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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.

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PubMed1986

Sorbitol concentrations in plasma in connection with transurethral resection of the prostate using sorbitol solution as an irrigating fluid.

20 patients undergoing transurethral resection of the prostate (TURP) using 5% sorbitol (N = 13) or Cytosol (N = 7) (5% sorbitol and 0.25% acetic acid) as an irrigating fluid were studied. The sorbitol concentration was determined in serum (plasma), as were sodium, prostatic acid phosphatase protein (PAP) and osmolality, as possible indicators of absorption of irrigating fluid. The plasma level of sorbitol immediately postoperatively, the increase in serum PAP and the decrease in serum sodium all reflect the amount of irrigating fluid absorbed during TURP. The three variables are intercorrelated. The plasma osmolality was not significantly changed. The maximum sorbitol concentration immediately postoperatively in any patient was 6.0 g/l (33.5 mmol/l). The mean for the series was 1.2 g/l (6.8 mmol/l). The mean serum PAP increase was 31 micrograms/l. The serum sodium decrease ranged between 0 and 14 mmol/l, mean 5.0 mmol/l. The mean half-life of sorbitol in plasma was short: 35 min, reflecting rapid metabolism. An estimate of the volume of fluid absorbed was made from the plasma sorbitol levels observed. A fluid absorption up to 2.3 l (mean 0.6 l) was found. A marked diuretic effect up to 14.1 ml/min (mean 7.8 ml/min) was observed in some cases when irrigation with sorbitol was combined with intravenous furosemide given postoperatively.

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PubMed1986

Mannitol concentrations in blood plasma in connection with transurethral resection of the prostate using mannitol solution as an irrigating fluid.

Thirteen patients undergoing transurethral resections of the prostate (TURP) using iso-osmolar 5% mannitol as an irrigating fluid were studied. Mannitol was determined in serum (plasma), as were sodium, prostatic acid phosphatase protein (PAP) and osmolality as probable indicators of absorption of irrigating fluid. The plasma level of mannitol (mean 2.7 g/l = 15 mmol/l) immediately postoperatively, the increase in serum PAP (mean 93 micrograms/l) and the decrease in serum sodium (mean 8.7 mmol/l) all reflect the amount of irrigating fluid absorbed during TURP. The three variables are intercorrelated. The plasma osmolality was unchanged (mean -1 mosmol/kg). A small but constant fraction of mannitol was found in the erythrocytes 2 hours after the operation, amounting to about 3% of the simultaneous plasma concentration. The mean plasma half-life of mannitol was 127 min in the absence of uraemia. In two cases showing a slight increase in serum creatinine the half-lives were prolonged. An estimate of the volume of fluid absorbed was made from the observed plasma mannitol levels. A fluid absorption of up to 3 litres (mean 1.1 l) was found. A strong diuretic effect was observed in some cases when irrigation with mannitol was combined with i.v. furosemide. We conclude that the i.v. diuretic should be withheld until the extent of fluid absorption has been estimated. If the sodium concentration in the serum is largely unchanged immediately postoperatively, diuresis can be induced by an intravenous diuretic.

Absorption↗

PubMed1987

Plasma haemoglobin concentrations and other influx variables in blood in connection with transurethral resection of the prostate using distilled water as an irrigating fluid.

Eight patients undergoing transurethral resection of the prostate (TURP) using sterile distilled water as an irrigating fluid were studied. The concentrations of plasma haemoglobin, serum sodium, serum prostatic acid phosphatase protein (PAP) and plasma osmolality were determined as possible indicators of absorption of irrigating fluid. In 3 patients there was a marked increase in plasma haemoglobin immediately postoperatively with a maximum of 3.3 g haemoglobin/l plasma. In the remaining 5 patients the plasma haemoglobin level did not exceed 0.7 g/l immediately postoperatively. In all cases there was a fairly rapid return of the elevated plasma haemoglobin level to preoperative values. There was also a postoperative increase in the serum PAP level which was not correlated with the simultaneous increase in plasma haemoglobin concentration. There was no significant change in the sodium, potassium or albumin concentration in serum nor in plasma osmolality postoperatively. There was some decrease in the postoperative serum creatinine and uric acid levels. The preoperative serum creatinine concentration was within reference limits in 7 patients and borderline high in 1 patient. The haemoglobin binding plasma protein haptoglobin showed a slight non-significant increase immediately postoperatively and a significant decrease in concentration 2 hours postoperatively. The mean plasma haemoglobin concentration immediately postoperatively did not exceed the mean preoperative haemoglobin binding capacity of serum. The mean preoperative haemoglobin binding capacity was 1.2 g/l and the mean plasma haemoglobin level was 1.2 g/l immediately postoperatively. Two hours later the mean plasma haemoglobin level was 0.8 g/l. The mean serum haptoglobin concentration was 2.4 g/l preoperatively, 2.6 g/l immediately postoperatively and 2.0 g/l 2 hours later.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗

PubMed1990

Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. I. Distilled water as an irrigating fluid.

