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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↗
PubMed2006

Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity?

AIM: The aim of this study was to investigate whether the preoperative degree of bladder outlet obstruction (BOO), detrusor underactivity (DUA) or detrusor overactivity (DO) affected the short-term outcome of transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). METHODS: Ninety-two patients with LUTS/BPH aged 50 years or older who were considered to be appropriate candidates for TURP were included in this study. Pressure-flow study and filling cystometry were performed to determine BOO, DUA and DO before TURP. The efficacy of TURP was determined at 3 months after surgery using the efficacy criteria for treatment of BPH assessed by the International Prostate Symptom Score, QOL index, maximum flow rate and postvoid residual urine volume. RESULTS: On preoperative urodynamics, 60%, 40% and 48% of patients showed BOO, DUA and DO, respectively. After TURP, 76% showed 'excellent' or 'good' overall efficacy, whereas only 13% fell into the 'poor/worse' category. The efficacy was higher as the preoperative degree of BOO worsened. In contrast, neither DO nor DUA influenced the outcome of TURP. However, the surgery likely provided unfavorable efficacy for patients having DO but not BOO. Only 20% of the patients who had both DO and DUA but did not have BOO achieved efficacy. CONCLUSIONS: Transurethral resection of the prostate is an effective surgical procedure for treatment of LUTS/BPH, especially for patients with BOO. DUA may not be a contraindication for TURP. The surgical indication should be circumspect for patients who do not have BOO but have DO.

Aged↗
PubMed2000

In-hospital mortality after transurethral resection of the prostate in Victorian public hospitals.

BACKGROUND: The purpose of the present paper was (i) to identify trends in in-hospital mortality after transurethral resection of the prostate (TURP) in Victorian public hospitals; and (ii) to explore associations between in-hospital mortality after TURP and age, adverse events, type of admission (emergency/planned), location of the hospital (metropolitan/rural), teaching status of the hospital and length of stay. METHODS: Trends in in-hospital mortality after TURP and the associations between in-hospital mortality and the aforementioned variables were studied using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) coded Victorian hospital morbidity data from public hospitals between 1987-88 and 1994-95. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) were based on univariate and multivariate logistic regression, respectively. RESULTS: After adjustment for age, comorbidity, and other confounding variables, the trend in mortality reduction over time was highly significant (P for trend < 0.0001, 95% CI for trend: 0.84-0.95). Highly significant associations with mortality were observed for emergency admissions (OR = 1.99, P < 0.0001), presence of adverse events (OR = 2.69, P < 0.0001), length of hospital stay (P for trend < 0.0001, 95% for trend: 1.88-2.15) and age (P for trend < 0.0001; 95% CI for trend: 1.26-1.48). CONCLUSIONS: Routinely collected data from hospitals can provide tentative evidence of improved effectiveness of a surgical treatment, provided analysis takes careful account of potential sources of bias, especially those related to possible changes in case selection over time. These kinds of data should stimulate a joint effort between clinicians, quality assurance experts and epidemiologists to confirm this attribution, and to locate the causative factors.

Adult↗
PubMed2006

Comparison of intrathecal fentanyl and buprenorphine in urological surgery.

OBJECTIVE: To evaluate and compare the characteristics of spinal block, its postoperative analgesic effects and side effects using intrathecal bupivacaine and its combination with fentanyl or buprenorphine in elderly patients undergoing urological surgery. METHODS: Sixty patients aged sixty and above scheduled for elective transurethral resection of prostate (TURP) randomly received hyperbaric bupivacaine 0.75% 2 ml (group L control, n = 20), buprenorphine 30 micrograms [DOSAGE ERROR CORRECTED] with hyperbaric bupivacaine 0.75% 2 ml (group B, n = 20) or fentanyl 10 micrograms [DOSAGE ERROR CORRECTED] with hyperbaric bupivacaine 0.75% 2 ml(group F, n = 20). Characteristics of spinal block, haemodynamic stability, postoperative analgesia and incidence of adverse effects were compared. All patients were followed for twenty four hours. RESULTS: The patients' blood pressures remained within 20% of baseline values. The mean time for the sensory block to reach T10 dermatomal level was 3.2 +/- 2 minutes in fentanyl-bupivacaine group versus 4.3 +/- 1 in buprenorphine-bupivacaine and 4.5 +/- 2 bupivacaine alone group. The duration of sensory block was significantly longer in buprenorphine-bupivacaine group. Median block levels reached T8 in all groups. All patients required postoperative analgesia in group L and F except 6 in buprenorphine group. CONCLUSION: Buprenorphine 30g in combination with bupivacaine 0.75% 2 ml provided analgesia of comparable clinical onset and longer duration but was associated with a clinically increased incidence of nausea and vomiting in elderly patients.

