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PubMed2001

Impact of medical therapy on transurethral resection of the prostate: a decade of change.

OBJECTIVES: To assess whether medical therapy has delayed the need for eventual transurethral prostatectomy (TURP), causing a shift in the population characteristics of men undergoing TURP (ie, older, more comorbidities, more advanced disease), resulting in more complications and poorer outcomes. The introduction of medical therapy for symptomatic benign prostatic hyperplasia (BPH) during the past decade may have changed the indications for TURP. METHODS: All patients who underwent TURP for symptomatic BPH at our institution in 1988 (before general introduction of medical therapy for BPH) and 1998 (medical therapy the primary initial therapy for BPH) were reviewed. We compared the two groups with respect to the total number of TURPs, indications for surgery, patient age, health status, weight of resected tissue, and preoperative and postoperative complications. RESULTS: Despite a 16% increase in men at risk of BPH-related events, a 60% decrease in the total number of TURPs performed for symptomatic BPH occurred in 1998 (n = 64) compared with 10 years earlier (n = 157). No significant difference was found in age between the two groups, and no increase in comorbid status was observed. Previous medical management had failed in 36% of men who required TURP in 1998. A significantly higher percentage of patients presented in acute urinary retention (55%) and upper tract obstructive uropathy (12.5%) in 1998 compared with 1988 (23% acute urinary retention and 1.3% obstructive uropathy). Patients in 1998 were healthier, underwent smaller resections, had their catheters removed earlier, and were discharged home earlier. Although they were more likely to be discharged home with a catheter in situ, no significant difference was observed in the incidence of postoperative complications. CONCLUSIONS: There has been a dramatic decrease in the number of TURPs performed for symptomatic BPH at our institution since the advent of medical therapy. The proportion of TURP patients presenting with urinary retention and hydronephrosis increased, but the average age, medical comorbidities, operative parameters, and postoperative complications have not significantly changed.

Age Factors↗
PubMed1985

[Catabolism of glycine used in lavage solutions in urologic surgery. Apropos of a prospective study of 20 patients undergoing endourethral resection of the prostate].

A prospective study was carried out on 20 patients admitted for transurethral prostatic resection, measuring renal function, body hydratation and levels of glycine metabolic products. This study has shown that only the haematocrit measurement during surgery allowed the early and reliable recognition of resorption of the solution. High glycine levels after resorption were reduced by increasing urinary excretion of glycine, serine, creatinine and to a lesser extent, threonine. The increased production of oxalate, another elimination pathway, leads to a urinary saturation with consequent risk of lithogenesis. Furthermore, this hyperoxaluria may cause an intersticial nephropathy as do the other secondary hyperoxalurias, including Crohn's disease, bowel by-pass or xylitol intoxication.

Acute Kidney Injury↗
PubMed1992

Pethidine as a spinal anaesthetic agent--a comparison with plain bupivacaine in patients undergoing transurethral resection of the prostate.

This study compares the anaesthetic effects of intrathecal pethidine or bupivacaine in patients undergoing surgery for transurethral resection of the prostate. Patients were randomly allocated to receive 3.5 ml of 0.5% plain bupivacaine or 1 mg kg-1 of 5% pethidine. The onset, extent and duration of sensory and motor blockade were studied. The cardiovascular and respiratory variables and frequency of side-effects were noted, both in the intra-operative period and the first 24 h of the post-operative period. There were no significant differences in intra-operative conditions or post-operative complications. The duration of block was significantly shorter with pethidine but was not associated with a difference in post-operative pain or analgesic requirements; this may have advantages when early post-operative mobility is indicated. We conclude that spinal pethidine is a satisfactory agent for transurethral resection of the prostate.

Aged↗
PubMed2001

Transurethral resection of the prostate syndrome.

Benign prostatic hypertrophy (BPH) is the most common benign tumor in men. It is a regional nodular growth of the prostate gland causing symptoms of urinary hesitancy and frequency. Transurethral resection of the prostate (TURP) is the definitive treatment for BPH. Absorption of large amounts of irrigating fluid can cause serious cardiovascular and central nervous system complications known as TURP syndrome. Close attention and assessment of the patient's vital signs and mental status by the registered nurse can increase the early detection and treatment of TURP syndrome. This is a US government work. There are no restrictions on its use.

Cardiovascular Diseases↗
PubMed2002

Transurethral resection of the prostate: the new old standard.

A literature search was performed for articles between June 2000 and July 2001 pertaining to transurethral resection of the prostate. Eight of the most interesting and/or groundbreaking articles, as deemed by the authors, were selected for review. Topics discussed include transurethral vaporization of the prostate, laser prostatectomy, preoperative finasteride, pelvic floor rehabilitation, the impact of the quantity of tissue removed, bladder infusion prior to catheter removal, and ethanol-glycine in assessment of the absorption of irrigation fluid.

