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PubMed2003

Bladder explosion during transurethral resection of the prostate.

A case of bladder explosion with wide rupture during transurethral resection of the prostate (TURP) is reported. Immediate cystography was performed and the patient was promptly operated; the postoperative course was uneventful. Intravesical explosion is caused by explosive gas formation and the more dangerous combination is the mixture of air and hydrogen; therefore, the introduction of air during TURP is necessary in order to produce a bladder explosion. This unusual complication of a common urological procedure is rare but serious, and should it arise always requires immediate surgical correction.

Aged↗
PubMed1977

The effect of transurethral resection of the prostate on lymphocyte response in patients with prostatic cancer.

The following study indicates that transurethral resection may affect the in vivo cellular aspects of the immune response in patients with prostatic cancer. This in vivo result seems to be supported by the fact that patients dying of carcinoma of the prostate at our institution usually had had an antecedent transurethral resection. Therefore, we emphasize that transurethral resection in patients with prostate cancer should be undertaken with clear-cut indications and with the knowledge that it may be an insult to the patient's immune system.

Aged↗
PubMed2004

Can the outcome of transurethral resection of the prostate be predicted preoperatively?

OBJECTIVES: To establish a formula for predicting the outcome of transurethral resection of the prostate using noninvasive parameters of preoperative evaluation. METHODS: The data of 54 men with a mean age of 57 years (range 43 to 78) were retrospectively analyzed. The International Prostate Symptom Score, quality-of-life score of the International Prostate Symptom Score questionnaire, maximal flow rate (Qmax) recorded during uroflowmetry, age, prostate volume calculated by transrectal ultrasonography, postvoid residual urine volume, and results of pressure-flow studies were evaluated to find a formula that would predict the outcome of transurethral resection of the prostate. The patients were evaluated by uroflowmetry, postvoid residual urine volume determination, and International Prostate Symptom Score questionnaire at 3 months postoperatively. Four different success criteria were investigated with the calculated equations. RESULTS: According to the discriminant analysis, two new scores were calculated as S(1) = (0.169 x age) - (0.0075 x Qmax) and S2 = (0.168 x age) - (0.095 x Qmax) - (0.007 x detrusor pressure at Qmax). For the four success criteria, the optimal cutoff, obtained from the receiver operating characteristic curves of S(1) and S(2), was 8.83 and 9.21, respectively. A statistically significant difference was not found between S1 and S2. The S1 formula had a sensitivity between 71.8% and 85.2%, specificity between 71.4% and 86.7%, and positive predictive value between 72.2% and 92.9% for the four different criteria using two simple variables (Qmax of uroflowmetry and age). CONCLUSIONS: Because urodynamic parameters did not add benefit to the formula consisting of age and Qmax of uroflowmetry with considerable sensitivity and specificity, performing urodynamic studies might not be useful for predicting the outcome of transurethral resection of the prostate.

Adult↗
PubMedDate not supplied

Experience with caudal block regional anesthesia for transurethral resection of the prostate gland.

Ninety five consecutive patients with obstructing prostatic enlargement requiring surgery underwent caudal anesthesia for transurethral resection of the prostate gland (TURP). Their mean age was 73 +/- 7.8 years, the mean preoperative volume of the prostate gland was 160cc and the mean resection time was 97.3 +/- 30 minutes. The anesthesia was satisfactory with a mean pain score of 0.3 +/- 0.6 on the 0-10 pain rating scale. No complication of the anesthetic procedure occurred. Ten patients were discharged free of catheter on the same day while all the remaining 85 patients were discharged within 48 hours of surgery. It is concluded that caudal anesthesia with 2% xylocaine with 1 in 80,000 adrenaline gives adequate anesthesia for transurethral resection of the prostate gland.

Aged↗
PubMed1984

Relationship of pretreatment transurethral resection of the prostate to survival without distant metastases in patients treated with 125I-implantation for localized prostatic cancer.

