Transurethral Incision Of Prostate Research Articles

RETROSPECTIVE MULTICENTRIC STUDY ON THE POST-SURGERY SYMPTOMATIC AND OBJECTIVE IMPROVEMENT OF BENIGN PROSTATIC HYPERPLASIA PATIENTS

Objectives: To evaluate patients of benign prostatic hyperplasia (BPH) preoperatively and identify those who would benefit from surgery, to evaluate outcome of surgery for BPH with respect to symptomatic and objective improvement of patients, and to compare the results of different surgeries for BPH being done different hospitals at Bhopal, which included transurethral resection of the prostate (TURP), transurethral incision of prostate (TUIP)/bladder neck incision (BNI), and Freyer’s prostatectomy? Methods: The present study was carried out at different hospitals of Bhopal. Patients presenting to the surgery outpatient department with symptoms of obstruction, namely, weak urinary stream, frequency hesitancy, intermittency, urgency, nocturia, etc., were included in the study. Some of the subjects included were patients presenting during emergency timings with complaints of retention of urine or occasionally other symptoms. The American Urological Association (AUA) Symptom Index questionnaire was administered to all such patients. They were also evaluated by ultrasound examination and patients having BPH on ultrasound (USG) were further evaluated by uroflowmetry. Results: Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship. Both maximum and average urinary flow rates (Q max and Qav) were improved by all the three surgeries However, TURP and Freyer’s prostatectomy showed greater improvement as compared to TUIP/BNI. Combination of AUA scoring, USG, and uroflowmetry helped us document improvement in our BPH patients and compared it favorably with other studies. Conclusion: Uroflowmetry was a simple assessment tool easy to learn and use. It was also inexpensive and formed a useful extension to clinical examination providing objective evidence of obstruction. It also helped to indirectly quantity the severity of obstruction. Symptom severity did not correlate with prostate size. Small prostates caused symptoms in the severe range also while even large prostates sometimes caused little symptoms. Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship.

Determining the correlation between transition zone index with international prostate symptom score and peak flow rate on clinical outcome after transurethral resection of the prostate in benign prostatic hyperplasia

Background: Benign prostatic hyperplasia (BPH) is a pathologic process which has common contribution to lower urinary tract symptoms (LUTS) in aging men. International Prostate Symptom Score (IPSS) is an important means of assesment in the clinical research of LUTS and BPH. Free flow rates (peak flow rate or Qmax) give an indirect measure for the probability of obstruction whereas subvesical obstruction only can be measured by invasive pressure-flow studies. Among the various surgical or minimally invasive techniques available for BPH like Intraprostatic stents (temporary/permanent), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), transurethral electrovaporization of prostate (TUVP), Transurethral incision of prostate (TUIP), lasers (Nd: YAG (Neodymium-doped yttrium aluminium garnet), Ho: YAG (Holmium yttrium aluminium garnet), potassium titanyl phosphate (KTP), diode, thulium laser) etc, transurethral resection of the prostate (TURP) is a safe and effective procedure. Comparison of difference in the pre and postoperative ultrasonic prostatic volume with amount of tissue resected at operation has established the accuracy of the method. The aims of present study are to determine the correlation between transition zone index with international prostate symptom score (IPSS) and peak flow rate (Qmax) on clinical outcome after TURP in BPH patients.Methods: A prospective study was conducted to determine the effect of the extent of tissue resection on symptom improvement after TURP in men and to evaluate any potential correlation between prostate size and outcome.Results: Total of 52 patients studied prospectively. Transitional zone (TZ) index was found to have a significant correlation with the clinical outcome.Conclusions: Symptomatic improvement after TURP will depend on the amount of tissue resected in terms of IPSS and peak flow rates.

