Resection Of Prostate Research Articles

Small prostate associated with higher incidence of detrusor underactivity and tendency of combination with bladder stone in patients with bladder outlet obstruction.

Benign prostate hyperplasia is the leading cause of lower urinary tract symptoms due to bladder outlet obstruction (BOO) in elderly male patients. The impact of prostate volume (PV) on clinical and urodynamic characteristics was evaluated in those patients with BOO requiring prostate de-obstruction maneuvers in this study. We retrospectively reviewed the clinical data of 301 patients underwent transurethral resection of prostate due to combination with urinary retention (UR) alone and bladder stone (BS) alone. The present study investigated the differences of subjective symptoms, sonographic parameters, and urodynamic characters and assessed the proportion of UR to BS as well as the incidence of detrusor underactivity (DU) in those patients according to PV. There was not a difference of age, international prostate symptoms scores, post-voiding residual, and peak flow rate (Qmax) among 3 groups (all P > .05), whereas increasing of intravesical prostate protrusion (IPP), bladder wall thick (BWT), detrusor pressure at Qmax, bladder contractility index, bladder outlet obstruction index (BOOI), and quality of life scores with enlargement of PV was found (all P < .05). Correlations between PV and IPP (R = 0.251), Qmax (R = -0.188), post-voiding residual (R = 0.215), BWT (R = 0.170), and quality of life scores (R = 0.165) at large prostate and relationships between BWT and BOOI (R = 0.246) and bladder contractility index (R = 0.239) in moderate prostate as well as IPP and BOOI (R = 0.204) in large prostate were significantly found (all P < .05). Significant higher proportion of UR was found in patients with moderate (18%) and large prostate (47.6%) when compared to that of small prostate (3.7%), whereas higher proportion of BS was found in patients with small prostate (96.7%) compared to that of moderate (82%) and large (52.4%) prostate. Lower incidence of DU was discovered in large prostate (31.9%) compared with small (55.6%) and moderate (47.2%) prostate. BOO patients with small prostate were associated with less severity of BOO but higher incidence of DU and had a tendency of occurrence of BS, which gave a support for the theory that multifactor involved in the formation of BS rather than BOO only.

Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia

Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia

A pilot intervention trial to reduce the use of post-procedural antimicrobials after common endourologic surgeries.

Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is commonly prescribed. We sought to reduce use of post-procedural antimicrobials after common endoscopic urologic procedures. A before-after, quasi-experimental trial with a baseline (July 2020-June 2022), an implementation (July 2022), and an intervention period (August 2022-July 2023). Three participating medical centers. We assessed the effect of a bundled intervention on excess post-procedural antimicrobial use (ie, antimicrobial use on post-procedural day 1) after three types of endoscopic urologic procedures: ureteroscopy and transurethral resection of bladder tumor or prostate. The intervention consisted of education, local champion(s), and audit-and-feedback of data on the frequency of post-procedural antimicrobial-prescribing. 1,272 procedures were performed across all 3 sites at baseline compared to 525 during the intervention period; 644 (50.6%) patients received excess post-procedural antimicrobials during the baseline period compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the baseline and intervention periods. At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.09; 95% CI 0.02-0.45). There was no significant increase in post-procedural unplanned visits at any of the sites. Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use at one of three sites, with no increase in complications. These findings demonstrate both the safety and challenge of guideline implementation for optimal perioperative antimicrobial prophylaxis.This trial was registered on clinicaltrials.gov, NCT04196777.

CLINICOPATHOLOGICAL CORRELATION OF P53 EXPRESSION IN BENIGN PROSTATIC HYPERPLASIA AND PROSTATE ADENOCARCINOMA

Objective: To assess clinicopathological parameters in patients with benign prostatic hyperplasia and prostate adenocarcinoma, and evaluate their correlation with p53 overexpression in these prostatic conditions. Methods: The present ambispective study was conducted in the Department of Pathology in a tertiary care hospital of Northern India from 2022 to 2024. This study included prostatic trucut biopsies, transurethral prostatic resection (TURP) chips, and radical prostatectomy specimens from patients with benign prostatic hyperplasia (BPH) or prostatic adenocarcinoma. Tissue samples were processed, embedded in paraffin, sectioned, and stained with hematoxylin and eosin (H&amp;E) for histopathological evaluation. Immunohistochemical (IHC) analysis was performed to assess p53 expression using the GenomeMe antibody. Data on age, histological type and histological grade were collected. Statistical analysis included Chi-square test was conducted to evaluate associations between p53 overexpression and clinicopathological parameters. Results: The study analyzed 50 cases, revealing significantly higher p53 expression in prostatic adenocarcinoma compared to BPH. The majority of participants were aged between 61-70 years (46%). There were 50% patients with adenocarcinoma, 26% with BPH, 20% with BPH and chronic prostatitis, and 4% with BPH with prostatic intraepithelial neoplasia. There were strong associations between p53 overexpression and specific diagnoses, histological type and histological grade (Gleason scores) in prostate cancer. Conclusion: The study findings suggest that p53 overexpression is closely linked to malignant prostate conditions and could potentially serve as a valuable biomarker for distinguishing between benign and malignant prostatic diseases, as well as predicting tumor aggressiveness.

