Transurethral Resection Of Prostate Group Research Articles

MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY Young Son, Emma Troyer, Ryan Moriarty, Sage Grenz, Maya Sengha, Dayna DeVincentz, Benjamin Fink, and Thomas Mueller Young SonYoung Son More articles by this author , Emma TroyerEmma Troyer More articles by this author , Ryan MoriartyRyan Moriarty More articles by this author , Sage GrenzSage Grenz More articles by this author , Maya SenghaMaya Sengha More articles by this author , Dayna DeVincentzDayna DeVincentz More articles by this author , Benjamin FinkBenjamin Fink More articles by this author , and Thomas MuellerThomas Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTs) caused by benign prostatic hyperplasia (BPH) in men is one of the most frequently encountered complaints in the urologist's office. Prostatic urethral lift (PUL) has been shown to be an efficacious and a minimally invasive treatment for BPH. There is a paucity of data with salvage PUL in BPH. The aim of the study is to determine the effect of PUL in patients with previously treated BPH and radiation therapy. METHODS: A retrospective chart review was performed on 445 patients between 6/2016 to 5/2022 of a single surgeon’s experience with PUL. Patients were subgrouped into those that had previous transurethral resection of prostate (TURP), transurethral needle ablation (TUNA), PUL, or radiation therapy (external beam radiation or brachytherapy). The previously treated groups were then compared to those undergoing primary PUL (no previous treatment for BPH). Patient demographics, international prostate symptom score (IPSS) and quality of life (QOL) were assessed through 24 months. RESULTS: A total of 444 patients were retrospectively reviewed. The previous prostatic urethral lift group consisted of 8 (1.8%) patients, previous TUNA had 12 (2.7%) patients, previous TURP had 15 (3.3%) patients and the previous radiation group had 14 (3.1%) patients of the total cohort. The previous urolift group were older (80.9 years) and had larger prostate volume (69.9 grams). The previous TURP group had the largest post void residual (PVR) at 276.1ml. The decrease in IPSS was seen in all groups that were noninferior to primary PUL (no prior treatment group). There was statistical significance for IPSS for the prior radiation group compared to primary PUL at 18 months (4.97 vs. 3.0). CONCLUSIONS: Efficacy of PUL has not been well studied in patients with previous prostatic treatments. Our study is one of the largest single surgeon’s experiences with patients with PUL. We show that repeated PUL in patients that had previous PUL, TUNA, TURP, or radiation can be effective. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1095 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Son More articles by this author Emma Troyer More articles by this author Ryan Moriarty More articles by this author Sage Grenz More articles by this author Maya Sengha More articles by this author Dayna DeVincentz More articles by this author Benjamin Fink More articles by this author Thomas Mueller More articles by this author Expand All Advertisement PDF downloadLoading ...

A comparative evaluation of thulium laser enucleation versus bipolar transurethral resection of prostate in the management of large prostate (>60 g): A prospective randomized controlled trial

Background: The prevalence of prostate enlargement increases with age in older men and is a prevalent clinical disease. The current study was conducted with the objective of comparatively evaluating the efficiency and safety of prostate resection techniques, thulium laser enucleation (ThuLEP) versus bipolar transurethral resection of prostate (TURP) for large prostate (>60 g) glands. Aims and Objective: The aim of the study was to compare result of ThuLEP versus Bipolar TURP in Large Prostate (>60 g) – A Prospective Randomized Study. Materials and Methods: In this prospective randomized controlled trial, symptomatic patients with BPH (benign prostatic hyperplasia) with a prostate gland >60 g indicated for surgery were included in the study. On the basis of the treatment, patients were grouped into Bipolar TURP and ThuLEP groups with 36 patients each. Demographics, patient characteristics, and laboratory investigations were recorded at baseline. Intraoperative parameters including operation time, blood loss, and complications were compared between groups. Uroflowmetry parameters were compared on days 7, 1, and 3 months of follow-up. Results: Baseline patient characteristics were comparable between groups. Major variation in the mean operative time (88.69 vs. 96.11 min, P = 0.002), the volume of blood loss due to capsular or sinus perforation (0.51 vs. 0.28 L, P < 0.001), mean duration of postoperative catheterization (30.50 vs. 21.26 h, P < 0.001), and a mean number of hospital stays (38.42 vs. 29.06 h, P < 0.001) was noted between Bipolar TURP versus ThuLEP group. The post-void residual urine was significantly higher in bipolar TURP vs. ThuLEP at 1 week following surgery (P = 0.042) but was similar at 1- and 3-month follow-ups. AT 3 months, the mean residual prostate volume was considerably lower in ThuLEP group than the bipolar TURP group. All related complications were comparable between groups, mild and transient in nature, and disappeared within 1 month of follow-up. Conclusion: The efficiency and safety of bipolar TURP and ThuLEP procedures for the management of large prostate are comparable. Due to the lower rate of blood loss, ThuLEP can be preferred in patients with coagulation disorders.

