Resected Weight Research Articles

Three-Year Outcome following Holmium Laser Enucleation of the Prostate Combined with Mechanical Morcellation in 330 Consecutive Patients

ObjectivesA prospective study to assess safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). MethodsBetween January 2000 and July 2003, 330 consecutive patients underwent HoLEP at our institution. All patients were pre-operatively assessed with transrectal ultrasound gland volume evaluation, maximum urinary flow rate (Qmax), international prostate symptoms score (IPSS), and the single-question quality of life (QoL). Intra-, peri-, and postoperative parameters were evaluated and the patients were reassessed at 1-, 3-, 6-, 12-, 18-, 24-, and 36-mo follow-up with the same examinations. ResultsPatients’ mean age was 66±8.1 yr; prostate volume was 62±34 cc. Enucleation time was 45.4±22.9min and morcellation time 17.3±14min, whilst resected weight was 40±27.5g. Catheter time was 23±14.7h and hospital stay was 48±26h. Mean serum hemoglobin and sodium did not drop significantly from baseline after the procedure (p=013). A significant improvement occurred in Qmax (25.1±10.7ml/s), IPSS (0.7±1.3), and QoL (0.2±0.5) at the 3-yr follow-up compared with baseline (p<0.05). Twenty-eight percent of patients complained of irritative urinary symptoms, typically self-limiting after 3 mo; transient stress incontinence was reported in 7.3% of patients. Nine patients (2.7%) had persistent BOO, requiring reoperation. ConclusionsHoLEP represents an effective and safe surgical intervention. The relief from BOO also proved to be durable after 3-yr follow-up. The present report adds to the evidence that HoLEP could be the standard “size-independent” surgical treatment for symptomatic BPE-related BOO.

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.

Transition zone volume measurement – is it useful before surgery for benign prostatic hyperplasia?

The aim of this study was to estimate the equivalence and correlation between transition zone volume, measured by transrectal ultrasound, and removed prostate tissue weight in surgically treated patients due to benign prostatic hyperplasia. This study involved 168 patients with histologically confirmed benign prostatic hyperplasia. Of these patients, 120 underwent transurethral resection of the prostate and 48 - open prostatectomy. The weights of the specimens were compared with the corresponding volumes of the transition zone. Equivalence and correlation between transition zone volume and removed tissue weight were analyzed. The mean (standard deviation, range) transition zone volume was 25.43 mL (+/-13.19, 5-61.6) in the transurethral resection group and 76.1 mL (+/-42.97, 13-275.8) in the open operation group. The mean removed tissue weight was 22.9 g (+/-13.41, 5-66) and 73.96 g (+/-44.96, 18-280), respectively, in the transurethral resection and open operation groups. The correlation between removed tissue weight and transition zone volume was stronger in the open operation group than it was in the resection group (r=0.957, P<0.001 vs. r=0.878, P<0.001). There was a significant difference between transition zone volume and resected tissue weight (P=0.001). However, in the open operation group, there was an agreement between transition zone volume and enucleated tissue weight (P=0.263). A significant correlation was detected between removed tissue weight and transition zone volume. There is a significant difference between volume measurement and resected tissue weight while enucleated tissue weight was in agreement with transition zone volume when an open prostatectomy was performed.

Validation of a Questionnaire for Measuring Morbidity in Breast Hypertrophy

There is a growing body of evidence suggesting that body mass index and predicted breast resection weight may not be appropriate criteria for determining insurance eligibility for breast reduction surgery. Eligibility should ideally be based on need. However, no method for determining need in patients seeking reduction surgery currently exists. The purpose of this investigation was to develop a validated questionnaire for measuring the burden of breast hypertrophy. Forty-five symptoms specific to breast hypertrophy were incorporated into a questionnaire that was subsequently administered to a sample of 101 women. Reliability and validity testing was performed according to established psychometric criteria. Three items were omitted based on low item remainder coefficients (Cronbach's alpha) and three were eliminated because of excessive skew. Intraclass correlation coefficients of 0.85 indicated favorable test-retest reliability. Content validity was achieved through the study design and then confirmed by a group of 11 plastic surgeons. The questionnaire showed reasonable criterion validity when compared with corresponding domains in the Short Form-36. Construct validity was excellent. Exploratory factor analysis revealed five questionnaire subdomains: (1) physical implications, (2) poor self-concept, (3) body pain, (4) negative social interactions, and (5) physical appearance. The authors have developed an evaluative tool termed the Breast Reduction Assessed Severity Scale Questionnaire for measuring the burden of breast hypertrophy. The questionnaire produces subdomain scores and an overall measurement of the burden of breast hypertrophy that may be useful in the assessment of patients.

