Transurethral Resection Of The Prostate Group Research Articles

Efficacy and safety of tamsulosin hydrochloride 0.2 mg and combination of tamsulosin hydrochloride 0.2 mg plus solifenacin succinate 5 mg after transurethral resection of the prostate: a prospective, randomized controlled trial.

ObjectiveThe objective of this study was to evaluate the safety and efficacy of tamsulosin hydrochloride 0.2 mg (TAM) and its combination with solifenacin succinate 5 mg (SOL) after transurethral resection of the prostate (TURP).Patients and methodsThe patients were randomized into three groups: TURP (group 1), TURP plus TAM (group 2), and TURP plus TAM + SOL (group 3). Patients in group 2 and group 3 received medication for 4 weeks. The primary efficacy end points were the mean change in total International Prostate Symptom Score (IPSS) and IPSS subscores. The secondary end points included quality-of-life score, Overactive Bladder Symptom Score, and short-form voiding and storage score of International Continence Society.ResultsIn total, 37 men (31.8%) in group 1, 37 men (31.8%) in group 2, and 42 men (36.2%) in group 3 completed the study. In total IPSS, no significant improvement was seen from baseline to the end of treatment in groups 2 and 3 compared with group 1. However, in group 2, the decrement in the IPSS storage score was smaller than group 1 (P=0.02), and in group 3, the decrement in the IPSS voiding score was smaller than group 1 (P=0.05). In groups 2 and 3 compared with group 1, improvements in the quality of life score, total score of Overactive Bladder Symptom Score, and short-form voiding score and storage score of International Continence Society were not statistically significant.ConclusionTreatment with TAM and combination of TAM and SOL did not have significant additional benefits for lower urinary tract symptoms during the early recovery period after TURP.

A comparative study on the clinical effects of 1470 nm diode laser vaporization and transurethral resection of the prostate for benign prostatic hyperplasia

Objective To compare the safety and efficacy of 1 470 nm diode laser vaporization of the prostate with transurethral resection of the prostate(TURP) in patients with benign prostatic hyperplasia(BPH). Methods From July 2014 to July 2015, 82 patients diagnosed as BPH were randomly divided into two groups.Forty cases of them underwent 1 470 nm diode laser vaporization and 42 cases for TURP.The operation time, hemoglobin decrease, serum sodium decrease, bladder irrigation time, duration of bladder catheterization and postoperative complications were recorded.The international prostate symptom score(IPSS), maximum flow rate(Qmax) and post-voiding residual volume(PVR) before and after operation were compared. Results No differences were found between the two groups in basic preoperative characteristics, such as: age, prostate volume, IPSS, PVR and Qmax(P>0.05). The mean operative time in the diode laser group was (64.8±14.6) min, slightly longer than tin he TURP group((59.3±14.5) min, P>0.05). The hemoglobin decrease, the serum sodium decrease, the time of bladder irrigating and the time of catheterization of 1470 nm diode laser group were all less than that in TURP group, the differences were significant between the two groups((2.06±1.43) g/L vs.(6.07±1.68) g/L, (1.16±0.67) mmol/L vs.(4.09±3.78) mmol/L, (5.08±2.80) h vs.(25.8±12.7) h, (3.38±1.17) d vs.(4.88±1.42) d, respectively; t=-11.615, -4.845, -10.337, -5.232; P 0.05). All patients were followed up for 3-12 months, the IPSS, PVR and Qmax of 3 months after surgery in 1 470 nm diode laser group and TURP group were all improved significantly compared with that of preoperative in both groups, but no statistical differences could be found between the two groups(IPSS: F inner grouP=527.65, P<0.001; F between groups=0.099, P=0.753; F across groups=0.040, P=0.843, PVR: F inner grouP=509.57, P<0.001; F between groups=2.817, P=0.097; F across groups=1.02, P=0.315; Qmax: inner grouP=60.06, P<0.001; F between groups=0.30, P=0.585; F across groups=0.394, P=0.532). Conclusion 1 470 nm diode laser vaporization of the prostate can significantly improve the patient's lower urinary tract obstruction symptoms, which show similar short-term effects with TURP.It also has advantages of less bleeding, shorter catheter indwelling time and rapid postoperative recovery compared with TURP, suggesting that it is a safe and effective operation for BPH treatment. Key words: Benign prostatic hyperplasia; Transurethral resection of prostate; Diode laser

