Transurethral Resection Of Prostate Patients Research Articles

Comparison of perioperative bleeding risk between direct oral anticoagulants in transurethral resection of prostate.

To evaluate the perioperative morbidity and mortality associated with direct oral anticoagulants (DOACs) and warfarin for patients receiving transurethral resection of prostate (TURP). This was a single-centre, retrospective cohort analysis of patients who underwent TURP for benign prostate hyperplasia from April 2019 to December 2023. The primary objective was to evaluate the perioperative bleeding and thromboembolic risk between anticoagulated (AC) vs no-AC patients. The secondary objective was to evaluate perioperative bleeding and thromboembolic risk between different formulations of DOACs. Patient demographics, prior treatment, prostate size, baseline bleeding risk, and operative details were collected. Bleeding and thromboembolic-related morbidity were captured within a 3-month postoperative period. Perioperative management of AC therapy was recorded, and all patients had their AC therapy withheld. Cohort characteristic between the AC vs no-AC, and DOAC groups were analysed with two-sided t-test, and chi-square test. Further logistic regression analyses were carried out to identified significant variables between the groups. These significant variables were used for adjustment in inverse probability-weighted treatment effect analysis to evaluate bleeding risk. There were 629 patients in the cohort, and 113 (18%) patients were receiving AC therapy. The AC patients were at 1.6 times statistically significant increased risk of acute bleeding, and 11 times increased risk of prolonged haematuria for >14 days. When compared to apixaban, patients on rivaroxaban conferred a statistically significant increased risk of acute bleeding by 2.21 times. Patients receiving AC therapy had a statistically significant increased risk of stroke in the perioperative setting (no-AC vs AC: 0.4% vs 2.7%, P = 0.01). This is the first study to evaluate risk of bleeding for TURP patients receiving DOACs. The AC patients are more likely to experience haematuria and stroke in the perioperative period despite withholding therapy. Apixaban appears to cause less bleeding-related complications than rivaroxaban.

Assessment of prevalence of sexual dysfunction in patients having lower urinary tract symptoms with benign prostatic hyperplasia and effect of various treatment modalities on sexual function.

Sexual dysfunction affects a couple's relationship and quality of life of the patient and the partner irrespective of age. In Lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH), sexual dysfunction is highly prevalent. This study aims to evaluate prevalence of sexual dysfunction in patients having LUTS with BPH and effect of various treatment on it. The study is hospital based prospective cross-sectional study. Total 106 patients were included in this study. Fifty-six patients underwent medical treatment and 50 patients underwent transurethral resection of prostate (TURP) according to lower urinary tract symptom score along with grades of prostate. We measured prevalence of lower urinary tract symptoms, erectile dysfunction (ED), ejaculatory dysfunction (EJD).We compared the pre and post treatment ED, EJD scores in both medical and TURP group. In our study, 11 (10.4%) patients had very mild ED, 12 (11.3%) had mild ED, 54 (50.9%) had moderate ED and 23 (21.7%) had severe ED. In our study, 11 (10.4%) patients had very mild EJD, 7 (6.6%) had mild EJD, 28 (26.4%) had moderate EJD and 2 (1.9%) had severe EJD. In medical group, ED pre-treatment versus ED post treatment was statistically significant (p = 0.0046), treatment of LUTS improves ED. EJD pre-treatment versus EJD post treatment was not statistically significant (p = 0.8368), treatment of LUTS associated with deterioration of EJD. In TURP group association of ED pre-treatment versus ED post treatment was statistically significant (p = 0.0319). Post TURP patients shows improvement in ED Association of EJD pre-treatment versus EJD post-treatment was statistically significant (p = 0.03000). Post TURP EJD deteriorate. We concluded that the severity of sexual dysfunction correlates with severity of LUTS. Ejaculatory function deteriorates after treatment of TURP compared to medical.

Robot-Assisted Radical Prostatectomy After Prior Transurethral Resection of Prostate: An Analysis of Perioperative, Functional, Pathologic, and Oncologic Outcomes.

