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PubMed1989

Norfloxacin versus trimethoprim-sulfamethoxazole. A study in patients with known bacteriuria undergoing transurethral resection of the prostate.

Three hundred and forty-three patients with suspected bacteriuria undergoing transurethral resection of the prostate (TUR-P) were randomized to treatment with either trimethoprim-sulfamethoxazole (TMP-SMX) or norfloxacin (NF) for 5 1/2 days beginning the evening prior to operation. It was possible to analyse 165 patients for efficacy. Elimination of bacteria on days 10 to 20 was achieved in 78.1% and 78.3% in the TMP-SMX and NF group, respectively. The accumulated elimination rates for the follow up period (days 10-42) were 68.5% for the TMP-SMX group and 76.2% for the NF group. The differences were not statistically significant. No patient had any clinical signs of upper urinary tract infection or septicemia. Three hundred and twelve patients were analysed for safety. Twenty-six patients reported 32 adverse drug events (ADEs). Four reactions in the TMP-SMX group were considered severe while in the NF group all the ADEs were of mild or moderate intensity. In this study NF seems to be at least as effective and safe as TMP-SMX.

Aged↗

PubMed1992

[Transurethral resection of the prostate in the urological management for patients with stroke].

We discuss the transurethral resection of the prostate (TUR-P) on 40 patients in the chronic stage of stroke, all of whom were refractory to conservative managements of urinary disturbance. All patients, between 35 and 89 years old (mean: 52.6 years), had only one episode of stroke and were diagnosed as benign prostatic hypertrophy or bladder neck contracture that appeared to cause urinary disturbance in these patients. At six months after TUR-P, all except for one patient, who needed an indwelling catheter due to a reinfarction, were catheter free. Of these cases 36 (92%) obtained independent micturition and did not develop urinary incontinence except transiently postoperatively. Two cases with impaired mobility and one case with progressive senile dementia required helpmates and/or a commode and so forth postoperatively. It is concluded that in chronic stroke patients TUR-P is recommended for those with benign prostatic hypertrophy or bladder neck contracture.

Adult↗

PubMed1984

Prevention of irrigating fluid absorption during transurethral resection of the prostate.

This thesis contains studies on the prerequisites for fluid absorption during transurethral resection of the prostate (TURP) and suggestions on its prevention. The pressure gradient bladder-prostatic fossa to pelvic veins and its relation to fluid absorption were studied in patients using a sensitive detection technique with a radionuclide. It is concluded that to prevent fluid entering the vascular system, the bladder pressure should be kept below the pressure in the pelvic veins. The physical properties of the irrigating jet of resectoscopes were investigated in model experiments including an artificial, "bleeding" prostatic fossa. The dynamic pressure of the jet amounts to only 1-3% of the driving head and thus is of marginal importance in fluid absorption. The effect of various flow rates on the optical field was also demonstrated. In patients with prostatism epidural and spinal analgesia increased the bladder capacity but always with a corresponding increase in bladder pressure. In a preliminary study a correlation was found between the minimum urethral resistance and the compliance of the detrusor during epidural analgesia. This may suggest a relation between prostatic obstruction and changes of the viscoelastic properties of the bladder wall. The effects of various irrigating flow rates on the pressure-volume response of the bladder and its relation to the pressure in the pelvic veins was also investigated. From this study it was concluded that the detrusor response was unaffected by flow rates used during TURP. The critical bladder pressure above which fluid is absorbed changed with the position of the patient. In the Trendelenburg (20 degrees) position it was 0.25 kPa (approximately equal to 2.5 cmH2O), increasing to 1.25 kPa in the horizontal and 1.75 kPa in the half-sitting (20 degrees) position. To prevent absorption bladder pressure must be monitored. A simple pressure warning device with an adjustable warning level and which can be combined with any irrigating technique is presented. Irrigation with a large driving head may thus be combined with a low pressure resection.

