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PubMed1999

Transurethral thermotherapy for benign prostatic hyperplasia significantly decreases infravesical obstruction: results in 134 patients after 1 year.

PURPOSE: We prospectively evaluated a decrease in outflow obstruction caused by benign prostatic hyperplasia (BPH) with second generation thermotherapy. MATERIALS AND METHODS: Transurethral microwave therapy was given with local anesthesia to 134 patients with urodynamically and cystoscopically documented obstruction by BPH and preserved detrusor function. Of 134 patients 67 (50%) had a general health score of 3 or greater. RESULTS: Urgency was the main complaint during thermotherapy. After a median followup of 24 months (minimum 12) 100 patients were evaluable at 6 and 12 months. Of the initial 134 patients 17 (13%) who required additional treatment (repeat thermotherapy, transurethral prostatic resection, permanent cystostomy), 7 who died during followup for treatment unrelated reasons and 10 who were lost to followup or refused evaluation were excluded from further analysis. Mean International Prostate Symptom Score decreased from 22.5 before to 3.6 at 6 months after treatment and remained stable at 12 months. Mean Quality of Life Index improved from 4.3 before to 1 at 12 months after treatment. Mean maximum flow increased from 7.3 ml. per second before to 14.5 at 6 months and 13.9 at 12 months after treatment. Mean post-void residual decreased from 199 to 34.8 and 37.2 ml. at 6 and 12 months, respectively. Urodynamic evaluation of 84 patients after 6 months revealed a decrease in mean detrusor opening pressure from 96.8 to 53 cm. water and mean detrusor pressure at maximum flow from 99.8 to 59.7 cm. water. Mean ultrasonographic prostate volume decreased from 57.6 to 42.4 cc and a cavity in the prostate was documented in 65 of the 84 cases (77%). All changes between the pretreatment and posttreatment values at 6 and 12 months, respectively, were statistically significant (paired t test p<0.00001). CONCLUSIONS: Targeted transurethral thermotherapy with second generation microwave equipment is minimally invasive, easy to apply and generally well tolerated with local anesthesia. Infravesical outlet obstruction and voiding pressures as assessed by pressure flow studies significantly decreased 6 months after treatment. Subjective voiding symptoms as well as post-void residual urine were significantly decreased, and urinary flow was improved 6 and 12 months after treatment of documented BPH.

Aged↗
PubMed1992

New relationships between prostatic intraepithelial neoplasia and prostatic carcinoma.

Our group has been studying the progressive molecular changes in prostatic epithelium which precede the invasive phenotype. Initial studies revealed similar alterations in cytoskeletal proteins between high grade prostatic intraepithelial neoplasia (PIN) lesions and invasive carcinoma. Specifically we observed an increased expression of certain cytokeratins and decreased expression of vimentin. We also noted a change in glycosylation as detected by Ulex europaeus staining. Using the latter technique we were able to microdissect and isolate nuclei from areas of low and high grade PIN lesions as well as from invasive carcinoma for morphometric analysis. Similarities in nuclear size, chromatin heterogeneity, and nuclear DNA content between low and high grade PIN and invasive carcinoma in carcinomatous specimens were noted. In contrast, these parameters were significantly different in low grade PIN lesions obtained from benign prostatic transurethral resection (TURP) specimens. In addition, DNA histograms revealed similar proliferative indices between high grade PIN and invasive carcinoma, which differed significantly from low grade PIN. Parameters thought to be relative to the invasive phenotype were also examined, such as the members of the metalloproteinase family; although normal luminal cells fail to express detectable levels of these enzymes, invasive carcinoma and even low grade PIN lesions express both the 72 kDa and 92 kDa type IV collagenase. Taken together, these data indicate that the dysplastic cells of PIN lesions and carcinomas are similar in nuclear and genomic features as well as protease expression. Our current working hypothesis is that these cells are already armed with the necessary proteases to invade the basal lamina but in an inactive form. Tumor progression requires an additional event of protease activation.