Background: We performed a retrospective comparison of surgical, oncologic, and functional outcomes after robot-assisted radical prostatectomy between patients who have undergone prior transurethral resection of prostate (TURP) to TURP-naive patients. Methods: Past robotic prostatectomy hospital data were scrutinized to form two matched groups of patients: those who have undergone prior TURP and TURP-naive patients. The perioperative and pathologic data along with functional and oncologic outcomes for a period of 3 years were compared between groups. Results: Compared with TURP-naive patients, prior TURP patients experienced longer robot-assisted laparoscopic prostatectomy times (p < 0.001), increased incidence of bladder neck reconstruction (p = 0.03), greater blood loss (p = 0.0001), and lesser nerve sparing (p < 0.01). Complication rates (p = 0.3), positive surgical margin (p = 0.4), extracapsular disease (p = 0.3), or seminal vesicle invasion (p = 0.1) were comparable between groups. Continence (p = 0.5) and potency (p = 0.1) at 1 year were not different between groups. Biochemical recurrence rates were not different at 3 years (p = 0.9). Diabetes slowed recovery of continence in patients with prior TURP compared with TURP-naive patients until 6 months after surgery. Conclusion: Although prior TURP makes subsequent robotic prostatectomy more technically demanding, it can be safely performed by experienced surgeons without compromising long-term functional or oncologic outcomes.

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.&#x0D; 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.&#x0D; 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 &lt;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).&#x0D; 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.

Post-operative day 2 versus post-operative day 4 foley catheter removal after trans urethral resection of prostate

Background: Usually after TURP surgery for BPH, a three-way foleys catheter is placed transurethrally and removed post-operative day 4. This study done at our institute is to help decide the interval for removal of foley catheter following TURP, which is most beneficial to the patients. The objective is to know whether the POD-2 removal of the catheter in post TURP patients will be beneficial compared to the traditional POD-4 removal.Methods: This is a prospective study on 100 patients with BPH who underwent TURP. Patients were assigned to POD-2 and POD-4 groups. A standard TURP was performed on all the patients. After removing the catheter on POD-2 and POD-4, the patients were observed, and outcomes were carefully recorded in the two groups.Results: The highest incidence of the disease was in the age group of 60 - 75 years (70%). The majority of patients had nocturia present in 80 out of 100 patients (80%).55% of patients had grade III prostatomegaly. Most of the patients, 55 (55%), had prostate volume between 30 and 50 grams. No statistical significance noted in terms of retention of urine, post-void residual urine. The average duration of hospital stay post-surgery for group I was 3.7 days, and in group II was 5.1 days which is statistically significant.Conclusions: Our study shows that early catheter removal after two days following Transurethral Resection of Prostate (TURP) is safe, cost-effective to the patient, reduces the post-operative hospital stay.

Functional capacity as a predictor of postoperative delirium in transurethral resection of prostate patients in Northeast Brazil.

IntroductionPostoperative delirium (POD) is a common disorder and its frequency varies from 15% to 25% after major elective surgery. There are few data on the incidence of POD in Brazil. Here, we sought to assess the incidence of POD following transurethral resection of the prostate (TURP) and to examine precipitating and predisposing factors associated.MethodWe performed a prospective observational study of elderly male patients undergoing TURP (N=55) in Northeast Brazil. Information on demographic, medical, cognitive and functional characteristics were collected. The participants were followed until hospital discharge. POD was diagnosed by the Confusion Assessment Method.ResultsA total of three participants (5.45%) were identified with POD. Episodes of delirium lasted 3±1 days. The study sample consisted of a healthy population. Patients with POD had longer hospital stay and more precipitating factors. The POD group showed statistically significant lower Barthel index score (p<0.001) and higher Pfeffer’s Functional Activities Questionnaire scores (p<0.01).ConclusionLoss of functional capacity was associated with POD in a healthy population of elderly patients undergoing TURP.

Review of IPSS Questionnaire in Postoperative Transurethral Resection of Prostate (TURP) for Streamlining Follow-up Protocols

Objective Clarify the role of IPSS questionnaire for post TURP operation patients, to assess and streamline best follow-up protocols Materials and Methods We identified 87 consecutive patients over 6 months undergoing standardized bipolar TURP. We retro-spectively reviewed patients at 3 months in follow-up clinic, where we performed tests including Qmax, Post-void residual (PVR) and IPSS (International Prostate Symptom Score). We identified patients who were discharged or underwent a change in standard management at this point, and used ROC (Receiver Operating Curve) curve analysis to identify the tools which showed the best ability to predict this decision. Results ROC curve analysis suggested Qmax (AUC: 0.7751) and IPSS (AUC 0.8571) were the best tools to predict a change in management. Given the IPSS tool is a questionnaire, thus holding most promise to streamline protocols, we applied Youden-J test to show IPSS=8 cut-off was best to identify management changes. Conclusion The IPSS tool is able to predict a need for change in management in post TURP patients at 3 months. This will allow a simple triage system to provide an efficient and effective decision-making process for discharge without the need for clinic attendance.

