Transurethral Resection Of The Prostate Patients Research Articles

A nomogram model for the occurrence of bladder spasm after TURP in patients with prostate enlargement based on serum prostacyclin and 5-hydroxytryptamine and clinical characteristics.

With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997). Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.

Postoperative Incidence of Symptomatic Urinary Tract Infection (UTI) and Microbial Pattern Seen in TURP Patients with Negative Cultures Preoperatively

Background: Transurethral Resection of the Prostate (TURP) is the gold standard for surgical treatment of benign prostate hyperplasia (BPH). One of the postoperative complications of TURP is urinary tract infection (UTI). Symptomatic UTI occur despite preoperative sterile urine, prophylactic antibiotics and a closed drainage system. We studied the incidence of such symptomatic UTI and the microbial pattern observed. Material and Methods: This was a prospective study of 220 patients who had monopolar TURP in our centre from 2015 to 2020. All patients had sterile urine before surgery. Catheters were removed three days postoperatively. Patients presenting with symptoms of UTI were subjected to urine culture and antibiotic sensitivity. The recorded variables include patient demographics, co-morbid factors; Diabetes, hypertension, presence or absence of preoperative catheterization, duration of surgery, presence of postoperative UTI, microbial patterns and antibiotic sensitivity patterns. Results: The mean age of the patient was 66.25 years. 35.5% had preoperative catheterization. 42 (19%) patients were established to have symptomatic UTI. Age ≥ 65 years, duration of surgery ≥60 mins led to higher infection rates but preoperative catheterization, diabetes and hypertension did not influence UTI rates. The commonest organism was E. Coli and the most common sensitive antibiotic was levofloxacin (quinolone). Conclusions: Symptomatic UTI post-TURP still occurs despite preoperative sterile urine and routine prophylactic antibiotics.

The influence of preoperative urodynamic parameters on clinical results in patients with benign prostatic hyperplasia after transurethral resection of the prostate

PurposeTo identify the urodynamic parameters affecting the clinical outcomes of transurethral resection of the prostate(TURP) surgery for patients with benign prostatic hyperplasia(BPH) by multifactor analysis and establish a regression model with diagnostic values.MethodsThe medical records of patients who underwent TURP surgery for BPH between December 2018 and September 2021 were collected from the urology department of the Second Affiliated Hospital of Kunming Medical University, Kunming, China. The patients’ clinical data and urodynamic parameters were collected before surgery. The urodynamic parameters affecting surgical efficacy were identified by multifactor analysis, and a regression model with diagnostic values was established and evaluated.ResultsA total of 201 patients underwent TURP, of whom 144 had complete preoperative urodynamic data. Each urodynamic factor was subjected to multifactor analysis, and the bladder contractility index (BCI), bladder outflow obstruction index (BOOI), bladder residual urine, and bladder compliance (BC) were found to be independent influence factors on the efficacy of TURP in patients with BPH. The diagnostic value of the regression model was analyzed by receiver operating characteristics (ROC) analysis, and it was found that the AUC = 0.939 (95% CI 0.886–0.972), for which the sensitivity and specificity were 95.19% and 80%, respectively.ConclusionsThe regression model had high diagnostic sensitivity and specificity in predicting the efficacy of surgery, and the diagnostic value was higher than that of individual urodynamic factors. Therefore, BCI, BOOI, bladder residual urine, and BC should be considered as independent influence factors on the efficacy of TURP surgery for BPH.

Comparison of surgical procedures for benign prostatic hyperplasia of medium-volume prostates: evaluation of the causes of rehospitalization from the French National Hospital Database (PMSI-MCO).

In France, transurethral resection of the prostate (TURP) is still the most commonly used surgical treatment for medium sized benign prostatic hyperplasia (BPH), but the Holmium Laser Enucleation of the Prostate (HoLEP) and laser vaporization procedures are becoming more common. For these three surgical procedures, we evaluate the initial complications, the short term (3months) and the 4-12-month postoperative complications necessitating re-hospitalization. From the French national hospital data base (PMSI-MCO), all hospitalizations for BPH treatment in 2018 were extracted. We document the complications during the initial hospitalization and any subsequent rehospitalizations during the one-year postoperative period. In 2018, 67,220 patients were treated for BPH: 46,242 TURP, 13,509 HoLEP and 7469 laser vaporization. Age and anticoagulation medications were similar for men treated by the three procedures, but TURP patients were more often hypertensive. Infections and hemorrhagic complications were the most common complications at the initial hospitalization: 17%, 10%, 13% for infections and 15%, 8.1%, 11% for hemorrhagic complications respectively, and TURP performed worse than the other two procedures at the initial hospitalization. During the first three months and then the subsequent nine months, there were fewer complications than initially, with little difference between the three procedures, all differences being less than 1%. Laser vaporization techniques led to fewer complications. However, the PMSI-MCO only registers complications during hospitalizations. This study should be extended to non-hospitalized, more minor complications.