Aged↗
PubMed2002

A demographic profile of patients undergoing transurethral resection of the prostate for benign prostate hyperplasia and presenting in acute urinary retention.

OBJECTIVE: To evaluate, in a prospective study, the demographic profile of patients with benign prostate enlargement who presented in acute urinary retention (AUR). PATIENTS AND METHODS: The study comprised all patients admitted for transurethral resection of the prostate and categorised into two groups, i.e. those presenting in AUR or electively. The factors evaluated included the length of hospitalization, the patients' occupation, their duration of symptoms and reasons for not seeking treatment. RESULTS: There was no significant difference in the mean age and occupational status of the two groups but those in AUR had more complications and a longer hospital stay after surgery; 60% of these men had had their urinary symptoms for > 1 year. When asked why they did not seek treatment earlier, 35% reported fear of surgery, while 41% thought that their symptoms were a normal part of ageing. CONCLUSION: There is a need to raise the level of public awareness of benign prostatic enlargement because those who present with AUR incur excess morbidity and longer hospitalization that could otherwise be avoided through earlier treatment and elective surgery.

Acute Disease↗
PubMed1993

Norfloxacin as prophylaxis against urethral strictures following transurethral resection of the prostate: an open, prospective, randomized study.

An open, prospective, randomized study was performed to investigate the effect of norfloxacin prophylaxis on stricture formation and operative outcome after transurethral resection of the prostate. After resection, the 359 patients studied were randomly divided into 2 groups: 1) those given norfloxacin as prophylaxis for 15 days following removal of the catheter (norfloxacin group) and 2) those given no antimicrobial prophylaxis during the same period (control group). Of the patients 94 were excluded. At followup 6 to 12 months postoperatively, the number of strictures in the anterior urethra was 2 of 135 in the norfloxacin group and 22 of 130 in the control group (p < 0.01). Strictures in the bladder neck developed in 3 of 135 and 4 of 130 patients, respectively (not significant). As a consequence of a lower structure incidence in the anterior urethra in the norfloxacin group, fewer patients in that group were dissatisfied with the operative outcome. The results suggest that norfloxacin provides effective prophylaxis against stricture formation after transurethral resection of the prostate.

Aged↗
PubMed2006

Transurethral electrovapor resection versus standard transurethral resection treatment for a large prostate: a 2-year follow-up study conducted in Taiwan.

INTRODUCTION: Those patients featuring a large prostate and undergoing transurethral resection typically face a longer duration of surgery, they have a higher degree of hemorrhage and a higher irrigant volume required for the procedure, and they tend to reflect a higher incidence of morbidity than is the case for a small prostate. We report on the relative safety and efficacy of transurethral electrovapor resection of the prostate (TUVRP) as compared with standard transurethral resection of the prostate (TURP) for Taiwanese patients having a prostate size >50 ml. PATIENTS AND METHODS: Seventy-six symptomatic benign prostatic hyperplasia patients featuring a prostate size >50 ml were randomized and underwent either TUVRP using wedge loop or standard TURP. Perioperative parameters, treatment outcome, and adverse events associated with the surgical procedure are assessed herein. RESULTS: Mean operation time, changes in hemoglobin levels, resected prostate weight, perioperative irrigant volume needed, and incidences of recatheterizations and readmissions, all differed significantly when the two surgical procedures were compared. The average expense differences for the two procedures were impressive (p < 0.0001). No postoperative intergroup sexual dysfunction differences were noted. Clinical improvements following either TUVRP or TURP were significant and sustained for at least a period of 2 years. Intergroup comparison of International Prostate Symptom Score, quality of life, peak flow rate, and postvoid residual volume revealed no significant differences at 2 years (p = 0.45, 0.48, 0.12, and 0.29, respectively). The need for postoperative medical retreatment and/or reoperation did not differ significantly between the two groups (p = 0.62 and p = 0.56, respectively, at 6 months and p = 0.47 and p = 0.48, respectively, at 2 years). CONCLUSIONS: The TUVRP procedure offers advantages as regards a number of perioperative parameters when compared with the TURP procedure, and it seems that TUVRP might provide at least an equivalent treatment outcome as is the case for TURP.

