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PubMed1992

Comparison of single-dose antibiotic prophylaxis in uncomplicated transurethral resection of the prostate.

We evaluated the necessity for antibiotic prophylaxis in uncomplicated transurethral resection of the prostate. A total of 107 patients was entered into a double-blind, prospective, placebo-controlled, randomized trial. Only 7 patients were excluded because they had positive preoperative urine cultures. All patients received a single dose of either 1 gm. cefonicid or saline placebo intramuscularly before surgery. No further antibiotics were administered. Urine cultures were obtained intraoperatively, daily while hospitalized, and at 2 and 4 weeks postoperatively. A growth of 10(4) organisms constituted a positive urine culture. Postoperative infection rates were statistically significant with 12% (6 of 51) in the cefonicid group and 37% (18 of 49) in the placebo group (p = 0.003). During the initial 2 days postoperatively there were no infections in the cefonicid treated patients as opposed to 8 in the placebo group (p = 0.003). Our study demonstrated the need for antibiotic prophylaxis to prevent infection after uncomplicated transurethral resection of the prostate. This can be accomplished by using a single dose, broad-spectrum cephalosporin (cefonicid). This procedure simplifies the implementation and decreases the cost of prophylaxis for transurethral resection of the prostate.

Aged↗
PubMed1978

Deep venous thrombosis following transurethral resection of the prostate: diagnosis by phleborheography.

Deep venous thrombosis is a potential complication of transurethral resection of the prostate. We evaluated 150 paients undergoing transurethral resection of the prostate for benign and malignant disease to determine the postoperative incidence of deep vein thrombosis, using phleborheography as the instrument of detection. Phleborheography is an accurate, inexpensive, non-invasive method that uses low pressure transducers to detect volumetric changes in the lower extremity through recording cuffs. A 4.6 per cent incidence of deep venous thrombosis was detected by this technique. At the time this complication was discovered no patient exhibited clinical signs of thrombophlebitis, which reinforces the belief that clinical diagnosis alone is not a reliable screening technique for deep venous thrombosis. Anticoagulant therapy appears to be effective and safe in the treatment of this postoperative complication.

Adenocarcinoma↗
PubMed2003

[Long-term follow-up of interstitial laser coagulation in the treatment of benign prostatic hyperplasia].

INTRODUCTION: Besides standard open or transurethreal adenoma resection, less morbid interstitial laser coagulation (ILC) is an alternative therapeutical option that could reduce lower urinary tract symptoms, especially in high-risk patients. Although short-term results indicate effectiveness, reliable long-term statistics are still lacking. Therefore, to assess long-term satisfaction and overall success rate, we re-evaluated patients with a mean follow-up of 7 years after laser treatment. METHODS: A total of 72 patients had been included in our ILC programme between 1993 and 1995. Mean age was 74 years. About 45 % of the patients had since died of other causes. In all, 23 patients were evaluated by telephone questionnaire, International Prostate Symptom Score (IPSS), Quality of Life (QoL), second surgical interventions or medical therapy. Our patient group was treated with interstitial Nd:YAG laser coagulation (mediLas fibertom). A perineal (34 %), transurethral (23 %) or combined (43 %) approach was chosen, depending on the preoperative volume of the prostate (range 40 - 100 ml; mean 59.3 ml). RESULTS: 68.4 % of the patients were satisfied with their current urological situation. Mean IPSS was 8.8 vs. 18.8 preoperatively mean QoL 1.5 vs. 3.3. 15.8 % had undergone conventional transurethral prostatic resection in the interim; one patient uses a urine catheter. 15.8 % receive medical treatment for lower urinary tract symptoms. CONCLUSIONS: Although the results of standard TUR or open surgery imply higher success, the long-term results of ILC demonstrate effectiveness. Further follow-up studies on a larger number of patients are advisable. The low morbidity of ILC makes this procedure an interesting alternative option in the treatment of high risk patients.

Aged↗
PubMed1993

A comparison of quality of life with patient reported symptoms and objective findings in men with benign prostatic hyperplasia. The Department of Veterans Affairs Cooperative Study of transurethral resection for benign prostatic hyperplasia.