Carcinoma↗
PubMed1995

Coagulopathies in patients after transurethral resection of the prostate: spinal versus general anesthesia.

This prospective, randomized study evaluated the effects of spinal versus general anesthetic technique on perioperative blood loss and the development of postoperative coagulopathies in 50 patients undergoing transurethral resection of the prostate (TURP). Preoperative hematologic measurements included hemoglobin, platelet count, electrolytes, prothrombin time, partial thromboplastin time, fibrinogen, factor V, plasminogen, antithrombin III, and fibrinogen degradation product (FDP) levels. All hematologic blood samples wre repeated postoperatively at 1, 6, and 24 h. Intraoperative blood loss was not significantly different between the spinal and general anesthesia groups. The total blood loss after TURP was significantly correlated (r = 0.76; P < 0.0001) with the prostatic tissue weight. When the tissue weight resected exceeded 35 g, blood loss was in excess of the linear correlation shown with the weight of resected prostatic tissue. Platelet count decreased and prothrombin time increased in the spinal group at all postoperative time intervals compared to preoperative value (P < 0.05). There was no significant difference in measured coagulation variables (fibrinogen, factor V, plasminogen, antithrombin III, and FDP) between the spinal and general anesthesia groups, but there were significant decreases in postoperative fibrinogen and Factor V levels compared to preoperative values in both spinal and general anesthesia groups. Three patients (6%) had increased FDP levels 1 h postoperatively. The prostatic tissue weight and the surgical duration was significantly higher in these patients. We conclude that perioperative blood loss in TURP patients is not affected by the anesthetic technique. However, 6% of TURP patients developed subclinical intravascular coagulopathies which correlated with mass of resected prostate tissue.

Aged↗
PubMed2002

Transurethral microwave therapy in 200 patients with a minimum followup of 2 years: urodynamic and clinical results.

PURPOSE: We investigated the long-term efficacy of the second generation Targis thermotherapy device (Urologix, Inc., Minneapolis, Minnesota) for decreasing outflow obstruction caused by benign prostatic hyperplasia. MATERIALS AND METHODS: At a minimum followup of 24 months 200 patients with bladder outlet obstruction documented on urodynamics and cystoscopy document with preserved detrusor function underwent transurethral microwave therapy while under local anesthesia. In 45% of cases the general American Society of Anesthesiologists health score was 3 or greater. RESULTS: After a median observation time of 42 months (range 2 to 72) 43 patients (22%) who required additional treatment (repeat thermotherapy, transurethral prostate resection or permanent cystostomy) were excluded from further analysis, as were 15 (7.5%) who died of causes unrelated to treatment during followup and 13 (6.5%) who were lost to followup or refused followup investigations. In the 162 patients evaluated 6 months after treatment the median International Prostate Symptom Score decreased from 23 points (range 10 to 34) before treatment to 3 (range 0 to 21) and remained stable at 12 and 24 months. Median maximum flow increased from 6 ml. per second (range 1 to 15) before treatment to 14.5 (range 4 to 50) 6 months after treatment and remained stable at 12 and 24 months. Median post-void residual urine volume decreased from 170 ml. (range 35 to 720) before treatment to 17 (range 0 to 327) after 6 months and then remained unchanged. Urodynamic evaluation in the 162 patients after 6 months showed a decrease from pretreatment median detrusor opening pressure of 87.5 to 53 cm. water. Median detrusor pressure at maximum flow decreased from 86 to 58 cm. water 6 (p <0.0001). At the 24-month followup 59 of the 129 evaluable patients agreed to undergo repeat urodynamic evaluation. Pressure flow analysis in these 59 cases revealed a decrease in median minimal urethral opening pressure from 70 to 40 cm. water at 6 months and to 38 cm. water at 24 months (p <0.0001). Median detrusor pressure at maximum flow decreased significantly from the pretreatment value of 86 to 55 cm. water at 6 months and 58 cm. water at 24 months (p <0.0001). CONCLUSIONS: In patients with a good initial response to treatment, which is achieved in approximately 80%, transurethral microwave therapy provides excellent long-term subjective and objective results. Improved urinary flow, decreased post-void residual urine volume and urodynamic parameters remain stable at 2 years. Transurethral microwave therapy with second generation microwave equipment did not compromise any conventional treatment needed in the 22% of patients who were nonresponders at 6 months.

