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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.
A case of severe hemorrhage after TURP leading to hypovolemic shock and its successful management by superselective unilateral arterial embolization is described. The authors conclude that arterial embolization is a safe and effective procedure for severe prostatic hemorrhage that may be performed in selected cases when conservative means or fulguration of the prostatic fossa have failed to achieve the control of the bleeding. Adequate selection of the patients, correction of any underlying coagulation defects and a proper resection technique are surely the most important issues in preventing any postoperative bleeding.
The purpose of this study was to investigate the effects of radical prostatectomy (RP) for prostate cancer, transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH), and the alterations induced by ageing on quality of life, urinary and sexual function, and bother. We evaluated 283 patients who filled in and returned the questionnaire used. A total of 105 were treated with RP and were selected prostate cancer patients with localised disease without recurrences. An additional 98 underwent TURP for BPH and a third group consisted of 80 apparently healthy men. The general quality of life was estimated by the Rand 36-Item Health Survey 1.0. Urinary function was estimated by the AUA Symptom Index and the UCLA Prostate Cancer Index (urinary function and bother scale). Sexual function and bother, were explored using the Brief Male Sexual Function Inventory for Urology. Patient outcome 2 years post treatment was compared to the pre-treatment status and to that of the matched control population. General quality of life was not affected by RP or TURP, with the exception of an increase in the emotional/well being domain in RP patients to control group levels. After RP there was more bother reported for the urinary function than urinary malfunction itself, while TURP, as expected, restored urinary function and bother to normal population norms. Elderly males had urinary function and bother similar to the operated patients. Estimating sexual function on RP patients, erectile dysfunction (ED) predominates, leading to decreased sexual life. TURP marginally affects sexual life, mainly due to the loss of ejaculation, while in men from the control group, sexual function, although affected, was still present.
OBJECTIVE: To compare the outcome of transurethral resection of the prostate (TURP) and transurethral microwave thermotherapy (TUMT) on symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with symptomatic BPH were treated by either TURP (32 patients; mean age 70 +/- 6 years) or TUMT (37 patients; mean age 67 +/- 9 years) and assessed using the Madsen-Iversen symptom score, measurements of urinary free flow rate and post-void residual urine volume, digital rectal examination, transrectal ultrasonography, cystometry and pressure-flow measurement, ultrasonography or intravenous pyelography (IVP) of the upper urinary tract, urine analysis and routine blood chemistry including serum prostate-specific antigen (PSA) level. Examinations were repeated at fixed intervals for up to 24 months after treatment. RESULTS: After both TURP and TUMT there was an improvement in symptom score, residual urine volume, free flow rate and infravesical obstruction. The improvements of free flow rate and obstruction were more pronounced after TURP. Serious complications, such as bleeding requiring a re-operation, occurred only in patients who underwent TURP. CONCLUSION: Satisfactory results were obtained after both treatments and the improvements with either treatment lasted for at least 24 months.
PURPOSE: Acute myocardial infarction was found to be the main cause of increased long-term mortality in patients after transurethral compared to open prostatectomy in various retrospective studies. We performed a randomized prospective study to compare morbidity and incidence of acute myocardial infarction in patients after transurethral compared to open prostatectomy for benign prostatic hyperplasia. MATERIALS AND METHODS: We studied 365 patients who were assigned to transurethral (236) or open (129) prostatectomy only according to the size of the prostate and who were followed for 7 to 8 years. The clinical status of the patients in both groups before and after the operation was compared, and the rate of myocardial infarction and long-term mortality was studied. RESULTS: More patients with a history of cerebrovascular accident (5.4 versus 0.8%) and indwelling catheters (16.3 versus 7.6%) before the operation were in the open prostatectomy group. Among the 236 patients operated on transurethrally 31 were reoperated on (6 more than once) during followup compared to 4 of the 129 patients who underwent open prostatectomy. In 15 patients from the transurethral prostatectomy group myocardial infarction developed compared to 9 patients in the open prostatectomy group. This difference was not statistically significant. The rate of acute myocardial infarction after prostatectomy, no matter which approach was used, was greater than 6% and it appeared to be higher when compared to the rate of infarction in the general population of the same age group, which is approximately 2.5% in our county. There was no statistically significant difference in the overall mortality rate between the transurethral and open prostatectomy groups, which was 14.4 and 8.5% respectively. CONCLUSIONS: Open prostatectomy is more effective in overcoming urinary obstruction than the transurethral approach. No significant differences in myocardial infarction or overall mortality rates were found between the 2 groups.
The author reports a consecutive series of 100 trans-urethral resections for prostatic hypertrophy with only one stenosis developing in a patient who had a urethral catheter before resection. In 99 patients who had never had a urethral catheter, transurethral resection never caused urethral stenosis. Drainage was ensured via supra-pubic catheter inserted at the start or end of the resection.
