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PubMed2006

Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention.

OBJECTIVES: To update the complications of transurethral resection of the prostate (TURP), including management and prevention based on technological evolution. METHODS: Based on a MEDLINE search from 1989 to 2005, the 2003 results of quality management of Baden-Württemberg, and long-term personal experience at three German centers, the incidence of complications after TURP was analyzed for three subsequent periods: early (1979-1994); intermediate (1994-1999); and recent (2000-2005) with recommendations for management and prevention. RESULTS: Technological improvements such as microprocessor-controlled units, better armamentarium such as video TUR, and training helped to reduce perioperative complications (recent vs. early) such as transfusion rate (0.4% vs. 7.1%), TUR syndrome (0.0% vs. 1.1%), clot retention (2% vs. 5%), and urinary tract infection (1.7% vs. 8.2%). Urinary retention (3% vs. 9%) is generally attributed to primary detrusor failure rather than to incomplete resection. Early urge incontinence occurs in up to 30-40% of patients; however, late iatrogenic stress incontinence is rare (<0.5%). Despite an increasing age (55% of patients are older than 70), the associated morbidity of TURP maintained at a low level (<1%) with a mortality rate of 0-0.25%. The major late complications are urethral strictures (2.2-9.8%) and bladder neck contractures (0.3-9.2%). The retreatment rate range is 3-14.5% after five years. CONCLUSIONS: TURP still represents the gold standard for managing benign prostatic hyperplasia with decreasing complication rates. Technological alternatives such as bipolar and laser treatments may further minimize the risks of this technically difficult procedure.

Humans↗
PubMed2001

Incidence and risk factors of bacteriuria after transurethral resection of the prostate.

INTRODUCTION: Postoperative bacteriuria is a frequent event after transurethral resection of the prostate, despite the use of prophylactic antibiotics. Certain risk factors have been clearly established (preoperative urinary catheter or bacteriuria, operating time), while others remain uncertain. MATERIALS AND METHODS: We conducted a prospective study in five urology centers, including non-catheterized patients with sterile preoperative urine undergoing transurethral resection of the prostate for benign prostatic hyperplasia. All received antibiotic prophylaxis with cefamandole. The incidence of bacteriuria and its risk factors were investigated. RESULTS: The postoperative bacteriuria rate was 26% (26/101), with 8% on removal of the catheter, 14% between the 7th and 10th postoperative days and 5% 1 month postoperatively. Factors associated with bacteriuria on univariate analysis were: operating time, disconnection of the closed urine drainage system and postoperative catheterization > or =3 days. Two variables were associated on multivariate analysis (logistic regression): operating time >52 min (odds ratio 9.0, 95% confidence interval 2.1-39.0) and disconnection of the closed urine drainage system (odds ratio 26.3, 95% confidence interval 6.1; 6.1-113). CONCLUSIONS: The postoperative bacteriuria rate after transurethral resection of the prostate was high in this study, raising the question of the choice and/or duration of prophylactic antibiotics. Prevention of postoperative bacteriuria must be based on careful hemostasis, prevention of postoperative catheter disconnections, and limitation of the duration of postoperative catheterization.

Aged↗
PubMed1987

Transurethral resection of the ureteral meatus invaded by carcinoma of the prostate: a new approach.

We present herewith our surgical procedure for the management of bilateral hydronephrosis and renal failure due to distal ureter infiltration by cancer of the prostate: transurethral resection of the ureteral meatus and intramural ureter or even extravesical ureter invaded by the carcinoma and placement of a double J catheter. We have performed this technique in 3 patients with good results.

Aged↗
PubMed2004

Interstitial laser coagulation for management of benign prostatic hyperplasia: long-term follow-up.

AIM: We evaluated the long-term results of transurethral interstitial laser coagulation in the treatment of benign prostatic hyperplasia (BPH) with up to 9 years of follow up at the Kurashiki Central Hospital and determined the patient characteristics that predict a favorable outcome. METHODS: From December 1993 to May 1997, a total of 82 patients were enrolled in the present study. Subjective and objective voiding parameters were collected from medical records and a self-administered questionnaire was sent to the patients. Kaplan-Meier plots were constructed to assess the risk of retreatment. RESULTS: The mean follow-up period was 48.4 months (range, 3-108 months). A total of 59 patients (72%) did not need any additional treatment at 12 months and 30 patients (37%) did not require additional treatment during the entire follow-up period. A total of 29 patients (35%) were retreated during follow-up. Transurethral prostate resection (TURP) was performed in 18 patients (22%). The remaining 11 patients (13%) were offered additional pharmacotherapy. The minimum and median retreatment-free durations were 3 and 14 months, respectively. Seven patients died and 17 were lost to follow-up. Men aged 71 years or older had greater likelihood of requiring retreatment than those younger than 71 years (P = 0.0397). No significant differences were noted in the other baseline characteristics. Among postoperative parameters, a rate of decrease of the International Prostate Symptom Score of the patient of lower than 60% and a rate of decrease in patient quality of life of lower than 50% at 3 months were associated with greater likelihood of retreatment (P = 0.0083 and P = 0.0006, respectively). CONCLUSIONS: Interstitial laser coagulation is effective for the treatment of BPH. Good long-term results and an acceptably low retreatment rate render this modality an effective alternative to TURP, especially for younger patients. Short-term improvement of subjective symptoms was predictive of favorable long-term outcome.

