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PubMed1997

Clinical significance of high-grade prostatic intraepithelial neoplasia in transurethral resection specimens.

OBJECTIVES: High-grade prostatic intraepithelial neoplasia (PIN) is the most likely precursor of invasive prostatic adenocarcinoma. The incidence and clinical significance of this lesion have not been previously defined in specimens from transurethral resections of the prostate (TURP). METHODS: To determine the frequency of PIN in TURP specimens and its relationship with adenocarcinoma, we reviewed 698 resections performed at Mayo Clinic between 1989 and 1990. A mean of 6 slides was analyzed for each case (range 1 to 36). The presence, extent, and architectural pattern of PIN were recorded. The results were correlated with many clinical and pathologic features, including patient age, Gleason score, stage, serum prostate-specific antigen (PSA) concentration, and patient follow-up. In a 1:2 nested matching case-control study, we compared the outcome of cases with PIN alone with that of the control group. Each patient with PIN alone (16 patients) was matched randomly with 2 patients with benign prostatic hyperplasia (BPH) alone (32 patients) according to age (+/- 5 years) and serum PSA concentration (+/- 1 ng/mL). RESULTS: Of 698 TURP specimens, 570 (81.7%) contained BPH and 128 (18.3%) contained adenocarcinoma and BPH. High-grade PIN was identified in 29 cases (4.2%), including 16 (2.8%) of those with BPH and 13 (10.2%) of those with cancer and BPH. Follow-up revealed adenocarcinoma in 3 of 14 patients (21.4%) with PIN and BPH only after 3, 5, and 7 years, respectively; mean follow-up for the 14 patients was 6 years (range 4 to 7 years), and none of the patients died of prostate cancer. Conversely, none of the patients (0%) without PIN in TURP specimens in the case-control study had subsequent adenocarcinoma. CONCLUSIONS: The overall incidence of PIN in TURP specimens was 4.2%, including 2.8% without cancer and 10.2% with coexistent cancer. Prostatic adenocarcinoma was diagnosed within 7 years in 21.4% of patients with PIN in TURP specimen. Conversely, none of those without PIN matched for age and serum PSA had adenocarcinoma at follow-up. These results indicate that high-grade PIN is uncommon in TURP specimens and, when found, indicates a significant risk of cancer. The presence of PIN in TURP specimens should be reported by the pathologist; in addition, the entire specimen should be submitted for histologic examination to exclude carcinoma.

Adenocarcinoma↗

PubMed2006

A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years.

OBJECTIVE: To compare holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP) for treatment of men with bladder outflow obstruction (BOO) secondary to benign prostatic hyperplasia with a minimum of 24-month follow-up. PATIENTS AND METHODS: Sixty-one patients were randomised to either HoLEP or TURP. All patients had BOO proven on urodynamic studies pre-operatively (prostate size 40-200 g). One patient died before treatment, which left 30 patients in each group. Perioperative data, as well as symptom scores, Quality of Life (QoL) scores, and maximum urinary flow rates (Qmax) were obtained at one, three, six,12, and 24 months. Post-void residual volumes, transrectal ultrasound (TRUS) volumes, and pressure flow studies were obtained six months post-operatively. Continence and potency data were also recorded. RESULTS: There were no significant differences between the two surgical groups pre-operatively. Mean pre-operative TRUS volume was 77.8+/-5.6 g (42-152) in the HoLEP group and 70.0+/-5.0 g (46-156) in the TURP group. Patients in the HoLEP group had shorter catheter times and hospital stays. More prostate tissue was retrieved in the HoLEP group. At six months, HoLEP was urodynamically superior to TURP in relieving BOO. At 24 months, there was no significant difference between the two surgical groups with respect to American Urology Association scores, QoL scores, or Qmax values; however, two patients in the TURP group required re-operation. CONCLUSIONS: HoLEP has less perioperative morbidity and produces superior urodynamic outcomes than TURP, when treating prostates >40 g. At 24 months of follow-up, HoLEP is equivalent to TURP.

Aged↗

PubMedDate not supplied

Transurethral prostatectomy using Vista bipolar radiofrequency system: comparison with conventional transurethral resection of the prostate.

