Transurethral Resection Of Prostate Procedures Research Articles

Spinal Anestesi Pada Tindakan Transuretral Resection Of Prostat (TURP)

Spinal anesthesia is the choice for Transurethral Resection of Prostate (TURP) procedures. TURP is a surgical procedure performed for patients with prostatic hyperplasia. When a TURP procedure is performed, excessive fluid absorption will occur because during the procedure the injured area causes the vein to open and irrigation fluid will be absorbed. The position of the surgical procedure in the lithotomy position makes the situation worse. Spinal anesthesia helps peripheral blood collection and reduces circulatory overload, early detection of TURP syndrome and bladder perforation. In this case, the procedure was carried out on a 67 year old man with a diagnosis of benign prostate hyperplasia (BPH) with a TURP surgical procedure. The patient was composmentis, ASA III. The patient underwent spinal anesthesia with a sub arachnoid block using Bupivacaine. During TURP procedures, TURP syndrome can occur which is influenced by the use of fluid as irrigation to widen the operator's field of view. Saline fluid should be used, but because it is expensive, H2O is often used as irrigation fluid. A complication of the TURP procedure is TURP syndrome

A STUDY ON TRANS URETHRAL RESECTION OF PROSTATE FOR SYMPTOMATIC BPH PRESENTING IN A TERTIARY CARE HOSPITAL

Introduction: Benign prostatic hyperplasia (BPH) is a common chronic progressive disease resulting in urinary obstruction in aging men. It is a pathologic process that consists of androgen-dependent increases in the number of epithelial and stromal cells in the periurethral area of the prostate. BPH contributes to, but is not the sole cause of, lower urinary tract symptoms in aging men. Many patients require surgical treatment and presently TURP (Trans Urethral Resection of Prostate) is considered the gold standard in surgical management of BPH. Aim: To observe and assess the outcome of TURP being done in Narayan Medical College and Hospital Sasaram, Bihar. Materials and Methods: The records of patients who presented to the surgical OPD with LUTS and were assessed to undergo TURP for prostatic hyperplasia. We present our experience with series of 47 patients and can say that TURP can be used for most patients presenting with BPH in peripheral areas. Result: In the study period 47 TURP procedures were performed for BPH. The mean age of the cohort was 67.9 years;( ranging from 56 to 84 years). The mean prostatic volume was 44.06 grams (range 32 to 76 grams) and mean operating time was 48 minutes (range 29 to 85 minutes). Blood transfusion was required in 3 patients (6.3%). No patients required open intervention and there were no mortalities. The common complications were bleeding (12%), UTI and clot retention. Conclusions: TURPis not available to majority of rural population having symptomatic benign prostatic hyperplasia (BPH) due to lack of facility but remains the treatment of choice provided trained surgeons and facilities are there. The overall cost of TURP is marginally higher for an average rural patient as compared to open surgery but is worthwhile in view of its inherent minimal trauma, short hospital stays and early recovery and huge cost advantage over newer therapies like HoLEPor PVP

Xanthogranulomatous epididymo-orchitis: A single-institutional case series and systematic review.

Xanthogranulomatous inflammation is a rare nonneoplastic and chronic inflammatory process, characterized by proliferation of foamy macrophages resulting in damage and necrosis of the affected tissue. Involvement of the testis/epididymis by the disease is a rare event. A case series of four male patients diagnosed with xanthogranulomatous epididymitis/orchitis (XGEO) at our institute was reviewed. In addition, a systematic review of XGEO was carried out using PRISMA Guidelines 2020. Twenty-nine articles describing 38 patients of XGEO were included in the study. XGEO usually has a subacute or chronic presentation and affects male individuals in the 5th or 6th decades of life. The disease is also known to occur in the pediatric age group. The patients present with swelling, tenderness, or pain in the scrotal region. Bilateral involvement has also been documented. Thirty patients were known to have one or more causal risk factors including diabetes mellitus (23.7%), spinal cord injury/neuropathic bladder (7.9%), prostatectomy (7.9%), trauma (4.1%), and transurethral resection of prostate procedure (4.1%). Complications observed were scrotal fistula, adhesions, and abscess formation. Radiological features reported are nonspecific and include heterogeneous echotexture, hypoechoic areas, and/or scrotal wall collections. Bacterial microorganisms isolated from the affected tissue demonstrated the presence of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Histological subtypes of XGEO are diffuse and focal. In the diffuse subtype, which is more common, there is extensive parenchymal destruction by inflammatory process accompanied by widespread ischemic necrosis. The mainstay of treatment in XGEO cases is surgical excision preferably orchidectomy. Conservative management has been attempted in young individuals and in patients with focal XGEO, but there is limited supporting evidence. We present data of four cases along with detailed systematic review of the disease examining its clinicopathological behavior and associated risk factors followed by operative approach.