Comparison of mean postoperative decrease in hemoglobin level in patients undergoing transurethral resection of prostate with and without preoperative intraprostatic epinephrine.

Objective: To determine and compare the mean decrease in hemoglobin level from the baseline value in patients undergoing TURP with and without preoperative intraprostatic epinephrine injection. Study Design: Analytical Cross Sectional study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Nov 2023 to Feb 2024. Methods: After ERC approval and taking informed consent a total of 40 patients with enlarged prostate and scheduled for TURP, having comparable baseline clinical and laboratory characteristics such as age, preoperative prostate size and baseline hemoglobin were enrolled in the study &amp; were divided in two equal numbered groups called group A and group B, each having 20 patients in it. Before performing monopolar TURP group A patients were given 200mcg of intraprostatic epinephrine injection diluted in 20ml of normal saline (10ml in each right &amp; left lobe) under transrectal ultrasonic guidance via the transperineal route, while no such intervention was done before TURP in group B patients. One pint of whole blood was transfused to the patients of both the groups intraoperatively and blood samples were sent to laboratory on 1st post-operative day to determine the postoperative hemoglobin levels of patients of both the groups. Data was entered on the designated pro forma for analysis. Results: Postoperative hemoglobin levels were significantly higher in group A patients (mean and S.D 11.83 ±1.01 g/dl) as compared to the group B patients (mean and S.D 11.00 ± 1.06 g/dl) with a p value of 0.015, and hence drop of hemoglobin levels from the baseline values were lower in group A patients (mean and S.D 1.28 ± 0.89 g/dl) as compared to the group B patients (mean and S.D 2.31 ± 0.98 g/dl), confirming a statistically significant difference with p value of 0.001. Conclusion: The hemorrhage associated with TURP can be decreased significantly by giving preoperative intraprostatic epinephrine injection. This is a clinically safe technique that can not only reduce the postoperative blood transfusion requirements but can also allow the operating surgeon to resect more tissue within the desired time thus increasing the efficacy of TURP.

Pre-operative prostatic artery embolisation before transurethral resection of prostate for prostate glands larger than 80mL – first randomised controlled trial

Pre-operative prostatic artery embolisation before transurethral resection of prostate for prostate glands larger than 80mL – first randomised controlled trial

Comparison of Early Versus Late Foley Catheter Removal after TURP- Our Experience

Objective: To compare early versus late catheter removal after Transurethral resection of prostate for benign prostatic hyperplasia in terms of postoperative complications. Study Design: Cross sectional Study. Place and Duration of Study: Urology Department, Armed Forces Institute of Urology, Rawalpindi Pakistan from Jan 2022 to Aug 2022. Methodology: A total of 100 patients undergoing monopolar Transurethral resection of prostate fulfilling the inclusion criteria were included in study after written informed consent. They were randomized in two equal Groups (50 patients each) by lottery method, Group A-catheter removed on day 2 and Group B-catheter removed on day 5, postoperative complications including urinary retention, hematuria, urinary tract infection and urethral stricture were recorded on proforma. Results: Both Groups had no statistically difference in demographic profile. In Group-A, 4(8%) patients had urinary retention and in Group-B, 3(6%) patients had urinary retention (p-value 0.438). The number of patients that had UTI in Group A and Group B were 1(2%) and 7(14%) respectively which was statistically significant (p&lt;0.001). However, hematuria, urethral stricture and epididymo-orchitis were not statistically significant among Groups with p-values of 1.00, 0.24 and 0.36 respectively. Conclusion: Early catheter removal after Transurethral resection of prostate resulted in decreased urinary tract infection rate as compared to delayed catheter removal without any other significant postoperative complications.