Efficacy of Sacral Plexus Block Combined with Dexmedetomidine for Prevention of Catheter-Related Bladder Discomfort in Patients with TURP

This work focused on investigating therapeutic efficacy of sacral plexus block combined with dexmedetomidine in preventing catheter-related bladder discomfort in patients receiving transurethral resection of the prostate. Sixty patients undergoing elective prostatectomy were randomized as group D or group M (n=30 each). Both groups were given dexmedetomidine 0.5 μg/kg 10 min before induction of general anesthesia. The severity score of catheter-related bladder discomfort, Richmond agitation sedation scale, visual analog scale score and adverse events at 30 min (T1), 2 h (T2) and 6 h (T3) postoperatively were recorded. 1 d preoperatively, as well as 1 and 3 d postoperatively, the neuropsychiatric function of patients was tested by mini-mental state examination and the incidence of postoperative cognitive dysfunction was observed. Compared with group D, group M had significantly decreased catheter-related bladder discomfort incidence at T1 and T2 (p<0.05), but with the passage of time, difference in the incidence of catheter-related bladder discomfort of both groups at T3 was of no statistical significance (p>0.05). Compared with group D, the visual analog scale scores of group M at T1, T2 and T3 remarkably decreased (p<0.05). Relative to group D, group M had remarkably reduced agitation scores at T1, T2 and T3 (p<0.05). Differences in the side effects rate and postoperative cognitive dysfunction incidence were not significantly different between both groups (p>0.05). Sacral plexus block combined with dexmedetomidine decreases postoperative catheter-related bladder discomfort rate among transurethral resection of the prostate patients and has good comfort and safety.

Comparative Effectiveness of Antibiotic Prophylaxis of Postoperative Complications After Transurethral Resection of the Prostate

Benign prostatic hyperplasia (BPH) is one of the most common benign diseases in men, as it leads to an enlarged prostate, the development of lower urinary tract symptoms, and worsens the quality of patient’s life. Surgical treatment is indicated to patients after non-effective drug treatment. Most often, transurethral resection of the prostate (TURP) is used. The objective: to improve the results of TURP in patients with BPH and acute urinary retention by optimizing antibacterial prophylaxis of postoperative complications in the early postoperative period. Materials and methods. An analysis of the surgical treatment of 179 patients with BPH with acute urinary retention after TURP was performed. The age of the patients varied from 51 to 84 years old, the average age was 64.9±5.1 years. All patients had a complex urological examination in the preoperative period. The patients were divided into two groups: I group – 85 patients after operation who were prescribed ceftriaxone in the early postoperative period; II group – 94 patients who received levofloxacin in the early postoperative period. Results. It was determined that complications occurred in 43 (24.1%) patients in the early postoperative period. Long-term macrohematuria was found in 23 (12.9%) patients, exacerbation of chronic pyelonephritis was in 13 (7.3%) patients after operation, acute urethritis developed in 7 (3.9%) patients, acute orchiepididymitis – in 9 (5, 0%) patients. It has been proven that the total frequency of complications in patients with BPH who received levofloxacin in the early postoperative period was statistically significantly lower than in the patients who were prescribed ceftriaxone. Conclusions. The use of levofloxacin for the prevention of early postoperative complications after TURP in patients with BPH complicated by acute urinary retention improves the results of surgical treatment by reducing the frequency of postoperative complications by 60%.

The Feasibility of Open Prostatectomy in Patients with History of Previous Prostate Surgery.