Blood Loss, Surgical↗
PubMed2004

Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery.

PURPOSE: In a retrospective nonrandomized study, we compared our experience with transurethral resection of the prostate (TURP) plus sequential laparoscopic bladder diverticulectomy with a series of combined open bladder diverticulectomies with transvesical prostatectomy. PATIENTS AND METHODS: We considered 12 consecutive patients (group A) having 16 diverticula who underwent sequential TURP and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group B) having 13 diverticula who underwent open bladder diverticulectomy and transvesical prostatectomy. We evaluated the size and position of the diverticulum, adenoma volume, operative time, postoperative hemoglobin variations, analgesia requirement, complications, postoperative hospital stay, and uroflowmetry results. RESULTS: No statistically significant differences existed between the groups in adenoma volume or diverticulum size or position. However, a significantly longer operative time was recorded in group A. The endolaparoscopic approach proved to be statistically superior to open surgery regarding blood loss, postoperative analgesia requirement, and hospital stay. No intraoperative complications were recorded. In addition, no statistically significant difference was found in uroflowmetry results. CONCLUSIONS: In our experience, the endolaparoscopic approach has proved to be safe, effective, and minimally invasive and therefore superior to transvesical prostatectomy and open bladder diverticulectomy. Its only disadvantage is the longer operative time.

Diverticulum↗
PubMed1988

Role of transurethral resection of the prostate in hematogenously disseminated metastasis.

Dissemination of tumor cells by vascular channels seems to be enhanced by certain surgical procedures, e.g. transurethral resection of the prostate, an operative procedure commonly used in the diagnosis and management of prostatic cancer, the third biggest killer of men in the United States. Circulating tumor cells have been the subject of great controversy as they are considered to be the connecting link between the primary tumor and the hematogenously disseminated metastatic growths. Isolation and identification of tumor cells which get released into the vascular channels is somewhat complicated. We report our experience with a technique for isolating and identifying prostatic tumor cells in the circulation and briefly discuss the role of transurethral resection of the prostate in the management of prostatic cancer.

Humans↗
PubMed2006

[Spinal anesthesia with low dose sufentanil-bupivacaine in transurethral resection of the prostate].

OBJECTIVE: To explore the clinical efficacy of intrathecally administered low dose sufentanil-bupivacaine in transurethral resection of the prostate (TURP). METHODS. Ninety patient (ASA I - III) undergoing TURP were randomly divided into 3 groups (n = 30); Group A, B and C. Group A received 7.5 mg bupivacaine + 5 microg sufentanil + 10% glucose; Group B received 7.5 mg bupivacaine + 7.5 microg sufentanil + 10% glucose; Group C received 15 mg bupivacaine + 10% glucose. The volume was 3 mL in every group. SP, DP, HR, SpO2, the degree of motor and sensory blockade and the side effect were observed. RESULTS: SP/DP was significantly decreased in Group C than that in Group and Group B (p<0.05), HR and SpO2 in group B were decreased to different degrees 15 min after the injection (p<0.05). The complete recovery time of motor nerve blockade and the regression time of sensory blockade were obviously prolonged in Group C (p<0.05). There were no significant differences in analgesic effect among the three groups during the operation, but the incidence of pruritus was higher in both group A and Group B than that in Group C during the first 24 hours after the injection. CONCLUSION: Spinal anesthesia with low dose sufentanil-bupivacaine possesses relatively steady hemodynamics. The blockade degree of motor and sensory blockade in this spinal anesthesia is lower than that in standard spinal bupivacaine in TURP.

Aged↗
PubMed1998

The impact of a clinical pathway for transurethral resection of the prostate on costs and clinical outcomes.

The purpose of this study was to evaluate the effects of implementing a clinical pathway for transurethral resection of the prostate on hospital costs and procedures, outcomes, and complications. Consecutive patients who underwent transurethral resection of the prostate for benign prostate hyperplasia in our hospital before (February-August 1996) and after (October 1996-March 1997) implementation of the clinical pathway were included. Statistical analyses included Student's t-test to test the impact of the clinical pathway on resource consumption and medical care processes, and multiple linear regression to control for patient characteristics such as age, severity of disease, and comorbidity. The major findings of this study were that implementation of the clinical pathway 1) decreased resource consumption and controlled medical care expenditure; 2) influenced physicians' patterns of practice and decreased the number of procedures performed; and 3) did not affect clinical outcomes or complication rates. In conclusion, our results support the hypothesis that the clinical pathway is an effective medical management tool to contain costs, which does not adversely affect quality of care. We suggest health policy makers promote clinical pathways in more hospitals to encourage appropriate resource consumption.

