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PubMed1993

Haemodilution during transurethral resection of the prostate using water as the irrigant fluid.

Of 58 patients who underwent transurethral resection of prostate (TURP), in whom water was used as the irrigant fluid, four patients had clinical evidence of the "TURP syndrome" (1). Although the serum sodium decreased to less than 120 in 7 patients, only one of them had clinical signs. Reduction in haemoglobin and serum proteins caused no untoward signs. It is concluded that water is an acceptable irrigant fluid.

Adult↗

PubMed1987

Transient blindness associated with transurethral resection of the prostate.

Visual impairment or even transient blindness can result from transurethral resection of the prostate when glycine is used as the irrigating fluid. Electroretinograms were obtained from patients in the anesthetic preparation area and in the recovery room immediately after surgery. Four patients reported visual aberrations ranging from a "gray darkening" to "light perception only" coincident with elevated serum levels of glycine. Electroretinograms consistently demonstrated a loss of oscillatory potentials only in those patients with visual impairment. Thirty-hertz "flicker-following" was also attenuated. The excessive serum levels of glycine may contribute to visual impairment and may account for the dropout of oscillatory potentials generated by the retina due to glycine's role in the retina as an inhibitory transmitter.

Acute Disease↗

PubMed1994

Hypertonic saline prehydration in patients undergoing transurethral resection of the prostate under spinal anaesthesia.

Thirty-three patients undergoing elective transurethral resection of the prostate were allocated randomly to receive either 0.9% isotonic saline 7 ml kg-1 (16 patients), or 3% hypertonic saline 7 ml kg-1 (17 patients) as a preload before spinal anaesthesia. After spinal anaesthesia, the incidence of systolic arterial pressure < 75% of control value was greater in the normal saline group than in the hypertonic saline group. Also, the mean dose of phenylephrine required to maintain arterial pressure > 75% of the baseline value was significantly greater in the normal saline group than in the hypertonic saline group.

Adult↗

PubMed1989

Transurethral resection of the prostate, serum glycine levels, and ocular evoked potentials.

Complications of transurethral resection of the prostate (TURP syndrome) when glycine is used as the irrigating fluid include cardiovascular and central nervous system abnormalities that occasionally include transient blindness. Serum sodium, glycine, potassium, chloride, ammonia, osmolality, carbonate, and blood urea nitrogen of 17 patients having TURP and 10 having cystoscopic examination were measured. Electroretinograms and visually evoked potentials (VEPs) were recorded in the preanesthetic preparatory area and in the recovery room immediately after surgery. Four patients reported visual aberrations coincident with increases in serum levels of glycine from a mean before surgery of 137.7 +/- 45.1 to 7,812.2 +/- 2,486.6 microM/l, mean +/- SD, after TURP. These patients also showed a reduction of serum sodium from 138 +/- 4.5 to 122 +/- 8.6 mEq/l that correlated significantly with serum levels of glycine (rho = -0.81). There were no statistically significant changes of serum ammonia and osmolality. Electroretinograms consistently demonstrated complete loss of oscillatory potentials. Thirty hertz flicker-following was also abolished. VEPs were more variably affected with prolongation of component "P100" latency found in both groups and probably resulting from sedative effects of diazepam. Patients experiencing the TURP syndrome showed abolishment of 30 Hz flicker-following in their VEPs. The elevated serum levels of glycine may contribute directly to visual aberrations resulting from glycine's role as an inhibitory transmitter in the retina.

Aged↗

PubMed1996

Operative factors and the long-term incidence of acute myocardial infarction after transurethral resection of the prostate.

We studied the association between the operative course of transurethral resection of the prostate (TURP) and the morbidity of acute myocardial infarction (AMI) in a cohort comprising 846 patients who underwent this operation between 1983 and 1992. Up to the end of 1993, a total of 69 patients had developed AMI, of which 10 patients had a reinfarction. The relative risk associated with absorption of 500 ml or more of the irrigating medium during surgery was 1.6 [95% confidence interval (CI) = 0.9-3.0] for a first-time AMI after TURP, 6.1 (95% CI = 1.8-20.7) for a reinfarction, and 2.2 (95% CI = 1.3-3.9) for a first-time or a reinfarction combined. A blood loss of 275 ml or more was associated with a decreased relative risk (RR = 0.4; 95% CI = 0.2-0.8) of a first-time AMI after TURP. Patients who lost less than 275 ml of blood and absorbed 500 ml or more of irrigating fluid during surgery had 4.4 times the risk of having an acute myocardial infarction (RR = 4.4; 95% CI = 1.7-11.8). These results appear to indicate that the operative course of TURP is important to the development of AMI over an extended period of time.

