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PubMed1997

Glycine 1.0% versus glycine 1.5% as irrigating fluid during transurethral resection of the prostate.

OBJECTIVE: To evaluate the potential benefits of reducing the glycine concentration from 1.5% to 1.0% in the irrigating fluid used during transurethral resection of the prostate (TURP) when 1% ethanol is used as the tracer of absorption. PATIENTS AND METHODS: The effect of 1% ethanol on the tendency for blood to haemolyse was tested in vitro and the optical condition of the irrigating fluids were studied during 10 TURPs. The breath ethanol level was monitored during 423 operations where these fluids were used in a randomized double-blind study. The incidence of 13 symptoms was recorded in the 77 patients who absorbed irrigating fluid. RESULTS: Ethanol slightly lowered the tendency for blood to haemolyse. Reducing the glycine concentration did not alter the optical conditions during TURP. The incidence of symptoms increased significantly as more glycine solution was absorbed, arterial hypotension and nausea being the most usual. Bradycardia, prickling skin sensations and feelings of uneasiness were less common when 1.0% glycine was used, but the choice of irrigating fluid had no effect on the total incidence of symptoms. CONCLUSION: We found no clear advantage in lowering the glycine concentration of the irrigating fluid used during TURP.

Absorption↗

PubMed2005

Impact of finasteride treatment on perioperative bleeding before transurethral resection of the prostate: a prospective randomized study.

In this preliminary, randomized study, 35 men were pretreated for 3 months with finasteride or placebo before transurethral resection of the prostate. The study was inconclusive because it did not show any benefit in terms of reducing perioperative bleeding during or after the resection but there is a need for a large, prospective, randomized study.

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PubMed1993

Absorption of irrigating fluid and height of fluid bag during transurethral resection of the prostate.

The purpose of this study was to examine the relationship between the static pressure and the absorption of irrigating fluid during transurethral resection of the prostate. We measured the absorption by the ethanol method in 550 operations during which the fluid bags were placed randomly at distances of 60-65, 70-75, 80-85 or 90-100 cm above the operating table. There was no difference in the volume of irrigant absorbed at different bag heights or any association between fluid height and absorption when different ranges of fluid absorption were analyzed. This suggests that irrigant absorption cannot be prevented by placing the fluid bags at a certain height within the range of 60 to 100 cm above the operating table.

Absorption↗

PubMed1984

[Transurethral resection of the prostate. Our experience in a series of 244 cases. Mid-term results].

Two hundred and forty four patients were treated by transurethral resection of the prostate (68% for adenomas and 32% for epitheliomas) between June 1980 and August 1982. The indications for surgery are based on obstruction of the urinary outflow tract, and the weight of prostatic tissue, which can best be assessed by ultrasound. TURP is the technique of choice for small and medium-size prostates. Hemorrhage is the most frequent complication at operation. Resorption TURP syndrome is extremely rare if an isotonic liquid is used. Urinary tract infections are best treated preoperatively. 2.6% of the patients suffered from urethral stricture despite the use of a 24 French resectoscope and early removal of the catheter. The greater the surgeon's experience, the lower the incidence of definitive urinary incontinence.

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PubMed1997

Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate.

OBJECTIVE: To evaluate the symptomatic and urodynamic effects of oxybutynin in the control of irritative micturitional symptoms during the first week after transurethral resection of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Fifty-three patients (median age 67 years, interquartile range 62-72) were included prospectively in a double-blind placebo-controlled study. Pre-operatively, uroflowmetry and cystometrography (CMG) were performed, and the post-void residual volume (PVR) measured; symptoms were rated according to the Boyarski score. CMG was repeated on the first post-operative day and medication was started on the third day. Before withdrawing the catheter on the fifth day. CMG was repeated. Three days later, symptoms were evaluated according to the Boyarski score and uroflowmetry and the estimate of PVR reassessed. RESULTS: In comparison with placebo, oxybutynin significantly decreased frequency, urgency and detrusor pressure at first sensation of filling. However, oxybutynin did not lower the rate of pre-operative detrusor instability and exerted no effect on the maximal capacity of the bladder and corresponding detrusor pressure. Dryness of mouth was reported in 13% and 65% of patients receiving placebo and oxybutynin, respectively. CONCLUSION: Oxybutynin alleviates early irritative symptoms after transurethral resection of BPH, without consistently modifying bladder urodynamics.

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PubMed1994

Blood coagulation status after transurethral resection of the prostate.

