Abstract
Transurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of infravesical obstruction due to benign prostatic hyperplasia (BPH). While TURP has proven long-term efficacy, it has some associated morbidities. This has fuelled the drive to develop alternative cost-effective options with comparable functional outcomes and a superior safety profile. The aim of this study was to evaluate transurethral electro-vaporization of the prostate (TUVP) combined with TURP as a “sandwich” procedure in relieving the obstruction caused by BPH with volume of 40-80cc. The medical notes of 57 consecutive patients with moderate to severe bladder outflow symptoms due to BPH who underwent TURP-TUVP as a sandwich procedure from April 2007 to March 2011 were reviewed for prostatic volume, duration of surgery, volume of irrigation fluid used intra-operatively and post-operative hospital stay. Similarly, the patients IPSS, Qmax and PVR were evaluated pre- and postoperatively. The mean patient age was 64.1 years (SD = 9.1), mean prostatic volume was 56.8 cc (SD = 8.9), mean resection time was 69.5 minutes (SD = 23.9) and mean volume of irrigation fluid (1.5% Glycine) used was 21.5 L (SD = 4.9).The mean post-operative hospital stay was 3.5 days (range 3- 4 days). Overall, 11 (19%) patients had blood transfusion, there was no incidence of TUR syndrome and one mortality was recorded from primary plasminolysis. Compared with baseline values, on follow-up at 3 months the IPSS, Qmax and PVR had improved significantly. Bladder neck stenosis occurred in 3 patients and was successfully treated with bladder neck incision. The sandwich combination of TURP and TUVP for the surgical treatment of BPH with volume larger than 40cc had satisfactory patient safety profile and resulted in significant improvement in IPSS, Qmax and PVR on follow-up at 3 months.
Highlights
Transurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of infravesical obstruction due to benign prostatic hyperplasia (BPH)
The objective of this paper was to demonstrate that the TURP-TUVP sandwich procedure minimizes blood loss and resection time in prostate adenomas larger than 40cc
The medical records of 57 consecutive patients presenting between April 2007 and March 2011 with moderate to severe symptoms of BPH and assessed to have a prostatic volume > 40cc were reviewed
Summary
Transurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of infravesical obstruction due to benign prostatic hyperplasia (BPH). While TURP has proven long-term efficacy, it has some associated morbidities This has fuelled the drive to develop alternative cost-effective options with comparable functional outcomes and a superior safety profile. Objectives: The aim of this study was to evaluate transurethral electro-vaporization of the prostate (TUVP) combined with TURP as a “sandwich” procedure in relieving the obstruction caused by BPH with volume of 40-80cc. Transurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of BPH, with proven long-term efficacy. TURP has well described morbidities, necessitating constant attempts at modification of the technique This is especially so for larger prostates (>40cc) where the resection time, blood loss, irrigation fluid volume used and incidence of complications tend to be greater. The concept behind combining TURP and transurethral vaporization of the prostate (TUVP) is to extend the use of endoscopic relief of prostatic obstruction, regardless of the size of the prostate
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