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PubMed2005

Role of risk factors for erectile dysfunction in patients undergoing transurethral resection of the prostate: early impact on sexual function.

INTRODUCTION: Transurethral resection of the prostate (TURP) has been long debated as a possible cause of erectile dysfunction (ED). We investigated the role of common risk factors for ED in patients aged 60 to 70 undergoing TURP Factors related to the treatment were also considered. MATERIALS AND METHODS: Ninety patients underwent TURP for benign prostate hyperplasia (BPH) from June 2002 to February 2003. Fourty-two of them, sexually active aged 60 to 70, were administered preoperatively and 3-month postoperatively the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires. A complete assessment of risk factors for ED was performed in the preoperative setting (treated hypertension, diabetes, cigarette smoking, hypercolesterolemy, cardiovascular disease). IIEF score was related to age, comorbidities, operative time, resected tissue weight, retrograde ejaculation, IPSS score. RESULTS: Nine (21.4%) patients reported worsened IIEF-5 score after TURP, and 33 (78.6%) unchanged/improved score. Cardiovascular disease was present in 56% of patients with worsened IIEF-5 score and in 12% of patients with improved/unchanged IIEF-5 score; it was the only factor that correlated significantly in the regression model. CONCLUSION: In general, most patients report a stable sexual function after TURP. Patients with known cardiovascular disease undergoing TURP had an increased risk of sexual impairment after this procedure.

Aged↗
PubMed1996

Prostatic tissue distal to the verumontanum and its significance for adenomatous recurrences after transurethral resection of the prostate. A cadaver study.

To elucidate possible causes of recurrences after transurethral resection of the prostate (TURP), we performed an anatomical study of the prostate in 37 cadavers. The anatomical study showed that a significant proportion of the prostatic adenoma laid below the verumontanum. This proportion in relation to the total prostatic length varied from 8.33 to 44.44%, while in relation to the weight it varied from 2.08 to 36.84%. After transurethral resection of the prostatic adenoma, part of the apical lobes below the verumontanum remains intact deliberately to secure continence. These adenomatous tissues left behind create the problem of the residual apical lobe. Recent reports in the literature have shown a higher incidence of prostatic adenomatous recurrences following TURP than after open prostatectomy. From our study and from an extended search in the literature, it seems that a possible reason for adenomatous recurrences can be due to the remaining residual apical lobes that are left behind after TURP, providing that the resection had been complete.

Humans↗
PubMed2001

Intravesical pressure and the TUR syndrome.

Intravesical pressure was measured continuously during 35 transurethral prostate resections using a fine suprapubic catheter. Absorption of irrigating fluid was detected by tagging it with ethanol and sampling the expired breath using an alcohol meter. Higher mean (SD) intravesical pressure was demonstrated in those patients who absorbed irrigating fluid (19.1 (7.7) mmHg) than in those who did not (12.4 (6.5) mmHg; p = 0.00004). Higher peak pressures were also demonstrated among absorbing patients. Traditional risk factors for fluid absorption, such as operator experience and resectate mass, were found to correlate with pressure exposure over time. Exposure to supranormal bladder pressure over time is the final common path for all causes of absorption. Vesical pressure monitoring may be a valuable feedback tool during difficult resections or operator training.

Absorption↗
PubMed1986

Diagnosis of adenocarcinoma in transurethral resectates of the prostate gland.

