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PubMed1981

The effect of local hypothermia on blood loss during transurethral resection of the prostate.

A prospective trial to investigate the effect of using cold irrigating solution during transurethral resection of the prostate was carried out. A control group of 44 patients was resected using irrigant at room temperature, and a trial group of 49 cases was resected using irrigant cooled to 2 degrees C. Blood loss during surgery was measured to see whether the cold irrigating solution had any effect on this loss. There was a small reduction in blood loss in the cold group, but this reduction was not statistically significant (0.5 greater than P greater than 0.3).

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PubMed1993

Urethral stricture following transurethral resection of the prostate. The role of local anaesthetics.

In a multicentre prospective study, 261 patients undergoing transurethral resection of the prostate (TURP) in 17 urology departments were randomised to receive lubricating jelly containing either 3% tetracaine hydrochloride, 1% lignocaine hydrochloride, or no local anaesthetic. No patient had a history of urethral instrumentation or a previous urethral stricture. After 6 months' follow-up, 25/79 patients (32%) treated with 3% tetracaine jelly developed urethral strictures, as did 4/92 patients (4%) who received 1% lignocaine and 2/90 (2%) who received the jelly without anaesthetic. It was concluded that the use of 3% tetracaine jelly is associated with a high incidence of post-TURP urethral strictures.

Follow-Up Studies↗

PubMed1995

Closed video transurethral resection of the prostate for the prevention of infection.

An instrument with which safe and clean video transurethral resection of the prostate (video TURP) can be performed has been developed by the author; its use could minimize the risk to the operating staff of being infected by such dangerous viruses as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The instrument consists of a bag made of transparent synthetic resin (polyvinyl chloride), used to cover the patient's penis and a resectoscope with a super miniature video camera unit. Irrigation fluid from the patient's bladder flow into the bag and is drained into the drainage hose through the conduit in the bottom of the bag. When this is used, contamination of clothes of the surgical staff and the surroundings with blood-contaminated irrigation fluid is avoided.

Humans↗

PubMed1991

Blood ammonia concentrations resulting from absorption of irrigating fluid containing glycine and ethanol during transurethral resection of the prostate.

In 30 patients the blood ammonia concentration was measured 30 min was after transurethral resection of the prostate during which absorption of irrigating fluid containing 1.5% of glycine and 1% of ethanol had been indicated by serial expired breath tests. The volume of irrigating fluid that had been absorbed was either measured volumetrically (n = 25) or estimated from the ethanol concentration in the expired breath (n = 5); the median volume of irrigating fluid absorbed was 1.3 litres (range 0.2-4.3). There was no consistent rise in the blood ammonia concentration, nor was there any correlation between the blood ammonia concentration and the volume of irrigating fluid absorbed. No patient developed symptoms that could be clearly related to hyperammonaemic glycine toxicity, but 18 of the 30 patients developed other signs of the "TURP syndrome". The present results suggest that irrigating fluid containing both glycine and ethanol does not significantly increase blood ammonia concentration or produce symptoms of glycine toxicity.

Absorption↗

PubMed1994

[Adverse reactions following transurethral resection of the prostate. Etiopathogenic considerations and report of a case of transient amaurosis]].

CNS changes following transurethral resection of the prostate are uncommon, but not insignificant. The foregoing condition may result from different causes including hemolysis, hyponatremia, brain edema, the use of atropine, or even postoperative vascular accidents, transient blindness being one of the most striking symptoms. The different etiologies are reviewed and a case of transient amaurosis, which we ascribe to brain edema, is analyzed. We underscore the importance of a detailed examination by the different specialists in order to institute the appropriate treatment and benefit patient recovery.

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PubMed2000

The volumetric fluid balance as a measure of fluid absorption during transurethral resection of the prostate.

