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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↗
PubMed2003

Combination of interstitial laser coagulation and transurethral resection of the prostate: ex vivo evaluations.

OBJECTIVES: To evaluate the combination of interstitial laser coagulation (ILC) and transurethral resection of the prostate (TURP) in an ex vivo model. Perioperative bleeding is still regarded as the main complication of conventional TURP. The minimally invasive procedure ILC and the highly effective TURP seem to be a promising concept to improve hemostasis. METHODS: Isolated blood-perfused porcine kidneys were used to determine hemostatic efficacy of different interstitial laser procedures (neodymium:yttrium-aluminum-garnet [Nd:YAG], 1064 nm; and holmium:YAG [Ho:YAG], 2100 nm) in combination with conventional TURP. Bleeding could thus be quantified in relation to tissue ablation for the different techniques. Additionally, the specimens were evaluated histologically. RESULTS: A combination of Nd:YAG ILC, followed by TURP, resulted in significantly (P <0.001) reduced bleeding compared with TURP alone for a standardized ablation volume of 16 cm(3) of perfused kidney tissue (5.1 mL/min versus 24.1 mL/min). Similarly, significantly (P <0.001) better hemostasis was demonstrated with the combination of Ho:YAG ILC compared with TURP alone (4.8 mL/min versus 24.1 mL/min). The differences between the two laser procedures were not significant. The histologic examinations revealed significantly larger coagulation zones for the groups pretreated with Nd:YAG ILC or Ho:YAG ILC compared with TURP alone. CONCLUSIONS: ILC before conventional TURP leads, ex vivo, to a significantly superior hemostasis compared with TURP alone. The hemostatic effects of Nd:YAG and Ho:YAG laser treatments seem comparable.

Animals↗
PubMed2003

Gyrus bipolar electrovaporization vs transurethral resection of the prostate: a randomized prospective single-blind trial with 1 y follow-up.

The Gyrus system uses bipolar electrocautery with saline irrigation to vaporize prostatic tissue and is compared to transurethral resection of the prostate (TURP) in a randomized prospective study with 1 y follow-up. Outcomes measured were fluid absorption, blood loss, period of catheterization, hospital stay, symptom scores, quality of life, flow rates, and post-void residual volumes at 3, 6, and 12 months. All measured parameters were similar, although re-catheterization rates were higher (30% vs 5%) in the Gyrus group. Clot evacuation rates were higher in the TURP group (19% vs 0%). The Gyrus device is safe and produces results that are similar to TURP at 1 y.

Aged↗
PubMed2003

Bipolar transurethral resection of the prostate--a new approach.

Benign prostatic hyperplasia (BPH) is a common problem among older men. Transurethral resection of the prostate (TURP) is a common surgical procedure for treatment of BPH. Typically, TURP is performed using monopolar electric current and a wire electrode; however, the irrigating solution used during this procedure has the potential to cause transurethral resection (TUR) syndrome. A new technology uses bipolar electrosurgery, which creates less risk of electrical shock, and saline irrigation, which eliminates the risk for TUR syndrome.

Aged↗
PubMed1993

[Clinical analysis in 2266 cases of transurethral resection of the prostate].

During the past 20 years from August 1971 to July 1991, 3215 cases of transurethral resection were performed at Kitasato University Hospital, and consisted of 2008 benign prostatic hyperplasias, 692 bladder tumors, 258 prostate cancers, 167 bladder neck contractures, 38 urethral strictures, 20 chronic prostatities and 32 various urologic diseases. On 2266 transurethral resections of the prostate including 2008 benign prostatic hyperplasias, and 258 prostate cancers analysis was conducted. Patient age ranged from 44 to 97 (mean, 70.1). Resected tissue varied from 1 to 177 (mean, 26.9) grams. The time required for resection was from 9 to 245 (mean, 73.0) minutes. The volume of irrigation fluid was from 4 to 92 (mean, 25.0) liters. The duration of catheter placement after operation was 3 to 44 (mean, 4.1) days and hospitalization, 10 to 81 (mean, 12.1) days. The number of complications and blood transfusions were 308 (13.6%) and 381 (16.8%) respectively. Resected amount of tissue, volume of irrigation fluid, duration of catheter placement and frequency of complication in the benign prostatic hyperplasia group exceeded those in prostate cancer group. The length of hospitalization and blood transfusion rates were higher in the prostate cancer group. The rate or frequency of each item increased with the operating time and amount of resected tissue. Today, 60 minutes of operating time as a limiting factor of transurethral resection is not considered a important factor. Based on the results of the 2266 TURP cases, an attempt will be made to establish safer methods of treatment.