Xanthogranulomatous orchitis combined with contralateral acute pyogenic orchitis: a rare case report

Xanthogranulomatous orchitis is a chronic, non-neoplastic inflammation that is quite rare. In this paper, we discuss the case of a 79-year-old male patient who presented with bilateral scrotum swelling and dysuria that persisted for two weeks. Despite two weeks of anti-infection treatment, the patient's symptoms persisted, leading to a decision to perform transurethral prostate resection and bilateral orchiectomy after careful consideration. After the surgery, the postoperative pathology indicated that the patient had xanthogranulomatous orchitis on the left side and acute positive orchitis with hemorrhage on the right side. Fortunately, three months after the procedure, the patient experienced no negative events and was pleased with the postoperative results.

Safety and efficacy of transurethral holmium laser enucleation of the prostate versus bipolar transurethral resection of the prostate in the treatment of benign prostatic hyperplasia: a prospective randomized controlled trial.

To evaluate the safety and efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) compared to bipolar transurethral resection of the prostate (bTUR-P) in the treatment of benign prostatic hyperplasia (BPH). A total of 220 BPH patients hospitalized from January 2022 to September 2023 were included in this study. These patients were randomly assigned to HoLEP and bTUR-P groups, with 110 participants in each group. We collected preoperative general information, perioperative data, complications, and postoperative follow-up indicators from both groups of patients. The baseline characteristics of patients in both groups were similar, with no statistical significance (P > 0.05). Compared to the bTUR-P group, the HoLEP group exhibited significantly less intraoperative bleeding (P < 0.001), shorter bladder irrigation time (P = 0.002), shorter catheter retention time (P < 0.001), and reduced postoperative hospitalization (P = 0.002). Additionally, the pain score during urination after catheter removal was significantly lower in the HoLEP group (P < 0.001). Postoperative complications occurred in both groups; however, they were less frequent in the HoLEP group (4 cases), primarily consisting of urinary retention and postoperative bleeding. The bTUR-P group experienced more complications (9 cases). Significant reductions in postoperative residual urine volume (RUV) were observed in both groups (P < 0.001). Both groups also showed significant improvements in Quality of Life (QoL) scores and International Prostate Symptom Scores (IPSS), with the HoLEP group demonstrating a more significant decrease in IPSS (P < 0.001). After comprehensive evaluation, HoLEP was superior to bTUR-P in terms of safety and efficacy. Therefore, HoLEP may be a preferable choice for the treatment of BPH.

Ejaculation preserving TURP (Ep-TURP): A viable alternative in sexually active males with BOO-a single centre prospective randomized study.

Benign prostatic hyperplasia (BPH) is a common urological condition, particularly among middle-aged and elderly men. Trans urethral resection of prostate (TURP) has some drawbacks, particularly concerning ejaculatory function. Ejaculation preserving TURP (Ep-TURP) is one such technique that aims at preserving the tissues that are primarily responsible for antegrade ejaculation. In this prospective study, patients with bothersome LUTS were randomized into Ep-TURP and standard TURP groups. Supramontal tissue was preserved in Ep-TURP while standard TURP group had resection of the entire prostatic tissue up to the verumontanum. The outcomes with regard to IPSS, Qmax, IIEF(Q9), Ejaculation and PVR were studied. Ejaculation projection score was separately calculated and assessed. About 60 patients were studied, with 30 in each group. At 6 months' follow-up, complication rates were the same in both groups. The IPSS, Qmax, IIEF were similar and comparable. There was no change in erection in all patients (P = 0.559). The ejaculation was well preserved in Ep-TURP (p<0.001). Ejaculation projection score was maintained at 3.77 in the Ep-TURP group while in the standard group it was 0 (P<0.001). Ep-TURP is a safe and a cost-effective method of preserving ejaculation in patients undergoing TURP. This procedure adds a better quality of life that greatly aids in enhancing the improving his psychological outlook towards life. Ep-TURP has now emerged as the standard procedure of choice in sexually active young males needing TURP, as the degree of ejaculation is largely well preserved in patients undergoing this procedure.

Effect of Prior Transurethral Prostate Resection (TURP) or Laser Enucleation (ThuLEP) on Radiotherapy-Induced Toxicity and Quality of Life in Prostate Cancer Patients Undergoing Definitive Radiotherapy.

