Monopolar Transurethral Resection Of Prostate Research Articles

The effect of acute urinary retention on the results of transurethral resection of the prostate.

Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.

Incidence and outcome of transurethral resection of prostate syndrome at a tertiary care hospital

Introduction: Monopolar transurethral resection of prostate (M-TURP) is rarely complicated with the dreaded syndrome the TURP syndrome due to absorption of larger amount of non-electrolyte hypo-osmolar irrigation fluid (1.5% glycine), longer duration of surgery and larger amount of tissue resection. This study aims to find out the incidence and perioperative outcome of TURP syndrome after monopolar TURP. Method: This was a cross sectional study of retrospectively collected data during the period of 4 years from June 1st 2018 to 30th May 2022, in Department of Urology of Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. Ethical approval was obtained from NAMS ethical committee. Microsoft Excel was used for descriptive analysis of the incidence of TURP syndrome, its relation with amount of resected tissue, duration of resection time, and the outcome (need of blood transfusion, length of hospital stay, mortality). Result: Out of 208 cases of monopolar TURP, 8/208(3.8%) had TURP syndrome. Patients with TURP syndrome were age group 70-85 y. Duration of surgery was &gt;60 min was in 5/8(62.5%), resection weight &gt;20 gm 6/8(75%), blood transfusion 1/8(12.5%), and hospital stay &gt;3 days in all 8/8(100%) cases. Mortality was nil in patients with TURP syndrome. Conclusion: The TURP syndrome was observed in 8/208(3.8%) and it was more common in older (&gt;60y) with longer duration (&gt;60 min) of surgery, and larger amount of prostatic tissue (&gt;20gm) resection.

The role of transurethral resection of prostate (TURP) in patients with underactive bladder: 12 months follow‐up in different grades of detrusor contractility

Male detrusor underactivity (DUA) definition remains controversial and no effective treatment is consolidated. Transurethral resection of the prostate (TURP) is one of the cornerstones surgical treatments recommended in bladder outlet obstruction (BOO). However, the role of prostatic surgery in male DUA is not clear. The primary endpoint was the clinical and voiding improvement based on IPSS and the maximum flow rate in uroflowmetry (Qmax) within 12 months. We analyzed an ongoing prospective database that embraces benign prostata hyperplasia (BPH) male patients with lower urinary tract symptoms who have undergone to TURP. All patients were evaluated pre and postoperatively based on IPSS questionnaires, prostate volume measured by ultrasound, postvoid residual urine volume (PVR), Prostate Specific Antigen measurement and urodynamic study (UDS) before the procedure. After surgery, all patients were evaluated at 1-, 3-, 6- and 12-months. Patients were categorized in 3 groups: Group 1-Detrusor Underactive (Bladder Contractility Index (BCI) [BCI] < 100 and BOO index [BOOI] < 40); Group 2-Detrusor Underactive and BOO (BCI < 100 and BOOI ≥ 40); Group 3-BOO (BCI ≥ 100 and BOOI ≥ 0). It was included 158 patients underwent monopolar or bipolar TURP since November 2015 to March 2021. According to UDS, patients were categorized in: group 1 (n = 39 patients); group 2 (n = 41 patients); group 3 (n = 77 patients). Preoperative IPSS was similar between groups (group 1-24.9 ± 6.33; group 2-24.8 ± 7.33; group 3-24.5 ± 6.23). Qmax was statistically lower in the group 2 (group 1-5.43 ± 3.69; group 2-3.91 ± 2.08; group 3-6.3 ± 3.18) as well as greater PVR. The 3 groups presented similar outcomes regard to IPSS score during the follow-up. There was a significant increase in Qmax in the 3 groups. However, group 1 presented the lowest Qmax improvement. There were different objective outcomes depending on the degree of DUA at 12 months follow-up. Patients with DUA had similar IPSS improvement. However, DUA patients had worst Qmax improvement than men with normal bladder contraction.

