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A 74-year-old man developed complete loss of vision after transurethral prostatectomy under spinal anaesthesia. Eyesight returned to normal over the next 12 hours. A direct inhibitory effect on the retina caused by glycine absorbed with the irrigation fluid is suggested as a possible cause.
A prospective audit was carried out of this unit's policy of non-irrigation following transurethral prostatectomy (TURP). Over an 11-month period 121 TURPs were performed. Only 29 patients required intervention to maintain bladder drainage post-operatively, 23 of these requiring bladder washout alone. In the remaining 6 patients catheter change and continuous irrigation were required. The weight of tissue resected was the only factor investigated which bore a significant relationship to the necessity for further intervention in bladder drainage post-operatively. Despite this, patients requiring continuous irrigation post-operatively could not be easily identified prior to or during surgery.
PURPOSE: We conducted a systematic review of randomized controlled trials evaluating the efficacy and safety of laser prostatectomy techniques compared to transurethral resection of the prostate for symptomatic benign prostatic obstruction. MATERIALS AND METHODS: We searched MEDLINE, the Cochrane library and reference lists of retrieved studies to identify randomized trials of 6 months or greater in duration with at least 10 subjects in each treatment arm. We extracted data on study design, subject and treatment characteristics, adverse events, urinary symptoms and urinary flow. RESULTS: A total of 16 studies involving 1,488 subjects were evaluated, including 8 comparisons of transurethral resection with contact lasers, 7 with noncontact lasers and 4 with hybrid techniques. Study duration ranged from 6 to 36 months. Mean patient age (67.4 years), baseline symptom score (20.2) and peak urinary flow (9.5 ml. per second) did not differ by treatment group. Transurethral resection of the prostate provided slightly greater improvement in urinary symptoms and flow. The pooled mean percentage improvement for urinary symptoms ranged from 59% to 68% with lasers and 63% to 77% with transurethral resection. Improvement for peak urinary flow ranged from 56% to 119% with lasers and 96% to 127% with transurethral resection of the prostate. Laser procedures resulted in fewer transfusions (less than 1% versus 7%) and strictures (0% to 7% versus 8%), and required shorter hospitalizations. Reoperation occurred more often (RR = 5.7) following laser procedures. CONCLUSIONS: Laser techniques are a useful alternative to transurethral resection of the prostate for treating benign prostatic obstruction. Small sample sizes and differences in study design limit any definitive conclusions regarding the preferred type of laser technique.
UNLABELLED: Surgical stress and anesthesia cause immunosuppression that may predispose patients to postoperative infections. T helper lymphocytes play a major role in the immune response by controlling cell-mediated and humoral immunity. The type of immune response generated is determined by the differentiation of precursor T helper cells into Th1 or Th2 cells. Each cell subset secretes a particular array of cytokines that further augment the differentiation into that subset. Th1 cells produce interferon gamma and are responsible for cell-mediated immunity. Th2 cells produce interleukin-4 and are more effective in inducing humoral immunity. Cytokine concentrations are altered during surgery and anesthesia, which may effect Th cell predominance and, therefore, subsequent immune responses. We determined Th1 to Th2 cell ratios in patients undergoing transurethral resection of the prostate (TURP) using either spinal or general anesthesia. Mononuclear cells were isolated before anesthesia, immediately after surgery, and after 24 h from patients undergoing TURP, 10 under general anesthesia and 9 under spinal anesthesia. T helper cell subsets were quantified by using flow cytometry, and the ratio of Th1 to Th2 cells was calculated. Th1 to Th2 ratios in patients receiving spinal anesthesia increased over the three time points studied (P = 0.029) but did not change in patients who had general anesthesia (P = 0.11). At 24 h, Th1 to Th2 ratios were significantly higher in the spinal group than in patients who received general anesthesia (P = 0.0157). Total T helper cell numbers remained constant. These data suggest that, from an immunological viewpoint, spinal anesthesia, but not general anesthesia, benefits the patient by maintaining Th1 cell numbers, thereby promoting cellular immunity. IMPLICATIONS: Spinal anesthesia may result in less immunosuppression after surgery. We found that the ratio of T helper 1 to T helper 2 cells was higher in patients undergoing prostate surgery by spinal rather than general anesthesia. Th1 cells promote protective immune responses that may result in fewer postoperative infections.
A retrospective study was done on 185 patients who underwent transurethral prostatectomy. Of these patients 6 had seminal vesicle tissue in the resected specimen. The presence of the yellow-brown pigment, lipofuscin, in the seminal vesicle epithelium was a consistent finding and, often, paramount to differentiation from carcinoma of the prostate. There was no pathological misdiagnosis of malignancy in this series. Of the 6 patients 2 suffered acute epididymitis postoperatively and 1 had persistent microscopic hematuria 2 months postoperatively. The high incidence of postoperative epididymitis probably is owing to contamination of the seminal vesicles by bacteria. Acquired during urinary tract manipulation, having access to the seminal vesicles and, thus, the vas deferens. In these patients vasectomy and broad-spectrum antibiotics are recommended because epididymal invasion by bacteria may already have occurred before pathologic diagnosis is obtained.