To assess the efficacy and safety of transurethral prostatectomy using Vista system, between 2002 and 2004, patients with symptomatic BPH without suspected cancer were treated using the Vista device. The therapeutic effect was retrospective studied compared with patients who were received by TURP. Bipolar resection using the Vista device exhibits a statistically difference in maximum urinary flow rate, RUV, IPSS and QOL(P < .05) 3 and 6 months after operation, and no transurethral resection syndrome occurred. TURP also exhibits a statistically difference in maximum urinary flow rate, RUV, IPSS and QOL(P < .05), but TURS occurred in 2 patients. Compared with TURP, the Vista device shows a statistically less blood loss (P < .05), and longer operation time in prostate enlarged III(0)(P < .05). The Vista system seems to be effective and safe, and especially fit the patients who have a bigger prostate and high risk factors. It appears to be an effective treatment for BPH. Long-term results should be evaluated.

Aged↗

PubMed2001

Computer-assisted transurethral laser resection of the prostate (CALRP): theoretical and experimental motion plan.

Computer-Assisted transurethral laser resection of the prostate (CALRP) is a treatment modality that was designed and developed based on an integrated system of computer, robotics and laser technology in association with a minimally invasive surgery known as laser transurethral resection of the prostate (LRP). CALRP possesses complementary capabilities that could remedy many of the problems faced by surgeons in conventional LRP by delivering a treatment with repeatability and reliability. The work deals primarily in determining the feasibility study of the computer-assisted lasing motion plan (planned motion sequence controlled by a program) for LRP. A theoretical motion plan that analyzes numerically the lasing motion of the fiber was designed by calculating the profile removal rate and in vitro experiments conducted on human cadaveric prostate to verify and validate the designed motion plan. The novel motion plan, which was executed experimentally using the LaserTrode lightguide, accomplished the objective of resecting the enlarged prostate with the aid of computer and robotics technology.

Cadaver↗

PubMed1998

Transurethral resection of the prostate and laser prostatectomy under local anesthesia.

OBJECTIVE: To perform transurethal resection of the prostate (TURP) and transurethral laser ablation prostatectomy (TULAP) under appropriate local anesthesia. PATIENTS AND METHODS: A total of 54 patients were examined in this study. We carried out TURP in 42 and TULAP in 12 of them under local anesthesia with lignocaine chloride. Patient's discomfort was recorded by means of a four-point descriptive pain scale. RESULTS: We had perfect pain control in the majority of the patients. Patient's acceptance was very high. No patient required conversion to general anesthesia. Complications due to local anesthesia were not observed. CONCLUSION: We believe that ours is a simple, safe and effective procedure.

Aged↗

PubMed1977

[Prevention of thromboembolic complications in transurethral resection of the prostate (author's transl)].

1. The effect of 2 X 500 ml Dextran 70 i.v. for prevention of postoperative deep vein thrombosis in patients with transurethral resection of the prostate was investigated in a controlled, prospective and randomized study. The diagnosis of deep vein thrombosis was made by means of the 125I-fibrinogen test. 2. A total of 86 patients were studied. Two out of 47 in the control group developed deep vein thrombosis and 3 out of 39 in the dextran group. The total number of all thromboembolic complications in the control group is 19.2% as compared to 7.7% in the dextran group. This difference is statistically seen not significant. 3. Dextran prophylaxis showed no side effects. 4. A search of the literature on thromboembolic complications in urology shows the following. The incidence of deep vein thrombosis is general urology is about the same as in general surgery, i.e. every third patient develops deep vein thrombosis. There are no studies which would show that the number of fatal pulmonary emboli can be significantly reduced by any sort of preventive method in urologic patients. 5. The incidence of deep vein thrombosis in open prostatectomies is around 50%. In transurethral resection, however, this figure is between 5 and 10%. But nevertheless there are fatal pulmonary emboli. There exist no studies showing a significant reduction in the incidence of deep vein thrombosis after prostatectomy by any form of prevention. In order to avoid the postthrombotic syndrom and fatal complications, a prevention of thromboembolism seems reasonable, if this form of prevention has minimal side effects.

Adult↗

PubMed2006

[Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH].

