Complications Of Transurethral Resection Research Articles

Effect of Ultrasound-guided Obturator Nerve Block on Complications in Transurethral Resection for Bladder Cancer

Effect of Ultrasound-guided Obturator Nerve Block on Complications in Transurethral Resection for Bladder Cancer

Effect of the Nurse-Led Sexual Health Discharge Program on the Sexual Function of Older Patients Undergoing Transurethral Resection of Prostate: A Randomized Controlled Trial.

Background: Sexual dysfunction is a complication of transurethral resection of prostate (TURP). There is a lack of knowledge of the effect of discharge programs aiming at improving sexual function in older patients undergoing TURP. Objective: To investigate the effect of the nurse-led sexual health discharge program on the sexual function of older patients undergoing TURP. Methods: This randomized controlled clinical trial was conducted on 80 older patients undergoing TURP in an urban area of Iran. Samples were selected using a convenience method and were randomly assigned into intervention and control groups (n = 40 in each group). The sexual health discharge program was conducted by a nurse in three sessions of 30–45 min for the intervention group. Sexual function scores were measured using the International Index of Erectile Function (IIEF) Questionnaire, one and three months after the intervention. Results: The intervention significantly improved erectile function (p = 0.044), sexual desire (p = 0.01), satisfaction with sexual intercourse (p = 0.03), overall satisfaction with sexual function (p = 0.01), and the general score of sexual function (p = 0.038), three months after the program. In the first month after the intervention, except in sexual desire (p = 0.028), no statistically significant effect of the program was reported (p > 0.05). Conclusion: The nurse-led sexual health discharge program led to the improvement of the sexual function of older patients undergoing TURP over time. This program can be incorporated into routine discharge programs for the promotion of well-being in older patients.

Clinical effect of addition and subtraction of Xiaojiyinzi prescription in the treatment of bleeding after bipolar vaporization of prostate for benign prostatic hyperplasia

Objective To explore the effect of addition and subtraction of Xiaojiyinzi prescription in the treatment of bleeding after bipolar vaporization of prostate for benign prostatic hyperplasia. Methods From June 2013 to June 2017, 90 patients with benign prostatic hyperplasia who underwent bipolar electrovaporization in the Traditional Chinese Medicine Hospital of Wenling were selected in this study.The patients were divided into observation group and control group according to a random number table, with 45 cases in each group.The observation group was given addition and subtraction of Xiaojiyinzi prescription, while the control group was treated with finasteride orally.The clinical effects of the two groups were compared and analyzed. Results The amount of bleeding in the control group at 3 days, 5 days and 7 days after operation were (13.69±1.27)mL, (8.37±1.23)mL, (6.13±0.58)mL, respectively, which in the observation group were (9.22±1.18)mL, (6.12±0.98)mL, (3.98±0.33)mL, respectively, there were statistically significant differences between the two groups(t=17.297, P=0.000, t=9.597, P=0.000, t=21.613, P=0.000). The amount of bleeding in both two groups decreased with the prolongation of time, and the differences were statistically significant between each two moments(all P<0.05). After treatment, the I-PSS and NIH-CPSI scores in the control group were (13.22±2.95)points and (13.64±4.22)points, respectively, which in the observation group were (8.11±1.35)points and (7.88±3.06)points, respectively, which were lower than those before treatment, and the differences were statistically significant(t=12.286, P=0.000, t=14.359, P=0.000, t=21.041, P=0.000, t=25.989, P=0.000). The scores in the observation group after treatment were lower than those in the control group, and the differences were statistically significant between the two groups (t=8.217, P=0.000, t=7.413, P=0.000). Conclusion Hemorrhage is the most common complication of transurethral resection of prostate in elderly men, which seriously interferes with postoperative recovery.The addition and subtraction of Xiaojiyinzi prescription can reduce bleeding and improve postoperative recovery. Key words: Prostatic hyperplasia; Prostatectomy; Postoperative complications; Hemorrhage; Xiaojiyinzi prescription; Finasteride; Quality of life; Treatment outcome

Risks and complications of transurethral resection of bladder tumors in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study

