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PubMed2001

The representation of blood flow in endourologic surgical simulations.

An image-based approach has been developed to represent bleeding in a simulator for transurethral resection of prostate (TURP). While previous attempts have simulated bleeding over tissue surfaces or in blood vessels, our approach focused on the macroscopic visualization of bleeding in a fluid environment. TURP is an ideal procedure for simulation-based training because of the dynamic environment and the variety of flow patterns it presents. The first step in the development of the simulator was the generation of blood flow movies which consisted of capturing videos of bleeding vessels in vitro, processing them to separate the actual blood from the background anatomy and organizing the movies into a parametric database. During the running of the simulation, resection of prostate tissue systematically triggers bleeding events and the playback of a blood flow movie. The blood flow movie is texture mapped onto a virtual surface that is positioned oriented, morphed, composited and looped into the virtual scene.

Blood Loss, Surgical↗
PubMed1988

[Diagnosis of adenocarcinoma in transurethral resection of the prostate: how much sampling is adequate].

The amount of prostatic tissue necessary to detect carcinoma in transurethral resection specimens with reasonable accuracy, was evaluated. The samples were taken from the patients with a clinical diagnosis of benign prostatic hypertrophy. Prostate chips from 647 such patients were examined microscopically. An average of 2.5 g of sample was mounted in each block. Adenocarcinoma was diagnosed in 58 cases (9.0%). Among them, 40 cases were in stage A1, and 18 in stage A2. Incidental carcinoma was found more frequently in prostate chips weighing less than 20 g. To detect carcinoma with 95% probability, at least 2 slides should be examined in stage A2, and 6 slides in stage A1.

Adenocarcinoma↗
PubMed2004

[A comparison of combined spinal-epidural anesthesia with epidural anesthesia for postoperative pain relief after transurethral resection of the prostate].

BACKGROUND: We compared combined spinal-epidural anesthesia (S group) and epidural anesthesia (E group) in terms of pain control after transurethral resection of the prostate (TUR-P). METHODS: All 32 patients received 0.2% ropivacaine at a rate of 2 ml x hr(-1) by a portable disposable pump postoperatively. RESULTS: S group was superior to E group in urethral pain control within three hours after operation. E group was superior to S group in decrease of back pain over six hours after operation. Fifteen patients (47%) suffered from irritability or low back pain and needed rescue analgesics. CONCLUSIONS: Our result indicates that 0.2% ropivacaine at a rate of 2 ml x hr(-1) is not satisfactory to relieve the postoperative pain. Long acting local anesthetics for spinal anesthesia are not suitable for TUR-P. Supplemental administration of opioid to epidural space or higher rate of continuous epidural infusor after operation might be better analgesic choice for TUR-P.

Aged↗
PubMed2003

Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate.

PURPOSE: To determine the optimal dose of intrathecal morphine that produces satisfactory analgesia with minimum side effects in elderly patients undergoing transurethral resection of the prostate (TURP). METHODS: In this double-blind prospective study, 42 patients undergoing TURP with spinal anesthesia were allocated to one of three groups. Group A (n = 14) received tetracaine, 10 mg, alone. Group B (n = 13) and Group C (n = 15) received morphine 0.05 mg and 0.10 mg, respectively, in combination with tetracaine. Postoperative pain, nausea and pruritus were evaluated using visual analogue scales (VAS). SpO(2) and respiratory rate were also assessed. RESULTS: At three, five, seven and 24 hr after spinal anesthesia, the VAS scores for pain in Groups B and C were significantly less than in Group A. Group C experienced significantly greater VAS scores for pruritus as compared to Groups A and B. There was no significant difference in the intensity of nausea among the three groups. No patient experienced hypoxemia (SpO(2) < 90%) and respiratory depression (respiratory rate < 10 beats*min(-1)) in any group. CONCLUSION: A dose of 0.05 mg in intrathecal morphine with spinal anesthesia would be optimal for elderly patients undergoing TURP.

Aged↗
PubMed1998

Long-term results following transurethral resection of the prostate.

