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Results for “Transurethral Resection of Prostate”

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PubMed1999

[Clinical trial of the effect of urethral catheter on the etiology of urethral stenosis following transurethral resection of the prostate].

OBJECTIVE: To analyze the effect of the urethral catheter and urethral secretions in the development of urethral stricture post-transurethral resection of the prostate (TURP). METHODS: A clinical study was conduced on 109 patients treated by TURP. The patients were randomly assigned to one of the following groups: A (suprapubic catheter), B (urethral catheter), C (urethral cleansing). The incidence of urethral stricture in the different groups was compared using the chi-square test and survival was analyzed by the Kaplan Meier method. RESULTS: 5 patients were lost to follow-up (4.5%). The median number of days the catheter was indwelling was one day for group A, and 4 days for groups B and C. The overall incidence of urethral stricture was 4.3%; by groups the incidence was 3.8% for group A, 3% for B and 5.9% for group C. The differences were not statistically significant. CONCLUSION: The study showed no statistically significant differences in the incidence of post-TURP urethral stenosis in patients with a suprapubic or urethral catheter. Furthermore, urethral stenosis was not less frequent in patients in whom urethral cleansing was performed.

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PubMed1981

Radical transurethral resection of the prostate for neurogenic dysfunction of the bladder in male paraplegics.

We herein report our experience with radical transurethral resection of the prostate in 50 paraplegics refractory to conventional conservative therapy, including the use of alpha-adrenolytic drugs and clean intermittent self-catheterization. The operation was successful in 46 patients (92 per cent) and unsuccessful in 4 tetraplegics with complete high cervical lesions. We discuss the rationales of this procedure for neurogenic dysfunction of the bladder and present urodynamic changes in the successful and unsuccessful cases. This extensive and, yet, microsurgically anatomical resection of the urethral sphincter is recommended for all refractory paraplegics except for complete tetraplegics with high cervical lesions.

Adult↗

PubMed1996

Reduction of length of stay and cost of transurethral resection of the prostate by early catheter removal.

OBJECTIVE: To determine whether early removal of the indwelling Foley catheter after transurethral resection of the prostate (TURP) significantly shortens the hospital stay without causing additional morbidity and thus saves costs. PATIENTS AND METHODS: For the year commencing 1 July 1991, 119 patients who had undergone TURP had their indwelling catheter removed on the first day after surgery. The results and morbidity of this group of patients were compared with those in 152 patients undergoing TURP during the previous year. The economic consequences of this protocol were calculated using both Medicare and CHAMPUS data. RESULTS: The demographics of the patients in both groups were similar. Post-operative complications occurred in 5% of the study patients and in 6.6% of controls; a transfusion was required in 2.5% and 1.3%, clot retention developed in 1.7% and 3.3% and the hospital stay was reduced from 3.1 to 1.28 days in the study and control patients, respectively. Using Medicare data, the mean cost saving of early catheter removal would be $829 and $1406 for patients aged < 70 and > 70 years, respectively. For CHAMPUS patients, the cost saving would be $1983. CONCLUSION: Early removal of the catheter after TURP did not increase morbidity and maintained the efficacy of the procedure. If this practice was adopted nationally, the savings resulting from the reduction in hospital stay would be considerable.

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PubMed1998

Single-dose antibiotic prophylaxis in transurethral resection of the prostate: a prospective randomized trial.

OBJECTIVE: To evaluate the efficacy of single-dose antibiotic prophylaxis in transurethral resection of the prostate (TURP). PATIENTS AND METHODS: A total of 139 patients were entered into a prospective randomized trial comparing single-dose antibiotic prophylaxis with no antibiotic before surgery. Twelve patients were excluded because they had significant bacteriuria before surgery (defined as > or = 10(5) bacteria/mL). Of the remaining 127 patients, 62 were allocated to the single-dose group (A) and 65 to the no-antibiotic group (B). All 62 patients in group A received 1 g of ceftriaxone intravenously 1-2 h before surgery with the anaesthetic premedication, the 65 in group B receiving none. Urine cultures were collected post-operatively as the catheter was removed and again 4 weeks after hospitalization. RESULTS: The incidence of post-operative bacteriuria was statistically significantly different, occurring in five patients (9%) in group A and 16 patients (26%) in group B (Fisher's exact test, one-tail P = 0.009). There was no significant difference between the groups 4 weeks after hospitalization. The overall incidence of bacteriuria post-operatively and 4 weeks after hospitalization was 11 patients (18%) in group A and 22 patients (34%) in group B (P = 0.03). CONCLUSION: Single-dose antibiotic prophylaxis with 1 g of ceftriaxone intravenously is effective in patients undergoing TURP and is recommended for such surgery.