SAFETY AND EFFICACY OF MONOPOLAR TRANSURETHRAL RESECTION OF PROSTATE IN LABORATORY PARAMETERS

Objective: This study aims to assess the safety and effectiveness of transurethral resection of prostate using preoperative and postoperative laboratory parameters. Material &amp; Methods: This was a retrospective study of all patients treated with transurethral resection of prostate at Karawang Hospital from January – August 2018. The laboratory parameters are measured in the preoperative and postoperative period, including haemoglobin, leucocyte, and electrolyte. The outcomes of the study were the comparison of laboratory parameters before and after monopolar transurethral resection of prostate. Results: A total of 142 patients were enrolled in this retrospective study. The mean age was 68 years. Transurethral resection of prostate was performed in all patients. The mean of preoperative level of haemoglobin was higher compared to postoperative level (13.21 gr/dL vs 12.79 gr/dL; p = 0.000). The mean preoperative level of leucocyte was higher during postoperative time compared to preoperative time (13.450 vs 7503.52 p = 0.000). The sodium level was lower postoperative than preoperative ( 137.76 vs 139.39; p = 0.000 ). The potassium level was higher preoperative than in postoperative (4.12 vs 4.02, p = 0.000 ). The logistic regression was performed and shows no significant association between prostate resected weight and length of surgery compared to laboratory parameters. There was no patient who needed blood transfusion or having electrolyte derangement. Conclusion: Based on laboratory parameters, monopolar transurethral resection of prostate is safe and effective in the treatment of benign prostate hyperplasia.

MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY

You have accessJournal of UrologyCME1 May 2022MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY Kirby R. Qin, William Wang, Damien Bolton, and Gregory Jack Kirby R. QinKirby R. Qin More articles by this author , William WangWilliam Wang More articles by this author , Damien BoltonDamien Bolton More articles by this author , and Gregory JackGregory Jack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) surgery is typically performed under general (GA) or spinal anaesthesia (SA). SA is considered the anaesthetic of choice for as it facilitates early identification of transurethral resection of prostate (TURP) syndrome. However, SA may be associated with longer time spent in the recovery room. Previous studies have compared GA and SA in regards to post-operative pain, but not post-operative recovery. We compare post-operative recovery metrics after GA and SA for BPH surgery. METHODS: This was a retrospective review of 500 consecutive patients from March 2019 to July 2021 who underwent surgical management of BPH at Austin Health in Melbourne, Australia. Our institution performs greenlight laser photoselective vaporisation of prostate (PVP), monopolar and bipolar TURP. All continuous variables were normally distributed, presented as mean±SD, and compared using the Student’s T-test and mean difference (MD) [95% CI]. Categorical variables were compared with the Chi-square test. Comparison of recovery time was achieved using multivariate linear regression. RESULTS: In total, 186 (37.2%) underwent SA for monopolar TURP (n=144, 77.4%), bipolar TURP (n=9, 4.8%) and PVP (n=33, 17.7%). In contrast, 314 (62.8%) underwent GA for monopolar TURP (n=213, 67.8%), bipolar TURP (n=6, 1.9%) and PVP (n=95, 30.3%). SA patients were older than GA patients (73.1±8.9 vs 71.2±8.9 years, MD 1.9 [0.3-3.5], p=0.02), but similar in terms of ASA (p=0.17) and prostate volume (67.3±35.0 cc vs 67.7±38.3 cc, p=0.91). As expected, anaesthetic time was longer for SAs (31.5±11.7 vs 26.6±25.3 minutes, MD 4.9 [2.8-7.0], p<0.001), but total operating room time was similar (76.7±26.6 vs 75.7±29.3 minutes, p=0.72). TURP syndrome amongst SAs and GAs were identical (1.6% vs 1.6%, p=0.99). Recovery room time (82.8±57.2 vs 74.7±42.7 minutes, p=0.07) and length-of-stay (2.5±2.0 vs 2.3±3.3 days, p=0.42) were similar after SA and GA. In multivariate analysis, higher ASA score (p<0.001), PVP surgery (p=0.03), longer resection time (p=0.04) and TURP syndrome (p=0.008) were associated with greater time spent in the recovery room, but choice of anaesthetic was non-significant (p=0.37). CONCLUSIONS: Although our study does not prove if SA can facilitate early identification of TURP syndrome, we have shown that the method of anaesthesia does not significantly impact time spent in the operating room and recovery room or inpatient length-of-stay. This may further support the ongoing use of SA for BPH surgery. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e476 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirby R. Qin More articles by this author William Wang More articles by this author Damien Bolton More articles by this author Gregory Jack More articles by this author Expand All Advertisement PDF DownloadLoading ...