PD24-03 A PROSPECTIVE, RANDOMISED TRIAL COMPARING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) TO STANDARD TRANSURETHRAL RESECTION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA: TWO-YEAR FOLLOW-UP RESULTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2016PD24-03 A PROSPECTIVE, RANDOMISED TRIAL COMPARING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) TO STANDARD TRANSURETHRAL RESECTION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA: TWO-YEAR FOLLOW-UP RESULTS Yuan yuanhu, Zou xiaofeng, Xiao rihai, Zhang guoxi, Liu folin, and Liao yunfeng Yuan yuanhuYuan yuanhu More articles by this author , Zou xiaofengZou xiaofeng More articles by this author , Xiao rihaiXiao rihai More articles by this author , Zhang guoxiZhang guoxi More articles by this author , Liu folinLiu folin More articles by this author , and Liao yunfengLiao yunfeng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1768AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium Laser enucleation of the prostate (HoLEP) has recently been proved a safe and technically feasible procedure for benign prostatic hyperplasia (BPH). However, its long-term safety, efficacy, and durability in comparison with the gold-standard transurethral resection of the prostate (TURP) have not yet been reported. We report the 2-yr follow-up results of a prospective, randomised clinical trial comparing HoLEP with standard TURP for symptomatic BPH. METHODS A total of 118 patients with bladder outflow obstruction (BOO) secondary to BPH were prospectively randomised 1:1 into either the HoLEP group or the TURP group. All patients were assessed perioperatively and followed at 1, 3, 6, 12, 18 and 24 mo postoperatively. The preoperative and postoperative parameters included International Prostate Symptom Score (IPSS), quality of life (QoL) scores, the International Index of Erectile Function (IIEF) questionnaire, maximum urinary flow rates (Qmax), transrectal ultrasound (TRUS)-assessed prostate volume, postvoid residual urine (PVRU) volume, and serum prostate-specific antigen (PSA) level. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared. All complications were recorded. RESULTS HoLEP was significantly superior to TURP in terms of the drop in haemoglobin (p < 0.001), intraoperative irrigation volume (p < 0.001), postoperative irrigation volume and time (p < 0.001), recovery room stay (p < 0.001), catheterisation time (p < 0.001), hospital stay (p < 0.001), and resected tissue (p < 0.001). There were no statistical differences in operation time and sexual function between the two groups. At 24 mo postoperatively, the HoLEP group had a maintained and statistically significant improvement in IPSS (p < 0.001), QoL (p < 0.001), Qmax (p = 0.012), and TRUS volume (p < 0.001), with urodynamically proven deobstruction (p < 0.001). More extensive clinical trials are required to validate these results. CONCLUSIONS HoLEP is a safe and highly effective technique for relieving BOO. At 2-yr follow-up, the clinical efficacy of HoLEP is durable and compares favourably with TURP. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e512 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yuan yuanhu More articles by this author Zou xiaofeng More articles by this author Xiao rihai More articles by this author Zhang guoxi More articles by this author Liu folin More articles by this author Liao yunfeng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Patient-Reported Quality of Life in Men with Transurethral Resection of the Prostate Undergoing Proton Therapy for Management of Prostate Cancer.

