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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↗
PubMed2005

New bipolar resection device for transurethral resection of the prostate: first ex-vivo and in-vivo evaluation.

BACKGROUND AND PURPOSE: Bipolar resection systems for transurethral resection of the prostate (TURP) offer some advantages over conventional monopolar devices. As both the active and the return electrode are placed on the tip of the resectoscope, current flow is locally limited, and negative effects caused by the current flow through the patient's body in the monopolar array can theoretically be reduced. Furthermore, bipolar resectoscopes use 0.9% sodium chloride solution as irrigation fluid, and therefore, the risk of TUR syndrome is theoretically eliminated. In this trial, we evaluated a new bipolar resectoscope in an ex-vivo model and in vivo and compared it with a standard monopolar resection device. MATERIALS AND METHODS: The modified model of the isolated blood perfused porcine kidney was used to determine cutting qualities, ablation rate, blood loss, and coagulation depth of the bipolar resection device compared with a monopolar resectoscope. A measurement system placed in the line between the generator and the patient was used to determine electric parameters when both resectoscopes were used in vivo. RESULTS: The ex-vivo evaluation showed worse cutting ability of the bipolar resection device compared with the monopolar resectoscope, with essential difficulties in starting a cut. The ablation rate was equal, as both resectoscopes had the same loop diameter. The bleeding rate was lower in bipolar (15.16+/-3.31 g/min) than monopolar (20.78+/-1.52 g/min) resection, whereas bipolar cutting resulted in marginally deeper coagulation zones (236.25+/-36.69 microm 216.0+/-42.25 microm). The in-vivo measurements made it clear that more power and more current is delivered to the patient during bipolar resection. The reason lies in a period at the beginning of each cut, when the patient's impedance is low and current flow high. CONCLUSION: Our results suggest that bipolar resection offers an alternative to conventional monopolar TURP. The advantage of a more localized energy field is at least in part compensated for by the higher generator output power during the procedure. Our ex-vivo results indicate a reduced bleeding rate compared with monopolar resection. Clinical studies have to be performed to prove the significance of our findings for patient treatment.

Animals↗
PubMed1991

Dilutional hyponatraemia following transurethral operation for clot retention.

Dilutional hyponatraemia with symptoms (TUR syndrome) may occur not only in association with transurethral prostatic resection, but also in other operations in which electrolyte-free irrigating fluid is used. This case report describes a patient who developed the TUR syndrome after blood clots had been removed from the bladder with the aid of a transurethral resectoscope.

Aged↗
PubMed1984

Independent plasma levels of sodium and glycine during transurethral resection of the prostate.

This study was done to evaluate the potential role of plasma glycine levels as an indicator of the biochemical changes occurring during or shortly after transurethral resection of the prostate ( TURP ). Seventeen patients undergoing TURP were studied to determine the fate of the absorbed glycine and its effects on other amino acids and their relationship to changes in serum sodium and osmolarity. Twelve patients showed more than 100 per cent increase in plasma glycine levels with values ranging to more than 100-fold elevation. Only two patients showed a change in serum sodium of greater than 10 mEq/l with corresponding change in osmolarity. In one such patient there was no accompanying change in plasma glycine. Thus, major changes in plasma glycine and serum sodium may occur independently of one another, and may separately account for manifestations of the reactions following TURP .

Aged↗
PubMed1997

The use of generic measures of health-related quality of life in the assessment of outcome from transurethral resection of the prostate.