Transurethral Resection of Prostate Without Traction: A Retrospective Observational Study

Introduction: Application of traction after monopolar transurethral resection of prostate (TURP) is a common practice that causes significant discomfort to the patients. So can we avoid the morbidity of traction in a selected group of the patient where there is no significant hematuria after TURP? Hence we did a retrospective observational study to look for feasibility and safety of traction less TURP.&#x0D; Methods: It is a retrospective observational study conducted in the Department of Urology, Manipal Teaching Hospital from August 2018 to August 2020 in patients who underwent traction less TURP. There was a total of 64 patients who fulfilled the inclusion criteria. All the demographic profiles, preoperative investigations, and perioperative parameters were noted. Postoperatively requirement of reapplication of traction, bladder washes, and application of tranexamic acid for hematuria, clot retention, and blood transfusion were noted. Statistical analysis was done by SPSS version 25.&#x0D; Result: Mean age and prostate size were 71 yrs. and 52 g. Sixteen(25%) patients were on antiplatelet therapy, fourteen(21%) patients had a catheter in situ and 34(53%) patients were on anti-BPH (Benign Prostatic Hyperplasia) medication. There were no patients who require re- traction, bladder washes, or application of intravenous tranexamic acid. There was one (1.56%) patient who had clot retention requiring evacuation and blood transfusion. VAS score after 8 hrs. and 12hrs. was 3.22 and 1.73. Mean hemoglobin fall was 0.81 g%.&#x0D; Conclusion: Traction after monopolar TURP can be safely omitted in carefully operated patients but traction should be reserved for those patients with continuous hematuria.&#x0D;

A prospective comparative study on the operative outcomes between monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: An institutional experience

Background: Benign prostatic hyperplasia (BPH) is a common disease in elderly men. Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the treatment of bladder outlet obstruction due to BPH. Its modification, bipolar TURP (B-TURP), promises to overcome its most prominent drawbacks, such as bleeding and dilutional hyponatremia. Aims and Objectives: This study aims to study the feasibility, effectiveness, and safety of B-TURP over M-TURP. Materials and Methods: A total of 110 patients with BPH were prospectively randomly assigned to undergo B-TURP (55) or M-TURP (55). Patient characteristics of the two groups were similar. Hemoglobin was measured preoperatively and postoperatively. IPSS, maximal flow rate, and post-void residual urine volume were assessed preoperatively. Duration of surgery, mean weight of resected tissue, mean irrigation fluid used, mean drop in hemoglobin, mean change in sodium, and mean post-operative irrigation used were also compared. Results: Duration of resection time was significantly shorter in M-TURP (P=0.0034). The mean change in sodium and mean post-operative irrigation used were significantly lower in bipolar group with P&lt;0.05 and 0.0024, respectively. The mean drop in post-operative hemoglobin concentration (P=0.0916) was statistically insignificant. There was one instance of the transurethral resection (TUR) syndrome in the M-TURP group whereas no TUR syndrome occurred in the B-TURP group. Conclusion: B-TURP and M-TURP are effective and safe techniques for the surgical treatment of BPH. B-TURP definitely reduces the incidence of dilutional hyponatremia and post-operative irrigation use making it a competitor to replace M-TURP as the new gold standard.

Monopolar Transurethral Resection of Prostate for Benign Prostatic Hyperplasia in Patients With and Without Preoperative Urinary Catheterization: A Prospective Comparative Study