Aged↗

PubMed1991

Calculation of irrigant absorption by measurement of breath alcohol level during transurethral resection of the prostate.

If ethanol is added to the irrigant used in transurethral resection of the prostate, absorption of the fluid can be immediately detected by measuring the ethanol concentration in the expired breath. During 90 resections where the irrigant contained 1.5% glycine and 1% ethanol, the breath alcohol level was compared with the amount of irrigant absorbed as determined by volumetric measurement. The results showed that the expired-breath ethanol level depended not only on the volume of irrigant absorbed but also on the rate of ethanol diffusion in the total body water, which increased with the ethanol concentration. By applying a derived mathematical model the absorption could be estimated from the breath alcohol level at any time during surgery, with a median deviation of 19% from the measured value.

Absorption↗

PubMed1979

Transurethral resection of large prostates.

A total of 102 men (mean age 70) underwent transurethral resection of the prostate. The weight of the resected prostate ranged from 40 to 152 g. Two deaths occurred in patients aged 85 and 92 years, both of whom were generally unfit. The average postoperative stay in hospital was 8.3 days. The proportions of patients with incontinence, infection, and stricture were similar to those in other series of resections and open prostatectomies, suggesting that resection of the larger prostate is safe and an acceptable alternative to an open operation.

Aged↗

PubMed1982

Transurethral resection of the prostate with and without continuous irrigation.

Four hundred patients undergoing transurethral resection of the prostate have been studied. An intermittent irrigation resectoscope was used in 200, and a continuous irrigation resectoscope in the remainder. The merits and demerits of continuous irrigation resection are discussed in the light of the results of these operations. The conclusion reached is that the continuous irrigation resectoscope has considerable advantages over the intermittent flow instrument. These advantages are most evident in the difficult operation, or in operations on the larger prostate, as well as in the tuition and demonstration of endoscopic surgery.

Adult↗

PubMed1991

[Hyponatremia during transurethral resection of the prostate].

In a retrospective study of 222 patients who underwent transurethral resection of the prostate under spinal anesthesia, plasma sodium levels during the operation were examined. The weight of prostate resected, the volume of irrigating fluid used and the duration of the operative procedure influenced the changes in plasma sodium levels. But, these changes were not statistically significant. The rise in central venous pressure values was associated with the absorption of irrigating fluid as evidenced by a drop in plasma sodium. The central venous pressure was monitored in 77 patients. There was a statistically significant correlation between the degree of hyponatremia and the rise in central venous pressure (P less than 0.001). The rise in central venous pressure reflected a change in the patient's cardiovascular status and it was, therefore, possible to treat the hyponatremia quickly and effectively. Central venous pressure monitoring is helpful in determining hyponatremia before it becomes clinically manifest.

Aged↗

PubMed1988

Devices for monitoring intravesical pressure during transurethral resection of the prostate.

The importance of maintaining a low intravesical pressure during transurethral resection of the prostate has been demonstrated in studies of the relationship between bladder pressure and the amount of irrigating fluid absorbed during the procedure. Several methods of monitoring pressure are described, and the advantages and disadvantages of each are discussed.

Electronics, Medical↗

PubMed1995

A randomised single institution study comparing laser prostatectomy and transurethral resection of the prostate.

We concluded a prospective randomised study comparing conventional electrocautery transurethral resection of the prostate (TURP) to laser prostatectomy using a right-angled Nd:YAG beam reflector. Seventy-one patients were evaluable, 34 laser and 37 TURP. Fifty patients have completed 6 months of follow-up. Using standard post prostatectomy outcome parameters of maximum flow rate and post void residual urine, laser prostatectomy shows equivalence at 6 months, with mean maximum flow rates of 8.76 ml/sec preoperatively improving to 15.47 ml/sec at 6 months, whilst for TURP patients, flow rates improved from a mean of 9.48 ml/sec preoperatively to 19.1 ml/sec at 6 months. Symptom scores remain higher for the laser patients at this time with a mean score of 9.27 compared to 4.43 for TURP patients. However, morbidity in the laser group is less, particularly given the absence of postoperative bleeding and the necessity for blood transfusion.