Antibiotic Prophylaxis↗

PubMed1994

Changes in haemodynamic variables during transurethral resection of the prostate: comparison of general and spinal anaesthesia.

We have compared changes in haemodynamic variables before and during transurethral resection of the prostate in 22 patients under general or spinal anaesthesia. In the general anaesthetic group there was a significant decrease in cardiac output (mean 32% (SEM 5%)) and mean arterial pressure (14% (3%)) after induction of anaesthesia and a significant decrease (27% (3%)) in heart rate before the start of resection. Otherwise, variables remained close to baseline values. In the subarachnoid block group, mean arterial pressure decreased after induction (16% (2%)), but overall variables remained unchanged. We conclude that with both these anaesthetic techniques the greatest changes in haemodynamic variables occurred shortly after induction, and that these changes were greater during general than spinal anaesthesia. The resection period was not associated with significant haemodynamic changes.

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PubMed1989

Monitoring irrigating fluid absorption during transurethral resection of the prostate (TURP); a comparison between 1 and 2% ethanol as a tracer.

In a series of 35 transurethral resections of the prostate 1% ethanol was compared to 2% ethanol as a marker of the irrigating fluid. The ethanol concentration in the expired breath of the patient (EB-ethanol) correlated significantly to the irrigant absorption, as measured volumetrically, and to the change in the serum sodium concentration at 10-min intervals during the operation. The pattern of changes in EB-ethanol indicated whether the main part of the absorption entered through the intravenous or the extravascular route. With 1% ethanol added to the irrigating solution the absorption of 100-150 ml in 10 min could readily be detected. The sensitivity was twice as great with 2% ethanol; however, 1% ethanol is sufficient for routine procedures as it permits absorption to be detected long before it is large enough to produce a TUR syndrome. Monitoring ethanol in the expired breath provides the surgeon with an instrument to check that preventive steps against further absorption are effective.

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PubMed1997

[The background factors influencing loss of sexual intercourse after transurethral resection of the prostate (TUR-P)--A study using the Sapporo Medical University-Questionnaire].

BACKGROUND: Sexual dysfunction after transurethral resection of the prostate (TUR-P) depends on multiple factors including preoperative erectile function itself. Using the Sapporo Medical University-questionnaire, we analyzed background factors contributing to loss of sexual intercourse after the operation. PATIENTS AND METHODS: We sent the self-administered questionnaires to 1,000 patients who had received TUR-P. Answers to questions were ranked as scores. Multiple regression analysis was used to identify factors significant for loss intercourse after TUR-P. RESULTS: The response rate was 63.5%. Patient with incomplete answers and those having diseases affecting voiding or sexual function and antiandrogen medication were excluded from the study. Leaving 536 patients for the final analysis. Scores for sexual desire and erectile function in the patients who received TUR-P were lower than those of age-matched healthy males. When we divided the patients according to frequency of sexual intercourse before and after TUR-P, there was distinct differences in age, scores for sensory disturbance, depression, the cooperative value of the sexual partner, sexual desire, erectile function, nocturia, residual sensation and urgency between those maintaining sexual intercourse and those having lost it. Multiple regression analysis using these factors indicated that the scores of erectile function was the most significant determinant for maintaining sexual intercourse after TUR-P in patients aged from 50 to 69 years, followed by the cooperative value of the sexual partner, residual sensation and sensory disturbance. In those 70 old and older, the score for erectile function was the most significant determinant, followed by the cooperative value of sexual partner. CONCLUSION: Our results suggest that, irrespective of age, the cooperation of the patient's sexual partner as well as erectile function significantly influence the maintenance of sexual intercourse after TUR-P. In addition, voiding condition and psychological status after TUR-P may affect the maintenance of sexual intercourse in patients in their fifties and sixties.

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PubMed1995

[Trigono-cervico-prostatotomy (TCP) versus transurethral resection of the prostate (TURP). Our experience].

