Resection Of Benign Prostatic Hyperplasia Research Articles

INCREASED PROSTATIC LYSOPHOSPHATIDYLCHOLINE ACYLTRANSFERASE ACTIVITY IN HUMAN PROSTATE CANCER:: A MARKER FOR MALIGNANCY

Phospholipase A2 and lysophosphatidylcholine acyltransferase (LAT) constitute a deacylation-reacylation cycle that incorporates arachidonic acid into the lipid membrane. In a preliminary report we found increased LAT activity in malignant prostate tissue. We measured LAT activity in prostate tissue from a large number of patients undergoing prostatectomy. Prostate tissue from 93 patients undergoing radical prostatectomy for prostate carcinoma, 14 undergoing cystoprostatectomy for bladder cancer, 55 undergoing transurethral resection for benign prostatic hyperplasia and 11 with prostate cancer undergoing transurethral resection for relief of obstructive symptoms was analyzed for LAT activity. In radical prostatectomy specimens using oleoyl coenzyme A as substrate mean increase in LAT activity between malignant and benign portions of the same specimen was 0.68 +/- 0.12 nmol./mg. protein per minute (p <0.00001). In all radical prostatectomy specimens analyzed LAT activity was 43% higher in the malignant than benign portions (2.25 +/- 0.15 versus 1.57 +/- 0.11 nmol./mg. protein per minute, p <0.001). In the 10 benign prostate specimens obtained from cystoprostatectomy mean LAT activity was 1.12 +/- 0.18 nmol./mg. protein per minute, which was significantly lower than that of benign portions of radical prostatectomy (p <0.05). LAT activity in benign cystoprostatectomy specimens was significantly higher than that in the 50 benign transurethral resection specimens (0.54 +/- 0.05, p <0.01), possibly due to heat damage in transurethral resection specimens during collection. However, LAT activity in transurethral resection specimens from patients with known prostate cancer was similarly increased. Similar results were obtained using arachidonoyl coenzyme A. We demonstrated increased LAT activity in malignant tissue from patients with prostate cancer. Thus, the deacylation-acylation remodeling cycle may be enhanced to provide more arachidonic acid to meet the demand for prostaglandin E2 synthesis in malignant tissue.

TRANSURETHRAL RESECTION OF THE PROSTATE AMONG MEDICARE BENEFICIARIES: 1984 TO 1997

We examine the epidemiology and associated risks of transurethral resection of the prostate among Medicare beneficiaries for the period 1984 to 1997. We used hospital claims for transurethral resection of the prostate from a 20% national sample of Medicare beneficiaries for the period 1991 to 1997. Risk of mortality and reoperation were evaluated using life table methods and compared to those for the period 1984 to 1990. We also examined the association between surgical volume and adverse outcomes following resection using unique urologist identifier codes from the 1997 part B Medicare claims. Compared to 1984 to 1990, age adjusted rates of transurethral resection for benign prostatic hyperplasia (BPH) during 1991 to 1997 declined by approximately 50% for white (14.6 to 6.72/1,000) and 40% for black (11.8 to 6.58/1,000) men. Of the men who underwent resection for BPH during the recent period 53% were 75 years old or older but 30-day mortality in men 70 years old or older was significantly lower than that in 1984 to 1990. Since 1987 the 5-year risk for reoperation following transurethral resection for BPH has remained 5%. For resection performed in 1997 we observed no statistically significant association between urologist surgical volume and risks of reoperation or 30-day mortality. Compared to the peak period of its use in the 1980s, older men are now undergoing transurethral resection of the prostate. Nevertheless, outcomes for men 65 years old or older continue to be good.

Oxybutynin in the Treatment of Early Detrusor Instability After Transurethral Resection of the Prostate

Objective To evaluate the symptomatic and urodynamic effects of oxybutynin in the control of irritative micturitional symptoms during the first week after transurethral resection of benign prostatic hyperplasia (BPH). Patients and methods Fifty-three patients (median age 67 years, interquartile range 62–72) were included prospectively in a double-blind placebo-controlled study. Pre-operatively, uroflowmetry and cystometrography (CMG) were performed, and the post-void residual volume (PVR) measured; symptoms were rated according to the Boyarski score. CMG was repeated on the first post-operative day and medication was started on the third day. Before withdrawing the catheter on the fifth day, CMG was repeated. Three days later, symptoms were evaluated according to the Boyarski score and uroflowmetry and the estimate of PVR reassessed. Results In comparison with placebo, oxybutynin significantly decreased frequency, urgency and detrusor pressure at first sensation of filling. However, oxybutynin did not lower the rate of pre-operative detrusor instability and exerted no effect on the maximal capacity of the bladder and corresponding detrusor pressure. Dryness of mouth was reported in 13% and 65% of patients receiving placebo and oxybutynin, respectively. Conclusion Oxybutynin alleviates early irritative symptoms after transurethral resection of BPH, without consistently modifying bladder urodynamics.

Incidence of Erectile Impotence Secondary to Transurethral Resection of Benign Prostatic Hyperplasia, Assessed by Preoperative and Postoperative Snap Gauge Tests

In an attempt to assess the impotence rate secondary to transurethral resection of the prostate more objectively than by merely interviewing patients, potency was evaluated with the Snap-Gauge* test. The test was used preoperatively to recruit patients with intact potency. The 98 patients studied underwent transurethral resection of the prostate and were retested during postoperative night 4. Of the 98 patients 64 remained potent while 34 did not. These 34 men were retested 3 months later, and 26 were potent and 8 were impotent. Therefore, 8 of 98 patients (8.3 percent) became impotent as a consequence of transurethral resection of the prostate. The risk specific to subgroups in cases of small (less than 10 gm. resectable tissue) and larger adenomas is 11.1 percent and 7.7 percent, respectively, for men older than 65 years, and 7.1 percent and 0 percent, respectively, for men younger than 65 years. A selective indication taking into account patient age and prostatic size might further lower the already low impotence risk of transurethral resection of the prostate. *Dacomed, Minneapolis, Minnesota.