Absorption↗

PubMed1999

An economic analysis of antimicrobial prophylaxis against urinary tract infection in patients undergoing transurethral resection of the prostate.

Despite the high level of safety and low incidence of mortality associated with transurethral resection of the prostate (TURP), urinary tract infections (UTIs)-the most common complication associated with this procedure-continue to be an important source of postoperative morbidity and costs. However, there is controversy about whether antimicrobial agents should be used as UTI prophylaxis in patients undergoing TURP and, if so, which agents should be used and for what duration. This retrospective study used multivariate regression analysis to evaluate the different types and durations of antibiotic prophylaxis in 222 patients who underwent TURP at a Veterans Affairs hospital between January 1, 1995, and March 30, 1998. The primary outcome measures were total medical costs (ie, medication use, clinic office visits, and hospital care in the 4 weeks after the procedure), length of hospital stay (total days in hospital due to the procedure), and probability of UTI (incidence of infection in the 4 weeks after the procedure). Results showed that there was no difference in the length of hospital stay regardless of the regimen or duration of pre-TURP antibiotic therapy. Patients who received pre-TURP ampicillin plus ceftizoxime incurred moderately higher total medical costs than did patients who received the least costly drug, cefazolin (P = 0.10). Similarly, patients who received post-TURP quinolones incurred a significantly higher total medical cost than did patients who received co-trimoxazole (P = 0.06). We found no evidence of a relationship between use of specific parenteral or oral antibiotic prophylaxis for UTI in patients undergoing TURP and the rate of UTI in such patients. Thus there is no justification for the use of more expensive antibiotic regimens. At our institution, the preferred pre-TURP prophylactic regimen would be cefazolin, whereas co-trimoxazole would be the most cost-effective post-TURP prophylactic regimen. Because duration of post-TURP prophylaxis does not appear to influence the rate of UTI, 24 hours would seem adequate.

Anti-Bacterial Agents↗

PubMed2002

A controlled trial of music and pre-operative anxiety in Chinese men undergoing transurethral resection of the prostate.

AIM OF THE STUDY: To test the effects of music intervention on pre-operative anxiety in Chinese males undergoing transurethral resection of the prostate. RATIONALE: No studies have measured the effects of music intervention in reducing pre-operative anxiety for patients with transurethral resection of the prostate (TURP). Previous studies have examined the effects of music on pre-operative anxiety but have not examined the possible effects of the presence of a carer as an independent variable in pre-operative anxiety levels of patients in addition to the music intervention. The cultural validity of applying a music intervention to the reduction of pre-operative anxiety was also investigated. DESIGN: A quasi-experimental design with three groups: music intervention, nurse presence and control group. METHOD: Thirty patients having TURP were randomly assigned (n = 10 each group) to one of the three groups. Pre- and post-test measures of systolic and diastolic blood pressure, heart rate and state anxiety using the Chinese State-Trait Anxiety Inventory (C-STAI) were obtained for the three groups. RESULTS: The findings showed that the music intervention significantly reduced all blood pressure levels for the patients. A reduction in state anxiety level was also found for the music intervention group. No significant reductions in blood pressure, heart rate and state anxiety level were found in the nurse presence and control groups. CONCLUSION: The results support the cross-cultural validity of using a music intervention in pre-operative anxiety reduction, in this case for TURP patients waiting in the theatre holding area.

Anxiety↗

PubMed2002

Does transurethral resection of the prostate facilitate detection of clinically significant prostate cancer that is missed with systematic sextant and transition zone biopsies?