The often-posed question of how much prostate tissue should be examined microscopically to detect carcinoma in transurethral prostatectomy specimens was approached by prospective study and probability analysis. Transurethrally resected prostate specimens were weighed, totally embedded, and examined histologically in 151 consecutive cases. Resected fragments and fragments involved by carcinoma were enumerated for each case. Adenocarcinoma was diagnosed in 39 (25.8%) of the cases. Specimens containing carcinoma had a mean of 111 total fragments, with a median of 3 and mean of 7 positive fragments. In two clinically unsuspected cases of poorly differentiated adenocarcinoma, the number of fragments involved by carcinoma was small (2 of 164 and 4 of 190 fragments). Assuming that study of a single microscopic section of a fragment determines whether carcinoma is present, probability formulations are presented expressing the likelihood that at least one fragment containing cancer is found in randomly selected fragments from a specimen. To achieve a 95% probability of detecting carcinoma in TUR specimens, a minimum of 95% of the fragments must be examined if one fragment contains a carcinoma, 63.1% of the fragments if three contain carcinoma and 25.8% of the fragments if 10 contain carcinoma. Literature review indicates many authors recommend examining fewer fragments of transurethrally resected prostate tissue than this study indicates are required to diagnose carcinoma.

Adenocarcinoma↗
PubMed1990

The predictive accuracy of staging transurethral resection of the prostate in the management of stage A cancer of the prostate: a comparative evaluation.

The role of staging transurethral resection of the prostate in the management of stage A prostate cancer is controversial. The accuracy of staging transurethral resection, A1/A2 substaging and probability of progression tables for predicting cancer progression was evaluated in untreated patients with stage A adenocarcinoma of the prostate who were followed for at least 5 years. Survival free of disease was predicted correctly in 93% of 52 patients who underwent staging transurethral resection of the prostate, 92% of 96 with the probability tables and in 85% of 96 using a common criteria for A1 and A2 substaging. Staging transurethral resection of the prostate upgraded patient risk in 7% of the low risk patients predicted by the probability tables and 14% of the stage A1 cancer patients. Staging transurethral prostatectomy and the probability of progression tables were more accurate in predicting survival free of disease than the A1/A2 substaging system. Comparison of the predictive accuracy of staging transurethral prostatectomy to that of the probability of progression tables showed no significant difference. There was no additional benefit from combining the 2 methods. When the probability of progression tables are used to predict cancer progression it may be unnecessary to use staging transurethral resection of the prostate in the patient with stage A prostate cancer.

Adenocarcinoma↗
PubMed2000

Spinal versus epidural anesthesia for transurethral resection of the prostate.

OBJECTIVE: To compare spinal versus epidural anesthesia for transurethral resection of the prostate. METHODS: A total of 65 patients undergoing transurethral resection of the prostate between September 1996 and March 1997, from the King Hussein Medical Centre, Amman, Jordan, were enrolled in this study. RESULTS: Epidural anesthesia was successful in 30 patients using an initial dose of 15 ml of 0.5% bupivicaine; whereas spinal anesthesia was successful in 32, using 2.5 ml of 0.5% bupivicaine. Sensory blockade at the level of T8 was similar in both techniques as were hypotension and postoperative hemorrhage. Differences occurred in the degree of motor blockade with a mean Bromage of 1 in the spinal group versus 3.8 in the epidural group (p <0.05). Maximum cephalic spread was achieved in 13 minutes in the spinal group versus 21 minutes in the epidural group (p<0.05), and the dose of propofol required to produce adequate hypnosis was 1.95 mg/kg/hour in the spinal group versus 2.8 mg/kg/hour in the epidural group (p<0.05). CONCLUSION: Spinal anesthesia proved to be superior to epidural anesthesia by providing lower incidence of patient movement.

Aged↗
PubMed2000

Safety and efficacy of transurethral resection of the prostate under sedoanalgesia.