BackgroundA significant proportion of patients undergo surgery for benign prostatic hyperplasia following acute urinary retention. Studies have reported conflicting results of improvement following transurethral surgery in these patients.ObjectiveTo compare perioperative complications and postoperative voiding parameters in patients undergoing monopolar transurethral resection of prostate with and without preoperative Foley catheterization.MethodsA prospective non-randomized study was conducted in patients undergoing monopolar transurethral resection of prostate for symptomatic benign prostatic hyperplasia. Patients were divided into those with Foley catheterization preoperatively (n=52), and those without catheters (n=90). Change in hemoglobin level, the resected volume of prostate, complications and the need for postoperative catheterization were compared. Postoperative symptoms score using International Prostate Symptom Score, maximum flow rate and post-void residual volume were assessed at three months follow up.ResultsThe mean operative duration, length of stay and resected volume were higher in those patients with catheters; however, no significant differences were noted for mean hemoglobin level change and need for postoperative recatheterization. Three patients in each group required recatheterization and, all were catheter-free at one week postoperatively. Complications developed in 16.1% (n=23) with most of them being Clavien I. Patients with catheters had a lower postoperative maximum flow rate than those without it (16.90 vs 19.75 mL/sec). Patients with catheters had a significantly better postoperative quality of life and symptom score.ConclusionMonopolar transurethral resection of prostate in patients with preoperative per-urethral Foley catheter for acute urinary retention had similar postoperative voiding parameters with comparable complication rates to those without a catheter.

The effect of short-term use of finasteride versus cyproterone acetate on perioperative blood loss with monopolar transurethral resection of prostate

BackgroundPerioperative bleeding is the most common complication related to transurethral resection of prostate; the aim of the study was to compare the effect of pre-operative use of finasteride versus cyproterone acetate (CPA) on blood loss with monopolar TURP.MethodsThis prospective randomized controlled study was conducted on (60) patients with BPH underwent monopolar TURP between July 2019 and July 2020. Patients were distributed into three equal groups; CPA group: 20 patients received cyproterone acetate 50 mg tab BID for two weeks before TURP, finasteride group: 20 patients received single daily dose of finasteride 5 mg for two weeks before TURP, control group: 20 patients received no treatment before TURP, all patients underwent monopolar TURP, and then histopathological examination of the resected tissues was done with assessment of the microvascular density of the prostate.ResultsOur study showed that there was significant decrease in intraoperative blood loss and operative time in CPA and finasteride groups in comparison with control group (p = 0.0012) (p < 0.0001), respectively, significant decrease in post-operative Hb and HCT value in finasteride and control groups in comparison with CPA group (p < 0.01), significant increase in specimen weight in CPA group compared to other groups (p < 0.01), and there was also significant decrease in microvascular density in CPA group in comparison with other groups (p < 0.01).ConclusionCyproterone acetate is more effective than finasteride in decreasing perioperative bleeding with TURP by decreasing microvascular density of the prostate.

Current Bladder Dysfunction Reports Thulium Laser Prostatectomy

The purpose of this review is to summarize the literature on safety and efficacy of minimally invasive thulium laser procedures for benign prostatic hypertrophy (BPH). Recent studies have confirmed long-term safety and efficacy of thulium laser prostatectomy. There has been recent literature published from around the world confirming safety and efficacy in treatment of large prostates, obese patients, and in patients taking oral anticoagulation. Newer thulium laser systems use a wavelength of 1.9μm instead of 2 μm. Thus far, no clinical differences have been seen in outcomes of thulium laser procedures done with this wavelength. The high-power thulium laser was first introduced in 2005 for treatment of BPH [1]. Thulium vapoenucleation (ThuVEP), thulium laser resection of the prostate-tangerine technique (TmLRP), thulium laser enucleation (ThuLEP), and thulium vaporization (ThuVP) are techniques for thulium laser prostatectomy that have been described. Studies using the 70W to 200W thulium laser systems demonstrated good efficacy of these procedures with low morbidity and few complications in prostates of small to medium sizes [2]. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP, and holmium laser enucleation of prostate (HoLEP) [1]. In general, thulium laser prostatectomy appears to have longer operative times, shorter catheterization times, shorter hospital stay, and lower transfusion rates compared to standard and bipolar TURP. Outcomes of HoLEP and thulium enucleation techniques appear to be similar. Overall, thulium laser prostatectomy appears to be very safe and effective with low morbidity [3].

Safety and Efficacy of Bipolar Transurethral Resection of the Prostate vs Monopolar Transurethral Resection of Prostate in the Treatment of Moderate-Large Volume Prostatic Hyperplasia: A Systematic Review and Meta-Analysis.