10 patients undergoing transurethral resection of the prostate using sterile distilled water as an irrigating fluid were studied. The extra- and intracellular distribution of water, the total content of water and electrolytes and the free amino acid concentrations in muscle tissue were determined together with the concentrations of free amino acids in plasma preoperatively, immediately postoperatively and 2 hours postoperatively. The content of water and concentrations of electrolytes in skeletal muscle did not change significantly from the preoperative to the postoperative period with the exception of the potassium concentration, which decreased 2 hours postoperatively. The following free amino acid concentrations in muscle tissue showed significantly decreased values 2 hours postoperatively compared with the preoperative values: taurine, serine, glutamate, proline and leucine. The concentrations of non-essential amino acids in muscle decreased significantly 2 hours postoperatively. This may be interpreted as a dilution effect. An increased concentration of some amino acids in plasma postoperatively may be explained as a haemoconcentration effect due to the use of a postoperative diuretic.

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PubMed1993

A review of 1486 transurethral resections of the prostate in a teaching hospital.

The authors reviewed retrospectively 1486 consecutive transurethral resections of the prostate (TURP) gland performed in a teaching hospital between 1985 and 1987. The death rate was 0.8% in an institution where senior residents were the primary resectionists in approximately 75% of TURPs. The results of this review are compared with those of a 1974 study of 2223 patients. They indicated that TURP was a reasonably well-tolerated surgical procedure in the training environment and was associated with lower mortality and morbidity and a shorter hospital stay for the patient than in the 1974 study. The authors believe that with proper supervision and instruction, resident urologists can obtain satisfactory results while gaining competence and experience in performing TURPs.

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PubMed2002

[Discitis after spinal anesthesia for transurethral resection of the prostate].

We described a case of discitis and meningitis following spinal anaesthesia for transurethral resection of the prostate. The patient received antibiotics for a month before surgery, because of Klebsiella prostatitis. Spinal anaesthesia was performed in L3-L4 interspace by using 22G Quincke needle. Bacteriaemia occurred during the first postoperative hours. Ten days after spinal anaesthesia, patient suffered from lumbar pain, exacerbated by vertebral percussion, and motor weakness within lower limb, which was marked on right side. MRI examination showed L3-L4 discitis with psoas abcess in regard, and epiduritis marked around L3 right spinal root. CSF examination confirmed meningitis but no bacteria was found. Antibiotics were administered over a 6 weeks period, and then patient discharged from hospital without neurological sequellae. Infectious discitis related to disk puncture during spinal anaesthesia and postoperative bacteriaemia was likely in our patient.

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PubMed1995

Does transurethral resection of the prostate pose a risk to life? 22-year outcome.

The clinical outcomes of 717 patients who underwent transurethral resection for benign prostatic hyperplasia between 1971 and 1981, and of 48 who underwent open prostatectomy during the same period were evaluated. All living patients could be followed for a minimum of 12 years postoperatively. The cumulative percentage of patients undergoing a secondary operation was substantially greater after transurethral resection of the prostate than after open prostatectomy. The volume of resected tissue, operating time, requirement for blood transfusion and hyponatremia during or after the procedure did not affect long-term outcome of patients in the transurethral resection group. Abnormal preoperative electrocardiography and azotemia appeared to be associated with increased risk of postoperative mortality after controlling for other variables (p < 0.05). Actuarial survival rates did not differ substantially for patients who underwent transurethral resection and open prostatectomy, and exceeded the expected survival rates in the general male population in the same age group in Japan. Both procedures are safe for the symptomatic relief of urinary obstruction due to benign prostatic hyperplasia. Prostatectomy does not jeopardize long-term survival of the patients.

Actuarial Analysis↗

PubMed2000

New technologies in transurethral resection of the prostate.