BackgroundInformation on the safety of transurethral resection of bladder tumors (TURBT) in patients receiving anti-thromboembolic drugs is currently lacking. This study aimed to evaluate the clinical safety of TURBT in patients receiving anti-thromboembolic agents compared with patients not taking these agents and patients who interrupted their use perioperatively.MethodsWe retrospectively analyzed data for patients who underwent TURBT at Jichi Medical University Saitama Medical Center from September 2013 to August 2016.Patients who underwent surgery while receiving antiplatelet and/or anticoagulant drugs were allocated to the continuation group, those who interrupted these drugs comprised the interruption group, and those who did not use these agents were designated as the control group. We compared the patient characteristics, hemoglobin levels, and complications among the three groups.ResultsA total of 174 patients were analyzed including 19, 18, and 137 in the continuation, interruption, and control groups, respectively. There were no significant differences in patient and tumor characteristics, apart from age, among the three groups. Decreases in hemoglobin levels were similar in the continuation, interruption, and control groups (−0.50 g/dl, −0.40 g/dl, and −0.50 g/dl, respectively).Significantly more patients in the continuation group experienced clot retention compared with the control group (21% vs 5%, p = 0.03). Large tumor size tended to be a risk factor for clot retention in the continuation group (p = 0.07). No patient in the continuation or interruption group required blood transfusion, compared with two patients (1%) in the control group. No patients in any of the groups experienced cardiovascular events during their hospital stay or required rehospitalization for hematuria after discharge.ConclusionsTURBT can be performed safely in patients who continue to take antiplatelet and/or anticoagulant agents, without increasing the risks of severe hemorrhage and blood transfusion. However, the risk of postoperative clot retention may be increased in these patients.

Complications in Transurethral Resection of the Bladder Tumor: Using Nerve Stimulator with or Without Ultrasonography for Obturator Nerve Block: A Comparative Study

BackgroundThe use of ultrasonographic guide is a suggested way to ease the obturator nerve block procedure. Accordingly, in this study, the procedures by selective obturator nerve block with and without use of ultrasonographic guide were compared.MethodsThis interventional study was performed as an open-label randomized clinical trial among 50 consecutive subjects under surgery for intramural tumors of urinary bladder in a training hospital in 2016. The subjects were randomly assigned to be operated under spinal anesthesia accompanied with selective obturator nerve block (10 mL of 1.5% lidocaine adding 1:200000 epinephrine) with or without ultrasonographic guide. The outcomes were compared across the groups.ResultsThere was no statistically significant difference between the onset time in group without guide (6.3 ± 2.2 minutes) and that in the guided group (5.9 ± 2.1 minutes). The time required for the nerve block (4.4 ± 1.3 minutes versus 1.7 ± 0.8 minutes) was significantly shorter (P = 0.001). There were less complications in the group with use of ultrasonographic guide showing significant difference (P = 0.01). The success rate in block was significantly higher in the group with ultrasonographic guide (100% versus 92%, P > 0.05).ConclusionsFinally, according to the obtained results, it may be concluded that ultrasonography guidance would improve efficacy of obturator nerve block compared with conventional techniques.

Serious complications of transurethral resection of the prostate

Objective To analyze the serious complications of transurethral resection of the prostate(TURP) Methods A retrospective study was conducted to summarize the clinical data of 1950 patients with benign prostatic hyperplasia from January 2005 to December 2014.All patients received TURP. The mean patient Age, disease course, IPSS score, PV and Qmax of 1 950 eligible patients were 71 years (54 to 87 years), 7.6 years(0.5 to 15.0 years), (65.1±33.4)ml, 25.5±3.9 and (8.1±2.6)ml/s, respectively. Intraoperative and postoperative complications were graded according to the CLASSIC and modified Clavien classifications, respectively.Serious complications were defined as grade Ⅲ or higher. Results Among the TURP procedures, 99 serious complications occurred, resulting in a serious complication rate of 5.1%, Serious intraoperative and postoperative complication rates were 1.2%(24 cases) and 3.9%(75 cases), respectively.Serious intraoperative complications included ureteral orifice injury (3 cases), bladder explosion(4 cases), and transurethral resection syndrome(17 cases). Serious postoperative complications included massive hemorrhage(26 cases), severe dysuria(18 cases) , permanent urinary incontinence (4 cases), cardio-cerebral vascular accident(5 cases), pulmonary thrombosis(3 cases), severe infection(18 cases), and death(1 case) Conclusions Serious complications may occur at any stages during TURP.Understanding the causes and characteristics of complications, strengthening the prevention and effective treatment is the key measure to reduce the incidence rates. Key words: Prostate; Transurethral resection of the prostate; Complication

Complications of Transurethral Resection of the Prostate

Benign prostatic hypertrophy can be treated by several therapeutic options including medical and surgical techniques. Among the surgical options, transurethral resection has a crucial role. Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hypertrophy (BPH). This technique was the first minimally invasive procedure of the modern surgical practice remaining the most commonly procedure. During 2010-2015, 324 patients were enrolled in our study, recording all postoperative complications. Our paper emphasizes all the theoretical aspects of TURP’s complications comparing to our data.