Two subsets of a single-center study population with benign prostatic hyperplasia (n(1) = 232; n(2) = 214) undergoing transurethral resection (TUR) of the prostate (TURP 1979 and 1995) entered a retrospective study designed to examine the long-term follow-up. The actual data were assessed with a patient-addressed questionnaire. Preoperative voiding patterns did not differ significantly; postoperative micturition revealed comparable results for both groups. Mortality and TUR syndrome rates were reduced to very low levels. The most significant improvement was found in blood transfusions. The postoperative incidence of urethral stricture (1.7 vs. 1.5%) or bladder neck contracture (2.7 vs. 2.4%) were low and did not alter significantly. Urinary incontinence changed for both collectives (11.4 vs. 3.3%). Urodynamic investigations revealed that all (n = 21) but 1 of the patients with TURP 1979 had the incontinence due to different bladder dysfunctions, but not because of postoperative stress incontinence. The questionnaire about the patient's actual contentment after TURP 1979 showed 79% of the patients still satisfied, 12% neutral and 9% dissatisfied with their micturition. Overall the patients reported a generally favorable view of TURP outcome in the long-term follow-up.

Aged↗
PubMed1994

Transurethral resection of the prostate for benign prostatic hypertrophy: factors associated with a successful outcome at 1 year.

OBJECTIVE: To investigate which patient and health service factors are predictive of outcome following transurethral resection for benign prostatic hypertrophy. PATIENTS AND METHODS: A total of 388 men were assessed before and 3, 6 and 12 months following surgery. Twenty-one patient characteristics and 12 health service factors were considered. Successful outcome was assessed in terms of avoidance of adverse effects of the operation (survival, lack of early complications and later problems) and improvement in symptoms, health status (assessed in three ways) and quality of life. An overall assessment based on all eight outcome measures was also used. Relationships between possible predictors and outcome were explored whilst controlling for three potential confounders: age, diagnostic category and co-morbidity. A linear logistic model was employed. RESULTS: Patients who had severe pre-operative symptoms but who otherwise enjoyed good health gained the most benefit from surgery. Generally speaking, outcome was not associated with any of the 12 health service factors studied. CONCLUSION: The results support the policy of watchful waiting for mild or moderately symptomatic patients as even if surgery becomes necessary because of a deterioration in the condition, the benefit resulting will be greater. However, any benefits of waiting for surgery would have to be balanced against any increase in urinary tract pathology or co-morbidity that men may suffer whilst waiting, as these will increase the likelihood of an adverse outcome of surgery. The question of whether to wait or not will only finally be resolved by means of a randomized controlled trial comparing transurethral resection of the prostate with watchful waiting.

Adult↗
PubMed1991

Differences in the leucine aminopeptidase activity in extracts from human prostatic carcinoma and benign prostatic hyperplasia.

Extracts of tissue showed that prostatic carcinomas contain less leucine aminopeptidase activity than benign prostatic hyperplasia. This is true when activity is expressed as specific activity (P = 0.0033), specific activity/% epithelium (P = 0.0007), activity/wet weight of tissue (P = 0.0028), or activity/wet weight of tissue/% epithelium (P = 0.0005). Almost all histochemically demonstrable activity is located in the epithelium. Enzymatic activities in extracts and in histochemical preparations showed similar differences between carcinoma and benign prostatic hyperplasia and were related (R = -0.38, P = 0.0400) to Gleason's grades. The transurethrally resected prostate cancers studied contained no well-differentiated tumors and a high proportion of poorly differentiated tumors. Histochemical activity is absent in most prostatic carcinomas and decreased in others. This observation is particularly interesting in view of the growing knowledge of tumor suppressor genes.

Aged↗
PubMed1994

[Prostate-specific antigen in patients with benign prostatic hyperplasia].

The authors examined 119 patients with the histological finding of benign prostatic hyperplasia (BPH). Before the planned operation of the prostate (transurethral resection or open prostatectomy) the authors examined in all patients the level of the prostate specific antigen (PSA) and the prostate volume by sonography. Of 119 patients 70 (58.8%) had elevated serum levels of PSA and in 35 (29.4%) the PSA level was higher than 10 ng/ml. The authors demonstrated a highly significant (p < 0.0001) linear relationship of the PSA serum level and volume of prostate in patients with BPH. Based on the results of simple regression analysis they elaborate an equation for the prostate volume: PSA ng/ml = (3.26 + 0.12 x volume of prostate (ml) +/- 8.44). By adding the value of the standard deviation of PSA the authors created an interval in which are most of the patients with BPH. The authors recommend supplementary examinations (transrectal sonography and biopsy of the prostate) in patients where there is a disproportion between the PSA level and the prostate volume.

Adult↗
PubMed2004

Acupuncture reflexotherapy in the treatment of sensory urgency that persists after transurethral resection of the prostate: a preliminary report.