A Study on Bipolar Transurethral Resection of Prostate (TURP) versus Transurethral Resection and Electrovaporization (TURP-TUVP) Sandwich Procedure

Background: TURP is the gold standard for the endoscopic treatment of BPH. Nonetheless, it remains associated with significant morbidity, especially in terms of hemorrhage leading to possible blood transfusion and delayed hospital discharge. TUVP is associated with reported improvements in subjective and objective measures but a high rate of postoperative irritative symptoms and lack of tissue for histologic examination. The concept behind TURP and TUVP sandwich procedure is to overcome the drawbacks of the two procedures. Objective: To compare the outcome of bipolar transurethral resection of prostate (TURP) and bipolar transurethral resection and electrovaporization of prostate (TURP-TUVP) sandwich procedure in patient with benign prostatic hyperplasia. Methods: This quasi experimental study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh from July 2017 to June 2019 over a period of 2 years. Sixty patients with BOO caused by benign prostatic hyperplasia scheduled for transurethral resection of prostate were included in this study. Patients were selected first by purposive sampling and were grouped into A and B with randomization. Group A patients underwent bipolar TURP while group B patients underwent sandwich method. Perioperative findings as well as IPSS Qmax and PVR after 3 months of operation were compared. Results: Operative time was significantly longer in TURP-TUVP group than in TURP group (P value 0.036).Post operative hospital stay was significantly longer in TURP group (P value <0.001). Catheterization time was significantly higher in TURP group (P value <0.001).Intra-operative irrigation was significantly higher in TURP-TUVP group (P value 0.001). Post operative irrigation time was significantly longer in TURP group (P value <0.001). Hemoglobin decrease was significantly higher in TURP group (P value <0.001). Similarly, sodium decrease was higher in TURP group than that of TURP-TUVP group but not statistically significant (P value 0.81).Clot retention was 2 (6.7%) in TURP group. Short-term follow up at 3 month showed no significant difference in IPSS in TURP and TURP-TUVP groups (P value 0.349), significantly higher Qmax in TURP-TUVP group (P value 0.022) and significantly higher PVR in TURP group (P value0.005) Conclusion:. TURP-TUVP procedure has higher operative time and intraoperative irrigation, but has significantly lower catheterization time, postoperative irrigation time, hemoglobin change and hospital stay. Bangladesh J. Urol. 2021; 24(2): 161-165

Morphometric Analysis of Prostate Zonal Anatomy After Transurethral Resection of Prostate and Holmium Laser Enucleation of Prostate Using Magnetic Resonance Imaging: A Pilot Study.

The primary purpose was to compare the completeness of adenomectomy and zonal anatomy of prostate on magnetic resonance imaging prostate after transurethral resection of prostate and Holmium enucleation of prostate. The secondary purpose was to investigate the relationship between preoperative total prostate volume and postoperative transition zone and peripheral zone volume after both procedures. A retrospective review of all patients who underwent transurethral resection of pros- tate or Holmium enucleation of prostate over 3 years (2017-2020) and had at least 1 postoperative magnetic resonance imaging prostate was performed. Volume estimations of the prostate and individual zones were per- formed, and statistical comparisons were made to evaluate morphometric changes between the 2 procedures. A total of 9 patients (mean age, 71.8 years) underwent transurethral resection of prostate and 12 patients (mean age, 66.9 years) underwent Holmium enucleation of prostate. The median pre-operative prostate volume in the Holmium enucleation of prostate group was higher than the transurethral resection of prostate group (101.5 g vs. 62 g; P =.102). However, there was a significant difference in the resected tissue weight favoring Holmium enucleation of prostate over transurethral resection of prostate (P value=.004). The postoperative transition zone and peripheral zone volume as calculated by magnetic resonance imaging remained relatively constant in both procedures. The peripheral zone volume on postoperative magnetic res- onance imaging was found to be independent of transition zone volume even for very large-sized prostates. A well-performed transurethral resection of prostate or Holmium enucleation of prostate cannearly completely eliminate the transition zone volume, irrespective of the size of the prostate as confirmed by magnetic resonance imaging prostate. Additionally, the peripheral zone volume is consistent across the entire spectrum of the prostate size.