Effects of bupivacaine combined with sufentanil citrate or dexmedetomidine on spinal anesthesia in transurethral resection of the prostate

Objective To evaluate the effects of bupivacaine combined with sufentanil citrate or dexmedetomidine on spinal anesthesia in transurethral resection of the prostate. Methods A total of ninety American Society of Anesthesiologists(ASA) Ⅰ or Ⅱ patients aging 65-75 y and body mass index(BMI) 20-30 kg/m2 who were scheduled for transurethral resection of prostate (TURP) were randomly divided into three groups (n=30): a dexmedetomidine group (group D), a sufentanil group (group S), and a normal saline group (group N). After spinal anesthesia with bupivacaine, dexmedetomidine (5 μg) was intrathecally injected in group D, sufentanil (5 μg) was intrathecally injected in group S, and group N received the same volume of normal saline. The blockage onset time and duration were recorded. The Richmond Agitation Sedation Scale (RASS) scores, shivering, nausea, vomiting and other adverse effects during and after operation were also recorded. Results There were no significant differences in age, BMI, operation time, transfusion volume, blood loss, and RASS scores among the three groups (P>0.05). Group S demonstrated remarkably high incidences of nausea and vomiting, compared with group N and D (P<0.05). Compared with group N, groups S and D presented remarkably decreases in the sensory blockage onset time, and increases in the blockage duration (P<0.05), and markedly reduced motion blockage onset time and extended duration(P<0.05). Conclusions Spinal anesthesia of bupivacaine combined with sufentanil or dexmedetomidine can produce good effects on TURP patients. However, patients compound dexmedetomidine got less side effects like shivering, nausea and vomiting. Key words: Dexmedetomidine; Transurethral resection of prostate; Sufentanil citrate; Bupivacaine; Subarachnoid blockage

Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia

Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia

Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia

Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia

The effect of continuous nursing service on the quality of life of patients with transurethral prostatectomy

Objective To explore the effect of continuous nursing care on the quality of life in patients with transurethral resection of prostate(TURP). Methods A total of 300 patients with TURP in this hospital from June 2012 to June 2015 were selected and were randomly divided into the control group and the study group, 150 cases of each group.The control group carried out routine discharge guidance and healthy education, and the study group carried out continuous nursing service on the basis of control group.The prostate symptom score, quality of life and self-care ability of the two groups were observed. Results 6 months after discharge, the score of prostate symptom in the study group was lower than that in the control group, the self-care ability was better than the control group, and the degree of rehabilitation knowledge was higher than that of the control group, and the quality of life was higher than that of the control group, and the differences were statistically significant(P<0.05). Conclusions The use of extended nursing service for TURP patients can obviously improve patients' self-care ability, improve the clinical symptoms of patients and improve the quality of life of patients.It is worth clinical application. Key words: Continuing care services; Transurethral resection of prostate; Quality of life; Self nursing ability

Young Academic Urologists' benign prostatic obstruction nomogram predicts clinical outcome in patients treated with transurethral resection of prostate: an Italian cohort study.

The aim of this study was to test the Young Academic Urologist nomogram for the prediction of transurethral resection of prostate outcome in patients with lower urinary tract symptoms and benign prostatic enlargement. Between April 2014 and March 2016, a consecutive series of patients with lower urinary tract symptoms undergoing trans-urethral resection of prostate in one center were enrolled. At baseline patients were assessed with international prostate symptom score, prostate specific antigen, prostate volume, transitional zone volume, maximal urinary flow rate and post void residual urine. At 3 months after trans-urethral resection of prostate patients were evaluated with uroflowmetry and international prostate symptom score questionnaire. Maximum urinary flow and transitional zone volume were plotted on the Young Academic Urologist nomogram to predict trans-urethral resection of prostate outcome. Receiver-operator characteristics curve analysis was used to evaluate predictive properties of the nomogram for the outcome of transurethral resection of the prostate. A total of 232 patients were consecutively enrolled. Out of them, 149 patients (65%) presented a positive outcome. The novel Young Academic Urologist nomogram presented an area under the curve of 0.77 (95% CI: 0.70-0.83) for trans-urethral resection of prostate outcome prediction. At the best cut-off value of 75% (nomogram probability) the sensitivity was 62% and specificity was 73%, the positive predictive value was 81% and the negative predictive value was 52%. The Young Academic Urologist nomogram was, in our experience, an excellent tool to predict a positive outcome after transurethral resection of prostate, although further studies are needed to confirm our results.

