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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.

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PubMed2002

[Implementation of a clinical pathway for transurethral resection in benign prostatic hyperplasia].

OBJECTIVE: Clinical pathways constitute a powerful tool for reducing the variability that occurs in clinical practice. The results obtained with the use of a clinical pathway for patients undergoing transurethral resection for benign hyperplasia of the prostate (BPH) are presented. METHODS: A prospective study was carried out on a cohort of 80 consecutive patients that had undergone transurethral resection for BPH after the application of a clinical pathway (5 days hospitalization) and compared with the results of a historical cohort of 80 consecutive patients that had been treated before the application of the clinical pathway. The exclusion criteria were diabetes mellitus, anticoagulation therapy with dicoumarin and other pathologies that changed the length of the preoperative stay established in the clinical pathway. For the evaluation of the degree of satisfaction, patients were asked to fill out a questionnaire included in the pathway documents. RESULTS: 73 patients met the inclusion criteria of the clinical pathway. 67 of the 80 patients that underwent surgery before the application of the clinical pathway were valid for comparative analysis. No statistically significant differences were found between both groups for age, prostate volume measured by DRE and US, previous treatment for prostatism, anesthetic risk and weight of the resected specimen. With the application of the pathway, the mean duration of hospital stay was reduced from 6 (SD 1.7; range 4-15) to 4.9 (SD 1.4; range 3-13) days (p < 0.0001) and the duration of urethral catheterization from 4.5 (SD 1.4; range 3-13) to 3.8 (SD 1.3; range 2-11) days (p < 0.01). Statistically significant differences were found before and after the application of the clinical pathway for degree of compliance of the preestablished antimicrobial prophylaxis guidelines during hospitalisation and after discharge, and thromboembolic prophylaxis. The relative risk of complications after discharge was less after the application of the clinical pathway (RR = 0.66), although it was not statistically significant (CI: 0.41-1.05). 63 of the 73 patients included in the clinical pathway submitted the questionnaire without identifying themselves. Duration of hospitalization was considered adequate by 89%, and coincided with the programmed and actual duration according to 82.5%. CONCLUSIONS: The application of a clinical pathway for patients undergoing transurethral resection for BPH has reduced costs by reducing the length of hospital stay and adverse effects. Furthermore, reducing the variability of medical care has improved its quality.

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PubMed1995

Economic modeling to assess the costs of treatment with finasteride, terazosin, and transurethral resection of the prostate for men with moderate to severe symptoms of benign prostatic hyperplasia.

OBJECTIVES: We developed a decision analytic model to compare the costs of treatment for an initial 2-year period with finasteride, terazosin, and transurethral resection of the prostate (TURP) in men with at least moderate symptoms of benign prostatic hyperplasia (BPH). Outcome measures were BPH treatment costs, duration of symptomatic improvement, and lost productivity days (work or other customary activity). METHODS: Patterns of health care resource use associated with the treatment of moderate to severe BPH and BPH-related complications were evaluated by a survey of urologists and validated by a urology consensus panel. BPH safety and efficacy studies in the published literature were used to provide probabilities of treatment success. Both a national health care resource database (Systemetrics) and Medicare data were used to estimate the costs of specific health care services (such as physician services and laboratory tests). RESULTS: The probabilities of first-year success (defined as symptomatic improvement) for surgery, finasteride, and terazosin were 88%, 67%, and 74%, respectively. The most expensive intervention was surgery, followed by finasteride and terazosin, at estimated 24-month costs of $6411, $2860, and $2422 for private insurance and $3874, $2161, and $1820 for Medicare, respectively. Duration of symptom improvement was comparable for the three treatments. Estimates of usual activity days lost (work or other customary activity) were 22, 8, and 8 days for surgery, finasteride, and terazosin, respectively. CONCLUSIONS: As a primary intervention for patients considering conventional clinical approaches to BPH treatment, pharmacotherapy is expected to be less expensive than TURP over the initial 2 years of therapy.

Adrenergic alpha-Antagonists↗
PubMed1992

[Review of 36 trigono-cervico-prostatectomies, carried out for prostatic pathology].

Review of 36 trigone-cervix-prostatectomies, performed in our services. Studies made before and after the procedure. Indications for trigone-cervix-prostatectomies. Complications and results obtained. Trigone-cervix-prostatectomies as an alternative to prostate transurethral resection, in a highly selected group of patients, because of its simplicity and better results.

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PubMed1987

The effect of parenteral emepronium bromide (Cetiprin) on postoperative vesical tenesms after transurethral resection of the prostate. A randomized, placebo-controlled study.