As part of a randomized, controlled, trial conducted by the Department of Veterans Affairs Cooperative Studies Program comparing the effectiveness of transurethral resection of the prostate to watchful waiting, we evaluated 707 men with mild to severe symptoms of benign prostatic hyperplasia (BPH). We examine the relationships among patient reported symptoms, quality of life responses, peak urine flow rates and post-void residual urine estimates. Correlations among responses to symptom and quality of life interviews, urine flow results and residual urine volume were low (less than 0.20). However, multivariate correlation analysis showed that patient reported irritative symptoms, such as urgency, frequency and nocturia, were associated with quality of life responses, while patient reported obstructive symptoms, peak urinary flow rates and post-void urine estimates were unrelated to diminished quality of life. Since the extent to which BPH interferes with the life-style is likely to influence the decision of the patient to seek medical evaluation, the lack of association between quality of life and obstructive symptoms may result in misdirected diagnostic evaluations. This may have a large role in the controversies regarding assessments of symptomatic BPH, guidelines for surgical intervention and outcomes of treatment. Further study is required to determine the influence of diminished quality of life and irritative symptoms on the outcomes of treatments for BPH.

Aged↗
PubMed1988

Factors associated with sexual dysfunction following transurethral resection of the prostate.

A retrospective analysis of 62 consecutive potent patients undergoing transurethral resection of the prostate is described. Each patient was interviewed a minimum of six months following surgery. Potency was retained in 89% of patients but 57% of these experienced a decrease from their preoperative level of function. Three factors were found to be significantly associated with a reduction in postoperative potency. These were systemic disease (p less than 0.001), small prostatic resections (p less than 0.001) and a reduced level of potency preoperatively (p less than 0.01). Of those men retaining a degree of potency, 90% achieved their first erection within two months of the procedure. The full extent of sexual dysfunction following transurethral resection of the prostate has not previously been appreciated, nor have the factors associated with this dysfunction.

Aged↗
PubMed1989

Transurethral resection of the prostate. A review of 1111 cases.

A review of 1111 transurethral resections of the prostate (TURP) revealed a mortality of 0.5% (6 patients). A stricture frequency of 3% was observed as a complication after the operation. A supplementary resection was done within one year in 9%. Transurethral resection syndrome of the prostate (TURP syndrome) occurred in two patients. Cancer incidence was 18%. Blood transfusions were given to 20% of the patients. The weight of resected prostatic tissue ranged from 4 to 115 g (mean 25 g), and was less than 20 g in 60%. Peroperative bleeding amounting to over 1800 ml occurred in 3.3% (37 patients).

Adult↗
PubMed1986

Transurethral resection of the prostate with local anesthesia in 100 patients.

We performed transurethral resections of the prostate in 100 patients under local anesthesia supplemented when appropriate by intravenous medication. In the first part of the study (40 patients) local anesthesia was infiltrated into the prostate transurethrally only, while in the second part (60 patients) infiltration was performed transurethrally and perineally. Prostate sizes ranged from 5 to 50 gm., and pain control was excellent in the majority of the patients, especially when perineal infiltration was added to the procedure. Of the patients 98 per cent said they would do it again, no patient required conversion to general anesthesia and there were no significant complications relating to the anesthesia. Local anesthesia with intravenous supplementation can be performed successfully in the majority of the patients with small to moderately sized prostate glands.

Aged↗
PubMed1991

Blood loss during transurethral resection of the prostate injected with phenol solution.

Blood loss during transurethral resection of the prostate (TURP) still represents a major hazard. Several methods of reducing bleeding during TURP have been recommended [7, 8, 9, 13]. In 1986, Muzafer showed that blood loss during open prostatectomy of the prostate injected with 5% phenol in almond oil solution was significantly smaller than in the non-injected group [9].

Aged↗
PubMed1989

Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate.

Thirty patients undergoing lidocaine spinal anesthesia for transurethral resection of the prostate (TURP) were studied to evaluate the effectiveness of low-dose intrathecal morphine (ITM) for postoperative analgesia. In a double-blinded fashion, groups of ten patients received either 0.1 mg morphine, 0.2 mg morphine, or placebo (control group) intrathecally with lidocaine 75 mg. Standard postoperative analgesics were available to all patients. Patients receiving 0.1 mg or 0.2 mg morphine reported significantly less postoperative pain as assessed by an inverse numerical visual pain scale and required significantly fewer postoperative analgesic interventions than the control group. There was no difference between the 0.1 mg ITM and 0.2 mg ITM groups with regard to severity of postoperative pain or analgesic requirements. The incidence of nausea and vomiting was significantly higher in the group receiving 0.2 mg ITM than in the control group. Six patients (60%) in the 0.2 mg ITM group, two patients (20%) in the 0.1 mg ITM group, and one patient (10%) in the control group experienced nausea and vomiting. No clinically evident respiratory depression occurred in any of the subjects. The authors conclude that administration of 0.1 mg or 0.2 mg of morphine intrathecally is effective in reducing postoperative pain following TURP and that 0.1 mg ITM is not associated with nausea and vomiting.