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

Development of a Hemostatic Urinary Catheter for Transurethral Prostatic Surgical Applications

To investigate a novel transurethral hemostatic catheter device with an integrated chitosan endoluminal hemostatic dressing (CEHD). Development and implementation of this technology may help address bleeding following surgery such as transurethral resection of prostate (TURP). Bleeding remains the most common complication following TURP, leading to increased morbidity and hospitalization. Investigation of hemostasis, delivery, safety and efficacy of the CEHD device is conducted using Female Yorkshire swine (N = 23). Hemostatic efficacy of the CEHD (N = 12) is investigated against a control of gauze (N = 12) in a splenic injury model (3 swine). The delivery, safety, and efficacy of the CEHD device (N = 10) are investigated against Foley-catheter control (N = 10) for 7 days using a swine bladder-neck-injury model. In the splenic injury study, 9/12 CEHD dressings successfully achieved hemostasis within 150 seconds (mean 83 seconds) vs success of 6/12 (mean 150 seconds) for gauze (P = .04). In the 7-day study, the CEHD was successfully deployed in 10/10 animals and all dressings were tolerated without histologic or clinical adverse effect. Hemostasis of the CEHD device was found to be noninferior to control catheters. Noninferiority is attributed to low bleeding rates in the swine bladder neck injury model. This investigation successfully demonstrated the feasibility of transurethral deployment of the CEHD in vivo. Routine use of safe and slowly dissolvable CEHDs could reduce the rate of complications and hospitalizations associated with bleeding and blood loss in TURP procedures. Further investigation is warranted.

ERECTILE FUNCTION OF BPH PATIENTS UNDERGOING A LASER PROCEDURE COMPARED TO A STANDARD TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): A SYSTEMATIC REVIEW AND META-ANALYSIS

Transurethral Resection of Prostate (TURP) has been the gold standard of surgical management in Benign Prostatic Hyperplasia (BPH) patients. Various techniques, including laser therapy, have been developed to provide a safe alternative to TURP. The effect of the laser on the patient's erectile function, however, is still unknown. The aim of this study is to evaluate the erectile function of individuals with BPH undergoing surgical intervention with laser procedure compared to the standard TURP procedure. A systematic search was conducted through PubMed and Science-Direct databases up to September 2021. All studies comparing laser therapy to TURP for patients with BPH and reporting the final International Index of Erectile Function (IIEF) and change of IIEF were included in this study. A total of three Randomized Controlled Trials (RCTs) and one retrospective study were included in the final analysis. According to the meta-analysis, laser therapy had a similar final IIEF score during the 12-month follow-up compared to the TURP procedure in the subgroup of IIEF-15, IIEF-5, and the combined analysis (p=0.62, p=0.72, p=0.79, respectively). The change of IIEF from baseline was similar among both modalities (p = 0.8). The effect of laser therapy on erection function was similar to the TURP procedure.