Aged↗

PubMed1998

[Evaluation of blood loss and absorption of irrigating fluid in transurethral resection of the prostate].

A questionnaire was sent to all Danish departments performing transurethral resection of the prostate (TUR-P) concerning the use of irrigating fluids and methods to estimate peroperative blood loss and absorption of irrigating fluid. Fifty-six of 60 departments used glycine as an irrigant. Seventeen percent of the departments measured blood loss peroperatively (HemoCue). Only two departments (3%) measured absorption of irrigating fluid quantitatively by the expired breath ethanol method. The other departments estimated blood loss and absorption of irrigant from the colour of the irrigating fluid. From studies of the literature we suggest the use of sorbitol/mannitol as irrigating fluid instead of glycine, as this may have fewer adverse effects, and we recommend quantitative measurements of blood loss and absorption of irrigating fluid to minimise the potentially dangerous consequences of TUR-P.

Blood Loss, Surgical↗

PubMed2004

Cognitive impairment after transurethral resection of the prostate (TURP).

PURPOSE: It has been suggested that cognitive impairment may occur following transurethral resection of the prostate (TURP) operations due to the effects of anaesthesia or hyponatraemia or both. The aim of the study was to investigate whether TURP was associated with long-term memory complaints or cognitive impairment. METHOD: Patients who had received a TURP or transurethral resection of a bladder tumour (TURT) in the previous 10 months were sent a questionnaire on memory problems and mood. Seventy-six TURP patients and 38 TURT patients returned the completed questionnaires. A sample of each patient group (30 TURP, 29 TURT) was assessed on standardized tests of cognitive abilities. RESULTS: There was no significant difference between the TURP and TURT patients on the Everyday Memory Questionnaire completed by themselves or by a family member (p > 0.05). On formal cognitive testing there were no significant differences between the groups, except on the overall grading of the Kendrick Assessment Scales of Cognitive Ageing, in which TURP patients performed at a significantly lower level than TURT patients. CONCLUSIONS: The results suggest that patients are no more likely to complain of memory problems following a TURP than with any other operative procedure. There was a slight difference in cognitive abilities but this did not indicate significant impairment of cognitive function.

Affect↗

PubMedDate not supplied

[Changes in prostate specific antigen levels during intravesical instillations with Calmette-Guerin bacillus: relationship with transurethral resection of the prostate].

OBJECTIVES: To evaluate variations on the serum PSA levels during and after administration of intravesical BCG and its relationship with previous transurethral resection of the prostate (TURP). METHODS: PSA serum concentration variations were studied after each instillation, at 1 month and at 3 months in 24 patients with superficial bladder cancer and/or CIS under weekly BCG instillations treatment. Three patients had undergone TURP. RESULTS: A raise in PSA was observed in 87.5% of the cases during BCG instillations, although the increase was only significative in patients who had undergone TURP. PSA values descended at one and three months. CONCLUSIONS: Endovesical BCG administration produces an increase on serum PSA levels. This variation is higher in patients with history of TURP.

Adjuvants, Immunologic↗

PubMed1997

Testing to predict outcome after transurethral resection of the prostate.

PURPOSE: We assessed the ability of routine clinical tests to predict outcome following transurethral resection of the prostate. MATERIALS AND METHODS: A total of 556 men randomized into a trial of surgery versus watchful waiting was evaluated preoperatively with symptom interview, quality of life assessment, uroflowmetry, urinalysis, standard chemistry panel, post-void residual urine determination and cystoscopy. The ability to predict avoidance of postoperative complications, and improvement in quality of life and genitourinary symptoms was assessed in the 249 men randomized to undergo transurethral resection of the prostate. RESULTS: Patients with the highest symptom scores were most likely to have symptom improvement and those most bothered by the symptoms were most likely to have improvement in quality of life. No objective tests measuring physiological parameters made clinically significant contributions toward predicting these outcomes. Lower obstructive symptom scores and larger perioperative infusions of intravenous fluids were associated with a greater chance of complications. CONCLUSIONS: Symptom analysis and quality of life assessment are most useful in selecting patients for transurethral resection of the prostate. Objective diagnostic tests are of limited additional benefit.

Follow-Up Studies↗

PubMed2004

Could the latest generation potassium titanyl phosphate lasers be the ones to make transurethral resection of the prostate an operation of historical interest only?