Aims: To compare outcomes of monopolar vs bipolar transurethral resection of the prostate (TURP) in the management of exclusively moderate-large volume prostatic hyperplasia in terms of maximum flow rate as a surrogate for clinical efficacy, duration of catheterization, hospital stay, operative time, resection weight, transurethral resection (TUR) syndrome, acute urinary retention (AUR), clot retention, and blood transfusion. Methods: We conducted a search of electronic databases (PubMed, MEDLINE, EMBASE, CINAHL, and CENTRAL), identifying studies comparing the outcomes of monopolar and bipolar TURP in the management of large-volume prostatic hyperplasia. The Cochrane risk-of-bias tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale for observational studies were used to assess included studies. Random effects modeling was used to calculate pooled outcome data. Results: Three RCTs and four observational studies were identified, enrolling 496 patients. No difference was observed in the clinical efficacy between each procedure at 3 months postoperatively (p = 0.99), 6 months (p = 0.46), and 12 months (p = 0.29). The use of bipolar TURP was associated with significantly shorter inpatient stay (p = 0.01) and a shorter duration of catheterization (p = 0.05). Monopolar TURP was associated with an increased risk of TUR syndrome (p = 0.03). Operative time (p = 0.58), resection weight (p = 0.16), AUR (p = 0.96), clot retention (p = 0.79), and blood transfusion (p = 0.39) were similar in both groups. Conclusion: Our meta-analysis demonstrated that bipolar TURP in the treatment of moderate-large volume prostatic disease may be associated with a significantly lower rate of TUR syndrome and shortened length of hospital stay, with similar efficacy when compared with monopolar TURP. Further high-quality RCTs with adequate sample sizes are required to compare both monopolar and bipolar TURP to open prostatectomy or laser enucleation in the treatment of exclusively large-volume prostates with stricter definition of size.

Monopolar trans-urethral resection of prostate: our initial experience in a new African hospital with few resources

Background: Diseases of the prostate including benign prostate hyperplasia constitute a significant portion of cases that are routinely managed by urologists worldwide. Where there is need for surgical intervention of clinical BPH, monopolar trans-urethral resection of prostate is a gold standard surgical option. The objective of our study is to describe and share our initial experience of monopolar TURP in our new African hospital with few resources, a stepping stone for future comprehensive research on TURP and urology capacity building.Methods: Retrospective study of twelve patients who had M-TURP using sterile distilled water as irrigation fluid over one year period, at Yobe State University teaching hospital, a new hospital in North-Eastern Nigeria. Data related to the TURP were extracted from the patients’ folders and operation theatre register, and then analyzed.Results: The mean age of patients was 67.4 years, recurrent urine retention was the commonest indication for M-TURP (50.0%), preoperative mean volume of prostate was 45.8 ml , mean duration of surgery was 63.8 minutes and mean weight resected prostatic chips was 18.4 grams. There was low complication rate (16.7%).Conclusions: M-TURP using sterile water as irrigation fluid is efficacious, reliable and pocket-friendly surgical option for our patients that needed surgery for clinical BPH. Patient selection and minimizing the time spent on M-TURP are of paramount importance in avoiding or reducing the risk of complications as observed in our study.

Comparison between Photoselective Vaporization of Prostate by Diode Laser and Monopolar Transurethral Resection of Prostate in Single Center Experience