Benign prostatic hyperplasia (BPH) is one of the most common problems in elderly men. Transurethral resection of the prostate (TURP) can be performed for most patients who need re-do prostate surgery, but open prostatectomy should be considered in patients with prostate size larger than 70 grams. This study assessed the feasibility of open prostatectomy (OP) after previous TURP in patients whose prostate size was larger than 70 grams. We subdivided patients into two groups: group 1 included patients who had a history of prostate surgery presented with severe voiding symptoms and a large prostate (>70 gram). Patients who were candidate for open simple prostatectomy without a history of prostate surgery were allocated to group 2. Between June 2007 and April 2018, 2700 patients underwent TURP or open prostatectomy in our department. 152 of 2700 patients came to us because of severe voiding symptoms after previous prostate surgery, but only 30 patients met the criteria to be enrolled in this study. Perioperative complication (capsular perforation) occurred in 4 (13.3%) patients in group 1 whereas none of the patients in the group 2 had capsular perforation. Hemoglobin drop in group 1 was not significantly different from patients in group 2. The rate of blood transfusion did not differ between the groups (2 [6.6%] patients in group 1 and 41 (5.6%) patients in group 2). After 6-12 months, re-operation rate because of urethral/bladder neck stricture was done in 10 (30%) patients in group 1 and 15 (2%) patients in group 2 (p < 0.05). Four (13.3%) patients in group 1 complained of urinary leakage (more than one pad per day) 6 months after the operation whereas 5 patients in group 2 used more than one pad per day (0.7%) (p > 0.05). Hospital stay was slightly longer in patients in group 1. Six months after the operation, the patients' quality of life was better in group 2 compared with group 1 (p < 0.05). Open simple prostatectomy was a feasible procedure in patients with large prostate after previous TURP, but it was associated with more complications in the long term.

Is type and crossmatch really necessary for transurethral resection of prostate? A retrospective study from a tertiary care center in Northern India

Background and Objectives: Rate of blood transfusion is considerably low in transurethral resection of the prostate (TURP). We follow type and crossmatch (TC) policy in TURP. The objective was to assess the suitability of TC policy along with the impact of preoperative (preop) prostate weight and hemoglobin (Hb) on the pattern of blood ordering (whether demand for TC was sent or not). Methods: Retrospective analysis of TURP patients was done from 2014 to 2017. Patients were divided into 2 groups on the basis of whether the demand for TC was sent or not. The age, preop prostate weight and preop Hb of patients where demand for TC sent was compared with patients where TC demand was not sent. Crossmatch to transfusion ratio (Crossmatch to transfusion ratio C/T ratio), Transfusion probability (%T) and Transfusion index (TI) were calculated. Results: Among the total 92 TURP patients, 42.4% (39/92) had TC samples sent preoperatively. Only three patients (3.2%, 3/92) required transfusion intraoperatively. CT ratio was 23.6, %T was 7.6% and TI was 0.07. Preop prostate weight and Hb were significantly higher and lower, respectively, for the group where request for TC was sent. Transfusion probability was also higher for this group. Conclusion: The blood utilization indices show the inadequate utilization of blood and that TC policy is unnecessary. Type and screen policy can be used for patients with large prostate and/or low Hb while type and hold would be appropriate for rest of the patients. Change in pretransfusion policy would reduce workforce and reagent wastage along with efficient inventory management.

High-Dose Rate (HDR) Brachytherapy is a Safe and Effective Treatment for Prostate Cancer Patients With Prior Transurethral Resection of the Prostate (TURP)