Conivaptan prophylactically in transurethral resection of prostate surgeries

Background Transurethral resection of prostate (TURP) requires the use of irrigating fluids. The absorption of large volumes of these fluids may lead to hyponatremia and consequently TURP syndrome. If not treated promptly, the patient becomes cyanotic, hypotensive, and ultimately sustains cardiac arrest. Conivaptan is one of vaptans, a new group of vasopressin receptor antagonists that are increasingly being used for the treatment of euvolemic, hypervolemic forms of hyponatremia especially in the ICU. This study evaluates the efficacy of a single dose of conivaptan to prevent hyponatremia in TURP patients. Patients and methods In a prospective, randomized, double-blinded study, 50 male patients scheduled for elective TURP under central neuraxial block were included in this study. Patients were divided into two groups (A and B) (n=25 for each group). Group A patients received intravenous conivaptan 20 mg over 30 min, whereas group B was the control group who received the usual maintenance fluid. Preoperative serum sodium and potassium levels in patients were measured, followed by intraoperative levels, and these levels were recorded after 60 min by blood gas analyzer using venous blood samples. All patients were carefully observed for the early symptoms of TURP syndrome perioperatively. The serum levels of sodium and potassium of all patients were measured 1 h after surgery. Results The mean level of serum sodium showed statistically significant reduction (hyponatremia) intraoperatively and postoperatively in group B. There was a statistically insignificant increase in the mean level of serum potassium (hyperkalemia) intraoperatively and postoperatively in both groups. Electrolyte changes were asymptomatic clinically. Conclusion A single dose of conivaptan was found to be effective in preventing a marked decrease in the serum sodium levels in patients undergoing TURP with no effect on the serum potassium level.

A randomized trial comparing thulium laser resection to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: four-year follow-up results

To report the results of a randomized prospective trial with a 4-year follow-up, comparing the thulium laser resection of the prostate-tangerine technique (TmLRP-TT) with transurethral resection of prostate (TURP) for treatment of symptomatic benign prostatic hyperplasia (BPH). BPH patients (96) were randomized for surgical treatment with TmLRP-TT (47) or TURP (49). All patients were assessed pre-operatively and followed at 12, 24, 36, and 48 months post-operatively. Several parameters related to BPH were collected at each follow-up, including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rates (Qmax), and post-void residual volume (PVR). All late complications were also recorded. Dramatic improvement in micturition parameters was observed after TmLRP-TT compared with pre-operative values. Median IPSS decreased 75.6 % in the subsequent 12 months and 61.2 % in 48 months, while median QoL decreased by 80.4 and 59.1 %, respectively. Compared with baseline, numerical values of Qmax increased 1.07-fold and those of PVR decreased 73.1 % in the fourth year. Moreover, all micturition parameters in the TmLRP-TT group were similar to those of TURP patients at every annual assessment. Some late complications after the operations were also observed: one patient suffered from urethral strictures and one from bladder-neck contractures after TmLRP-TT. Re-operation rates were equal in the two groups. Micturition remained stable after TmLRP-TT during the 4-year follow-up. Outcomes compared favourably with TURP, with lower peri-operative morbidity and equally low occurrence of late adverse effects. Thus, TmLRP-TT can be an available option for BPH patients, especially older, high-risk patients.

Application of clinical nursing pathway in patients with transurethral resection of prostate

Objective To study the application effects of clinical nursing pathway in patients with transurethral resection of prostate.Methods A total of 93 patients were divided into control group of 45 cases and observation group of 48 cases,routine nursing care was taken in control group,the observation group received clinical nursing pathway to implement standardized management..The average length of stay,incidence of complications and degree of satisfaction were compared between two groups.Results The hospitalization days and incidence of complication were significantly reduced,while the satisfaction was improved in the observation group.There were statistical differences between the two groups,P ＜ 0.05.Conclusions Clinical nursing pathway can improve the clinical efficiency,promote patient's recovery,increase satisfaction,and reduce the incidence of complication in transurethral resection of prostate patients. Key words: Transurethral resection of the prostate; Clinical pathway; Nursing

Photoselective vaporization of prostate vs. transurethral resection of prostate: A prospective, randomized study with one year follow-up