Case Report Tuberculosis of The Prostate: Findings of Post Transurethral Resection of Prostate (TURP) Procedure

Background: Prostate tuberculosis (PTB) is one of extra pulmonary tuberculosis which potentially has more frequent fatal complications and more severe quality of life deterioration. It is a very rare disease, with prevalence of 2.6% of all urogenital tuberculosis (UGTB). Prostate tuberculosis may be a sexually transmitted disease and leads to sexual dysfunction. Case: Male, 54 years old, with urinary retention, dysuria, flank pain in the last 1-month, recurrent urinary tract infection in the past 1 year and decrease body weight of 8 kg in 1 month. Physical examination demonstrates enlarged prostate. Patient was referred to Wangaya Hospital with benign prostate hyperplasia (BPH) and suspect malignancy. After underwent clinical and supporting examination, patient underwent TURP procedure. Histopathology examination revealed PTB. Patient was then treated with first line anti-tuberculosis drug (ATD). Discussion: Multiple risk factors are involved in TB disease. PTB spread occur through hematogenous, lymphatic, or direct routes. Clinical features and supporting examinations of PTB are non-specific. Diagnosis often made through incidental histology finding post TURP. Standard ATD regiment administered based on World Health Organization (WHO) guideline. Duration can be prolonged due to suboptimal concentration to prostate tissue. Conclusion: Multidisciplinary approach for extra pulmonary TB is needed. Thorough history taking, and high index of suspicion are important aspects. PTB diagnosis should be considered in patients with recurrent lower urinary tract symptoms refractory to standard therapy in TB endemic area.

Impact of COVID-19 on endourology surgical practice in Saudi Arabia: A national multicenter study

ObjectiveTo identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia. MethodsA retrospective study of seven tertiary hospitals from January 2019 to April 2019, and from January 2020 to April 2020 was performed. Records of urology outpatient department (OPD) visits and endourology procedures in the first third of 2020 were analyzed and compared with those in the first third of 2019, as well as, during the full curfew time, i.e. April 2020 versus April 2019. ResultsNumber of OPD visits in the first third of 2020 and 2019 were 19 499 and 26 594, respectively (p<0.001). Number of OPD visits in April 2020 was 1512, with a 78.6% decrease compared to that in April 2019, and among them 1373 (90.8%) were teleclinics. Number of elective procedures in the first third of 2020 has decreased by 34.3% (from 3025 to 1988) compared to that in the first third of 2019 (p<0.001). There were 120 elective procedures in April 2020, 84.1% lower than that in April 2019. Percutaneous nephrolithotomy, shockwave lithotripsy, and transurethral resection of prostate procedures declined by 94.2%, 98.5%, and 93.8%, respectively. Most procedures were performed as day surgery (85.0%). Number of emergency procedures in 2020 have fallen by 9.3% compared to 2019 (p=0.286). Urolithiasis was the commonest pathology (52.6%) presented to the emergency room (52.6%). ConclusionDuring COVID-19 pandemic, urology services slashed by >75%, including OPD visits and elective endourology procedures. Most hospitals have changed their strategic preventive measures by increasing the rate of teleclinics and day surgeries.

Outcome Comparison of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Patients in Karawang General Referral Hospital

Background: Benign Prostatic Hyperplasia (BPH) is the most common pathological condition in man that causes Lower Urinary Tract Syndrome (LUTS). The most popular therapeutic modality for BPH is Transurethral Resection of Prostate (TURP). This study describes the TURP outcome in BPH patient with prostate size &gt; 75 grams compared to &lt; 75 grams in Karawang General Referral Hospital.Methods: We performed a retrospective review of clinical outcome from BPH patient with LUTS who underwent TURP procedure between January 2017 – April 2018. Data was taken through patient medical records and processed descriptively to describe complications, quality of life, and clinical laboratory data. Qualitative data compared with Chi-Square test.Results: During this study, we evaluated 40 patients, 20 patients with prostate size &gt; 75 grams (group 1) and 20 patients with prostate size &lt; 75 grams (group 2). Mean age in group 1 was 65.6 ± 9.9 years and in group 2 was 65.3 ± 10.2 years. International Prostate Symptom Score (IPSS) after TURP between group 1 and group 2 showed a significant difference, while incomplete emptying was found mostly in group 2 (p &lt; 0.05). There was no significant difference in Quality of Life Score between group 1 and group 2 (p &gt; 0.05). From laboratory results, we found a reduction of hemoglobin in both groups with p-value &lt; 0.05 or no significant difference.Conclusions: Transurethral Resection of Prostate (TURP) procedure for patient with prostate size &gt; 75 grams is safe and effective with lower complications and there is no significant difference compared to patient with prostate size &lt; 75 grams.