BACKGROUND: Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). Recently, less invasive transurethral laser prostatectomy, such as visual laser ablation (VLAP) or interstitial laser coagulation (ILCP), have been developed. Herein, we investigated the efficacy of VLAP and ILCP compared to TURP. METHODS: A total of 80 patients with BPH were treated: 20 patients by VLAP, 30 patients by ILCP and 30 patients by TURP. All patients were followed up for 12 months after their operations. Treatment outcomes were evaluated by four different criteria: (i) the International Prostatic Symptom Score (I-PSS), (ii) the maximum flow rate (Qmax), (iii) postvoided residual urine volume before treatment and one, three, six and 12 months after treatment, and (iv) prostatic volume before operation and three and six months postoperatively. RESULTS: The I-PSS, Qmax and residual urine volume were significantly improved compared to baseline levels and the improvement continued for 12 months in the three groups: for I-PSS (P<0.001 in the VLAP group and P<0.0001 in the ILCP and TURP groups), Qmax (P<0.001 in the VLAP and ILCP groups, and P<0.0001 in the TURP group), residual urine volume (P<0.01 in the VLAP group and P<0.0001 in the ILCP and TURP groups). Significant reduction of the prostatic volume was recorded only in the ILCP and TURP groups (P<0.001). CONCLUSION: Visual laser ablation and ILCP can be good alternative treatments for BPH. Visual laser ablation provides good outcomes in patients with small-sized BPH and with risk factors such as heart disease or anticoagulation therapy.
INTRODUCTION AND OBJECTIVES: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis. MATERIAL AND METHODS: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data. RESULTS: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53-79 years). The PSA at the time of diagnosis was <4ng/ml in 8 cases; 4-10ng/ml in 16 cases and >10ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19-150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy. CONCLUSIONS: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during follow-up.
We report a case of hyperammonemia and transient blindness following transurethral prostatic resectin. Glicine and ammonia metabolism are reviewed. Water intoxication may not account for these symptoms.
This retrospective study compares two patient groups undergoing transurethral prostatectomy in the same department nearly 60 years apart. The first 100 patients (group A) were operated in 1935-36, the last 100 (group B) in 1991-92. In group A the main indication was residual urine of more than 5o ml, and in 33% total retention. In group B the main indications were elevated symptom score and low flow, supplemented with pressure flow measurements in some patients. To our surprise, total acute retention was the indication in 23% of group B, only a minor reduction from 26% of group A. Median age was increased from 66 years (49-83) in group A to 75 years (57-92) in group B. Of the first 100 patients 7% (3-14%) died within one month after the operation, in group B 0% (0-4%). Preoperative infection rate fell from 29% to 11%, and the number of patients with impaired kidney function fell from 30% to 8%. Postoperative results were satisfactory in 54% and 85%, respectively.
Peri-operative blood loss was compared in a prospective, randomized double-blind study between two groups of patients undergoing transurethral prostatectomy (TURP) under spinal (subarachnoid) analgesia: the first received the non-steroidal anti-inflammatory drug diclofenac sodium, the second group received placebo. The total blood loss and the blood loss per gram of prostate resected did not differ significantly. Some 80% of patients were completely pain free at 8 and 24 h post-operation, and low pain scores recorded by the remaining 20% of patients supported the conclusion that TURP performed under spinal analgesia is not commonly associated with severe post-operative pain.
OBJECTIVE: To conduct a systematic review of randomized controlled trials evaluating the efficacy and safety of transurethral microwave thermotherapy (TUMT) compared with transurethral resection of the prostate (TURP) in treating men with symptomatic benign prostatic hyperplasia (BPH). METHODS: We searched Medline, the Cochrane Library and reference lists of retrieved studies to identify randomized trials of >/= 6 months duration with >/= 10 patients in each treatment arm. Data were extracted on study design, patient and treatment characteristics, urinary symptoms, urinary flow, adverse events and repeat treatment for BPH. RESULTS: Six studies were evaluated, involving 540 patients. The mean age (67.8 years), baseline symptom score (19.5), and peak urinary flow (PUF, 8.6 mL/s) did not differ by treatment group. The pooled mean urinary symptom score decreased by 65% with TUMT and 77% with TURP. The weighted mean (95% confidence interval) difference for the symptom score at the follow-up was -1.83 (-3.09 to -0.58) points, favouring TURP. The pooled mean PUF increased by 70% with TUMT and 119% with TURP. The weighted mean difference for the PUF at the follow-up was 5.37 (4.22-6.51) mL/s, favouring TURP. Retrograde ejaculation (57.6% vs 22.2%), transfusions (5.7% vs 0%) and re-treatment for strictures (relative hazard 9.76) were all significantly more common after TURP, but re-treatment for BPH was significantly more common after TUMT (relative hazard 10.0). CONCLUSIONS: TUMT techniques are effective and safe short-term alternatives to TURP for treating BPH. However, TURP provided greater symptom and urinary flow improvements and fewer subsequent BPH treatments than TUMT.