Comparison of Modified Open Prostatectomy and Classic TURP in Patients with Benign Prostatic Hyperplasia: A Clinical Trial

Introduction: The aim of this study was to compare the results of recovery of patients with benign prostatic hyperplasia through two surgical methods, including TURP (Transurethral resection of prostate) and modified open prostatectomy (OP) was performed.
 Methods: In this clinical trial study, 100 patients with benign prostatic hyperplasia who were referred to the Urology Clinic of Shahid Rahnemon Hospital from 1996 to 1997 were admitted to the study on the inclusion and exclusion criteria and were randomly assigned to one of the surgical groups using the modified OP or TURP approach. The results of the study in both groups were analyzed through SPSS 16 software. Due to the normal distribution of data, T-test and Chi-Square statistical tests were applied to analyze the data.
 Results: The mean age of the patients undergoing modified OP surgery and the TURP patients was 70.36 ± 8.35 and 69.39 ± 8.44 years, respectively. The maximum urinary flow (Qmax) was significantly higher in the modified OP group than in the TURP group (P <0.001). In addition, the mean duration of operation in the modified OP group was significantly lower than the TURP group (P = 0.001). The increase in obstructive and excitatory symptoms in the TURP group was statistically significant 6 months after surgery (P = 0.009 and P = 0.011, respectively).
 Conclusion: While TURP is the standard therapy for patients with BPH‎, the findings of this study indicate that modified OP is a safer and more reliable procedure with fewer postoperative complications. It is recommended that modified OP be considered as a treatment for the patients with BPH.

A comparative study between traditional and ejaculation preserving Transurethral resection of prostate

This is to evaluate the efficacy & safety of a modified ejaculation preservation Transurethral Resection of Prostate ( epTURP ) , in comparison with the traditional technique - Transurethral Resection of Prostate ( TURP ) . A prospective controlled clinical interventional study whereby 40 Iraqi male patients scheduled for TURP were randomly assigned into 2 groups; group 1 treated with epTURP, and group 2 treated with TURP. Pre & post-operative evaluation of the patients included history taking, filling the international prostate symptom score ( IPSS ), the international index for erectile function ( IIEF – 15); questions 9,10,13 & 14, measurement of ejaculate volume, Uroflowmetry (Q-max) & measurement of Post Voiding Residual urine (PVR). Follow up schedule was at 6 weeks & 3 months post-operatively. The Mean age of patients was 59 year, mean prostate volume was 46 ml. Post-operatively 19/22 patients in the epTURP group & 3/18 patients in the TURP group had preserved their antegrade ejaculation, which led to a significant difference between the 2 groups in mean ejaculate volume & IIEF .There was a comparable improvement in post-operative values of IPSS, Q-max & PVR in both groups. Complications were minimal & manageable in both groups. In Conclusion The epTURP was in our experience a safe & effective technique in preserving antegrade ejaculation & improving urinary outflow in patients with prostate volume approaches 50 ml . Keywords: Transurethral resection of prostate, ejaculation preservation, uroflowmetry, post voiding residue, ejaculate volume

Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study

ObjectiveTo investigate and compare the postoperative efficacy and complications of the transurethral resection of prostate (TURP) and holmium laser enucleation (HoLEP) using the nationwide insurance database of Korea. MethodsWe created a cohort of benign prostatic hyperplasia (BPH) patients treated with TURP and HoLEP between 2011 and 2017 from the nationwide database of reimbursement. We compared the postoperative effects between the two surgical groups. ResultsWe retrieved a total of 58,346 patients (TURP 38,308 and HoLEP 20,038 patients). The mean follow-up duration was 51.6 and 47.6 months, respectively. The rate of reoperation was significantly higher in the TURP group (4.50%) than in the HoLEP group (1.27%) (P < .01). The postoperative use of alpha-blockers and dutasteride/finasteride was significantly higher in the TURP group until 24 months postoperatively. The rate of the postoperative use of medications for symptoms of overactive bladder was lower in the TURP group than in the HoLEP group until 12 months postoperatively, but it did not differ after 12 months postoperatively. Overall, urethral surgeries were less frequently performed in the TURP group than in the HoLEP group (P < .05); however, more severe cases required surgeries under general anesthesia in the TURP group (P < .05). Postoperative surgery for stress incontinence was performed in 0.10% and 0.31% of patients after TURP and HoLEP, respectively (P < .01). ConclusionThis study showed the superiority of HoLEP compared to TURP in terms of postoperative efficacy and its inferiority in terms of complications of stress incontinence in real life practice.