OBJECTIVES: To investigate the performance of the EuroQol (EQ) quality-of-life measure and the Nottingham Health Profile (NHP) in assessing the outcome of transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO), and to determine which men experience the greatest increase in health-related quality of life (HRQL) after TURP. PATIENTS AND METHODS: A prospective cohort study was undertaken over 12 months from Arpil 1992 of 314 men who completed the EQ, the NHP and a symptom inventory before undergoing elective TURP for probable BPO (Group 1). Identical postal questionnaires were used to follow up this group at 6 weeks, 6 months and 12 months post-operatively, with response rates of 79%, 74% and 69%, respectively. Overall, 92% of patients responded at either 6 or 12 months after surgery. A group of 51 men who had not undergone operation, also with LUTS and probable BPO, were similarly followed over 6 months, before eventually undergoing TURP (Group 2). These patients differed from Group 1 in being younger, less symptomatic and having a higher baseline quality-of-life score, but the inclusion of this group from a broadly similar diagnostic category allowed outcome to be assessed over time in the absence of surgery. RESULTS: There was a significant improvement in all LUTS 6 weeks after TURP; post-micturition dribbling and storage symptoms continued to improve for up to one year. The NHP revealed pre-operative morbidity in all dimensions of the profile. At 12 months after surgery there were significant improvements in the domains of social interaction, energy, pain, emotional reactions and sleep. The EQ profile also showed morbidity in all dimensions before surgery, with significant improvement at 12 months in usual activities, mood and pain/discomfort. The EQ self-rated health and composite quality-of-life score also showed improvement with TURP which continued for 12 months after surgery. The patients in Group 2 tended to deteriorate over the 6 months of follow-up using all measures, but the changes were not significant. The EQ composite quality-of-life score also discriminated between patients on the basis of age, number of symptoms and ASA grade, suggesting that these subgroups experienced differing amounts of benefit from surgery. CONCLUSION: TURP led to significant improvement in the indices of generic HRQL as measured using the NHP and EQ; this improvement continued for 12 months after surgery and mirrored the symptomatic improvement. The EQ confirmed clinical experience, in that men who were younger, fitter and most symptomatic experienced the greatest benefit from surgery. This has not been shown previously using a quality-of-life measure. Generic HRQL measures can be incorporated easily into clinical trials and both the measures used in this study have sufficient sensitivity to be used in this population. The EQ has the advantage of generating a composite quality-of-life score which is easy to interpret and can be used in cost-utility analysis. The addition of HRQL measures leads to a more robust appraisal of the results of surgical intervention. Ultimately, patient-based outcome from TURP will be assessed using a combination of psychometrically tested disease-specific and generic measures, together with symptom scoring.

Activities of Daily Living↗
PubMed1998

Haematuria and clot retention after transurethral resection of the prostate: a pilot study.

OBJECTIVE: To determine, prospectively, the effect of clinical factors on the duration of frank haematuria and the incidence of clot retention after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Seventy-nine men who underwent TURP in a 3-month period were entered into this study, during which the time to cessation of bleeding and the occurrence of clot retention(s) were recorded over a 4-week period. The effect of other clinical factors (histology, weight of tissue resected. operative duration, grade of surgeon and resection rate) was also assessed. RESULTS: Gross haematuria ceased in 47%, 73%, 96%, and 97% of patients at the end of the first, second, third and fourth weeks, respectively. The duration of postoperative bleeding was significantly associated with the weight of tissue resected and the operation time (P<0.001 and <0.05, respectively). Furthermore, five patients were re-admitted with clot retention, but there was no significant correlation between the occurrence of this morbidity and any of the other indices. CONCLUSION: Postoperative bleeding usually stops within 3 weeks of TURP. This period, which is about half the time hitherto assumed, is directly related to the size of the gland resected and the duration of the procedure. However, the occurrence of clot retention is not significantly associated with the duration of haematuria or any of the other clinical factors evaluated. Thus, a high fluid intake is mandatory for 3 weeks after TURP, but men who continue to bleed should be advised to continue with a high-fluid regimen until their urine is clear.

Aged↗
PubMed1988

Relations between irrigant absorption rate and hyponatraemia during transurethral resection of the prostate.