OBJECTIVE: To assess the safety and efficacy of sedoanalgesia (local anaesthesia with sedation) in patients with benign prostatic hyperplasia (BPH) undergoing transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The study comprised 50 patients with BPH, two-thirds of whom were graded III-IV using the American Society of Anesthesiologists system. All patients had a topical instillation of lignocaine jelly 2% into their urethra, combined with 1% lignocaine (100-200 mg) with 1 : 400 000 adrenaline infiltration of the prostate via the perineal route. Sedation and anxiolysis were obtained with the intramuscular pethidine (0.5 mg/kg) and promethazine (1 mg/kg). Standard TURP was then carried out, with pain monitored during surgery using a visual analogue scale (VAS, maximum 10 points) and the amount of analgesic required after TURP recorded. The amount of prostatic tissue excised, duration of surgery, blood requirement, catheter interval, complications and hospital stay were recorded. The effectiveness of TURP was assessed by comparing symptom scores, uroflowmetry and postvoid residual volume before and after surgery. RESULTS: The mean intraoperative VAS was < or = 1 at any time during or after surgery; no patient required any postoperative analgesics. Only two patients complained of discomfort during the procedure and even they were comfortable after a supplemental dose of pethidine (12.5 mg). There were no conversions to general or regional anaesthesia. No blood transfusion was required in any patient. All patients began a normal diet 30 min after surgery and all were discharged within 48 h of surgery. There were no deaths; one patient had transient urinary incontinence and three had mild urinary tract infection. CONCLUSION: Sedoanalgesia was an effective, safe and simple alternative to general or regional anaesthesia for TURP in patients with BPH.

Adult↗
PubMed2006

Serum and prostatic tissue concentrations of moxifloxacin in patients undergoing transurethral resection of the prostate.

The spectrum of pathogens causing chronic bacterial prostatitis comprises Gram-negative, Gram-positive and atypical microorganisms. Because of its broad spectrum of activity, the group 4 fluoroquinolone moxifloxacin might be a suitable antibiotic for treatment of bacterial prostatitis. The aim of this prospective study was to investigate the penetration of moxifloxacin into prostatic tissue in patients with benign prostatic hyperplasia. Patients received a single dose of moxifloxacin 400 mg in an 1 hour lasting infusion (250 ml) for perioperative prophylaxis before undergoing transurethral resection of the prostate (TURP). Serum concentrations were determined in all patients before infusion, at the end of infusion (time point 0), 0.5, 1 and 2 h after the end of infusion. Patients were randomized for tissue sampling either 0, 0.5, 1 or 2 h after the end of infusion. At beginning of TURP approximately 1 g of tissue was sampled for analysis. Concentrations of moxifloxacin in serum and tissue were determined by HPLC. 39 patients were evaluated. Median serum and prostatic tissue concentrations peaked at 0 h (4.94 mg/ L and 8.50 mg/ kg, respectively). The lowest concentrations were quantified at 2 h after the end of infusion (2.46 mg/ L and 3.88 mg/ kg, respectively). The prostatic tissue concentrations of moxifloxacin were approximately twice as high as in corresponding serum. At the end of infusion the tissue and serum concentrations seemed to be already equilibrated, as their ratios did not differ significantly during the time of investigation. After an intravenous infusion of 400 mg the serum and prostatic tissue concentrations of moxifloxacin were well above the MIC values of most important prostatic pathogens. The high tissue/ serum ratio and the extended antibacterial spectrum suggests active concentration in the prostate which may translate into increased efficacy compared to group 2 and 3 fluoroquinolones in the treatment of chronic bacterial prostatitis.

Aged↗
PubMedDate not supplied

[Use of alpha1-adrenergic blockaders in treating voiding disorders after transurethral resection of the prostate].

Removal of infravesicular obstruction by transurethral resection (TUR) of the prostate rapidly eradicates obstructive symptoms but irritative symptoms persist. We studied the effect of alpha 1-adrenoblockers (A1AB) in respect of optimization of TUR effects. The trial was performed in 1998-2002 and included 197 patients treated surgically (TUR) for benign prostatic hyperplasia (BPH). 96 patients received no A1AB in the postoperative period (group 1). 52 patients took terazosine (group 2) and 49 patients were given tansulosine (group 3). IPSS symptoms and QoL estimation were registered monthly, the patients recorded the urination. After 3 and 6 months after TUR, maximal urination rate (MUR) and residual urine were assessed. It was found that MUR and QoL did not differ significantly between the groups but in groups 2 and 3 a fall in the overall score by IPSS was greater. The positive symptomatic improvement was achieved due to relief of the symptoms of urinary bladder filling corresponding to an increase in physiological capacity of the organ, the difference being significant (p < 0.05).