Adult↗
PubMed1992

External beam radiotherapy for incidental adenocarcinoma of the prostate discovered at transurethral resection.

This paper updates the results of 89 patients treated between 1967 and 1989 for incidental carcinoma discovered at transurethral resection of the prostate (Stanford stage T0 or AJC-UICC stage T1) with external beam irradiation. Twenty-two patients had Stanford T0 focal (less than 5% involvement of the prostatic chips) and 67 presented with Stanford T0 diffuse (5% or more involvement). Follow-up ranges from 4 months to 25.1 years, with a mean follow-up of 9.8 years. The actuarial local control for Stanford T0 focal is 100%, and 70% for Stanford T0 diffuse at 15 years. There was no difference in survival between Stanford T0 diffuse and T0 focal and the expected survival of an age-matched control population. Patients who were treated when younger than 65 had a similar local control and distant relapse when compared to those treated when 65 or older. There was no difference in local control, freedom from relapse, or disease-specific survival when the 38 patients who received irradiation to the prostate only are compared with the 29 who also received pelvic irradiation for Stanford T0 diffuse carcinoma. Patients with a Gleason score of 6 or more, when compared with those with a score of 5 or less, experienced more distant relapses and similar local control, suggesting that patients with a high grade tumor have occult metastases at presentation.

Adenocarcinoma↗
PubMed1999

Does anaesthetic technique affect the outcome after transurethral resection of the prostate?

OBJECTIVE: To determine if the choice of anaesthetic (spinal or general) has any influence on outcomes after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The records of 261 patients undergoing TURP between October 1995 and July 1998 were selected for a matched-cohort study. There were 87 complete datasets for cases performed under general anaesthesia and each was matched to two patients (174) from those undergoing spinal anaesthesia. The cohorts were matched by age, physical status score and date of operation. The primary outcome measures were length of stay in the recovery room and satisfaction with postoperative analgesia. RESULTS: There were no significant differences in major outcomes. There was a higher incidence of some minor adverse events in the group having general anaesthesia. Back pain was more common after spinal anaesthesia. CONCLUSION: Spinal anaesthesia was not associated with an improved outcome after TURP. The choice of anaesthesia should be made by the patient, surgeon and anaesthetist on the basis of the known risks of particular adverse events.

Analgesia↗
PubMed1985

Hyponatraemia following transurethral resection of the prostate.

In a prospective study of 100 patients undergoing transurethral resection, changes in serum sodium were estimated during the per-operative and post-operative periods. The weight of prostate resected and the volume of irrigant fluid used influenced the changes in serum sodium. In 93 patients these changes were not statistically significant. In only seven patients were significant falls in serum sodium recorded, in one case to a level of 103 mmol/l. All seven exhibited the clinical features of the transurethral syndrome and there was one post-operative death which we attributed to it. The TUR syndrome undoubtedly exists and its incidence in this series was 7%. Its pathogenesis and clinical management are discussed.

Aged↗
PubMed2006

Role of transurethral resection of the prostate and biopsy of the peripheral zone in the same session after repeated negative biopsies in the diagnosis of prostate cancer.

OBJECTIVE: To determine the role of the transurethral resection of the prostate (TURP) together with biopsies of the peripheral zone in the diagnosis of prostate cancer after repeated negative transrectal biopsies and increasing prostate-specific antigen (PSA) levels. METHODS: From 2003 to 2004, 43 patients, aged 53-69 yr, were seen for a history of at least two negative biopsies for prostate cancer. Thirty-five men had an increasing PSA level and underwent another set of biopsies. Seven patients had prostate cancer (20%); three were lost at follow-up and four had a Charlson comorbidity index >1. The remaining 21 were offered TURP and biopsy of the peripheral zone. Bladder outlet obstruction had no influence on decision-making. Fourteen men accepted. RESULTS: Eight patients (57%) had prostate cancer and underwent radical prostatectomy. Six cancers were detected only with TURP, one with TURP and biopsy, and one with biopsy alone. After a median of 9 mo of follow-up, two of six patients underwent rebiopsy for a rising PSA level, but no cancer was detected. CONCLUSIONS: TURP combined with a set of transrectal needle biopsies of the lateral portion of the gland is a safe procedure with a high diagnostic power after repeated negative biopsies in patients with persistently increasing PSA levels.