Comparison of The Urinary Flow Rate Improvement After Transurethral Incision and Transurethral Resection of Prostate for Small Sized Symptomatic Benign Enlargement

Objective: To compare the mean improvement in urinary flow rate after transurethral resection of prostate (TURP) and transurethral incision of prostate (TUIP) for small sized symptomatic benign prostatic enlargement (SBE). Study design: Randomized controlled trial. Duration of study: January 2016 to December 2017. Setting: Department of Urology Institute of Kidney Diseases Hayatabad Peshawar. Methodology: A total of 216 patients presenting to our OPD having lower urinary tract symptoms due to benign prostatic enlargement were included in the study. Their medical history, physical and digital rectal examination were performed. Urine analysis, urine C/S, Blood Complete, Serum Creatinine Prostate Specific Antigen, Uroflowmetry and Ultrasound were performed. All patients were randomized into two groups; Group A (TURP) and Grouped B (TUIP). Results: Our study shows that in Group A (TURP) mean age was 57 years with standard deviation ± 3.78 while in Group B (TUIP) mean age was 60 years with standard deviation ± 3.13. The status of uroflowmetry (post-operative) among two groups was analyzed as in Group A (TURP) 5(5%) patients had uroflowmetry 15 ml. Mean uroflowmetry was 17 ml with standard deviation ± 3.64. Where as in Group B (TUIP) 9(8%) patients had uroflowmetry 15 ml. Mean uroflowmetry was 16 ml with standard deviation ± 3.55. Mean urinary flow rate was compared between TURP and TUIP in which showed that there is no significant difference between the two surgical procedures in term of urinary flow rate. Conclusion: Our study concludes that there was no significant difference between TURP and TUIP in term of mean urinary flow rate for small sized symptomatic benign prostatic enlargement.

The outcomes of transurethral incision/resection of the prostate (TUIP/TURP) performed early after renal transplantation.

In the early period after renal transplantation, urinary retention stemming from bladder outlet obstruction (BOO) may directly affect graft success. The aim of this study was to evaluate the early and long-term outcomes of transurethral resection of the prostate (TURP) and transurethral incision of prostate (TUIP) procedures performed in the first month following RT due to BOO. Between February 2009 and March 2016, 38 male patients underwent TURP/TUIP due to BOO within the first 30 days of renal transplantation. The urodynamic and renal function assessment results of all patients were collected during the pre-and postoperative periods. All patients were followed up for a minimum of 12 months for short and long-term complications. The results were evaluated retrospectively. The mean age of the patients who underwent operations was 59.2±12 years. The median duration of dialysis was 41 months (range 0-180). Before the operation the mean serum creatinine (sCr) level was 1.8±0.7 mg/dL, the mean total PSA level was 1.6±1.1 ng/mL. Of the voiding parameters, the mean Qmax and Qave were measured as 8.2±4.5 mL/sec and 4.6±2.5 mL/sec, respectively. The median post-micturition residual urine (PMR) was 105 mL (range 10-400). TURP/TUIP operations were performed at a median of 19 days (range 8-30) after renal transplantations. None of the patients experienced major complications. In the early postoperative period, 5 patients (13.1%) developed urinary tract infection. The mean decrease in sCr in the first month following TURP/TUIP was 1.4±0.4 mg/dL (p<0.001). The mean Qmax (22.4±11.1 mL/sec), and Qave (11.7±5.4 mL/sec) increased significantly (p<0.001), while the median PMR (15 mL, range 0-205) decreased significantly (p<0.001). The mean follow-up period after the procedure was 46.8±23.3 months. During the follow-up period, 3 (7.8%) patients suffered from urethral stricture and 2 (5.2%) patients from bladder neck obstruction. In the surgical treatment of urinary retention arising from BOO in the first month following renal transplantation, TURP/TUIP yield safe and successful results. In addition, regarding the short and long term outcomes, these procedures may be safely performed with low morbidity.