BACKGROUND: A prospective study was conducted to determine whether transurethral resection of the prostate (TURP) facilitates detection of prostate cancer that is missed with systematic sextant biopsies associated with transition zone (TZ) biopsies. METHODS: A total of 139 consecutive patients underwent transperineal TZ biopsies of each lobe in addition to a transrectal systematic sextant peripheral zone (PZ) biopsy. Patients whose biopsies were negative for cancer received TURP for relief of lower urinary tract obstruction when indicated. RESULTS: Cancer was detected in biopsy specimens of 40 patients. Of these cancers, 18 originated in the PZ alone and 22 were located both in the TZ and the PZ. No cancers were detected in the TZ alone. Of 99 patients who were proven not to have cancer by the biopsies, 18 were indicated for TURP. Five of these patients (28%) had cancer in the resected tissues. All cancers were clinically organ confined and their Gleason sum scores were 2-5. Cancer-positive chips accounted for less than 10% of all resected specimens. Of the 66 patients with negative biopsies and without indication for TURP, four (6%) were revealed to have an elevation of the serum PSA level during follow up. They were later proven to have cancer by a second biopsy. CONCLUSION: Routine use of TZ biopsy is not warranted for detection of cancer. Transurethral resection of the prostate can detect cancers in patients with negative PZ and TZ biopsies. However, cancers detected by TURP may not always be clinically significant and only four of 66 patients who were not indicated for TURP and received a close follow up were later found to have cancer, although their follow-up period was short. Thus, it still remains to be elucidated whether TURP is necessary for all patients with negative biopsies of the prostate.

Aged↗

PubMed2005

Urinary morbidity and incontinence following transurethral resection of the prostate after brachytherapy.

PURPOSE: We analyzed the risk of urinary morbidity and incontinence in patients undergoing transurethral resection of the prostate (TURP) following prostate brachytherapy. MATERIALS AND METHODS: A total of 2,050 patients underwent transperineal radioactive seed implantation of the prostate with or without external beam radiation therapy for the diagnosis of prostate cancer between June 1990 and February 2004. Of the 2,050 patients 38 (2%) underwent minimal (channel) TURP due to urinary symptoms or retention. Urinary morbidity was recorded prior to implantation and at followup intervals using the International Prostate Symptom Score and quality of life assessment scores. All patients underwent post-implantation computerized tomography based dosimetry at 1 month. The dose to 90% of prostate volume, prostate volume covered by 15% of the prescription dose and dose to 30% or 5 cm of urethral volume were recorded. Of the 38 patients 11 (29%) underwent Pd implantation alone and 12 (32%) received a partial (67%) Pd implant with external beam radiation therapy to a median dose of 45 Gy (range 41.4 to 59.4), while 15 (39%) underwent I implantation alone. Median followup after implantation was 38 months (range 2 to 97). RESULTS: Seven of the 38 patients (18%) undergoing TURP had urinary incontinence. Median time to TURP was 11 months (range 1 to 73). 25% Of patients who received an implant and external beam radiotherapy had urinary incontinence following TURP compared with 15% who underwent implantation alone (p = 0.26). There was no significant correlation between incontinence risk based on the dose to 90% of prostate volume (p = 0.32), the dose to 30% or 5 cm of urethral volume (p = 0.30) or prostate volume covered by 15% of the prescription dose (p = 0.36). Two of 24 patients (8%) who had underwent 2 years or less after implantation had urinary incontinence compared with 5 of 14 (36%) who underwent TURP greater than 2 years following implantation (p = 0.04). CONCLUSIONS: Urinary incontinence developed in 18% of patients who underwent TURP following prostate brachytherapy. No significant correlations between radiation dose, preimplant prostate volume or hormonal therapy were identified with regard to this risk. Patients in late retention or with obstructive symptoms (greater than 2 years) following implantation who require TURP are at greater risk for incontinence.

Aged↗

PubMed1988

[Transurethral resection of the prostatic gland (TUR-P) and incidental carcinoma].

During the four years between January, 1983 and December, 1986, transurethral resection of the prostatic gland (TUR-P) was performed on 108 patients with benign prostatic hypertrophy at Osaka Municipal Kita Citizen's Hospital. Histopathological examination of the transurethral resection specimens revealed 9 cases (8.3%) of incidental carcinoma. In this study, the average patient age, preoperative prostatic acid phosphatase (PAP) level and weight of resection specimens were compared for all 108 patients. For the 9 patients with incidental carcinoma, the clinical stage, histological grade and therapy were evaluated.