Different ablative treatments are in clinical use to lower perioperative morbidity and to maintain efficacy of transurethral resection of the prostate. Modifications to electrodes or high frequency units, or both, as well as improvements in laser technology have been tried. Transurethral resection is performed with a modified high frequency generator. The technique of 'coagulating intermittent cutting' allows reduction in morbidity and maintains the advantages of classical transurethral resection.

Humans↗

PubMed1992

Suprapubic catheter following transurethral resection of the prostate: a way to decrease the number of urethral strictures and improve the outcome of operations.

A prospective, randomized study was done to investigate the role of transurethral catheters in stricture formation after transurethral resection of the prostate. The operative outcome after using transurethral catheters made of 2 different materials compared with suprapubic catheters was also investigated. We studied 344 patients who underwent transurethral resection of the prostate. After resection the patients were randomly divided into 3 groups: 1) those drained by a transurethral polytetrafluoroethylene (Teflon)-coated latex catheter, 2) those drained by a transurethral polyvinylchloride catheter and 3) those drained by a suprapubic polyvinylchloride catheter. At 6 to 24 months the numbers of strictures in the anterior urethra were 10 of 102 and 11 of 102 in the transurethral drainage groups, respectively. The corresponding number of strictures in the suprapubic drainage group was 1 of 94 (p less than 0.01). Strictures in the bladder neck had developed in 5 of 102, 3 of 103 and 3 of 94 patients, respectively (not significant). As a consequence of a lower incidence of strictures in the anterior urethra in the suprapubic drainage group, more patients in that group were satisfied with the results of the operation.

Drainage↗

PubMed2003

Rotoresect for bloodless transurethral resection of the prostate: a 4-year follow-up.

OBJECTIVE: To report the results and long-term follow-up of transurethral resection of the prostate (TURP) with a new resection device, the Rotoresect (Karl Storz, Tuttlingen, Germany). PATIENTS AND METHODS: Most endoscopic resection techniques for benign prostatic tissue aim for high ablation rates and minimal bleeding. Available resection electrodes are effective, but cause high blood loss (loop electrode), or less bleeding but poorer ablation rates (electrovaporization). To resolve these conflicts the Rotoresect was developed in 1995; it consists of a specially designed rotating resection electrode, driven by a micromotor, and a high-frequency current to enable simultaneous coagulation, vaporization and mechanical tissue removal during resection. To date, 84 patients with benign prostatic hyperplasia have had their prostate resected with this device (mean prostate size 46.0, sd 18.4 mL) and have been assessed for up to 4 years. RESULTS: During resection there was very little bleeding, with no significant changes in haemoglobin or sodium levels. The mean (sd) duration of catheterization was 1.4 (1.1) days; the urinary peak flow rate was improved from 9.7 (3.2) to 24.2 (8.23) mL/s and the residual urine volume reduced from 187.3 (109.6) to 22.7 (19.5) mL. The International Prostate Symptom Score and quality-of-life index were both improved, from 24.0 (7.5) to 4.1 (2.7), and 4.2 (3.2) to 0.8 (0.9), respectively. Overall the results were stable during the 4 years of follow-up. CONCLUSION: The Rotoresect combines the advantages of standard resection (high ablation rate) by actively rotating the resection electrode, and the haemostatic effect of electrovaporization (minimal blood loss) by simultaneous tissue coagulation and vaporization.

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PubMed2006

[Radical prostatectomy in patients with history of transurethral resection of the prostate].

OBJECTIVES: To perform a retrospective evaluation of surgical complications and morbidity in patients undergoing radical retropubic prostatectomy (RRP) as elective treatment for organ-confined prostate cancer in our center with previous transurethral resection of the prostate (TURP). METHODS: Between 1980-2004 we performed 59 radical prostatectomies in patients with previous TURP. We analyze the morbidity and mortality of the RRP, its functional outcomes, and the accordance between clinical and pathological stage. RESULTS: Mean time between TURP and RRP was 16 months. Mean patient age at the time of diagnosis was 63 years. Clinical stage: 16 T1a, 18T1b, 20T1c, 3T2a, 2T2b. Average surgical time was 180 minutes. Intraoperative events: technical difficulties in the dissection of the gland 57%, bladder neck preservation 27%, neuro vascular bundles preservation 3.39%, ureter ligation 1.69%, rectal laceration 1.69, urethrorrhagia 1.69%, urinary leak 5%, and blood transfusions 11.8%. Postoperative complications: urinary tract infection 10.17%, wound infection 10.17%, pelvic hematoma 5.08%, deep vein thrombosis 1.69%, and one sudden death of unknown cause one month after surgery. Pathologic report: 49pT2b, 8 pT3 and 2pT4. Late complications: erectile dysfunction 85.7%, vesicourethral anastomosis stenosis 10.3%, and complete urinary incontinence 3%. CONCLUSIONS: Radical retropubic prostatectomy in patients with previous TURP is technically more difficult and has comparable outcomes to RRP patients without previous TURP.