PD39-09 BLADDER FUNCTION RECOVERY AFTER TREATMENT IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY – CLINICAL RESULTS AND PREDICTIVE FACTORS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction III1 Apr 2017PD39-09 BLADDER FUNCTION RECOVERY AFTER TREATMENT IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY – CLINICAL RESULTS AND PREDICTIVE FACTORS Kau Han Lee and Hann-Chorng Kuo Kau Han LeeKau Han Lee More articles by this author and Hann-Chorng KuoHann-Chorng Kuo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1736AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor underactivity is an important yet still under-research issue. The treatment outcome in patients with detrusor underactivity (DU) is usually unfavorable and no better compared to untreated patients. Therefore, we aim to identify the predictive factors of satisfactory treatment in male patients with detrusor underactivity. METHODS We retrospectively reviewed 86 cases of men with video-urodynamic proven detrusor underactivity from 2000 to 2015. DU was defined as low voiding pressure, low flow rate, post void residual (PVR)>300mL and a low voiding efficiency (VE) < 33% in this study. VE > 50% after treatment was considered satisfactory outcome. Patient's demographics and urodynamic parameters include first sensation of filling (FSF), full sensation of filling (FS), urgency sensation (US), compliance at capacity, maximal flow rate (Qmax), detrusor voiding pressure (Pdet), voided volume, cystometric bladder capacity (CBC) and PVR were compared between the satisfactory group and unsatisfactory group. Various treatment options including transurethral resection of prostate (TURP), transurethral incision of prostate (TUIP) and medication (include botulinum toxin injection) were performed according to clinical and video-urodynamics findings. RESULTS After a mean follow up of 31 months, 63 patients had satisfactory outcome. Satisfactory group has significantly higher detrusor pressure and compliance at capacity than unsatisfactory group. There was significant improvement in FSF, FD, US, Pdet, Qmax, voided volume, PVR and CBC after treatment in satisfactory group meanwhile in unsatisfactory group there were only significant changes in US, PVR and CBC. CONCLUSIONS A higher detrusor pressure and compliance at capacity at baseline were predictive of satisfactory treatment outcomes in male patient with detrusor underactivity. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e748 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kau Han Lee More articles by this author Hann-Chorng Kuo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Robotic-assisted Bladder Diverticulectomy: Assessment of Outcomes and Modifications of Technique

To present outcomes of robotic-assisted bladder diverticulectomy (RABD) and technique modifications that may improve outcomes. Sixteen consecutive RABDs were performed at our institution by 2 experienced robotic surgeons. Charts were reviewed for patient characteristics, perioperative data, and long-term functional outcomes. Eleven patients (69%) underwent RABD using an external dissection approach, whereas 5 patients (31%) underwent RABD using a modified internal dissection technique (immediate entry into the bladder diverticulum). The mean age of our cohort was 68 years (range, 59-79 years), and 15 of 16 patients (93.8%) were men. Two patients (12.5%) had known malignancy in the diverticulum. Eleven patients (69%) underwent a preoperative outlet procedure (9 transurethral resection of prostate and 2 transurethral incision of prostate) at a median time before RABD of 163.5 days (range, 26-622 days). Median operative time for external RABD was 228 minutes (range, 144-353 minutes) compared with that of 149 minutes (range, 130-189 minutes) for the internal dissection technique. No patient required blood transfusions, and there were no 30-day Clavien grade 3 or 4 complications. Median hospital stay was 2 days (range, 1-3 days). Median postvoid residual before intervention was 458 mL (range, 78-1100 mL) compared with that of 214 mL (range, 46-527 mL) after RABD. Mean American Urological Association symptom score was 18 (range, 5-29) preoperatively compared with that of 7 (range, 2-21) postoperatively. RABD is safe with a low risk of intraoperative or postoperative complications and results in both improved voiding symptoms and diminished postvoid residuals. Modifications of technique from an external dissection approach to an internal dissection approach has led to a dramatic reduction in operative time.