We examined for a possible correlation between coagulopathy and fluid absorption, serum level of prostatic acid phosphatase (S-PAP) and blood loss in 25 patients undergoing transurethral resections of the prostate (TURP). Blood coagulation parameters were measured before and at the end of TURP and 10 and 24 hours later. Fluid absorption was measured by the ethanol method. There was a close correlation between the changes in haemostatic parameters and blood haemoglobin concentration. No relationship was found between the coagulation status and fluid absorption, S-PAP or blood loss during the operation. Fibrinolysis was evidenced by increasing titres of fibrin degradation products in most patients. However, no increase occurred in the two patients who required reoperation because of severe postoperative bleeding, which implies that fewer blood clots were formed in these cases. We conclude that the coagulation parameters during and after TURP varies primarily with the dilution of the blood.

Absorption↗

PubMed2000

Does endoscopic laser ablation of the prostate stand the test of time? Five-year results from a multicentre randomized controlled trial of endoscopic laser ablation against transurethral resection of the prostate.

OBJECTIVE: To determine the long-term objective and subjective outcome of patients with benign prostatic enlargement (BPE) treated by endoscopic laser ablation of the prostate (ELAP), as part of a multicentre randomized controlled trial of ELAP against TURP. PATIENTS AND METHODS: Initially, 151 patients with BPE were randomized to undergo either ELAP or TURP, starting in March 1992. ELAP was performed using the Urolasetrade mark fibre (Bard, Covington, GA, USA) in conjunction with a Nd:YAG laser source. All patients who had originally participated in the study were approached 5 years later to obtain a urological history, American Urological Association (AUA) symptom score and two measurements of urinary flow rate, with an ultrasonographic assessment of the postvoid residual urine volume (PVR). RESULTS: The mean duration of follow-up was 61 months; 109 patients were traced, comprising 69 who were alive and well, and had undergone no further bladder outlet surgery, 26 who had required revision surgery, 12 who were dead or terminally ill and three who had dementia. Both ELAP and TURP produced sustained improvements in mean AUA score, maximum flow rate and PVR, with respective values at 5 years of 6.3, 17.8 mL/s and 76 mL, and 6.5, 20.0 mL/s and 55 mL. Eighteen of 47 ELAP patients (38%) and eight of 51 (16%) TURP patients underwent revision surgery within the follow-up. CONCLUSION: ELAP and TURP produced similar subjective and objective outcomes at 5 years. The re-operation rate after ELAP was more than double that after TURP and suggests that ELAP should not be used routinely in the management of men with BPE.

Endoscopy↗

PubMed2005

Use of a virtual reality, real-time, simulation model for the training of urologists in transurethral resection of the prostate.

OBJECTIVE: There is a growing need to develop surgical skills outside the operating theatre. In this study we describe the development of a virtual reality training system for practising transurethral resection of the prostate (TURP). MATERIAL AND METHODS: A face validity study was performed using a questionnaire sent to 28 experienced urologists to find out the ideal characteristics of a simulated TURP. Based on the comments a simulator was constructed and a content validity study was then performed in which nine experienced urologists tested the simulator and answered a second questionnaire. After corrections to the simulator, a basic construct validity test was performed. RESULTS: We have developed a computer-based simulator based on the requirements listed by 17 urologists. It consists of a modified resectoscope connected to a haptic device and supported by a frame. The software provides a virtual view of the prostatic lumen and resectoscope tip, a haptic rendering that generates force feedback and a simulation module that computes the information from the haptic device, resectoscope fluid tap and handle and the foot pedals. The software also simulates bleeding, absorption of irrigation fluid and pressure gradients. Variables are measured and presented in a result file after each "operation". Nine experienced urologists performed a content validity study and changes were made accordingly. A basic construct validity test performed by seven inexperienced students showed a significant improvement in performance after they each performed six simulated procedures. CONCLUSION: We have developed a simulator that may be used to practise TURP and which meets most of the demands raised in a face validity study. A basic construct validity test showed improved performance after repeated practice in the simulated environment.

Computer Simulation↗

PubMed2002

Development of transurethral resections of the prostate in relation to nocturia in northern Sweden 1992-1997.