OBJECTIVE: Trigonocervicoprostatotomy (TCP) has been considered up to now an alternative treatment to transurethral resection of the prostate (TURP) when evaluating the size of the prostate. This paper demonstrates that endoscopic visualization is more important when choosing the surgical procedure and that both techniques can achieve satisfactory results. METHODS: The prostate volume is evaluated by ultrasound and according to the endoscopic findings, TURP or TCP is performed. The prostatic lobes are routinely biopsied if the latter procedure is chosen. RESULTS: We compared the results of 34 TCP and 30 TURP procedures using the values of I-PSS and uroflowmetry before and after surgery. In 86.2% of the TCPs and 80% of the TURPs, the patients are asymptomatic with I-PSS less than 7 and significantly improved uroflowmetry data. Biopsy disclosed adenocarcinoma in one patient submitted to TCP. CONCLUSIONS: TCP represents an alternative to TURP not only for small prostates (30 gm) but also for medium-sized prostates (50-60 gms), depending on the endoscopic findings. TCP is not indicated for lateral lobes that fall on the prostate floor. Performing a biopsy routinely in TCP does not prolong the operating time significantly and permits detecting subclinical adenocarcinoma of the prostate.

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PubMed1999

No evidence of fluid absorption during continuous low-pressure transurethral resection of the prostate: assessment by measuring expiratory breath ethanol concentrations.

OBJECTIVE: Measurement of the ethanol concentration in expired breath during transurethral resection of the prostate (TURP). METHODS: TURP is a noninvasive method to estimate the amount of irrigant absorbed. The expiratory breath ethanol concentrations (EBEC) were measured with a standard alcohol breath analyzer in 35 patients in the course of TURP. All interventions were performed with a 27-french continuous flow resectoscope using a solution of 1. 5% glycine + 1% ethanol as irrigating fluid. Serum sodium and osmolality were measured pre- and postoperatively. No patient developed signs of transurethral resection syndrome; no significant changes in serum sodium, osmolality and EBEC were found throughout the operation. CONCLUSION: Absorption of irrigant fluid during TURP with continuous low-pressure irrigation seems to be extremely slight (if not absent) as measured by expired breath ethanol method.

Absorption↗

PubMed2000

Transurethral holmium laser resection of the prostate.

PURPOSE: We evaluated the efficacy of the holmium:YAG laser for transurethral endoscopic prostatectomy for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We treated 103 patients with BPH with holmium:YAG laser resection of the prostate. A high power holmium laser generating a maximum of 60 or 81 W. was used in a pulsed mode, applying energy directly to prostatic tissue via a forward firing 550 micron. fiber transurethrally under direct vision. Treatment outcome was evaluated by the International Prostate Symptom Score, quality of life score, maximum flow rate and post-void residual urine volume. We also compared holmium laser surgery and transurethral resection of the prostate for operative factors, such as surgical duration, bleeding volume and catheterization time. RESULTS: Average symptom score, quality of life score, peak flow rate and post-void residual significantly improved at 1 week, 1 month and 3 months postoperatively, with improvement maintained up to 36 months postoperatively in the holmium:YAG group. Intraoperative bleeding volume was significantly lower and catheterization time was significantly shorter for holmium:YAG than for transurethral prostatic resection. Use of the holmium laser caused no complications. CONCLUSIONS: Because of its effectiveness and safety holmium:YAG resection is a viable potential surgical alternative for symptomatic BPH. The holmium:YAG laser has been verified to be useful for many purposes in urology.

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PubMed1993

Differences in outcome of transurethral resection of the prostate for benign prostatic hypertrophy between three diagnostic categories.

As part of a prospective cohort study of 388 men undergoing transurethral resection of the prostate (TURP) for benign prostatic hypertrophy, pre-operative factors and the outcome of surgery during the first post-operative year were compared between patients in whom their surgeon felt the principal reason for operating was chronic retention (37%), acute retention (with no chronic retention) (28%), or symptomatic prostatism (with no history of chronic or acute retention) (35%). Although in many respects the patients in the 3 diagnostic categories were similar, patients with chronic retention were more likely to be younger, of higher social class and to have worse general health. Patients with acute retention were more likely to present with a urinary tract infection and to have electrocardiographic abnormalities, and symptomatic patients presented with more severe urinary symptoms. Minor differences between the categories with regard to post-operative morbidity and mortality were not statistically significant at the 5% level. However, some significant differences did exist. Patients with acute retention were more likely to experience urinary and non-urinary infections and impotence after surgery, while symptomatic patients reported less improvement in their health status as regards pain and social isolation. These results suggest that the method of categorisation is clinically valid and a necessary distinction to make when auditing TURP.

Acute Disease↗

PubMed1994

Transurethral resection of the prostate for benign prostatic hyperplasia--a local review.