Aged↗
PubMed2004

Vaporization of the prostate.

PURPOSE OF REVIEW: Transurethral resection of the prostate remains the treatment of choice for men with symptomatic benign prostatic enlargement. Concerns regarding the morbidity of this operation have led to the development of alternative surgical procedures. Vaporization of the prostate can be achieved using either laser energy or electrosurgery. The advantage of these approaches is that they allow tissue removal with reduced blood loss. Vaporization techniques have been around for almost a decade and more powerful lasers have recently become available. This has led to a minor resurgence in interest in laser vaporization. We reviewed articles on all forms of vaporization of the prostate published in the 12 months from August 2002. RECENT FINDINGS: Electrovaporization of the prostate is an effective treatment for men who require surgery for benign prostatic enlargement. The results are well maintained at 5 years follow-up with low reoperation rates. Scanty data are available for the Gyrus (Gyrus Medical Ltd, Cardiff, Wales) bipolar electrovaporization system but preliminary results suggest there is no significant advantage over transurethral resection of the prostate. Early forms of laser vaporization of the prostate are not as effective as either transurethral resection of the prostate or transurethral electrovaporization of the prostate and have a higher retreatment rate. Newer, more powerful lasers have been recently introduced with encouraging initial results in small numbers of patients. SUMMARY: Electrovaporization of the prostate is a safe, effective and durable alternative to transurethral resection. Early laser vaporization techniques have high retreatment rates, which limit their cost-effectiveness. Few data are yet available on high-powered lasers for bladder outflow obstruction. Whether any vaporization technique will stand the test of time is unclear.

Aged↗
PubMed1982

An objective comparison of transurethral resection and bladder neck incision in the treatment of prostatic hypertrophy.

Transurethral resection has become the operation of choice in almost all cases of benign prostatic enlargement. However, when the gland does not exceed 30 gm. bladder neck incision is easier to perform, results in a lower morbidity, and is less likely to be followed by incontinence and retrograde ejaculation. We studied 2 groups of men with proved obstruction. Complete urodynamic investigation was done on 51 patients before and on 44 patients after the operation. We compared our subjective and objective findings in the 2 groups. The conclusion suggest that bladder neck incision is as effective as transurethral resection in relieving the obstruction of prostatic enlargement in the presence of a small gland.

Humans↗
PubMed2003

Effect of transurethral resection of the prostate on blood coagulation test results.

AIM: To evaluate results of coagulation tests and serum sodium levels during the early postoperative period in patients undergoing transurethral resection of the prostate. PATIENTS AND METHODS: In a prospective study, blood coagulation tests were performed and serum sodium levels measured in 27 patients before and at the end of transurethral resection of the prostate and 24 h later. The causes of the changes in coagulation test results were also investigated. RESULTS: There were significant decreases in the platelet counts (p < 0.001) and fibrinogen (p < 0.001), hemoglobin (p < 0.05), and sodium (p < 0.0001) concentrations at the end of the operation. The prothrombin time was prolonged (p < 0.01). The activated partial thromboplastin time did not change. There was a statistically significant correlation between the changes in prothrombin time and fibrinogen concentration and the amount of irrigating solution used during the operation and the difference between the volume given and collected as irrigation. Coagulation test results, hemoglobin concentration, and serum sodium level returned to normal values 24 h after the operation. CONCLUSION: Our results show that there was a transient change in platelet count, prothrombin time, and fibrinogen and serum sodium concentrations during the early postoperative period which can be explained on the basis of dilution of the blood.

Aged↗
PubMed1992

Effects of serum acid phosphatase [correction of phosphate] elevation following transurethral prostatectomy on long-term mortality.

Studies of surgery for symptoms of bladder outlet obstruction in men suggest that a possible higher long-term mortality occurs in patients having transurethral prostatectomy compared with patients having an open prostatectomy. It is the purpose of this study to determine if intraoperative factors affect the long-term survival of patients having transurethral prostate resection for benign prostate hypertrophy. In 158 consecutive patients having transurethral prostatectomy for benign adenoma who were followed for eight years, 28 patients died during the follow-up period. In comparing those patients who are alive with those patients who have died, there was no significant difference at the time of surgery in intraoperative irrigant absorption as indicated by changes in serum sodium and there was no significant difference in the intraoperative absorption of prostate tissue substances as indicated by changes in serum acid phosphatase. The only factor in this study associated with long-term survival was age of the patient at the time of surgery with older patients having a higher long-term mortality. This study suggests that age of the patient rather than intraoperative factors is associated with long-term survival following transurethral prostatectomy.

Acid Phosphatase↗
PubMed1999

[A case report of urinary tract infection and meningitis caused by methicillin-resistant Staphylococcus aureus (MRSA) after transurethral resection of the prostate].