AIMS: In this study, we wanted to evaluate whether acupuncture reflexotherapy is able to treat the sensory irritative components of LUTS (lower urinary tract symptoms) that persist after transurethral resection of the prostate. METHODS: We have evaluated 42 patients, randomly selected into three groups: 14 patients received placebo, 15 patients received oxybutynin, and 13 patient were treated with electrostimulation by acupuncture reflexotherapy. RESULTS: Before treatment, the mean maximum flow rate (Qmax) was 21.0 +/- 3.2 mL/sec, the mean International Prostate Symptom Score (I-PSS) score was 12.9 +/- 4.2, the mean I-PSS Quality of Life (IPSS QoL) score was 3.6 +/- 1.2. At the first check-up performed after 3 months, we could observe that the I-PSS and QoL scores were 12.6 +/- 4.3 and 3.8 +/- 1.3 in the group who received placebo; the scores decreased to 11.1 +/- 3.2 and to 3.1 +/- 1.0, respectively, in the 15 patients treated with oxybutynin and decreased to 6.1 +/- 2.6 and 1.3 +/- 1.1, respectively, in the 13 patients who underwent acupuncture reflexotherapy. At 1-year follow-up, these parameters were practically similar. The voiding diaries allowed us to deduce that the average number of daytime voidings decreased by 8% in patients who received oxybutynin and decreased by 20% in 13 patients who underwent reflexotherapy; the average number of nocturnal micturitions decreased by approximately 20% and 60%, respectively, in patients who received oxybutynin and reflexotherapy. CONCLUSIONS: This study has pointed out that acupuncture reflexotherapy has a real benefit in patients with sensory urgency that persists after transurethral resection of the prostate.

Acupuncture Therapy↗
PubMed2005

Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study.

In the present study we aimed to demonstrate the efficacy of short-term pretreatment with finasteride in patients undergoing transurethral resection of the prostate (TUR-P). For this purpose 40 patients with BPH, who were candidates for TUR-P, were randomized into two groups. The first group (n=20) received 5 mg finasteride/day for 4 weeks prior to surgery and the second group (n=20) remained as the control. Patients who underwent prior prostate or urethral surgery and had a diagnosis of prostate cancer or chronic renal failure, patients who received finasteride, aspirin, coumadin or similar anticoagulant drugs prior to surgery and patients who had capsule perforations or open sinuses during the surgery were excluded from the study. All patients had a normal digital rectal examination and PSA values less than 4 ng/ml. As we look at the results there was no statistically significant difference between the finasteride group and control group regarding age, IPSS, PSA, prostate volumes, preoperative serum hemoglobin, hematocrit values and mean operating times and used irrigating fluids. The total amount of bleeding and bleeding per gram resected tissue were significantly lower in the finasteride group regardless of prostate volume. Furthermore the decrease in the hemoglobin and hematocrit values was higher in the control group. As a conclusion four weeks of finasteride pretreatment provided a significant decrease in peroperative bleeding regardless of prostate volume without any major side effects.

Age Factors↗
PubMed1988

Irrigating fluid absorption and blood loss during transurethral resection of the prostate studied with a regular interval monitoring (RIM) method.

A method for the study of physiological events during transurethral resection of the prostate (TUR) is described. Measurements of volumetric irrigating fluid balance, blood loss, central venous pressure (CVP) as well as blood haemoglobin and serum levels of sodium and glycine were performed at 10-min intervals. This regular interval monitoring (RIM) method offers the possibility to retrospectively correlate changes that occur during TUR at discrete time intervals. In 20 patients undergoing TUR, irrigating fluid absorption occurred throughout the procedure although the risk of having an absorption increased 30 min after surgery commenced. Increase of blood loss coincided with intravascular but not with extravascular absorptions. If there was a rapid massive intravascular absorption of about 500 ml/10 min, the CVP increased greater than 2 mmHg. The total intraoperative blood loss was not greater in patients with large absorption volumes. RIM will detect absorption greater than the urine excretion in any given period of time. If absorption occurs during a limited time of the TUR, RIM allows a partial correction for the urinary excretion in the volumetric fluid balance.

Absorption↗
PubMedDate not supplied

Aztreonam monotherapy as prophylaxis in transurethral resection of the prostate: a multicenter study.