Age Factors↗
PubMed1996

[Results of transurethral resection of prostate plus incision (TUR-P+I) for benign prostatic hypertrophy].

The results of 14 patients treated by TUR-P+I and 15 patients by TUR-P between September 1991 and August 1993 were reviewed to evaluate the effects of TUR-P+I. Tur-P+I is a combined technique of channelling TUR-P and transurethral incision of the bladder neck and the prostate. After receiving modest TUR of the adenoma, the bladder neck and anatomical capsule of the prostate was incised by electroresectoscope at 6 o'clock position from the bladder neck toward to verumontanum. Before operation, the maximum floor rate, average flow rate, and residual urine volume were measured, which were respectively 9.9 +/- 5.6 ml/s (M+SEM), 4.4 +/- 2.3 ml/s, and 130 +/- 80 ml in TUR-p+I group, and 11.6 +/- 2.9 ml/s, 4.3 +/- 1.8 ml/s, and 60 +/- 60 ml (p < 0.01) in TUR-P group. The operation time and resected tissue weights were similar in both groups; 68 +/- 16 min and 11 +/- 5.2 g in TUR-P+I group, and 72 +/- 25 min and 11 +/- 6.5 g in TUR-P group. The post-operative maximum flow rate, average flow rate and residual urine volume were respectively improved to 19.0 +/- 5.7 ml/s, 9.3 +/- 3.7 ml/s, and 20 +/- 20 ml in TUR-P+I group, and 14.6 +/- 6.1 ml/s (p = 0.057), 6.6 +/- 2.6 ml/s (p < 0.05), and 30 +/- 30 ml (not significant) in the TUR-P group. Neither significant blood loss nor complications were experienced in either procedure. It is suggested that TUR-P+I could be a safe and effective alternative of TUR-P. Longer follow-up and the prospective study are required to establish the value of the current combined technique.

Aged↗
PubMed2004

Randomized comparison of loops for transurethral resection of the prostate: preliminary results.

PURPOSE: To evaluate the comparative efficacy and morbidity of standard transurethral resection of prostate (TURP) and transurethral vaporesection (TUVRP) using four types of loops. PATIENTS AND METHODS: In a one-to-one randomized study, 50 patients with lower urinary-tract symptoms suggestive of bladder outlet obstruction and benign prostatic enlargement underwent TURP. Clinical data were collected using digital rectal examination, transrectal ultrasonography for evaluation of prostate volume, IPSS and IIEF-5 questionnaires, and serum prostate specific antigen concentrations. Intraoperative blood loss and fluid absorption were evaluated by measuring serum hemoglobin and respiratory alcohol concentration. Patients were followed at 3 and 18 months with evaluation of clinical symptoms, flow rates, residual urine volumes, and complications. RESULTS: There were no significant differences in blood loss, intraoperative fluid absorption, procedure time, or weight of the resected tissue between standard TURP and TUVRP with the various loops. No significant complications (infections, urethral stricture, reintervention) were seen. CONCLUSIONS: In this comparison of the clinical outcome and morbidity of standard TURP versus different loops for TUVRP, there were no significant differences in any of the parameters evaluated.

Aged↗
PubMed2001

Expression of multidrug resistance related proteins and proliferative activity is increased in advanced clinical prostate cancer.