Adult↗
PubMed1983

Results of transurethral resection of the benign prostate.

This retrospective study reviews the results of 200 consecutive transurethral resections of prostate (TURP) for benign disease performed in two small district general hospitals. There was 1 postoperative death (0.5 per cent). Ninety-five per cent of the patients were discharged from follow-up with satisfactory results. Nine patients (4.5 per cent) are still under review either for postoperative complications or persistent symptoms.

Aged↗
PubMed1997

Comparison of the effect of two heights of glycine irrigation solution on serum sodium and osmolality during transurethral resection of the prostate.

BACKGROUND: The absorption of sodium-deficient, hypotonic irrigation solution is believed to contribute, in certain cases, to hyponatraemia and hypo-osmolality and, in severe cases, to the so-called transurethral resection of the prostate (TURP) syndrome. METHODS: The effect of the height of 1.5% glycine irrigation solution during intermittent-flow TURP on serum sodium and osmolality was studied peri-operatively in 40 patients. The height of the glycine was set at 70 (n = 20) or 150 (n = 20) cm above the operating table. RESULTS: We found no statistically significant difference in the measured serum sodium (P = 0.929) and osmolality (P = 0.260) values between the two groups during the 24 hr study period. CONCLUSIONS: The height of the irrigation solution is not important in the development of hyponatraemia and hypo-osmolality, and other factors are probably more important.

Aged↗
PubMed1990

[A study on local administration of thrombin following transurethral resection of the prostate--clinical investigation with four-way balloon catheter].

The effect of local administration of thrombin via a newly devised four-way balloon indwelling catheter was investigated on 89 patients who underwent transurethral resection of the prostate (TURP). The catheter was introduced into the bladder immediately after TURP, the balloon was inflated with sterile water and mild moist sponge traction was applied to seal the bladder neck for 15 minutes. At the same time, the thrombin solution, 5,000 U in 5 ml of saline, was then injected into the prostatic fossa via the newly added infusion channel to promote early hemostasis. The results were compared with those of 36 randomized control patients, who were treated with the conventional three-way balloon catheter of the same size. The results obtained with this new device were favorable, showing significantly less postoperative hemorrhage in the thrombin infusion group than in the control group. In 7 of 89 thrombin infused patients, serum FDP revealed mild elevation for 2 hours after TURP. In 2 of these 7 patients FDP was closely correlated with thrombin infusion. However, no adverse reactions were observed in any patient in the thrombin infusion group. In conclusion, our new device to administer locally the thrombin solution is effective and safe for management of bleeding after TURP.

Aged↗
PubMed1999

Influence of investigative and operative procedures on serum prostate-specific antigen concentration.

