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PubMed2001

Effects of irrigation fluid temperature on core body temperature during transurethral resection of the prostate.

OBJECTIVES: To determine the effect irrigation fluid temperature has on core body temperature changes in patients undergoing transurethral resection of the prostate (TURP). METHODS: Fifty-six male patients (mean age 71.2 +/- 8.2 years) scheduled for TURP were enrolled in the study. Patients were randomized to one of two groups. Group 1 consisted of 27 patients who received room temperature irrigation fluid (70 degrees F) throughout TURP; group 2 consisted of 29 patients whose procedure was performed with warmed irrigation fluid (91.5 degrees F). The irrigation fluid used for both groups was glycine. The baseline temperature, final temperature, total time in the operating room, and amount of irrigation fluid used during the procedure were recorded for each patient. RESULTS: No significant difference in the average time spent in the operating room or in the total irrigation fluid used between the two groups was observed. Of the 27 patients who received room temperature irrigation fluid, 15 (55.6%) had a decrease in body temperature. A decrease in temperature was observed in 21 (72.4%) of the 29 patients who received warm irrigation fluid. Groups 1 and 2 had 12 (44.4%) of 27 and 8 (27.6%) of 29 patients, respectively, who demonstrated an elevation in their core body temperature. CONCLUSIONS: The results of our study suggest that irrigation fluid temperature is not a factor responsible for altering the core body temperature in patients undergoing TURP.

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PubMed1988

Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative catheterization.

The value of prophylactic antibiotics in transurethral resection of the prostate (TURP) remains controversial. We have conducted a prospective study in which 308 patients undergoing TURP have been randomized to receive no antibiotic cover (n = 150) or 36 h perioperative cover with temocillin. In 62 patients the urine was found to be infected at the time of operation. In these patients the incidence of postoperative urinary-tract infection (UTI) was 33% in the group who received temocillin, and 87% in the control group (P less than 0.001). In patients with sterile urine at operation (n = 235), the incidence of postoperative UTI was 13% in the temocillin group compared with 24% in the control group (P less than 0.05). Gram-positive organisms were mainly responsible for infection which occurred in patients who had received temocillin. A high incidence of postoperative UTI occurred in patients who had required preoperative catheterization despite the fact that their preoperative urine specimen was sterile. We conclude, (i) prophylactic antibiotics are of benefit in patients undergoing TURP, (ii) the antibiotic administered should be active against both gram-positive and gram-negative organisms, (iii) patients with an indwelling catheter should be considered at a higher risk of infection whether or not organisms are cultured from their preoperative urine specimen.

Adult↗

PubMed1976

Combined cystometric, sphincter electromyographic and uroflowmetric studies before and after transurethral resection of the prostate.

Detrusor and urethral function was studied in 10 patients before and 3 months after transurethral resection of the prostate by means of flowmetry, and simultaneous gas cystometry and integrated sphincter electromyography. THE PATIENTas cystometry and integrated sphincter electromyography. The patient had no clinical signs of neurological disease. Six had neurogenic exaggeration of the detrusor reflex in the preoperative studies. In 3 patients changes in the detrusor reflex were found postoperatively. Postural changes in detrusor reflex excitability were encountered preoperatively and postoperatively. The preoperative finding of detrusor hyperreflexia in the majority of the patients is ascribed to lesions in the detrusor reflex organization at 2 anatomical sites: 1) a subclinical lesion of the cerebral circuits of the detrusor reflex control owing to arteriosclerosis and 2) an increase of sensory detrusor-reflex triggering stimuli from the morphologically changed prostatic urethra. The study calls for diagnostic techniques for delineation of minimal cerebrospinal impairment and objective assessment of the sensory innervation of the urethra.

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PubMed1984

Endotoxin contamination of Foley catheters associated with fevers following transurethral resection of the prostate.

In 1980 an investigation was conducted due to an apparent cluster of fevers following transurethral resections of the prostate ( TURP ), where the presence of prostatitis or urinary tract infections ( UTIs ) could not account for most cases, and the usage of antimicrobials did not prevent them. When unused, prepackaged , sterilized samples from 13 lots of triple lumen catheters were analyzed, four were found to contain high levels of endotoxin (ET), with a range of 49,150-greater than or equal to 6.25 ng/catheter. Additionally, these lots were highly pyrogenic to rabbits. The maximum incidence of febrile patients (42%) correlated with usage of catheters from the lot where ET levels were the highest. The febrile rate for a second urologist, who used single lumen catheters, was less (12/33 v 0/12). Further consideration should be given to sterile operative equipment which may still be pyrogenic.