Sixty patients were randomized to treatment with either emepronium bromide (Cetiprin) 25 mg t.i.d. or placebo, both medications administered intramuscularly, after transurethral resection of the prostate. Postoperatively, the number of episodes with vesical tenesms and the need for adjuvant analgesic medication were registered. No significant differences in the number of episodes with vesical tenesms or the need for adjuvant analgesic medication were found between the patients treated with emepronium bromide and those treated with placebo.

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PubMedDate not supplied

Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate.

BACKGROUND AND OBJECTIVES: Superior hypogastric plexus block has been used to treat cancer pain of the pelvis. METHODS: A patient with severe chronic nonmalignant penile pain after transurethral resection of the prostate underwent a single superior hypogastric plexus block with local anesthetic and steroid. The patient was also started on medications that treat neuropathic pain a few hours after the procedure was finished. RESULTS: The superior hypogastric plexus block resulted in complete pain relief immediately after the procedure. The pain relief continued at 1, 2, 4, and 8 months follow up. CONCLUSIONS: In this case of severe penile pain the superior hypogastric plexus block was useful diagnostically and therapeutically.

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PubMed1984

Effect of emepronium bromide (Cetiprin) on symptoms and urinary bladder function after transurethral resection of the prostate. A double-blind randomized trial.

75 patients were randomized to be treated with either emepronium bromide (Cetiprin) 200 mg 4 times a day or placebo after transurethral resection of the prostate. The patients were evaluated urodynamically pre- and postoperatively, and further evaluated by micturition symptom charts. No significant differences in symptoms or objective findings were found between the patients treated with emepronium bromide and those treated with placebo.

Aged↗
PubMed1994

Mental status after transurethral resection of the prostate.

We examined cognitive functions by means of a standardized mini-mental status (MMS) test before and 2 and 24 h after surgery in 100 patients undergoing transurethral resection of the prostate (TURP). There was a strong correlation between the results of this test on all three occasions, but a transient deterioration in the MMS score occurred 2 h after TURP in two thirds of the patients. Fluid absorption was the factor most strongly associated with the change in MMS status during TURP, while the preoperative health status and the choice of anesthesia (general or spinal) had no influence.

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PubMed1989

Consequences of fluid absorption during transurethral resection of the prostate using distilled water or glycine 1.5 per cent.

This prospective and randomized study compared the consequences of two irrigating fluids, distilled water and glycine for transurethral prostatectomy. Forty-nine consecutive unselected patients undergoing transurethral resection of the prostate with spinal anaesthesia were investigated. The irrigating fluid was either distilled water (group A, 24 patients) or glycine 1.5 per cent (group B, 25 patients). The absorption of irrigating fluid was measured, all surgical events and any clinical signs of TURP syndrome during and after surgery were recorded. Early signs of TURP syndrome were observed in one patient in group A and in four in group B without further consequence. From all the biological variables, only plasma protein concentration, haematocrit, free plasma haemoglobin and free bilirubin concentrations were found to have changed. Plasma protein concentration and haematocrit decreased significantly during and after surgery in the two groups. Free plasma haemoglobin increased significantly with time: a significantly higher concentration was observed in group A than group B. Free bilirubin concentration increased with time in the two groups and was statistically greater in group A. With the two irrigating fluids, we observed a significant amount of haemolysis and haemodilution without clinical consequences. A low irrigating fluid pressure, a short resection time, and the use of spinal anaesthesia seems to us to be essential. Close observation of patients following transurethral prostatectomy is needed but the choice of the irrigating fluid does not seem to be important.

Absorption↗
PubMed2004

[Transurethral resection of the the prostate for lower urinary tract obstruction from advanced prostate cancer].

OBJECTIVE: To investigate the role of transurethral resection of the prostate (TURP) in the treatment of lower urinary tract obstruction due to advanced prostate cancer. METHODS: A retrospective analysis was made of the clinical materials of 26 patients with advanced prostate cancer treated by TURP from May, 2002 to November, 2003. RESULTS: Of the 26 patients, aged 56 - 92 years (75 on average), 3 were at Stage C and 23 at Stage D, and 9 had a history of urine retention, of whom 1 with renal function insufficiency received TURP after 1 month suprapubic drainage. There was little blood loss and no need for blood transfusion. Incontinence was temporary and no retention occurred after surgery. The international prostate symptom score (IPSS) and Karnofsky score improved significantly (29.7 +/- 4.6 versus 8.6 +/- 3.4 and 55 +/- 20 versus 77 +/- 32 respectively, P < 0.05). CONCLUSION: TURP is a safe and efficient therapeutic option to relieve lower urinary tract obstruction due to advanced prostate cancer.