We report on quality of life (QOL) and early toxicity among men with prostate cancer who underwent transurethral resection of the prostate (TURP) before proton therapy. Between 2006 and 2010, 1,289 patients were treated definitively with proton therapy for prostate cancer at our institution and enrolled on a prospective outcomes-tracking protocol. Ninety-six of the men had received a TURP before proton therapy, while 1,193 men had not. Baseline comorbidities, medications, expanded prostate index composite (EPIC) score, international prostate symptom score (IPSS), and CTCAE vs.3 toxicity assessment were collected prospectively. The Kaplan-Meier product limit method was used to estimate freedom from toxicity. Men who had TURP before proton therapy had lower baseline EPIC scores for urinary incontinence, bowel summary, and sexual summary compared with the non-TURP group, but no significant difference in urinary obstructive score was observed. After controlling for baseline scores, there was no significant difference in bowel summary or sexual summary scores between the two groups over time. There were, however, differences for urinary irritation/obstruction scores and urinary incontinence scores favoring those patients who did not have a TURP-like procedure. Toxicity assessment showed that the 2-year and 5-year rates of grade 3 genitourinary toxicity in the pretreatment TURP group were 12.3% and 17.2%, respectively. Pretreatment TURP was associated with both a high incidence of physician-assessed toxicity and inferior patient-reported QOL scores both before and after proton therapy treatment. Studies investigating QOL and toxicity after specific prostate cancer therapies should stratify patients by pretreatment TURP. Longer follow-up is needed to confirm if these differences ever resolve.

Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials.

To assess the efficacy and the safety of Greenlight(TM) high-performance system (HPS) 120-W laser photoselective vaporization of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH). The related original studies only including randomized controlled trials were searched by databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register. The databases were updated till July 2014. The risk ratio, mean difference, and their corresponding 95% confidence intervals were calculated. Risk of bias of the enrolled trials were assessed according to Cochrane Handbook. A total of four trials involving 559 patients were enrolled. Statistical analysis was performed by software Review Manager (V5.3.3). There was no significant difference in International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) between PVP and TURP at 6-, 12-, and 24-month follow-up. Patients in the PVP group were associated with significantly lower risk of capsule perforation (risk ratio (RR) = 0.06, 95% confidence interval (95%CI) = 0.01 to 0.46; p = 0.007), significantly lower transfusion requirements (RR = 0.12, 95%CI = 0.03 to 0.43; p = 0.001), a shorter catheterization time (mean difference (MD) = -41.93, 95%CI = -54.87 to -28.99; p < 0.00001), and a shorter duration of hospital stay (MD = -2.09, 95%CI = -2.58 to -1.59; p < 0.00001) than that in the TURP group. In the TURP group, the patients were associated with a lower risk of re-operation (RR = 3.68, 95%CI = 1.04 to 13.00; p = 0.04) and a shorter operative time (MD = 9.28, 95%CI = 2.80 to 15.75; p = 0.005) than those in the PVP group. In addition, no statistically significant differences were detected between groups in terms of the rates of transurethral resection syndrome, urethral stricture, bladder neck contracture, incontinence, and infection. Greenlight(TM) 120-W laser PVP is as effective as TURP for symptom reduction and improvement of the quality of life. Laser PVP shows advantages over TURP in terms of intraoperative safety, whereas TURP is found to have a shorter operative time and lower re-operative risk.

Cystostomy-free open suprapubic transvesical prostatectomy: Is it a safe method?