Gigantomasty: Treatment with a Short Vertical Scar

During the past 15 years, reduction mammoplasty with a short vertical scar has become increasingly common in the world of plastic surgery. Still, the indication for this technique often is limited to smaller reduction weights, so that the inverted T-scar techniques have yet to be regarded as the gold standard for excessive breast hypertrophy. In the authors' department, their own modification of vertical scar reduction mammoplasty, based on the techniques of C. Lassus, G. Maillard, and M. Lejour, has been performed since 1990. During the past 10 years, the authors have used it for all breast sizes. To investigate the safety and the results for patients with very large breast volumes (gigantomasty involving at least > or =1,000 g of excised tissue per one side), this study retrospectively evaluated 25 women with a mean age of 43.1 +/- 11.2 years who underwent surgery from January 2002 to June 2003. A protocol was used to record patient satisfaction and complaints and to quantify the final result objectively. The average resection weight for the 25 women was 1,227 +/- 300 g (maximum, 2,300 g) on the right side and 1,218 +/- 343 g (maximum, 2,100 g) on the left side. The sternal notch-to-nipple distance was reduced from 37.1 +/- 4 cm to 23.4 +/- 2.1 cm on the right side and from 37.4 +/- 3.5 cm to 24 +/- 2 cm on the left side. The brassiere size was reduced by about three cup sizes on the average. During an average follow-up period of 2 years (n = 15), patient satisfaction was high, with good acceptance of the breast shape and a low rate of major complications (12%). The results suggest that the authors' modified vertical scar technique can be used successfully for all dimensions of reduction mammoplasty regardless of breast weight.

Breast Volume Determination in Breast Hypertrophy

Sir: We would like to congratulate Sigurdson and Kirkland on their interesting work.1 Besides the variety of methods described to assess breast volume, surface imaging represents a new alternative for precise, accurate, and observer-independent breast volume computation.2 We do appreciate this new approach by the authors, because we compared classic assessment methods to this new three-dimensional technology.3 We agree that anthropomorphic measurements are relatively feasible, cheap, and fast and can be accomplished with a standing patient. The authors also mention the limitations, especially with regard to projecting the inframammary fold onto the anterior breast surface and the resulting decrease in precision of the measurement in case of a deviation of the projected point. This aligns with our findings that anthropomorphic measurements are less reproducible and are not observer-independent, because of internal variation of the manual measurements and less anatomically well-defined landmarks.3,4 We have determined that different breast volume assessment methods measure different areas of breast tissues.3 Anthropomorphic methods attempt to derive a correlation between breast volume obtained by other assessment methods and linear measurements. The authors apply a water displacement method that is a modification of Tezel and Numanoglu’s technique, using a cylindrical container to derive a formula for breast volume determination.1,5 With this container, the posterior breast volume delimitation is defined as a planar level, comparable to molding techniques; posteriorly located breast portions are not included; and smaller volumes are computed.3 Using three-dimensional surface imaging, the rear demarcation of the volume area is not obtained either, but by using special software, the thorax wall curvature is calculable. This computed posterior breast volume delimitation is curved and shows high agreement with the segmented real thorax wall curvature obtained by magnetic resonance imaging data.2 Furthermore, the breast volume measurements obtained using three-dimensional surface imaging are highly correlated to the volume computations derived by magnetic resonance imaging, and calculated regression equations assist in comparing the different methods.2,3 We also observed that the precision of breast volume measurements is influenced by the examined breast volume and described the potential anatomical influences that are responsible for the reduced precision in breast volume calculation.2 It would be of great interest to know whether the described formula also correlates to other breast volume determination methods, whether the authors have also observed that the breast volume could influence the precision of their method, and whether the formula is applicable for the postoperative evaluation, which is desirable to assess the outcome and to clinically validate the formula by comparing the volume changes with the resection weight. Three-dimensional surface imaging offers the possibility of quantitatively evaluating and documenting actual morphological changes of the breast region before and after surgery with regard to volume, shape, contour, projection, surface, and symmetry (Fig. 1). Currently, three-dimensional surface imaging is not a routine method and is not affordable for everyone; therefore, due to the above-named advantages, we highly appreciate the presented method, because cost effectiveness is more important these days. With further development and elimination of existing obstacles, we believe that three-dimensional technology will become more widely applicable and affordable in the field of plastic and reconstructive surgery.Fig. 1.: Clinical applications of three-dimensional surface imaging for breast reduction. (Left) Color-coded differences of superimposed postoperative results on the preoperative surface model to quantify change of shape (deviation in mm) and volume (calculated volume difference in cc using three-dimensional imaging compared with the resection weight) of the right breast; (right) sagittal slice with two-dimensional deviation to visualize change in ptosis of the right breast after surgery (in mm).Maximilian Eder, M.D. Nikolaos A. Papadopulos, Ph.D. Laszlo Kovacs, M.D. Department of Plastic and Reconstructive Surgery Klinikum rechts der Isar Technical University Munich Munich, Germany DISCLOSURE The authors have no financial or commercial relationships with other people or organizations that could inappropriately influence their work.