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1997

Voiding dysfunction following transurethral resection of the prostate: symptoms and urodynamic findings.

PURPOSE: Persistent voiding dysfunction following transurethral resection of the prostate is not uncommon. We determined the correlation, if any, between the subjective complaints in men with voiding dysfunction after transurethral resection of the prostate and the urodynamic findings. MATERIALS AND METHODS: A total of 50 consecutive men with voiding dysfunction following transurethral resection of the prostate was evaluated with the American Urological Association symptom index and multichannel urodynamics. Patients with urethral stricture, urinary retention or prostate cancer were excluded from the study. Urodynamic parameters assessed included detrusor instability, bladder capacity, sphincteric insufficiency using the Valsalva leak point pressure, voiding pressure-flow studies as determined by the Abrams-Griffiths nomogram (obstructed, unobstructed or equivocal) and post-void residual. RESULTS: Mean patient age was 71 years and mean interval from last transurethral resection of the prostate was 58 months (range 2 to 252). Mean total, obstructive and irritative symptom scores were 16.3, 5.8 and 10.5, respectively. A total of 20 patients (40%) complained of incontinence (14 urge and 6 stress). According to the Abrams-Griffiths nomogram 62% of the cases were unobstructed, 16% obstructed and 22% equivocal. Urodynamic abnormalities were demonstrated in 43 patients (86%), and included detrusor instability (54%), obstruction with or without detrusor instability (16%), sphincteric insufficiency (8%), detrusor hypocontractility (4%) and sensory urgency (4%). There was no difference in the total, irritative or obstructive scores among obstructed, unobstructed or equivocal cases. Similarly there was no difference in scores among patients with and without detrusor instability. Age, number of transurethral resections and interval since last transurethral resection were unrelated to pressure-flow results or detrusor instability. Post-void residual was significantly greater in obstructed cases and bladder capacity was significantly less in those with detrusor instability. The cause of incontinence was demonstrated in 19 of 20 patients (95%): 4 (20%) had sphincteric insufficiency and 15 (75%) had detrusor instability. CONCLUSIONS: Symptoms are unreliable in predicting urodynamic findings with respect to obstruction and detrusor instability. There is a high incidence of detrusor instability in patients with voiding dysfunction after transurethral resection of the prostate. Urodynamic obstruction is a less likely occurrence.

Aged↗
PubMed1996

Does transurethral resection of the prostate compromise the radical treatment of prostate cancer?

Obstructive voiding symptoms are frequent complaints in men with prostate cancer. Some men with prostate cancer require transurethral resection of the prostate (TURP) for relief of these symptoms. Two central questions have been raised regarding whether TURP may have adverse effects on morbidity and mortality in patients with prostate cancer. The first question deals with potential tumor cell dissemination at the time of TURP, resulting increased progression and mortality rates. A review of the literature suggests the risk of tumor dissemination during a TURP is small or negligible. However, patients with prostate cancer and obstructive symptoms appear to have a greater likelihood of high-stage disease at presentation. When the pathological stage is known, progression and mortality outcomes are similar in TURP and non-TURP treated patients with prostate cancer. The second question deals with the potential that TURP increases treatment-related morbidity of radiation therapy or radical prostatectomy. When TURP is required before radiation therapy, the literature suggests that delaying radiation 6 to 8 weeks from the time of the TURP will minimize incontinence and bladder neck contracture to acceptable levels. The literature also indicates that radical prostatectomy may be performed with no increased morbidity following a TURP.

Humans↗
PubMed2005

A hybrid technique using bipolar energy in transurethral prostate surgery: a prospective, randomized comparison.