Aim:To compare open suprapubic transvesical prostatectomy (OSP) without insertion of suprapubic cystostomy, OSP with insertion of cystostomy, and transurethral resection of the prostate (TURP).Patients and Methods:A total of 104 patients with an indication for prostatectomy were retrospectively assigned to TURP (group 1), OSP with cystostomy (group 2), and OSP without cystostomy (group 3). They were evaluated for length of the operation, length of hospital stay, post-operative complications, hemoglobin drop, changes of blood pressure, and intraoperative blood loss.Results:Mean age was 67.2 ± 8.7 in group 1, 73.3 ± 8.4 in group 2, and 74.0 ± 5.7 in group 3. Prostatic volume was 35.9 ± 13.8, 74.1 ± 33.8, and 74.3 ± 31.8 in groups 1, 2, and 3, respectively. There was no significant difference in prostatic volume between groups 2 and 3 (P = 0.99), but in group 1 it was lesser than groups 2 and 3 (P = 0.00). Length of the operation was 1.2 ± 0.2 in group 3 and 1.1 ± 0.2 in group 2, without a significant difference (P = 0.45). Length of hospital stay in group 3 (2.3 ± 0.4 days) was lesser than that in group 2 (2.6 ± 0.7) (P = 0.01). The amount of hemoglobin drop was 1.1 ± 0.9 in group 1, 1.1 ± 0.7 in group 2, and 1.4 ± 0.91 in group 3 without a significant difference between all groups. The amount of bleeding during operation was 173 ± 103 in group 2 and 161 ± 78 in group 3 (P = 0.98).Conclusion:OSP without insertion of cystostomy tube is a relatively safe method; however, larger studies are needed. It is also comparable to TURP in terms of postoperative efficacy and complications.

Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis.

To compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia. We prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL). All groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate (Q max), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q max. TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q max and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria. TURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.

Laparoscopic Radical Prostatectomy after Previous Transurethral Resection of the Prostate in Clinical T1a and T1b Prostate Cancer: A Matched-Pair Analysis.

To analyze and compare surgical, oncological and functional outcomes of laparoscopic radi­cal prostatectomy (LRP) in patients with and without previous transurethral resection of the prostate (TURP). In total, 785 men underwent LRP at our institution from January 2002 to December 2012. TURP had been performed previously in 35 of these patients (TURP group). A matched-pair analysis iden­tified 35 additional men without previous TURP who exhibited equivalent clinicopathological characteristics to serve as a control group. Perioperative complications and surgical, functional, and oncological outcomes were compared between the two groups. The groups were similar in age, body mass index, serum prostate-specific antigen level, and pre- and post-operative Gleason scores. Patients in the TURP group had greater blood loss (231 vs. 139 mL), longer opera­tive times (262 vs. 213 min), a greater probability of transfusion (8.6% vs. 0%), and a higher rate of complications (37.1% vs. 11.4%) compared with the control group. The positive surgical margin rate was higher in the TURP group, but this difference was not statistically significant (P = .179). The continence rates at one year after surgery were similar, but a lower continence rate was identified in the TURP group (42.9% vs. 68.6%) at 3 months. Bio­chemical recurrence developed in 17.1% and 11.4% of the patients in the TURP and control groups, respectively, after a mean follow-up of 57.6 months. LRP is feasible but challenging after TURP. LRP entails longer operating times, greater blood loss, higher complication rates and worse short-term continence outcomes. However, the radical nature of this cancer surgery is not compromised.

A Comparison of 120 W Laser Photoselective Vaporization versus Transurethral Resection of the Prostate for Bladder Outlet Obstruction by Prostate Cancer

Objective: To compare the mid-term outcomes of photoselective vaporization of prostate (PVP) with GreenLight HPS 120 W laser and transurethral resection of the prostate (TURP) for obstructive lower urinary tract symptoms (LUTS) in men with prostate cancer (CaP). Patients and Methods: Seventy four patients with locally advanced (T3/T4) CaP with severe LUTS or acute urinary retention (AUR) were allocated to TURP (n = 36) or PVP (n = 38). International Prostate Symptom Scores (IPSS), maximum flow rates (Qmax) and post-void residual volumes (Vres), PSA levels, prostate volumes, complications, catheter removal and hospitalization periods were recorded. Patients were reassessed at 3, 6, and 12 months. Results: The catheter removal time was significantly longer in the TURP group (3.8 ± 1.1 vs. 1.2 ± 0.7 days, p = 0.02), whereas failure of initial voiding trial was higher in PVP (2.7 vs. 13.1%, p = 0.01). No significant difference in IPSS, Qmax and Vres values was observed within the follow-up period between two groups. A significant difference in urethral stricture rate (8.3 vs. 0%), catheter removal time (3.8 ± 11 vs. 1.2 ± 0.7 days) and hospital stay (2.9 ± 0.6 vs. 1.1 ± 0.5 days) was observed in favor of PVP. Conclusions: Palliative PVP is very safe and effective by means of symptomatic relief in patients with locally advanced CaP.