Holmium:YAG Transurethral Incision Versus Laser Photoselective Vaporization for Benign Prostatic Hyperplasia in a Small Prostate

We assess the perioperative, short-term and long-term functional outcomes of treating bladder outlet obstruction secondary to a small prostate by 1 of 2 laser techniques. A retrospective review using a prospectively maintained database was performed of patients treated for bladder outlet obstruction secondary to a prostate smaller than 40 ml. Patients who were treated with GreenLight™ photoselective vaporization of the prostate or holmium laser transurethral incision of the prostate were included in the study. From January 2002 through December 2010, 191 cases of 1,682 laser prostate surgeries were described. GreenLight photoselective vaporization of the prostate was performed in 144 (75.4%) cases and holmium laser transurethral incision of the prostate was performed in 47 (24.6%) cases. A significantly shorter mean operating time, hospital stay and catheter duration were observed in the holmium laser transurethral incision of the prostate group (30.3 ± 16 minutes, 0.8 ± 0.8 days and 1.3 ± 1.9 days, respectively) than in the photoselective vaporization of the prostate group (45.8 ± 22 minutes, 0.3 ± 0.4 days and 0.4 ± 0.6 days, respectively, p <0.05). At 1 and 5 years after photoselective vaporization of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement in mean maximal flow rate of 57.7% and 62.8%, 58.3% and 57.2%, 65.4% and 73%, and 127.6% and 167.1%, respectively. At 1 and 5 years after holmium laser transurethral incision of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement of mean maximal flow rate of 55.3% and 52.8%, 49.2% and 49%, 45% and 78.1%, and 67.4% and 35.4%, respectively. Subjective and objective urine flow parameters were comparable at different followup points. There was no significant difference between the 2 groups in terms of early and late complications (p >0.05). Reoperation rates were 10.4% and 6.4% in the photoselective vaporization of the prostate and holmium laser transurethral incision of the prostate groups, respectively (p >0.05). The mean estimated cost per holmium laser transurethral incision of the prostate procedure was significantly lower than per photoselective vaporization of the prostate procedure (509.34CAD vs 1,765.92CAD, p = 0.002). Holmium laser transurethral incision of the prostate and GreenLight photoselective vaporization of the prostate seem to be equally effective, safe and durable surgical treatment options for small prostates even in high risk patients.

Transurethral incision of prostate (TUIP) for minimally enlarged prostates.

To compare the efficacy of Transurethral Incision of Prostate (TUIP) with Transurethral Resection of Prostate (TURP), in terms of improvement in peak flow rate (Q-Max) and number of complications. It was an interventional, quasi-experimental study. This study was conducted at the Armed Forces Institute of Urology (AFIU), Rawalpindi, from November 2006 to December 2007. A total of 60 patients were inducted in the study with thirty patients in each group undergoing TUIP (Group A) and TURP (Group B). Patients of any age with prostate less than 35 grams needing surgical interventions were included in the study. Patients with recurrent disease, multiple co-morbid conditions, higher center dysfunctions, neurogenic bladder and associated strictures were excluded. In TUIP, a single median incision was made at 6 'O clock position, starting from interureteric ridge upto verumontanum, going upto prostatic capsule. In group B, standard TURP was done. All the cases were operated by the same consultant under spinal anaesthesia. Follow up was done at the end of the 1st week and 1st, 3rd and 6th months. Mean operative time was shorter (17.01+/-1.97 minutes) in group A as compared to group B (27.06+/-23.06 minutes, p<0.05). There was no statistically significant difference between the two groups regarding peak flow. Complications were less in group A (08) and more in group B (n=28, <0.05). TUIP and TURP were equal in terms of improvement in flow rate, but operative time was shorter in TUIP with less post operative complications. So, TUIP is a better choice in prostates weighing less than 35 grams.

Bipolar Transurethral Resection in Saline (TURis®): Outcome and Complication Rates After the First 1000 Cases

