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At least 1,063 records · Page 59Linked to original sources
PubMed1999

Thick loop transurethral resection of the prostate.

OBJECTIVES: To evaluate the safety and efficacy of the new resection loops for transurethral resection of the prostate (TURP). These loops, which are both thicker and have a modified shape, allow simultaneous resection, increased tissue vaporization, and improved hemostasis. METHODS: Two open studies have been performed with the thick resection loop. In one series, 91 patients underwent TURP with the Vapor Cut (G. Vallancien, Paris), and in another series, 65 patients underwent Wedge (Microvasive, Natick, Mass., USA) resection (A. Perlmutter, New York). RESULTS: At 1 year follow-up, patients who underwent thick loop resection enjoyed the same clinical benefit of thin loop TURP without additional morbidity. Peak urinary flow rate improved to 18.4 and 16.3 cm3/s at 1 year with the Vapor Cut and Wedge, respectively. IPSS fell to 7.2 (Vapor Cut) and 6.2 (Wedge). Postoperative bleeding, meatal stenosis, and urethral stricture were noted, but no impotence or incontinence was observed. CONCLUSIONS: Thick loop resection offers the advantage of improved surgical vision during resection, thus allowing a more accurate and safer resection. This can be performed with only minor modifications of the standard TURP technique.

Electrosurgery↗
PubMed1995

Urogenital manifestations of Wegener granulomatosis.

We report 8 patients with Wegener granulomatosis (WG) who suffered from symptomatic urogenital involvement including acute urinary retention related to prostatitis, orchitis, ureteral stenosis, bladder pseudotumor, and penile ulceration. Urogenital manifestations occurred as an isolated manifestation of WG in 4 patients, at the onset of the disease in 1 patient, and as the only symptom of relapse in 3. Data used to distinguish specific WG involvement from infection or cyclophosphamide urothelial toxicity are discussed. Four patients needed a surgical procedure consisting of suprapubic cystostomy for acute urinary retention, bilateral ureteral double J stents for bilateral ureteral stenosis, and prostate transurethral resection. Urogenital symptoms promptly resolved with medical therapy. High-dose corticosteroids and immunosuppressive drugs should be used as first-line therapy to avoid unnecessary surgery.

Adult↗
PubMed1996

The effect of race and ethnicity on the use of selected health care procedures: a comparison of south central Los Angeles and the remainder of Los Angeles county.

The purpose of this study was to compare the use of eight hospital-based procedures (appendectomy, cesarean section, coronary artery angioplasty (PTCA), coronary artery bypass grafting (CABG), carotid endarterectomy, hysterectomy, mastectomy, and transurethral prostate resection) in South Central Los Angeles (SCLA) to the remainder of Los Angeles County. The authors used age- and gender-adjusted procedure rates and population-weighted multivariate regression techniques, adjusting for illness proxies, physician distribution, hospital distance, income, and ethnicity variation to quantitate the effect of SCLA residence. Four procedures were performed at significantly lower rates among residents of SCLA: PTCA, CABG, carotid endarterectomy, and cesarean section. In multivariate regression models, SCLA was also a significant predictor for appendectomy, mastectomy, and transurethral prostatectomy (TURP). The SCLA effect was diminished but not eliminated when ethnicity variables were incorporated into regression models. The use of selected procedures by residents of SCLA frequently differs from that of residents of the remainder of Los Angeles Country. Some differences are not attributable to level of health, income, ethnicity, or the availability of medical resources.

Adult↗
PubMed1986

Antibiotic prophylaxis and secondary haemorrhage following transurethral resection of the prostate: a prospective trial.

One hundred and sixty-two patients were studied in a random double-blind controlled trial of co-trimoxazole to prevent secondary haemorrhage following transurethral resection of the prostate (TURP). There was a significant correlation between the incidence of post-operative urinary infection and secondary haemorrhage (P less than 0.05) but no difference between the incidence of bleeding in the treatment and placebo groups. Although infection may play a role in the development of secondary haemorrhage, co-trimoxazole for 10 days does not decrease the incidence of this complication.

Aged↗
PubMed1993

Blood loss during transurethral resection of the prostate as measured by the HemoCue photometer.

Blood loss was measured with the portable HemoCue photometer and the absorption of irrigating fluid was assessed by the ethanol method during 700 transurethral resections of the prostate. The blood loss ranged between 10 and 3,825 ml (median 300 ml). The weight of the resected prostatic tissue and the operating time were independent predictors of the amount of blood lost. General anaesthesia (n = 82) and malignant histology (n = 114) were associated with a smaller blood loss. In the patients who were given regional anaesthesia (n = 618), an mean systolic blood pressure of 100 mmHg or less resulted in a smaller bleed. Large-scale irrigating fluid absorption was typically associated with a blood loss of medium size and ranged between 500 and 1,000 ml. The incidence of such absorption was negligible in the patients in whom the blood loss per gram of resectate was less than 10 ml/g. Blood loss was also measured every 10 min during the course of another 110 operations, from which 20 patients with operating times in excess of 60 min were selected. Our analysis showed that no excessive blood loss occurred after 60 min of surgery.