Acid Phosphatase↗

PubMed1994

Costing transurethral resection of the prostate and diagnosis related group in Australia compared with United States costs.

The cost of a transurethral resection of the prostate is of considerable concern to the community. More of these procedures are being performed as the number of patients in the aged population increases. The costs of wages and salaries, purchase of equipment and depreciation, stationery, linen, investigations (pathology) and pharmaceuticals are compared with the bed charges (as charged to a private patient), the cost per inpatient day and the cost per inpatient treated, which is calculated from the operating fund budget expenditure of The Bendigo Hospital. The cost per diagnosis related group (DRG) 336 (defined as: transurethral prostatectomy, age greater than 69 and/or complication/co-morbidity; mean length of stay 7.0; relative weight = 0.9869) and DRG 337 (defined as: transurethral prostatectomy, age less than 70 without complication/co-morbidity; mean length of stay 5.8; relative weight = 0.7788) are compared with the figures for a similar procedure in 1987 in a United States hospital and extrapolated, by the use of the Consumer Price Index, to 1992 levels. The findings demonstrate that transurethral resection of the prostate as costed in this hospital compares very favourably with that in a US hospital, and favourably from the point of view of health care costs.

Aged↗

PubMed2002

[Sudden bradycardia and hypotension in five patients under spinal anesthesia during transurethral resection of the prostate].

We reported five patients had developed sudden bradycardia and hypotension under spinal anesthesia during transurethral resection of the prostate. The symptoms occurred not only just after the induction of spinal anesthesia, but also at the end of operation. It seems that these symptoms are caused from water intoxication, myocardial ischemia or vagal reflex. This emphasizes the importance of rigorous vigilance on patients until the end of operation.

Aged↗

PubMed2004

Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors.

It is known that a proportion of patients who undergo transurethral resection of the prostate (TURP) will develop erectile dysfunction (ED). This study examined the incidence of ED after TURP using objective and subjective parameters and risk factors for the development of ED. All benign prostate hyperplasia (BPH) patients who were indicated for TURP had to meet the criteria of the International Index of Erectile Function (IIEF) 5 scores of more than 16, and with normal nocturnal penile tumescense (NPT) which had at least one episode of nocturnal erections with both base and tip rigidity exceeding 55% for at least 10 min. The patient's nocturnal erection were measured using Rigiscan, over two consecutive nights, approximately 3-4 days preoperatively and 3 months postoperatively. A total of 63 patients were eligible for the study; the mean age was 63.3 years (range 49-85 years). Nine (14%) patients were found to have postoperative ED. Patients who developed ED postoperatively had a lower IIEF-5 score and NPT parameters preoperatively (for all parameters, P<0.0001). For risk factors, diabetes mellitus were found to be a significant independent risk factor. The incidence of ED post-TURP using objective parameters was 14%. Without taking note of the risk factors, TURP is a safe procedure with regard to sexual function.

Aged↗

PubMed2005

[Effect of dutasteride on reduction of intraoperative bleeding related to transurethral resection of the prostate].