TURis((R)) is an emerging technique that shows the same efficacy of monopolar resection. However, there is currently little available data on the safety of bipolar devices. We assessed outcome and safety of TURis on a large cohort of patients with at least 6 months' follow-up. Between January 2006 and October 2007, 1000 consecutive transurethral resection (TUR), 376 transurethral resection of prostate, 480 transurethral resection of bladder neoplasm, and 144 transurethral incision of prostate were performed. All procedures were carried out with a bipolar device in physiologic saline (TURis). The resectoscope used was an Olympus 26F in continuous flow-type Iglesias with continuous aspiration. The loops were all disposable/single use. The incidence of unwanted stimulation of the obturator reflex, TUR syndrome, thermal skin lesion, blood transfusion, urethral strictures, and bladder neck contractures were recorded. None of the patients operated experienced a TUR syndrome or a thermal skin lesion. The median follow-up of the entire cohort was 12 months (range, 6-24 months); 663 patients had at least 1-year follow-up (66.3%). Urethral stricture occurred in 27 patients (2.7%). Four patients developed a bladder neck contracture after transurethral resection of prostate (1%). Early postoperative clot retention occurred in 21 patients (2.1%), and 11 patients needed one or more transfusion (1.1%). Only six patients (2%) submitted to TUR of a neoplastic lesions at the lateral bladder wall experienced an unwanted trigger of the obturator reflex. TURis offers the patient the same results as monopolar technology guaranteeing maximum safety without increasing the incidence of urethral strictures.

Outcome audit of nurse‐led lower urinary tract symptoms clinic: lessons and challenges for practice

AbstractThe objective of this article was to review the outcome of assessments performed at a recently established nurse‐led one‐stop male lower urinary tract symptom (LUTS) assessment clinic. Retrospective audit was performed on 107 patients assessed between December 2006 and August 2007. Information obtained included demographics, symptoms, International Prostatic Symptom Score (IPSS), prostate‐specific antigen (PSA), electrolyte profile, mid‐stream sample of urine (MSSU), ultrasound scan of renal tracts, uroflowmetry (urinary flow studies), management plan and clinical outcome. The mean age of the patient was 65·8 years, and patients waited 15·7 weeks (previously up to 2 years) for consultation. Symptomatically, 51% had moderate (IPSS score 8–19) and 38% had marked symptoms (score 20–35), and 43·5% reported sexual dysfunction. The mean PSA, prostatic volume and postvoid residual urine volume were 4·9 ng/mL, 50·4 cc and 101·9 mL, respectively. The average maximum urinary flow was 14·9 mL/s, and only 1% of all MSSU obtained revealed urinary tract infection. The final clinical outcomes identified nine prostate cancers, three renal cancers, three bladder calculi, two urethral strictures, two atonic bladders, one new‐onset diabetes and one pelvi‐ureteric junction obstruction. From a treatment perspective, 70·1% patients had alpha‐blockers, 42·9% had a 5‐alpha reductase inhibitor, 15% had anticholinergics, 1% had transurethral incision of prostate, 2% had optical urethrotomy, 3% had cystolitholapaxy, 3% had radical nephrectomy and 8% had transurethral resection of prostate. This clinic had significantly reduced the waiting time for first assessment in people with LUTS. Additionally, it has highlighted areas for further refinement and revision and firmly establishes the need for ongoing reaudit. We tentatively suggest the inclusion of ultrasound renal tracts as part of LUTS assessment.

Tratamiento endoscópico de la hiperplasia benigna de próstata bajo anestesia local-sedación en pacientes de alto riesgo

Introduction and objetiveThe aging of the population causes an increase of the number of men affected by benign prostatic hyperplasia (BPH) with a large number of pathology associated that may limit its surgical treatment. In this study we try to show the effectiveness and security of local anaesthesia and sedation in the endoscopic treatment of the BPH in patients with high surgical- anaesthetic risk. MethodsDuring the last 4 years, 38 patients underwent surgical treatment of BPH with ages between 78 and 86 years (average 81,4± 3,2) with severe obstructive prostatic syndrome and high surgical-anaesthetic risk. 15 patients underwent, transurethral incision of prostate (TUIP) and in 23 patients, transurethral resection (TURP) was performed. The blockade anesthetic was made by transrectal periprostatic infiltration finger-guided with 10-15 millilitres of lidocaine 2%. During the procedure an intravenous perfusion of propofol and remifentanil was administered. The obtained results as well as the patient’s satisfaction degree was evaluated by means of the elaboration of a questionnaire. ResultsThe average length of the surgical treatment was of 12 ± 5 minutes (rank 8 - 25), having itself not stated complications derived from the anesthetic technique. They referred a slight annoyance 4 patients (11%) that was treated increasing the rate of the sedative perfusión. The satisfaction’s degree with the received treatment has been good in the 95% of patients. ConclusionsWe considered that the TUIP as much as TURP made under local anesthesia with sedation are safe, effective methods and well tolerated, that fundamentally are indicated in aged patients and when the surgical-anesthetic risk is elevated.