UNLABELLED: OBJECTIVES-INTRODUCTION: Retrospective study of a series of patients with prostate surgery (suprapubic prostate adenomectomy -APS-, and prostate transurethral resection -RTU-P-) for presumed BPH symptomatic non-respondent to the conservative medical treatment. Analysis of prevalence, incidence, clinical-pathological, treatment, tumor progression and evolution of the patients with incidental prostate cancer (CPI) detected. MATERIAL AND METHODS: 1593 patients with prostate surgery (APS and RTU-P) during 6 years (1996-2001) were revised. APS 35%, RTU-P 65%. Revision of all pathological anatomy of surgical specimens and the evolutions of the patients with CPI. RESULTS: 78 CPI; Prevalence 4,89%; Incidence 13 cases/year. Mean age 73.6 years. Digital rectal examination was normal in 100%, mean PSA 6 ng/ml (0.5-30). Group APS: 25 CPI (32%); prevalence 4.55%; incidence 4 cases/year; mean PSA 7.7 ng/ml (2.8-30); mean weight resection 65 gs. Group RTU-P: 53 CPI (68%); prevalence 5,07%; incidence 9 cases/year; mean PSA 5.2 ng/ml (0,5-29); mean weight resection 20 gs. 22% biopsy previously by high PSA, mean PSA 14 ng/ml (4,8-30). Gleason average 5 (mean 4.8), rank 3-8. pTla 66%, pTlb 33%. TREATMENT: 57% follow-up watched without treatment (wait and see); 18% hormonal treatment; 3% finasteride; 9% Radical Prostatectomy; 9% radiotherapy. Follow Lost 4%. Mean follow-up 47.19 months (12-96). Tumor progression 13.3% (10 patients). Specific CPI mortality 2.6% (2 patients). CONCLUSIONS: We didn't observe significant differences between the prevalence of CPI in both groups (APS and RTU-P). The detected tumours were mainly well differentiated and in stage pTla. In more than half of the cases an expectant attitude without treatment was decided. 13,3% of tumor progression after 47.19 months of follow mean and specific CPI mortality 2.6%.

Aged↗

PubMed1987

[Bed-side management of post-operative bleeding in transurethral resection of the prostate--hemostatic trial with thrombin solution injected into the resected cavity of the prostate].

To control post-operative bleeding from the resected cavity in transurethral resection of the prostate (TUR-P), 20,000 units of thrombin dissolved in 5-20 ml of physiological saline was injected into the cavity in one shot with a new type of 3-way Foley catheter. The catheter has two holes close to the balloon, and the holes provide outlets through which the solution is directly injected into the cavity. Out of 23 patients between 58 and 87 years old, 11 were given thrombin and 12 were control cases. In each case, urine blood volume (ml/hr) was determined before (a) and after (b) injection. The hemostatic effect was assessed with a "hemostatic index" of b/a. There was a statistically significant difference in the hemostatic indices between thrombin group and the control. (p less than 0.02) This new hemostatic method proved to be a very useful easy bed-side technique to control bleeding even in sudden bleeding after TUR-P. No serious side effects were found during the course of this study.

Aged↗

PubMed1985

Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia.

Heat loss during anaesthesia and surgery is a common problem. In patients with restricted cardio-pulmonary reserves this may endanger the postoperative outcome. In order to compare thermal balance we studied 25 men undergoing transurethral resection of the prostate (TURP), using either general anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per- and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines increased, while no such changes could be detected using epidural analgesia. The ability to increase mean body temperature by increasing heat production was negatively correlated to age.

Age Factors↗

PubMed1996

Do low molecular weight heparin and dextran increase the blood loss in transurethral resection of the prostate?

OBJECTIVE: To evaluate whether the use of dextran or the combination of low molecular weight heparin and dextran increases the blood loss in elective transurethral resection for benign prostatic hyperplasia. PATIENTS AND METHODS: This open randomized controlled study included 198 patients operated under spinal anaesthesia who were allocated to four groups differing in the combination of prophylactic treatment used for thrombosis and for the substitution of blood loss. The prophylactic treatment was either dalteparin sodium, continued each day until mobilization, or 3% Ringer dextran-60 just before operation and continued with 6% dextran-70 for 2 days post-operatively, and the volume substitute was Ringer dextran or Ringer's acetate. Thus, the four treatments (by prophylaxis and volume substitute, respectively) were dalteparin and Ringer's acetate, dalteparin and dextran, dextran and Ringer's acetate, and dextran and dextran. The haemoglobin lost to the irrigation fluid was measured and used to calculate blood loss. RESULTS: Patients receiving dextran had a larger post-operative and total blood loss than those who did not. The need for transfusion did not differ between the treatment groups. CONCLUSION: The combination of dalteparin and dextran was not associated with an increased blood loss above that with dextran alone.

