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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.

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PubMed1981

Decreases in electric thoracic impedance during transurethral resection of the prostate: an index of early water intoxication.

Thoracic impedance of 18 patients undergoing transurethral resection of the prostate was measured 15 minutes preoperatively, and 30 and 60 minutes after the start of the operation. Impedance variations were compared to variation in 1) cardiac output, 2) serum sodium osmolality and 3) alveolar-arterial oxygen tension difference. Thoracic impedance, initially 24.6 plus or minus 0.3, decreased to 23.8 plus or minus 0.5, 30 minutes after the onset of the operation (p less than 0.0005) and 22.9 plus or minus 0.5, 30 minutes later (p less than 0.01 from previous reading and 0.0005 from control). Patients in whom impedance had decreased 10 per cent or more from control values received 10 mg. furosemide intravenously 60 minutes after the onset of the operation. This therapy permitted the restoration of impedance values, cardiac output, alveolar-arterial oxygen tension difference and serum sodium osmolality to values statistically similar to those found in the 10 patients who had not sustained such precipitous decreases in impedance within 60 minutes. We believe that the measurement of thoracic impedance during transurethral prostatic surgery offers the most sensitive index of early water intoxication. Measurements can be obtained without delay in the operating room and, thus, permit immediate correction of the condition.

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PubMed2003

The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation.

BACKGROUND AND OBJECTIVES: The aim of our study was to compare the three different regional anaesthesia methods in patients who underwent transurethral resection of the prostate (TURP) and to determine the ideal anaesthesia method for TURP operation. METHODS: Totally 77 ASA II-III patients were preloaded with 500 ml 0.9% NaCl solution before regional anaesthesia. In group E (n:27) epidural anaesthesia were achieved by applying 75 mg bupivacaine heavy + 50 microg fentanyl in the L3-L4 intervertebral space. In group SP (n:28) 15 mg bupivacaine heavy + 50 microg fentanyl were used for spinal anaesthesia (L3-L4 intervertebral space) while in group SA (n:30) 10 mg bupivacaine heavy + 50 microg fentanyl were used with saddle blockade. Systolic arterial pressure (SAP), heart rate (HR), peripheral oxygen saturation (SpO2), serum sodium measurement was recorded before and after hydration and during operation. The motor block and sensory level have been measured. RESULTS: Intraoperative SAP values were more stable than the other groups in group SA. The decrease in HR values were significant 15 minutes after prehydration in three groups (p < 0.05). SpO2 values of the groups were stable during the operation. The time to reach the maximum block was very short in patients in Group SA (p < 0.0001). There was a statistically significant difference between the groups in terms of motor block values (p < 0.0001). No fully paralysed sample was seen in Group SA even though there was a sufficient surgical anaesthesia. CONCLUSIONS: Saddle block has some advantages compared to spinal and epidural anaesthesia methods such as achieving adequate anaesthesia, stable haemodynami, the lower degree of motor blockage and no full blockage in patients. Saddle block is an the most optimal anaesthesia method for TURP operation.

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PubMed1988

Analysis of the possibility that transurethral resection promotes metastasis in prostate cancer.

The issue of transurethral resection (TURP) in patients with known prostatic adenocarcinoma is a current clinical controversy. Data have accumulated to associate this procedure with an adverse risk of distant spread and death for a defined subset of patients with moderate and poorly differentiated, T3 and T4 (Stage C) tumors. Review of available literature demonstrates that examination of this subset is incomplete in studies that do not find an adverse prognosis. The reason for the association of TURP and metastasis may be related directly to the resection via mechanical dissemination of tumor or indirectly through association with unknown adverse factors. Retrospective review may be unable to separate these two hypotheses, but hazard function analysis is presented and is consistent with surgical enhancement of metastases. Strategies for avoiding the adverse effect represent areas for possible further clinical research.

Adenocarcinoma↗

PubMed1991

Chlamydia trachomatis in chronic abacterial prostatitis: demonstration by colorimetric in situ hybridization.

Twenty-three transurethral resected prostate specimens with histologic evidence of chronic abacterial prostatitis were evaluated by colorimetric in situ hybridization for evidence of Chlamydia trachomatis. Intracellular chlamydia bodies were detected in seven of 23 cases (30.4%). In five of seven positive cases, chlamydia inclusion bodies were present within both epithelial cells and intraluminal histiocytes. In two of seven positive cases, extracellular chlamydia bodies were identified in conjunction with intraepithelial inclusions. In only one case were extraductal, extraacinar, intrahistiocytic inclusion bodies observed. Our study confirms previous reports implicating C trachomatis as an etiologic agent in chronic abacterial prostatitis, and underscores the applicability of DNA probes for the detection and identification of C trachomatis in routinely fixed, paraffin-embedded tissues.