Efficacy of bipolar "button" plasma vaporization of the prostate for benign prostatic obstruction, compared to the standard technique.

Objective:The objective of the following study is to evaluate the efficiency of transurethral plasma vaporization of the prostate in saline bipolar plasma vaporization of the prostate (BPVP) using the button electrode and comparing it to the standard transurethral resection of the prostate (TURP).Patients and Methods:During the period of the year between 2007 and 2013, 152 patients with benign prostatic hyperplasia were rolled in our study. Fifty-two patients were underwent BPVP and 100 TURP. All patients were evaluated preoperatively, 24 h and at 3 months postoperatively. International Prostate Symptom Score (I-PSS), quality-of-life (QOL) score, Qmax and Qave and post void residual (PVR) urine. Operative time, hospital stay, catheterization time, and complications were reported. Mean serum Hb, hematocrit and serum sodium changes were reported preoperatively and within 24 h postoperatively in both groups. Statistical analysis is performed using SPSS program version 20 for windows.Results:Mean age at surgery was 60.8 ± 8 (range 63- 92) and 66 ± 8.6 (range 50-83) for BPVP and TURP groups, respectively. Mean prostatic volume was 46 ± 11 (range 30-92) and 43 ± 8 (range 30-80) in both groups, respectively. Patients from both series had similar preoperative characteristics. The mean operative duration 53 ± 21 1 ± 2.1 (range 1-7) versus 3 ± 3.3 (range 3-8) days (P value 0.0001) were significantly (range 20-80) versus 62 ± 16 min (range 30-126) (P value 0.004), catheterization period 2 ± 0.28 ( range 2-4) versus 3 ± 3.2 (range 2-7) days (P value 0.03).Conclusions:BPVP has superior efficacy in short-term results and less complication rates compared with classic TURP.

A prospective, randomized comparative study of monopolar transurethral resection of the prostate versus photoselective vaporization of the prostate with GreenLight 120-W laser, in prostates less than 80 cc.

In this study we aimed to compare photoselective vaporization (PVP) with the GreenLight 120-W Laser and monopolar transurethral resection as surgical treatments of prostates less than 80 cc in men with obstructive benign prostatic hyperplasia. From February 2009 to March 2012 we allocated 101 patients with a prostate glands of less than 80 cc; patients were randomly assigned for surgical treatment with monopolar transurethral resection of the prostate (TURP) (n = 62) or PVP (n = 39). Serum prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax) postmicturition residual (PMR), transrectal ultrasound volumes (TRUS), postvoid urine residual (PVR), complications, re-operations and hospitalization time were collected. The patients were seen in the follow up at 6, 12 and 24 months. Median age was 69 (56-87) years old in the TURP group and 67 (51-87) years old in the PVP group. Mean preoperative prostate volume was 55 cc (40-72) and 60 cc (41-75) cc in the TURP group versus the PVP group. There was no statistically difference in subjectively (IPSS, SHIM) and objectively (Qmax-PMR) parameters and postoperatively complication rates between the two groups (p > 0.05). A significant difference was observed in the PVP group with a 2 (1-4) days hospital stay compared with 5 (3-9) days for the TURP group (p < 0.001). Prostate PVP and TURP are effective surgical treatments for benign prostatic hyperplasia. Postoperative functional improvements were durable and equivalent in the two groups. The two techniques have a similar complication rate.

Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia: a meta-analysis of randomized controlled trials

To evaluate the efficacy and safety of plasmakinetic resection of the prostate (PKRP) versus transurethral resection of the prostate (TURP) for the treatment of patients with benign prostate hyperplasia (BPH), a meta-analysis of randomized controlled trials was carried out. We searched PubMed, Embase, Web of Science and the Cochrane Library. The pooled estimates of maximum flow rate, International Prostate Symptom Score, operation time, catheterization time, irrigated volume, hospital stay, transurethral resection syndrome, transfusion, clot retention, urinary retention and urinary stricture were assessed. There was no notable difference in International Prostate Symptom Score between TURP and PKRP groups during the 1-month, 3 months, 6 months and 12 months follow-up period, while the pooled Qmax at 1-month favored PKRP group. PKRP group was related to a lower risk rate of transurethral resection syndrome, transfusion and clot retention, and the catheterization time and operation time were also shorter than that of TURP. The irrigated volume, length of hospital stay, urinary retention and urinary stricture rate were similar between groups. In conclusion, our study suggests that the PKRP is a reliable minimal invasive technique and may anticipatorily prove to be an alternative electrosurgical procedure for the treatment of BPH.

Diode Laser (980 nm) Vaporization in Comparison With Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: Randomized Clinical Trial With 2-year Follow-up

To compare outcomes of diode laser vaporization of prostate with transurethral resection of the prostate (TURP) as a gold-standard treatment. A total number of 115 patients with benign prostatic hyperplasia underwent TURP and 980-nm diode vaporization of prostate in a balanced randomization (1:1) from 2010 to 2012 and were followed up for 24 months. Baseline characteristics of the patients, perioperative data, and postoperative outcomes were compared. The primary end point of the study was assessing the values of International Prostate Symptom Score (IPSS), and maximum flow rate (Qmax) to predict the functional improvement of each group. The trial is registered at http://www.irct.ir (number IRCT201202138146N3). The mean age (± standard deviation) of the patients was 68.2 ± 7.8 years in TURP and 68.5 ± 8.8 in diode groups. In TURP and diode groups, the operation time was 54.9 ± 15.3 vs 60.6 ± 22.6 minutes (P = .14), Foley catheterization time was 88.9 ± 22.5 vs 20.1 ± 4.6 hours (P = .0001) and postoperative hospital stay was 59.9 ± 14.4 vs 25.8 ± 9.2 hours (P = .0001) respectively. Outcome with regard to increase in Qmax, decrease in IPSS, and decrease in postvoid residual urine volume showed a dramatic improvement in both groups during the first 6 months. In the TURP group, the values of IPSS and Qmax were respectively lower and higher than diode patients at 12 and 24 months of follow-up. According to our study, diode laser vaporization (980 nm) offers a safe and feasible procedure in the management of patients with symptomatic benign prostatic hypertrophy; however, at longer follow-up the functional outcome of diode laser vaporization has been less efficient than TURP.

Determination of prostate adenoma weight reduction due to vaporisation process occurring during transurethral resection of the prostate.

IntroductionTransurethral resection of the prostate (TURP) is regarded as the gold standard surgical treatment for benign prostatic hyperplasia (BPH). The completeness of TURP may be assessed indirectly by estimation of the weight of glandular tissue removed. This parameter is often lower than expected. Tissue vaporisation in the course of TURP could be a contributory cause.AimTo quantitatively evaluate tissue vaporisation occurring in the course of transurethral resection of the prostate and electrovaporisation of the prostate (EVAP) performed under experimental conditions.Material and methodsThe study was performed on 26 prostate glands removed during retropubic prostatectomy. Immediately following surgery all adenomas were halved and TURP or EVAP were carried out on both halves of each gland for period of 5 min. The amount of prostate tissue which vaporised during EVAP and TURP were calculated.ResultsThe mean weight (± standard deviation) of the adenoma lost due to resection and vaporisation in the TURP group was 10.00 ±2.92 g and 4.26 ±1.59 g, respectively. The latter accounted for 30.10 ±7.71% of total prostate weight reduction. The mean prostate weight lost in the course of EVAP was 5.03 ±1.58 g.ConclusionsThe vaporisation significantly contributes to the prostate tissue loss occurring during transurethral resection of the prostate.