Aged↗

PubMed1994

Urinary control after radical transurethral resection of the prostate in male paraplegics: urodynamic evaluation of its effectiveness in relieving incontinence.

We report our investigation of urinary incontinence in 51 male paraplegics with radical transurethral resection of the prostate. Pre-operatively, 28 cases (55.9%) had moderate or severe incontinence, which persisted post-operatively only in 21 cases (41.2%) and was less severe. Post-operatively, bladder compliance was improved from 22.1 +/- 22.6 ml/cmH2O to 36.4 +/- 38.5 ml/cmH2O, and the maximum pressure of uninhibited detrusor contraction was reduced from 40.2 +/- 21.5 cmH2O to 18.3 +/- 19.0 cmH2O. These significant improvements are thought to contribute to the relief of urinary incontinence, regardless of the reduction in maximum urethral closure pressure.

Adult↗

PubMed1994

Total transurethral resection versus minimal transurethral resection of the prostate--a 10-year follow-up study of urinary symptoms, uroflowmetry and residual volume.

OBJECTIVE: To assess the long-term results of total transurethral resection (T-TURP) and minimal transurethral resection of the prostate (M-TURP) in patients with obstructive symptoms caused by benign prostatic hyperplasia. PATIENTS AND METHODS: Between September 1979 and September 1980, 167 patients were studied: 83 were randomized to T-TURP and 84 to M-TURP. The patients were examined pre-operatively and 6 and 12 months post-operatively. Ten years post-operatively they were invited to attend for further examination, including uroflowmetry, determination of residual volume and evaluation of subjective symptoms. RESULTS: At the 10-year follow-up 39 patients were found to have died and 47 were lost to follow-up. Twelve patients had undergone repeat TURP and seven had been treated for urethral stricture. Thus 33 T-TURP and 29 M-TURP patients underwent detailed examination. Significant relief in obstructive and irritative symptoms was seen in both groups. The improvement in maximum flow rate remained stable throughout the follow-up period, with no significant differences between the two groups. Post-void residual urine decreased throughout follow-up, with minor differences between the groups. CONCLUSION: M-TURP is recommended as an alternative to T-TURP.

Adult↗

PubMed1982

Immunological responsiveness after transurethral resection of the prostate: general versus spinal anaesthetic.

The effects of surgery on the immune response (as measured by a variety of parameters) were examined in patients undergoing transurethral resection of the prostate (TURP) for benign disease. Two groups were assessed, one having the procedure performed under a general anaesthetic and the other under a spinal anaesthetic. A significant reduction in lymphocyte numbers and in the response of lymphocytes to the mitogens PPD and PWM and to histocompatibility antigens in mixed lymphocyte culture was seen in patients after TURP under a general anaesthetic but minimal changes were found in the patients who had a spinal anaesthetic. Cortisol levels were not elevated in either group after surgery. The immunodepression occurring after TURP appears to be due to general anaesthesia rather than the trauma of the surgery.

Aged↗

PubMed1993

Predeposit autologous blood transfusion in elderly patients undergoing transurethral resection of the prostate.

In order to reduce the rate of homologous blood transfusion, predeposit autologous blood transfusion has been introduced in 134 out of 266 patients undergoing transurethral resection of the prostate since February 1988. Nine (6.7%) out of 134 patients who deposited their own blood were also transfused with homologous blood. In contrast, the rate of homologous blood transfusion was 22.7% in 132 patients who did not deposit autologous blood. Overall homologous blood transfusion rate (14.7%) in the past 4.5 years has been much lower than in the previous 4 years (22.2% in 203 patients). In 6 patients in whom blood donation was performed concurrently with administration of recombinant human erythropoietin, decrease of haemoglobin level was significantly less than in those without rHuEPO. Predeposit autologous blood transfusion can reduce homologous blood transfusion rate. It is safe and easily performed, and more effective when combined with rHuEPO administration even in elderly patients undergoing TURP.

Aged↗

PubMed1997

Length of postoperative hospital stay after transurethral resection of the prostate.