To evaluate the usefulness of the volumetric fluid balance for indicating and quantifying fluid absorption during transurethral resection of the prostate, 62 patients showing fluid absorption on ethanol monitoring (control method) were selected from a series of 410 operations. The volumetric fluid balance, which was measured as the difference between the input and output of irrigating fluid with and without a correction for the blood loss, proved to be an unreliable clinical tool for measuring the absorption. It indicated that fluid absorption occurred only in 40 or 18 of the 62 patients, depending on whether a correction for blood loss was made or not, the volume being only 59% and 71% (median), respectively, of that obtained by the control method. The absorption averaged 1 L in the patients in whom the volumetric measurements did not indicate absorption. The incidence of symptoms of the 'transurethral resection syndrome' increased with the absorbed fluid volume only when measured by the control method.

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PubMed2002

Three-year follow-up of laser prostatectomy versus transurethral resection of the prostate in men with benign prostatic hyperplasia.

OBJECTIVES: To present our 3-year data comparing laser prostatectomy and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Laser prostatectomy was one of the first new minimally invasive treatment modalities for BPH, and few reports of the long-term results of this treatment regimen have been published. METHODS: One hundred men with BPH in whom medical therapy had failed were randomized to undergo either laser prostatectomy or TURP. Preoperative measurements included American Urologic Association symptom score, prostate-specific antigen, uroflowmetry, and transrectal ultrasonography (TRUS). Laser prostatectomy was performed using the potassium titanyl-phosphate/neodynium:yttrium aluminum-garnet laser. TURP was performed in a standard manner with video monitoring. Patients were seen in follow-up at 1, 3, 6, and 12 months and every 12 months thereafter, with the following data obtained: symptom score, peak urinary flow rate, prostate-specific antigen level, and TRUS volume. RESULTS: A total of 100 patients were entered into the study, with 50 patients in each treatment group. The mean age was 68.2 years (range 45 to 90) for the laser patients and 67.4 years (range 54 to 82) for the TURP group. The mean symptom score decreased from 22.0 to 9.9 at 36 months of follow-up for the laser patients compared with 21.2 to 7.7 for the TURP patients. The mean peak flow rate increased from 8.2 to 12.3 mL/s at 36 months for the laser group with a similar increase from 7.3 to 12.8 mL/s for the TURP patients. The mean TRUS volume for the laser patients decreased from 33.9 to 32.9 cm3 at 36 months compared with a mean TRUS volume of 29.6 cm3 preoperatively for the TURP patients that decreased to 26.3 cm3 at 36 months. CONCLUSIONS: At 36 to 72 months of follow-up, the durability of results achieved by the patients in the laser cohort was similar to that for patients undergoing TURP.

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PubMed2000

Intravesical pressure during irrigating fluid absorption in transurethral resection of the prostate.

OBJECTIVE: In order to control fluid absorption, various approaches are used to reduce intravesical pressure during transurethral resection of the prostate (TURP). With a view to finding a target pressure for such efforts, pressure and fluid absorption were compared in a meta-analysis of four previous studies comprising three different irrigation techniques. MATERIALS AND METHODS: Intravesical pressure was recorded during TURP in which the irrigating fluid was evacuated intermittently (n = 48) by a suprapubic tube (n = 23) or a trocar (n = 30). Fluid absorption was compared with the mean and maximum pressures and the duration of excessive pressure (>2 kPa) over 10-min periods. RESULTS: Mean bladder pressure during fluid absorption was between 1.0 and 2.5 kPa. The maximum pressure during absorption varied greatly during the first 30 min of TURP, but thereafter it ranged between 2 and 3 kPa. Only the duration of pressures >2 kPa increased with fluid absorption (p < 0.02). The maximum pressures were highest with the intermittent technique, while the other indices of intravesical pressure showed the highest values when the suprapubic tube was used. The lowest pressures usually occurred when the trocar was used, but fluid absorption still occurred, as the pressure was much higher during some of these operations. CONCLUSIONS: Fluid absorption occurred at moderate intravesical pressures with all three irrigation techniques. The best strategy for reducing fluid absorption is to keep the pressure below 2 kPa for as long as possible during TURP.

Absorption↗

PubMed1997

Transurethral resection of the prostate: still the gold standard.