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PubMed1995

A method of measuring fluid balance during transurethral resection of the prostate.

OBJECTIVE: To design a practical system for non-invasively monitoring fluid balance during transurethral resection of the prostate (TURP) and other endoscopic procedures. MATERIALS AND METHODS: Load cell transducers are incorporated into a platform placed under the operating table. Output is passed to a digital weighmeter and then to a portable computer. The raw data is filtered using software written by the authors (CAL) and the output displayed both numerically and graphically on the computer screen. The device was tested under laboratory conditions and then assessed in the clinical setting. RESULTS: The device proved stable in both the laboratory and clinical settings. Examples of the common patterns generated during TURP are presented. The prototype has been used routinely in our practice to warn the surgeon and anaesthetist of fluid overload and has been used to monitor fluid balance in several studies. CONCLUSIONS: This instrument provides a practical method of monitoring total fluid balance during TURP. It can be used with either general or regional anaesthesia and provides information not otherwise available. It provides an early warning of significant changes in total fluid balance, particularly irrigant fluid absorption. Use of this device serves to prevent development of the TUR syndrome, a potentially fatal complication of endoscopic surgery. Our ultimate aim is to produce a refined version that is simple, compact and cheap enough to be used routinely in all urological theatres. The cost of a single episode of intensive care for a patient developing iatrogenic complications from irrigant absorption would offset the cost of such a device.

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PubMed1995

Effects of bladder capacity and height of fluid bag on intravesical pressure during transurethral resection of the prostate.

We studied the intravesical pressure profile and the fluid absorption in 30 men undergoing transurethral resection of the prostate with the irrigating fluid bags placed 55-60, 70-75, 80-85 or 90-100 cm above the operating table. The maximum intravesical pressure, but not the mean pressure or the period of time during which there was excessive pressure (> 2 kPa), increased when the fluid bags were placed higher. The urologist consistently reached about half the possible maximum pressure as indicated by the bag height at the end of each intermittent filling of the bladder. A large bladder capacity promoted lower maximum and mean pressures and shortened the period of excessive intravesical pressure. However, neither bag height nor bladder capacity correlated with the absorption of irrigating fluid.

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PubMed1999

Water as an irrigant in transurethral resection of the prostate: a cost-effective alternative.

The safety of water as an irrigant solution in transurethral resection of the prostate (TURP) has been a controversial issue. Although it has been mostly abandoned in more affluent countries, it is still widely used in developing countries simply because of financial reasons. With this study, we attempted to show in a representative number of cases that this method can be applied without major fluid absorption, as would be indicated by changes in sodium (Na), creatinine (Crea), blood urea nitrogen (BUN), and free haemoglobin (fHb) levels in serum. Prospectively, we assessed the occurrence of clinical symptoms of TUR-syndrome, as well as changes in serum parameters in 60 patients irrigated during TURP with sterile water. Values of patients with some degree of resorption, as indicated by a drop in serum sodium, were compared to patients without any resorption. There was no TUR-syndrome in our patients, and serum levels of all parameters did not change significantly after TURP with water. Patients with a drop in sodium post-TURP did not have significant changes in Crea, BUN or fHb. The average saving was 162.60 USD per treatment. In our study population, water was a safe irrigation solution. Even with some degree of resorption, there were no significant haemolysis or metabolic imbalances. Saving for the patient are considerable and render the treatment affordable.

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PubMed1998

[Reduction of hospital stay, because of the early removal of the bladder catheter in transurethral resection of the prostate].