The serum sodium concentration (S-Na) and the volume of irrigating fluid absorbed were measured during 10-min periods in the course of 85 transurethral resections of the prostate (TUR). The hyponatraemic response to absorption of the irrigant was found to be dependent on the volume of fluid absorbed and the time required for the absorption. During the first 10 min of absorption the distribution volume of the irrigating medium was roughly equal to the extracellular space, but after this period the volume was greater. The sodium level could be compensated for further absorption to the extent of 200-300 ml irrigant per 10-min period; when this volume was exceeded, hyponatraemia was aggravated. The results indicate that in the development of the very low S-Na level typical of a severe TUR reaction, a rapid massive absorption is a more important factor than a large total absorbed volume.

Absorption↗
PubMed1993

[Autologous blood transfusion in transurethral resection of the prostate].

With the purpose to avoid the risk of transfusion mediated infection and complication, predeposited autologous blood transfusion was performed. From April 1990 to March 1991, transurethral resection of the prostate (TUR-P) were performed in 27 patients (mean age: 72.5 years) with benign prostatic hypertrophy (BPH). Autologous blood (200-400 ml, mean 244 ml) was predeposited 3 weeks prior to TUR-P in 18 patients (mean age: 73.9 years) and transfused during or just after the operation in 16 (five patients required some homologous blood in addition to their own banked blood). Another three patients were transfused with homologous blood only. The mean values for hemoglobin concentration were 13.7 +/- 0.4 g/dl before blood deposition and 12.8 +/- 0.5 g/dl on the day of operation (recovery rate: 92.5 +/- 2.7%). Although no complication was found in autologous blood transfusion group (11 patients), one case of systemic exanthema and one case of type C hepatitis were observed in homologous blood transfusion group (8 patients). In TUR-P, positive correlations were observed among resected prostate weight (Pro-wt), blood loss (B.) and operation time (Op-T.). Correlation efficient between Pro-wt. and B. was 0.80, that of B. and Op-T. was 0.77 and that of Pro-wt. and Op-T. was 0.85. From these results and ultransomographic measurement of the prostate weight, the amount of blood loss can be calculated preoperatively, there by the amount of blood needed for transfusion will be estimated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Intraprostatic tissue infection in catheterised patients in comparison to controls.

OBJECTIVE: To determine the effect of indwelling urinary catheter on frequency of intraprostatic tissue infection and posto-perative morbidity in patients with benign prostatic hyperplasia undergoing transurethral resection of prostate (TURP). METHODS: Frequency of intraprostatic tissue and urinary infection, prevalent organisms, histopathology of prostatic tissue, post-operative morbidity were analyzed for 25 consecutive patients' of clinically diagnosed benign prostatic hyperplasia who underwent TURP in catheterized and non-catheterized groups. RESULTS: Patients mean age was 62.2+7.9 years. In non-catheterized group nocturia and frequency were the most common symptoms. Ninety two percent and 28% patients acquired intraprostatic tissue infection in catheterized and non-catheterized group respectively, while 80% of catheterized patients and 24% of the non-catheterized patients had bacteriuria. Catheterized patients had E. coli as prevalent organism both in intaprostatic tissue and urine (34.8% and 40% respectively). E. coli Serratia and enterobacter were equally prevalent in intraprostatic tissue of non-catheterized patients. Enterobacter was the prevalent organism in urine (50%) of these patients. There was no significant difference in the presence of non-specific inflammatory cells in the two groups. Catheterized group showed significantly high frequency of fever >38.5 degrees C and hematuria for more than 24 hours. CONCLUSION: Catheterization significantly increases the frequency of intraprostatic tissue infection as well as morbidity of TURP.

Aged↗
PubMed1992

Clinical information system that enhances the use of resources in endoscopic prostatic procedures.