Clinical benefit of liver hanging maneuver for right-side major hepatectomy

15171 Background: Liver hanging maneuver is a new technique in anterior approach of major hepatectomy. However, the impact of the maneuver has never been fully investigated in patients with liver tumors. To evaluate the surgical benefits of liver hanging maneuver, we set up a comparative study in right-side major hepatectomy. Methods: From 2000 to 2006, 326 hepatectomy were performed in our institution. Fifty-eight patients with liver tumor (hepatocellularcarcinoma in 36, metastatic liver tumor in 13, and the others in 9) considered for right-side major hepatectomy were prospectively analyzed. Right-side hepatectomy included 26 right hepatectomy, 24 extended right hepatectomy, and 8 tri-segmentectomy. The patients were devided into a group with conventional approach (n = 21), a group with anterior approach without hanging maneuver (n = 19), and a group with approach with liver hanging maneuver (n = 18). In the three groups, age, body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, tumor size, resected liver weights, intraoperative blood loss, frequency of transfusion and surgical time were analyzed. Results: In conventional approach, anterior approach without hanging maneuver, and approach with liver hanging maneuver, mean age was 55, 59, and 65 years, and mean tumor size was 65, 75, and 108mm, respectively. Patients with liver hanging maneuver were significantly elder (p&lt;0.05) and have larger tumor size (p&lt;0.01). There were no significant differences in body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, and resected liver weights. Mean intraoperative blood loss was 1771, 805, and 704g, and mean surgical time was 562, 483, and 435minutes, and the frequency of red blood cell transfusion was 33, 21, and 17%, respectively. Patients with liver hanging maneuver had significantly less intraoperative blood loss (P=0.0001) and surgical time (P=0.002). The frequency of red blood cell transfusion in the liver hanging maneuver group was significantly lower than that of the conventional group (p&lt;0.05). Postoperative morbidity rate were 33.3, 15.8, and 16.7%, respectively. Conclusions: Liver hanging maneuver is less invasive and a quite useful method for right-side major hepatectomy. No significant financial relationships to disclose.

Does intraprostatic inflammation have a role in the pathogenesis and progression of benign prostatic hyperplasia?