Comparison of Hiraoka's Transurethral Detachment Prostatectomy and Transurethral Resection of the Prostate Effects on Postoperative Erectile Function in Patients With Benign Prostatic Hyperplasia: A Prospective Randomized Controlled Study

BackgroundCurrently, no study has focused on the postoperative erectile function in patients with benign prostatic hyperplasia (BPH) by comparing Hiraoka's transurethral detachment of prostate (TUDP) and transurethral resection of prostate (TURP). AimTo compare the effects of Hiraoka's TUDP and TURP on postoperative erectile function in patients with BPH after long-term follow-up. MethodsA total of 104 consecutive patients with BPH treated in our hospital between September 2018 and February 2019 were included in the study. All patients who met the inclusion criteria were randomly divided into the Hiraoka's TUDP (n = 52) and TURP (n = 52) groups. Patient baseline data were collected. The international index of erectile function (IIEF-5), minimal clinically important difference (MCID), and quality of life scale (QOLS) were used to evaluate erectile function and quality of life 3, 6, and 12 months after surgery. Primary study endpoints were IIEF-5 and MCID. Secondary study endpoints were QOLS and independent prognostic factors for MCID. OutcomesHiraoka's TUDP experienced greater improvement in postoperative IIEF5 scores than patients who underwent TURP. ResultsPatients in the Hiraoka's TUDP group had significantly higher mean IIEF-5 scores than those in the TURP group 6 and 12 months after surgery (6 months: 18.9 vs 14.8, P < .001; 12 months: 18.1 vs 15.7, P < .001). The percentages of patients in the TUDP group who achieved an MCID were 88.5% and 80.8%, compared to 30.8% and 46.2% in the TURP group (P < .001 for both), 6 and 12 months after the operation, respectively. Patients in the TUDP group had lower QOLS scores than those in the TURP group after the surgery. The surgical method was an independent prognostic factor for MCID (odds ratio = 0.218). Clinical ImplicationsUntil now, no study has focused on the postoperative erectile function in patients with BPH by comparing Hiraoka's TUDP and TURP. Our study addressed this issue, which can add a new paradigm in the management to BPH. Strength & LimitationsThe comparison between Hiraoka's TUDP and TURP using a statistically appropriate, adequately powered methodology is the strength of the study. The single center and less participants are the limitations of the study. We believe that multicenter and large-sample studies are needed to further verify these study conclusions. ConclusionsAmong similar cohorts of patients with BPH who underwent TUDP and TURP, patients who underwent Hiraoka's TUDP experienced greater improvement in postoperative IIEF5 scores than patients who underwent TURP, while improvement in IPSS was similar among both groups.Pan C, Zhan Y, Zhao Y, et al. Comparison of Hiraoka's Transurethral Detachment Prostatectomy and Transurethral Resection of the Prostate Effects on Postoperative Erectile Function in Patients With Benign Prostatic Hyperplasia: A Prospective Randomized Controlled Study. J Sex Med 2020;17:2181–2190.

Comparison of the efficacy and safety between 1470nm laser photoselective vaporization of prostate and transurethral resection of prostate for the treatment of benign prostatic hyperplasia

Objective To compare the clinical efficacy and safety of 1470 nm diode laser and transurethral resection of prostate(TURP) for the treatment of benign prostatic hyperplasia(BPH). Methods From January 2013 to January 2016, 186 cases of BHP were assigned to 1470 nm diode laser group (n=72)and TURP group (n=114). The preoperative clinical parameters of the two groups were comparable not statistically significant.Then operation condition, follow-up and complication rate were compared between two groups.The clinical effect of two group was analyzed. Results The operation time, estimated blood loss(EBL), postoperative catheter remove and hospital stay were significant better in 1470 nm laser group than TURP group(P 0.05). Conclusions Both surgical approaches of 1470 nm diode laser and TURP show good effect for treating BPH, but the 1470 nm diode laser demonstrates better effica-cy with less blood loss, shorter catheter remove time and hospital stay. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate; Lasers

Efficacy of Bladder Neck Incision (BNI) Versus Transurethral Resection of Prostate (TURP) in Management of Benign Prostatic Hyperplasia (BPH) Causing Obstruction: A Randomised Controlled Study

Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.

Evaluation of the super-selective prostate artery embolization combined with TURP for patients with large volume (>80 ml) benign prostatic hyperplasia