57 Impact of obturator nerve block on the short-term complications of transurethral resection of bladder tumor

57 Impact of obturator nerve block on the short-term complications of transurethral resection of bladder tumor

Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease

Urologists have not reached a consensus regarding the pre-, intra-, and postoperative management of patients taking antiplatelet agents. This study aimed to evaluate the clinical course of patients receiving antithrombotic monotherapy with acetylsalicylic acid (ASA) 100 mg who underwent transurethral resection of bladder cancer. This study was designed to compare the surgical outcomes for 108 transurethral resections of bladder cancer performed for patients taking antiplatelet therapy and for 105 procedures performed for patients who had never taken antiplatelet agents before surgery. Antiaggregant therapy was maintained according to criteria evaluated by a urologist, surgeon, anesthesiologist, and cardiologist. Variables were described using the mean as the location index and using standard deviation as a dispersion index if continuous percentages were used elsewhere. Group comparisons were performed using the t test or the chi-square test for categorical data, and Fisher's exact test was used where appropriate. The mean operative time for patients taking ASA was 31 min (range 10-65 min), whereas it was 26 min (range 5-60 min) for control subjects. The difference between pre- and postoperative hemoglobin values was -0.6 g/dl in the group receiving antiplatelet therapy and -0.8 g/dl in the control group (p = 0.0720). Transfusional support was required during four procedures performed for patients taking antiplatelet therapy and during two procedures for the control group (p = 0.242). No adverse cardiac events or anesthesia-related complications occurred. Three patients in the treatment group and two patients in the control group required reintervention to ensure hemostasis during the postoperative period. None of the patients in either group underwent rehospitalization for hematuria after leaving the hospital. The current results suggest that continued use of anti-aggregant monotherapy does not increase the risk of overall bleeding or reintervention for patients undergoing transurethral resection of bladder neoplasms and that suspending aspirin before such a procedure is therefore unnecessary.

The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate

PurposeThe aim of the study was to evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of the prostate (TURP).MethodsAll patients with benign prostatic hyperplasia submitted to monopolar TURP from January 2006 to February 2008 at a non-academic center were evaluated for complications occurring up to the end of the first postoperative month. All complications were classified according to the modified CCS independently by two urologists, and the final decision was based on consensus. If multiple complications per patient occurred, categorization was done in more than one grade. Results were presented as complication rates per grade.ResultsForty-four complications were recorded in 31 out of 198 patients (overall perioperative morbidity rate: 15.7%), and their grading was generally easy, non-time-consuming and straightforward. Most of them were classified as grade I (59.1%) and II (29.5%). Higher grade complications were scarce (grade III: 2.3% and grade IV: 6.8%, respectively) There was one death (grade V: 2.3%) due to acute myocardial infarction (overall mortality rate: 0.5%). Negative outcomes such as mild dysuria during this early postoperative period or retrograde ejaculation were considered sequelae and were not recorded. Nobody was complicated with severe dysuria. There was one re-operation due to residual adenoma (0.5%).ConclusionsThe modified CCS represents a straightforward and easily applicable tool that may help urologists to classify the complications of TURP in a more objective and detailed way. It may serve as a standardized platform of communication among clinicians allowing for sound comparisons.

Transient acute liver failure complicating transurethral resection syndrome

Transurethral resection (TUR) syndrome, resulting from dilutional hyponatraemia for excessive absorption of irrigating fluid, represents the most relevant complication of transurethral resection of prostate (TURP). Ethanol is used as a tracer in the irrigant solution to monitor fluid absorption with a breathalyser. An unusual case of transient acute liver failure complicating TUR syndrome is reported. A 54-year-old male patient, without risk factors for the development of toxic hepatitis, was subjected to TURP for treatment of benign prostatic hyperplasia. Fluid absorption (2275 ml), estimated by breathalyser, exceeded maximum allowed absorption (2000 ml) only at the end of the surgical intervention. No signs of possible toxicity were evident in the few hours following the intervention. About 10 h after the end of TURP, the patient developed sweating, vomiting and diarrhoea. Laboratory analysis revealed severe hyponatraemia (116 meq/l) with signs of severe liver impairment (total bilirubin 5.8 mg/dl, alanine aminotransferase 56,500 U/l, aspartate aminotransferase 32,700 U/l), kidney failure (serum creatinine 1.93 mg/dl) and serum ethanol levels of 219 mg/dl (0.2%). The patient was treated with acetylcysteine 150 mg/kg i.v. and furosemide 50 mg i.v. Liver and renal functions improved in few days and recovered completely within 30 days. The TUR syndrome observed in this case was probably extravascular in nature, and could have been identified and prevented by measuring ethanol levels 10 min after ending the surgical procedure. The performance of such a test should be strongly recommended to all surgeons. The clinicians attributed the development of liver impairment in this case to ethanol toxicity. However, further studies are warranted to confirm whether hepatic injury can represent a possible complication of TUR syndrome when ethanol solution is used as irrigant fluid.