We determined the effect of cystoscopy (flexible and rigid), transrectal ultrasonography (with and without needle biopsy of the prostate) and transurethral resection of the prostate or bladder tumour on the serum prostate-specific antigen (PSA) concentration. Samples were taken from 60 men before and up to 14 days following these procedures. Flexible cystoscopy did not result in a significant increase in serum PSA concentration, with a median increase of 0.1 microgram/L (P > 0.05). Small but statistically significant increases in serum PSA levels 1 day post-procedure were observed following rigid cystoscopy and transrectal ultrasound without biopsy. The median increase in serum PSA concentration following rigid cystoscopy was 0.15 microgram/L (P = 0.04) and following transrectal ultrasound was 0.3 microgram/L (P = 0.01). In both cases the serum PSA level had normalized by 2 days post-procedure. Transurethral resection of bladder tumours resulted in a variable rise in serum PSA, with a median increase of 2.6 micrograms/L after 1 day, which returned to normal over 7-14 days. Ultrasound-guided needle biopsy of the prostate and transurethral resection of the prostate produced significant increases in serum PSA levels, which took up to fourteen days to return to normal. The median increase in serum PSA following needle biopsy was 6.0 micrograms/L and following transurethral resection of the prostate (TURP) was 13 micrograms/L. Samples for PSA measurement may safely be taken within 24-48 h of flexible cystoscopy and transrectal ultrasonography (TRUS) providing prostatic biopsy is not carried out. For other procedures it is necessary to wait for at least 14 days to ensure that false positive PSA results are not obtained.

Aged↗
PubMed1989

Pontine myelinolysis and delayed encephalopathy following the rapid correction of acute hyponatremia.

We describe a case of pontine myelinolysis associated with hyponatremia and hyperammonemia resulting from bladder irrigation during a transurethral prostatic resection. Following the procedure the patient exhibited seizurelike activity. He underwent rapid correction of the hyponatremia, he initially recovered but developed encephalopathy 19 days later. Magnetic resonance images showed symmetrical lesions in the white matter of the cerebellar peduncles. A relatively small pontine lesion was also noted. The patient later recovered. This case demonstrates that myelinolysis associated with rapid correction of hyponatremia may be greater in the cerebellar peduncles than in the central pons.

Aged↗
PubMed1997

Interstitial iodine-125 radiation without adjuvant therapy in the treatment of clinically localized prostate carcinoma.

BACKGROUND: This study was designed to evaluate the efficacy of iodine-125 interstitial radiation in the treatment of prostate carcinoma classified as T1 or T2. METHODS: One hundred twenty-six consecutive patients with adenocarcinoma of the prostate (T1, 23%; T2, 77%) were treated with iodine-125 radionuclides between January 1, 1988, and December 31, 1990. Four patients died of intercurrent illness within 1 year postimplant, leaving 122 men in the study. The prescribed minimum radiation dose was 160 gray. Median follow-up was 69.3 months. Prebiopsy prostate specific antigen (PSA) values (median, 5.0 ng/mL) were available for all patients. Posttherapy evaluation included clinical, biochemical (PSA), and pathologic (repeat needle biopsy) studies. No patient was surgically staged, and none received androgen deprivation therapy. Morbidity was graded according to the Radiation Therapy Oncology Group grading scale. Statistical appraisal was performed by the Kaplan-Meier method. PSA failure was defined in two ways: (1) PSA progression, i.e., 2 consecutive increases from a nadir value; and (2) failure to attain an arbitrary serum PSA value of 1.0 or 0.5 ng/mL at last follow-up. RESULTS: The overall 7-year survival was 77%; there were no deaths from prostate carcinoma in this cohort. The 7-year actuarial PSA progression free outcome was 89%, and the PSA < or = 1.0 ng/mL outcome was 87%. When PSA < or = 0.5 ng/mL was selected as an outcome end point, and PSA values in this series of radiation-treated patients were compared with PSA values proposed to indicate disease free survival after radical prostatectomy (PSA < or = 0.3-< or = 0.6 ng/mL), the 7-year actuarial disease free survival was 79%. Morbidity was minimal except in patients who had preimplant or postimplant transurethral prostate resection. CONCLUSIONS: Outpatient-based iodine-125 prostate brachytherapy for prostate carcinoma classified as T1 or T2 resulted in biochemical outcomes comparable to end points resulting from radical prostatectomy and external beam radiation.

Adenocarcinoma↗
PubMedDate not supplied

Brachytherapy for clinically localized prostate cancer: results at 7- and 8-year follow-up.

