Outcomes Of Transurethral Resection Of The Prostate Research Articles

Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) under Monitored Anesthesia Care MAC/Sedation (macTURP), as compared with TURP under general (genTURP) or spinal (spTURP) anesthesia, is a safer and infrequently used technique reserved for high-risk patients. The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TURP between 2008 and 2019. Demographics, lab values, medical history, and 30-day outcomes were compared. Univariate and multivariate regression models for postoperative complications were constructed. A propensity score-matched analysis was then performed for genTURP and macTURP and for spTURP and macTURP as a sensitivity analysis. A total of 53,182 patients underwent TURP. Older patients (>80) with diabetes requiring insulin (7.9%), leukocytosis (7.4%), history of chronic obstructive pulmonary disease (COPD) (7.8%), dyspnea (7.2%), and of ASA > 2 (58.8%) were more likely to undergo macTURP as compared with genTURP (p < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP (p = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP (p = 0.005). All other postoperative complications showed similar rates between the three procedures. The propensity-matched cohorts demonstrated that no differences in postoperative complication rates were noted between macTURP and genTURP and between macTURP and spTURP. MacTURP was found to be feasible with a good safety profile as compared with genTURP and spTURP. MacTURP could be used in elderly, frail, and co-morbid patients with a similar safety profile as compared with more invasive anesthetic techniques.

Efficacy and safety of bovhyaluronidase azoximer in patients undergoing transurethral resection of the prostate

Introduction. Inflammation and fibrosis may have a significant role in pathogenesis of benign prostatic hyperplasia and associated lower urinary tract symptoms. Moreover, those factors may compromise the outcomes of surgical interventions for bladder outlet obstructions, such as transurethral resection of the prostate (TURP). Additional measures, such as administration of anti-fibrotic agents, may decrease the incidence of certain complications (e.g. bladder neck stenosis, urethral stricture) and improve overall outcomes of TURP. Bovhyaluronidase azoximer is an enzyme combined with high molecular mass copolymer which may inhibit surgery-related tissue remodeling and prevent excessive fibrosis.Materials and methods. Sixty-five patients undergoing monopolar TURP were enrolled in this prospective randomized open-label study. Patients in Group 1 (n = 34) received 5 intramuscular injections of bovhyaluronidase azoximer (3000 IU) on days 3, 6, 9, 12 and 15 after TURP in addition to standard therapy. Patients in Group 2 (n = 31) received conventional peri-operative therapy. All patients routinely underwent uroflowmetry and post-void residual volume measurement on follow-up 3 months after TURP. Incidence of fibrosis-associated complications was compared using Fisher’s exact test. Uroflowmetric parameters were compared using Mann-Whitney U-test.Results. One patient in Group 1 was excluded from the study due to mild allergic reaction after second injection of bovhyaluronidase azoximer. There were three cases of clinically significant fibrosis-associated complications in Group 2 which were confirmed on imaging (9.7 %). One case of stricture in bulbar urethra was later successfully managed with anastomotic urethroplasty, and two cases of bladder neck stenosis were managed with transurethral incision. No such complications were observed in Group 1 (0 %). However, the difference was not statistically significant (p = 0.1079). Otherwise, there were no adverse events in both groups. Median Qmax in Groups 1 and 2 was 24 ml/s and 22 ml/s, respectively (p = 0.08). Median Qave in Groups 1 and 2 was 15 ml/s and 9 ml/s, respectively (p &lt;0.00001). Median of post-void residual volume in Groups 1 and 2 was 25 ml and 40 ml, respectively (p = 0.00438).Conclusion. This study was underpowered to demonstrate significant difference in incidence of fibrosis-related complications of TURP, though there was a trend towards lower risk in patients treated with bovhyaluronidase azoximer. There was also a statistically significant difference in Qave and post-void residual volume in favor of Group 1, which may demonstrate lower rates of subclinical fibrosis. Overall, treatment with bovhyaluronidase azoximer was safe. Robust studies with longer follow-up are required to confirm efficacy of bovhyaluronidase preparations in post-TURP setting.

Outcome benefits to transurethral resection of the prostate in patients with benign prostatic hyperplasia at Medan regional hospital

Background: Benign prostatic hyperplasia (BPH) is a pathologic process that cause of lower urinary tract symptoms (LUTS) in aging men. Transurethral resection of the prostate (TURP) is still the current gold standard of BPH treatment. International Prostate Symptoms Score (IPSS) and the quality of life (QoL) index are used for assessing the TURP results.Objective: This study would like to show the benefits outcome of TURP in patients with BPH evaluated with IPSS score and QoL index in Medan regional hospital.Methods: This research is a retrospective study of BPH patients that is treated with TURP at Universitas Sumatera Utara Hospital from September 2019 – August 2020. Patients will be divided into 2 groups, group 1 with patients who have a prostate size &lt;80 grams and the second group with a prostate size&gt; 80 grams. All patients who were included in this study were assessed for their complaints using the IPSS and QoL index before and after taking an operation. Statistical analysis was performed using independent t test and Mann Whitney test. The data were significant if the p value &lt; 0.05. Results: There are 60 patients enrolled in this study that treated with TURP. The mean age of patients in the group 1 was 69.57 ± 7.698 years and 69.84 ± 5.893 years in the group 2. There is no significant difference between group 1 and group 2 in postoperative IPSS and QoL results (p &gt;0.05). Conclusion: TURP procedure is preferable option of BPH for patients in any prostate size.