In this study we evaluated, by means of an automated management system, the identification of subgroups of patients within certain operative categories whose predictable length of stay was compatible with treatment on a 5-day ward. This was achieved by using a computer directed analysis of urological workload on prospectively collected clinical data. Graphical presentation of the results was achieved by a technique known as the patient-bed dissociation curve. Patients with bladder outflow obstruction treated by transurethral prostatic resection (701) and bladder neck incision (113) were selected from a total of 7,162 hospital admissions. The main outcome measures were length of stay and complication rates for the 2 procedures. The results demonstrated that a group of patients about to undergo transurethral resection could be selected by age and source which would indicate an 18% greater probability of discharge within 5 days. These patients were easily identifiable in advance and would be suitable for treatment on a 5-day ward. It was concluded that computer-held clinical data were easily accessible to the surgeon. The process of detailed analysis need not take time. With properly directed studies the information retrieved could be used to effect change. The patient-bed dissociation curve may prove a valuable tool in examining and comparing discharge patterns in any groups of patients.

Adult↗
PubMed1987

Transurethral incision versus transurethral resection of the prostate for the treatment of benign prostatic hypertrophy. A preliminary report.

Thirty-seven patients with prostatism and an estimated prostatic weight of less than or equal to 20 g were randomly allocated to transurethral incision or resection of the prostate. Both procedures had an 85% success rate as judged by patients' personal evaluation. At 3 and 12 months follow-up a significant and identical improvement was noted in symptom score and uroflowmetry in the two groups. Postoperative catheterization time and hospital stay was only half as long in the incision group as in the resection group. No patients became impotent as a consequence of the procedures. Frequency of retrograde ejaculation was 28% in the incision group versus 100% in resected patients. Incision of the prostate is easy to perform and seems to be followed by less severe complications. It has a high patient acceptability and may cut the cost of transurethral surgery.

Aged↗
PubMed2001

Iatrogenic ejaculation disorders and their prevention.

Ejaculation is mediated by sympathetic fibers originating from the D10-L2 medullar center. These nerves rise from the lumbar ganglia of the paravertebral sympathetic trunk and travel posteriorly to the vena cava and then to the interaortocaval space, on the right side, and laterally to the aorta, on the left side. They are the principal constituents of the superior hypogastric plexus. Many surgical operations can cause an ejaculation disorder, but the most important is retroperitoneal lymphadenectomy (RL) for testis cancer, because it involves young patients and it has been the subject of important researches in order to perform lymph node dissection without ejaculation loss (unilateral lymphadenectomy and nerve sparing lymphadenectomy). Our experience concerns 41 patients who underwent RL for testis cancer from 1983 to 1998. Survival rate was 95.2% (mean follow up 64 months). RL was performed bilaterally in 14 patients. Two of them died of metastases within 2 years after the operation. Ejaculation was maintained in only 4 of the 12 surviving patients (33%). All the 17 patients (100%) underwent right monolateral RL and 7 of the 10 (70%) underwent left monolateral RL preserved ejaculation. The anatomosurgical concepts of the RL sparing the ejaculation can be adopted in other retroperitoneal surgical operations that can produce ejaculation disorders, such as wide lymphadenectomy for renal cell carcinoma or tumors of the upper urinary tract, exeresis of pre- aortic tumors, exeresis or disjunction of horseshoe kidney and aorto-iliac revascularization. Surgical therapy of benign prostatic hyperplasia (BPH) (open surgery or transurethral prostatic resection) is associated with retrograde ejaculation in nearly 100% of cases. The mechanism of the dysfunction is clear, if following the procedure the bladder neck remains opened. Loss of ejaculation is reported in variable percentage after the newer endoscopic techniques for the treatment of BPH. Transurethral needle ablation (TUNA) seems to have the lower risk of retrograde ejaculation. Retrograde ejaculation can also be related to a traumatic injury of the posterior urethra, because of the trauma itself or the therapy. Finally, the ejaculation disorder can be produced by several drugs that block, as a main or secondary effect, the alpha-adrenoreceptors or act at the central level. This side effect has to be kept in mind when these drugs are used in young or sexually active patients.

Ejaculation↗
PubMed1998

Evidence-based care of Chinese men having transurethral resection of the prostate (TURP).