In our study, the post-radiotherapy quality of life of prostate cancer patients who previously underwent transurethral resection of the prostate (TURP) is compared to those who had thulium laser enucleation of the prostate (ThuLEP) and those who had no prior surgery. It also aims to identify and assess risk factors affecting therapy tolerance in this patient group. We analyzed 132 patients with localized prostate cancer treated with definitive radiotherapy (RT), including 23 who had prior TURP and 19 who previously underwent ThuLEP. A total of 62% of patients underwent irradiation within 12 months after surgery. We included only patients treated with radiotherapy using the IMRT technique. Changes in patient-reported urinary toxicity were evaluated using the International Prostate Syndrome Score (IPSS) and the quality of life index of the World Health Organization (QoL/WHO-PSS) over a three-year post-radiotherapy period. Patients with prior TURP experienced significant deterioration in QoL and IPSS immediately after irradiation (p < 0.001), whereas those without previous surgery showed both less significant differences in IPSS and QoL scores. In conclusion, patients with previous TURP/ThuLEP differ from those without previous surgery in urinary quality of life and acute and chronic urinary symptom profiles after RT. The surgical technique (ThuLEP vs. TURP) and the time interval to irradiation are crucial factors affecting RT tolerance in acute and late settings. The previously operated patient group reported a significantly longer period of increased symptom burden.

The urinary tract reconstruction in a robot-assisted surgery for rectal malignancy with combined prostate and seminal vesicle resection.

In certain cases of rectal malignancy in which invasion is confined to the prostate and/or seminal vesicles, bladder-sparing surgery may be chosen instead of total pelvic exenteration. However, even if the bladder is preserved, postoperative urinary dysfunction and vesicourethral anastomotic leakage are concern. We employ various techniques based on robot-assisted radical prostatectomy for reconstructing the urinary tract. These techniques include advanced reconstruction of vesicourethral support, total anatomical reconstruction, and a method called anterior reconstruction. In addition, suture fixation of bladder to the anterior abdominal wall, and re-approximation of bladder by peritoneal suture were done. Reliable robot-assisted vesicourethral anastomosis and reinforcement of the anastomotic wall could potentially enhance the self-voiding rate and decrease the risk of anastomotic failure.

The Role of Transurethral BPH Surgeries in Management of Urinary Symptoms in Prostate Cancer Patients, Narrative Review.

Prostate cancer and benign prostate hyperplasia (BPH) are two ubiquitous pathologies that may coexist. A significant percentage of patients with different stages of prostate cancer suffer lower urinary tract symptoms (LUTS) due to associated BPH. We aimed to review the literature regarding the role of transurethral surgeries in the management of prostate cancer patients and the different available management options. The evidence in literature for the use of BPH surgeries in prostate cancer patients is based mainly on low-quality retrospective studies. In patients on active surveillance, BPH surgeries are beneficial in relieving LUTS without oncological risk and can eliminate the contribution of adenoma to PSA level. In patients with advanced prostate cancer, palliative BPH surgery can relieve LUTS and urinary retention with unclear oncological impact; however some reports depict that the need for BPH surgery in advanced prostate cancer is associated with poorer prognosis. In patients receiving radiotherapy, various studies showed that transurethral resection of prostate (TURP) is associated with increased radiotoxicity despite some recent reports encouraging the use of Holmium Laser Enucleation of the Prostate (HoLEP) to improve urinary symptom scores before radiotherapy. The most commonly reported techniques utilized are TURP, photoselective vaporization of prostate (PVP) and HoLEP. The use of BPH surgery is justified for relieving LUTS in selected prostate cancer patients on active surveillance or in advanced stages, however the use in the pre-radiotherapy settings remains controversial. Future prospective and randomized controlled trials are required for validating the benefits and assessing potential hazards.

263 - Warm Irrigation Improving Perioperative Outcomes of Transurethral Resection of Prostate: A Prospective Parallel Arm Single Blinded Randomized Control Trial

263 - Warm Irrigation Improving Perioperative Outcomes of Transurethral Resection of Prostate: A Prospective Parallel Arm Single Blinded Randomized Control Trial

264 - Duration of Medication Therapy and Outcomes after Transurethral Prostate Resection for Patients with Benign Prostatic Obstruction

264 - Duration of Medication Therapy and Outcomes after Transurethral Prostate Resection for Patients with Benign Prostatic Obstruction

Correlation Between Urethral Length and Urethral Stricture After Transurethral Resection of Prostate