PURPOSE OF REVIEW: We have witnessed an explosion of interest in surgical alternatives to transurethral resection of the prostate over the past decade. These have predominantly involved the delivery of heat to the prostate to cause either coagulation or vaporization. The latest generation laser technique involves the delivery of the potassium titanyl phosphate wavelength at high powers to cause large volumes of prostatic vaporization. This short review assesses the limited present evidence base supporting its use and asks the question of whether it will relegate transurethral resection of the prostate to an operation of historical interest only. RECENT FINDINGS: The 80 W delivery system clearly results in impressive tissue vaporization with minimal bleeding. There is a learning curve to the procedure with operative times varying between 30 and 120 min. The postoperative recovery appears rapid and generally uncomplicated with early catheter removals. The short-term results suggest equivalent efficacy to transurethral resection of the prostate with improved safety; the lack of phase III trials, however, means that the durability of the procedure cannot be assessed at this early stage. SUMMARY: Like many of the surgical alternatives to transurethral resection of the prostate this procedure shows early promise and represents the latest evolutionary development in the laser prostatectomy story. Only randomized comparisons with transurethral resection will tell us if it is a worthy challenger or simply a young pretender to the throne.

Aged↗

PubMed2003

Ex-vivo comparison of the haemostatic properties of standard transurethral resection and transurethral vaporization resection of the prostate.

OBJECTIVE: To compare the haemostatic properties of standard transurethral resection of the prostate (TURP) and transurethral vaporization resection of the prostate (TUVRP), as perioperative bleeding is still regarded as the major complication of prostate resection. MATERIALS AND METHODS: Isolated blood-perfused porcine kidneys were used to determine the haemostatic efficacy of TURP and TUVRP (using two different electrodes). Bleeding was quantified precisely in relation to tissue ablation for the two techniques, and specimens were evaluated histologically. RESULTS: Both TUVRP groups had significantly less bleeding (P = 0.005) than the TURP group for a standardized ablation volume of perfused kidney tissue (18.9, 19.5 and 24.1 mL/min, respectively). The different TUVRP electrodes had no significant haemostatic differences. The histology showed significantly (P = 0.03) larger coagulation zones for the TUVRP groups than for standard TURP. CONCLUSIONS: TUVRP ex-vivo was associated with significantly better haemostasis than TURP. The haemostatic properties of different active electrodes for TUVRP seem to be equivalent.

Animals↗

PubMed1998

Efficacy of transurethral electrovaporization of the prostate with respect to standard transurethral resection.

Transurethral electrovaporization of the prostate (TVP) has been introduced as an alternative to standard transurethral resection of the prostate (TURP) with lesser morbidity. However, the efficacy of this new technique has not been well known. To compare the results of standard TURP and TVP, 76 patients with symptomatic benign prostatic hyperplasia (BFH) were divided into two groups in a randomized clinical trial. Preoperative assessment included AUA Symptom score, maximum flow rates (Qmax), digital rectal examination, serum prostate specific antigen, and transrectal ultrasonography, with biopsy if the patient was randomized to vaporization. Transrectal temperature measurements and the hemoglobin concentration of the irrigation fluid were investigated in all the patients during the procedure. Although the transrectal temperature was higher in the TVP group (0.53-1.27 degrees C; mean 0.83 degrees C), no associated complication were determined. However, blood loss was significantly lesser than with TURP (340 mL v 60 mL). Two patients in the TURP group required blood transfusions, and one had sphincteric incontinence, whereas one postoperative retention, one reoperation with bladder perforation, and one sphincteric incontinence were seen in the TVP group. On the other hand, 12-month follow-up demonstrated that the uroflow rates improved in a similar manner. The Qmax increased in the TURP and TVP groups from 8.8 and 8.3 mL/sec to 19.6 and 17.2 mL/sec, respectively. The mean AUA Symptom Score decreased from 13.7 to 7.9 and 6.1 at 6 and 12 months, respectively. In the TVP group and from 14.6 to 7.3 and 7.0 at 6 and 12 months, respectively, in the TURP group. There were significant differences in the mean catheterization time (P < 0.0001) and hospital stay (P < 0.0001) in favor of TVP. Our results suggest that TVP is a safe and effective alternative treatment for symptomatic BPH.

Aged↗