.3 ml after the operation (P < 0.01). However in the TURP group the average IPSS decreased from 26.9 +/- 4.2 preoperatively to 10.8 +/- 3.6 6 months after the operation (P < 0.01), the Q (max) increased from 5.7 +/- 2.4 ml/s preoperatively to 19.1 +/- 3.7 ml/s postoperatively (P < 0.01), and the average RU decreased from 102.3 +/- 43.3 ml preoperatively to 22.6 +/- 16.3 ml after the operation (P < 0.01). There were no significant differences in these parameters between these 2 groups (all P > 0.05). The average catheter retention time was 31.5 h in the PKRP, significantly shorter than that in the TURP group (61.5 hours, P < 0.01). The incidence rate of post-operational asynodia in the PKRP group was 14.3%, not significantly different from that in the TURP group (15.2%, P > 0.05). During the operation no hemorrhage or transurethral resection syndrome (TURS) occurred in the PKRP group, however, there were 5 cases of TURS and 18 cases of blood transfusion in the TURP group. CONCLUSION: PKRP has the same therapeutic efficacy as TURP on BPH. Moreover, it was more cheaper and with lower complication than TURP.

Aged↗
PubMed2003

Optimization of low pre-operative hemoglobin reduces transfusion requirement in patients undergoing transurethral resection of prostate.

OBJECTIVE: To identify factors that influence peri-operative hemorrhage in view of reducing the need for transfusions in patients undergoing trans uretheral resection of prostate (TURP). METHODS: All patients undergoing TURP between January 1997 and December 1999 were identified using ICD 9CM coding and indexing system. Overall 430 patients were identified, however, 384 charts were included and reviewed for demographics, pre and intra-operative data and post-operative morbidity. Patients were divided into two groups on the basis of presence of significant hemorrhage. RESULTS: Overall 384 patients were analyzed. Nineteen patients had hemorrhage--group I whereas 365 had no significant hemorrhage--group II. Mean age and co-morbidities in the two groups were similar. However, in group I, 58% presented with urinary retention compared to 33% in group II. In group I, factors that reached statistical significance include; operative time (p<0.05), mean resected tissue weight (p<0.02), and patient presentation (urinary retention) (p<0.032). There was no significant difference in the two groups with respect to type of anesthesia (regional versus general) and histology of the resected tissue. Patients with mean pre-operative hemoglobin of 10.6 % had a 37% transfusion rate. CONCLUSION: Operative time, weight of resected prostate tissue are inter related and are only partly controllable. Low pre-operative hemoglobin is the only reversible factor in reducing transfusion following TURP.

Adult↗
PubMed1994

[Cancer of the prostate stage T1. Incidental carcinoma. Review of the literature and an appraisal of the classification].

A major problem in the management of incidental prostatic carcinoma (T1) is that the biological potential of these tumors varies across individuals. In 1975, Jewett suggested separating T1 tumors in two subgroups, called A1 (T1a) and A2 (T1b). The publications reviewed herein demonstrate that it is difficult to identify prognostic factors of potential usefulness for making therapeutic decisions in an individual patient with T1 prostatic carcinoma. Histological examination of tissue removed by transurethral resection or prostatectomy for benign prostatic hypertrophy does not allow determination of the size of the carcinoma or of its histological grade. A large number of patients with incidental carcinoma of the prostate also have other, independent prostatic tumors, especially in the outermost areas of the gland. Consequently, patients with incidental prostatic cancer should have additional diagnostic investigations including repeated prostate specific antigen assays, multiple biopsies, transrectal ultrasonography, computed tomography, and, if called for, magnetic resonance imaging. The value of second-look transurethral prostatic resection (TURP) for improving the accuracy of staging is controversial. This procedure may be indicated only in a small subgroup of carefully selected patients. Flow cytometry analysis of tumor cells may be useful for making therapeutic decisions in patients with T1 prostatic carcinomas. The progression rate in untreated patients with T1a tumors ranges from 16% to 36% and the proportion of patients with residual tumors after TURP is 40% to 80%. Based on these figures, radical prostatectomy can be considered the treatment of choice in young operable patients.