BACKGROUND AND PURPOSE: An image-based approach has been developed to represent bleeding in a simulator for transurethral resection of the prostate (TURP). Whereas previous groups attempted to simulate bleeding mathematically over tissue surfaces or in blood vessels, our approach focused on macroscopic visualization of bleeding in a fluid environment. The TURP is an ideal procedure for simulator-based training because of its importance as a skill to acquire as well as its long learning curve. The most challenging step in creating a realistic TURP simulator is simulated bleeding. MATERIALS AND METHODS: We took an image-based approach in which we generated blood flow movies of bleeding vessels having different severity and position under variable fluid flow conditions and processed them to separate the blood flow from the background anatomy. We then organized the movies into a parametric database. During the running of the simulation, resection systematically triggers the playback of a blood flow movie (bleeding event). The movie is texture mapped onto a virtual surface that is positioned, oriented, morphed, composited, and looped into the virtual scene. RESULTS AND CONCLUSION: The technique produced an accurate depiction of bleeding vessels one would encounter during a TURP. The image changes readily according to the fluid flow state.
PURPOSE: We investigated the value of percent Gleason grade 4/5 as a predictor of long-term outcome in men with prostate cancer diagnosed at transurethral resection who received deferred treatment. MATERIALS AND METHODS: A series of 305 men with prostate cancer diagnosed at transurethral resection from 1975 to 1990 who had subsequent expectancy was analyzed. Mean patient age at diagnosis was 74 years (range 52 to 95). Slides were reviewed, and the Gleason score, percent Gleason grade 4/5 and modified Gleason score (the sum of the dominant and worst grades) were assessed. RESULTS: At followup 271 men (89%) had died, including 110 (36%) of prostate cancer. Gleason score, percent Gleason grade 4/5 and modified Gleason score were significant predictors of disease specific survival (p <0.001). Of all men 34% had tumors without any grade 4/5 pattern, of whom only 8% died of prostate cancer compared with 52% with any grade 4/5 pattern (p <0.001). Gleason score 6 tumors with focal grade 4 (less than 5%) had a worse prognosis than pure Gleason score 3 + 3 = 6 tumors (p = 0.008). There was nonsignificantly shorter survival for Gleason score 4 + 3 = 7 than for Gleason score 3 + 4 = 7 disease (p = 0.19). In Cox models including all possible pairs of Gleason score, percent Gleason grade 4/5 and modified Gleason score the percent Gleason grade 4/5 and modified Gleason score were stronger than Gleason score, although all 3 were independently significant prognosticators. CONCLUSIONS: Percent Gleason grade 4/5, modified Gleason score and Gleason score are predictors of disease specific survival in patients with prostate cancer on deferred treatment. Our study indicates that any grade 4/5 pattern impairs the prognosis significantly.
BACKGROUND: Our purpose was to evaluate the effect of intrathecal fentanyl 25 microg added to 18 mg of 6 mg ml(-1) hyperbaric ropivacaine on the characteristics of subarachnoid block and postoperative pain relief in patients undergoing TURP surgery. METHODS: The patients were randomly assigned into two groups: Group S (saline group, n=16) received 3 ml of 18 mg hyperbaric ropivacaine + 0.5 ml saline--in total, a 3.5-ml volume intrathecally; and Group F (fentanyl group, n=15) received 3 ml of 18 mg hyperbaric ropivacaine + 0.5 ml of 25 microg fentanyl--in total, a 3.5-ml volume intrathecally. In both groups the onset and recovery times of the sensory block, degree and recovery times of the motor block and side-effects were recorded and statistically compared. RESULTS: There was no significant difference between the groups in achieving the highest level of sensory block, and in the times taken to reach the peak level. Regression to L1 was significantly prolonged in the fentanyl group compared with the saline group (P=0.004). Times to the first feeling of pain and the first analgesic requirement were significantly prolonged in the fentanyl group compared with the saline group (P=0.011 and P=0.016, respectively). The frequency of pruritus was significantly higher in the fentanyl group compared with the saline group (P=0.022). CONCLUSION: Addition of fentanyl 25 microg to hyperbaric ropivacaine 18 mg for spinal anesthesia in patients undergoing TURP may significantly improve the quality and prolong the duration of analgesia, without causing a substantial increase in the frequency of major side-effects.