Very high residual volumes should not prevent transurethral resection of the prostate being offered to men presenting with urinary retention

Objective.The aim of this study was to identify factors at presentation that can help to predict outcomes and guide subsequent management decisions in patients with acute on chronic retention. Material and methods. The medical notes of 187 consecutive patients presenting with urinary retention at two teaching hospitals between 2008 and 2009 were reviewed. All patients were followed up for a minimum of 3 years. All patients were catheterized at presentation. The majority then underwent one or more of trial without catheter (TWOC), transurethral resection of the prostate (TURP) (both considered successful if the patient voided with a subsequent postvoid residual volume of <200 ml on three successive occasions) or long-term catheterization. Patient factors such as age, associated acute kidney injury (AKI), performance status, residual volume, prior lower urinary tract symptoms (LUTS), treatment of LUTS, diagnosis of diabetes and neuropathy were recorded. Results.Increasing age (p = 0.002) and increasing residual volume (p = 0.046) were associated with a significant increase in the failure of TWOC. The rate of AKI increased significantly with residual volume (p < 0.0001). As residual volume increased so did the likelihood that a patient would undergo TURP (p = 0.0009). Age did not appear to influence the outcome of TURP (p = 0.17). Increasing residual volume did not significantly reduce the likelihood of successful TURP (p = 0.068). Conclusions.High residual volumes should not preclude TURP. There is a clear correlation between AKI and residual volume. Increasing age and residual volume both reduce the likelihood of successful TWOC.

Transurethral resection of the prostate in kidney transplant recipients: urological and renal functional outcomes at long‐term follow‐up

To assess prospectively the safety and efficacy of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms attributable to benign prostatic hyperplasia (BPH) in patients who have undergone renal transplantation (RT). To assess the impact of TURP on renal graft function. Urological and renal functional outcomes of TURP performed in RT recipients for treatment of lower urinary tract obstruction attributable to BPH were prospectively assessed in a series of 32 consecutive patients with follow-up of ≥48 months. Maximum urinary flow rate (Qmax ) at uroflowmetry, International Prostate Symptom Score (IPSS), post-void residual urine volume (PVR), haemoglobin and serum creatinine (sCr) levels were recorded before TURP and 1, 6, 24 and 48 months after the procedure. The trends in these variables after TURP were evaluated. Early and delayed complications were assessed and graded according to the Clavien classification system. TURP was performed at a mean of 6 months after RT. No intraoperative complications occurred. Seven postoperative complications were observed (21.9%): two Clavien grade II and five Clavien grade IIIa. Qmax , IPSS and PVR improved significantly after surgery and the improvement was maintained until 48 months. No patient required a repeat TURP during follow-up. SCr levels significantly decreased 1 and 6 months after TURP and did not significantly increase at long-term follow-up. TURP for lower urinary tract obstruction attributable to BPH in RT recipients is safe and effective since it improves urinary flow, bladder emptying and related urinary symptoms. TURP allows an early significant improvement of graft function that is maintained at a follow-up of 48 months.

Diagnostic and Predictive Value of Voiding Diary Data Versus Prostate Volume, Maximal Free Urinary Flow Rate, and Abrams-Griffiths Number in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

To investigate the information of voiding data in relation to symptoms and well-being in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and to compare this information with that of prostate volume (Vprostate), maximal free urinary flow rate (Q(max,free)), and obstruction grade (OG). We performed mandatory tests, recommended tests, and pressure-flow studies in 384 consecutive men with LUTS suggestive of BPH. We estimated nocturia, diuria, and mean voided volume (Vmean) from their voiding diaries. Symptoms and well-being were quantified by American Urological Association symptom index (SI), quality-of-life score (QoL), symptom problem index (SPI), and BPH impact index (BII). We investigated the influence of Vprostate, Q(max,free), OG, Vmean, nocturia, and diuria on SI, QoL, SPI, and BII. We re-evaluated 48 men 6 months after transurethral resection of the prostate (TURP). We analyzed the predictive value of preoperative Q(max,free), Vprostate, OG, Vmean, nocturia, and diuria for the improvements of SI, QoL, SPI, and BII after TURP. We studied the improvements of Q(max,free), OG, Vmean, nocturia, and diuria after TURP and the improvements of SI, QoL, SPI, and BII. Prostate volume, Q(max,free), and OG were only slightly associated with SI, QoL, SPI, and BII, in contrast to Vmean, nocturia, and diuria. The predictive value of all parameters on the outcome of TURP was poor. Improvements of all parameters were strongly associated with improvements of SI, QoL, SPI, and BII after TURP. Voiding data should have a prominent role in the initial evaluation of men with LUTS suggestive of BPH.