Adenocarcinoma↗

PubMed2000

Assessment of penile small nerve fiber damage after transurethral resection of the prostate by measurement of penile thermal sensation.

PURPOSE: To determine the occurrence of penile small nerve fiber damage following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). MATERIALS AND METHODS: Penile nerve function was evaluated in 18 consecutive patients prior to and one month after TURP for BPH. To test nerve fibers of small diameter, the penile warm and cold sensory thresholds were measured by means of a Peltier-based device, as well as the penile sympathetic skin potentials obtained following electrical stimulation at the wrist. To test nerve fibers of large diameter, the pudendal nerve somatosensory evoked potentials (pSEPs) and the penile vibratory thresholds were recorded. Clinical erectile function was quantified using a standardized questionnaire (erectile dysfunction symptom score, EDSS). Urinary handicap was assessed by the measurement of maximum flow rate (MFR) at uroflowmetry and by a standardized questionnaire (AUA symptom score, AUASS). RESULTS: Penile warm threshold (+7.8 vs +6.3C, p = 0.005), cold threshold (-8.5 vs -5.7C, p = 0.003) and vibratory threshold (9.3 vs 7.9 microm., p = 0.03) were significantly higher after than prior to TURP. The amplitude of pSEPs tended to decrease (1.7 versus 2.3 microV, p = 0.06), whereas the remaining neurophysiological parameters were unchanged. Clinical assessment by EDSS demonstrated a significant postoperative erectile function impairment (20.2 vs 17.5, p = 0.04), whereas mictional function improved (MFR: 19 vs 8.8 ml./s and AUASS: 4.9 versus 15.1, p < 0.0001). CONCLUSIONS: This study highlights the occurrence of penile small nerve fiber damage following TURP and supports the hypothesis of neurogenic damage as the primary cause of post-operative erectile dysfunction.

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PubMed1995

Incidence of erectile impotence secondary to transurethral resection of benign prostatic hyperplasia, assessed by preoperative and postoperative Snap Gauge tests.

In an attempt to assess the impotence rate secondary to transurethral resection of the prostate more objectively than by merely interviewing patients, potency was evaluated with the Snap-Gauge test. The test was used preoperatively to recruit patients with intact potency. The 98 patients studied underwent transurethral resection of the prostate and were retested during postoperative night 4. Of the 98 patients 64 remained potent while 34 did not. These 34 men were retested 3 months later, and 26 were potent and 8 were impotent. Therefore, 8 of 98 patients (8.3%) became impotent as a consequence of transurethral resection of the prostate. The risk specific to subgroups in cases of small (less than 10 gm. resectable tissue) and larger adenomas is 11.1% and 7.7%, respectively, for men older than 65 years, and 7.1% and 0%, respectively, for men younger than 65 years. A selective indication taking into account patient age and prostatic size might further lower the already low impotence risk of transurethral resection of the prostate.

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PubMed1991

Transurethral resection of the prostate and metastatic prostate cancer.

Demonstration of malignant cells in blood specimens collected during transurethral resection of the prostate (TURP) has implicated TURP in the dissemination of prostatic cancer. Of 153 patients who underwent radiation therapy for prostate cancer between January 1977 and June 1990 and were retrospectively analyzed, 93 were evaluable. Fifty-nine patients required TURP before radiation therapy for prostatic obstruction (BPH and/or cancer); the remaining 34 patients underwent radiation therapy after fine-needle aspiration biopsy. No statistically significant difference in failure rate could be detected between these groups, with a failure rate of 47% (28 of 59 patients) at a median follow-up time of 49 months (range, 8 to 146 months) in the TURP group versus a failure rate of 47% (16 of 34 patients) at a median follow-up time of 50 months (range, 3 to 122 months) in the group who underwent biopsy only (Fisher's exact test, P = 0.23). Within the confines of this retrospective study, it appeared that TURP did not enhance the development of metastatic disease.

Adenocarcinoma↗

PubMed1999

The relative amount of epithelium, muscle, connective tissue and lumen in prostatic hyperplasia as a function of the mass of tissue resected.