OBJECTIVE: To assess the temporal trend in surgical treatment of benign hypertrophy of the prostate in Sweden, particularly the possible influence of nocturia on the probability to be treated by a transurethral resection operation of the prostate (TURP). MATERIALS AND METHODS: There were 2501 elderly men recruited by a questionnaire from a group of pensioners (n=4035; response rate 62%). Their age was 73.3 (6.4) years. The questionnaire included questions on their health and diseases, drugs, sleep habits and the number of nocturnal voiding episodes. Data on deaths from July 1, 1992 to December 31, 1997 were obtained. RESULTS: During the study period 176 TURPs had been performed on 170 men (annual incidence of first TURP: 12.4 treatments/1000 men). The annual rate of TURP was 8.4 treatments/1000 men at ages under 69 years, in men at ages 70-74 years 15.7 and in men 75 years and older 12.7 treatments/1000 men, respectively (p < 0.05). When divided in two time periods of equal length (33 months), 107 (14.1 treatments/1000 men/year) TURPs were performed during the first time period (P1), and 63 (8.6 treatments/1000 men/year) were performed during the second period (P2), (OR P2 vs. P1: 0.59; CI 0.43-0.81). During P1, but not during P2, there was an increase in TURP frequency number in relation to the number of nocturnal micturitions (p < 0.0001). CONCLUSIONS: TURPs decreased by 41% from P1 to P2. During P1 the occurrence of nocturia showed a significant influence of the probability to be subjected to TURP. No such tendency was recorded during P2.

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PubMed1990

Prevention of TUR syndrome by detection of trace ethanol in the expired breath.

Previous studies suggest that severe symptoms of the 'TUR syndrome' occur from transurethral prostatic resection only when the volume of irrigant absorbed exceeds 2000 ml. An ethanol-containing irrigating fluid was used in this study of 100 transurethral resections so that the irrigant absorption could be monitored by measuring ethanol in expired air. Fluid absorption was found in 41 patients, and in nine of them the volume of irrigant absorbed exceeded 1000 ml. Four of these operations were terminated promptly when the ethanol monitoring indicated rapid massive absorption that threatened to exceed 2000 ml. There were few and only mild adverse effects of the irrigant by following this regimen. It is concluded that ethanol monitoring makes it possible to prevent the TUR syndrome by selective termination of those operations in which large amounts of irrigant is absorbed.

Absorption↗

PubMed1991

Measurement of prostate-specific antigen and prostatic acid phosphatase concentrations in serum before and 1-42 days after transurethral resection of the prostate and orchidectomy.

Preoperative intra-individual variation for determinations of prostate-specific antigen and prostatic acid phosphatase concentrations, 15-30% in 92 patients with benign prostatic hyperplasia, limits the diagnostic usefulness of both tumor markers. In benign prostatic hyperplasia (214 patients), concentrations of these tumor markers increased in the initial postoperative period. Prostatic acid phosphatase concentration then decreased by the third postoperative day. Prostate-specific antigen concentration remained above normal in the first postoperative week but had decreased by 42 days. In prostatic carcinoma (46 patients), the concentrations of these tumor markers did not increase postoperatively. During the first week, the concentrations of prostatic acid phosphatase began to fall, but prostate-specific antigen showed a decrease only at 42 days. After orchidectomy (11 patients), the concentrations of both markers had decreased by five days. Concentrations of prostate-specific antigen but not of prostatic acid phosphatase were significantly increased in patients with metastases at 42 days postoperatively. When the concentration of tumor marker did decrease, the magnitude of change was greater for prostatic acid phosphatase than for prostate-specific antigen. These changes were accentuated after an orchidectomy.

Acid Phosphatase↗

PubMed1993

Effect of transurethral resection of the prostate on detrusor instability and urge incontinence in elderly males.

Detrusor instability is common in men with evidence of outflow obstruction due to benign prostatic hypertrophy and typically reverses in about two thirds of patients after transurethral resection of the prostate (TURP). It is also common among the elderly without outflow obstruction and may lead to urge incontinence. To determine whether TURP has an effect on detrusor instability and urge incontinence in elderly men, or whether these abnormalities are due to other age-associated changes, 12 males (mean age 80 years) with urge incontinence or frequency and urgency of micturition, and symptomatic benign prostatic hypertrophy, were studied by 24-hour monitoring of incontinence and videourodynamic examination, before and after TURP; 7/12 patients were significantly cognitively impaired. Preoperatively, all patients showed detrusor instability, which reversed postoperatively in only one patient, a significantly smaller proportion than that consistently reported in younger patients. Preoperatively, 11/12 patients were incontinent. After TURP, 8/11 patients had an improvement in the amount of incontinence, by up to 458 g in 24 hours. Those who improved had been urodynamically more severely obstructed preoperatively. Those with the most improvement were also cognitively impaired. We conclude that, in the geriatric population, detrusor instability and urge incontinence may be the result of age-associated changes and not secondary to obstruction. Detrusor instability is likely to persist following TURP. Preoperative urodynamic assessment of obstruction in the incontinent male with benign prostatic hypertrophy may be useful since the severity of incontinence responds well to TURP if there is marked obstruction. Cognitive impairment should not be a deterrent to operation.