Objective To explore the safety and efficacy of super-selective prostate artery embolization (PAE) combined with TURP (transurethral resection of prostate) as an alternative method for patients with severe large BPH (>80 ml). Methods From March 2015 to June 2017, a total of 40 patients with large benign prostatic hyperplasia who failed in medical treatment were selected for PAE combined with TURP (18 cases)and TURP (22 cases). In the PAE combined with TURP group, the mean age was (75.0±8.7) years (ranging 60-88 years) and the mean prostatic volume was (111.0±23.3) ml, ranged from 83 to 145 ml). The international prostate symptom score (IPSS), quality of life (QOL), maximal urine flow rate (Qmax)and postvoid residual urine(PVR) were(25.2±3.6), (5.1±1.0), (6.4±2.3)ml/s and (107.7±32.6)ml, respectively. In the TURP group, the mean age was (76.0±6.9) years (ranging 62-85 years) and the mean prostatic volume was (107.5±27.4) ml, ranged from 80 to 150 ml). The IPSS, QOL, Qmax and PVR were(24.3±4.2), (4.9±0.9), (6.7±2.2)ml/s and (106.6±32.2)ml, respectively. Clinical data of all of patients were analyzed retrospectively, including operative time, estimate blood loss, weight and efficacy of resected tissue, time of continuous bladder irrigation and catheterization, IPSS, QOL, PVR, Qmax and postoperative complications. Results There were significant differences in the operative time [(75.8±25.1)min vs.(103.2±27.7) min], estimate blood loss [(122.8±33.9)ml vs.(447.6±36.0)ml], weight of resected tissue [(99.9±24.2)g vs.(82.9±15.5)g], efficacy of resected tissue [(76.9±20.7)g/h vs.(41.7±14.2)g/h], continuous bladder irrigation time [(1.4±0.5) d vs.(2.4±0.8) d] and catheterization time [(2.2±0.4)d vs.(3.4±0.6)d] between PAE combined TURP group and TURP group(P 0.05). Conclusions PAE combined TURP could be used a safe and effective therapy for treating patients with LUTS due to large volume (>80 ml) BPH. It has been a priority in less blood, more efficient of resected tissue and less postoperative complications. Key words: Benign prostatic hyperplasia; Prostatic artery embolization; Low urinary tract symptoms

Impact of transurethral plasmamakinetic enucleation surgery in treating elderly patients with benign mass hyperplasia on prostate symptom score and life quality

Objective To evaluate the impact of transurethral plasmamakinetic enucleation surgery(TUPKEP) in treating elderly patients with benign mass hyperplasia on prostate symptom score and life quality. Methods From March 2012 to September 2014, 128 elderly patients benign mass hyperplasia in our hospital were selected and 78 patients who were treated with TUPKEP was taken as TUPKEP group while the other 50 patients who underwent transurethral resection of prostate(TURP) was taken as TURP group. Operation conditions, international prostate symptom score (IPSS) and quality of life score (SF-36) and adverse reactions and complications of two groups before and after treatment were compared. Results Compared with TURP group, urinary catheter placing time and postoperative hospital stay time of TUPKEP group were shorter, the operation time of TUPKEP group was longer, intraoperative blood loss and postoperative bladder residual urine volume of TUPKEP group were reduced, and prostate tissue removal and the maximum urine flow rate of TUPKEP group were increased (P 0.05). Conclusions TUPKEP in the treatment of elderly patients with benign mass hyperplasia has some advantages of less surgery trauma, low complications and recurrence rate for improving the recovery and life quality, therefore, TUPKEP in the treatment of elderly patients with benign mass hyperplasia has good feasibility and safety, and is worthy of clinical use. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate; Quality of Life

Outcomes of transurethral resection and holmium laser enucleation in more than 60 g of prostate: A prospective randomized study.

Aim:Transurethral resection of prostate (TURP) is considered a gold standard surgical procedure. The management of benign prostatic hyperplasia (BPH) has undergone tremendous change in recent years and shifted from open to minimal invasive procedure. With the advancement in technology and skills of surgeons, lasers have been used more liberally, particularly holmium laser. Holmium laser enucleation of prostate (HoLEP) is seen as close rival of TURP. The objective if this study is to observe long- and short-term outcomes of transurethral resection and holmium laser enucleation in the prostate of more than 60 g.Materials and Methods:This prospective randomized study includes 164 patients. Inclusion criteria were age <75 years after failed or poor response to medical therapy, prostatic size >60 g, gross hematuria secondary to BPH, recurrent urinary tract infection, acute urinary retention, postvoid residual >150 ml, and Schafer Grade II or more. BPH associated with neurogenic bladder, stricture urethra, and carcinoma prostate were excluded from the study. Group 1 comprises patients who underwent TURP and Group 2 comprises who underwent HoLEP. Follow-up was done at 1, 3, 6, 12, and 24 months after the surgery.Results:Data of 144 patients were analyzed. The mean age of patients in TURP and HoLEP group was 66.78 ± 7.81 and 67.70 ± 7.44 years, respectively (P = 0.47), mean prostatic volume was 74.5 ± 12.56 and 75.6 ± 12.84 g, respectively (P = 0.60), operative time was 73.10 ± 10.49 and 89.56 ± 13.81 min, respectively (P = 0.0001). Mean resected tissue was 44.80 ± 9.87 and 48.49 ± 10.87, respectively (P = 0.03). The sexual function did not changed significantly in postoperative follow-up.Conclusion:HoLEP is associated with less blood loss, lower transfusion rates, and a shorter hospital stay. The disadvantage of HoLEP is longer operative time and postoperative dysuria.