BACKGROUND: In recent times there has been a number of newer methods advocated as treatment for bladder outlet obstruction. Prior to embracing these newer technologies, the authors' experiences with conventional transurethral resection of the prostate should be evaluated and compared with those experienced in the newer modalities. The objective was to determine whether a standard transurethral resection of the prostate (TURP) still compared favourably with the newer modalities in terms of duration of stay, duration of catheterization, re-admission rate, re-catheterization rate, cost and long-term results. The results are compared with those of workers whose level of expertise was the best that could be achieved with transurethral needle ablation (TUNA) and laser prostatectomy. METHODS: During the 3-year period from September 1992 to September 1995, 575 TURP were carried out in a regional hospital. The total duration of stay, the postoperative duration of stay, the re-catheterization and re-admission rates were assessed and the costs estimated. RESULTS: Transurethral resection of the prostate was shown to compare favourably in terms of the duration of hospital admission and the duration of catheterization, and to have a significantly lower re-catheterization rate and a significantly lower re-admission rate than the newer modalities. CONCLUSION: Transurethral resection of the prostate is still the method of choice for surgical management of bladder outlet obstruction, and it remains as the gold standard. Having reviewed the results of the newer modalities as carried out by the experts in those fields, it was found that TURP compares favourably with those procedures. From the point of view of duration of stay, duration of catheterization, re-admission rate and re-catheterization rate, as well as cost and long-term results, TURP remains as the gold standard and the newer modalities are not believed to be advantageous at this stage.

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PubMed2006

[A study of 4,031 patients of transurethral resection of the prostate performed by one surgeon: learning curve, surgical results and postoperative complications].

A total of 4,031 patients who underwent transurethral resection of the prostate (TURP) performed by one surgeon between May 1979 and December 2003 were retrospectively examined to determine the improvement of the surgeon's skill in performing TURP assessed by using a learning curve, surgical results and postoperative complications. Analysis using the learning curve, which displayed the relationship between the number of TURP procedures and the speed of resection (i.e., the weight of tissue resected divided by the operation time), revealed that 81 operations were needed before the surgeon's skill reached a plateau in performing TURP. The means +/- standard deviations of the weight of tissue resected, operation time and speed of resection were 17.0 +/- 14.6 g, 21.0 +/- 13.5 minutes, 0.80 +/- 0.32 g/minutes, respectively. As the number of TURP procedures increased and the level of skill improved, the operation time was significantly reduced and the speed of resection was significantly increased. The incidences of postoperative complications were 2.4% for blood transfusion, 0.3% for the TURP syndrome, 1.5% for hemostatic procedures, 2.8% for bladder neck contracture, and 1.0% for urethral stricture. The incidences of transfusion and the TURP syndrome decreased as the surgeon's skill improved. The mortality rate was 0.1%.

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PubMed1999

[Early catheter removal after transurethral resection of the prostate].

BACKGROUND: Thanks to the introduction of new optical systems and advances in technology, transurethral resection is now the most widely used method in the management of prostatic adenoma. METHODS: A study has been carried out on 25 patients aged from 50 to 80 years submitted to an uncomplicated transurethral resection of the prostate for benign hyperplasia. Patients with intense retention of urine, capsular perforation, bladder neck undermining, considerable haemorrhage in the recovery room and postoperative fever have been excluded from the study. The urethral catheter which is normally removed 3 to 5 days post operatively, was removed within 24 hours of surgery. RESULTS: 80% of patients were discharged within 48 hours and the follow-up carried out by means of bacterial urinary culture, urinary pressure monitor and echography, showed that there were no significant complications. CONCLUSIONS: In conclusions, this study made it possible to select patients on which an early catheter removal is possible and to evaluate the real advantages of such a method.

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PubMed1987

[The course of pyuria after transurethral resection of the prostate and factor analysis of its duration].