OBJECTIVE: To analyze the effects of removal of the bladder catheter 48 hours following transurethral resection of the prostate for benign prostatic hyperplasia in relation to the length of hospital stay and the incidence of important postoperative complications. METHODS: A study was conducted on 117 patients who had undergone TURP at our hospital over a period of one year. They were divided into two groups: group I comprised 55 patients in whom the bladder catheter had been systematically removed 48 hours following the procedure and had been discharged from hospital once they had attained a satisfactory micturition; group II comprised 62 patients in whom the bladder catheter was removed following conventional practice. RESULTS: The mean length of hospital stay for the early catheter removal group was 2.02 days versus 3.85 days for group II. The postoperative complication rate was similar for both groups. CONCLUSIONS: Early removal of the bladder catheter following TURP does not increase the complication rate. It shortens the length of hospital stay and reduces the cost of the procedure.

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PubMed1987

Radical transurethral resection of the prostate in male paraplegics revisited: further clinical experience and urodynamic considerations for its effectiveness.

We report our experience with radical transurethral resection of the prostate performed on 89 male spinal cord injury subjects. The over-all success rate of modified sphincterotomy was 90 per cent, although there was a 14 per cent recurrence rate with time. Urodynamically, success was characterized by a statistically significant reduction in the degree of detrusor-sphincter dyssynergia, an increase in vesical compliance and a reduction in detrusor hyperreflexia. These results suggest an effect on the distal sphincteric area by the adrenergic system in the genesis of detrusor-sphincter dyssynergia. It is suggested that radical transurethral resection of the prostate exerts this effect via a surgical sympathectomy, while continence is preserved by the activity of the untouched external urethral sphincter.

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PubMed1993

Comparison of NHS and private patients undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy.

OBJECTIVES: To compare the operative thresholds and clinical management of men undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy in the NHS and privately. DESIGN: Cohort study of patients recruited by 25 surgeons during 1988. SETTING: Hospitals in Oxford and North West Thames regions. PATIENTS: Of 400 consecutive patients, 129 were excluded because of open surgery (nine), lack of surgeons' information (three), and emergency admission (117) and three failed to give information, leaving 268 patients, 214 NHS patients and 54 private patients. MAIN MEASURES: Sociodemographic factors, prevalence and severity of symptoms, comorbidity, general health (Nottingham health profile) obtained from patient questionnaire preoperatively and reasons for operating, and operative management obtained from surgeons perioperatively. RESULTS: NHS and private patients were similar in severity of symptoms and prevalence of urinary tract abnormalities. They differed in four respects: NHS patients' general health was poorer as a consequence of more comorbid conditions (49, 23% v 7, 13% in severe category); the condition had a greater detrimental effect on their lives (36, 17% v 2, 4% severely affected; p < 0.01); private patients received more personalised care more quickly and were investigated more before surgery, (29, 54% v 60, 20% receiving ultrasonography of the urinary tract); and NHS patients stayed in hospital longer (57, 27% v 3, 6% more than seven days; p < 0.001). CONCLUSIONS: Private patients' need for surgery, judged by symptom severity, was as great as that of NHS patients, and there was no evidence of different operative thresholds in the two sectors, but, judged by impact on lifestyle, NHS patients' need was greater.

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PubMed2004

The cost of feedback microwave thermotherapy compared with transurethral resection of the prostate for treating benign prostatic hyperplasia.

OBJECTIVE: To compare the efficacy of a new microwave thermotherapy for treating benign prostatic hyperplasia (BPH), the ProstaLund Feedback Treatment (PLFT, ProstaLund Operations AB, Lund, Sweden) and transurethral resection of the prostate (TURP) in a clinical trial to their effectiveness in clinical practice over 1 year, to estimate their cost over 1 year, and to evaluate the cost of re-interventions over a longer period (2-3 years). PATIENTS AND METHODS: In a large randomized international 1-year clinical trial PLFT was as effective as TURP in improving symptoms of BPH and urinary flow. Because PLFT is an outpatient procedure it was less costly than TURP. However, the cost-effectiveness of the new procedure depends on its long-term effectiveness in clinical practice. All 146 patients in the randomized clinical trial were included in the present analysis. The outcome was based on the International Prostate Symptom Score (IPSS) and the bother score, and costs were estimated from treatment-related adverse events and hospitalization. To validate the estimates based on the clinical trial 1-year data on effectiveness and complete resource use in clinical practice were collected in a retrospective observational study from hospital charts and patient questionnaires of 88 patients who had undergone either TURP or PLFT. To assess the number of re-interventions after TURP after the first year information was obtained from hospital and surgical procedure data in the Swedish inpatient registry. The 3-year data for a total of 52,010 patients who had an index hospitalization for TURP between 1990 and 1995 were available for the analysis. The estimate of long-term consequences of PLFT was based on complication and re-intervention data for 87 patients who had undergone PLFT between 1997 and 1999. RESULTS: The mean 1-year costs in the clinical trial were estimated at [symbol: see text] 1763 for PLFT and [symbol: see text] 3209 for TURP. When all treatment-related resource use in clinical practice for 88 patients was included the costs were estimated at [symbol: see text] 1924 and [symbol: see text] 3264 for PLFT and TURP, respectively. The IPSS and bother scores were not significantly different between the groups in both datasets. Using the registry data the cost of TURP including re-interventions (TURP and bladder neck incisions) was estimated at [symbol: see text] 3159 over 2 years and [symbol: see text] 3185 over 3 years; the respective costs for PLFT were [symbol: see text] 2121 and at [symbol: see text] 2151. CONCLUSIONS: In the 1-year clinical trial PLFT was as effective but less costly than TURP, but long-term data are still lacking. However, the preliminary analysis over 3 years indicates that the average cost of the procedure remains lower than the total cost of TURP for the same period.