Aged↗
PubMed1976

Combined electromyography and gas urethral pressure profilometry before and after transurethral resection of the prostate.

Combined electromyographic and gas urethral pressure profilometry was done on 10 consecutive patients before and 3 months after transurethral resection of the prostate. A significant reduction was found postoperatively in the functional urethral length, whereas the maximum urethral closure pressure remained unchanged. Increase in urethral resistance in prostatic obstruction of the posterior urethra was related to the increase in the functional length of the posterior urethra rather than to mechanical occlusion of the urethral lumen. Periurethral striated muscle activity was recorded from the membranous urethra to the urethrovesical junction with the maximal activity located in the membranous urethra. Marked striated muscle activity also was found consistently at the bladder neck.

Adenocarcinoma↗
PubMed1988

Severe hyponatremia without severe hypoosmolality following transurethral resection of the prostate (TURP) in end-stage renal disease.

A 55-year-old man on chronic hemodialysis underwent a transurethral resection of the prostate (TURP), during which 3% sorbitol solution was used for urethral irrigation. Following the procedure, he developed symptomatic hyponatremia (serum sodium, 106 mEq/L), but had only mild hypoosmolality (serum osmolality, 269 mosm/kg). The "osmolal gap" was 47 mosm/kg, probably from sorbitol absorbed systemically during the TURP. Hemodialysis raised the serum sodium to 118 mEq/L, and the serum osmolality to 284 mosm/kg, while lowering the osmolal gap to 26 mosm/kg. The presence of severe hyponatremia with only modest hypoosmolality may occur in patients with renal failure following the systemic absorption of hypotonic fluids containing solutes such as sorbitol and mannitol. Hemodialysis offers the advantages of correcting the hyponatremia while removing the unmeasured solute, thus preventing rapid increases in the serum osmolality.

Humans↗
PubMed2006

[Discontinuous oral ciprofloxacin for transurethral resection of the prostate. Initial results].

OBJECTIVES: To describe the rate of infectious complications using a discontinuous scheme of oral ciprofloxacin in transurethral resection of the prostate (TUR-P). To try to weigh the influence of clinical background, operative complications and postoperative outcome on the development of such complications. To compare the results to those obtained with equal methodology using antibiotics in a continual scheme until the catheter removal. METHOD: A prospective open study was designed including 53 consecutive patients with sterile urine and without indwelling catheter subjected to TUR-P. Patients received oral ciprofloxacin 500 mg (4 doses) before going to the surgical room, the night of surgery, next morning of surgery and before catheter removal. Three patients were excluded after incorporation (5.6%) and all the remainders completed follow up. RESULTS: Fifty patients are analyzed. Fever was present in 8 patients (16%). Systemic clinical infection was present in 3 patients (6%). No isolated-germ postoperative bacteriuria was present. Previous urinary infection (UTI) was statistically associated to systemic clinical infection (p = 0.007) and to active chronic prostatitis on operative biopsy (p = 0.002). CONCLUSION: Probably previous UTI antecedent made less advisable the discontinuous scheme use in TUR-P, although a greater number of patients is needed to confirm these statement. When these results are compared to those using antibiotics in a continual scheme until catheter removal, a significant higher frequency of fever is seen (p = 0.022).

Administration, Oral↗
PubMed2001

Is transurethral resection of the prostate safe and effective in the over 80-year-old?

OBJECTIVE: To assess the safety and effectiveness of transurethral resection of the prostate (TURP) in patients over 80 years old. PATIENTS AND METHODS: The records of all patients over 80 years old undergoing TURP at one institution over a 3.5-year period were studied retrospectively. RESULTS: 31% of patients underwent TURP for symptoms and 68% for urinary retention. The early complication rate was 41%. The late complication rate was 22%. There were no deaths within 30 days of surgery. Of all patients, 80% were satisfied with the outcome of their operation. Of all patients with retention, 80% were able to void with small residual volumes by 6 weeks after operation. CONCLUSIONS: Although TURP in the over 80-year-old male is associated with significant morbidity, it is an effective treatment for urinary symptoms or retention. The majority of patients are able to void afterwards and are satisfied with the outcome of their surgery.

Aged↗
PubMed1995

[Primary mucinous adenocarcinoma of the prostate].