The course of pyuria and bacteriuria was reviewed in 54 patients undergoing transurethral resection of prostate. Pyuria, which was seen in all cases, lasted for 70.1 +/- 24.7 days and bacteriuria defined as more than 10(4)/ml occurred in 16 patients (30%) postoperatively. To analyze the factors affecting the duration of pyuria, we utilized Hayashi's multidimensional quantification I theory. The factors included age, serum protein, preoperative indwelling catheter, preoperative urinary tract infection, resected weight, postoperative infection, the duration of postoperative indwelling catheter, and the way of antibacterial prophylaxis. The most important factor was resected weight (range 42.8 days), the second was postoperative infection (range 23.9 days) and the third preoperative infection (range 20.9 days). The other factors had no significance. Our analysis showed good correlation between the observed and predicted duration of pyuria (r = 0.82, p less than 0.005).

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PubMed1989

[Etiology of urethral stenosis. I. After transurethral resection of the prostate. Apropos of 2 comparative series. Review of the literature].

The authors study the incidence of urethral strictures after transurethral resection of prostate. A retrospective study of 135 patients and a prospective study of 187 patients found respectively 74% and 3.2% of urethral stenosis. Two important data are seen in this study, the duration of urethral catheter of 24 hours post operatively and the internal urethrotomy when they found a pathologic urethra pre operatively reduce the incidence of urethral strictures. With a normal urethra pre operatively and 24 hours of urethral catheter post operatively, any stenosis occurred, equally when an internal urethrotomy is done with a pathologic urethra pre operatively.

Cystoscopy↗

PubMed2000

A randomized trial comparing bladder infusion with standard catheter removal after transurethral resection of the prostate.

OBJECTIVE: To examine the effect of bladder infusion before catheter removal on patients' readiness for discharge and the day of discharge after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The study comprised 75 consecutive patients undergoing TURP who were randomized to either have their catheter removed in the standard manner (38 patients), or to undergo bladder infusion before a trial of voiding (ToV) on the second day after TURP (37 patients). RESULTS: In those undergoing bladder infusion, seven (19%) patients were discharged on the same day as their ToV, compared with five (13%) in the standard group. Of the 75 patients, 15 (68%) were discharged by the third day after TURP whether or not the bladder had been filled. In the infusion group, 23 (62%) were ready for discharge on the same day as their TOV, compared with only 14 (37%) in the standard group (P < 0.05). CONCLUSION: Bladder infusion before a ToV after TURP significantly increases the rate of readiness for discharge, allowing an early decision to discharge on the second day in a large proportion of patients.

Humans↗

PubMed2006

Hemolysis in transurethral resection of the prostate using distilled water as the irrigant.

BACKGROUND: To investigate the incidence and time course of hemolysis and its clinical effects following transurethral resection of the prostate (TURP) using distilled water as the irrigant. METHODS: Between March 1996 and April 1997, 39 patients who underwent TURP due to benign prostatic hyperplasia (BPH) were randomly included in this study. The levels of plasma hemoglobin, haptoglobin and serum lactic dehydrogenase (LDH) were checked in all patients before, immediately after, and 24 hours after the operation. Serum creatinine and sodium were also checked in 24 patients starting August 1996. Significant hemolysis was identified as simultaneous elevation of plasma hemoglobin (> 10 g/dL), serum LDH and reduction of plasma haptoglobin after TURP. RESULTS: Among the 39 subjects, hemolysis occurred in 17 (43.6%), whose plasma hemoglobin and serum LDH increased while plasma haptoglobin decreased immediately after operation (p < 0.05), but no significant differences between the data before and 24 hours after the operation were noticed. In the hemolysis group, serum creatinine increased while serum sodium decreased immediately after operation (p < 0.05), but the data before and 24 hours after the operation had no significant differences. There were no changes in serum creatinine and sodium levels after TURP in patients without hemolysis. The weight of the resected prostate was 42.5 +/- 15.5 g in the hemolysis group and 23.3 +/- 8.3 g in the nonhemolysis group, while duration of TURP was 68.9 +/- 19.6 minutes in the hemolysis group and 34.2 +/- 8.4 minutes in the nonhemolysis group. Patients with hemolysis had higher resection weight and longer resection time than those without hemolysis (p < 0.001). CONCLUSION: Using distilled water as an irrigant for TURP might cause hemolysis, especially in patients with larger prostates and longer resection times. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.