A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP in patients with prostate volume 30 to 80 mL: Early complications, physiological changes and postoperative follow-up outcomes.

We compare BIVAP saline vaporization of the prostate with bipolar transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia. In total, we included 86 patients treated with BIVAP (n = 44) and bipolar TURP (n = 42). The inclusion criteria were maximum urinary flow rate (Qmax) ≤10 mL/s, International Prostate Symptom Score (IPSS) ≥16, and prostate volume measured with transrectal ultrasound scan between 30 and 80 mL. Serum electrolyte, hemoglobin, and hematocrit levels were determined preoperatively and postoperatively. All patients were evaluated at the postoperative first and third months and the IPSS score, post-void residual urinary volume (PVR), Qmax, and average urinary flow rate (Qave) were compared. Statistical analyses were performed using SPSS 16.0 program and statistical significance was set at p < 0.05. Preoperative demographic characteristics were similar in the 2 groups. The mean operation time was significantly higher (p = 0.02) and hospitalization time was significantly lower (p = 0.04) in the BIVAP group when compared to the bipolar TURP group. There was no significant difference between 2 groups in terms of preoperative and postoperative serum electrolyte, hemoglobin and hematocrit levels. Postoperative complication rates were similar in the 2 groups. The only exception was the rate of severe dysuria, which was significantly higher in the BIVAP group. No statistical difference was noted between the groups in terms of postoperative follow-up results. Bipolar TURP is a safe and highly effective technique which can be used in the surgical treatment of benign prostatic obstruction with minimal side effects. BIVAP saline vaporization of the prostate seems to be a potential alternative to bipolar TURP with shorter hospitalization time.

Cystolithotripsy using the Holmium laser: Evolving uses for the laser lithotrite

Objective: The optimal management of bladder stones remains unclear, with a range of approaches described. We aim to describe our results using Holmium:YAG laser lithotripsy for the management of bladder stones. Patients and methods: Data were collected prospectively on 20 (19 male, one female) patients undergoing laser lithotripsy for bladder calculi at a single centre from February 2013 to February 2014. The mean patient age was 69.75 years (range 51–87). Patient demographics, stone size, operative details and post-operative events and hospital stay were recorded. A 365 or 550 micron Holmium:YAG laser fibre, with a power setting of 1.0J and a frequency of 10Hz was used in all cases. Results: The mean stone size was 2.2cm (1–4cm). The mean operative time was 32.85 min (15–70 min). Operative time correlated positively with stone size ( r=0.74). Three patients underwent laser stone fragmentation followed by transurethral resection of the prostate (TURP) during the same anaesthetic. Visibility remained clear in all these patients during lithotripsy, allowing complete fragmentation and stone clearance. Intra-operative bleeding was noted during the TURP procedure as expected. There were two episodes of self-limiting post-operative pyrexia but no reported cases of post-operative sepsis. Apart from the three patients undergoing TURP, there were no cases of post-operative bleeding and no cases required blood transfusion. Stone clearance was complete after a single procedure in 100% of cases. The mean hospital stay was 2.5 days (1–7 days), with a mean post-operative stay of 1.8 days. Conclusion: Laser lithotripsy offers a safe and effective management option for bladder stones, including those which are large and hard. It offers the key benefit of lithotripsy under direct vision, with no recorded mucosal injury in our series and thus no intra-operative or post-operative haematuria (outside of the TURP group).

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP.

To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80 mL, serum PSA < 4 ng/mL, IPSS ≥ 20, Qmax ≤ 10 mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. Both groups were similar in patient age, prostate volume, preoperative IPSS and Qmax. The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Qmax. But the TUVP group had significantly lower IPSS and higher Qmax than TURP group. Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.

Robotic assisted laparoscopic radical prostatectomy following transurethral resection of the prostate: perioperative, oncologic and functional outcomes.

