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PubMed1997

[Comparison of prostatic electro-vaporization and transurethral resection in the treatment of benign prostatic hypertrophy].

The objectives of this study was to compare electrovaporization (EVAP) of the prostate to transurethral resection of the prostate (TURP). A prospective evaluation of 60 patients treated for benign prostatic hypertrophy (BPH) was carried out between November 1994 and November 1996. Twenty five patients were treated with TURP and 35 patients with EVAP. All patients had a minimum 12 month follow-up. The results obtained were comparable in terms of surgical procedure time with a bloodless surgical field using EVAP. EVAP was advantageous in reducing the time with indwelling urinary catheter postoperatively and reducing hospital stay. At 12 month follow-up results of flow rates and symptom scores were similar for both TURP and EVAP. Reoperation rate for residual BPH in the EVAP group was higher than for TURP, suggesting that EVAP should probably be limited to smaller sized glands. This study suggests that EVAP is a viable alternative to TURP in selected patients. It requires no specialized equipment and may allow a reduction in catheterization and hospital stay.

Electrosurgery↗
PubMed2004

Cost aspects of transurethral resection of the prostate, contact laser prostatectomy, and electrovaporization.

OBJECTIVES: To compare the costs of transurethral resection of the prostate (TURP), contact laser prostatectomy (CLP), and electrovaporization in men with lower urinary tract symptoms associated with benign prostatic hyperplasia. METHODS: We conducted a randomized controlled trial that included men with lower urinary tract symptoms who met the criteria of the International Scientific Committee on benign prostatic hyperplasia. Subjective changes were quantified using questionnaires validated by the American Urological Association. The maximal free urinary flow rate was estimated. Morbidity and mortality were registered. These parameters were measured at regular intervals for up to 1 year and once during long-term follow-up. A cost analysis together with a sensitivity analysis was performed on the basis of a follow-up of 12 months. RESULTS: A total of 50 men were randomized to TURP, 45 to laser treatment, and 46 to electrovaporization. The subjective and objective changes were very similar during the 12 months of follow-up. The costs were highest for CLP (1885 dollars), followed by TURP (1707 dollars), and were lowest for electrovaporization (1489 dollars). However, the length of hospital stay decreased during the trial more for CLP and electrovaporization than for TURP. Recalculations demonstrated almost equal costs for CLP and TURP (1697 dollars and 1643 dollars, respectively) and the lowest costs for electrovaporization (1386 dollars). CONCLUSIONS: Electrovaporization has a better cost-effectiveness than CLP and TURP in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia. CLP and TURP showed very similar cost-effectiveness ratios.

Cost-Benefit Analysis↗
PubMed1993

[Pre-operative, operative and postoperative complications in 2266 cases of transurethral resection of the prostate].

Pre-operative and operative complications in 2266 patients having undergone transurethral resection of prostate (TURP) for the past 20 years at Kitasato University Hospital were analyzed. They consisted of 2008 benign prostatic hyperplasia and 258 prostate cancer patients. Seven hundred and fifty four patients showed some of physical disorders prior to TUR:hypertension in 147 cases, diabetes mallitus in 87, ischemic heart disease in 46, chronic obstructive lung disease in 41 and others. Operative and postoperative complications of TURP were seen in 308 cases (13.6%). Perforation of the prostatic capsule was seen in 100 cases (4.4%) and bladder perforation into intraperitoneal cavity in 6 cases (0.3%). Transurethral fulgulation for postoperative hemorrhage was conducted on 79 cases (3.5%). Hyponatremia lower than 130 mEq/L was noted in 14 cases (0.6%). Severe urinary tract infection leading to bacteremia was observed in 9 cases (0.4%). Postoperative epididymitis was evident in 20 cases (0.8%). There was postoperative urinary incontinence in 19 cases, 3 of which was treated with Teflon-paste injection successfully. One patient had to undergo AMS-800 artificial sphincter implantation. The number of postoperative urethral stricture patients requiring urethral dilatation or internal urethrotomy was 12 (0.5%) and postoperative bladder neck contracture was seen in 20 cases (0.9%). One patient (0.04%) who developed DIC after profuse postoperative hemorrhage died on the 37th postoperative day. The efficiency of TURP depends not so much on the skill of cutting as on the speed and accuracy of orientation and haemostasis. The quick recognition of anatomical landmarks will assure effective and safe resection.