PURPOSE: The relative amounts of epithelium, connective tissue, muscle and gland lumen in benign prostatic hyperplasia have been reported but they have not been correlated with prostate size. We determine if the relative amount of prostatic tissue varies with prostate size. MATERIALS AND METHODS: Paraffin blocks of transurethrally resected prostate tissue were randomly chosen from the archives of 58 patients with benign prostatic hyperplasia. Two new slides per patient were made and stained with prostate specific antigen or Masson trichrome, respectively. A total of 20 images from each slide were captured using a high resolution camera, digitized and analyzed with computer software for the relative percentage of the various tissue components. RESULTS: As the amount of prostate tissue resected increased from less than 10 to greater than 70 gm. the epithelium had a 4-fold increase from 5.37 to 21.92%, the muscle component had a 42% decrease from 28.46 to 16.62%, the lumen doubled from 7.05 to 14.01% and the connective tissue remained relatively unchanged from 35.58 to 31.53%. There was a statistically significant difference in all components of prostatic tissue except for connective tissue when comparing prostates less than 30 versus greater than 30 gm., including epithelium 6.52 versus 16.10% (p <0.01), muscle 28.45 versus 20.78% (p <0.01), lumen 7.42 versus 14.58% (p <0.01) and connective tissue 35.74 versus 32.45% (p <0.06). The stroma-to-epithelium and muscle-to-epithelium ratios each had a 9-fold decline (p = 0.01). CONCLUSIONS: As the prostate increases in size, there is statistically significant more epithelium and lumen, and less muscle tissue.

Connective Tissue↗

PubMed1999

A comparison of midnight versus early morning removal of urinary catheters after transurethral resection of the prostate.

PURPOSE: This article describes a study that compares the outcomes of midnight versus early morning urethral catheter removal after transurethral resection of the prostate. SUBJECTS AND SETTING/METHODS: The research setting was a large, metropolitan hospital in Sydney, Australia. Forty-eight patients who had undergone transurethral resection of the prostate were randomly assigned to either group A, catheter removal at 2400 hours (n = 20), or group B, catheter removal at 0600 hours (n = 28). MAIN OUTCOME MEASURES: Data collected included time to first void, volume of first void, time between catheter removal and discharge from hospital, weight of prostatic resection, and tissue pathology. RESULTS: There was no significant difference between the 2 groups with respect to pathology, weight of prostatic resection, mean volume of first void, or time to first void after catheter removal. There was a significant difference in the time between catheter removal and discharge from hospital. Eighty-five percent of those having catheters removed at 2400 hours were discharged on the same day as catheter removal, as compared with 65% of those who underwent catheter removal at 0600 hours (chi 2 = 12.684; P < 0.005). CONCLUSION: After transurethral resection of the prostate, removal of the urethral catheter at 2400 hours reduced the length of hospital stay, but did not significantly affect the time to first void or the volume of the first void.

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PubMed2006

Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial.

PURPOSE: We compared the impact of HoLEP and TURP on sexual function. MATERIALS AND METHODS: Between January 2002 and January 2003, 120 patients with a mean age +/- SD of 65.2 +/- 7.1 years who had benign prostatic hyperplasia were enrolled in this 2-center, prospective, randomized study. A total of 60 patients with a mean age of 65.25 +/- 6.9 years underwent HoLEP (group 1) and 60 with a mean age of 64.18 +/- 7.2 years underwent TURP (group 2). Patients were assessed before surgery, and at 12 and 24-month followup visits. Subjective symptoms were scored by the International Prostate Symptom Score, the International Prostate Symptom Score quality of life question, IIEF, 10 nonvalidated general assessment questions, physical examination, serum prostate specific antigen and transrectal ultrasonography. RESULTS: A total of 32 patients (53.3%) in group 1 and 31 (51.6%) in group 2 reported various degrees of erectile dysfunction before surgery according to the IIEF-EF score. Differences between preoperative and postoperative orgasmic domain scores in each group were significant (p <0.001). A slight but not significant increase in the mean IIEF-EF domain score was reported in each group at postoperative assessments without any difference between the 2 surgical approaches. According to general assessment question analysis the prevalence of subjectively reported postoperative retrograde ejaculation was significantly higher than at baseline assessment in the 2 groups with no differences between the 2 surgical procedures. CONCLUSIONS: TURP and HoLEP significantly lowered the IIEF orgasmic function domain with no differences between techniques. This was caused by retrograde ejaculation. Marginal, nonsignificant erectile function improvement was reported after surgery in the 2 groups.

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