Aged↗
PubMed2001

Detection of prostate-specific antigen RNA before and after radical retropubic prostatectomy and transurethral resection of the prostate using "Light-Cycler"-based quantitative real-time polymerase chain reaction.

OBJECTIVES: To report our initial experience gained in establishing real-time reverse transcriptase-polymerase chain reaction (RT-PCR) detection of prostate-specific antigen (PSA) mRNA using the quantitative online PCR system LightCycler. Many studies have thus far failed to provide the desired proof that the detection of circulating PSA-expressing tumor cells with RT-PCR in the blood samples of patients with prostate cancer (PCa) is a highly sensitive prognostic and course marker. One of the possible reasons is the lack of reliable quantification methods. METHODS: Blood samples before and after surgery were obtained from 87 patients who underwent radical prostatectomy for locally confined PCa and 27 patients who underwent transurethral resection of the prostate for benign prostatic hyperplasia. Eight days postoperatively, additional blood samples were obtained from the patients with PCa. Quantitative no-nested RT-PCR for PSA mRNA (291 bp) was performed using the LightCycler system applying the SYBR Green protocol. The number of circulating LNCaP tumor cell-equivalents per sample was estimated from the mean amplification value measured in a given number of LNCaP cells. RESULTS: PSA mRNA was detected preoperatively in 19 patients with Stage pT2 tumor (40%) and in 28 patients with tumor greater than Stage pT2 (72%), but in only 2 patients with benign prostatic hyperplasia (8%; analysis of variance, P <0.001). Significant quantitative differences were observed among Stage pT2 disease (1034 LNCaP tumor cell-equivalents/mL), greater than Stage pT2 disease (7830 cells/mL), and benign prostatic hyperplasia (58 cells/mL; analysis of variance for all groups, P <0.001). The correlation between the detection of PSA expression by RT-PCR and the Gleason score and serum PSA value was statistically significant. CONCLUSIONS: Our results show that the initial experience with the LightCycler system for PSA-assisted detection of circulating PSA mRNA in PCa by RT-PCR may be a promising preoperative prognostic marker for organ-confined or locally advanced PCa. Long-term follow-up of these patients with PCa must demonstrate the clinical value of molecular diagnostics with quantitative RT-PCR systems.

Analysis of Variance↗
PubMed1997

Atypical signs of glycine absorption following transurethral resection of the prostate: two case reports.

Two cases of atypical transurethral resection (TUR) syndrome occurring during the post-operative course are reported. Atypical clinical events such as confusion, drowsiness and sudden hypotension could not be explained by the amount of glycine fluid absorption, because in both cases this was less than 1000 mL. However, high serum concentrations of glycine were noted without marked hyponatraemia and with normal measured osmolalities. We suggest that the absorption of glycine is related to its high lipid solubility rather than to its direct passage through an evident prostatic effraction or periprostatic extravasation.

Aged↗
PubMed2001

Is there a relationship between the amount of tissue removed at transurethral resection of the prostate and clinical improvement in benign prostatic hyperplasia.