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PubMed1995

[Surgical treatment of benign prostatic hypertrophy and Kelami syndrome].

The authors analyze a group of 116 consecutive patients treated with transvesical prostatic adenomectomy or transurethral prostatic resection for benign prostatic hypertrophy (BPH) isolated five of them with a Kelami syndrome. These patients, aged between 53 and 70 years old, had a relevant ventral penile deflection with severe sexual impairment postoperatively. Among them only one asked for a corrective surgical procedure. Aetiology, preventive measures and therapeutic choices are discussed. Authors pointed out that this syndrome is actually underestimated considering the high number of transurethral or open surgery procedures for BPH.

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PubMed2005

A comparison of the effect of 1.5% glycine and 5% glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection.

OBJECTIVE: To examine changes in the pathophysiology and frequency of the transurethral resection (TUR) syndrome with two irrigation fluids, as variable amounts of irrigation fluid are absorbed during TUR of the prostate (TURP), and although polar solutes are required to prevent an effect on diathermy, the solutes may have effects when absorbed. PATIENTS AND METHODS: Between December 2001 and March 2003, 250 patients were included in a prospective randomized trial comparing glycine 1.5% with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, temperature change, biochemistry including a glycine assay, and peri-operative symptoms. Blood samples were taken immediately before and immediately, 5 and 24 h after TURP. Irrigating fluid absorption during TURP was measured with 1% ethanol as a marker and breath ethanol measurements. Operative details were recorded, including the type of anaesthesia (with or with no sedation), resection time and weight of resected tissue. Peri-operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of < or = 125 mmol/L with two or more associated symptoms or signs of TUR syndrome. RESULTS: Five (2%) patients had TUR syndrome; all five were irrigated with glycine, although this difference was not statistically significant (P = 0.06). Of the five men, three had hypotension, four were tired, one was nauseous, two had parasthesia, two had 'uneasiness', one had blurred vision and two were confused; none had chest pain. There was a large variation between the groups in the level of glycine assayed immediately after TURP; a high glycine level was associated with the TUR syndrome (P = 0.01). There was no difference between the groups in levels of sodium, potassium, urea, creatinine, osmolality, calcium, haematocrit, albumin serum levels or peri-operative blood loss (defined as a change from before to after TURP in haemoglobin level, accounting for transfusions). CONCLUSIONS: An increase in serum glycine was associated with TUR syndrome; there were large variations in the amounts of glycine absorbed, reaching levels many times the upper limit of normal. In other studies, glycine was reportedly toxic, and that the levels recorded were many times the upper limit of normal may have both immediate and long-term effects.

Absorption↗
PubMed1987

Prophylactic chemotherapy with fosfomycin trometamol salt during transurethral prostatic surgery: a controlled multicenter clinical trial.

A prospective, randomized controlled study was carried out in 24 Italian urology wards in 675 patients undergoing transurethral prostatic resection, utilizing three different chemoprophylactic treatments with either amoxycillin (AMX), co-trimoxazole (CTX) or fosfomycin trometamol salt (FT) in order to prevent postoperative urinary tract infections. FT significantly lowered the incidence of both postoperative bacteriuria and symptomatic infections in comparison to AMX and CTX. Transient side effects, mild or moderate, were observed in 6.6% of cases. Similar safety and protective results were obtained in 233 patients undergoing different transurethral instrumentations who were chemoprophylactically treated with FT.

Aminoglycosides↗
PubMed2002

[Twenty-eight cases report of transurethral resection of the prostate combined with repair of inguinal hernia].

OBJECTIVES: To discuss the surgical method of benign prostatic hyperplasia (BPH) with inguinal hernia. METHODS: Twenty eight cases of BPH with inguinal hernia were treated with transurethral resection of the prostate (TURP) combined with repair of inguinal hernia by PPM at the same time. RESULTS: All patients had been followed up for six months to four years, in which recurrence of hernia or other complications were not found. Qmax was more than 15 ml/s after operations, and IPSS were about 0-7 scores for all patients. The mean time of hospitalization was 4.2 days. CONCLUSIONS: TURP combined with repair of inguinal hernia at the same time is a simple and effective method, which can avoid second operation, and it is more significance to the aged especially.

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PubMed1983

The dissemination of cancer by transurethral resection of locally advanced prostate cancer.