OBJECTIVE: The pharmacological action of 5-alpha-reductase inhibitors (5-ARI) would reduce angiogenesis associated with benign prostatic hyperplasia (BPH), thereby decreasing peroperative bleeding during transurethral resection of the prostate (TURP). Dutasteride, a double inhibitor of 5-alpha-reductase iso-enzymes types 1 and 2, was not been previously studied in the context of reduction of peroperative bleeding related to TURP. MATERIAL AND METHODS: We conducted a multicentre, randomized, double-blind, placebo-controlled, parallel group study to evaluate the efficacy of dutasteride 0.5 mg per day, in peroperative bleeding related to TURP for BPH in patients over the age of 50 years with a prostatic volume greater than 30 cm3. Treatment was administered for 4 weeks before the operation. The primary endpoint was haemoglobin, expressed in grams, and expressed in relation to the weight of prostate resected, also expressed in grams. RESULTS: 59 patients were evaluated (32 treated with dutasteride and 27 treated with placebo). A significant difference in peroperative bleeding was observed between the dutasteride group (1.944 +/- 1.816 g of Hb/g of prostate resected) and the placebo group (1.401 +/- 1.021 g of Hb/g of prostate resected). Preoperative treatment was well tolerated. CONCLUSION: The working hypothesis of the study was not confirmed due to the low bleeding rate in the placebo group and the results suggest that a longer duration of treatment with dutasteride would reduce intraoperative and postoperative bleeding in TURP.

Aged↗

PubMed1999

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia.

OBJECTIVES: Transurethral resection of the prostate (TURP) can cause elevation of total serum prostate-specific antigen (PSA). However, the effect of these procedures on free PSA and percent free PSA is still unknown. The aim of this study was to investigate the effect of TURP on serum total PSA, free PSA, and free/total (f/t) PSA ratio in patients with benign prostatic hyperplasia (BPH) and to determine the reliability of f/t PSA ratio after such interventions. METHODS: Fifty-three patients with BPH who underwent TURP because of severe bladder outlet obstruction symptoms were included in this study. All patients underwent digital rectal examination and transrectal ultrasound (TRUS), and routine hematologic (complete blood count) and serum biochemical tests, urine analysis, and a peak urinary flow test were performed. Serum total PSA and free PSA levels were determined 1 hour before and 24 hours after TURP by using enzyme immunometric assay. Preoperative and postoperative free and total PSA and f/t PSA ratio were statistically compared. RESULTS: Although postoperative total PSA and free PSA increased significantly compared with preoperative values (P <0.001 and P = 0.024, respectively), the difference between preoperative and postoperative f/t PSA ratios was not statistically significant (P = 0.103). CONCLUSIONS: Finding no significant change in f/t PSA ratio, although there is a significant increase in the serum levels of total and free PSA, suggests to us that f/t PSA ratio may be a more reliable parameter in the early period after such interventions as TURP.

Aged↗

PubMed1984

Hyperammonemia after transurethral resection of the prostate: a report of 2 cases.

We report on 2 patients who became deeply comatose after transurethral resection of the prostate. Both patients were severely hyponatremic and hyperammonemic but the course of the comas followed serum ammonia concentrations more closely than serum sodium concentrations. The genitourinary irrigant used in both procedures was a 1.5 per cent glycine solution. Serum amino acid analyses in 1 patient suggested that the postoperative hyperammonemia was due to catabolism of glycine absorbed during surgery. The inadequate activation of normal pathways of ammonia metabolism in this patient may have been caused by a partial deficiency of the urea cycle enzyme argininosuccinate synthetase. We believe that hyperammonemia should be considered as a cause of encephalopathy after transurethral resection of the prostate. The 1.5 per cent glycine genitourinary irrigating solution may not be as nontoxic as generally believed.

Aged↗

PubMed2005

Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate.