There has been a recent resurgence of interest in the role of transurethral resection of the prostate for benign prostatic hyperplasia in view of the introduction of new modalities. We have conducted a retrospective analysis of 175 cases operated from October 1988 to June 1989 with an aim to ascertain the present mortality and morbidity rates associated with this procedure. The main presenting symptoms were acute retention of urine (54%) and bladder outlet obstruction (33%). The average weight of the prostate resected was 24.2 gm and 3% of specimens revealed malignant changes on histology. Seventy-five percent of the patients have post-operative stay of 5 days or less. Urinary tract infection was the commonest complication (16%). Clot retention requiring re-scope occurred in 2% of our patients. Twelve percent (12%) of our patients developed acute retention post-operatively but only 2% required re-scope as the rest resolved conservatively. We had one mortality in our series as a result of post-operative pneumonia. After 6 months follow-up, 4% complained of mild urinary incontinence and another 4% noted retrograde ejaculation. Six percent developed urethral strictures which required surgical treatment. Three years after the procedure, we retrieved the case notes of our cohort to analyse long-term results. We note that ninety-eight percent of our patients were discharged after nine months follow-up. This includes the 4% who complained of mild stress incontinence at 6 months follow-up. The remaining 2% was discharged after 24 months because of recurrent urethral stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

Transrectal focused ultrasound combined with transurethral resection of the prostate for the treatment of localized prostate cancer: feasibility study.

PURPOSE: We studied the feasibility of combined treatment with high intensity focused ultrasound (HIFU) and transurethral resection or incision of the prostate for localized prostate cancer to decrease the risk of posttreatment prolonged urinary retention. MATERIALS AND METHODS: Included in this feasibility study were 30 patients fulfilling certain criteria, namely localized prostate cancer indicated for HIFU, age 60 years or older, prostate volume 45 cc or less, no more than 4 positive samples at sextant biopsy, baseline prostate specific antigen (PSA) 10 ng/ml or less and no evidence of cancer extension. They received the combined treatment under general anesthesia using an Ablatherm HIFU device (EDAP SA, Lyon, France). RESULTS: The enrolled patients were a mean of 72 years old and presented with a median prostate volume of 30 cc. Median Gleason score was 6, median PSA was 7 ng/ml and pretreatment sextant biopsies provided a median of 2 positive samples. Mean operative time was 2 hours 48 minutes, including resection and HIFU. An average of 616 HIFU shots were delivered. The urinary catheter was removed at day 2 after treatment. Median hospital stay was 3 days. Only a few complications were observed. In regard to the oncological aspects at a mean of 20 months of followup 86% of the patients had negative biopsies after HIFU. Median PSA was 0.9 ng/ml. At 1 year of followup the mean International Prostate Symptom Score was 8. Regarding sexual function, 73% of previously potent patients reported preserved sexual activity. CONCLUSIONS: The combination of endoscopic resection or incision of the prostate with HIFU treatment decreases urinary catheterization time and improves posttreatment urinary status without additional morbidity.

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PubMed2006

Palliative transurethral resection of the prostate: functional outcome and impact on survival.

OBJECTIVE: To assess the long-term functional and oncological outcome in a consecutive series of patients undergoing palliative transurethral resection of the prostate (pTURP). PATIENTS AND METHODS: We retrospectively assessed all patients who had a pTURP between 1992 and 2004 at our institution. Patients with incidental prostate cancer (pT1a/pT1b) were excluded. In all, 89 patients (mean age 75.9 years, sd 0.9, at diagnosis) entered the study. RESULTS: The median (range) prostate-specific antigen level at diagnosis was 25.7 (0.7-5000) ng/mL and the mean Gleason score was 7. The mean (sd, range) interval between the diagnosis of prostate cancer and pTURP was 1.5 (0.3, 0.5-10.9) years. The indications for pTURP were refractory urinary retention in 30%, severe bladder outlet obstruction with a postvoid residual urine volume of > 100 mL in 43%, and bladder stones, haematuria and hydronephrosis in 9% each. The mean (sd, range) follow-up after pTURP was 2.6 (0.2, 0.1-7.3) years. The peri-operative mortality (<30 days) was 2%, and 22 patients (25%) died during the follow-up. As estimated by Kaplan-Meier analysis, the 1-, 2- and 5-year survival rates were 83%, 70% and 61%, respectively. Patients with prostate cancer in the pTURP specimen had a shorter 3-year survival (52%) than those with a negative histology (89%, P = 0.03). At the last follow-up, 79% of men voided spontaneously and were continent. A repeat pTURP was necessary in 25% of patients, 11% required permanent catheterization and 10% were incontinent. CONCLUSION: Despite greater peri-operative mortality and morbidity than conventional TURP, pTURP is a fairly safe and effective procedure. Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 5-year survival of 61% in this series seems to justify this intervention.