In 1973 a study was done on 443 patients treated with radiation therapy for cancer of the prostate. An actuarial analysis was done on survival comparing patients whose cancer was diagnosed by transurethral resection of the prostate to those diagnosed by needle biopsy. This analysis indicated a doubling of recurrence and of deaths of patients diagnosed by transurethral resection of the prostate. This effect of transurethral resection of the prostate was observed in patients with T3 and T4 cancer of intermediate, poor or unstated differentiation. It was not observed in those with well differentiated cancer. The effect was not caused by a difference in the extent of cancer or a distribution of histologic subtypes between the 2 diagnostic groups. Therefore, it appears that transurethral resection of the prostate causes dissemination on locally advanced prostatic cancer and clinical studies are suggested to avoid or minimize this effect.

Biopsy↗
PubMed1998

Transurethral incision versus resection of the prostate for small to medium benign prostatic hyperplasia.

OBJECTIVE: To compare the effects of transurethral incision and resection of the prostate in patients with small to medium benign prostatic hyperplasia. PATIENTS AND METHODS: Patients were assessed preoperatively using the Madsen-Iversen symptom score, post- void residual urine volume, urinary flow and cystoscopy. Those eligible for the study were randomized to undergo either transurethral incision or resection of the prostate. Follow-up visits were scheduled at 2-3.6, 12, 24 and 60 months post-operatively with an assessment by symptom score and urinary flow rate; most patients also underwent cystoscopy at 24 and 60 months. RESULTS: The maximum urinary flow rate was significantly higher in those undergoing resection than incision at all but the last follow-up visits. Cystoscopy 24 months after surgery showed adhesions between the lateral lobes, closed incisions or obstructing prostatic lobes in most of the patients undergoing incision, but not in those resected (P < 0.001, chi-square test). During follow-up, a second transurethral procedure was carried out for persistent or recurrent symptoms, combined with a maximum urinary flow rate of < 10.0 mL/s, in 10 patients who underwent incision and in three who were resected (P = 0.039, chi-square test). CONCLUSION: Transurethral resection is preferable to transurethral incision of the prostate in the treatment of small to medium benign prostatic hyperplasia.

Aged↗
PubMed1989

Vasopressin responses during transurethral resection of the prostate.

The serum vasopressin (S-AVP) concentration, serum sodium concentration and osmolality, central venous pressure and fluid balance were measured during 10-min periods in 32 patients undergoing transurethral resection of the prostate. Concentration of S-AVP was unaffected by uncomplicated resection; irrigant absorption resulted in immediate increase in S-AVP concentration, but this increase could not explain the hypertension that occurred in some patients with absorption; a sudden decrease in the systolic arterial pressure was followed by a marked increase in S-AVP concentration; and extensive blood loss did not stimulate release of AVP, provided there was no associated arterial hypotension.

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PubMed1993

[Antibiotic prophylaxis for transurethral resection of the prostate--comparison of oral administration therapy with intravenous administration therapy].

To compare the prophylactic effect of oral and intravenous antibiotics against postoperative fever and urinary tract infection (UTI) after transurethral resection of the prostate (TUR-P), we conducted a multi-center prospective randomized study. The incidence of pyrexia over 38 degrees C was defined as the primary endpoint. One hundred and fifty patients with sterile urine before TUR-P were entered into this study. The patients were allocated randomly into the two arms; arm A cefotiam 4 g a day for 7 days, arm B tosufloxacin 300 mg a day for 7 days, based on the stratification into the 4 groups determined with/without preoperative indwelling catheters and with/without the history of preoperative UTI. Of these patients, 143 were eligible. We divided 124 patients without preoperative UTI and without indwelling catheters as the "low risk group", and the other 19 patients with preoperative UTI and/or with indwelling catheters as the "high risk group". In the low risk group, 9 patients out of 63 (14.3%) in arm A and 6 out of 61 (9.8%) in arm B had pyrexia during 7 postoperative days. The incidence of fever in arm B was 4.4% less than that in arm A and the 95% confidence limit was from -7% to 16%. In the high risk group, 4 out of 11 (36.4%) patients in arm A and none of 8 in arm B had fever but the difference was not significant. The incidence of post operative UTI in the low risk group on the 4 to 5, 9 to 12, 23 to 26 and 37 to 40 postoperative days was 8.3, 16.4, 25.0 and 23.9% in arm A and 6.7, 16.7, 29.6 and 36.7% in arm B, respectively. The prophylactic effect of oral administration of tosufloxacin is equivalent to that of the intravenous administration of cefotiam. The use of oral antibiotics is beneficial to reducing the cost of medication.

Administration, Oral↗