Adult↗
PubMed2003

Transurethral resection of the prostate as catheter-free day-care surgery.

OBJECTIVE: To evaluate the feasibility of transurethral resection of the prostate (TURP) as catheter-free day-care surgery. PATIENTS AND METHODS: The study comprised 64 patients (mean age 62.4 years) with a mean (range) American Urological Association symptom score of 21.4 (9-31) and prostate volume (by ultrasonography) of 32.8 (17-50) mL, and with no significant comorbidity. The patients were admitted on the morning of the surgery and, under brief spinal anaesthesia, underwent standard TURP. After surgery the urethral catheter was removed as soon as the effluent was clear. The patients were discharged after they could pass urine freely and with a good stream. RESULTS: The mean duration of catheterization after TURP was 7.15 h; 59 patients (92%) had their catheter removed within 10 h (mean duration 6.42 h). There were no major complications during or after TURP. After removing the catheter, no patients required its reinsertion for failure to void or for clot retention. The mean hospital stay after TURP was 10.7 h and 98% of patients were discharged within 23 h of surgery. CONCLUSION: TURP can be conducted safely in a day surgery setting in patients with mild to moderate benign prostatic enlargement and no coexisting medical illness.

Aged↗
PubMed2004

Transurethral electrovaporization vs transurethral resection for symptomatic prostatic obstruction: a meta-analysis.

OBJECTIVE: To compare the effectiveness and safety of transurethral electrovaporization (TUEVP) and transurethral resection of the prostate (TURP) for symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). METHODS: Publications comparing TUEVP and TURP were identified systematically using Medline, the Cochrane Controlled Trial Register and other database search engines. From a total of 25 randomized controlled trials, 20 studies met the predefined inclusion criteria and were subjected to a formal meta-analysis. Primary endpoints were symptom scores and peak urinary flow rates. Secondary endpoints included transfusion requirements, operative time, duration of catheterization, incidence of adverse events, hospital stay, re-operation rates and sexual dysfunction. RESULTS: After 1 year of follow-up there was no significant difference between TUEVP and TURP in urinary symptom scores and peak urinary flow rates. There was heterogeneity at baseline for both primary outcome measures. TUEVP was associated with significantly lower transfusion requirements, a shorter catheterization time, and a shorter length of stay. TURP was associated with a lower risk of urinary retention afterward and re-operation than was TUEVP. CONCLUSION: This formal meta-analysis suggests that both TUEVP and TURP in patients with symptomatic bladder outlet obstruction provide comparable improvements in maximum urinary flow rates and symptom scores. While comparative analysis is limited by the methodological shortcomings of the underlying studies and the short follow-up, both TURP and TUEVP may offer distinct advantages in terms of secondary outcomes. A future, well-designed, multicentre randomized clinical trial with extended follow-up may be needed to better define the role of vaporization techniques in treating patients with symptomatic BPH.

Electrocoagulation↗
PubMed1989

Combined transurethral resection of the prostate and inguinal herniorrhaphy.

From 1983 to 1985, ten men had combined transurethral resection of the prostate (TURP) and inguinal herniorrhaphy; hernia repair immediately preceded transurethral resection. Eight men had unilateral inguinal hernia repair and two had bilateral inguinal herniorrhaphy. Four men had additional procedures done concurrently. Follow-up ranged from 14 to 33 months (mean 22.4 months). There were no recurrent hernias or infections of the hernia incision. These results suggest that combined TURP and inguinal herniorrhaphy can be safely accomplished during a single period of anesthesia.

Aged↗
PubMedDate not supplied

Transurethral resection of the prostate-related changes in the prostate gland: correlation of MRI and histopathology.

PURPOSE: The purpose of this work was to demonstrate signal changes of the prostatic urethra after transurethral resection of the prostate (TURP) on MR images and histopathologic correlation. METHOD: Sixty-three patients with prostate cancer confirmed by either TURP (Group A, 19 patients) or transrectal biopsy (Group B, 44 patients) were evaluated by endorectal MRI before radical prostatectomies. The MR images of postcurettaged prostatic urethras were correlated with the histopathologic features. RESULTS: On the T2-weighted images, a thin zone of hypointense signal surrounding the curettaged prostatic urethra was identified in 52.6% (10/19) of Group A patients, imaged soon after (mean 21.1 days) TURP, but was indiscernible in Group B patients and the other Group A patients, imaged later after TURP (mean 49.2 days). This hypointense signal zone histopathologically correlates with a zone of inflammatory tissue reaction surrounding the widened urethra. CONCLUSION: Inflammatory tissue reaction surrounding curettaged prostatic urethra after TURP accounts for the presence of a low signal zone on T2-weighted images.