Chlamydia Infections↗

PubMed2003

Infravesical obstruction due to benign intraurethral prostatic cyst.

We report a case of symptomatic intraurethral prostatic cyst in a 42-yr-old man without clinical evidence of benign prostatic hyperplasia. The intraurethral cyst makes it unique from the all previously reported cases of prostatic cysts located medially within the prostate. Transurethral resection of the cyst with limited resection of the prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms.

Adult↗

PubMed2001

Postoperative mortality in patients with liver cirrhosis undergoing transurethral resection of the prostate: a Danish nationwide cohort study.

OBJECTIVE: To examine the risk of 30-day postoperative mortality from transurethral resection of the prostate (TURP) in patients with liver cirrhosis, who are reportedly at considerably increased perioperative risk. PATIENTS AND METHODS: For the period 1 January 1977 to 31 December 1993, a population-based cohort was identified comprising Danish patients diagnosed with liver cirrhosis and a random sample of Danes also undergoing TURP. Logistic regression models were used to estimate the association between liver cirrhosis, age, type of admission, comorbidity and 30-day mortality. RESULTS: In a cohort of 23 133 patients with liver cirrhosis, 30 underwent TURP; 150 controls with no liver cirrhosis also underwent the same procedure. Of the patients with liver cirrhosis, 6.7% died within 30 days of TURP; the estimated adjusted odds ratio was 3.0 (95% confidence interval 0.4-22.9) for the 30-day postoperative mortality in patients with liver cirrhosis compared with patients without (mortality 2%). Advanced age, comorbidity and acute admission seemed to be associated with an increased postoperative mortality. CONCLUSION: This study indicates that TURP in patients with liver cirrhosis was associated with increased mortality.

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PubMed1992

Estimation of irrigant absorption during transurethral resection of the prostate. Assessment of fluorescein as a marker.

Absorption of irrigating solution may complicate transurethral resection of the prostate (TURP), and a system which warns of fluid overload reliably would be of benefit in the prevention of these complications. Fluorescein can easily be detected at very low concentrations in blood and can be added to the irrigating solution in amounts invisible to the naked eye, providing a possible means of easily monitoring the absorption of irrigant solution during TURP. To test this hypothesis, the plasma concentration of fluorescein was determined at intervals after intraperitoneal injection in rats. Although the published data on fluorescein suggest that it meets the criteria for a suitable marker substance to be introduced into the irrigant solution, the results show that plasma fluorescein is constant and not dose related. The addition of fluorescein to the irrigant solution would not provide a quantitative means of determining the volume of irrigant absorbed. The use of other substances may provide the answer to this major clinical problem. We have defined a set of criteria which such a substance should fulfil.

Absorption↗

PubMed1994

Continuous versus intermittent flow irrigation in transurethral resection of the prostate.

OBJECTIVE: We compared fluid absorption, blood loss, and immediate postoperative complications in transurethral resection of the prostate (TURP) performed with the continuous flow and the intermittent flow irrigation techniques. We also studied pressure conditions under which fluid absorption occurs when continuous flow irrigation is used. METHODS: One experienced urologic surgeon performed TURP in 40 patients using suprapubic drainage of the bladder and in 40 other patients using the intermittent-filling technique. Fluid absorption was measured by the ethanol method every ten minutes. The intravesical pressure was recorded continuously in 23 of the patients with suprapubic drainage. RESULTS: Fluid absorption was more common when suprapubic drainage was used (P < 0.004). There were no differences in operating time, blood loss, postoperative complications, or in the period of hospitalization. Low-degree absorption occurred during minor elevations of the intravesical pressure, and massive fluid absorption was associated with pressures between 1.0 and 2.5 kPa (10 and 25 cm H2O). CONCLUSIONS: Continuous flow irrigation promoted fluid absorption, which occurred at lower pressures than commonly believed. With respect to other parameters, we found no superiority of one irrigating technique over the other.

Absorption↗

PubMed1999

Failure to void after transurethral resection of the prostate and mode of presentation.