In recent years, there has been a resurgence of interest in interstitial radiation as a cost-effective and efficient method of treating organ-confined prostate cancer. We describe our 7- and 8-year results with transperineal Iodine-125 and Palladium-103 implantation. A total of 551 consecutive patients were treated. Of these, 320/551 (58%) received implant alone (Group I), and 231/551 (42%)--considered higher risk patients--were also treated with a modest dose (45 Gy) of external beam irradiation (Group II). The median follow-up for Group I was 55 months, and for Group II, 60 months. At 7 years, the actuarial freedom from biochemical failure (prostate-specific antigen (PSA) < or = 1.0 ng/mL) was 80% in Group I patients, and, at 8 years, 65% in Group II patients. Morbidity was minimal if patients had not undergone prior transurethral prostate resections. The results indicate that interstitial radiation is a valid treatment for clinically localized prostate cancer.

Actuarial Analysis↗
PubMed1998

Value of the Danish Prostate Symptom Score compared to the AUA symptom score and pressure/flow studies in the preoperative evaluation of men with symptomatic benign prostatic hyperplasia.

The Danish Prostate Symptom Score (DAN-PSS) is a new questionnaire for the assessment of lower tract urinary symptoms (LUTS), which claims to be able to predict bladder outlet obstruction. We evaluated the ability of the DAN-PSS to assess LUTS, to predict obstruction, and to predict treatment outcome in men with symptomatic uncomplicated BPH. Twenty-five consecutive men with symptomatic uncomplicated BPH filled in the AUA symptom score and the DAN-PSS and underwent uroflowmetry and pressure-flow studies prior to transurethral prostatic resection (TURP). Patients were reevaluated 4 days and 8 months after surgery. AUA score and DAN-PSS both assessed LUTS and were sensitive to symptom changes after therapy. Compared to pressure/flow studies, neither score correlated with bladder outlet obstruction. Peak urinary flow, however, correlated significantly with obstruction. None of the diagnostic tools used was able to improve patient selection for surgical treatment. The DAN-PSS is a valid and sensitive questionnaire for the assessment of LUTS. It is not able, however, to predict bladder outlet obstruction. In men with uncomplicated BPH, urodynamic evaluation of bladder outlet obstruction did not improve the subjective outcome of TURP.

Aged↗
PubMed1975

Surgery of prostatic carcinoma.

Seven surgical treatments for the management of prostatic cancer are briefly reviewed. A transurethral prostatic resection is of value, not only for the relief of bladder outlet obstruction, but also in the definitive management of Stage A lesions. The long-term survival for patients with Stage C disease treated by radical prostatectomy plus interstitial irradiation demonstrates the efficacy of this mode of therapy. Pelvic lymphadenectomy has yielded valuable information on the stage of the disease; long-term survival was related to the presence of lymph node metastases. Lymphadenectomy may have contributed to the 5-year survival rate of those with regional lymph node involvement, but there is no direct evidence to support this view. The early results in patients treated by cryosurgery indicate that this mode of therapy can be very effective in the ablation of the local lesion and may very well have a useful place in the surgical armamentarium for the management of prostatic cancer.

Cryosurgery↗
PubMed1992

Predicted prostate specific antigen results using transrectal ultrasound gland volume. Differentiation of benign prostatic hyperplasia and prostate cancer.

METHODS: The diagnostic performance of transrectal ultrasound (TRUS) gland volume and prostate specific antigen (PSA) results were evaluated in 204 men consecutively scheduled to undergo transurethral prostatic resection (TUR). RESULTS: Nonpalpable prostate cancer was detected by TRUS alone in 18% (29 of 161) and by TUR alone in 9% (14/161), for an overall cancer incidence of 27%. A predicted PSA value (TRUS gland volume x 0.20 ng/ml/g = polyclonal PSA) was used for comparison with serum PSA for each patient. TRUS positive predictive value improved from 52% to 86% when serum PSA exceeded the predicted value. The specificity and positive predictive value of PSA at 2.5 ng/ml were 23% and 37%, respectively, which increased to 88% and 72%, respectively, when serum PSA exceeded the predicted value. CONCLUSIONS: Predicted PSA values produce decision levels near the 95th percentile for each patient and assist individual biopsy decisions better than grouped gland volume ranges. Wider application of TRUS and PSA in any clinical setting or early detection program is now possible.