PURPOSE: We assessed the efficacy and safety of transurethral resection and vaporization with bipolar PlasmaKinetic energy. MATERIALS AND METHODS: During a 2-year period 101 men with benign prostatic hyperplasia were randomly assigned to PlasmaKinetic surgery or standard transurethral prostate resection (TURP). Patient demographics, indications for surgery, preoperative and postoperative International Prostate Symptom Score, uroflowmetry scores, operative time, catheterization duration, hospital stay and complication rates were compared. RESULTS: Complete data on 96 patients with a mean age +/- SD of 69.1 +/- 6.1 years was available at a mean followup of 18.3 +/- 6.7 months (range 12 to 23). In the PlasmaKinetic and TURP groups mean operative time was 40.3 +/- 11.4 (range 30 to 60) and 57.8 +/- 13.4 minutes (range 45 to 75), respectively (p <0.01). The mean volume of saline irrigation during the PlasmaKinetic procedure was significantly lower than that of hyperosmolar solution irrigation during TURP (p <0.05). Patients in the PlasmaKinetic and TURP groups were catheterized a mean of 2.3 +/- 0.7 (range 2 to 4) and 3.8 +/- 0.7 days (range 3 to 5), respectively (p <0.05). The mean improvement rate from baseline at month 12 in International Prostate Symptom Score and the maximal urinary flow rate was similar in the 2 groups. Severe irritative symptoms were the most common complaints after PlasmaKinetic surgery, as observed in 6 cases (12.2%). Recatheterization was necessary in 3 cases (6.1%) cases in the PlasmaKinetic group and in 1 (2.1%) in the TURP group. During followup urethral stricture formation was observed in 3 patients (6.1%) cases in the former group and in 1 (2.1%) in the latter group (p = 0.002). Reoperation was required in 2 (4.1%) and 1 (2.1%) cases in the PlasmaKinetic and TURP groups, respectively. CONCLUSIONS: : Transurethral surgery with PlasmaKinetic bipolar energy seems to be a promising alternative to prostatic tissue removal with shorter operative, catheterization and hospitalization times, although increased rates of postoperative irritative symptoms and urethral stricture formation must be further evaluated.

Electrocoagulation↗
PubMed1992

Transurethral incision versus transurethral resection of the prostate. A subjective and objective analysis.

A prospective study was undertaken comparing transurethral incision of the prostate (TUIP) with transurethral resection (TURP) in the treatment of 220 patients with urinary obstruction caused by a small, benign prostate. Patients were managed alternately by TUIP and TURP, and their symptoms and urodynamic findings evaluated before and after surgery. Subjectively and objectively, the results were comparable in both groups. Pre- and post-operative complications were significantly less for the TUIPs than the TURPs. TUIP was significantly better than TURP in terms of shorter operating time, duration of hospitalisation and reduced need for transfusion. We recommend TUIP as the operation of choice for the relief of obstruction in the presence of a small, benign prostatic enlargement.

Aged↗
PubMed1992

[Clinical evaluation of oral ofloxacin in 3-day therapy for transurethral resection of the prostate].

The effectiveness of oral administration of an antibacterial alone was compared with that of intravenous administration of an antibiotic in patients with benign prostatic hyperplasia undergoing transurethral resection of the prostate (TUR-P). In group A (23 patients), surgery was carried out by administering 200 mg of ofloxacin (OFLX) alone, during the day before surgery and in the morning of the day of surgery and three times a day from the morning after surgery for two days, making the total dose 1,800 mg, and total period of administration 3 days. In group B (22 patients), 1 g of Cefotetan (CTT) was intravenously infused twice a day for 3 days from the operative day, making the total dose 6 g. The patients in both groups were given no other antibacterials or antibiotics. The maximum body temperature was recorded for post-operative 2 weeks. Negativization of bacteria by bacterial culture in the urine and disappearance of the pyria, were followed up on an outpatient bases. The mean maximum body temperature up to post-operative week 2 was 37.1 +/- 0.3 degrees C and 37.0 +/- 0.3 degrees C in groups A and B, respectively. The mean number of days required until negativization of bacteria in the urine was 41.5 +/- 38.9 days and 43.3 +/- 24.9 days in groups A and B, respectively. The mean number of days required until disappearance of the pyuria was 76.5 +/- 23.0 days and 68.2 +/- 17.9 days in groups A and B, respectively. No significant differences were noted by Student's t-test between groups A and B.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1987

Does transurethral resection of the prostate promote metastatic disease?