AIM OF STUDY: To measure the effect of specific preoperative information on postoperative anxiety, satisfaction with information, and demand for analgesia, of Chinese males having transurethral resection of the prostate (TURP). DESIGN: A controlled experimental design. The researchers allocated all patients (n = 30) undergoing TURP in a general hospital in Hong Kong, during a 3-month period, to one of two groups. The experimental group (n = 15) received a specific information pamphlet and a general preoperative counselling video. The control group (n = 15) received a video alone. PROCEDURE AND MEASURES: Following ethical approval, a researcher took baseline measures of state and trait anxiety using the Chinese State-Trait Anxiety Inventory (C -STAI). Five days after surgery the researcher administered the C-STAI (A-State), a patients' satisfaction questionnaire, and, recorded requests for analgesia during the first 5 postoperative days. RESULTS: Experimental subjects reported significantly lower anxiety levels post-operatively and a significantly higher level of satisfaction with the preoperative information, than controls. Postoperative demand for analgesia did not significantly differ between groups. CONCLUSIONS: The findings support the importance of providing patients with specific, written preoperative information about their surgery and its effects to minimize their postoperative anxiety levels, and improve their satisfaction with the care provided.

Anxiety↗
PubMed2001

[Infectious myocarditis--clinical and morphological diagnosis (a literature review)].

For comparative evaluation of patient life quality we selected 3 groups depending on methods of surgical treatment of prostate benign hyperplasia. The groups of comparison included the patients who underwent prostate transurethral resection (n = 36), postpubic extravesical adenomectomy (n = 31) and transvesical adenomectomy (n = 35). It was established that informative clinical indices in evaluation of life quality were urination maximal rate, time of urination delay, urination time. Informative psychodiagnostical methods for evaluation of life quality in patients with benign hyperplasia of prostate are "MCF scale", "Asthenia scale", Test for differential self-appraisal of functional state, "Scale of reactive and personal anxiety", "Risk of coronary behavior" and Izenk's questionnaire. Total algorithm was developed permitting to predict the patient life quality with rather high accuracy.

Biomarkers↗
PubMed1995

A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate.

OBJECTIVES: To assess the safety and efficacy of endoscopic laser ablation of the prostate (ELAP), performed with the Urolase fiber and the neodymium:yttrium-aluminum-garnet laser, compared to transurethral resection of the prostate (TURP) in patients with bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH). METHODS: In this multicenter, prospective, randomized study, a total of 151 patients were treated (ELAP, 76; TURP, 75) of whom 137 completed 1 year follow-up (ELAP, 67; TURP, 70). Safety parameters included measurement of preoperative and 24-hour postoperative sodium, hematocrit, and hemoglobin values and careful monitoring of adverse events. Efficacy was assessed with the American Urological Association symptom score (6), urinary flow rates, and residual urinary volume measurements. RESULTS: There was 1 death in each group during the study period unrelated to the treatment procedure. There was a clinically significant improvement in all efficacy parameters in both groups. Between group comparisons favored TURP in maximum flow rate, residual urinary volume, and symptom score. ELAP had a better safety profile than TURP in the defined safety parameters of drop in hemoglobin and hematocrit values. In 16% of patients, a blood transfusion was required after TURP compared with no transfusions in the ELAP group. Urinary tract infections and dysuria were more frequent in the ELAP group. CONCLUSIONS: ELAP performed with the Urolase fiber is a useful alternative therapy to TURP in patients presenting with bladder outflow obstruction secondary to BPH.

Aged↗
PubMed1999

Transurethral electrovaporization-resection of the prostate using the "wing" cutting electrode: preliminary results of safety and efficacy in the treatment of men with prostatic outflow obstruction.