To evaluate the clinical and patient-reported outcomes and toxicities in prostate cancer patients undergoing HDR brachytherapy after TURP.Data was prospectively collected for patients undergoing HDR brachytherapy from October 1991 to March 2016. Patients were classified according to NCCN risk criteria. Implants were performed under ultrasound-guidance with CT based planning. Goal dosimetric constraints included V100 Prostate > 95%, D1cc Urethra < 105%, D1cc Bladder < 75%, and D1cc Rectum < 75%. Multivariate cox analysis (MVA) was performed and adjusted for age, T stage, Gleason score, initial PSA, and androgen deprivation therapy (ADT) use. Sexual health inventory for men (SHIM) score, International Prostate Symptom Score (IPSS), and CTCAE v5.0 graded toxicity were recorded.2266 patients underwent HDR brachytherapy. 228 underwent a prior TURP. The median follow-up was 61.1 months (range 3 - 257.4 mos). The median time from TURP to HDR was 52.5 months (range 0.17 - 392 mos). A total of 641, 431, 617, and 577 patients were low-, favorable intermediate-, unfavorable intermediate-, and high-risk, respectively, of which 41, 49, 53, and 85 patients with TURP were low-, favorable intermediate-, unfavorable intermediate-, and high-risk, respectively. Patients with a prior history of TURP were more advanced in age and had a higher incidence of high-risk disease (P < 0.001). Of the patients with history of prior TURP, 49 (22%) and 54 (24%) patients experienced Gr 1 and 2 GU toxicity. 8 patients (3.5%) experienced grade 3 GU toxicity with a median time to occurrence of 16 mo (0.2 - 57.7 mo), and 3 of the Grade 3 toxicities resolved. No grade ≥4 GU toxicity and significant differences in toxicity were observed between the cohorts (P = 0.108). Patient-reported SHIM scores were found to not be statistically significant between prior TURP and non-TURP patients, with average decreases in SHIM no greater than 5 points at all time points in the TURP cohort. No significant differences were observed in biochemical free survival, distant metastases free survival, and prostate cancer specific survival at 4 and 8 years between patients who did and did not receive a prior TURP (8-yr BCFS 84.7% (95% CI: 78.2%-91.8%) vs. 89.1% (95% CI: 87.3-91.0%), respectively; P = 0.16). The TURP cohort was found to have lower overall survival (8-yr OS 72.0% (95% CI 64.8%-79.9%) vs. 81.9% (95% CI: 80.0% - 84.1%) respectively; P = 0.041), and may be attributed to the older age of the TURP cohort (P < 0.001).HDR brachytherapy is a safe and effective treatment modality with low toxicity for prostate cancer patients after a prior TURP.

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia.

Background: Transurethral resection of the prostate (TURP) is regarded as the “gold standard” for the treatment of benign prostatic hyperplasia (BPH) in elderly men. However, ~15% of patients who had undergone TURP had intraoperative and postoperative complications, such as bleeding, urinary incontinence and urethral stricture. Transperineal percutaneous laser ablation (TPLA) is a method that places the optical fibre directly into the prostate with the guidance of ultrasound imaging, and the percutaneous transperineal approach is performed distal to the urethra and rectum to protect these structures and reduce urethral or postoperative infection. Several studies on TPLA for BPH treatment have been reported recently; however, high-quality randomised controlled trial (RCT) to evaluate its efficacy, safety, and long-term follow up remain absent.Methods: This study is a multicentre, open-label RCT to assess the efficacy and safety of TPLA vs. TURP to treat BPH. We hypothesise that the TPLA has non-inferior efficacy to TURP in the International Prostate Symptom Score (IPSS) at 3 months changing from the baseline and lower incidence of post-surgery complications. One hundred and fourteen patients with BPH will be recruited at 19 sites and randomly assigned at 1:1 to TPLA or TURP groups. The patients will be followed up at 1, 3, 6, 12, and 24 months after the procedure.Discussion: The study will be the first multicentre clinical trial including 16 participating centres in China, Italy, Switzerland, and Poland with relatively large sample size 114. By comprehensively compare the safety and efficacy of TPLA with TURP in patients with BPH, especially concerning the improvement of lower urinary tract symptoms (LUTS) and complication incidence, the study will help to illustrate the clinical value of TPLA and provide a beneficial alternative treatment for BPH patients.Clinical Trial Registration: The study has been registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn), identifier [ChiCTR1900022739].

Associations Between Kidney Dysfunction and Risk Factors in Patients with Transurethral Resection of the Prostate.