We present a case of meningitis that developed following a urinary tract infection caused by methicillin-resistant Staphylococcus aureus (MRSA) after transurethral resection of the prostate. The patient, a 69-year-old man with diabetes mellitis, underwent transurethral resection of the prostate following a diagnosis of benign prostatic hypertrophy. On the 4 th day after surgery, high fever occurred immediately after the removal of the indwelling urethral catheter. Cultures of urine and blood revealed MRSA. On the 6 th day after surgery, severe lumbago was evident and MRSA was isolated from cerebrospinal fluid. Separate administration of arbekacin or vancomycin, to which the isolated MRSA was sensitive, was not effective. Combined therapy with fosfomycin, vancomycin and human immunoglobulin effectively relieved the inflammation. Although it is generally reported that the pathogenicity of MRSA is low in the urinary tract, this case suggests that a urinary tract infection caused by MRSA can advance to sepsis and meningitis.

Aged↗
PubMed1997

Neuroendocrine stains and proliferative indices of prostatic adenocarcinomas in transurethral resection samples.

OBJECTIVE: To determine whether the quantification of certain neuroendocrine and proliferative markers would help in the prognostic evaluation of prostatic adenocarcinomas obtained during transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Samples from two groups of patients with prostate cancer were examined. One group comprised 23 patients, of whom 12 were stage IV and 11 stage III, all with Gleason scores of > or = 7; this group was designated as high-grade, high-stage (HGHS). The second group comprised 10 consecutive patients with stage T1a adenocarcinoma of the prostate with Gleason scores of < or = 6, designated as low-grade, low-stage (LGLS) tumours. Tumour tissue from each TURP was stained with MIB-1 (an indicator of cell proliferation), neuron-specific enolase (NSE), chromogranin A (ChA) and synaptophysin (Syn), and 1000 cells counted to determine the percentages of positive cells in both benign and malignant tissue. The percentage of MIB-1-positive cells was designated as the proliferative index (PI). Patients were clinically followed to evaluate tumour progression, documented by rising prostate-specific antigen (PSA) levels, X-ray evidence of recurrent or metastatic carcinoma, or tissue biopsy showing malignancy. RESULTS: The mean number of neuroendocrine cells (NEC) for each marker and the mean PI were greater in the HGHS tumours than in the LGLS tumours or surrounding benign tissue of either group (P < 0.01). The LGLS tumours were remarkable for a having mean PI of about twice that of the benign tissue (2.9 and 1.3, respectively, P < 0.01); the NEC in these cases were more frequent in the benign than in the malignant tissue. There was no significant difference between the mean PIs and the mean percentages of NEC in the 14 HGHS tumours that progressed and the nine HGHS tumours that did not (P values 0.37-0.96). CONCLUSIONS: Although the PI assessed by MIB-1 and the number of NEC-positive cells were much higher in HGHS than LGLS tumours, this finding did not appear to have independent prognostic significance. The significance of the higher PI in LGLS tumours than in corresponding benign tissue is uncertain; LGLS tumours had fewer NEC than the surrounding benign tissue. The quantification of any of these four markers (MIB-1, NSE, ChA, Syn) was not prognostically helpful in these groups of cancers present in TURP specimens.

Aged↗
PubMed1990

Transurethral resection versus transurethral incision of the prostate. A prospective randomized study.

In this ongoing study, patients with an estimated prostate size of no more than 20 gm are randomized to undergo either transurethral resection of the prostate (TURP) or transurethral incision (TUIP) at the 6 o'clock position. To date, 93 patients have been included, and 3 months postoperatively, 80 to 90 per cent of the patients in each group reported improvement. There was also a significant decrease in symptom scores and a significant increase in maximum urinary flow rate, with great variation within each group but without difference between the groups. In both groups, there appears to be some deterioration over time. Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly in favor of TUIP. Loss of ejaculation was reported by 37 per cent of patients after TURP and by 13 per cent after TUIP (not statistically significant). There was no difference between the groups in the need for further surgery. Therefore, TUIP is recommended as an alternative to TURP in patients with small prostates.

Adult↗
PubMed1985

Klebsiella oxytoca endocarditis after transurethral resection of the prostate gland.

Klebsiella oxytoca endocarditis developed in an 87-year-old man after transurethral resection of the prostate gland. He was treated for K oxytoca urinary tract infection and septicemia seven weeks before admission. Fever and bacteremia persisted for ten days during therapy for endocarditis. He was treated with a combination of cefazolin and tobramycin for six weeks. Despite peak serum bactericidal titers of only 1:4, the patient recovered completely and was apparently healthy at followup two years later.

Aged↗