The authors assessed the relationship between transurethral resection of the prostate (TURP) and the probability of survival without distant metastases (survival) in patients with clinically localized prostatic cancer. Fifty-eight patients with obstructive voiding symptoms who underwent TURP within 12 months before pelvic lymphadenectomy and 125I-implantation were compared with 131 patients who did not require TURP before implantation. None received other treatment for the tumor. The overall survivals for the two groups were not significantly different, P greater than 0.1. When stratified by tumor grade or the presence or absence of pelvic lymph node metastases, the survivals for the two groups were also similar, P = greater than 0.1. However, survival associated with Stage C tumors was greater in the No TURP than in the TURP group (P = 0.003), and survival associated with Stage C tumors was greater in the TURP than in the No TURP group (P = 0.005). These data fail to provide convincing evidence that transurethral resection of prostatic cancers has an unfavorable impact on disease progression.

Adenocarcinoma↗
PubMedDate not supplied

Bacteremia in connection with transurethral resection of the prostate.

A bacteriological survey of 50 consecutive patients undergoing transurethral resection of the prostate was performed. Preoperatively, 28% of the patients had asymptomatic bacteriuria. In the postoperative period, 46% of all the patients developed transient bacteremia. A significantly higher rate of bacteremia was found in patients with hypertrophy of the prostate than in those with cancer of the prostate and in patients undergoing long-lasting surgical intervention. Patients who developed bacteremia due to pathogenic bacteria were hospitalized for a significantly longer period of time.

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PubMed1991

Reliability of questionnaire responses as compared with interview in the elderly: views of the outcome of transurethral resection of the prostate.

Three hundred and eighty-eight men undergoing transurethral resection of the prostate for benign prostatic hypertrophy completed a presurgical questionnaire and three follow-up questionnaires 3, 6 and 12 months after surgery. The questionnaires covered details of prostatic symptoms, general health, and expectations and results of surgery. At each follow-up point 40 randomly selected patients were interviewed by two female research assistants. The response rate to the questionnaires was over 90% at each follow-up point while that for the interviews was lower at around 80%. We examine the reliability of the postal questionnaires in assessing health status by comparing questionnaire and interview responses, with a view to the wider employment of such a method in the follow-up of surgical patients. In general, and as reported elsewhere, responses to questions on easily defined topics are highly comparable between questionnaire and interview. Responses to more subjective questions are moderately reliable, but with a tendency for postal questionnaires to underestimate a patient's health problems. It is difficult to assess the reliability of the questionnaires with regard to questions of an intimate nature since such questions caused embarrassment during interview with consequent incomplete responses.

Adult↗
PubMed1993

[Neurotoxic role of glycocolle and derivatives in transurethral resection of the prostate].

72-year-old patient underwent an elective transurethral resection of the prostate (TURP) performed with a spinal anaesthesia. The irrigation solution contained glycine at a concentration of 15 g.l-1. The patient's level of consciousness deteriorated over the next 4 hours. He went in an areflexic coma with pupillary areflexia and left mydriasis. The diagnosis of TUR syndrome was substantiated by a sodium blood concentration of 98 mmol.l-1, an osmotic gap of 48 mosmol.kg-1 and blood ammonia at 415 mumol.l-1. To investigate the pathophysiological role of glycine and its metabolites, their concentrations were measured by chromatography and spectrometry in plasma and CSF 8, 24 and 48 hours postoperatively. Glycine and its metabolites (serine, alanine, glyoxylic acid and glycolic acid) accumulated during the postoperative period in both blood and CSF. The central nervous system is in direct contact with these neurotropic compounds. Glycine is an inhibitory neurotransmitter, whereas glyoxylic acid and glycolic acid are considered as to be neurotoxic.

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PubMed1995

Early catheter removal: a prospective study of 100 consecutive patients undergoing transurethral resection of the prostate.