The aim of the study is to explore the value of audit in investigating and reducing the length of stay (LOS) of patients after transurethral resection of the prostate (TURP). All TURPs in a district general hospital (DGH) were audited over 30 weeks. Particular attention was paid to patients whose LOS was longer than the average for the group (mean: 6.4 nights; median: 5 nights). Older age of the patient, larger resections and late removal of suprapubic catheters were statistically significant in prolonging LOS (P < 0.001). General anaesthesia was associated with longer stay than regional anaesthesia, but the difference was not statistically significant. Among patients whose LOS exceeded the average of 6 nights, social circumstances and detrusor underactivity were the most important causes of late discharge, accounting for 44% (28/63) of these cases. Where factors were avoidable, changes were implemented. Increased use of regional anaesthesia was encouraged. Catheters were removed earlier, and discharges, whenever possible, were pre-planned. A re-audit was carried out 1 year after the original audit and a significant decrease in LOS was found (mean: 5.2 nights; median: 4 nights; P < 0.01). Audit can increase awareness of prolonged hospital stay and highlight areas for change. Re-audit can confirm the effectiveness of these changes.

Age Factors↗

PubMed1998

Transurethral resection of the prostate vs high-energy thermotherapy of the prostate in patients with benign prostatic hyperplasia: long-term results.

OBJECTIVE: To evaluate the outcome and durability of high-energy transurethral microwave thermotherapy (HE-TUMT) in comparison with transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Fifty-two patients with BPH and lower urinary tract symptoms were randomized and treated either by TURP (21 patients; mean prostate volume 45 mL, SD 15) or HE-TUMT (31 patients, mean prostate volume 43 mL, SD 12). Long-term results were obtained at a mean (SD) follow-up of 2.4 (0.5) years. RESULTS: During the follow-up, the mean symptomatic improvement stabilized at 56% after TUMT and 74% after TURP. The mean maximum urinary flow rate increased by 62% after TUMT and 105% after TURP. Before treatment, 78% of patients in the TURP group were obstructed according to urodynamic investigation and after treatment, 14% remained obstructed. In the TUMT group, 67% of patients were obstructed before treatment and 33% remained so afterward. Six patients (19%) underwent TURP after TUMT (four after 1 year) and two patients were also treated with medication. One patient underwent a bladder neck incision after TURP to treat bladder neck sclerosis. Three patients were not satisfied with the outcome after the additional TURP. CONCLUSION: Both treatment modalities show good symptomatic and objective results at > 2 years of follow-up. Most re-treatments were performed > or = 1 year after treatment and were based on subjective findings.

Aged↗

PubMed1993

[Early detection of absorption of irrigating fluid during transurethral resection of the prostate with alcohol gas detector tube].

Nineteen patients (mean age, 70 years; range, 58-80 years) undergoing elective transurethral resection of benign hypertrophy of the prostate (mean weight of resectate, 25 g; range 10-59 g; mean resection time, 61 min; range 45-80 min) under spinal anesthesia were studied for early detection of absorption of irrigating solution by means of expired breath alcohol analysis. The irrigating fluid used in all resections was tenfold diluted Urigal solution containing 1% ethanol. Expired breath was collected into a rubber bag every 10 min during the surgery, and the concentration of ethanol was analyzed using a gas detector tube (GASTEC LTD.). Hemodynamic parameters including central venous pressure were routinely measured at the same intervals. The volumetric fluid balance was measured every 20 min. Blood was collected preoperatively, at the same 20-min intervals during the resection, and 4-6 hours after the end of the operation. Serum electrolytes, hemoglobin and total plasma protein concentration were measured, and blood gas tension was analyzed. Mean arterial pressure, central venous pressure, blood gas tension showed no significant changes at these observed time intervals. Heart rate decreased 120 min after the start of the operation. Ethanol was detected in the expired breath 10 min after the start of the surgery, and showed progressive increase in concentration until the end of the surgery. Serum electrolyte concentrations and hemoglobin content showed gradual decrease proportional to the increase in irrigating fluid volume. The ethanol concentration in the expired breath was significantly correlated with the change in serum sodium concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗

PubMed2001

Acute myocardial infarction after transurethral resection of the prostate.

Several factors inherent in the transurethal resection of the prostate (TURP) procedure may impose stress on the cardiovascular system. The risk of acute myocardial infarction (AMI) is usually considered to be low but has still been an issue during the last 10 years. Interestingly, the concerns are focused on a possible adverse effect of TURP on the long-term risk of AMI and on survival. Selection bias has been a problem in many of the published studies, however. Co-morbidity is also difficult to handle when the follow-up lasts for several years, in particular since benign prostatic enlargement alone seems to be associated with an increased risk of cardiovascular disease.

Humans↗