C6 Are there any factors predicting the postoperative complications of transurethral resection of the prostate?

C6 Are there any factors predicting the postoperative complications of transurethral resection of the prostate?

Low PAI-1 activity in relation to the risk for perioperative bleeding complications in transurethral resection of the prostate

Introduction Low levels of plasminogen activator inhibitor type 1 (PAI-1) have been associated with increased risk for perioperative bleeding in some case reports. The aim of this study was to investigate prospectively whether low PAI-1 activity increases the risk for perioperative bleeding in patients undergoing transurethral resection of prostate, an organ with high fibrinolytic activity. Patients and methods 62 patients with benign prostatic hyperplasia planned for transurethral resection were included. Blood samples for PAI-1 were taken together with other routine preoperative blood samples 1 week before surgery but analyzed after the hospitalization. The intraoperative blood loss was determined by measuring the amount of hemoglobin in the irrigating fluid. The postoperative blood loss was estimated from calculations of hemoglobin mass (Hb mass), which is a product of hemoglobin concentration and blood volume. Hb mass was calculated before surgery and on the day of discharge, and was adjusted for intraoperative blood loss and transfused Hb mass. Bleeding complications were defined as re-operation due to bleeding, more than 40 ml intraoperative bleeding/g resected prostatic tissue or postoperative blood loss corresponding to more than 100 g of hemoglobin. Results Bleeding complications were observed in 3 of 4 (75%) patients with low PAI-1 levels, defined as < 1 U/ml, and in 16 of 58 (28%) patients with PAI-1 levels > 1 U/ml ( P = 0.082). After adjustment for resection time, resected prostatic mass and systolic blood pressure this became borderline significant (odds ratio 11.8; 95% confidence interval 1.00–139; P = 0.05). Conclusion Low PAI-1 activity may contribute to the risk of bleeding after transurethral resection of the prostate.

Transurethral resection in women with lower urinary tract symptoms

To evaluate the preliminary safety, efficacy and complications of transurethral resection (TUR) in the management of women with lower urinary tract symptoms. One hundred and eight women (mean age, 57.6 years) with moderate to severe lower urinary tract symptoms underwent TUR between September 1998 and December 2002. At preoperative baseline, 6 months and 24 months postoperatively, all patients underwent clinical evaluations including the standardized American Urological Association symptom score, peak urine flow, postvoid residual urine volume and quality-of-life assessments. Operative time, catheter time, hospital stay and incidence of side-effects were also recorded. The total mean operative time was 19.25 +/- 6.70 min. The mean catheter time was 26.2 +/- 12.8 h and the mean hospital stay was 2.08 +/- 0.84 days. No patient needed a blood transfusion or experienced hyponatremia. The total storage and voiding symptom scores and quality of life score had improved significantly 6 months after the surgical procedure (P < 0.01). There were little changes in peak flow rate and residual urine volume. Complications of the procedure included urinary tract infections (n = 4) and stress incontinence (n = 3). Two patients later underwent bladder neck suspension procedure. In this preliminary study, there was significant clinical improvement maintained at all follow-up intervals and the results were not comparable to TUR of the prostate in men with clinical benign prostatic hyperplasia. The risks associated with TUR in women, especially of stress incontinence, are significant. A multicenter clinical trial is currently underway to determine the long-term efficacy and safety of TUR in women.

Haemostasis during transurethral resection of the prostate (TUR-P)

SummaryIntra-operative and postoperative loss of blood are probably the predominant complications of transurethral resection of the prostate (TUR-P). They provide a motive for trying to find alternative methods of treatment. However, the search for other ways of reducing blood-loss, or even preventing it altogether, should not keep us from further developing TUR-P to decrease the level of these complications. Along with adequate knowledge of the physical effects which play a role in efficient occlusion of injured blood vessels, the authors advocate the following: properly modified resection electrodes, high-frequency generators, adequate resection strategies and training courses.