OBJECTIVES: Contemporary audits and reviews of outcome after transurethral resection of the prostate (TURP) make little reference to failure to void following catheter removal after this operation. There have been few reports of the likelihood of a successful trial without a catheter after TURP related to mode of presentation. We report the results of a retrospective review of outcome of TURP related to mode of presentation, age, and prostate histologic findings in a consecutive series of patients in a London Teaching Hospital. METHODS: A consecutive series of 379 patients (381 TURPs) was reviewed to document the incidence of and risk factors for failure to void following initial trial without a catheter after TURP. RESULTS: Twelve percent of men failed to void after TURP on the initial trial without a catheter. In those patients presenting with lower urinary tract symptoms, there were no instances of failure to void. Ten percent of patients with acute retention (painful inability to void, urine volume less than 800 mL), 38% with chronic retention (maintenance of spontaneous voiding, bladder volume greater than 500 mL), and 44% with acute on chronic retention (painful retention, urine volume greater than 800 mL) failed to void after TURP. Only 1% of patients required management by long-term catheterization. Failure to void on catheter removal was not related to age or prostate histologic findings. CONCLUSIONS: Bladder volume at initial presentation in patients with urinary retention provides important information about the likelihood of re-establishing spontaneous voiding catheter removal following TURP. Patients should be warned that there is a significant chance of failure to void after TURP, the exact risk depending on their mode of presentation, but that most will ultimately not require a permanent indwelling catheter.

Adult↗

PubMed1990

Elevated mortality following transurethral resection of the prostate for benign hypertrophy! But why?

This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

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PubMed1995

Is follow-up necessary after transurethral resection of the prostate?

OBJECTIVE: To assess the necessity for routine out-patient review following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy. PATIENTS AND METHODS: One-hundred and two patients with histologically proven benign prostatic hypertrophy were prospectively reviewed as out-patients. The views of their general practitioners were established by postal questionnaire. RESULTS: At their first out-patient review 94 of 102 (92%) patients were discharged and only 2% (2/102) patients remained under review after 1 year. Apart from routine urine analysis, only four additional investigations were initiated at the routine clinical assessment. One patient was listed to undergo prostatic surgery again following the post-operative out-patient review. Over the next 16 months only three patients (3%) were re-referred with further urological problems. Confidence in a system without routine hospital out-patient review was expressed by 90% of general practitioners and 78% of patients. CONCLUSION: Follow-up after TURP cannot be justified in terms of the perceived therapeutic benefit to patients. Patients should be discharged to the community and be assessed rapidly in out-patients if and when problems arise.

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PubMed1986

Value of clinical decision on antibiotic treatment of fever episodes following transurethral resection of the prostate.

The value of clinical decision on antibiotic treatment of fever episodes following transurethral resection of the prostate was assessed in 134 patients. Besides bacteriuria, need of blood transfusions and various catheter problems were associated with a significant number of fever episodes. The majority of patients with fever not given antibiotic therapy had negative urine cultures (90%), whereas 41% of the patients with fever treated with antibiotics showed negative urine cultures indicating an overtreatment of these patients. Out of the total number of patients, only 10% with subsequent negative urine cultures received antibiotics, a figure which should be compared to the inevitable rate of overtreatment when general antibiotic prophylaxis is preferred.

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PubMed1990

Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. II. Isotonic 2.2% glycine solution as an irrigating fluid.

Seventeen patients undergoing transurethral resection of the prostate using isotonic 2.2% glycine solution as an irrigating fluid were studied. The extra- and intracellular distribution of water, the total content of water, and the concentrations of electrolytes and free amino acids in muscle tissue were determined together with the concentrations of free amino acids in plasma preoperatively, immediately postoperatively and 2, 6, 24 and 48 hours postoperatively in two groups with separate sampling periods. There were no significant changes in water content and sodium or chloride concentrations in muscle tissue postoperatively. Potassium and magnesium concentrations decreased late in the postoperative phase. In plasma there was a fifty-fold increase immediately postoperatively in the glycine concentration (mean fluid absorption 0.71) followed by a six-fold increase in muscle tissue 6 hours postoperatively. The glycine metabolite serine also increased in plasma and muscle. Other muscle amino acid concentrations decreased immediately postoperatively probably due to the massive glycine entrance into the cells. Later postoperative changes in some muscle amino acids (glutamine, glutamate, alanine, tyrosine and arginine) may be explained more by the operative trauma than by the influence of glycine. Two different types of metabolic effects are seen in this material. The first is that of the glycine infusion and the metabolic effects of glycine. The second is the catabolic influence of the surgical trauma. Accumulation of glycine in tissues in some patients with the possible production of ammonia and the effects of glycine as an inhibitory neurotransmitter must be considered as risk factors when choosing glycine as an irrigating fluid.