To compare the incidence of acute and/or chronic intraprostatic inflammation (ACI) in men undergoing transurethral resection of the prostate (TURP) for urinary retention and lower urinary tract symptoms (LUTS), as recently a role was suggested for ACI in the pathogenesis and progression of BPH, and urinary retention is considered an endpoint in the natural history of this condition. Details of TURPs done between January 2003 and December 2005 at one institution were obtained from the operating theatre database. Patients were divided by indication (retention/LUTS). Clinical data and histology reports were then reviewed and bivariate and logistic regression used to compare the pathological features between these groups. Of 406 patients, 374 had evaluable data; 70% of men with urinary retention had ACI, vs 45% of those with LUTS (P < 0.001). On logistic regression, the pathological factors associated with TURP for acute retention compared to that for LUTS were ACI, old age, and resection weight to a lesser degree. Inflammation appears to be important in the pathogenesis and progression of BPH. In this study, the risk of urinary retention due to BPH was significantly greater in men with ACI than in those without, and the association of TURP for retention with ACI was stronger than that with prostate weight. This finding might offer new avenues for the medical treatment of men with LUTS due to BPH.

Large-Volume Reduction Mammaplasty

Eighty-six women underwent modified inferior pedicled reduction mammaplasty. All were grouped according to body mass index (BMI): 14 in the overweight group, 51 in the obese group, and 21 in the morbidly obese group. The mean ages were 34, 35, and 36, respectively, for the 3 groups and were not statistically different. The mean resection weight in the overweight group was 929 g, 1316 g for the obese group, and 1760 g for the morbidly obese group. Wound healing complications increased with BMI; the overweight, obese, and morbidly obese groups had 21%, 43%, and 71% of complications, respectively. The results were not statistically different. The rate of repeat operations increased proportionally with the BMI to 7%, 8%, and 19%, respectively. Postoperative BMI was measured in 30 patients. Fifty percent of this group had limited preoperative activity secondary to breast enlargement. The mean postoperative follow-up period was 43 months. Forty-seven percent of this group continued to have limited activity after breast reduction with a mean BMI of 37.8 kg/m2. The mean BMI of all women was 37.41 kg/m2 with a total BMI change of -0.4 kg/m2, suggesting that most women do not lose a significant amount of weight after breast reduction. There was no statistical difference in long-term BMI.

Changes in the Serum Prostate-specific Antigen Level One Year after Transurethral Resection of the Prostate

Purpose: We wanted to investigate how transurethral resection of the prostate (TURP), for treating patients with benign prostate hyperplasia (BPH), affected the serum prostate-specific antigen (PSA) levels. Materials and Methods: The serum PSA levels were measured before and 12 months after operation in 57 patients who underwent TURP for BPH. The total prostate weight, as measured by transurethral ultrasonography (TRUS), and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in the PSA levels after the operation. Results: The preoperative mean PSA density was 0.10±0.08ng/ml/cc. The postoperative serum PSA levels were decreased significantly after TURP (p=0.002). Removal of 1g of BPH tissue reduced the serum PSA levels by an average of 0.22±0.4ng/ml. The changes in the serum PSA level one year after TURP correlated with the resected chip weights [Y=0.406+0.176x (r=0.526, p<0.05)]. Conclusions: TURP caused a long term decrease in the serum PSA level. One year after TURP, the PSA levels should be expected to decrease according to the resected chip weights. (Korean J Urol 2007;48:691-695) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

経尿道的前立腺切除術後の持続膀胱洗浄

We investigated whether continuous bladder irrigation after Transurethral Resection of the Prostate (TURP) would prevent catheter obstruction by the clot. We analyzed data from 761 patients registered in "a multi-institutional study of TURP clinical pathway" sponsored by the Ministry of Health, Labor and Welfare between 2001 and 2003. The difference of clinical backgrounds of the cases, resected weight, operating time, risk of being feverish, risk of catheter obstruction and chance of postoperative Transurethral Fulguration (TUF) between each institution were investigated. The risk factor of catheter obstruction is characterized and the significance of continuous bladder irrigation is discussed. The incidence of catheter obstruction in the four institutions, in which 90% or more of patients underwent continuous bladder irrigation, was significantly lower than that in the three institutions, in which continuous bladder irrigation was performed in selected patients whose hematuria was severe (4.4% VS 12.9%, p<0.001). There was no difference in the frequency of either pyrexia or postoperative TUF. Logistic regression analysis showed that significant factors for catheter obstruction are continuous bladder irrigation, resected tissue weight and preoperative urinary infection. Routine continuous bladder irrigation achieved a lower incidence of catheter obstruction. However, we recommend that urologists should decide whether to perform routine continuous irrigation, considering the frequency of catheter obstruction, safety, labor and cost.