Absorption↗
PubMed2000

Pretreatment with finasteride decreases perioperative bleeding associated with transurethral resection of the prostate.

OBJECTIVES: The efficacy of finasteride in the treatment of gross hematuria associated with benign prostatic hyperplasia is well established. We evaluated a regimen of pretreatment with finasteride in decreasing perioperative bleeding associated with transurethral resection of the prostate (TURP). METHODS: A prospective analysis compared 25 patients pretreated with finasteride for 2 to 4 months before TURP with 50 patients without pretreatment. Patients in each group were further separated by the amount of prostate tissue resected. Patients were then followed up for perioperative bleeding, defined as a perioperative blood transfusion requirement or a return visit to the emergency room with gross hematuria or clot retention. RESULTS: None of the patients with less than 30 g of prostate tissue resected experienced perioperative bleeding. In patients with 30 g or more resected, several episodes of bleeding occurred. In the patients pretreated with finasteride, 1 (8.3%) of 12 experienced perioperative bleeding; in the control group, 7 (36.8%) of 19 had an episode of bleeding. CONCLUSIONS: In patients with large prostate glands undergoing TURP, pretreatment with finasteride appears useful in reducing perioperative bleeding.

Aged↗
PubMed2000

Clinical outcome 1 year after transurethral vaporization and resection of the prostate.

OBJECTIVES: To evaluate the 1-year safety and effectiveness of transurethral vaporization of the prostate (TUVP) compared with transurethral resection of the prostate (TURP) in alleviating outflow obstruction. METHODS: Two experienced surgeons performed 26 TUVPs and 28 TURPs. The intraoperative blood loss was measured by photometry and fluid absorption by the ethanol method. The treatments were evaluated by means of the International Prostate Symptom Score (IPSS), quality-of-life score, transrectal ultrasound, prostate-specific antigen level, urinary flow rate, and postvoid residual urine volume. RESULTS: After TUVP, the median IPSS decreased from 22 to 4.5 and the quality-of-life score from 4.5 to 1.5. The corresponding data for TURP were from 25 to 5.5 and from 4.0 to 1.0. The median urinary flow rate increased from 4 to 10 mL/s after TUVP and from 2 to 11 mL/s after TURP. The postvoid residual urine volume decreased to 35% (TUVP) and 15% (TURP) of the preoperative volume. The blood loss was larger during TURP (P <0.04), but complications during follow-up were more frequent after TUVP (P <0.02). Patients with fluid absorption during surgery had a lower quality-of-life score at follow-up (P <0.02) and tended to have a smaller reduction in prostate size (to 79%) than those without absorption (to 67% of baseline). CONCLUSIONS: TUVP and TURP were both effective in alleviating outflow obstruction, but the outcome appeared to be slightly better for TURP.

Aged↗
PubMedDate not supplied

[Pharmacological and cost effectiveness bases of the use of categel and categel S [correction of F] in urological practice].

Preparations catedgel and catedgel S made in Austria (Montavit) was tried in Moscow hospital N 50. Categel is a sterile gel of methylcellulose with 2% lidocain and 0.05% chlorhexidine, catedgel S contains the same components but lidocain. Categel significantly reduces the risk of infectious-inflammatory complications after endourological manipulations, improves endoscopic diagnosis and makes some manipulations less painful. Comparative pharmacological cost-effect assessment of categel S and glycerine effects in prostatic transurethral resection. Categel was found 2.11 times more effective. It also improves quality of life of the patients. Categel can be recommended for wide use in urology.

Aged↗
PubMed1986

Bacteremia following transurethral instrumentation. The predictive value of a serum bactericidal activity test.