Early detection of TUR(transurethral resection) syndrome--ethanol measurement in ventilated patients

A major complication of transurethral resection of the prostate (TURP) is the excessive absorption of irrigation solution resulting in hypervolemia and dilutional hyponatremia. Marking the irrigation fluid with ethanol is a method for the early detection of fluid absorption. Currently this method is being used in spontaneously breathing patients undergoing regional anaesthesia. The goal of this study was to determine whether this method is also reliable for patients undergoing general anaesthesia. Fifty-nine patients underwent TURP in either spinal anaesthesia (SPA), or general anaesthesia with semi-open (ITNO) and semi-closed (ITNC) systems. Plasma alcohol concentrations ([Eth]p), exhaled ethanol ([Eth]e), plasma sodium concentration ([Na+]), and central venous pressure (CVP) were measured. The irrigation fluid contained ethanol in an concentration of approx. 1%. We assumed that significant fluid absorption took place when [Eth]p exceeded 0.1/1000. Measurements were performed immediately prior to and during surgery at 10-minute intervals. [Eth]p correlated directly with [Eth]e for both forms of anaesthesia. [Eth]p and [Na+] correlated inversely both for SPA and ITNC. Changes in [Eth]p did not parallel changes in CVP. Clinically relevant episodes of fluid absorption were accompanied by the detection of exhaled ethanol in all groups. We conclude that measuring exhaled ethanol is a minimal invasive monitoring technique that allows the detection of significant fluid absorption in both spontaneously breathing as well as ventilated patients with sufficient sensitivity. The ethanol levels are not predictive of the sodium concentration both in SPA and general anaesthesia. Thus, additional determinations of [Na+] is recommended whenever [Eth]e exceeds 0.2/1000.

Seminal Vesicle Urinary Reflux as a Complication of Transurethral Resection of Ejaculatory Ducts

Seminal Vesicle Urinary Reflux as a Complication of Transurethral Resection of Ejaculatory Ducts

Continuous versus intermittent flow irrigation in transurethral resection of the prostate

Objective. We compared fluid absorption, blood loss, and immediate postoperative complications in transurethral resection of the prostate (TURP) performed with the continuous flow and the intermittent flow irrigation techniques. We also studied pressure conditions under which fluid absorption occurs when continuous flow irrigation is used. Methods. One experienced urologic surgeon performed TURP in 40 patients using suprapubic drainage of the bladder and in 40 other patients using the intermittent-filling technique. Fluid absorption was measured by the ethanol method every ten minutes. The intravesical pressure was recorded continuously in 23 of the patients with suprapubic drainage. Results. Fluid absorption was more common when suprapubic drainage was used (P < 0.004). There were no differences in operating time, blood loss, postoperative complications, or in the period of hospitalization. Low-degree absorption occurred during minor elevations of the intravesical pressure, and massive fluid absorption was associated with pressures between 1.0 and 2.5 kPa (10 and 25 cm H 20). Conclusions. Continuous flow irrigation promoted fluid absorption, which occurred at lower pressures than commonly believed. With respect to other parameters, we found no superiority of one irrigating technique over the other.

Microbiological study of bladder tumors, their histology and infective complications

The microbiology of bladder tumors and the infective complications of transurethral resection (TURBT) were studied prospectively in 51 patients. Patients taking antimicrobials were excluded. Those with significant preoperative bacteriuria were included in the study when results of the preoperative urine specimen were unavailable at the time of operation. Infected tumors were found in 18 percent of males and 75 percent of females. A wide range of bacteria, including anaerobes, was isolated; when streptococci or coliforms were cultured from the tumor, they were always found in significant numbers in the preoperative urine specimen. Perioperative bacteremia and postoperative complications requiring parenteral antibiotics were more common in females and in patients with significant preoperative bacteriuria. No correlation was found between tumor infection and histologic grade or stage of tumor. Patients with sterile preoperative urine and positive bacterial cultures from tumors were no more likely to have postoperative urinary tract infections than those with negative tumor cultures.

Incontinence following transurethral resection of the bladder neck in the female.

Incontinence is an unwelcome complication of transurethral resection (TUR) of the bladder neck in the female. A computerised analysis of 238 procedures performed during the period 1940 to 1972 was carried out to assess the morbidity due to this complication and to evaluate possible predisposing factors. Initially 15.2% of patients were incontinent but 70% of these soon became continent without further treatment. The remaining 4.7% were treated by surgical or other measures. The incidence of incontinence was unrelated to the amount of tissue removed or to the number of operations, but was significantly lower when the operation was done for polypi of the bladder neck and significantly higher in patients with a cystocele or urethrocele. It seems possible to reduce the incidence of incontinence by careful selection of cases.