Objectives:To evaluate in a prospective, randomized study, the efficacy and safety profile of photoselective vaporization of prostate (PVP) using a 80W potassium titanyl phosphate (KTP) laser when compared to standard transurethral resection of prostate (TURP) in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE).Materials and Methods:Between February 2009 and August 2009, 117 patients satisfying the eligibility criteria underwent surgery [60 PVP{Group A}; 57 TURP{Group B}]. The groups were compared for functional outcome (both subjective and objective parameters), perioperative parameters and complications, with a follow up of one year. P value<0.05 was considered statistically significant.Results:The baseline characteristics of the two groups were comparable. Mean age was 66.68 years and 65.74 years, mean IPSS score was 19.98 and 20.88, mean prostate volume was 44.77 cc and 49.02 cc in Group A and B, respectively. Improvements in IPSS, QOL, prostate volume, Q max and PVRU at 12 months were similar in both groups. PVP patients had longer operating time, lesser perioperative blood loss, shorter catheterization time and a higher dysuria rate when compared to TURP patients. The overall complication rate was similar in the two groups.Conclusions:In patients with LUTS due to BPE, KTP-PVP is an equally efficacious alternative to TURP with durable results at one year follow up with additional benefits of lesser perioperative blood loss, lesser transfusion requirements and a shorter catheterization time. Long term comparative data is awaited to clearly define the role of KTP-PVP in such patients.

Outcomes of robot‐assisted radical prostatectomy in men with previous transurethral resection of prostate

• To critically analyze and compare surgical, oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) in patients with and without previous transurethral resection of prostate (TURP). • The study comprised 158 cases of RARP for clinically localized prostate cancer, including 26 cases that had undergone previous TURP (Group A). • Surgical, oncological and functional (short- and intermediate-term) outcomes of Group A were compared with 132 cases without previous TURP (Group B). • Post TURP patients were found to have significantly greater blood loss (494 vs 324 mL) and a need for bladder neck reconstruction (26.7% vs 9.7%) compared to the non-TURP group. • Surgical time (189 vs 166 min), conversion rate, margin positivity rate and biochemical recurrence rate were also higher. • Incontinence rates were higher both at 6 (14% vs 11.8%) and 12 (25% vs 8%) months follow-up. • RARP is feasible but challenging after TURP. It entails a longer operating time, greater operative difficulty and compromised oncological or continence outcomes. • These cases should be handled by an experienced robotic surgeon with the appropriate expertise.

Comparison of hemodynamic profiles in transurethral resection of prostate vs transurethral resection of urinary bladder tumors during spinal anesthesia: a bioimpedance study

Study Objective Transurethral resection of prostate (TURP) is more frequently associated with perioperative fluid and electrolyte disturbances than transurethral resection of bladder tumors (TURT) because of irrigating fluid absorption. Because fluid overload may cause hypertension, we compared the patients' intraoperative hemodynamic profiles (including the incidence of hypertension) during TURP vs TURT, both performed during spinal anesthesia, by using the bioimpedance method. Design Prospective single-blind study. Setting University hospital. Patients 80 (40 in each group) men, ASA physical status I and II. Interventions Patients underwent TURP or TURT surgery with spinal anesthesia. Measurements Mean arterial pressure, heart rate, cardiac index, and systemic vascular resistance were compared between the 2 groups. A mean arterial pressure greater than 30% from the baseline value was considered as hypertension. Plasma sodium was measured preoperatively, intraoperatively, and postoperatively. Main Results Transurethral resection of prostate patients received more irrigating fluid (7900 ± 2310 vs 5650 ± 21 560, P < 0.05) and had a higher calculated volume of fluid absorbed: 638 ± 60 vs 303 ± 40 mL for the TURT patients ( P < 0.05). Mean arterial pressures were higher with TURP, 30 minutes after the onset of surgery and at the end of the procedure (111 ± 15 vs 100 ± 10 and 109 ± 14 vs 99 ± 14 mmHg, respectively; P < 0.05). However, there was no hypertension in either group. There were no differences in hemodynamic measurements of hyponatremic vs normonatremic patients. Plasma sodium decreased postoperatively more in the TURP group (140.4 ± 2.6 mEq/L baseline to 134.1 ± 3.5 mEq/L, P < 0.05) and was lower postoperatively in the TURP group compared with TURT (134.1 ± 3.5 vs 137.2 ± 2.9 mEq/L, P = 0.04). Conclusions Although more irrigating fluid was absorbed in the TURP group, there were no episodes of hypertension in either group.