OBJECTIVE: To determine whether early catheter removal after transurethral resection of the prostate (TURP) leads to early hospital discharge with no increase in complications. PATIENTS AND METHODS: From October 1992 50 consecutive patients undergoing TURP in each of two hospitals were catheterized for < 24 h or > 36-48 h after the operation. Patients were followed up to assess the frequency and extent of post-operative complications. RESULTS: The two groups, which were standardized as far as possible, had a similar outcome whether the catheter was removed within 24 h or > 36 h after TURP. CONCLUSION: Brief catheter drainage after TURP is safe and allows an earlier discharge from hospital than the standard duration of catheterization.

Aged↗
PubMed1997

Trapping of electrolytes during fluid absorption in transurethral resection of the prostate.

Absorption of irrigating fluid into the blood during transurethral resection of the prostate is associated with diffusion of sodium ions from the interstitial fluid space into the plasma. Some of this sodium is "trapped" and removed from the body in connection with bleeding and excretion of urine. The magnitude of this sodium loss was calculated over 10-min periods throughout 20 operations during which absorption of glycine solution occurred. The amount of trapped sodium increased with the amount of blood lost, a 1000-ml bleed correlating with a loss of 10 mmol of sodium. Two thirds was trapped with the plasma loss and one-third with the osmotic diuresis. This mechanism contributes to the absolute loss of sodium from the body. The total sodium loss, however, accounts for one third of the maximum hyponatraemia and is still dominated by the plasma-derived sodium excreted during the glycine-induced osmotic diuresis.

Absorption↗
PubMed2005

[Transurethral resection of the prostate for patients with the permanent cardiac pacemaker].

OBJECTIVE: To evaluate the transurethral resection of the prostate (TURP) for patients with the permanent cardiac pacemaker. METHODS: A retrospective study was made on TURP for 8 patients aged from 62 to 71 and equipped with the cardiac pacemaker for 2 to 7 years, because of sick sinus syndrome (5 cases), complete atrioventricular block (2 cases), and three-cord block (1 case). The pacemakers varied accordingly, Type DDD in 4, Type AAI in 3 and Type VVI in 1 of the patients. RESULTS: All the operations were successful, and all the patients experienced satisfactory recovery. CONCLUSION: Patients with the permanent cardiac pacemaker can receive TURP.

Aged↗
PubMed1997

Transurethral resection of the prostate with microprocessor controlled electrosurgical unit.

PURPOSE: We analyzed the efficacy and side effects of a microprocessor controlled high frequency unit for transurethral resection of the prostate. MATERIALS AND METHODS: A high frequency device with microprocessor control was used in 934 consecutive patients undergoing transurethral resection of the prostate. Indications for transurethral resection, medical history, preoperative findings, operative parameters, operative and immediate postoperative complications, and postoperative peak flow rate and residual urine were evaluated. RESULTS: Postoperative peak flow rate and residual urine were comparable to those with standard transurethral resection of the prostate. One patient died on postoperative day 1 for a mortality rate of 0.1%. The immediate morbidity rate was 6.9%. CONCLUSIONS: Morbidity and mortality in this study were lower than those in previous series on transurethral resection of the prostate.

Aged↗
PubMed2006

Gyrus bipolar versus standard monopolar transurethral resection of the prostate: a randomized prospective trial.

OBJECTIVES: To compare bipolar plasmakinetic (PK) with standard monopolar transurethral resection of the prostate (TURP). METHODS: A total of 70 patients were prospectively randomized into two groups: 35 patients underwent PK TURP with the Gyrus device, and 35 patients underwent standard monopolar TURP. We evaluated the time to catheter removal and hospital discharge, operating time, blood loss, postoperative irrigation, complications, urinary flow rates, symptom relief, and postvoid residual volumes. RESULTS: At baseline, the study groups were comparable in age, prostate volume, mean prostate-specific antigen value, International Prostate Symptom Score, quality-of-life score, flow rate, and postvoid residual volume. The mean catheterization time was 72 and 100 hours in the PK and standard groups, respectively. This difference was statistically significant (P <0.05), as was the difference in the time to hospital discharge. No difference was found in the mean resection time, amount of resected tissue, or variations in hemoglobin and sodium levels. The improvement in flow rate, postvoid residual volume, International Prostate Symptom Score, and quality-of-life score was comparable between the two groups at 12 months of follow-up. CONCLUSIONS: In our experience, PK TURP showed comparable perioperative results to those obtained with standard TURP, but with more favorable postoperative outcomes. The resection time and blood loss were similar between the two groups, but the need for continuous bladder irrigation after surgery and time to catheter removal and hospital discharge were significantly shorter in the PK group.