PurposeBenign prostate hyperplasia (BPH) with urinary retention can result in kidney dysfunction. Several risk factors might influence deterioration in kidney function. The aims of this study were to assess the association between kidney dysfunction and risk factors in patients with transurethral resection of the prostate (TURP).MethodsWe reviewed medical records of BPH patients managed by TURP and having high levels of blood urea and creatinine. Data collected were age, history of hypertension, diabetes mellitus (DM), urinary tract infection (UTI), urinary retention, and urinary tract stones, duration of obstruction, and blood-urea and -creatinine levels before and after TURP. Chi-suare and paired t- tests were used.ResultsThere were 64 patients in the study. More were aged 60–69 years (42.2%) than other age-groups, 53.1% had a history of hypertension, 12.5% DM, 35.9% UTI, all urinary retention, 14.1% urinary tract stones, and 92.2% obstruction duration <14 days. There were significant differences in blood-urea and -creatinine levels between before and after TURP (p<0.001). There were no significant differences between age-group, hypertension, DM, UTI, urinary retention, urinary stones, or duration of obstruction with kidney dysfunction after TURP (p>0.001).ConclusionAge, hypertension, DM, UTI, urinary retention, urinary tract stones, and duration of obstruction can be risk factors of kidney dysfunction in TURP patients, and TURP might improve blood-urea and -creatinine levels. There was no significant association between kidney recovery and kidney dysfunction with the number of risk factors in TURP and pre-TURP patients.

Outcome benefits to transurethral resection of the prostate in patients with benign prostatic hyperplasia at Medan regional hospital

Background: Benign prostatic hyperplasia (BPH) is a pathologic process that cause of lower urinary tract symptoms (LUTS) in aging men. Transurethral resection of the prostate (TURP) is still the current gold standard of BPH treatment. International Prostate Symptoms Score (IPSS) and the quality of life (QoL) index are used for assessing the TURP results.Objective: This study would like to show the benefits outcome of TURP in patients with BPH evaluated with IPSS score and QoL index in Medan regional hospital.Methods: This research is a retrospective study of BPH patients that is treated with TURP at Universitas Sumatera Utara Hospital from September 2019 – August 2020. Patients will be divided into 2 groups, group 1 with patients who have a prostate size &lt;80 grams and the second group with a prostate size&gt; 80 grams. All patients who were included in this study were assessed for their complaints using the IPSS and QoL index before and after taking an operation. Statistical analysis was performed using independent t test and Mann Whitney test. The data were significant if the p value &lt; 0.05. Results: There are 60 patients enrolled in this study that treated with TURP. The mean age of patients in the group 1 was 69.57 ± 7.698 years and 69.84 ± 5.893 years in the group 2. There is no significant difference between group 1 and group 2 in postoperative IPSS and QoL results (p &gt;0.05). Conclusion: TURP procedure is preferable option of BPH for patients in any prostate size.

Effect of preoperative finasteride on perioperative blood loss during transurethral resection of the prostate and on microvessel density in patients with benign prostatic hyperplasia: An open label randomized controlled trial.

Objective:Transurethral resection of the prostate (TURP) is a common procedure for the treatment of benign prostatic hyperplasia (BPH). Previous studies on the effect of 5-alpha reductase inhibitors on perioperative blood loss in TURP and microvessel density (MVD) in the prostate are equivocal. We evaluated whether pretreatment with finasteride for 2 weeks before surgery can reduce perioperative blood loss in TURP and MVD in the prostate.Materials and Methods:Sixty-eight patients of BPH planned for TURP were randomized into two groups. The study group comprising 34 patients was treated with finasteride (5 mg/day) for 2 weeks and the placebo group comprising 34 patients received placebo for 2 weeks, before TURP. Blood loss was measured in terms of a reduction in the blood hemoglobin (Hb) and hematocrit (HCT) levels between preoperative values and 24 h after surgery. MVD was measured in the resected prostate tissue stained with anti-CD31 monoclonal antibody.Results:The reduction of Hb and HCT in the finasteride group was significantly lower than the reduction in the placebo group (P < 0.05). The artery (P = 0.005), vein (P = 0.05), and gland (P = 0.008) densities were significantly less in the finasteride group than in the placebo group. There was no significant correlation between blood loss and MVD.Conclusions:Our study suggests a clear advantage of the preoperative use of finasteride for 2 weeks by reducing the perioperative blood loss in TURP in patients with BPH. While there is a significant reduction in MVD in the prostate on treatment with finasteride, it is not clear that this is the mechanism of reduction in blood loss in TURP.

Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined.

Controversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary. Patients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence. Patients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07-1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p=0.04) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due to the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking. A simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.