PURPOSE: Advanced disseminated prostate cancer is highly resistant to cytotoxic chemotherapy. We identified proteins that may be involved in multidrug resistance in clinical prostate cancer. Expression of these proteins was examined in the context of tumor progression. MATERIALS AND METHODS: Paraffin embedded, formalin fixed prostate cancer specimens from archival sources of 3 distinct patient groups were examined. These groups were clearly distinct with regard to pathological stage and responsiveness to antihormonal therapy. Group 1 consisted of patients with organ confined prostate cancer treated with radical prostatectomy (early pathological stage T2N0M0). Group 2 patients had disseminated, early advanced prostate cancer and were treated with transurethral prostatic resection for urinary obstruction before receiving antihormonal therapy. Group 3 patients had disseminated prostate cancer with relapse despite antihormonal treatment (late advanced prostate cancer) and they underwent transurethral prostatic resection to relieve the symptoms of urinary obstruction. Immunohistochemical study was done to detect P-glycoprotein, multidrug resistance associated protein, lung resistance protein, glutathione-S-transferase pi, p53, Bcl-2, Bax, topoisomerase I, IIalpha and IIbeta, and Ki-67. RESULTS: Advanced tumors were distinguished from locally confined tumors because they exhibited significantly higher histological grade and proliferative activity. The expression of multidrug resistance associated protein, p53, topoisomerase IIalpha, Ki-67 and topoisomerase IIbeta was significantly related to a higher Gleason sum score. The number of cases expressing multidrug resistance associated protein, lung resistance protein, glutathione-S-transferase pi, p53, Bcl-2, topoisomerase IIalpha and Ki-67 was significantly increased in the group with advanced disseminated prostate cancer. Topoisomerase I and IIbeta were homogeneously and highly expressed at all stages of prostate cancer progression, while P-glycoprotein was not expressed in any tumors regardless of the patient group. CONCLUSIONS: Up-regulation of the expression of the drug transporters multidrug resistance associated protein and lung resistance protein, detoxifying enzyme glutathione-S-transferase pi, and apoptosis inhibiting proteins Bcl-2 and p53 may be an explanation of the resistance of disseminated progressive prostate cancer to chemotherapy. As shown by the up-regulation of Ki-67 and topoisomerase IIalpha, increased proliferation reflects the aggressiveness of metastatic prostate cancer. Research on agents that counteract multidrug resistance mechanisms and may sensitize prostate carcinoma to cytotoxic chemotherapy may possibly lead to more effective treatment of progressive disseminated prostate cancer.

ATP-Binding Cassette Transporters↗
PubMed2004

Transurethral needle ablation versus transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia: 5-year results of a prospective, randomized, multicenter clinical trial.

PURPOSE: We report the 5-year efficacy and safety of transurethral needle ablation of the prostate (TUNA) compared to transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 121 men 50 years or older with LUTS secondary to BPH a minimum of 3 months in duration were enrolled in this prospective, randomized clinical trial at 7 medical centers across the United States. Of the participants 65 (54%) were randomly selected to receive TUNA and 56 (46%) were selected to receive TURP. International Prostate Symptom Score, quality of life, peak urinary flow rate, post-void residual urinary volume, and prostate size and configuration were evaluated before the procedure and then annually for 5 years after the procedure. Adverse events were also recorded throughout the study. RESULTS: Improvement from baseline for TUNA and TURP retained statistical significance at each interval for International Prostate Symptom Score, quality of life and peak flow rate. Post-void residual volume was statistically significant at all time points for TURP and at year 5 for TUNA. The TURP group reported 41% retrograde ejaculation, while the TUNA group reported none. The incident of erectile dysfunction, incontinence and stricture formation was also greater in TURP than in TUNA cases with significantly fewer adverse events for TUNA than for TURP. CONCLUSIONS: The results of this study demonstrate stable treatment outcomes after 5 years of followup and suggest that TUNA is an attractive treatment option for men with LUTS due to BPH.

Aged↗
PubMed1999

Electromotive drug administration of lidocaine as an alternative anesthesia for transurethral surgery.

PURPOSE: A multicenter study was undertaken to evaluate the safety, efficacy and cost of electromotive drug administration of intravesical lidocaine to produce bladder local anesthesia as an alternative to traditional methods of spinal or general anesthesia. MATERIALS AND METHODS: A total of 94 patients were enrolled in the study who had either a history of bladder tumor that required cold cup bladder biopsy with fulguration for possible recurrence as a comparison trial, a bladder tumor treated with transurethral resection/fulguration or benign prostatic hyperplasia/carcinoma treated with transurethral resection. Pain scores using a Verbal Rating Scale were recorded for each individual biopsy, fulguration and resection event. Data for direct and indirect costs were collected using a standardized form for each patient to capture the details of the procedure, including times, drugs and disposables for each patient. RESULTS: There was a significant reduction in pain for patients who received electromotive intravesical lidocaine compared to no anesthesia for biopsy (p<0.03). Similarly, electromotive intravesical lidocaine for bladder biopsy and transurethral bladder tumor resection/fulguration was associated with higher patient satisfaction compared to previous treatments (p<0.00002). In contrast, electromotive intravesical lidocaine was insufficient for 3 of 6 transurethral prostatic resections. The cost per patient was about $146 Cdn less with electromotive intravesical lidocaine than with conventional general/spinal anesthesia. CONCLUSIONS: Electromotive intravesical lidocaine may be a safe, effective and affordable form of anesthesia for the ambulatory care of patients requiring transurethral bladder biopsy, resection or fulguration with a potential for cost savings.