Association of Irrigation Fluid Used and Serum Electrolyte Changes in Trans Ureteral Resection of Prostate (Turp) at Dr. Hedgewar Rugnalaya, Aurangabad

Introduction: Trans Urethral Resection of the Prostate as a gold standard treatment for benign prostatic hyperplasia is performed with fluid irrigation that may cause electrolyte disturbance due to excessive fluid absorption; and may lead to electrolyte imbalance crises. It can cause hemolysis and changes in hematocrit value. Here in this study we primarily focused on electrolytic disturbances only. Different types of irrigation fluid are used for Trans-Urethral Resection of Prostate (TURP) procedure worldwide. In our institute we used sterile water as an irrigation fluid. The advantage of using sterile water are-Easily available, cheap, electrically inert, nontoxic, transparent, and easy to sterile and disadvantage is it is hypotonic. Ideal irrigation fluid should be isotonic, nonhemolytic, electrically inert, nontoxic, transparent and easy to sterile and should be inexpensive. Objective: This study is to determine the incidence of changes in electrolyte level in TURP procedure. Materials and methods: A descriptive retrospective study was conducted at Dr. Hedgewar Hospital, Aurangabad between January to December 2017. The subjects were BPH patients who underwent TURP surgery at Dr. Hegdewar Rugnalaya. Data were retrieved from medical records. We used sterile water as an irrigation fluid in TURP procedures. We had performed pre and post-operative electrolyte level, weight of prostate, amount of irrigation fluid used. Results: 76 subjects, the mean age was 70.77 years and the mean weight of the prostate was 47.56 grams. No significant change in levels of Sodium, Potassium and chloride noted post operatively (mean changes in electrolytes are Na+-0.51, K+-0.05, CL--1.03 respectively). Conclusion: Serum electrolyte levels were not significantly changes after surgery.

Does length of time spent on the waiting list for TURP influence the outcome?

With an ever increasing demand for operative procedures within the NHS but little increase in capacity, waiting lists are lengthening, particularly for benign procedures. We sought to determine whether increasing time on a waiting list influences the outcome from a transurethral resection of prostate (TURP), with a primary outcome measure of success at inpatient trial without catheter (TWOC) and pre-operative, peri-operative and post-operative secondary outcome measures. Data was collected from four separate retrospective TURP audits performed between 2009-2015. A total of 379 TURP procedures were included with the time on the waiting list ranging from 8 to 384 days. In patients who were not catheterised pre-operatively success at in patient TWOC by 30 day intervals (in 30 day intervals from 1-30 days to over 151 days) was 79%, 83%, 88%, 87%, 100% and 83%; in those with a catheter, success was 46%, 71%, 75%, 100%, 50% and 86%. In conclusion waiting longer for a TURP does not adversely affect the outcome of inpatient TWOC. Level of evidence: Not applicable – this is a single centre audit over multiple time points.

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.