Clinical Trials as Topic↗
PubMed1987

Experience with hypotonic 2.5% sorbitol solution as an irrigating fluid in transurethral resection of the prostate.

19 patients were studied in connection with transurethral resection of the prostate using the intermittent technique and hypotonic 2.5% sorbitol solution as an irrigating fluid. No diuretics were given postoperatively. In 2 patients there was a slight elevation of the serum creatinine level preoperatively but in 17 patients serum creatinine was within the reference limits. The plasma sorbitol concentration was determined at 20-min intervals for two hours. The mean plasma concentration of sorbitol immediately postoperatively was 379 mg/l (2.1 mmol/l) and the highest level observed was 1,900 mg/l (10.6 mmol/l). The half-life for sorbitol in plasma was 21 min (mean calculated in 11 cases). The range was 11-33 min. With increasing immediate postoperative plasma sorbitol levels there was also an increase in the half-life, corresponding to saturation of the sorbitol metabolizing enzyme system. The absorbed fluid volumes were calculated from the immediate postoperative plasma concentration of sorbitol, which gave a mean of 0.23 1 and a maximum of 1.01. Haemodilution effects with decrease in the serum sodium and serum albumin concentrations were noted, but they were much less marked than when 5% sorbitol solution was used as an irrigating fluid. There were only insignificant increases in the plasma haemoglobin concentrations postoperatively, which were probably due to heat decomposition of red blood cells in the bladder during the operation. About 7% of the absorbed amount of sorbitol was eliminated in the urine (mean). The highest value observed was 18% in the case showing the highest plasma sorbitol concentration immediately postoperatively (1,900 mg/l). Sorbitol was eliminated in the urine over a period of 6 hours postoperatively.

Aged↗
PubMed1987

Absorption and elimination of mannitol solution when used as an isotonic irrigating agent in connection with transurethral resection of the prostate.

12 patients were studied in connection with transurethral resection of the prostate using the intermittent technique and isotonic 5% mannitol solution as an irrigating fluid. No diuretics were given postoperatively. The serum creatinine concentrations were normal in 10 patients and slightly elevated in 2. The plasma mannitol levels were followed for four hours postoperatively. The highest concentration observed in the series was 6,275 mg/l (34.9 mmol/l) immediately postoperatively. The maximum level was observed immediately postoperatively in all patients (mean 2,140 mg/l, 11.9 mmol/l). The mean half-life of mannitol in plasma was 163 min (10 patients). The patient with the highest serum creatinine concentration preoperatively (138 mumol/l) showed a marked prolongation of the half-life (692 min). The mean intravenous fluid absorption calculated from the immediate postoperative mannitol concentrations was 0.68 l (range 0.05-1.78 l). A decrease in the serum sodium concentration was observed immediately postoperatively (mean 5.4 mmol/l, range 0-19 mmol/l). There was a correlation between the decreases in the serum sodium concentration and the simultaneous plasma mannitol concentration. There was no significant change in plasma osmolality. Mannitol elimination in urine was followed for 24 hours postoperatively in 7 patients. The mean absorbed volume of irrigating fluid was calculated from the elimination data and was found to be 0.481, which should be compared with the figure obtained from the calculation based on the immediate postoperative plasma mannitol concentration, which gave 0.49 l (mean) in the same 7 patients. This shows that, in spite of the theoretical assumptions made in the calculation of absorbed fluid volume from the plasma mannitol concentration, this method of calculation is valid.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Evaluation of immediate and late results of transurethral resection of the prostate.

A total of 401 men who underwent transurethral resection of the prostate (TURP) between 1983 and 1986, were prospectively evaluated in 1987, 167 of them were sent a questionnaire about their ability to pass urine 1990. Our results showed that TURP was safe with no immediate mortality. The hospital stay was, however, long (median 7.0 days). It should be possible to shorten the hospital stay of those in the age group 60 and 70 years. After a mean of 6.5 years, 92% of patients were satisfied with their ability to pass urine.

Aged↗
PubMed1999

[A comparative study of a thick and standard loop in transurethral resection of the prostate].

We compared the safety and efficacy of transurethral resection of the prostate (TURP) with a thick loop and with a standard loop. We compared 36 consecutive men (median age, 70 years) with symptomatic benign prostatic hyperlasia (BPH) treated by TURP with a thick loop to a cohort of 36 men (median age, 72 years) treated by TURP with a standard loop. The safety parameters of evaluation included the operative time, blood loss, chronological changes in serum sodium, and complications. The efficacy parameters of evaluation included International Prostate Symptom Score, quality of life assessment, peak urinary flow rate, and post-void residual urine volume. The operative time (median, 49.5 versus 43.5 minutes), blood loss (median, 179 versus 127 ml), and change in serum sodium (median, -4.0 versus -6.0 mEq/L) were not significantly greater in the thick loop group than in the standard loop group, respectively. There were no major complications in either group. Clinically significant improvement was observed in all efficacy parameters in both groups, with no difference between the two groups. These results suggest that TURP with a thick loop is not necessarily superior to TURP with a standard loop in terms of decreasing the blood loss and decreasing the operative time.