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PubMed1991

[Study of the long-term administration of ofloxacin to the patients following transurethral resection of the prostate].

The present study was undertaken to evaluate the clinical efficacy of long-term administration of ofloxacin (OFLX) to the patients following transurethral resection of the prostate. The patients were randomly divided into two groups: A and B. All the patients were administered flomoxef (FMOX) intravenously for 3 days following transurethral resection of the prostate (TUR-P). In group A, 100 mg of OFLX twice daily was thereafter administered for 4 to 15 weeks to 22 patients until they showed an improvement in pyuria. In group B, which served as a control, neither OFLX nor any other antibiotics were administered to 26 patients until they showed an improvement in pyuria. No patients complained of urination trouble due to infection. At the same time, cultures of bacillus in the urine were also examined 4 days, 7 days and 2 weeks after TUR-P with these two groups. The mean days necessary for the improvement of pyuria were 64.9 +/- 20.5 in group A, 66.3 +/- 18.4 in group B. At 2 weeks after TUR-P, bacillus in the urine were negative in 19/22 patients in group A, and 14/26 in group B. Chi-square test showed significance for these two groups. Accordingly, OFLX was useful for bacillus in the urine, but OFLX was not so useful for shortening the continuance of pyuria of post TUR-P. No patients complained of nausea or any other complications during the study.

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PubMed1994

Clinical outcome and reoperation after low-weight transurethral resection of the prostate.

The clinical outcome and reoperation rate after low-weight transurethral prostatectomies are not well documented. Seventy-four consecutive patients who underwent a transurethral resection of the prostate weighing 10 g or less over a 24-month period were evaluated with a preoperative and postoperative comparative symptom score analysis. The overall clinical outcome in these patients was: improvement in 44%, no change in 39% and unfavorable in 17%. Irritative and obstructive voiding symptoms resolved in 32% and 43% of patients, respectively. Reoperations were performed in 23% of the patients. These results are compared with reports of resections of larger glands, revealing a dissimilarity in clinical outcome and resolution of symptoms.

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PubMed1989

[Prompt antibiotic prophylaxis in resection of the prostate and removal of the bladder catheter].

Several regimens of antibiotic prophylaxis have been used in transurethral prostatic resection. In this study 50 patients received 1 g of cefotaxime during resection and thereafter were divided at random into two groups: one group received another 1 g dose of cefotaxime when the bladder catheter was removed, while the other group was left untreated at that stage. The administration of cefotaxime during both prostatic resection and catheter removal resulted in a highly significant reduction of infection risk, duration of hospitalisation and cost of antibacterial treatment. The most important risk of sepsis seems to be related to an apparently innocuous procedure: removal of the bladder catheter with resumption of spontaneous micturition.

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PubMed1995

Transurethral resection of the prostate in 539 patients at a district general hospital.