The bacteremic rate following transurethral instrumentation and the possibility of a serum bactericidal activity test to predict which patients that were at an increased risk of developing bacteremia was evaluated. Of 33 investigated patients, all elderly men, 14 underwent transurethral prostatic resection, 14 cystoscopy and 5 urethrotomy. None of the patients received prophylactic antibiotic treatment. The majority (97%) of the patients had bacteria isolated from the urinary tract before the instrumentation. Gram-positive cocci accounted for about two thirds (64%) and Gram-negative rods for about one third (31%) of all isolates. The most frequent species isolated were coagulase negative staphylococci (29%), Streptococcus faecalis (19%) and Klebsiella pneumoniae (12%). The bacteremic rate was 21%. None of the patients developed septicemia. Forty-four per cent of the patients with greater than or equal to 10(5) colony forming units/ml (cfu/ml) in urine developed bacteremia compared with 8% in patients with a sterile urine or less than 10(5) cfu/ml in urine (p less than 0.05). The urethral/prostatic flora was the source of bacteremia in at least one patient. Eighty-one per cent of the isolated strains were serum resistant. About half (54%) of the Gram-negative rods were more or less sensitive against actual, fresh patient serum. All Gram-positive cocci were resistant. There was no difference in the serum sensitivity between bacteria isolated from bacteremic patients and non-bacteremic patients. In conclusion, this study confirmed the relative high risk of developing bacteremia following transurethral instrumentation, especially if the urine is infected.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

[Analysis of the absorcion's factors of irrigating fluid during transurethral resection of the prostate].

OBJECTIVES: In this study it was our intention to evaluate the relation between the reabsorption of irrigating fluid and three variables: time of the intervention, volume of solution of glicina employee and weight of the fragments, during the RTU of prostate fulfilled to low hydraulic pressure. MATERIAL AND METHOD: We study 74 patients that RTU of prostate was performed with suprapúbica derivation with Amplatz's pod 30 ch. The ethanol was monitored in expired air every 15 minutes during the intervention. Likewise we annotated the time of the intervention, the volume of glicina used and the weight of the fragments extracted. Statistically Anova's text was in use for comparison of averages. RESULTS: 13,6% of the patients absorbed irrigating fluid in some quantity. The range of absorption belongs to 100 cc until 2.000 cc. We did not find a statistically significant difference in the averages of time of resection, volume of glicina and weight of the fragments between the group of patients that had absortion of irrigating fluid and they that didn't had. CONCLUSIONS: Our data show that the operative time, the volume of irrigating fluid and the weight of the resected fragments do not influence the reabsorption of liquid of irrigation when a RTU is realized to low hydraulic pressure.

Absorption↗
PubMed1991

Do doctors and patients agree? Views of the outcome of transurethral resection of the prostate.

In an attempt to establish the extent to which patients and doctors agree on the outcome of health care, the pre- and postoperative states of health of 388 men undergoing transurethral resection of the prostate for benign disease were studied. Generally, high levels of concordance (greater than 70%) were obtained. The strongest agreement was for clearly defined events, such as episodes of acute retention (95%); the weakest agreement occurred over the most subjective symptoms, prognostic expectations, and ambiguous terms (around 60%). The level of agreement was not associated with any characteristics of the patient, surgeon, or treatment.

Cystoscopy↗
PubMed1985

Variability of heparin levels and bleeding with low-dose heparin prophylaxis following transurethral resection of the prostate.

Plasma heparin levels and operative/postoperative bleeding were assessed in 16 patients of varying body weights who received subcutaneous low-dose heparin prophylaxis for deep vein thrombosis during and after transurethral resection for benign prostatic hypertrophy. The concentration of heparin in the blood at operation and subsequently was found to vary widely but did not correlate with the extent of blood loss. When adjusted for body weight, plasma heparin concentration showed significantly less variation from patient to patient. In this respect, body weight was a more effective parameter than lean body mass or surface area. Adjustment of heparin dosage by body weight may be advisable when using low-dose heparin prophylaxis.

Body Surface Area↗
PubMed1998

[Living with enlarged prostate].

An ageing man has been the focus of nursing research only rarely. Therefore, the aim of this study was to describe the meanings that men aged 65 or over attached to living with enlarged prostate before the transurethral resection of prostate. The data were collected by interviewing seven ageing men, who have had transurethral resection of the prostate. The data were analysed using Giorgi's method, which is based on phenomenology. Living with enlarged prostate has an effect on ageing men's physical, social and emotional well-being. Because of problems with voiding they avoided physical exercise and outdoor activities. They were also fatigued, since they have to go to the toilet many times at nights. It was possible that the voiding need was so sudden and frequent that the men limited their social participation. The symptoms caused by an enlarged prostate had often lasted for a long period. They have also affected on sex life and aroused depression and shame in ageing men.

Activities of Daily Living↗
PubMed2003

Collagen fibers in human prostatic lesions: histochemistry and anisotropies.