OBJECTIVE: Plasmakinetic vaporesection of the prostate (PKVP) using normal saline irrigation has the theoretical advantage of avoiding transurethral resection syndrome and minimizing blood loss. It may also shorten the operative time since tissue is resected instead of just vaporized. The aim of this study was to evaluate the efficiency, safety and advantages of PKVP compared with standard transurethral resection of the prostate (TURP) at a regional acute hospital. METHODS: A total of 60 consecutive men admitted from a waiting list for surgery for benign prostatic hyperplasia (BPH) were prospectively randomized to either PKVP or TURP. Peri- and postoperative outcome data at 3 months were obtained. RESULTS: The PKVP loop achieved a fast and sharp cutting action similar to that with the traditional TURP loop. Data analysis was based on 51 patients. There were no significant differences between the methods in resection time, postoperative catheterization time and hospital stay. The mean reductions in serum sodium 2 hours after PKVP and on postoperative day 1 were 0.52 mmol/L and 3.35 mmol/L, respectively, while mean reductions in haemoglobin were 0.36 g/dL and 0.24 g/dL, respectively. There was no significant difference in haemoglobin reductions between PKVP and TURP (p = 0.326 at 2 hours; p = 0.192 on day 1) and serum sodium (p = 0.757 at 2 hours; p = 0.888 on day 1). Both groups achieved comparable improvement in International Prostate Symptom Score (p = 0.862), quality-of-life score (p = 0.169) and peak flow rate (p = 0.96) at 3-month follow-up. CONCLUSION: PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting.

Aged↗

PubMed2000

American Society of Anaesthesiologist Physical Status (ASA-PS): a predictor of treatment outcome of transurethral resection of the prostate (TURP).

Various factors such as age have been shown to be related to the successful outcome of transurethral resection of the prostate (TURP). Age may not necessarily correlate with the general health and fitness of the patient. A more accurate way to predict outcome of TURP is the pre-operative American Society of Anaesthesiologists Physical Status (ASA-PS) score. This study showed better urological performance, improved QOL and LOS with lower ASA-PS score. It indicates therefore, that ASA-PS is a possible predictor of treatment outcome for TURP. This study indicates a positive correlation between ASA-PS and treatment outcome of TURP.

Age Factors↗

PubMed2000

Histologic effects of holmium:YAG laser resection versus transurethral resection of the prostate.

BACKGROUND AND PURPOSE: Holmium laser resection (HoLRP) is an effective surgical alternative to transurethral resection of the prostate (TURP). We investigated whether an adequate histologic diagnosis could be made from HoLRP tissue specimens. PATIENTS AND METHODS: A series of 120 patients were randomized to TURP (N = 59) or HoLRP (N = 61). Each histologic specimen was reviewed by a single pathologist, who was blinded to the treatment. Weight of tissue, histologic diagnosis, and degree of thermal artifact were assessed. Thermal damage was graded as follows: 1 = no significant thermal injury; 2 = <25% of the tissue damaged (minimal); 3 = 25% to 80% of the tissue damaged (moderate); and 4 = >80% of the tissue damaged, with loss of prostatic architecture (extensive). RESULTS: The mean weight of the TURP and HoLRP specimens was 15.6 g and 9.6 g, respectively. The mean grade of thermal artifact for the TURP group was 1.8 and for the HoLRP group 2.6. Of the HoLRP specimens, 56 (92%) were grade < or = 3. Of the entire series of 120 specimens, 5 contained malignant tissue, all of which were from the TURP group. Four of these specimens were adenocarcinoma of the prostate, whereas the other was a transitional-cell carcinoma. Of the four specimens that contained prostate cancer, two were stage pTla tumors. CONCLUSIONS: Although identifiable prostatic architecture was maintained in the majority of histologic specimens from the HoLRP group, the tissue quality was inferior to that of TURP. There was significantly more vaporization and subsequent tissue loss with HoLRP, and the thermal damage to tissue was greater.

Adenocarcinoma↗

PubMed1975

The effect of dicynene on blood loss during and after transurethral resection of the prostate.

The effect of Dicynene on blood loss during and after transurethral resection for benign enlargement of the prostate was studied in 76 patients. Median loss of blood at operation was 17 ml in those given Dicynene compared with 72 ml in the placebo group (p equals less than 0.001). Median postoperative blood loss was 38 ml in the Dicynene group, and 103 ml in the placebo group (p equals 0.05). Clinical evidence of deep vein thrombosis was found in neither group. Dicynene helps to reduce blood loss in transurethral resection.

Aged↗