The prognosis for irradiated patients with localized prostatic carcinoma following transurethral resection of the prostate (TURP) has been debated. Controversy centers upon whether or not TURP has an adverse effect on the outcome. A retrospective analysis of 264 patients treated during 1974-1991 with radical external beam radiotherapy was performed. Ten patients who were irradiated postoperatively were excluded. One hundred and nine patients with urinary obstruction underwent TURP. In another 155 patients, pathological diagnosis was made by needle aspiration or tru-cut biopsies. One hundred and one patients received endocrine manipulation, 58 (40%) in the needle biopsy group, and 43 (39.5%) in the TURP group. Lymph node staging by pelvic lymphadenectomy (20 cases), lymphangiography (15 cases), and CAT and/or NMR (113 cases) was performed in 148 patients. Nodal metastases were found in 38 patients, 19 in the needle biopsy group, and 19 in the TURP group. Disease-related, disease-free and metastasis-free survivals were calculated for all stages and within each tumor stage and histological grade for both groups. Correlation of pretreatment factors with clinical outcome was evaluated by multivariate analysis. Overall, disease-related survival was significantly higher (P = 0.05) in patients undergoing needle biopsy than in those who had TURP (58% vs. 38% at 10 years). This difference was more significant in the subset of patients with well differentiated tumors (P < 0.01). However, no difference could be observed between the two groups in histological grade 2 and 3 tumors or by stage comparison.(ABSTRACT TRUNCATED AT 250 WORDS)
The rate of resection for benign prostatic hypertrophy shows considerable variability among small geographic areas. To help inform the decision to recommend prostatectomy to men with prostatism without signs of chronic retention, we performed a decision analysis to compare the expected outcomes with immediate transurethral resection and watchful waiting. Data used in the model originated from the medical literature, Medicare claims data, and patient interview studies. In our base-case analysis for 70-year-old men, immediate surgery resulted in the loss of 1.01 months of life expectancy, but when adjustments were made for quality of life, immediate surgery was favored with a net utility benefit of 2.94 quality-adjusted life-months. However, the analysis was particularly sensitive to the degree of disutility attributed to the index symptoms of prostatism. We conclude that patient preferences should be the dominant factor in the decision whether to recommend prostatectomy.
The exclusion of prostatic carcinoma in TUR specimens represents a considerable problem for the histopathologist. A technique for the separation of tissue on an anatomical basis which has been carried out on 50 patients is presented. It permits more representative histological sampling of TUR specimens and more accurate characterisation of prostatic carcinoma, but further refinement is recommended.
Three men in their 70s had long-term changes in mood and personality dating from immediately after transurethral prostatectomy. Focal abnormalities in the brain were not detected. The possibility of psychiatric as well as cardiovascular sequelae from this operation deserves investigation.
When all transurethrally resected material of 53 subsequent patients was microscopically examined, primary adenocarcinoma of the prostate was found in 18 patients and benign disease in 35. Only 9 of the patients with histologically confirmed malignancy of the prostate were clinically diagnosed. The proportion of prostatic chips that contained malignant tissue ranged from 1-96%. A mathematical analysis evaluating the probability of including a carcinoma when different numbers of blocks were processes was performed. The analysis showed that when the patient has a clinically malignant diagnosis the probability of 100% is reached by the processing of one block. If the patient has a clinically benign diagnosis, however, the probability of 98% is first reached by the processing of 8 blocks, if such an amount of material is available.
Using venous occlusion impedance plethysmography, leg blood flow was measured in seventeen men undergoing transurethral prostatectomy under either amethocaine spinal anaesthesia (SAB) or nitrous oxide-halothane general anaesthesia (GA). Mean leg blood flow doubled (206% of pre-operative control value) following induction of SAB, remained elevated throughout surgery (146% of control at the end of operation) and had returned to pre-operative levels (94%) by two hours postoperatively. Under GA, mean blood flow rose gradually during surgery to 136% of control by the end. However, mean blood flow was only 28% of control at one hour postoperatively, rising to 66% of control by two hours. Analysis of variance showed a significant difference in blood flow changes between the two groups (Greenhouse Geisser P = 0.005). The early postoperative fall in leg blood flow in the GA group might be important in the aetiology of postoperative deep vein thrombosis.
Whether complete resection was possible with TURP was explained. A lot of adenoma remains after transurethral resection of the prostate (TURP), the other hand transurethral enucleation of the prostate (TUE) is useful for complete resection of an adenoma.