The present study focuses on establishing patterns of collagen fibers distribution in prostatic nodular hyperplasia and adenocarcinomas, in comparison with the normal tissue. Sections of prostatic transurethral resection were subjected to Gömöri's method for collagen fibers and reticulin and analyzed under ordinary and polarized light microscopy. Controls and hyperplastic regions present collagen fibers with variable thickness that run in different directions, establishing a tridimensional network. These fibers exhibit birefringence and dichroism thus demonstrating their fibrillar integrity. On the other hand, increased variability in collagen fiber distribution and anisotropical properties occur in adenocarcinomas evaluated in accordance withthe Gleason's score. In some of their areas, a well-defined collagen network delimitates the base of transformed epithelial cells whereas in other areas the collagen fibers are disorganized and do not establish a boundary between the epithelial structures and the stroma. In these areas, collagen is found in the stroma. It was also observed that adenocarcinoma tumor cells rest on a scaffold of thin and dendritic collagen fibers. Collagen fibers of the prostatic stroma of the adenocarcinomas may show a modification in arrangement and fibrillar compactness. In prostatic nodular hyperplasia, there is no change in collagen molecular integrity, since collagen affinity for silver and collagen birefringence are similar to controls. In adenocarcinoma with high dedifferentiation degree, thin and branched strongly argyrophilic and birefringent collagen fibers are detected in regions of cell proliferation. In the adjacent stroma, hyaline plaques are indicative of matrix degradation or remodellation.

Adenocarcinoma↗
PubMed2006

[Diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia (report of 3 cases)].

OBJECTIVE: To investigate the characteristics of diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia. METHODS: Retrospective analyses were made of the clinical data of 3 cases of ejaculatory duct obstruction following prostatic hyperthermia. RESULTS: The 3 cases were diagnosed as urethrostenosis and deformity of the posterior urethra by transurethral ultrasound and semen analysis. And all the 3 patients had undergone prostatic hyperthermia for prostatitis. Transurethral resection of the ejaculatory duct (TURED) was performed to remove the obstruction and the postoperative semen analysis showed both semen volume and sperm count to be normal. CONCLUSION: Urethra microwave thermotherapy, urethra radiofrequency, or per urethra rheophore ablation can be adopted in the treatment of protatitis, but should be strictly indicated and cautiously selected lest secondary iatrogenic ejaculatory duct obstruction should result. For the treatment of this obstruction, TURED is the first choice.

Adult↗
PubMed1985

[Effect of flash chemoprophylaxis by cefotaxime on the appearance of postoperative bacterial superinfections in surgery of the prostate].

The effect on bacteriologically documented postoperative infection of flash prophylaxis using two intravenous injections of 20 mg/kg cefotaxime each was evaluated in a double blind, randomized trial against placebo. 181 participants free of urinary tract infection prior to surgery had either transurethral prostatic resection (TUR) (n = 90) or open prostatectomy (OP) (n = 91). Urine samples, blood samples, prostate specimens and skin swabs were investigated for pathogens. Rate of urinary tract infection was significantly reduced by cefotaxime (CTX) prophylaxis in both groups. CTX lowered the incidence of early postoperative urinary tract infection from 30% to 4% in TURs and from 46% to 4.5% in OPs. Similarly, a significant difference was demonstrated for incidences of intra and postoperative bacteremia. In open prostatectomy patients, a reduced rate of wound infection and shorter hospital stay were noted in the treated group. Pathogens recovered in this study were Streptococcus (29%), Staphylococcus (20.5%), Enterobacteriaceae (45.75%), Pseudomonas (1.25%), Acinetobacter (3%), and Bacteroides fragilis (0.5%). CTX prophylaxis apparently has no bearing on postoperative emergence of resistant pathogens. Percentage of resistance to CTX in delayed postoperative infections was 33% in the control group and 35% in the treated group. We conclude that flash CTX prophylaxis in transurethral or open prostatectomy is of benefit in reducing morbidity and hospital costs.

Bacterial Infections↗
PubMed1996

[Treatment of prostate benign hyperplasia (BPH) with visually controlled laser, assessment at 2 years, and anatomopathologic findings].

The endoscopically-guided lateral discharge laser (VLAP) has been considered an alternative in the management of benign prostate hyperplasia (BPH). The purpose of this paper is to describe the technique, results obtained in 20 treated patients, and pathoanatomical findings in those later treated with prostate transurethral resection. Four patients were carriers of an indwelling catheter, while IPSS/QL mean values in the other 16 patients were 23/4. Mean maximum flow was 7.01 mL/s. Assessment after one and two years shows a fall of mean IPSS/QL to 5/1 and mean maximum flow to 15.2 mL/s and 21 mL/s, respectively, but the difference is not significant. This paper also describes the morbidity affecting 65% patients, which is comparable to the retreatment rate (15%) obtained in other series published. The results are similar to those described in the literature although, in our view, the high rate of complications undermines this choice as an alternative in BPH management.

Aged↗