経尿道的前立腺切除術 (TURP) に対する多施設共通クリニカルパスの進化

Improvement of perioperative management for transurethral resection of the prostate (TURP) by revising the common clinical path was investigated in multiple hospitals. We discussed perioperative outcomes using the common path in 2002 and revised it for 2003. Changes in perioperative outcomes between 2002 and 2003 and differences among hospitals were compared. There were no statistically significant differences in age, proportion of patients with mildly impaired activity of daily living and/or impaired cognition, general anesthesia, operating duration, resected weight, incidence of intraoperative complications and blood transfusion between 2002 and 2003. Although there were no differences in preoperative hospital stay, re-hospitalization rate and charges for surgery and anesthesia, Foley catheter was removed significantly earlier from postoperative day 2.9 to 2.3 and total medical charge significantly decreased from 43,703 to 39,661 units (1 unit = 10 yen). The incidence of postoperative pyrexia increased from 2.4% to 11.2% in 2003, however, the incidences of epididymitis, postoperative bleeding and postoperative difficulty on micturition remained stable. The average and standard deviation of postoperative hospital stay and total medical charge at each hospital decreased, however, differences among hospitals found in 2002 remained in 2003. We found that standardization can be accomplished by discussing perioperative management using a common path in multiple hospitals and revising the path as needed. Common clinical path should be a valid method of advancing standardization in Japan.

Postoperative Changes in Prothrombin Time following Hepatic Resection: Implications for Perioperative Analgesia

Disorders of coagulation may occur after uncomplicated hepatic resection in patients who have normal preoperative coagulation profiles and liver function tests. We present a retrospective study performed in a tertiary care university teaching hospital examining changes in liver function tests and coagulation profiles in patients undergoing hepatic resection. Data were obtained for 124 patients. When compared to the preoperative values, prothrombin times were significantly increased throughout the postoperative period. Prolongation of the prothrombin time was related to both duration of surgery and hepatic resection weight. There was no relationship between prothrombin time and patient age. Disorders of coagulation occur after hepatic resection even in patients who have normal preoperative coagulation and liver function tests. This has implications for anaesthetic practice, particularly when considering the use of an indwelling epidural catheter in patients undergoing hepatic resection.

Hemolysis in Transurethral Resection of the Prostate Using Distilled Water as the Irrigant

To investigate the incidence and time course of hemolysis and its clinical effects following transurethral resection of the prostate (TURP) using distilled water as the irrigant. Between March 1996 and April 1997, 39 patients who underwent TURP due to benign prostatic hyperplasia (BPH) were randomly included in this study. The levels of plasma hemoglobin, haptoglobin and serum lactic dehydrogenase (LDH) were checked in all patients before, immediately after, and 24 hours after the operation. Serum creatinine and sodium were also checked in 24 patients starting August 1996. Significant hemolysis was identified as simultaneous elevation of plasma hemoglobin (> 10 g/dL), serum LDH and reduction of plasma haptoglobin after TURP. Among the 39 subjects, hemolysis occurred in 17 (43.6%), whose plasma hemoglobin and serum LDH increased while plasma haptoglobin decreased immediately after operation (p < 0.05), but no significant differences between the data before and 24 hours after the operation were noticed. In the hemolysis group, serum creatinine increased while serum sodium decreased immediately after operation (p < 0.05), but the data before and 24 hours after the operation had no significant differences. There were no changes in serum creatinine and sodium levels after TURP in patients without hemolysis. The weight of the resected prostate was 42.5 +/- 15.5 g in the hemolysis group and 23.3 +/- 8.3 g in the nonhemolysis group, while duration of TURP was 68.9 +/- 19.6 minutes in the hemolysis group and 34.2 +/- 8.4 minutes in the nonhemolysis group. Patients with hemolysis had higher resection weight and longer resection time than those without hemolysis (p < 0.001). Using distilled water as an irrigant for TURP might cause hemolysis, especially in patients with larger prostates and longer resection times. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.