The efficacy and safety of aztreonam in the prophylaxis of urinary tract infection following transurethral resection of the prostate (TURP) in patients with preoperatively sterile urine were studied in a multicenter trial including 300 patients at six Italian urology centers. The present report describes the first 192 patients enrolled in the protocol. Aztreonam or placebo was administered to each patient in three doses, which were given at the induction of anesthesia and 8 and 16 hours later. The development of bacteriuria was monitored by cultures of urine obtained before surgery, 3 days later, at removal of the bladder catheter, at discharge from the hospital, and at a follow-up visit 39-46 days after surgery. A febrile peak was observed for 6% of aztreonam-treated patients and for 20.9% of the placebo group (P less than .005), while bacteriuria was reported in 17.9% and 59.3% of these groups, respectively (P less than .001). From our data, TURP appears to be a clean-contaminated procedure requiring antibiotic prophylaxis, and aztreonam appears to reduce significantly the incidence of postoperative bacteriuria after this surgical procedure.

Adult↗
PubMed1991

Visual evoked potentials and visual acuity after transurethral resection of the prostate.

Changes in visual evoked potentials, visual acuity, blood ammonia levels and serum electrolytes (Na+ and K+) after transurethral resection of the prostate using glycine as an irrigating fluid performed under subarachnoid block were studied in 12 patients, in the pre-operative and immediate postoperative periods. Visual evoked potentials (p100 latency), recorded by shift of a checkerboard pattern, increased significantly from a pre-operative value of mean (SEM) 101.18 (1.63) msec in the right eye, and 102.5 (1.47) msec in the left eye to 108.91 (1.8) msec (p less than 0.01) and 108.08 (2.53) msec (p less than 0.01) respectively in the postoperative phase. There were no changes in visual acuity as assessed by a Snellen's chart, blood ammonia levels and serum electrolyte concentrations. The amount of glycine used intra-operatively for irrigation ranged from 3 to 31 litres.

Aged↗
PubMed1993

European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate.

A prospective randomised trial was undertaken in nine European Hospitals to test antibiotic prophylaxis for men undergoing transurethral resection of the prostate. Of the men with no significant growth (< 10(4) cfu ml-1) in their preoperative urine, 247 received a single 1 gram dose of ceftazidime with the induction of anaesthesia, 256 received 1 g daily from the time of induction of anaesthesia until removal of the urethral catheter (but < or = 5 days) and 261 received no prophylaxis. Of evaluable patients 83 (33.9%), 45 (18.7%) and 29 (11.6%) of the no-prophylaxis, single-dose and multidose groups, respectively, developed urinary tract infection in the immediate post-operative period. There were significantly fewer febrile episodes and fewer prescriptions for alternative antibiotics in teh ceftazidime-treated groups. For men developed peri-operative septicaemia and all were in the no-prophylaxis group. We conclude that patients, even those with culture-negative urine pre-operatively, benefit from antibiotic prophylaxis and that antibiotic prophylaxis should be considered for all men undergoing prostatic surgery as a routine procedure.

Aged↗
PubMed1997

Transurethral microwave thermotherapy (Prostatron version 2.5) compared with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a randomized, controlled, parallel study.

OBJECTIVE: To compare transurethral microwave thermotherapy (TUMT) with urethral cooling in a high-energy protocol (Prostatron version 2.5), with transurethral resection of the prostate (TURP) for the treatment of symptomatic, uncomplicated, urodynamically obstructive benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with moderate to severe symptomatic, uncomplicated BPH, unequivocally obstructed as assessed from the Abrams-Griffith nomogram, who were technically suitable for either form of treatment, were randomized into two groups of 30 patients each to undergo either TUMT or TURP. Five efficacy variables, i.e. the American Urological Association (AUA) symptom score, maximum flow rate (Qmax), post-void residual urine volume (PVR), voiding pressure at maximal flow (Pdet max) and prostatic volume determined by ultrasonography (PV) were measured initially and 6 months after treatment using a defined protocol. Complications were recorded during and up to 6 months after the treatment. As the variables were independent, the data were analysed using a paired t-test for each to assess the treatment effect for each group. RESULTS: After TURP, all the variables improved significantly; after TUMT, the symptoms improved both clinically and statistically (P < 0.001), with the mean AUA symptom score decreasing from 18.4 to 5.2. However, none of the objective variables improved after TUMT. The energy delivered under software control correlated poorly with prostatic volume (r = 0.322). TUMT had considerably lower morbidity than TURP, but failure of ejaculation occurred in four of 18 sexually active men after TUMT. CONCLUSIONS: Despite considerable improvement in their symptoms, TUMT using the Prostatron and Prostasoft v2.5 did not alleviate obstruction in patients with BPH. Patients treated using TUMT controlled by this software should be informed of the possibility of ejaculatory dysfunction.

Aged↗