Comparative evaluation of different modalities of treatment in benign prostatic hyperplasia at tertiary care teaching institute

Background:Benign prostatic hyperplasia (BPH) is the most common disease occurring in men as the age advances. There are various treatment modalities available, amongst which trans-urethral resection of prostate (TURP) is widely used but role of open Freyer's prostatectomy and medical management can't be ignored at the same time. This study was done to compare different modalities of treatment, to evaluate the individual modality in view of its efficacy, complications and patient satisfaction, to compare the different modalities in their efficacy for management of BPH and their complication profile, to suggest the best form of therapy that can be offered to patients.Methods: A retrospective comparative study was conducted including 90 patients having benign prostatic hyperplasia (BPH) were enrolled for the study and randomly divided into three groups of 30 patients each. Group I consists of patients undergoing for Freyer's prostatectomy, Group II consists of patients undergoing TURP and in Group III patients were managed conservatively with medical management. Results:Temporary Incontinence of urine was the most common complication occurred found in 6 cases (20%) in Freyer’s prostatectomy group I and in 3 cases (10%) in TURP group II; per-urethral catheter was removed between 2-5 days in all 30 cases (100%) of TURP, but in Freyer’s prostatectomy it was kept up to average 10 days (8-18); All 30 cases (100%) of in Group II where TURP done were discharged within 6 days of surgery whereas in Group I where Freyer's prostatectomy done, most of the cases 21 (70%) were discharged between 11-15 days post-operatively. In Group III, patients were managed by medical management patients, 11 cases (36.67%) presented with acute urinary retention (AUR) and 19 (63.33%) patients presented with lower urinary tract symptoms (LUTS) without retention.Conclusions:TURP is having definite advantage over Freyer's prostatectomy, because Length of hospitalization, postoperative complications are less frequent. Transurethral resection is the method of choice in the treatment of benign prostatic hyperplasia especially in patients with mild to moderate prostatic enlargement and in the elderly patients with co-existing medical disease. Endoscopic instruments, training and more experience is required for TURP. Medical management can delay immediate surgery but later on surgical management is usually required.

The comparative study of TURP and SPPC in the treatment of elderly patients with benign prostatic hyperplasia

Objectives To compare the clinical effect of transurethral resection of prostate (TURP) and suprapublic transvesical prostatectomy (SPPC) clinical in the treatment of elderly patients with hyperplasia of prostate. Methods 70 cases of senile patients with benign prostatic hyperplasia(BPH) were divided into TURP group(n=35) and SPPC group(n=35). Results There was not statistical significance in excision prostate weight of perioperative indicators between the two groups(P>0.05), and the operation time, intraoperative blood loss, bladder douche time, catheter indwelling time and hospital stay in TURP group were significantly less than the SPPC group(P<0.01). Two groups of patients with Compared with preoperative values, postoperative IPSS, QOL and PVR significantly reduced (P<0.05), the MFR was significantly higher than before operation (P<0.05). IPSS, QOL and PVR in TURP group were significantly lower than SPPC group after 3 months and 12 monthsP<0.01). Blood transfusion in the SPPC group was not performed, 2 cases of blood transfusion in the TURP group were performed. Bladder spasm in SPPC group happened and 3 cases of incision infection and bladder spasm occured in SPPC group, only 2 cases of bladder spasm happened in TURP group and without incision infection, a few patients with cutting syndrome, postoperative urethral stricture, postoperative complications such as temporary incontinence and urinary extravasation occured in TURP group. Conclusions When medical environment is perfect, TURP and SPPC in the treatment of elderly patients with BPH is safety, efficacy and security, and worth clinical promotion. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate; Urinary Bladder; Electrosurgery

Economic Evaluation Study (Cheer Compliant) Laser Prostatectomy for Benign Prostatic Hyperplasia