Outcomes of High-Dose Rate (HDR) Brachytherapy in Intermediate- to High-Risk Prostate Cancer Patients with Prior Transurethral Resection of the Prostate (TURP)

The purpose of this study was to evaluate the effect of prior TURP on genitourinary toxicity, sexual function, and biochemical-failure free survival (bFFS) in patients receiving HDR brachytherapy at a large volume academic center. Data was prospectively collected for patients undergoing HDR brachytherapy from August 2010 to December 2016. Patients were classified according to NCCN risk criteria. Patients with favorable intermediate-risk disease underwent HDR monotherapy alone and patients with unfavorable intermediate- to high- risk disease underwent a combination of IMRT and HDR brachytherapy boost. Implants were performed under ultrasound-guidance with CT based planning. Goal dosimetric constraints included V100 Prostate >95% and D1cc Urethra <105%. Univariate log rank test was used for treatment categorization to compare biochemical-failure free survival (bFFS). Multivariate cox analysis (MVA) was performed and adjusted for age, T stage, Gleason score, initial PSA, and androgen deprivation therapy (ADT) use. Sexual health inventory for men (SHIM) score, International Prostate Symptom Score (IPSS), and CTCAE v5.0 graded toxicity were recorded. 248 patients underwent HDR brachytherapy and were included in the analysis. 31 patients had prior TURP. The median follow-up was 47 months (range 3 – 83 months) and the median age was 71 (range 57 – 83). A total of 146 and 102 patients were intermediate- and high-risk, respectively, of which and 12 and 19 patients with TURP were intermediate- and high-risk, respectively. Median time from TURP to HDR was 18 months (range 3 – 146). 14 (45%) and 7(23%) patients with a history of TURP experienced Gr 1 and 2 GU toxicity. There were no patients that experienced Gr ≥3 GU toxicity. Patient reported GU and sexual function quality of life outcomes were not found to be statistically significant between prior TURP and non-TURP patients. One patient with a prior TURP experienced a biochemical recurrence. No significant difference was observed in biochemical-failure free survival between patients who did and did not receive a prior TURP (96±4% vs. 86±4%, respectively; p = 0.36). HDR brachytherapy is a safe and effective treatment for patients diagnosed with prostate cancer who received prior TURP.

Does detrusor underactivity affect the results of transurethral resection of prostate?

We aimed to evaluate the outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and diagnosed to have weak detrusor contractility by urodynamic study. A prospective study of 32 male patients had BPH candidate for TURP diagnosed to have impaired detrusor contractility by preoperative urodynamic study. We studied the postoperative outcome after TURP regarding international prostate symptoms score (IPSS), maximum flow rate (Qmax), post-voiding residual urine (PVR), the patients need for catheter, and urodynamic pressure flow study (PFS) parameters (maximum detrusor contractility, bladder contractility index (BCI), maximum bladder capacity and compliance) after 6month follow-up. Twenty-one cases presented with urethral catheter because of chronic or refractory retention. Twenty patients voided preoperatively during PFS with mean detrusor pressure (Pdet) at Qmax 23.97 ± 25.54 cmH2O and the mean BCI was 51.04 ± 23.86, while twelve patients did not void with mean maximum Pdet 21.75 ± 7.34. After 6month follow-up, there was significant improvement in IPSS, Qmax, and detrusor contractility (Pdet at Qmax and BCI) postoperatively in all patients, and there was no significant postoperative improvement of post-voiding residual urine (p value 0.92). Finally, 11 patients voided normally without RU, 7 patients needed timed triple voiding with crede maneuver and small RU, and 14 patients needed CIC. There were significant improvements in IPSS, detrusor contractility, and urine flow after TURP in patients with BPH and weak bladder contractility, although the risk of postoperative urine retention in approximately 43% of cases and needed CIC.

Evaluation of Hypotensive Prevention Effect of Intramuscular Glycopyrrolate in Spinal Anaesthesia of Elderly TURP Patients: A Randomized Control Trial