Glomerulation Observed During Transurethral Resection of the Prostate for Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia is a Common Finding But No Predictor of Clinical Outcome

Although glomerulation in the bladder mucosa when the bladder is overdistended is a finding suggestive of interstitial cystitis (IC), it is sometimes observed at transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We prospectively investigated the incidence and clinical implications of glomerulation found at TURP. From December 2003 to October 2005, 197 patients aged 50 years or older who were considered to be appropriate candidates to undergo TURP for LUTS/BPH were investigated in this study. Just before beginning resection under spinal anesthesia, the bladder was filled to a water pressure of 80 cm and the capacity was measured. After evacuation of the fluid, careful inspection was conducted for glomerulation during refilling. Before TURP, and 3 and 12 months after TURP, the International Prostate Symptom Score and O'Leary-Sant IC Symptom and Problem Index were determined, and uroflowmetry and measurement of residual urine volume were performed. Glomerulation was observed in 40 of the 197 patients (20.3%). There was no difference in bladder capacity between the glomerulation and nonglomerulation groups, although the glomerulation group was younger with lighter resected weight and a higher baseline IC problem index than the nonglomerulation group. There were no differences in other parameters before, 3, and 12 months after TURP between the 2 groups. Although glomerulation at TURP is a common finding, the clinical implications related to IC are unknown. Glomerulation itself may not be a predictor of the clinical outcome of TURP. Glomerulation observed during transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is a common finding but no predictor of clinical outcome.

Is the short‐term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity?

The aim of this study was to investigate whether the preoperative degree of bladder outlet obstruction (BOO), detrusor underactivity (DUA) or detrusor overactivity (DO) affected the short-term outcome of transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Ninety-two patients with LUTS/BPH aged 50 years or older who were considered to be appropriate candidates for TURP were included in this study. Pressure-flow study and filling cystometry were performed to determine BOO, DUA and DO before TURP. The efficacy of TURP was determined at 3 months after surgery using the efficacy criteria for treatment of BPH assessed by the International Prostate Symptom Score, QOL index, maximum flow rate and postvoid residual urine volume. On preoperative urodynamics, 60%, 40% and 48% of patients showed BOO, DUA and DO, respectively. After TURP, 76% showed 'excellent' or 'good' overall efficacy, whereas only 13% fell into the 'poor/worse' category. The efficacy was higher as the preoperative degree of BOO worsened. In contrast, neither DO nor DUA influenced the outcome of TURP. However, the surgery likely provided unfavorable efficacy for patients having DO but not BOO. Only 20% of the patients who had both DO and DUA but did not have BOO achieved efficacy. Transurethral resection of the prostate is an effective surgical procedure for treatment of LUTS/BPH, especially for patients with BOO. DUA may not be a contraindication for TURP. The surgical indication should be circumspect for patients who do not have BOO but have DO.

Role of transition zone sampling by TURP in patients with raised PSA and multiple negative transrectal ultrasound-guided prostatic biopsies.

The purpose of the study was to determine the role of transurethral resection of the prostate (TURP) to detect prostate cancer in patients with consistently negative transrectal ultrasound-guided biopsies of the prostate. We retrospectively identified and analysed the patients who also had at least two sets of transrectal ultrasound guided sextant prostate biopsies before their TURP during the period between 1998 and 2002. A total of 14 such patients were identified and the outcome of TURP was analysed. Three patients were found to have cancer in the resected specimen (3/14 = 21%). All three cancers were significant (Gleason scores between 6 and 8) and required further treatment. In patients who have rising levels of prostate-specific antigen and who have had multiple negative peripheral zone biopsies, the presence of biologically important transition zone cancers needs to be considered. This can be detected by transurethral resection of the prostate that samples the transition zone of the prostate.

Detrusor instability with equivocal obstruction: A predictor of unfavorable symptomatic outcomes after transurethral prostatectomy.

To elucidate whether preoperative urodynamic findings can predict outcomes of transurethral resection of the prostate (TUR-P). Sixty-two patients with symptomatic benign prostatic hyperplasia were categorized in three different ways based on findings of preoperative pressure-flow study (PFS) and cystometry: urodynamic obstruction (determined by the Abrams-Griffiths nomogram), detrusor instability (DI), and combination of both. Outcomes of TUR-P regarding symptom, function, and quality of life (QOL) were analyzed by changes in the International Prostate Symptom Score (I-PSS), maximum flow rate in uroflowmetry, and QOL index before and after TUR-P, respectively. Overall outcome was defined as success when all of the three categories showed successful improvement. Neither urodynamic obstruction alone nor DI alone predicted outcomes of TUR-P. However, symptomatic and overall outcomes were significantly worse in patients who were not obstructed but had DI. Postoperative persistent DI was more frequently noted in patients without clear obstruction (60%) than in those with obstruction (27%). Patients with equivocal obstruction showed less satisfactory symptomatic outcomes of TUR-P when DI was accompanied. Persistent DI might be the principle cause of unfavorable outcomes. Preoperative evaluation of DI is of benefit because it enhances predictive value of the PFS.