1975 CONTEMPORARY TRANSURETHRAL RESECTION OF PROSTATE PRACTICE PATTERNS AMONG UNITED STATES UROLOGISTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology I1 Apr 20121975 CONTEMPORARY TRANSURETHRAL RESECTION OF PROSTATE PRACTICE PATTERNS AMONG UNITED STATES UROLOGISTS William Lowrance, Andrew Southwick, A.C. Maschino, and Jaspreet Sandhu William LowranceWilliam Lowrance Salt Lake City, UT More articles by this author , Andrew SouthwickAndrew Southwick Salt Lake City, UT More articles by this author , A.C. MaschinoA.C. Maschino New York, NY More articles by this author , and Jaspreet SandhuJaspreet Sandhu New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2135AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to describe contemporary trends in transurethral resection of prostate (TURP) by examining case logs submitted for American Board of Urology (ABU) certification. We compared electrosurgical TURP versus laser vaporization TURP and examined the impact of surgeon age on those practice patterns. METHODS US urologists submit case logs for their initial board certification and recertification. We analyzed these logs from 2004-2010 for trends and used logistic regression to assess the impact of age on TURP utilization. RESULTS In total 4,709 urologists submitted case logs for certification between 2004 and 2010. Of these, 3,955 urologists included at least 1 TURP, of which 2,334 (59%) performed exclusively electrosurgical TURP and 309 (8%) performed exclusively laser vaporization TURP. We observed a large increase in the number and proportion of laser vaporization TURP procedures performed and a smaller corresponding decrease in electrosurgical TURPs. In 2004, only 11% of patients received a laser vaporization TURP by certifying urologists; in 2010 44% did (Table). Median age for urologists performing exclusively electrosurgical TURP was the same as those performing laser vaporization TURP (43 years). Those performing any laser vaporization procedures had substantially higher case volumes compared with those performing only electrosurgical procedures (median annual case volume, [IQR]: any laser vaporization: 18 cases [10, 30], electrosurgical only: 10 [4, 18]; Wilcoxon rank-sum test p<0.0005). Compared to their younger colleagues, older urologists were significantly less likely to perform ¡Ý1 laser vaporization TURP when undergoing their second recertification (odds ratio [OR] per year: 0.94; p=0.009), but not their initial certification (OR per year: 0.98; p=0.3) or first recertification (OR per year: 0.97; p=0.13). Table. Number (proportion) of TURP procedures performed by year of urologist (re)-certification. N=67,042 Number of Urologists Electrosurgical TURP (a) Laser Vaporization (b) Total 2004 493 7,116(89%) 906(11%) 8,022 2005 494 6,612(85%) 1,152(15%) 7,764 2006 588 6,816(72%) 2,660(28%) 9,476 2007 574 5,810(60%) 3,836(40%) 9,646 2008 565 5,296(56%) 4,114(44%) 9,410 2009 595 5,716(54%) 4,812(46%) 10,528 2010 646 6,858(56%) 5,338(44%) 12,196 Total 3,955 44,224 22,818 67,042 (a) CPT codes: 52601, 52612, 52614; (b) CPT codes: 52648, 52649 (CPT code 52649 was available for reporting in January 2008). CONCLUSIONS Among urologists undergoing board certification or recertification in 2010, 56% of TURPs were done electrosurgically. We also found that older age was significantly associated with lower likelihood of performing laser vaporization TURP among those undergoing their second recertification. These data provide estimates of current TURP practice patterns and further our understanding of the evolving surgical treatment of benign prostatic hyperplasia. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e797 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Lowrance Salt Lake City, UT More articles by this author Andrew Southwick Salt Lake City, UT More articles by this author A.C. Maschino New York, NY More articles by this author Jaspreet Sandhu New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of Virtual Reality-Simulated Training on Urology Residents' Performance of Transurethral Resection of the Prostate

There are virtual reality simulators for practicing the transurethral resection of prostate (TURP) procedure, but only few data on its effect on surgical performance are available. The purpose of this study was to test if practicing the TURP procedure in a virtual reality simulator (PelvicVision) increases the skills and dexterity of urology residents when performing the procedure on patients. Twenty-four urology residents attended a 5-day course on diagnosis and treatment of benign prostatic enlargement. Each of the residents performed three video-recorded TURP procedures. Between two of the procedures (on day 2 and 3, or 3 and 4) the residents underwent criterion-based practice using a simulator. The TURP procedure was evaluated using objective structured assessment of technical skills. Video-recordings of the procedures were analyzed on a minute-to-minute basis. Mean practice time in the simulator was 198 minutes before reaching the criterion level. Comparison of the first and last TURP procedures showed an increase in autonomous operation time and time spent on resection, and a tendency to decreased hemostasis time without increased blood loss. The proportion of residents believed to be able to perform a simple TURP procedure increased from 10% to about 75%. Objective structured assessment of technical skills scores and self-evaluations were significantly improved. The scores increased significantly more with than without simulator practice. The resident's self-evaluations showed increased knowledge about the procedure and the technical equipment used. Patient follow-up showed no increased risks. Practice in a simulator-based environment improves the skills and dexterity of urology residents when performing the procedure on patients, without increased risks for the patients.