Purpose:The aim of this study was to assess surgical, oncologic and functional results after robotic-assisted laparoscopic radical prostatectomy (RALP) with and without previous transurethral resection of the prostate (TURP).Methods:Between December 2005 and January 2010, 200 patients underwent RALP, of whom 16 (8%) had received previous TURP and 184 (92%) had not. Perioperative and postoperative data were compared between those with previous TURP (group 1) and those without previous TURP (group 2). All patients included in the study had at least 1-year follow-up.Results:Preoperative clinical parameters were comparable between both groups. Group 1 patients were found to have significantly more need for bladder neck reconstruction (93.75 % vs. 15.21%, P <0.001), more rectal injury (18.75% vs. 0%, P <0.001), higher incidence of major complications (18.8% vs. 1.1%, P<0.001), and smaller specimen volume (31.63 mL vs. 45.49 mL, P<0.001) than group 2. The 12-month continence rate was 93.8 % in group 1 and 97.8% in group 2 (P =0.344). A nerve-sparing technique was significantly less successfully performed in group 1 patients than in group 2 (33.3% vs. 92.0 %, P=0.001).Conclusions:Performing RALP for prostate cancer in patients who have had previous TURP is a technically demanding procedure and may be potentially associated with a higher perioperative major complication rate in short-term follow-up. Neurovascular bundle preservation is technically more challenging.

Comparison of the risk of postoperative infection between transurethral vaporesection and transurethral resection of the prostate

We observed in our department at 3 months two episodes of bacteremia postoperatively to photoselective vaporization of the prostate (PVP). We decided to compare the frequency of postoperative urinary tract infections (POUTIs) in patients with preoperative bacterial colonization of urine between PVP and transurethral resection of the prostate (TURP). From January 2010 to December 2011, we studied patients who underwent PVP or TURP for benign prostatic obstruction in our department. Preoperative urine culture (UC) was carried out for all patients and we included those with preoperative bacterial colonization of the urinary tract. Patients were treated preoperatively with an appropriate antibiotic treatment and/or inductive prophylactic antibiotics. Patients were diagnosed with POUTI if they had clinical signs of infections (e.g., fever) and a positive UC during the month after surgery. Patients were treated by PVP in 49 cases and TURP in 62 cases. A preoperative indwelling urinary catheter was inserted in 80% of the patients. During the postoperative period, eight episodes of fever were identified in the PVP group (16%), five (8%) in the TURP group (P = 0.18). We then studied the subgroup of patients with multiple bacteria strains present in the preoperative UC and identified significant differences. The risk of POUTI was significantly higher in patients treated by PVP than in those treated by TURP (P = 0.018). We found significant differences between subgroups of patients with positive preoperative cultures (containing various bacterial strains). The risk of POUTI was significantly higher in patients treated by PVP.

Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a randomized clinical trial

To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), for treatment of benign prostatic hyperplasia (BPH). A total of 164 cases of BPH were selected from patients who were hospitalized between January 2010 and December 2011. Patients had received either HoLEP or TURP treatment. Clinical data were collected from the perioperative period, 1 month after surgery, and 12 months after surgery. There was no significant difference between the two groups in the maximum urinary flow rate (Q max), postvoid residual volume (PVR), international prostate symptom score (IPSS), or quality-of-life score (QOL score) at 1 month after surgery (p = 0.56, p = 0.346, p = 0.536 and p = 0.145, respectively). However, after 12 months, patients from the HoLEP group demonstrated better scores in Qmax, PVR, IPSS, and QOL than those from the TURP group (p = 0.037, p = 0.003, p < 0.001 and p = 0.019, respectively). The two groups had comparable operation time (p = 0.105), catheterization time (p = 0.173), and length of hospital stay (p = 0.395), but were statistically different in the weight of resected prostate tissue (p < 0.001), bladder irrigation time (p < 0.001), hemoglobin levels (p = 0.011), and blood sodium levels (p = 0.002) after surgery. Compared to TURP, HoLEP was safer and had better long-term efficacy as assessed by multiple quantitative measures. Therefore, HoLEP may present a better option in the treatment of BPH.