Systematic Removal of Catheter 48 Hours Following Transurethral Resection and 24 Hours Following Transurethral Incision of Prostate

Systematic Removal of Catheter 48 Hours Following Transurethral Resection and 24 Hours Following Transurethral Incision of Prostate

Systematic Removal of Catheter 48 Hours Following Transurethral Resection and 24 Hours Following Transurethral Incision of Prostate: A Prospective Randomized Analysis of 213 Patients

The interval before removal of the catheter used in prostatic transurethral surgery depends to a great extent on the surgeon, with a frequently empirical orientation. We conducted a prospective, randomized and controlled study of 213 patients who underwent transurethral surgery for benign prostatic hyperplasia. The catheter was removed systematically 24 hours after transurethral incision and 48 hours after transurethral resection of the prostate (group 1--52 and 54 patients, respectively) or the catheterization interval was determined by each surgeon in accordance with the usual criteria (group 2--52 and 55 patients, respectively). No statistically significant differences were noted between these 2 groups in regard to complications. We conclude that systematic removal of the catheter at the aforementioned periods is cost-effective, safe and comfortable for the patient.

Transurethral incision and posterior resection of prostate (TUI-PRP) for selected patients with benign obstructive prostatic disease.

Transurethral incision and posterior resection of the prostate (TUI-PRP) is described and used to overcome my three concerns in performing transurethral incision of the prostate (TUIP). The favorable result from TUI-PRP is presented.

Transurethral incision of prostate

Transurethral incision of the prostate was performed in 100 males with prostates that measured under 30 g via rectal examination or transrectal ultrasound. Urodynamic measurements including uroflow rate, post-void residual, as well as physical examination have been evaluated in these patients. Eighty-five percent of these patients have been successfully treated with outpatient transurethral incision of the prostate.

Transurethral Resection Versus Transurethral Incision of the Prostate

A new operation, transurethral incision of prostate (TUIP), performed on 846 patients in 20 years, is offered primarily for the management of bladder outlet obstruction in young, middle-aged, and those old men with small prostates who otherwise would be subjected for years to dilatation, massage, and drugs with only partial and temporary relief. In matched cases, results and complications are the same for TUIP and TURP except for the troublesome bladder neck contracture and the higher incidence of reflex into the seminal vesicles and sexual complications after resection of the prostate. Transurethral incision is unsuitable for large prostates. As for economics, compassion and wisdom in fee collection are justified. Cost reduction in health care may be necessary, but it hurts everyone involved. There is no such thing as unnecessary surgery when the critics are charged with decision making about the health and life of the patient before surgery. Finally, before the advent of the third-party payment, operations were avoided because of the financial burden. The surgeon, the patient, and the relatives silently consented to no care. This "silent consent" did not improve the quality of life but did contain costs--as well as longevity.

Transurethral Incision of Prostate Compared with Transurethral Resection of Prostate in 132 Matching Cases

In a prospective project during a 2-year period 132 patients with bladder outlet obstruction who were candidates for transurethral incision of the prostate were managed alternately by transurethral incision and transurethral resection of the prostate. Both operations were compared in matched patients. The results and complications favored transurethral incision, although there was no statistical significance except for the high incidence of bladder neck contracture after transurethral resection (p equals 0.028).

Transurethral incision of prostate

The first transurethral incision of the prostate (TUIP) by the author was done in 1969. An analysis of 150 TUIP's performed thus far is given and compared with 150 concomitant subsequent resection, whereas 8 patients in the TURP group have had reresection. There has been no contracture of the bladder neck, no incontinence of urine, fewer strictures, and less sexual changes associated with this new method.