Carcinoma↗
PubMed1997

Diazepam for relief of irrigation pain after transurethral resection of the prostate.

Irrigation of the bladder after transurethral resection of the prostate is often distressing because of pain arising from detrusor muscle spasm. The effect of post-operative oral diazepam was compared with sacral epidural (caudal) block at the time of surgery, both treatments together and a control group, assessed by three-point rank scoring. Either treatment significantly reduced the incidence of pain reported by patients, P < 0.001. No patient experienced pain after both treatments.

Aged↗
PubMed1988

Lower extremity edema from bladder compression of the iliac veins.

Two elderly men were referred to our vascular clinic for the management of bilateral lower extremity edema of 2 to 3 months' duration. Their evaluation included phlebograms, which demonstrated external compression of their iliac veins. CT scans of the pelvis suggested that large bladders caused the compression. Each patient had mild symptoms of prostatism. Transurethral resection of the prostate was recommended to and accepted by each patient. Decompression of the bladder was accompanied by complete relief of the lower extremity venostasis in both patients. Review of the literature yielded only eight similar cases of this unusual cause of lower extremity edema.

Aged↗
PubMed1984

An unusual complication to transurethral resection of the prostate. A case report.

During a transurethral resection of the prostate, performed in epidural anaesthesia, a 77-year-old man developed dyspnoea and distension of the lower abdomen. Acute cystostomy revealed a large bladder diverticulum containing 2 liters of irrigating fluid together with some tissue chips and 3 small bladder tumours. The tissue chips functioned as a stop valve only permitting entrance of fluid. In the absence of preoperative radiological examination of the urinary bladder meticulous cystoscopic examination of every tiny opening in the bladder is mandatory.

Aged↗
PubMed2000

Transurethral resection of the prostate: failure patterns and surgical outcomes in patients with symptoms refractory to alpha-antagonists.

BACKGROUND: alpha-Antagonists (AAs) are ineffective in some men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) may be required. Reasons for AA failure and surgical outcomes in these patients have not been reported. METHODS: We retrospectively reviewed cases of TURP for LUTS due to bladder outlet obstruction from 1995 to 1998. The TURP patients in whom AA therapy had failed (group 1) were compared with those who had symptomatic BPH but were not taking AAs (group 2). Comorbid conditions that might influence treatment results were considered, as were sizes of resection and pathologic results. RESULTS: No differences occurred between groups 1 (n = 38) and 2 (n = 25) in age, length of postoperative follow-up, or resection size. However, outcomes were poorer in group 1 than in group 2. A trend toward greater comorbidity that might lead to voiding dysfunction, though not statistically significant, was seen in group 1. CONCLUSIONS: Postoperative results of TURP may be less successful after AA therapy failure. This may be due to preoperative risk factors that affect voiding function rather than to prostatic size.

Adrenergic alpha-Antagonists↗
PubMed1998

The release of free prostate specific antigen into the circulation during transurethral resection of the prostate: kinetics and interaction with serum protease inhibitors.

OBJECTIVE: To determine the nature and extent of the release of prostate specific antigen (PSA) and its interaction with its plasma protein-derived inhibitors after transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Twenty-three consecutive patients undergoing routine TURP for benign prostatic hyperplasia had blood samples taken pre-operatively and then post-operatively at 8-hourly intervals for 24 h. Further samples were obtained at 48 and 72 h post-operatively. Serum free and total PSA were determined by immunofluorometric assay. The major plasma protein inhibitors for PSA were also determined by immunoassay. RESULTS: The mean free and total PSA fractions increased significantly post-operatively with levels greatest immediately after surgery. There was also a gradual increase in the complexed PSA fraction, reaching a peak at 48 h. The concentration of the major serum inhibitors of PSA (alpha-1-antichymotrypsin and alpha-2-macroglobulin) also declined immediately after surgery. CONCLUSION: Increases of serum total PSA in patients after TURP are caused by increases in the free PSA fraction. The exponential decline in free PSA concentrations is consistent with the complexing of PSA with its protease inhibitors present in the plasma. The formation of this complex suggests that the free PSA released into the circulation at the time of TURP is the enzymatically active form.

Humans↗