Aged↗
PubMed1995

A comparative study of transurethral resection of the prostate using a modified electro-vaporizing loop and transurethral laser vaporization of the prostate.

PURPOSE: We determined the relative efficacy of a modification of transurethral resection of the prostate using a vaporizing loop (VaporTrode) with transurethral laser vaporization of the prostate using the Ultraline fiber. MATERIALS AND METHODS: A comparative trial of 58 patients with symptomatic prostatism was performed. Parameters evaluated included operative time, postoperative catheterization time, American Urological Association (AUA) symptom score, peak urine flow and post-void residual urine. RESULTS: Of the 29 patients who underwent electro-vaporization AUA symptom score decreased from 15.3 to 5.3 and 4.9, and peak urine flow increased from 8.2 to 14.9 ml. per second and 15.6 ml. per second at 1 and 3 months, respectively (p = 0.01). Of the 29 patients undergoing laser vaporization of the prostate AUA symptom score decreased from 14.7 to 10.1 and 7.6, and peak urine flow increased from 9.7 to 13.7 ml. per second and 14.9 ml. per second at 1 and 3 months, respectively (p = 0.025). However, there were significant differences in mean catheterization time (electro-vaporization group 14.7 hours and laser group 79.6 hours, p < 0.001), and cases of postoperative irritative symptoms (3 electro-vaporization and 19 laser) and retention requiring repeat catheterization (6 laser). CONCLUSIONS: Our early clinical experience highlights several potential advantages of electro-vaporization, particularly the low incidence of postoperative morbidity. Currently a multicenter clinical trial is underway to determine the long-term efficacy and safety of electro-vaporization as a potential therapeutic modality in the treatment of men with symptomatic benign prostatic hyperplasia.

Electrosurgery↗
PubMed2006

[Macroscopic haematuria after transurethral resection of the prostate].

UNLABELLED: Although macroscopic haematuria during the month following transurethral resection of the prostate, due to sloughing of necrotic tissue, is a phenomenon well known to urologists since introduction of endoscopic resection, its pathophysiological and epidemiological characteristics are poorly defined. The objective of this retrospective study was to define the incidence of serious macroscopic haematuria after transurethral resection of the prostate (TURP) and to identify the risk factors for macroscopic haematuria. PATIENTS AND METHODS: The hospital database was used to identify patients treated by TURP between 1997 and 2004 and rehospitalized during the 31 days following the procedure. Files of patients presenting with haematuria and bladder clots were selected and analysed. RESULTS: Ten of a series of 624 patients undergoing TURP were hospitalised for bladder clots and their case files were analysed: median age: 72 years, median duration of TURP: 45 min and median weight of resection: 12 g. The operators' experience and the duration of post-TURP catheterization were not informative. In 2 cases, prostate cancer was diagnosed after analysis of resection chips. Two patients were treated by anticoagulants. Patients were essentially rehospitalized during the 2nd week (median: 11th day). A bladder catheter for was inserted for lavage in each case. No patient required reoperation or removal of clots under general anaesthesia. Two patients were transfused. CONCLUSION: We did not identify any risk factor for sloughing leading to macroscopic haematuria during the month following TURP. Macroscopic haematuria justifying rehospitalization is a rare event. However, in view of this low incidence, optimal analysis could only be performed in the context of a national prospective register.

Aged↗
PubMed2002

Thick vs thin loop transurethral resection of the prostate: a double-blind prospective trial of early morbidity.

OBJECTIVE: To compare blood loss, irrigation requirements and hospital stay between standard transurethral resection of the prostate (TURP) and resection incorporating vaporization, i.e. transurethral vaporization resection (TUVRP). PATIENTS AND METHODS: Seventy patients were prospectively randomized in a blinded fashion between TURP with a standard resection loop (thin loop) or resection with a roller cutting electrode (thick loop). The outcome was assessed as the change in haemoglobin at 30 min and 24 h after the resection finished. Secondary outcome measures were irrigation requirements, length of catheterization, hospital stay, changes in serum sodium, and complications. The nursing staff and surgical registrar managing the patients after surgery were unaware of the resection technique used. RESULTS: Data were available for 65 patients (36 thin loop and 29 thick loop resections). The mean decrease in haemoglobin after TURP was 14.8 g/L at 30 min and 11.8 g/L at 24 h; for TUVRP the corresponding values were 14.6 and 14.2 g/L (P = 0.69). In addition, there was no difference in irrigation requirements, changes in serum sodium, length of catheterization, hospital stay or bleeding complications. CONCLUSION: The use of a thick loop at higher cutting current settings during TUVRP offers no advantage over standard thin-loop TURP.