Background: Transurethral resection of prostate has been regarded as the gold standard surgical management of benign prostatic hyperplasia (BPH).With the evolution of new technologies, laser prostatectomy emerged as an alternative. Aim of the study: To compare the rate of outcome of diode laser vaporization of prostate and Transurethral Resection of Prostate in Al Diwaniya governorate. Patients and methods: From October 2017 to October 2018, forty patients with surgical indications of prostatectomy were enrolled in this study. Their ages ranged from 60-75 years with a mean age 68.6 years and prostate size ranged from 40-80 ml with a mean size 62.175 ml. Twenty patients underwent diode laser vaporization of prostate and another 20 patients underwent Transurethral Resection of Prostate. The choice based on surgeon preference and patient ability. Preoperative evaluation was done for all patients by history, physical examination and investigations. International Prostate Symptoms Score, maximum flow rate, digital rectal examination, prostate specific antigen, abdominal ultrasound, urinalysis, blood urea, s.creatinine, complete blood count were all done preoperatively. One pint of compatible fresh blood prepared. Results: The rate of significant bleeding and transfusion in diode PVP and TURP was (zero vs. 35% respectively) , in PVP and TURP the mean irrigation amount perioperatively was (10.10 vs. 33.15 pints respectively) , mean operative time was (70.80 vs. 50.00 min respectively) ,mean hospital stay was (16.03 vs. 30.09 hours respectively), mean time to urethral catheter removal was (24 vs. 81.71 hours respectively), postoperative complication rate (mainly dysuria) was (75% vs. 65% respectively), mean postoperative IPSS was (14.40 vs. 14.20 respectively) , mean postoperative Qmax was (15.45 vs. 16.30 ml/sec respectively). There was no statistical difference between both groups in regard to lowering IPSS or increment in Qmax. The mean cost was (1500 vs. 500.42 dollars) in diode PVP and TURP respectively. Conclusion: Diode laser vaporization of prostate is a good alternative to TURP with comparable results in treatment of BPH especially in patients taking anticoagulant drugs who cannot stop their medication. However, the high cost of this procedure and dysuria as a complication may prevent the common use of this technique.

Prostatic artery embolization versus transurethral resection of the prostate in management of benign prostatic hyperplasia.

BackgroundTransurethral resection of the prostate (TURP) is considered the gold standard surgical intervention for prostate size less than 80 g. Prostatic artery embolization (PAE) has been suggested as a minimally invasive interventional radiological procedure in the management of benign prostatic hyperplasia (BPH), especially by using the PErFecTED technique. We aim through our study to evaluate the efficacy and safety of PAE compared with those of monopolar transurethral resection of prostate (M-TURP) and bipolar transurethral resection of prostate (B-TURP) in treating lower urinary tract symptoms (LUTSs) secondary to BPH.MethodsWe randomized 60 patients into 3 equal groups representing M-TURP, B-TURP, and PAE. Patients were followed up at 1 and 6 months postoperatively with regard to the International prostate symptom score (IPSS) score; uroflowmetry; prostate volume by transrectal ultrasound; and postvoid residual urine.ResultsThe mean operative time was 59, 68, and 89 minutes for the M-TURP group, the B-TURP group, and the PAE group, respectively; only one patient, who represented 5% of the M-TURP group and 1.7% of the whole study population, developed transurethral resection syndrome. Four patients of the PAE group complained of postembolization syndrome, which represented 20% of the cases. Only two patients in our study, both belonging to the PAE group, developed acute urinary retention after catheter removal, representing 10% of the PAE group and 3.33% of the whole study population. The improvement in the IPSS score, the average uroflowmetry (Q-average) score, postvoid residual urine, and prostate volume reduction was noted in all groups, with more statistically significant improvement in each of the M-TURP and the B-TURP groups than in the PAE group.ConclusionPErFecTED technique is a novel way of embolization, with statistically significant improvement for patients complaining of LUTSs due to BPH in terms of improvement of IPSS, uroflowmetry, prostate size, and amount of postvoid residual urine, yet these results are still not comparable with either the results of M-TURP or B-TURP that still show more effective improvement.

Comparison Between Photoselective Vaporization of Prostate by Diode Laser and Monopolar Transurethral Resection of Prostate in Single Center Experience

Comparison Between Photoselective Vaporization of Prostate by Diode Laser and Monopolar Transurethral Resection of Prostate in Single Center Experience

Bipolar versus monopolar transurethral resection of the prostate (TURP): A prospective study of two urology centers