OBJECTIVE: To assess in a prospective trial the influence of the amount of tissue resected at transurethral resection of the prostate (TURP) for benign prostatic enlargement on the symptom improvement as assessed by symptom scores. METHODS: Between December 1996 and August 1998 a total of 138 men (mean age 68.2, range 53-89) with symptomatic benign prostatic enlargement who underwent TURP participated in this prospective study. Patients were assessed preoperatively with the International Prostate Symptom Score (IPSS), the American Urological Association Bother Score (AUA-BS) and the Benign Prostatic Hyperplasia Impact Index (BPH-II) as well as urinary flow rate measurements (Qmax) and prostate volume (PV) and residual urine determination by ultrasound. The amount of tissue resected was weighed. Patients were followed with reevaluation of Q(max), residual urine and the symptom and bother scores at 3 and 6 months. RESULTS: A close correlation between preoperative PV (mean 49.0 ml, SD 22.0, range 13-140) and the resected tissue weight (RTW, mean 24.7 g, SD 18.0, range 6-128) was seen (r = 0.75, p < 0.001). Age was correlated with preoperative PV (r = 0.23, p < 0.05). While significant mean improvements in Q(max), residual volume and IPSS, AUA-BS and BPH-II were found 3 and 6 months postoperatively, a negative correlation was seen between the RTW and the IPSS, the AUA-BS and the BPH-II 3 months after TURP (r = -0.23, p < 0.024; r = -0.23, p < 0.025; r = -0.20, p = 0.05). No statistically significant correlation was seen between symptom change and the percentage of PV removed or the residual prostatic weight. Classification of the patients into groups depending on preoperative PV (< 30, 31-50, 51-70 and >70 ml) showed a tendency for patients with larger PV to gain more symptom improvement postoperatively. CONCLUSIONS: Early symptom improvement after TURP will depend on the amount of tissue removed but the relationship is weak and affected by several other confounding factors. Apparently, the symptomatic improvement after TURP is not primarily dependent on the relative completeness of the resection. Patients with larger prostates and larger RTW tend to gain more symptomatic benefit from TURP than do patients with smaller prostates.

Aged↗
PubMed1988

Prophylactic subcutaneous heparin does not increase operative blood loss in transurethral resection of the prostate.

A prospective randomised study of subcutaneous heparin compared with no heparin was performed in 60 patients undergoing transurethral resection of the prostate. Operative blood loss in the irrigation fluid was measured using a haemoglobinometer. Blood loss correlated with the amount of prostate resected and the duration of the procedure. Subcutaneous heparin had no significant effect on the measured blood loss in transurethral resection of the prostate and can be used as a safe means of prophylaxis against thrombo-embolic complications.

Administration, Cutaneous↗
PubMed1977

Changes in the serum concentrations of sodium, potassium, and free haemoglobin during transurethral resection of the prostate--parts of the TUR-syndrome?

In 133 patients undergoing transurethral resection of the prostate under standardized conditions the concentration of serum sodium decreased, and the concentration of free plasma haemoglobin increased significantly after the operation. Such changes were not found in a control group of 31 patients undergoing cystoscopy or bladder biopsy. The changes in the operated group are believed to be caused by the absorption of water used as irrigating fluid during the resection.

Adult↗
PubMed1996

Femoral vein blood flow during transurethral resection of the prostate.

OBJECTIVE: To determine whether bladder distension affects venous haemodynamics during transurethral resection of the prostate (TURP) such that irrigating fluid is more easily absorbed. PATIENTS AND METHODS: The right common femoral vein was examined using an ultrasound Doppler blood-flow scanner in 10 patients (mean age 73 years, range 63-80) undergoing TURP. Measurements of blood flow were performed before, during and after the bladder was filled with irrigating solution. Fluid absorption was measured by the ethanol method. RESULTS: Measurements before, half-way through and immediately after the resection all showed that the luminal diameter and the cross-sectional area of the femoral vein increased significantly when the bladder was filled with irrigating fluid. Furthermore, a decrease in the normal variation of blood flow with breathing often occurred when the bladder was filled, indicating that proximal venous obstruction was the cause of the increase in vessel diameter. However, there was no apparent association between these changes and the absorption of irrigating fluid. CONCLUSIONS: Filling the bladder with irrigating fluid with the patient in the lithotomy position during TURP was followed by signs of iliac venous obstruction but this did not correlate with the absorption of irrigating fluid.

Aged↗
PubMed1994

Monitoring of body weight during transurethral resection of the prostate: preliminary report.

The fear of vascular overload by irrigant during transurethral resection of the prostate is a reason for an incomplete resection. With continuous measurement of the patient's body weight and, thus, body water, irrigant entrance is immediately identified. We present a scale of proved accuracy and reliability, allowing more effective resection while eliminating the possibility of TUR syndrome.

Body Weight↗
PubMed1982

Blood loss during transurethral resection of the prostate.

Blood loss during operation was measured in 106 patients undergoing transurethral resection of the prostate, using a colorimetric technique. The total blood loss was related to the length of operation and the weight of prostate resected. There was no relationship between blood pressure and the blood loss during operation. However there was a significant reduction in blood loss if the patient received a regional rather than a general anaesthetic. Blood loss was lower in those patients undergoing prostatectomy for carcinomatous disease.

Aged↗