Humans↗
PubMed1997

Risk of incontinence with transurethral resection of the prostate after radiation therapy for prostate cancer.

BACKGROUND: It has been reported that transurethral resection of the prostate (TURP) after definitive radiation therapy for prostate cancer is associated with a significant risk of incontinence. The presumed reason for incontinence is external sphincter damage from TURP or pre-existing damage from either extension of prostate cancer or radiation therapy. METHODS: We reviewed seven recent cases of TURP for bladder outlet obstruction in patients who had undergone radiation therapy for clinical stage T(3-4)M(0)N(0) adenocarcinoma of the prostate. All seven men progressed to either chronic retention or debilitating obstructive symptoms with weak peak flows from 3.4 to 5.1 cc/s (mean 4 cc/s). Each of them subsequently underwent a limited TURP. RESULTS: Voiding symptoms were reduced in all patients and peak flows were improved to 6.3 to 20 cc/s (mean 14.8 cc/s) with mean follow-up 35 m. No patient developed stress urinary incontinence postoperatively. CONCLUSION: These results suggest that TURP can be performed successfully after radiation therapy with minimal risk of stress incontinence.

Adenocarcinoma↗
PubMed2004

Real life practice in the management of benign prostatic hyperplasia.

PURPOSE OF REVIEW: To review the current diagnostic and treatment options of lower urinary tract symptom due to benign prostatic hyperplasia and to put data from real life practice into perspective. RECENT FINDINGS: The overall incidence rate of lower urinary tract symptom/benign prostatic hyperplasia was found at 15 per 1000 man-years (95% CI 14.8-16.1). The incidence increases with age from 3/1000 man-years at 45-49 years to 38/1000 man-years at 75-79 years. Recent diagnostic studies include the use of PSA to estimate prostate volume and its predictive value for the long-term risk of prostate enlargement. Variability of the International Prostate Symptom Score when filled at home and in the hospital is discussed. The first-line treatment option remains medical therapy. The most prescribed alpha-blockers are terazosin, alfuzosin, and tamsulosin, which are comparable in efficacy. The efficacy of finasteride is also confirmed, especially for enlarged prostates with the possibility of volume reduction up to 30%. Interventional therapy begins when there is evidence of moderate to severe symptoms. Long term results put transurethral microwave thermotherapy in advantage over other minimally invasive modalities. Surgical treatment remains the procedure with the best results. Open prostatectomy is still indicated for severely enlarged prostates. Transurethral resection for medium-sized prostates and bladder-neck incision for small prostates also remain the best option. SUMMARY: Real life practice studies in the last few years have broadened our insight into the application of different diagnostic and treatment modalities. Since results from randomized controlled trials can not always be extrapolated to daily urological practice, real life practice studies made data available to complement data from randomized controlled trials.

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PubMed2002

Malignant anterior urethral strictures: a rare complication of transurethral resection of malignant prostate.

A 65-year old male presented with obstructive voiding symptoms and recurrent hematuria following transurethral resection of malignant prostates. Following an unsuccessful attempt at catheterization, urethroscopy revealed narrowing of anterior urethra secondary to multiple nodular lesions. Biopsy of lesion showed adenocarcinoma positive for prostate specific antigen. This rare presentation has been reported only twice in past. Clinical presentation, pathophysiology and brief review of literature are discussed.

Adenocarcinoma↗