Aged↗
PubMed1987

Single dose antibiotic prophylaxis in high risk patients undergoing transurethral prostatectomy.

In a randomized controlled clinical trial single dose antibiotic prophylaxis (gentamicin 80 mg IV) was evaluated in 36 patients with indwelling urethral catheters undergoing transurethral prostatic resection. Prophylaxis resulted in a significant reduction in postoperative bacteriuria (P less than 0.01), pyrexia (P less than 0.001), bacteraemia (P less than 0.01) and septicaemia (P less than 0.05). During the same period there was one case of postoperative bacteriuria but no systemic infection in 25 consecutive patients undergoing elective prostatectomy with no local risk factors and in the absence of prophylaxis. A policy of selective antibiotic prophylaxis is justified and in high risk patients with in-dwelling catheters single dose prophylaxis is highly effective.

Bacteriuria↗
PubMed1983

The patient, disease status, and treatment options for prostate cancer: stages D1 and D2.

The treatment of choice for disseminated prostate cancer remains endocrine manipulation, either bilateral orchiectomy or exogenous estrogens. The recommended dose of diethylstilbestrol is 1 mg tid. Unanswered questions include: When should endocrine manipulation be instituted for the patient with advanced prostatic cancer? At the time of diagnosis, when clinical symptoms occur, or not at all? With few exceptions those patients relapsing after initial endocrine manipulation do not respond to successive attempts at further endocrine therapy. Much of the confusion in this regard relates to the variable response criteria used, more often subjective than objective. Since the polyclonal theory of prostatic cancer is attractive, its logical extension is the evaluation of combinations of treatments including both endocrine manipulation and cytotoxic agents. Because the currently available antiandrogens and luteinizing hormone-releasing hormone agonists have mechanisms of action different from conventional estrogens or bilateral orchiectomy, they too may have a role in the multimodal treatment of advanced prostatic cancer. Therapy for stage D1 prostatic cancer implies that information is available either from pelvic lymphadenectomy or from fine-needle aspiration cytology related to abnormal findings on CT scanning, lymphangiography, or excretory urography. Some evidence exists supporting the case of potential cure by radical prostatectomy when pelvic nodal involvement is minimal. Other options include standard external beam irradiation therapy, endocrine therapy with transurethral prostatic resection, and finally, observation until distant metastases occur. Because of the increased risk of distant metastases in patients with stage D1 prostatic cancer, adjuvant chemotherapy programs are rational with clinical trials now in progress.

Androgen Antagonists↗
PubMed1990

Effects of intravenous infusion of human prostate tissue substances in dogs.

Symptoms of postresection syndromes following transurethral prostatectomy have been associated with a transient increase in serum acid phosphatase due to intraoperative absorption of prostate tissue substances. Factors associated with postoperative syndromes include intraoperative absorption of irrigant solution, intraoperative blood loss, and intraoperative absorption of prostate tissue substance. An animal model was used in this study to determine the isolated physiologic effects of intravenous infusion of a saline prostate tissue extract using an infusion schedule comparable to that of transurethral prostate resection. Twenty-four animals received either normal saline infusion (control) or saline prostate tissue extract infusion (experimental). The experimental group showed a significant decrease in fibrinogen, platelet count, white blood count, activated clotting time, and plasma volume. These results suggest that the isolated effects of intravascular absorption of prostate tissue substances are due to disseminated intravascular coagulation, most likely resulting from tissue thromboplastin and activation of plasminogen.

Absorption↗