Aged↗
PubMed1999

The use of ethanol to monitor fluid absorption during transurethral resection of the prostate.

Ethanol monitoring is a method for assessing fluid absorption during transurethral resection of the prostate. The method is based on the principle that absorption can be measured by expired-breath tests provided that an irrigating fluid containing ethanol 1% is used. A nomogram for transformation of the ethanol data into meaningful indices of fluid absorption, such as the volume of irrigant absorbed and the degree of hyponatraemia, has been approved for routine use within the European Union. To make a correct interpretation, however, one must learn how to distinguish the pattern of breath ethanol changes typical of absorption of fluid directly into the blood from the pattern associated with the rare intraoperative events in which fluid is deposited in a pool in the retro- or intraperitoneal space. The ethanol method is well documented, but it is still sparsely used outside Scandinavia, due to its lack of a patent and differing opinions concerning the need for measuring fluid absorption.

Absorption↗
PubMed2003

Long-term follow-up after transurethral resection of the prostate, contact laser prostatectomy, and electrovaporization.

OBJECTIVES: To compare the long-term results of subjective changes, flowmetry, morbidity, and mortality after transurethral resection of the prostate, contact laser prostatectomy, and electrovaporization in men with lower urinary tract symptoms associated with benign prostatic hyperplasia. METHODS: A prospective randomized controlled trial was conducted. Included in the study were men with lower urinary tract symptoms, who met the criteria of the International Scientific Committee on Benign Prostatic Hyperplasia, had a prostate volume between 20 and 65 cm(3), and a Schäfer obstruction grade of 2 or greater. The subjective changes were quantified using the International Prostate Symptom Score, Symptom Problem Index, quality-of-life question, and benign prostatic hyperplasia impact index. Morbidity was registered objectively and by patient questionnaire. Maximal flow was measured by free uroflowmetry. These parameters were measured at regular intervals for up to 1 year. At the end of 2002, all patients were invited for a long-term follow-up examination, including the aforementioned parameters. RESULTS: Fifty men were randomized to undergo transurethral resection of the prostate, 45 laser treatment, and 46 electrovaporization. Of the 50 men, 70% were followed up for a maximum of 7 years. The values for the International Prostate Symptom Score, Symptom Problem Index, quality-of-life score, and benign prostatic hyperplasia impact index increased slightly after a mean follow-up of 4.3 years. The maximal uroflow decreased similarly in all treatment groups to about 150% of the preoperative values. Morbidity, reoperation rates, and mortality were also similar. CONCLUSIONS: This study, with up to 7 years of follow-up, demonstrated durable subjective and objective results for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia after transurethral resection of the prostate, contact laser prostatectomy, or electrovaporization. No clinically relevant differences were found among these modalities.

Aged↗
PubMed1989

The incidence of perioperative myocardial infarction with transurethral resection of the prostate.

We performed a prospective study of 250 men undergoing transurethral resection of the prostate to determine the incidence of perioperative myocardial infarction. The prevalence of coronary artery disease in the study group was 27%. Patients had measurement of total creatine kinase and its MB isoenzyme and electrocardiography preoperatively and on the first three postoperative days. Only one myocardial infarction was diagnosed, an incidence rate of 0.4%. The overall rate of serious post-operative complications was 3.6%. No deaths occurred during the operative hospitalization. We conclude that with transurethral resection perioperative myocardial infarction is a rare event despite the high prevalence of coronary artery disease in this surgical population. Routine postoperative surveillance with electrocardiograms and creatine kinase determinations in asymptomatic patients is not warranted.

Aged↗
PubMed1991

Should urologists wear spectacles for transurethral resection of the prostate?