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PubMed1996

Expired breath ethanol measurement to calculate irrigating fluid absorption during transurethral resection of the prostate: experience in a district general hospital.

OBJECTIVE: To estimate differences in the absorption of ethanol-tagged irrigant fluid in patients undergoing transurethral resection of the prostate (TURP) using measurements of ethanol concentration in the breath. PATIENTS AND METHODS: The study comprised 100 randomly selected patients (mean age 71 years, range 38-85) undergoing TURP. At frequent intervals during TURP, the ethanol content of end-expiratory breath samples was measured using an alcometer, venous blood samples were drawn for determination of serum sodium, ethanol and haemoglobin concentration and the absorption of irrigant fluid and blood loss were estimated. These variables were compared between patients operated on by experienced and inexperienced surgeons. RESULTS: Ethanol was detected in the expired breath of 39 patients. Patients who absorbed irrigant fluid underwent longer operations than those who did not (median 33 min and 23 min, respectively; P < 0.01), had a greater weight of prostatic tissue resected (median 27.5 g and 16.5 g, respectively; P < 0.01) and lost more blood intra-operatively (median 295 mL and 143 mL, respectively; P < 0.01). Consultant urologists performed 75 of the operations, with 25 patients (33%) having detectable breath ethanol, and trainees carried out the remaining 25 operations, where 14 (56%) patients had ethanol detected in the expired breath. The difference in peak end-expiratory ethanol values between patients in the consultant and trainee group was significant (P < 0.0). Furthermore, the incidence of 'significant' irrigant fluid absorption, i.e. a peak breath alcohol > 300 mg/L (indicating > 1 L of irrigant absorption) was one patient (1.3%) from those operated upon by a consultant and four (16%) from those treated by a trainee (P < 0.05). CONCLUSIONS: Irrigant absorption occurs frequently during TURP and is more likely to occur in operations performed by trainee urologists.

Absorption↗

PubMed2004

Is routine post-operative haemoglobin measurement required after transurethral resection of the prostate?

The aim of this study is to evaluate the rate of blood transfusion during the post-operative period in patients undergoing transurethral resection of the prostate (TURP) and to determine the value of using post-operative haemoglobin (Hb) measurement as a guide to transfusion requirements. In a retrospective study, pre- and post-operative Hb measurements and the resected prostatic tissue weights were recorded for 106 patients. There was a statistically significant change in the Hb concentration within 48 h of the operation (P < 0.0001), although this was clinically insignificant in the majority of patients. The post-operative blood transfusion rate was 0.85% and there was a significant correlation between change in Hb concentration and the resected tissue weight (P < 0.0001). Our results show that routine post-operative Hb is not necessary in patients following a TURP.

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PubMed1986

Influence of various irrigation fluids on serum enzyme patterns following transurethral resection of the prostate.

Serum levels of a variety of enzymes were determined preoperatively and repeatedly postoperatively in a comprehensive biochemical study of 60 patients undergoing transurethral resection of the prostate (TURP). These patients were divided into four groups depending on the type of fluid used for irrigation during TURP. Prostatic acid phosphatase (PAP, analysed by radio-immunoassay) in serum showed a marked postoperative increase but wide inter-individual variation in all groups. It returned to normal within 24 to 48 hours. When water was used for irrigation, similar but less pronounced increases were observed for serum lactate dehydrogenase (LD, LD-1) and aminotransferases (ASAT, ALAT). This is interpreted as being due to an influx of irrigating fluid into the general circulation from the bladder through opened veins, by absorption from a perivesical accumulation or, in the case of PAP, also from the prostatic wound. The enzyme increases (other than PAP) may be due to their release from haemolysed red cells in the bladder or in a perivesical fluid accumulation, which conjecture is supported by the marked increase also seen in plasma haemoglobin. When iso-osmolar fluids were used for irrigation signs of haemodilution, such as a postoperative decrease in serum sodium, were observed. Several of the variables studied may be used as markers to indicate the quantity of irrigating fluid absorbed during resection. Plasma haemoglobin, serum LD (or LD-1) in connection with water irrigation, serum sodium in connection with iso-osmolar fluid irrigation and serum PAP, regardless of the type of irrigating fluid used, are some practical suggestions for such markers.