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PubMed1987

Urinary tract infections in connection with transurethral resection of the prostate.

The study evaluates the incidence and consequences of infectious complications after 700 transurethral resections of the prostate. The patients were treated individually for bacteriuria according to urine cultures. No general antibacterial prophylaxis was used. 376 patients (54%) had negative urine cultures throughout the course and received no antibacterials. Of the 256 patients with an indwelling catheter before surgery only 64 (25%) had negative cultures throughout, as opposed to 312 (70%) out of 444 patients without an indwelling catheter preoperatively. Antibacterial treatment was given to 127 patients (18%) before surgery because of bacteriuria. Positive urine cultures postoperatively indicated antibacterial therapy to 197 patients (28%). Four non-fatal cases of septicemia were recorded. The influence of bacteriuria and indwelling catheters on the postoperative course and on the length of hospital stay is documented. It is concluded that antibiotic prophylaxis may be indicated in patients with a preoperative urethral catheter; other patients should be treated if and when bacteriuria occurs.

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PubMed1997

Laser prostatectomy versus transurethral resection of the prostate for benign prostatic hypertrophy: comparative changes in haemoglobin and serum sodium.

A prospective study was undertaken to examine differences in haemoglobin concentration and serum electrolytes in two patient groups undergoing surgical treatment for benign prostatic obstruction. Group one underwent conventional transurethral resection of the prostate (TURP), and group two were treated by laser ablation of the prostate (LAP). Twenty-six patients were enrolled in LAP group, 25 in the TURP group. Both patient groups had the procedure performed under epidural anaesthesia. Serial measurements of haemoglobin and sodium were performed at three time intervals: immediately preoperatively, in the recovery room and 24 hours postoperatively. A fall in serum sodium levels between the mean preoperative reading (140 mmol/l) and 24 hours post surgery (138 mmol/l) was the only statistically significant alteration sustained in the laser patients (P < 0.0001). A fall in haemoglobin from preoperative measurement to recovery room measurement of 0.71 g/l was statistically significant (P < 0.0001), but did not persist to the 24 hour postoperative time period. The TURP group demonstrated statistically significant falls in both sodium and haemoglobin levels at both postsurgery measurements. Mean serum sodium levels fell from 141 mmol/l preoperatively to 138 mmol/l (P < 0.0001) in the recovery room and 137 mmol/l (P < 0.0001) at 24 hours. Preoperative haemoglobin fell from 14.8 g/l to 13.6 g/l (P < 0.0001) in recovery and 13.7 g/l (P < 0.0001) at 24 hours.

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PubMed1990

[Resorption of the lavage fluid during transurethral resection of the prostate. Apropos of 13 cases].

The authors report on thirteen patients who developed a variety of symptoms after transurethral resection of the prostate; confusion, seizures, blurred vision with mydriasis, nausea and vomiting, bradycardia, and hypotension. This post-resection syndrome is caused by resorption of a large amount of the hypotonic solution used during the surgical procedure and containing 1.5% glycine. Postoperative sodium levels were assayed in all patients and consistently found to be low (105 to 124 mEq/l). Serum glycine was measured in three patients and the very high levels found suggest that absorption of glycine during transurethral resection of the prostate may contribute to the symptoms of encephalopathy.

Absorption↗

PubMed1993

Patient-perceived health status before and up to 12 months after transurethral resection of the prostate for benign prostatic hypertrophy.

As part of a prospective cohort study of 388 men undergoing transurethral resection of the prostate (TURP) for benign prostatic hypertrophy, the perceived physical, social and emotional health before and 3, 6 and 12 months after surgery was assessed using the Nottingham Health Profile. Before surgery, 88% of patients reported one or more specific health problems, most commonly concerning sleep (75%). The areas of daily life considered by the patients to be most affected by their health status were employment (by 33% of those currently in work), sex life (31%), social life (29%) and holidays (29%). Comparisons with other patient groups are described. Three months after surgery the proportion of patients reporting at least one health problem had fallen to 66%. Significant improvements occurred in all aspects of health, particularly sleeping problems. The improvements persisted for all aspects during the year following surgery with the exception of physical mobility, which deteriorated. These improvements were reflected in a significant reduction in perceived limitations in the patients' daily lives, with a tendency for the patients to perceive fewer limitations 1 year after surgery than at the 3-month assessment.

Activities of Daily Living↗