Incidence of Erectile Impotence Secondary to Transurethral Resection of Benign Prostatic Hyperplasia, Assessed by Preoperative and Postoperative Snap Gauge Tests

Incidence of Erectile Impotence Secondary to Transurethral Resection of Benign Prostatic Hyperplasia, Assessed by Preoperative and Postoperative Snap Gauge Tests

Does Transurethral Resection of the Prostate Pose a Risk to Life? 22-Year Outcome

The clinical outcomes of 717 patients who underwent transurethral resection for benign prostatic hyperplasia between 1971 and 1981, and of 48 who underwent open prostatectomy during the same period were evaluated. All living patients could be followed for a minimum of 12 years postoperatively. The cumulative percentage of patients undergoing a secondary operation was substantially greater after transurethral resection of the prostate than after open prostatectomy. The volume of resected tissue, operating time, requirement for blood transfusion and hyponatremia during or after the procedure did not affect long-term outcome of patients in the transurethral resection group. Abnormal preoperative electrocardiography and azotemia appeared to be associated with increased risk of postoperative mortality after controlling for other variables (p less than 0.05). Actuarial survival rates did not differ substantially for patients who underwent transurethral resection and open prostatectomy, and exceeded the expected survival rates in the general male population in the same age group in Japan. Both procedures are safe for the symptomatic relief of urinary obstruction due to benign prostatic hyperplasia. Prostatectomy does not jeopardize long-term survival of the patients.

Laser prostatectomy: our initial experience of a technique in evolution.

Recently great interest has been generated in alternatives to transurethral resection for benign prostatic hyperplasia. Lasers are currently being assessed, but marketing has for the moment outstripped basic science. A cystoscopic approach was used delivering Nd:YAG or KTP laser energy via forward and sidefiring fibers and contact tip devices in 51 patients. The sidefiring device is intended to coagulate a volume of prostate that subsequently sloughs, leaving a cavity. Treatment of the apical and middle lobe tissue using this technique was unsatisfactory. A further disadvantage was the interval between treatment and improvement in urine flow, which was approximately 6 weeks. The use of temporary prostatic stents has helped to overcome this delay in treatment effect. Encouraging early results have been achieved using forward-firing fibers to treat apical and middle lobe tissue. The use of contact tip devices to perform bloodless prostatotomies in combination with sidefire or bare fiber has also proved useful. Laser prostatectomy is an exciting field with considerable potential but remains in the developmental stage.

Bladder Wall Histology and Duration of Obstruction

In BPH patients, obstruction leads to a progressive modification in the structure of the bladder wall, with histo-pathological changes which are often irreversible. In order to detect these changes and their possible correlation with function, muscle biopsies of the bladder were taken from 28 patients during endoscopic resection for benign prostatic hyperplasia. The samples were examined by means of electron microscope to show ultrastructural charges. The magnitude of the lesions can be correlated to function, seriousness and duration of the obstruction. Detecting histo-pathological damage can justify earlier treatment in obstructed BPH patients, in order to avoid those bladder lesions, which are the probable cause of clinical disorders which may persist even after therapy of the adenoma.

Comorbidities and perioperativecomplications among patients with surgically treated benign prostatic hyperplasia

We address the question of whether or not age and comorbidity are related to intra- and postoperative complications after a transurethral resection. The data are derived from a retrospective, population-based study conducted in Hagen, Germany, which included all patients with an initial prostatectomy for benign prostatic hyperplasia (N = 621) during the five-year period 1984-1988. Seventy-seven percent of the patients had at least one of the following preoperative risk factors: heart disease, hypertension, smoking, chronic obstructive lung disease, and diabetes. There was no intraoperative death. The risk of intraoperative circulatory complications was found to be related to age only for patients without a history of heart diseases or hypertension. The incidence of major complications was 3.1 percent and was significantly higher in the oldest age group. Three patients (0.54%) died postoperatively in the hospital. Infections were the most frequent postoperative complications. The relationship of age and overall postoperative complications was not statistically significant either for patients with (p = 0.121) or without any comorbidity (p = 0.651). Based on this study it seems reasonable to conclude that age is not a clinically relevant risk factor for perioperative complications in patients who have a transurethral resection for benign prostatic hyperplasia.

Modified Cystoscope Sheath for Prostate Balloon Dilation

Balloon dilation of the prostate is being assessed as an alternative to transurethral resection for benign prostatic hyperplasia. Frequently, balloon dilation is performed under fluoroscopic guidance or requires the use of different-sized prostatic balloon dilators. The use of the Karl Storz modified cystoscope sheath allows any urologist to perform balloon dilation of the prostate easily as an office procedure. The modified sheath permits the use of paracatheter cystoscopy, which ensures safe and effective balloon dilation by allowing direct visualization of the balloon in the prostatic urethra. This technique has been successful and without complications in 41 patients undergoing balloon dilation of the prostate at our medical center.

A new method of prostatectomy, transurethral detachment and resection of benign prostatic hyperplasia.

A new method of prostatectomy, transurethral detachment and resection of benign prostatic hyperplasia.

Anatomical Factors Influencing the Technique of Transurethral Resection for Benign Prostatic Hypertrophy

The importance of recognition of normal and pathological anatomical characteristics of the urethra, prostate, bladder neck and benign prostatic hyperplasia, and the recognition of the role of the arterial blood distribution throughout the prostate and the venous return from the prostatic area is outlined. It is described how these factors influence the technique of transurethral resection for benign prostatic hyperplasia.