Background and objectives:Recently, using of bipolar transurethral resection of the prostate has challenged the for- mal monopolar transurethral resection of the prostate. The aim of this study was to evaluate the efficacy and safety of bipolar transurethral resection of prostate versus monopolar transurethral resection of prostate in the treatment of prostate enlargement. Methods: From September 2018 to April 2019, appropriate sample of 44 patients with symp- tomatic benign prostate hyperplasia randomly assigned to two groups, first group (n=21) operated on by monopolar transurethral resection of prostate, second group (n=23) operated on by bipolar transurethral resection of prostate in Rizgary Teaching Hospital and Zheen International Hospital, all patients were fully assessed preoperatively and postop- eratively by serum electrolyte, hemoglobin, operative time. Results: Mean resection time was 56.7 ± 5.8 minutes (mo- nopolar) and 63.1 ± 4.7 minutes (bipolar). The mean volume of irrigant was 17.6±1.6 liter (monopolar) and 20.4±1.8 liter (bipolar). The monopolar group showed a greater decrease in serum Sodium (5.7mEq/L) in contrast to the bipolar group (1.4 mEq/L), a statistically significant difference was detected. The monopolar group showed a statistically significant decrease in Hb (2.5 gm/dl) in contrast to the bipolar group (0.4 gm /dl). Conclusions: T he study showed that bipolar transurethral resection of prostate was superior to monopolar transurethral resection of the prostate with regards to less reduction in serum Sodium level and less decline in hemoglobin level as well as less hospital stay and catheterization days.

Pyuria and Post-Operation Urinary Tract Infection after Diode Laser Vaporesection of the Prostate.

Background: Monopolar transurethral resection of prostate (m-TURP) remains the gold standard for benign prostate obstruction (BPO). Recently developed laser surgical technique provides fewer peri-operative complications with equivalent outcomes. Diode laser vaporesection (DiLRP) offers better hemostasis, shorter catheterization duration, and shorter hospital stay, however, deep thermal penetration might cause prolonged prostatic urethra inflammation and subsequent complications. We conducted a retrospective study to compare the pyuria duration and post-operative urinary tract infection sequelae (POUTIs) between DiLRP and m-TURP. Methods: From July 2011 to September 2015, we retrieved medical records for patients with lower urinary tract symptoms resulting from prostate obstruction who underwent m-TURP and DiLRP. Demographic characteristics were recorded from a computerized database. The duration of pyuria after operation was compared by Kaplan-Meier analysis and risk factors were evaluated by Cox regression analysis. Results: One hundred twelve patients underwent DiLRP and 81 underwent m-TURP performed by the same surgeon during the same period. The mean age of the patients was 72 ± 7.3 years in the DiLRP group and 70 ± 7.6 years in the m-TURP group (p = 0.069). There was a higher percentage of anticoagulant used in the DiLRP group than in the m-TURP group (18.5% vs. 7.4%, p = 0.028). Operation time was longer but post-operative normal saline irrigation interval was shorter in DiLRP compared with m-TURP, respectively (62.8 ± 20.6 vs. 47.4 ± 22.1 minutes, p < 0.001; 2.1 ± 0.3 vs. 2.5 ± 0.9 days, p < 0.001). The post-operative infections were statistically significantly higher in the DiLRP group, including epididymitis (10.2% vs. 1.2%, p = 0.013) and POUTIs-related hospitalization (8.3% vs. 1.2%, p=0.031).The DiLRP resulted in longer pyuria period (16 vs. 12 weeks, p = 0.0014), with factors including operative method by DiLRP (hazard ratio [HR]: 1.828, p = 0.003) and age (HR: 0.665, p = 0.040). Conclusions: According to our study, DiLRP associated with more POUTIs is possibly caused by a longer pyuria period. Further larger prospective studies are necessary for the evaluation of the association between post-operative pyuria and POUTIs.

The industrial revolution for the management of benign prostate obstruction: worldwide publication trends for surgical and medical therapies over the past two decades.