To determine which surgical treatment for lower urinary tract symptoms, which is suggestive of benign prostatic hyperplasia (BPH), is more cost-effective and yields a better patient's preference. Treatment outcome, cost, and perioperative complications to assess the treatment effectiveness of using laser prostatectomy as a treatment for BPH were investigated in this study.This retrospective study included 100 patients who underwent transurethral resection of prostate (TUR-P) and another 100 patients who received high-powered 120 W (GreenLight HPS) laser prostatectomy between 2005 and 2011.International Prostate Symptom Score and uroflow parameters were collected before the surgery and the uroflow and postvoiding residual volumes were evaluated before treatment and at 3, 6, 12, and 24 months after treatment. The results of 100 treatments after HPS laser prostatectomy were compared with the results of 100 patients who received TUR-P from the same surgeon. Complication rates and admission costs were analyzed.From 2005 to 2011, 200 consecutive patients underwent endoscopic surgery. Study participants were men with BPH with mean age of 71.3 years old. The peak flow rate went from 8.47 to 15.83 mL/s for 3 months after laser prostatectomy. Laser therapy groups showed better improvement in symptom score, shortened length of stay, and quality of life score when compared with those of TUR-P procedures. The estimated cost for laser prostatectomy was high when compared with cost of any other TUR-P procedural option at Chang Gung Hospital (P = 0.001). All admission charges were similar except for the cost of the laser equipment and accessories (mainly the laser fiber) (P = 0.001). Due to this cost of equipment, it increased the total admission charges for the laser group and therefore made the cost for the laser group higher than that of the TUR-P group.Perioperative complications, such as the need for checking for bleeding, urinary retention rate or urosepsis rate within 30 days after the surgery, held no significant differences between both groups.Compared with alternative treatment options, laser prostatectomy of the prostate is clinically effective but yields a high cost of treatment for symptomatic BPH.

MP3-10 REDUCTION OF ENLARGED PROSTATE DECREASES THE INCIDENCE OF INGUINAL HERNIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2015MP3-10 REDUCTION OF ENLARGED PROSTATE DECREASES THE INCIDENCE OF INGUINAL HERNIA Yu-Hua Fan, Hsiao-Jen Chung, Eric Huang, Alex Lin, and Kuang-Kuo Chen Yu-Hua FanYu-Hua Fan More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , Eric HuangEric Huang More articles by this author , Alex LinAlex Lin More articles by this author , and Kuang-Kuo ChenKuang-Kuo Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.113AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with benign prostatic obstruction may need to strain to void and this effort over time may have a direct impact on the abdominal wall contributing to the development of inguinal hernia (IH). Furthermore, the published data showed that patients with IH present higher intensity of lower urinary tract symptoms. It is interesting to know whether transurethral prostatectomy for benign prostatic hyperplasia (BPH) could reduce the incidence of IH. METHODS We recruited male patients who were newly diagnosed with BPH and aged 50 years or older from a urology dataset including 3,431,366 individuals selected from the National Health Insurance Research Database for the year 2006 to 2010. According to treatment strategies, patients were assigned to one of the following categories: transurethral resection of prostate (TURP), alpha-1 blockers only, 5alpha-reductase inhibitors ± alpha-1 blockers. All subjects were followed up to the end of 2010 or the development of IH. Patients were excluded if they had prostatic cancer, constipation, chronic obstructive pulmonary disease, or IH developed within 6 months of diagnosis of BPH. The age-adjusted cox time-dependent model was used to calculate the risk of IH between different treatment groups. RESULTS We identified 171965 incident male patients with newly diagnosed BPH. Of the BPH patients, 8294 (4.82 %) underwent TURP (TURP group), 151753 (88.25%) received alpha-1 blockers only (AB group), 11918 (6.93%) received 5alpha-reductase inhibitors plus alpha-1 blockers or not (5ARI group). The incidences of IH in different treatment group were as follows: 93 (1.12%) in TURP group, 2334 (1.54%) in AB group, 147 (1.23%) in 5ARI group. Both the incidences of IH in TURP and 5ARI group were significantly lower than that in AB group (both P < 0.001). There was no difference in incidence rates of IH between TURP and 5ARI group. We further subdivided the TURP group into two subgroups according the weight of resected specimens and these were < 15 gm and >=15 gm. There was no difference in incidence rates of IH between the two subgroups of TURP. No matter what the weight of the resected specimens, no significant differences in incidence rates of IH were noted between TURP and 5ARI group. However, both subgroups of TURP group have significantly lower incidence rates of IH than AB group (both P < 0.001). CONCLUSIONS Prostate size-reducing treatments, including TURP and 5ARI, could significantly reduce the incidence of inguinal hernia in BPH patients compared with alpha-1 blockers. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e22 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yu-Hua Fan More articles by this author Hsiao-Jen Chung More articles by this author Eric Huang More articles by this author Alex Lin More articles by this author Kuang-Kuo Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Choosing the surgical treatment method for benign prostatic hyperplasia