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PubMed2001

The pathophysiology, diagnosis and therapy of the transurethral resection of the prostate syndrome.

In this article, the authors analyze a syndrome first described by Creevy in the 1940s, which may occur during a transurethral resection of the prostate (TURP). The syndrome is characterized by cardiocirculatory and neurological problems due to rapid changes in intravascular volume and plasma solute concentrations caused by excess irrigating fluid absorption. This article reviews the available literature and reports on the experience of our clinic, a specialist department in the physiopathology, diagnosis, therapy and prevention of TURP syndrome.

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PubMedDate not supplied

[Effect of transurethral resection of the prostate on the state of patients with ischemic heart disease].

The water-salt equilibrium and the degree of endogenous intoxication (albumin fluorescence test) were examined in 60 patients with transurethral resection of the prostate (TURP), 40 of whom had ischemic heart disease (IHD). Body temperature, ECG, ST segment and echocardioscopy were daily monitored perioperatively in all patients. The results showed a lack of any pronounced changes in the water-salt equilibrium in TURP that lasted up to 1.5 hours and included big volumes of 5% glucose; they were also indicative of a lower postoperative binding albumin ability, which is normally most pronounced in patients with hyperthermia. As for the IHD patients, hyperthermia was found to be concurrent in them with the onset of ischemia of the myocardium and with its low contractive ability, which can be referred to as a significant factor in case of the above patients.

Adenosine Triphosphate↗

PubMed1999

Transrectal ultrasound with separate measurement of the transition zone volume predicts the short-term outcome after transurethral resection of the prostate.

OBJECTIVES: To determine whether the volume of prostatic adenomas as assessed by transrectal ultrasound (TRUS) influenced the outcome after transurethral resection of the prostate (TURP). METHODS: TRUS with total prostate and transition zone (TZ) volume determinations was performed preoperatively in 298 consecutive patients undergoing TURP for benign prostatic hyperplasia without prior urodynamic evaluation. Postoperatively, the outcome of surgery was stated as excellent (no or minor remaining symptoms), improved (but with some remaining symptoms), or failure (the same or aggravated symptoms) according to a patient-administered questionnaire. Six possible risk factors were evaluated: TZ volume 20 cc or less, neurologic disorders, previous TURP/transurethral incision of the prostate (TUIP), diabetes, indwelling catheter, and age older than 80 years. RESULTS: Thirty patients (10.1%) had treatment failure, 45 (15.1%) improvement, and 223 (74.8%) had excellent outcome. After subdivision into preoperative TZ volume of 20 cc or less and greater than 20 cc, it was found that the outcomes of 20.9% (n = 19) were failures if the TZ volume was 20 cc or less but only 5.3% (n = 11) if the TZ volume was greater than 20 cc. Additional independent risk factors for failure were neurologic disorders and previous TURP/TUIP. When all patients with risk factors were excluded (TZ volume 20 cc or less, neurologic disorders, previous transurethral surgery, and diabetes), the risk of failure was 3.3%. CONCLUSIONS: Patients with a preoperative TZ volume greater than 20 cc and no history of neurologic disorders, previous TURP/TUIP, or diabetes had a very high chance of favorable outcome after TURP, even though no pressure/flow evaluation had been performed preoperatively.

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PubMed1996

Sequential laparoscopic bladder diverticulectomy and transurethral resection of the prostate.

The surgical treatment of prostatic obstruction associated with a clinically significant bladder diverticulum has classically combined open diverticulectomy with relief of the bladder outlet obstruction. This report demonstrates that this result may be efficiently achieved by performing transurethral surgery followed immediately by laparoscopic excision of the diverticulum. As assessed by a retrospective comparison with four open bladder diverticulectomies combined with transurethral resection of the prostate, laparoscopic diverticulectomy markedly reduces the postoperative and convalescence period. The overall financial saving that ensues may benefit both the patient and the healthcare system. Sequential laparoscopic bladder diverticulectomy and transurethral resection of the prostate illustrates the increasing possibilities of minimally invasive surgery.

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