Réduction mammaire selon la technique verticale pour gigantomastie avec fibroadénomatose massive : à propos d'un cas clinique

Vertical reduction mammaplasty is one of the most debated « short-scar » breast reduction technique. Advantages and drawbacks of the technique are discussed; most of the authors do not accept it as the technique of choice for high glandular resection weights. In our case report we achieve it for a resection weight up to two kilograms with an areolar transposition distance of more than ten centimetres. We show that it is reasonable to realize it dealing with gigantomastia. The massive fibroadenomatosis is observed following immunosuppressive treatment for kidney transplantation. Cyclosporine intake, even sporadic, is at the origin of the growth of these multiple, bilateral and large fibroadenomas. Drug-induced cytokines stimulate their development.

Endoscopic mucosal resection using a cap-fitted endoscope improves tissue resection and pathology interpretation: an animal study

Endoscopic mucosal resection using a cap-fitted endoscope (EMRC) has been proposed to be significantly better and safer for tissue resection compared with standard snare EMR. However, there are no valid animal or clinical data to support this. We aimed to compare EMRC with standard snare EMR in a porcine model with respect to tissue resected, ease of procedure, and degree of diathermic injury to the resected specimen. Gastric EMRs were randomly performed in pigs using a variety of techniques, including EMRC (1mm and 17-mm cap) and the standard snare technique, using a single-channel method without a grasping forceps. Geometric and histological assessment of the resection specimen for size, histological depth, and diathermic injury were performed by a single pathologist, blinded to the endoscopic techniques used. Thirty-six gastric mucosal resections were randomly performed in three pigs. Use of EMRC resulted in a statistically significant greater resection specimen by weight, size, and histological depth compared with standard EMR (P < 0.04). Large-cap EMRC resulted in a statistically significant greater resection weight and size compared to small-cap EMRC (P < 0.05). There was a statistically significant greater degree of diathermic injury in the specimens resected using the standard snare EMR technique compared with EMRC (P < 0.006). There were no acute complications with either technique. Gastric EMRC is more technically effective than and as safe and easy as standard snare EMR. Use of the cap, especially the larger cap, is associated with larger and deeper mucosal resection and less diathermic injury compared with the standard snare technique, making the pathologic assessment of depth and margin involvement more reliable. When possible, EMRC should be the EMR method of choice.

90 Transurethral resection of prostate for locally advanced prostate cancer with bladder outlet obstruction

Introduction: Bladder outlet obstruction is a common complication of locally advanced carcinoma of the prostate. The aim of this study was to evaluate the operative morbidity and outcome after TURP for locally advanced prostate cancer and to compare it with the results from patients who had a TURP for benign prostate hyperplasia.Methods: Between January 1998 and December 2003 422 consecutive patients had a TURP for BPH and 53 consecutive patients underwent a TURP for LUTS with a diagnosis of locally advanced prostate cancer.Results: Mean age at time of surgery was 76.6 years (range 63–95) and mean PSA was 100.2 (range 0.3–2630) for those with cancer. Before the TURP 24.5% of the patients had hormonal treatment alone, 11.3% had radiotherapy and 64.2% had not treatment for their prostate cancer. At TURP histopathology revealed high grade cancer (Gleason score 8–10) in 75% and moderate grade (Gleason score 6 or 7) in 25%. Mean resection weight was 12.6 gram (range 2–65). There was no difference in the overall mortality, failure to void or complication rates between the established prostate cancer and the BPH group (Chi‐squared, P &lt; 0.05).Conclusion: TURP can be performed with little fear of excess complications in patients with established cancer of the prostate gland.