Aim. To assess the surgical treatment outcomes for benign prostatic hyperplasia. Methods. The surgical treatment outcomes for benign prostatic hyperplasia were analyzed in 72 patients. 44 patients underwent transvesical prostatectomy ended with blind urinary bladder stitch, 28 patients with a prostate volume of less than 60 ml were offered transurethral resection of prostate. The patients’ mean age was 73.6 years. Inclusion criteria were: average urination flow rate (Qav) 10 ml/sec, total international prostate symptom score (I-PSS) 19, residual urine volume 50 ml. Prostate volume ranged from 29 to 150 ml. All interventions were performed using regional anesthesia. The effect of surgical treatment was assessed 3 months after the surgery was performed. Results. Self urination was restored at 2-3rd day. All patients had no residual urine. Urine flow parameters in patients after transvesical prostatectomy were: maximum urination flow rate (Qmax) - 24±1.3 ml/sec, Qav - 11.6±1.1 ml/sec; in patients after transurethral resection of prostate: Qmax - 17.2±0.8 ml/sec, Qav - 11.4±1.2 ml/sec. I-PSS index in the transvesical prostatectomy group was 2.3±0.3 compared to 9.7±1.1 points in transurethral resection of prostate group. Irritative symptoms prevailed in patients from transurethral resection of prostate group, 23 (82%) of them have improved after 1 month treatment with α1-adrenoblockers. Conclusion. Transvesical prostatectomy ended with blind urinary bladder stitch is still a radical and effective option for benign prostatic hyperplasia surgical treatment. Transurethral resection of prostate is effective in patients with prostate volume less than 60 ml and requires additional medical correction of irritative symptoms during the postoperative period.

Effects of bipolar and monopolar transurethral resection of the prostate on urinary and erectile function: a prospective randomized comparative study

To evaluate the outcomes of bipolar vs conventional monopolar transurethral resection of the prostate (TURP) on urinary and erectile function. A total of 286 patients with benign prostatic hyperplasia (BPH) were randomized to bipolar or monopolar conventional TURP treatment groups. Operative and early postoperative variables and complications were recorded and all patients were re-evaluated at 1, 3, 6 and 12 months after surgery using the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume (PVR) and the erectile function domain of the International Index of Erectile Function (IIEF-ED). A comparative evaluation of erectile function was performed on 188 preoperatively non-catheterized patients with regular sexual partners. The operating time was shorter in the bipolar TURP group. Postoperative bleeding and blood transfusion requirements did not significantly differ between the two groups. Sodium levels were significantly lower in the monopolar group than in the bipolar group. Transuretheral resection syndrome developed in two (1.4%) patients in the monopolar group. Both groups had similar and significantly improved IPSS values, maximum urinary flow rate values and PVR measurement. ED worsened in 32 (17.0%) patients, improved in 53 (28.2%) patients, and was unchanged in 103 (54.8%) patients. Changes in the IIEF scores during the follow-up period were similar between the bipolar and monopolar groups. Bipolar TURP is a safe and effective procedure that is associated with a significantly shorter operating time, a smaller reduction in serum sodium levels and a similar efficacy compared with conventional monopolar TURP.

Transurethral resection of prostate with plasmakinetic energy: 100 months results of a prospective randomized trial

Study Type - Therapy (RCT). Level of Evidence 1b. What's known on the subject? and What does the study add? Standard monopolar transurethral resection of prostate (TURP) remains the gold standard surgical treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. Plasmakinetic offers rapid tissue removal and haemostasis during resection with better vision under saline irrigation while eliminating risk of TUR syndrome. Our results show that Plasmakinetic has similar long-term results to standard TURP. • To compare long-term results of transurethral resection of prostate with PlasmaKinetic(®) energy (Plasmakinetic) and standard transurethral resection of prostate (TURP). • During the 2-year period between 2001 and 2002, 101 patients with lower urinary tract symptoms related to benign prostatic hyperplasia were enrolled into the study. • Patients were randomly assigned to either Plasmakinetic or standard TURP groups using computer-generated simple random tables in a 1:1 ratio. • After the publication of initial results, follow-up continued until December 2010. Patients were called by phone and invited for control at 60th and 100th months. • An International Prostate Symptom Score (IPSS) form was completed and uroflowmetry was performed to show the final status of the operation. • Overall, 67 of 101 patients (34 patients in Plasmakinetic group and 33 patients in TURP group) completed the 100th month control. • IPSS increased to 8.5 ± 1.6 and 9.4 ± 0.9 in the Plasmakinetic group and 7.9 ± 1.3 and 8.7 ± 1.2 in the TURP group at 60 and 100 months, respectively. • Mean maximal flow rate increased to 17.2 ± 3.9 mL/s in the Plasmakinetic group and to 16.9 ± 4.1 mL/s at 12 months in the TURP group but decreased to 15.9 ± 2.5 and 15.8 ± 3.0, respectively (P= 0.34) at 100 months. • Reoperation was performed in six patients in the Plasmakinetic group and four patients in the TURP group at the end of 100th month. • Our 100 months results suggest that Plasmakinetic technology can be used as a first-line treatment instead of monopolar TURP.