This study audited length of hospital stay, mortality and morbidity associated with transurethral resection of the prostate (TURP) in a district general hospital over a 4-year period between 1990 and 1993. Five hundred and thirty-nine TURPs (409 benign and 130 malignant; median age 69 years) were carried out, which represented a twofold increase over the 4-year period. Although the mean duration of stay was 5 days, 92.5% of patients had a hospital stay of less than 7 days. One (0.2%) death occurred in a patient with ischaemic heart disease on the first postoperative day. The commonest cause of morbidity and delayed discharge from hospital was presence of outflow symptoms in nine (1.7%) patients. Transurethral resection of the prostate is a safe procedure in an ever-increasing elderly population with concomitant medical illness, but improved identification of 'at-risk' patients is required in order to further lower the morbidity associated with this procedure.

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PubMed2006

Is using ethanol-glycine irrigating fluid monitoring and 'good surgical practice' enough to prevent harmful absorption during transurethral resection of the prostate?

OBJECTIVE: To evaluate the utility of using a tracer of 1% ethanol in 1.5% glycine for the early detection of irrigation fluid absorption during transurethral resection of the prostate (TURP). PATIENTS AND METHODS: In all, 126 men undergoing TURP were irrigated with a solution of 1% ethanol and 1.5% glycine; their expired air was tested for ethanol every 20 min, and again at the end of the procedure. Maximum absorption by the breath-ethanol reading was compared with the serum concentration of absorbed glycine (analysed by anion-exchange chromatography). RESULTS: Complete data on 120 men were assessed; 75% of the men absorbed irrigation fluid, with glycine levels above the normal range. The sodium levels tended to decrease with increasing glycine levels (Spearman's rank correlation coefficient, - 0.57; 120 men) and five men (4%) developed clinical features of the TUR syndrome. There was a weak correlation between breath-ethanol levels and serum glycine levels (Spearman's rank correlation coefficient, 0.54). The experience of the surgeon, the weight of the resected chips, and the operative duration were not significantly predictive of irrigation fluid absorption. CONCLUSIONS: A rising breath-ethanol level indicates irrigation fluid absorption. However, irrigating fluid absorption is unpredictable, supporting the case for alternative, potentially safer irrigants.

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PubMed1979

Bladder explosion during uninterrupted transurethral resection of the prostate. A case report and an experimental model.

A bladder explosion during transurethral resection with intraperitoneal rupture of the bladder is reported. Immediate operative repair was successful and the final result satisfactory. Gas formed during in vitro and in vivo prostatic resections was analysed by means of an oxygen electrode and gascromatographs. Hydrogen was dominant but oxygen and several explosive hydrocarbons were demonstrated. The gas formed in vitro was highly explosive. Oxygen content in gas formed in vivo was considerably lower. Admixture of atmospheric air during transurethral resection increases the risk of explosion and should be avoided and the air pocket in the bladder be kept at an absolute minimum.

Explosions↗

PubMed2002

How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method.

OBJECTIVE: To evaluate the effect of basic measures to minimize the absorption of irrigating fluid during transurethral resection of the prostate (TURP) to the planned end-point, using the ethanol method to guide the surgeon. PATIENTS AND METHODS: Forty-six patients underwent TURP with intermittent irrigation using sterile water and 2% ethanol. The ethanol content in the expired breath of the patients was assessed every 5 min using a breath-alcohol monitor. In 25 patients no absorption was indicated but 21 showed some absorption according to the ethanol analyses. The operator was then immediately alerted, paused briefly to determine the route of absorption and to take advantage of blood clots to seal off leakage sites. On resuming the resection, attention was given to the pressure gradients in the operating field, based on bladder compliance and the flow in the irrigating jet. Repeated ethanol analyses were used to assess the result and to guide the surgeon's efforts. RESULTS: No operation had to be terminated prematurely; the mean absorption in the 21 patients in whom any ethanol was detected was 121 (75-230) mL. In 14 patients absorption occurred once, in six twice and in one there were three small absorption events. The group with absorption did not differ significantly from that with no absorption in operative duration (mean 48 and 47 min), resected weight (mean 32.8 and 31.6 g) or blood loss (mean 550 and 483 mL). CONCLUSION: If the surgeon is alerted at the first positive ethanol reading, effective measures to minimize absorption can be taken early. Regular use of the ethanol method as an alarm system should permit TURP with a minimum of absorption and avoid an early interruption or premature termination of surgery because of absorption.

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