Previously published data have suggested that transurethral resection of the prostate might promote the subsequent appearance of metastatic disease. To confirm or deny these observations 145 patients underwent radical prostatectomy, after having had the disease diagnosed either by transurethral resection of the prostate or transrectal needle biopsy. Of the 145 patients 6 were excluded from analysis since they had had transurethral resection of the prostate and transrectal needle biopsy. In 33 patients the disease was diagnosed by transurethral resection of the prostate only and in 106 it was diagnosed by transrectal needle biopsy only. The relative distribution of Gleason grade and the positive versus negative margins among the 2 populations were similar. Using time to first evidence of distant disease as the endpoint of the study no difference in failure rates could be detected between the 2 populations. It is concluded that transurethral resection of the prostate does not enhance the appearance of metastatic disease.

Adenocarcinoma↗
PubMed1998

Transurethral electrovaporization of the prostate vs. transurethral resection. Results of a multicentric, randomized clinical study on 150 patients.

AIM OF THE STUDY: To evaluate clinical, urodynamic efficacy and safety of TURP and TVP in patients with symptoms due to obstructive benign prostatic hypertrophy with a prospective multicentric randomized study. MATERIALS AND METHODS: 150 patients with BPH, urodynamically obstructed, were randomized to receive TURP or TVP. At the end of the recruitment phase, 80 patients underwent TURP and 70 patients underwent TVP. Patients were clinically evaluated by the I-PSS score at months 0, 1, 3, 6 and 12. Preoperative evaluation included complete blood routine examination, PSA, transrectal ultrasound and pressure/flow studies. Pressure/flow studies were also performed after 3 months. RESULTS: There was no statistical difference between groups in any of the preoperative parameters. All patients were considered urodynamically obstructed at preoperative pressure studies. As for catheter days and hospitalization days, statistical differences between TVP and TURP were found; catheter days were 2.71 days (SE 0.12) in the TURP group vs. 1.9 (SE 0.24) in the TVP group (p < 0.000). Hospitalization was 4.7 days (SE 0.22) after TURP and 3.9 days (SE 0.24) after TVP (p < 0.000). Mean preoperative I-PSS score was 18.84 and 18.19 in the TVP and TURP groups, respectively. At 3, 6 and 12 months, IPSS was 5.52 and 5.50, 3.77 and 4.94, 3.52 and 4.04 for TURP and TVP, respectively. Mean preoperative peak flow rate (PFR) was 8.78 and 7.26 ml/s for TURP and TVP, respectively; after 3, 6 and 12 months, PFR was 19.21 and 18.8, 20.77 and 20.13, 20.30 and 20.31 ml/s, respectively. After 3 months, 6 patients in the TURP group (7.5%) and 7 patients in the TVP group (10%) were borderline obstructed. 1 patient in the TVP group (1.4%) was still obstructed and underwent TURP. As for complications, 4 patients (5.7%) in the TVP group had stress urinary incontinence after 12 months vs. 1 (1.25%) in the TURP group. DISCUSSION: The present study clearly demonstrates that TVP is as effective as TURP in relieving urinary obstruction due to BPH, it offers some advantages in terms of catheterization and hospital stay, but at the price of a higher incidence of postoperative urine incontinence. Technical improvements might solve this problem in the future, perhaps combining TVP with TURP of the apical tissue.

Aged↗