Acid Phosphatase↗

PubMed1991

Long term survival after transurethral resection of the prostate. Influence of preoperative bacteriuria and indwelling catheter treatment on late mortality.

In this report we have analysed the long term survival after transurethral resection of the prostate in patients with cancer and benign hyperplasia, with special reference to the effect of bacteriuria. One hundred and eighty-nine men were followed for seven years after operation. Life tables according to the Kaplan-Meier method indicated a decreased survival rate for patients with preoperative catheter treatment and/or bacteriuria (p = 0.004 and p = 0.013, respectively). In order to evaluate the influence on the long-term survival of each of these factors alone as well as of other factors like diagnosis, age at operation and perioperative antibiotic treatment, a multivariate analysis, according to Cox proportional hazards method was made. This displayed a two-fold increase of mortality in the patients attributed to the catheter treatment per se, whereas bacteriuria alone was not associated with an increased risk of earlier death.

Aged↗

PubMedDate not supplied

Average charges for a radical prostatectomy and a transurethral resection of the prostate (TURP): geographic variations, 1994.

In 1994 MetLife paid claims from group health policy insured for 1,004 radical prostatectomies and 1,597 transurethral resections of the prostate (TURPs). The total average hospital and physician charges were $18,680 and $7,600, respectively, with marked geographic variation evident for both procedures by area and state. The Pacific area led with a total charge of $20,790 for a radical prostatectomy, 11.3 percent above the U.S. average and the South Atlantic area reported the highest average TURP charges, $8,710 (14.6 percent above norm). For both surgeries, the East South Central area reported the lowest average total charge, 21.2 percent lower than the norm for a TURP and 30.9 percent lower than the national prostatectomy average. Charges 20 percent or more above the national average were reported in Illinois, California, Georgia and North Carolina for a TURP and in Illinois, California and Pennsylvania for a radical prostatectomy. Of the study states, Tennessee, Washington, Michigan and Oklahoma had charges 20 percent or more below the national average for a prostatectomy; Washington, Ohio, Tennessee, Alabama and Oregon each had average TURP charges 25 percent or more below the U.S. average. Physician fees differed by more than 95 percent between New York ($3,240) and Michigan ($1,660) for a TURP and by 113 percent between the doctors' charges for a prostatectomy in New York ($8,710) and those in Tennessee ($4,080). On average, patients remained in the hospital for 5.56 days for the radical procedure with lengths of stay ranging from 7.02 days in New York to 4.42 days in Missouri. TURP patients were in the hospital for an average of 3.66 days with Indiana patients staying the longest (5.58 days) and those in Oregon the shortest (2.29 days).

Cost Control↗

PubMed2005

[Anaesthesia and prostate surgery].

OBJECTIVES: To review the current data about anaesthetic management in prostate surgery with special regards on analysis and prevention of specific risks, appropriate anaesthetic procedure keeping with surgery and patient, recognition and treatment of adverse events. DATA SOURCES AND EXTRACTION: The Pubmed database was searched for articles (1990-2004) combined with references analysis of major articles on the field. DATA SYNTHESIS: It is strongly recommended to settle germfree urine in the preoperative period. The thromboembolic risk of radical retropubic prostatectomy for cancer parallels lower abdomen oncologic surgery and is prolonged. Preoperative evaluation of cardiovascular, respiratory, neurological and metabolic comorbidity is a source of prognostic information and an essential tool in the management of elderly patients with prostate disease. Extreme patient positioning applied in prostate surgery induces haemodynamic and respiratory changes and are associated with severe muscular and nervous injuries. The laparoscopic access for radical prostatectomy is a growing alternative to the open surgical procedure. Acute normovolaemic haemodilution is a consistent and cost-effective blood conservation strategy in reducing allogenic blood transfusion for radical retropubic prostatectomy. Whether open transvesical or transurethral prostatectomy for treatment of benign hypertrophy depends on the size of the gland: transurethral resection is safe up to 80 g. Intrathecal anaesthesia with a T9 cephalad spread of sensory block, produces adequate conditions for transurethral prostatectomy and allows a rapid diagnosis of irrigating fluid absorption syndrome. In spite of recommended preoperative antibiotic prophylaxis, bacteriemias are frequent during transurethral prostate resection.

Adenoma↗