IntroductionResearch for management of benign prostate obstruction (BPO) for adult males remains a cornerstone of urology research. This landscape has witnessed the rise and fall of multiple therapies, both surgical and medical. Our aim was to formally evaluate the publication trends for these interventions over the past 20 years.Material and methodsA systematic search was performed in a Cochrane style. Data was analysed using the independent t-test and Pearson's correlation coefficient (SPSS version 24). To observe changes in trends more effectively, data was sub-divided into two time periods: 1997 to 2006 and 2007 to 2016.ResultsOver the past 20 years, 4236 papers have been published concerning for BPO (surgical, n = 2177 and medical, n = 2059). For surgical treatments, these included articles on monopolar transurethral resection of prostate (TURP) (n = 340), bipolar TURP (n = 260), HoLEP (n = 293) and Greenlight laser (n = 395). For medical therapies, these included alpha blockers (848), 5-alpha reductase inhibitors (n = 618) and PDE5I (n = 91). Between the two time periods the change was +18.8% (p = 0.108) for monopolar TURP, +497.1% (<0.001) for bipolar TURP, -54.5% (p <0.001 for prostatic stents and -81.9% (p <0.001) for transurethral microwave therapy (TUMT). There was over 290% rise in number of publications related to BPO laser surgery (p <0.001). For medical interventions, the change was +11.5% (p = 0.397) for alpha blockers, -1.9% (p = 0.867), +49.0%( 0.122) for phytotherapy, +2075% (p <0.001) for PDEI and +2375.0% (p <0.001) for combined alpha blocker and anti-muscarinics.ConclusionsInterventions for BPO have undergone a high volume of research. In particular, minimally invasive laser surgeries and combined medical therapies have seen significant expansion.

Bipolar versus Monopolar Transurethral Resection of Prostate (TURP), Advantages and Disadvantages in 6-Month Follow-Up

Background: We compared bipolar TURP with current monopolar TURP for safety and efficacy in 6 months follow-up. Methods: A total of 94 patients with LUTS (lower urinary tract symptom) related to BPH (benign prostatic hyperplasia) were included. They were randomized into group B, who underwent bipolar TURP (47 patients), and group M, who underwent monopolar TURP (47 patients). Preoperatively, by using IPSS (international prostate symptom scale) and IIEF-5 (international index of erectile function-5) questionnaires severity of LUTS and Erectile function were assessed. All patients were submitted to transrectal ultrasonography and PSA determination. Surgical and immediately postsurgical variables and accidents were charted; all cases were re-assessed at three and six months after surgery by use of IPSS and IIEF-5 (international index of erectile function-5) questionnaires. Urethral stricture incidence, post-surgical reoperation rate, total postoperative catheter time and hospital stay, change in serum sodium, and hemoglobin were also recorded in two groups. Results: There was no distinct difference between two groups in regards to blood transfusion necessity. The level of serum Na was clearly lower in the monopolar group postoperatively. Catheterization time and duration of hospitalization were clearly shorter in the B-group; transurethral resection syndrome did not happen in any cases of the groups. The groups were corresponded about IPSS improvement. Changes in erectile function, regarding IIEF-5 scores, were similar between the groups. Conclusions: Bipolar TURP is an impressive and secure technique that is correlated with a distinctly shorter catheterization time, shorter hospital stay, less decrement in the levels of serum sodium, and is correspondent with monopolar TURP in regards to efficacy by attention to IPSS IIEF-5 scores.

Simultaneous antegrade and retrograde endoscopic surgery for benign prostatic hyperplasia with vesical calculi – A single-centre experience

ObjectiveTo describe the effectiveness and safety of our novel technique of simultaneous percutaneous cystolithotripsy with transurethral resection of prostate (TURP) for patients with benign prostatic hyperplasia (BPH) complicated with large vesical calculi. Patients and methodsThis was a retrospective analysis of 25 patients who underwent simultaneous percutaneous cystolithotripsy with TURP between January 2012 and January 2016. Technique: A 28-F Amplatz sheath was inserted percutaneously into the bladder after sequential dilatation under cystoscopic guidance. Percutaneous cystolithotripsy using a nephroscope and pneumatic lithoclast was then performed simultaneously along with monopolar TURP. Preoperative parameters reviewed included: patient’s symptoms, International Prostate Symptom Score, uroflowmetry pattern, prostate volume, and stone burden on ultrasonography of the abdomen and pelvis. Postoperative parameters analysed included: duration of irrigation, time until catheter removal, length of hospital stay, and complications. ResultsThe mean age of the patients was 67.8 years. The mean prostate size was 62.28 mL and the mean stone burden was 3.18 cm. The mean operating time was 54.2 min. The mean time until catheter removal was 3.2 days. ConclusionSimultaneous percutaneous cystolithotripsy with TURP in patients with BPH with large bladder calculi is safe and feasible.