Contribution of a new case of prostatic mucinous adenocarcinoma of primary origin. Diagnosis was established by histochemical techniques alcian blue, PAS and alcian-PAS) processing the fragments from the prostate transurethral resection (PTUR). Neither the existence of extraprostatic tumoration, local infiltration, or metastasis was recognized. No correlation between preoperative prostatic acid phosphatase (PAP) (50) and prostatic specific antigen (PSA) values (3ng/m) was evidenced. After radical prostatectomy both markers remain undetected one year after surgery.

Adenocarcinoma, Mucinous↗
PubMed1978

A new method for treating prostatic hypertrophy.

Since 1969, when I did the first transurethral prostatic incision on a 51-year old man with bladder neck obstruction, 245 patients have undergone this procedure; 220 have been followed for 3 months to 8 years. Almost one-half of these patients were between 70 and 90 years old. Comparison of the first 220 patients who had transurethral incision with 220 patients who had transurethral prostatic resection showed that only two who underwent incision required subsequent resection, while 8 patients in the resection group had to have repeat resection. Contracture of the bladder neck and urinary incontinence did not occur with transurethral incision, and the incidence of epididymo-orchitis and stricture is lower with this method than with resection.

Adult↗
PubMed1986

3-year followup of urinary symptoms after transurethral resection of the prostate.

A total of 84 patients underwent detailed symptom analysis and urodynamic study preoperatively, and 3 and 12 months after transurethral resection of the prostate. In addition, 69 patients were contacted 3 years postoperatively for a detailed symptom analysis. These 3-year data then were compared to earlier evaluations. At 3 years 75 per cent of the patients claimed to have improvement, while 13 per cent stated that they were the same symptomatically. At the 1-year evaluation 84 per cent of the patients believed that they were improved and 10 per cent stated that they were unchanged. At 3 years 18 per cent of the patients had urge incontinence (an increase from 6 per cent at 1 year), while none complained of marked nocturia or frequency. Mean total irritative and obstructive symptoms were minimal and unchanged from the 1-year evaluation. Of the patients 33 per cent noticed decreased or absent erections and most blamed the surgery. One patient required another prostatic resection, while stricture developed in 3 and bladder neck contracture occurred in 6. We conclude that prostatic resection results in reasonable 3-year symptomatic improvement but it is hampered by other complications, including bladder neck contracture and, possibly, impotence.

Aged↗
PubMed2007

Instrumental treatments for benign prostatic obstruction.

PURPOSE OF REVIEW: The need to treat increasing numbers of patients with symptomatic benign prostatic obstruction has led to the continuous development of various novel or modified instrumental procedures with minimal invasiveness. The aim of the following review is to provide an overview of the current research focused on the complications and morbidity of instrumental treatment options for symptomatic benign prostatic obstruction. RECENT FINDINGS: A systematic Medline database search, over the past 12 months of the literature with a focus on articles about surgical treatment for benign prostatic obstruction or benign prostatic hyperplasia, provided some interesting new data concerning laser prostatectomy (holmium laser enucleation of the prostate and photoselective vaporization of the prostate) and transurethral resection of the prostate using bipolar electrocautery systems available for the review. SUMMARY: The data of this review period confirmed a favorable safety profile of holmium laser enucleation of the prostate for treating patients with comorbidities. Photoselective vaporization of the prostate seems to be an efficient technique with a favorable safety profile. Its long-term potential, however, has to be confirmed by randomized controlled studies. Transurethral resection of the prostate using bipolar electrocautery systems appears to offer the advantages of improved hemostasis and the ability to avoid transurethral resection syndrome. More randomized comparisons, however, need to be undertaken before an accurate general picture is available.

Humans↗
PubMedDate not supplied

[Causes of erectile dysfunction after transurethral resection of hyperplastic prostate and its prophylaxis].

The study was made of 60 sexually active patients with prostatic hyperplasia after monopolar transurethral operations (mean age 61.3 years). 30 patients entered a control group, 30 ones--the study group. The latter received 10 mg vardenafil each other day for 7 weeks after the intervention. The patients filled in questionnaire, underwent dopplerography and electromyography of the penis. Questionnaire said that erection was worse after operation in 6 (20%) patients (p < 0.01) of the control group and none of the study group. The latter also showed better circulation. All the men with postoperative erectile dysfunction (ED) had electromyographic signs of impaired autonomic innervation of the penis. Thus, ED after transurethral operations for prostatic hyperplasia is primarily neurogenic and is seen in 20% operated patients. Early vardenafil therapy is effective in prevention of postoperative ED.

Adult↗