Aged↗
PubMed2004

Safer transurethral resection of the prostate: coagulating intermittent cutting reduces hemostatic complications.

PURPOSE: Transurethral resection of the prostate (TURP) is still the gold standard for the surgical treatment of symptomatic benign prostatic hyperplasia. However, the associated morbidity and blood loss remain concerns. A coagulating intermittent cutting (CIC) device with constant voltage pulses and controlled pulse intervals was recently developed. The impact of CIC on bleeding and blood transfusion rates as well as the occurrence of the TUR syndrome were investigated. MATERIALS AND METHODS: From January 2000 to July 2002, 271 consecutive patients with symptomatic benign prostatic hyperplasia underwent TURP with the CIC device. In addition to blood transfusion rates, serum hemoglobin and electrolytes were determined in all patients immediately before and after TURP. RESULTS: The mortality rate in the 271 patients subjected to TURP was 0.0%. Mean decrease in hemoglobin after TURP was 1.08 mg/dl. Intraoperative and postoperative blood transfusions were required in 7 patients (2.6%), and clinical signs of the transurethral resection syndrome were noted in 1.1% of patients. CONCLUSIONS: Coagulating intermittent cutting dramatically improves the safety of TURP by decreasing intraoperative and postoperative blood loss, and the rate of blood transfusions. With this blood sparing device we anticipate a lower incidence of hemostatic complications from TURP.

Adult↗
PubMed1984

Ceftriaxone in the prevention of postoperative infection in patients undergoing transurethral resection of the prostate.

One hundred twenty-nine patients undergoing transurethral resection of the prostate were treated preoperatively with either 1 g of ceftriaxone or placebo in a double-blind, randomized study. Sixty-three patients received placebo and 66 received ceftriaxone. Postoperative urinary tract infections developed in eight placebo-treated patients, for a 12.7 percent failure rate, compared with two ceftriaxone-treated patients, for a 3 percent failure rate. The difference in rates of infection was statistically significant (p less than 0.05). No adverse effects due to treatment were noted. The high rate of postoperative infection in the placebo-treated group indicates that maintenance of sterility during and after this operative procedure is a problem. A single 1 g prophylactic preoperative dose of ceftriaxone was safe and efficacious in reducing the rate of postoperative infection after transurethral resection of the prostate.

Cefotaxime↗
PubMed1991

[Coma during transurethral resection of the prostate].

Two cases of coma occurring during transurethral resection of the prostate are reported. The 76 and 85-year-old patients lapsed into coma, ranking 9 and 8 on the Glasgow scale, respectively 90 and 120 min after the start of the resection, without any previous haemodynamic alterations. In one patient, coma occurred when the urethral catheter became blocked with fragments of prostates. In the other, coma was initiated by a rupture of the prostatic capsule, with passage of washing fluid (1.5% glycine solution) into the peritoneal cavity. The role played by acute hyponatraemia (128 and 123 mmol.l-1 respectively) and glycine poisoning (10,188 and 11,840 mmol.l-1 respectively) are discussed. These cases underline the interest of regional anaesthetic techniques, allowing an early diagnosis and a rapid surgical procedure which will avoid a worsening of the condition.

Administration, Intravesical↗
PubMed1996

How complete is a transurethral resection of the prostate?

OBJECTIVE: To determine the completeness of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The prostate volume of 432 patients was measured by transrectal ultrasonography (TRUS) before they underwent a TURP performed by one of three consultant urological surgeons. The prostate tissue collected at resection was weighed, multiplied by 1.2 to compensate for 'shrinkage', and the amount of tissue removed expressed as a percentage of the pre-operative prostate volume determined by TRUS (resection ratio). The patients were categorized into groups based on pre-operative prostate size. RESULTS: The mean weight of prostate tissue resected was 25.6 g. Resection ratios increased with prostate size, with the largest occurring in prostates of 71-110 g. The surgeon did not resect more than 50% of the gland volume in any group. CONCLUSION: This study counters the theory that a complete resection of the prostate is routinely achieved. The endoscopic appearances probably imply a complete resection of the adenoma but a considerable volume of the gland remains. This has important implications for the detection of prostate carcinoma at TURP and for the staging of the disease.

Endoscopy↗