The transeference of two antibiotics, i.e. cefmetazole (CMZ) and fosfomycin (FOM), into prostatic tissues was examined. Prostatic tissue samples were obtained from patients with benign prostatic hyperplasia while undergoing open prostatectomy or transurethral resection of the prostate (TUR-P). 2 g of CMZ or 4 g of FOM was intravenously administered within about 10 minutes starting 1 hour before the removal or resection of the prostate, and blood samples were collected at the end of the administration and during surgery. In TUR-P, resected prostatic tissues were washed with the TUR perfusate and the antibiotic in the tissue was presumed to be released into the perfusate. The following preliminary experiments were, therefore, carried out. The removed prostate was divided into three segments, i.e. urethral region, central region and capsular region, and the CMZ or FOM level in each tissue was measured. The remaining tissues were cut into small pieces for immersion in the TUR perfusate for 10-90 minutes. The tissue fragments were removed every 10 minutes to measure the tissue concentration of CMZ or FOM. The concentration of CMZ or FOM in the prostatic tissues did not vary among the three regions, however it markedly decreased with increase in the period of immersion. This suggested that the concentration of these agents into the prostatic tissues was represented by the concentration in the tissues near the urethra obtained immediately after the start of TUR-P.(ABSTRACT TRUNCATED AT 250 WORDS)
PURPOSE: The Bandloop is a new electroresection loop that is broader than the standard loop and thickens from front to back. We compared the safety and efficacy of the Bandloop to the conventional loop electrode for transurethral prostatectomy. MATERIALS AND METHODS: A randomized prospective study was performed on 53 patients with lower urinary tract symptoms and estimated prostatic volume greater than 30 ml. on transrectal ultrasonography. The Bandloop was used in 25 cases (Bandloop group) and standard loop was used in 28 (standard group). Surgical outcomes, including International Prostate Symptom Score, resected prostatic weight, operative time, uroflowmetry, post-void residual urine, postoperative catheterization period, time to disappearance of macrohematuria, and serial changes of hemoglobin and urinalysis, between the 2 groups were compared. RESULTS: A total of 23 Bandloop and 28 standard loop cases were evaluable. There was no difference in preoperative estimated prostatic volume (mean 44.7 versus 47.8 ml.), resected prostatic weight (36.5 versus 29.4 gm.) or operative time (61 versus 60 minutes) between the 2 groups. The ratio of resected weight-to-estimated prostatic volume was significantly greater in the standard group (81.4% versus 61.9%). There was no difference in postoperative catheterization period (3.3 versus 3.4 days) or time to disappearance of macroscopic hematuria (5.0 versus 5.0 days). Postoperative changes in symptom score (-15.1 versus -15.9), maximum flow rate (11.8 versus 16.3 ml. per second at 12 weeks) and residual volume (-31.6 versus -48.6 ml. at 12 weeks) demonstrated no significant difference between the 2 groups. There was no difference in intraoperative and postoperative bleeding estimated by serial changes in serum hemoglobin and urinalysis after surgery. No patient had major complications or required transfusion. CONCLUSIONS: Transurethral prostatectomy using the Bandloop is as safe and effective in achieving subjective and objective improvements as standard transurethral prostatectomy. However, our randomized study indicates that the Bandloop offers no advantage compared to the standard loop electrode for transurethral prostatectomy.
23 patients with benign prostatic hyperplasia (BPH) aged 60-82 years underwent transurethral resection (TUR) of the prostate in different periods after thermal treatment which had appeared uneffective or brought complications. In the performance of the endoscopic techniques we found macroscopic changes of the prostatic parts of the urethra and bladder cervix characteristic for certain thermal impact (energy, power, site of exposure). Intraoperative bleeding of prostatic tissue was also different depending primarily on the time which had passed after the thermal treatment. Minimal bleeding occurred at least 3 months after the thermotherapy. Thus, thermal treatment of the prostate can be used in combined treatment of BPH for reducing intra- and postoperative hemorrhage due to subsequent TUR. Among the methods of thermal therapy, transurethral microwave thermotherapy is preferable as minimally invasive and deeply penetrating into the depth of the prostatic gland with maximal effect. TUR of the prostate should be performed not earlier than 3 months after thermotherapy which is indicated only for patients at high risk of intraoperative hemorrhage because of unaffected circulation. Therefore, it is desirable to include transrectal dopplerography of the prostate to urological examination of BPH patients.
OBJECTIVE: To determine whether anterograde ejaculation is preserved after transurethral resection of both the prostate and bladder neck (TURP and TURBN). PATIENTS AND METHODS: Between 1994 and 1997, 45 patients (mean age 53.2 years, range 42-62) with bladder neck obstruction and small obstructive adenomas (< 35 g) underwent TURP/TURBN, preserving part of the supramontanal prostate and prostatic urethra for > 1 cm from the verumontanum. They were assessed before and after 0.5-2 years to determine the type of ejaculation, symptom scores and sexual function, and compared with 10 similar patients who had undergone a conventional TURP. RESULTS: With preservation of > 1 cm of the supramontanal prostate, anterograde ejaculation was maintained in 80% of the patients, whereas only one patient in the control group retained anterograde ejaculation. CONCLUSIONS: The preservation of anterograde ejaculation after TURP (in approximately 20% of cases) and after transurethral incision of the prostate (> 90% cases) reported in the literature probably relates more to the presence of an adequate amount of residual prostatic tissue than to the existence of a hypothetical 'pre-prostatic sphincter'.