Contamination of the eyes by irrigation fluid during transurethral resection (TUR) of the prostate was assessed by measuring droplet splashes on to spectacles worn by 2 surgeons. During 30 consecutive operations, droplet splash contamination occurred during every procedure. The number of splashes increased with time. The use of spectacles during TUR will reduce the risks of eye contamination from droplet splashes and therefore the possibility of transmission of the human immunodeficiency virus from infected patients.

Eye Protective Devices↗
PubMed1996

The quality of life of patients on a waiting list for transurethral resection of the prostate.

We evaluated the quality of life of 50 patients with benign prostatic hypertrophy on a waiting list for transurethral resection of the prostate. The patients had a median age of 68 years (range: 48-84 years) and had been on the waiting list for a median of eight months (range: 2-36 months). Patients were assessed using the Benign Prostatic Hypertrophy Health-Related Quality of Life Survey Questionnaire. All patients had disagreeable urinary symptoms that interfered with their normal activities, for example, 92% of patients were troubled by disturbed sleep. The patients also had worries about the possibility of prostatic cancer (40%) and a perceived deterioration in sexual performance during the preceding year (56%). Eleven of the 14 patients who were re-evaluated one year after a transurethral resection of the prostate were completely free of any bothersome urinary symptoms.

Aged↗
PubMed2000

Loss of high-molecular-weight cytokeratin antigenicity in prostate tissue obtained by transurethral resections.

OBJECTIVE: Staining of prostatic basal cells for the expression of high-molecular-weight cytokeratin has been suggested as a way of distinguishing benign from malignant prostate glands. We evaluated the utility of high-molecular-weight cytokeratin in the diagnosis of malignancy in prostate specimens obtained in various ways. DESIGN: Prostate tissues obtained from needle biopsies, transurethral resections, and total prostatectomies were immunostained with monoclonal antibody 34betaE12, an antibody directed against high-molecular-weight cytokeratins. RESULTS: Antiserum to high-molecular-weight cytokeratin only stained the basal cells in normal glands in 3 (12%) of 25 specimens obtained by transurethral resection. Other antigens, such as the alternate 10-nm filament protein vimentin, were unaffected and were detected in 100% of these specimens. However, keratin antigenicity in transurethral biopsies could be restored in these specimens by antigen retrieval in a low pH citrate buffer using a microwave heat technique. Keratin staining in needle biopsies and total prostatectomies was unaffected. CONCLUSION: In summary, our results indicate the technique of transurethral resection results in a specific loss of keratin antigenicity. This limits the utility of anticytokeratin 34betaE12 in interpreting transurethral resections without the application of antigen retrieval.

Adenocarcinoma↗
PubMed2002

Sequential transurethral resection of the prostate and laparoscopic bladder diverticulectomy: comparison with open surgery.

OBJECTIVES: To compare our experience with transurethral resection of the prostate and sequential laparoscopic bladder diverticulectomy with a previous series of combined open bladder diverticulectomy and transvesical prostatectomy. METHODS: We compared the data of 10 consecutive patients (group 1) who underwent sequential transurethral resection of the prostate and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group 2) who underwent traditional combined open bladder diverticulectomy and transvesical prostatectomy. The following parameters were considered: size and position of the diverticulum, transrectal ultrasound adenoma volume, operative time, postoperative hemoglobin variations, analgesic requirement, complications, postoperative hospital stay, and urinary flowmetry. RESULTS: No statistically significant differences existed between the two groups either for diverticulum size (6.8 versus 7.2 cm) or diverticula position. A significant difference was observed in the operative time (247 minutes for group 1 versus 136 minutes for group 2, P <0.0001), mean postoperative hemoglobin decrease (2.6 g/dL for group 1 and 3.9 g/dL for group 2, P = 0.001), analgesic requirement (1.3 ampoules of buprenorphine cloritrate for group 1 versus 1.8 ampoules for group 2, P = 0.45), and postoperative hospital stay (3 days for group 1 versus 9.6 days for group 2, P <0.0001). No statistically significant difference was recorded for control flowmetry. No intraoperative complications were recorded for the two groups. CONCLUSIONS: In our series, sequential transurethral resection of the prostate and transperitoneal laparoscopic diverticulectomy for large diverticula proved to be a safe, effective, and minimally invasive procedure, despite the longer operative times compared with transvesical prostatectomy and open bladder diverticulectomy.

Combined Modality Therapy↗