Aim: To show the effects of urethral length, and surgical or patient related parameters on urethral strictures after Transurethral Prostate Resection (TURP). Materials and Methods: The study included 127 patients who underwent TURP for benign prostate hyperplasia (BPH) unresponsive to medical treatment in our clinic between May XXX and February XXX. The patients were separated into two subgroups as those who underwent second surgery because of urethral stricture and those who did not. These two groups were compared in respect of age, height, weight, total prostate specific antigen, fall in hemoglobin values, increase in urine peak flow rate, decrease in the post-micturition residual volume, prostate volume, operating time, tissue amounts, resection rate, and urethral length. Results: Urethral stricture was determined in 13.4% of the patients. A statistically significant difference was determined between the two groups in respect of age and urethral length (p

Holmium laser enucleation of the prostate versus transurethral resection of the prostate in treatment of benign prostatic hyperplasia: A meta-analysis of 13 randomized control trials

Holmium laser enucleation of the prostate versus transurethral resection of the prostate in treatment of benign prostatic hyperplasia: A meta-analysis of 13 randomized control trials

A double blinded randomized prospective trial of comparison between control and study group, nefopam versus tramadol on shivering scores after spinal anesthesia in patients undergoing Transurethral resection of prostate

IntroductionShivering is a common and distressing complication that can occur after subarachnoid block (SAB) in patients, particularly those undergoing transurethral resection of the prostate (TURP) due to the use of irrigating fluid and older age group. This study aims to compare the effectiveness of nefopam and tramadol in reducing intraoperative shivering compared to a control group, in Indian patients. MethodologyThis study is a double-blinded randomized control trial with a total of 99 patients undergoing elective TURP under SAB were enrolled. The patients were randomly divided into three groups (GT, GN, and GC): GT received tramadol (0.5 mg kg-1) and GN received nefopam (0.15 mg kg-1). Both tramadol and nefopam were premixed into 100 ml of normal saline (NS) and GC received 100 ml NS, given over 15 min just before SAB. The induction protocol was the same for all groups, and shivering score, hemodynamic parameters, and body temperature (BT) were recorded. ResultsThe overall incidence of shivering was 29.67 % (27/91), with the lowest incidence being in GN (16.67 %, 5/30), followed by GT (22.58 %, 7/31) and GC (50 %, 15/30). Both nefopam and tramadol resulted in a significant (p < 0.05) decrease in the incidence of shivering compared to control. Among the hemodynamic parameters and BT, no significant difference was seen between GT, GN, and GC (p > 0.05). ConclusionBoth nefopam and tramadol were effective in reducing the incidence but the severity was controlled better with nefopam during TURP under SAB.

Intrathecal Dexmedetomidine as an Adjuvant to Low Dose Hyperbaric 0.5% Bupivacaine on Haemodynamic Parameters in Patients Undergoing Transurethral Resection of Prostate.

To determine the role of dexmedetomidine in potentiating the local anaesthetic efficacy of a low dose of bupivacaine when used as an adjuvant. A prospective, double-blind, randomised study. Place and Duration of the Study: Department of Anaesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from July 2021 to February 2022. One hundred and eight patients of ASA physical class I-III undergoing transurethral resection of the prostate (TURP) under sub-arachnoid block (SAB) were enroled and distributed into two equal groups. Group BUPIPURE (BP) was given 7.5 mg of pure 0.5% hyperbaric bupivacain whereas group BUPIDEX (BD) was given 6 mg of 0.5% hyperbaric bupivacain with 3 μg dexmedetomidine intrathecally. The effects in Both groups were compared using chi-square and unpaired t-tests. A significance level of p <0.05 was used to evaluate the statistical significance. Both groups demonstrated a steady decrease in mean heart rate (mean HR 98.9-62.7 per minute as compared to 79.1-59.4 per minute in groups BP and BD, respectively), however, no patient reached to HR <50/min. Group BP had a higher HR variability than group BD. The two groups' median peak sensory levels were similar. However, a statistically significant difference was revealed in the time taken for 2-segment regression (87.5 ± 11.3 min vs. 115.5 ± 6.2 min p <0.001 in BP and BD), as well as the time to reach T10 sensory level (13.56 ± 2.5 min vs. 10.9 ± 3.0 min p <0.001). In patients having TURP, intrathecal dexmedetomidine combined with low-dose bupivacaine results in a quicker start, extended sensory and motor block, and a decreased need for rescue analgesics. Adjuvants, Dexmedetomidine, Spinal anaesthesia, Transurethral Resection of Prostate.

Video Demonstration of Step-by-step Technique of Bipolar Transurethral Resection of Prostate as: An Educational Tool for Residents

Video Demonstration of Step-by-step Technique of Bipolar Transurethral Resection of Prostate as: An Educational Tool for Residents