After the initial enthusiasm subsided lasercoagulation of the prostate has been criticized because the extent of tissue destruction cannot be controlled and many patients may be expected to have significant postoperative obstructive as well as irritative voiding symptoms which may last for weeks. Thanks to new laservaporization techniques these disadvantages have been largely eliminated. With the Holmium laser a real resection of prostatic tissue is possible allowing the surgeon to see the prostatectomy defect immediately and to assess tissue destruction during the operation ("what you see is what you get"). The postoperative voiding disturbances are diminished and comparable to those after TUR-P. At the Department of Urology of the University of Berne 116 patients were treated with the Holmium laser for benign prostatic hyperplasia (BPH). During the initial learning period 12 patients required a secondary TUR-P due to persistent obstruction and in 12 patients a combined laser/conventional resection was performed due to underestimated prostate size. 5 patients were lost to follow-up. In the remaining 87 patients the median duration of catheterization was 2 days. 10/87 patients required postoperative treatment for urinary tract infection. There were no significant perioperative decreases in hemoglobin and no cases of TUR syndrome. 66 patients have been followed for 6 months and 30 patients have been followed for 12 months. The maximum urinary flow improved from 7 ml/s preoperatively to 15 ml/s at 6 months and 14 ml/s at 12 months. The volume of residual urine decreased from a median of 120 ml preoperatively to 24 ml at 6 and 12 months. The IPSS decreased from a median of 20 preoperatively to 3 at 6 and 12 months. In 50 patients followed with pressure-flow study pre- and 6 months postoperatively detrusor pressure at maximum flow decreased from 90 cm H2O to 55 cm H2O and linear PURR sank from 2.06 to 0.6. Taking into account the initial learning curve, transurethral Holmium laser resection of the prostate is a promising method of treatment for BPH as shown by the increase in urinary flow and decrease in detrusor pressure. Although it does not yet rank equally with TUR-P, it is a less invasive alternative providing efficient, safe and almost bloodless' treatment of BPH.
Stricture formation after transurethral prostatectomy was studied in a randomized clinical trial including 185 patients. The patients were allocated to either a 2-day urethral catheter-dilation or internal Otis urethrotomy and to an operation with either a polytetrafluoroethylene coated or an uninsulated metal resectoscope. Urethral stricture was defined as an obstruction resulting in a maximum urine flow rate of less than 15 ml. per second and not permitting the passage of a 21F cystoscope. The frequency of urethral strictures was significantly lower after Otis internal urethrotomy (4 per cent) than after a 2-day urethral catheter dilation (16 per cent). The incidence of stricture formation was similar in patients operated on with a polytetrafluoroethylene coated (8 per cent) and with an uninsulated metal (12 per cent) resectoscope sheath. The incidence of stricture formation was unrelated to age, duration of preoperative and postoperative catheterization, operating time and presence of urinary tract infection.
We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters, urinary incontinence, post-micturition dribbling, and quality of life in patients after transurethral prostatectomy (TURP). Fifty-eight consecutive patients who were selected to undergo TURP for benign prostatic hyperplasia (BPH) were admitted into the study: 28 were randomly assigned to a control group (A), 30 formed the investigational group (B) during an initial visit conducted before surgery. In group B patients, perineal exercises were demonstrated in detail, and tested for their correct use via simultaneous rectal and abdominal examination. After the removal of the urethral catheter, these patients were instructed to perform pelvic floor muscle exercises at home and were evaluated before the exercises and at weekly intervals postoperatively. The American Urological Association Symptom Score improved significantly after TURP in both groups. The average quality of life score improved more significantly in group B after TURP, from 5.5 to 1.5 (P < 0.001). The grade of muscle contraction strength after 4 weeks of PME increased from 2.8 to 3.8 in group B (P < 0.01); it was unchanged in the group A. The number of patients with incontinence episodes and post-micturition dribbling was significantly lower in the group B at weeks 1, 2, and 3 (P < 0.01). Our results show that pelvic floor muscle re-education produces a quicker improvement of urinary symptoms and of quality of life in patients after TURP. Its early practice reduces urinary incontinence and post-micturition dribbling in the first postoperative weeks. The exercises are simple and easy to perform in the clinical setting and at home, and therefore should be recommended to all cooperative patients after TURP.
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