Efficacy of Bipolar Transurethral Resection of the Prostate: Comparison with Standard Monopolar Transurethral Resection of the Prostate

Purpose: We wanted to assess the efficacy of bipolar transurethral resection of the prostate (TURP) compared with standard monopolar TURP. Materials and Methods: All 25 patients with symptomatic benign prostatic hyperplasia (BPH) who underwent TURP from July 2004 to June 2005 were retrospectively reviewed. Thirteen consecutive patients underwent standard monopolar TURP and 12 underwent bipolar TURP using the Gyrus PlasmaKinetic system. Results: The mean weight of resection was 29.7g for the bipolar TURP and 22.5g for the monopolar TURP. The operative time was shorter (82.5 vs 98.1 minutes, respectively), the estimated blood loss was less (252 vs 268cc, respectively) and the mean post-operative hospital stay was shorter (5.3 vs 5.7 days, respectively) in the bipolar TURP group. However, these differences were not statistically significant. The acute complications were significant hyponatremia in one patient and clot retention in one patient after monopolar TURP, but no complications occurred after bipolar TURP. The maximal flow rate increased from 6.4 to 14.7ml/sec in the bipolar TURP group, and it increased from 6.7 to 15.2ml/sec in the monopolar TURP group. Conclusions: Compared to monopolar TURP, bipolar TURP can be easily and safely used for treating symptomatic BPH with less morbidity. (Korean J Urol 2006;47:377-380) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Transurethral Prostatic Resection for Acute Urinary Retention in Patients with Prostate Cancer

Few studies have focused on clinical findings in prostate cancer patients receiving transurethral resection of the prostate (TURP) for acute urinary retention (AUR). We compared the clinical findings (preoperative characteristics, operative morbidities, and pathology results) of patients with diagnosed prostate cancer undergoing palliative TURP for AUR with those of patients undergoing TURP for AUR who were diagnosed with prostate cancer postoperatively. The charts of 25 patients with prostate cancer undergoing TURP for AUR between 1986 and 2003 were retrospectively reviewed. Fourteen patients underwent palliative TURP (group A) and the other 11 patients with newly diagnosed prostate cancer received TURP (group B). The data, including preoperative characteristics, operative morbidities, and pathology results were analyzed. There were no significant differences between the 2 groups in parameters such as age at diagnosis and operation, operative time, hospitalization, and catheter duration. However, the Gleason score was higher in group A (7.6 +/- 1.7) than in group B (5.4 +/- 1.8) (p < 0.005). The mean resected weight was lower in group A (19.9 g) than in group B (39.5 g). Group A was more likely to receive recatheterization (33.3% vs 0%, p = 0.058) and repeat operation (28.6%), although the difference was not statistically significant. There were no complications such as transurethral resection syndrome or perioperative death in either group. TURP can be performed safely for relief of AUR in patients with prostate cancer, no matter if the cancer was diagnosed before or after surgery. The higher Gleason score and more advanced cancer stage, as found in group A, may correlate to high recatheterization and reoperation rates due to preexisting tumor progression.

Transurethral Prostatectomy Using a 22F Continuous Running Irrigation System Resectoscope

Purpose: The twenty-six F sized continuous running irrigation transurethral resection (TUR) system has showed a relatively high risk for inducing postoperative urethral stricture in Korean men. We evaluated the efficacy and safety of recently available 22F continuous running irrigation TUR system for treating benign prostatic hyperplasia (BPH) patients. Materials and Methods: A total of seventy patients with severe symptomatic BPH underwent transurethral prostatectomy (TURP). The 26F system was used in 31 cases and the 22F system was used in 39 patients. The total resection weight, the resection rate, and the intraoperative and immediate postoperative complication rates were compared between the 2 groups. The patients were followed for 2 weeks, 4 weeks and 3 months postoperatively to check for the development of urethral stricture. Results: The total resection weight was 14.89.5gm in the 22F group and 11.210.2gm in the 26F group (p> 0.05). The resection rates were 0.240.10gm/min and 0.190.11gm/min, respectively. The rate of urethral stricture requiring any type of management was 15.4% (6/39) in the 22F group and 38.7% (12/31) in the 26F group (p