OBJECTIVES: Transurethral vaporization-resection of the prostate (TUVRP) is a modification of the standard transurethral prostatectomy (TURP). The technique uses the "Wing" resection loop with electrovaporization current to achieve simultaneous resection, vaporization, and coagulation of prostatic tissue. We evaluate the early safety and efficacy results of TUVRP in the treatment of patients with prostatic outflow obstruction. METHODS: The first 31 patients treated with TUVRP since September 1997 are reported. The group included 19 patients with urinary retention and 12 patients with lower urinary tract symptoms (LUTS). Patients with symptoms were assessed at baseline with the International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax). The same parameters were evaluated at 3 months for the entire group. Safety parameters included changes in serum hematocrit and sodium concentration, incidence of side effects, and changes in sexual function. RESULTS: All patients with retention were voiding spontaneously with an IPSS of 3.9+/-3.1 and Qmax of 21.3+/-10.2 mL/s. In the patients who presented with LUTS, the IPSS decreased from 24.3+/-8.3 to 4.1+/-4.9 at 3 months and Qmax increased from 5.2+/-4.5 mL/s to 16+/-7.5 mL/s at 3 months (P <0.001). Mean resection weight was 27.9+/-18.4 g. Mean postoperative catheter time was 24.1 hours. Mean change in hematocrit concentration was 2.5 mL/dL and the change in sodium concentration was 0.8 mEq/L. Complications included 1 patient with a bladder neck contracture, 1 with a urethral stricture, and 1 with clot retention; 1 patient developed transurethral syndrome. No change in sexual function was noted in this group. CONCLUSIONS: TUVRP is a promising new modification of TURP. This procedure combines the excellent debulking capabilities of TURP (with preservation of the entire specimen for histopathologic examination) and adds the benefits of electrovaporization, resulting in minimal blood loss and electrolyte disturbance.

Aged↗
PubMed2001

Stray radiofrequency current as a cause of urethral strictures after transurethral resection of the prostate.

PURPOSE: This study was designed to define the pattern and significance of stray currents induced by two electrosurgical generators (ESGs) in relation to urethral strictures forming after transurethral resection of the prostate (TURP). MATERIALS AND METHODS: A 24F resectoscope irrigated with glycine was activated at various power outputs in different modes, with intact loops and loops with faulty insulation, simulating TURP. The Valleylab and ERBE ESGs were compared for inducing capacitance. An ESG analyzer simulated tissue impedance and recorded the stray currents induced along the resectoscope sheath. A fresh pig liver was used for assessment of tissue damage caused by the currents. RESULTS: In the cutting mode, the ERBE ESG produced a mean stray current of 70 mA with an intact loop and 144 mA with a loop having faulty insulation. The Valleylab ESG produced 150 mA and 161 mA, respectively. In the coagulation mode, the ERBE ESG produced an average leakage current of 35 mA and, with a loop with faulty insulation, 40 mA. The Valleylab ESG produced 148 mA and 151 mA, respectively. CONCLUSIONS: Electrical injury may represent a significant cause of urethral stricture after transurethral electrosurgery. The critical power density of 7.5 W/cm2 (which is likely to cause a urethral burn) may be reached, especially with the use of loops with faulty insulation or nonconductive lubricating gel. The ERBE ESG produced significantly less capacitance, decreasing the risk of urethral electrical burn. Conductive gel prevents dangerous current concentration.

Electric Injuries↗
PubMed2005

[Application of intracavitary retrograde dissection in transurethral vaporization resection of the prostate].

OBJECTIVE: To evaluate the effect of intracavitary retrograde dissection during transurethral vaporization resection of the prostate (TUVRP). METHODS: The efficacy of intracavitary retrograde dissection of the prostate with PK bipolar generation was evaluated in 260 cases in view of the volume of intraoperative bleeding, operation time, safety and postoperative bleeding, catheterization time and prognosis in comparison with the results of exclusive use of TUVRP. RESULTS: Intracavitary retrograde dissection of the prostate provided good operative view as compared with conventional TUVRP. CONCLUSION: Intracavitary retrograde dissection is a practically feasible procedure for benign prostatic hyperplasia.

Aged↗