Aged↗
PubMed1992

Spinal versus epidural anesthesia during transurethral resection of the prostate.

The operative superiority of epidural anesthesia during transurethral resection of the prostate (TURP) stimulated this study. Twenty patients scheduled for TURP were randomly allocated to receive either spinal anesthesia (n = 10) with 8 ml bupivacaine 0.5%+ 5ml lignocaine 2%. During and after the operative procedure, PR, BP, ECG, and pulse oximetry were monitored, and blood Hb and Hct, plasma free Hb, and serum sodium and potassium levels were measured. Both techniques resulted in similar PR and BP changes. TURP with spinal anesthesia resulted in more prolonged period of hyponatremia and more increased duration of raised plasma free Hb.

Aged↗
PubMed1996

[Blood loss during transurethral resection of the prostate].

Measurement of the perioperative blood loss during transurethral resection of the prostate was performed using the modern HemoCue photometer in 100 men. The measurement lasts only 5-10 minutes. The median weight of the removed prostate was 28 grams and the operating time 60 minutes. The median blood loss was 393 ml (range 8-1843 ml) and was positively correlated to operating time, change in the peroperative blood pressure, volume of the irrigating fluid and the drop in the postoperative serum sodium. Perioperative measurements of the blood loss draw the surgeons' attention to the haemostasis, provide an objective measure of the most important factor for morbidity during TURP and allow a rational policy for blood transfusion. It is an advantage to place this measurement in the hands of professionals, i.e. laboratory technicians, who are trained to quality-secure the measurement and preserve the photometer.

Aged↗
PubMedDate not supplied

Vesical explosion during transurethral resection of the prostate: report of a case.

OBJECTIVE: Vesical perforation during transurethral resection of the prostate (TURP) is usually related to high increases in intravesical pressure. However, it may rarely be related to explosion precipitated by the contact of the electrocautery with some gases produced during the resections. The authors present a case of vesical explosion, discuss its mechanism and suggest some measures for prevention. METHODS/RESULTS: A 71-years-old male underwent TURP and hemostasy of bleeding from the bladder neck due to persistent hematuria. A wire loop electrode set at a cutting and coagulating current of 80 watts was used. During coagulation of a bleeding in the anterior aspect of the vesical neck when the bladder was empty, a loud pop was heard and a jolt was felt at the lower abdomen. Inspection revealed a hole in the dome of the bladder with loops of small bowel visible. A low midline incision was done, and the intraperitoneal bladder rupture was repaired. CONCLUSION: Although uncommon, vesical explosion during TURP may occur and some preventive measures, discussed herein, can be performed to avoid this complication.

Aged↗
PubMed1988

Absence of lactate accumulation on transurethral resection of the prostate using 2.5% sorbitol solution as an irrigating fluid.

19 patients with benign hyperplasia of the prostate were studied. During transurethral resection of the prostate, 2.5% sorbitol solution was used as an irrigating fluid. Blood samples were taken preoperatively, immediately postoperatively, and 60 and 120 min postoperatively. Samples were analysed for sorbitol metabolites (fructose, glucose, lactate and pyruvate) and inorganic phosphate. The series was divided into two groups, one with low absorption and one with high absorption of irrigating fluid. The limit for the plasma sorbitol concentration immediately postoperatively, dividing the groups, was 1.0 mmol/l, corresponding to an absorbed fluid volume of about 0.1 l. There was a slight increase in lactate and a significant decrease in pyruvate in the blood in both groups postoperatively. Blood fructose was zero in the group with low absorption of irrigating fluid whereas there was a slight increase in the group with high absorption, with a maximum of 0.53 mmol fructose/l. Blood glucose did not show any significant changes postoperatively. Inorganic phosphate in serum showed a significant decrease postoperatively in both groups. There were no significant differences between the groups at the various postoperative sampling times with regard to lactate, pyruvate, glucose or inorganic phosphate in the blood. Thus, we did not observe any accumulation of lactate in the blood when using 2.5% sorbitol solution as an irrigating fluid with absorbed fluid volumes up to 1 litre (corresponding to 25 g sorbitol).

Blood Glucose↗