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PubMed2005

Preoperative administration of chlormadinone acetate reduces blood loss associated with transurethral resection of the prostate: a prospective randomized study.

OBJECTIVES: To assess the effects of giving chlormadinone acetate (CMA) before surgery on blood loss associated with transurethral resection of the prostate (TURP), in a prospective randomized controlled study. PATIENTS AND METHODS: Candidates for TURP among patients with benign prostatic hyperplasia were randomized to either treatment with CMA (CMA+) or not (CMA-). In principle, CMA was started at least 28 days before TURP and continued until just before surgery. RESULTS: In all, 33 patients in the CMA+ (median duration of treatment 34.5 days) and 38 in the CMA- group were evaluable. The mean blood loss during TURP was less in the CMA+ (237.3 mL) than in the CMA- group (263.1 mL), but the difference was not significant. There was significantly less blood loss per gram of resected prostate tissue in the CMA+ (9.6 mL/g) than in the CMA- group (13.3 mL/g) (P < 0.05). Haematuria on the day of and the day after TURP was also significantly less severe in the CMA+ than in the CMA- group (P < 0.001 and P < 0.05, respectively). The mean microvessel density of resected prostate tissue was significantly less after CMA treatment (P < 0.001). CONCLUSIONS: CMA given for 1 month before TURP could reduce blood loss to some extent during and after TURP, and this may be related to a decrease in microvessel density.

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PubMed1985

Transurethral resection of the prostate and bladder neck incision: a review of 700 cases.

Transurethral resection (TUR) is regarded as the treatment of choice for relief of outflow tract obstruction in the male, but bladder neck incision (BNI) is an acceptable alternative when the gland is small. Seven hundred cases of TUR/BNI have been reviewed (TUR = 388; BNI = 312). BNI was performed when the gland was less than 35 g and where there was no clinical suspicion of malignancy. The operative details of our single incision technique are given. While the patients in the BNI group were younger, catheter stay was shorter, there was less infection, a significantly reduced need for blood transfusion and a satisfactory outcome in terms of control and need for further surgery. BNI is a technically simpler procedure than TUR and is easy to teach and learn. Results show it is safe and effective for patients in acute retention as well as those treated electively and it is the operation of choice for small benign prostates.

Adult↗

PubMed2001

Blood loss during transurethral resection of the prostate after 3 months of treatment with finasteride.

OBJECTIVES: To study whether pretreatment with finasteride, compared with placebo, reduces the blood loss, operating time, amount of irrigating fluid absorbed, resources used, and other exploratory indexes of extensive surgery during transurethral resection of the prostate (TURP). METHODS: This double-blind, randomized, placebo-controlled, single-center, 6-month pilot study was designed to study the effects of 3 months of finasteride (5 mg daily) on blood loss during surgery in 60 men who required TURP. The prostate size was measured by transrectal ultrasonography, the surgical blood loss was measured by a HemoCue photometer, and fluid absorption was determined by the ethanol method. The microvessel density was counted using microscopic staining and immunoperoxidase techniques. RESULTS: Finasteride significantly reduced the prostate size before TURP (P <0.001 versus placebo). No significant between-group differences were found in blood loss (geometric mean 257 and 268 mL for finasteride versus placebo), fluid absorption, operating time, resection weight, or microvessel density. A positive correlation was found between the blood loss and the resection weight. Exploratory analyses indicated that finasteride might reduce the proportion of patients with high blood loss volumes. For prostates with resection weights greater than or equal to the median (18.6 g), finasteride was associated with less blood loss (median 324 mL, n = 14) than in the controls (median 547 mL, n = 14, P <0.01). CONCLUSIONS: Pretreatment with finasteride may help reduce the blood loss in TURP, except in the smallest resections.

Absorption↗