Objective: Spinal anesthesia is one of the options for transurethral resection of the prostate (TURP) patients. However, due to patient old age, risk factors, and the procedure itself, hemodynamic instability is common and hazardous. Glycopyrrolate, an anticholinergic drug, has been used in many indications, including in hypotensive prevention in cesarean section patients undergoing spinal anesthesia. The study aims to evaluate the hypotensive prevention effect of the drug in elderly (&gt;60 years) spinal anesthesia TURP patients.Methods: Prospective randomized control trial of 62 elderly who indicated to TURP from December 2019 to January 2020. American Society of anaesthesiologists (ASA) classification of more than three, glycopyrrolate's contra-indication and unable to take spinal anesthesia, were exclusion criteria. 0.2 milligram (mg) intramuscular glycopyrrolate 15 minutes before spinal anesthesia was the primary testing process. Data were collected concurrently with hemodynamic parameters, which were recorded as a baseline and every five munites up to 60 minutes. The analysis was done with both single and repeated measure analysis.Results: Hypotensive incidence was significantly less in the glycopyrrolate group(38.7 vs. 74.2%). Intravenous fluid and vasopressor requirements were also lower. All hemodynamic parameters were higher in the treatment group, except heart rate, which was not different among the groups.Conclusion: Intra-muscular glycopyrrolate could prevent spinal anesthesia-related hypotension without a difference in heart rate in elderly TURP patients in our data.

Comparison between a transurethral prostate split and transurethral prostate resection for benign prostatic hyperplasia treatment in a small prostate volume: a prospective controlled study.

BackgroundTransurethral resection of the prostate (TURP) was considered the golden standard to treat benign prostatic hyperplasia (BPH) for decades. However, TURP was associated with low efficiency to alleviate the lower urinary tract symptoms (LUTS) and a significantly higher risk of bladder neck contracture (BNC) for patients with small-volume BPH. Our study aims to compare the therapeutic effect of a transurethral split of the prostate (TUSP) with TURP for patients with small-volume BPH (<30 mL).MethodsIn this study, 101 small-volume BPH patients were randomly divided into two groups (TUSP and TURP group). The patient’s baseline characteristics and perioperative outcomes were recorded. The follow-up was done at six months, one year and two years after surgical treatment.ResultsNo significant differences were observed between the two groups for the baseline characteristics, including age, prostate volume, prostate-specific antigen (PSA) level, concurrent disease, post-void residual (PVR), maximum urinary flow rate (Qmax), international prostate symptoms score (IPSS), and quality of life (QoL) score. The operative time and hemoglobin decrease were significantly lower in the TUSP group compared to the TURP group. However, no significant differences were observed between both groups for catheterization time, postoperative hospital stay, and incidence of transurethral resection syndrome (TURS). However, of the late complications, the incidence of BNC in the TUSP group was significantly lower than the TURP group. No significant differences were found between both groups for other complications, including postoperative bleeding, micturition urgency, micturition frequency, micturition pain, urinary tract infection, recatheterization, transient incontinence, and continuous incontinence. Follow-up results showed that the IPSS of the TUSP group was significantly lower than the TURP group, while the Qmax of the TUSP group was significantly higher than the TURP group.ConclusionsThis study shows that TUSP may be an efficient and safe treatment for small-volume BPH (<30 mL) with a lower incidence of postoperative BNC and better longtime clinical outcomes than TURP. It suggested that TUSP could be an ideal treatment choice for small-volume BPH.

Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia

PurposeTo compare clinical and functional outcomes of prostatic artery embolization (PAE) with those of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Materials and MethodsNoninferiority randomized trial was conducted involving men over 60 years of age with LUTS secondary to BPH. From November 2014 to January 2017, 45 patients were randomized to PAE (n = 23) or to TURP (n = 22). PAE was performed with 300- to 500-μm microspheres with the patient under local anesthesia, whereas bipolar TURP was performed with the patients under spinal or general anesthesia. Primary outcomes were changes in peak urinary flow (Qmax) and international prostate symptoms score (IPSS) from baseline to 12 months. Quality of life (QoL), and prostate volume (PV) changes from baseline to 12 month were secondary outcomes. Adverse events were compared using the Clavien classification. ResultsMean Qmax increased from 6.1 mL/s in the PAE group and from 9.6 mL/s in the TURP patients (P = .862 for noninferiority), and mean IPSS reduction was 21.0 points for PAE and 18.2 points for TURP subjects (P = .080) at 12 months. A greater QoL improvement was reported in the PAE group (3.78 points for PAE and 3.09 points for TURP; P = .002). Mean PV reduction was 20.5 cm³ (34.2%) for PAE subjects and 44.7 cm³ (71.2%) for TURP subjects (P < .001). There were fewer adverse events reported in the PAE group than in the TURP group (n = 15 vs n = 47; P < .001). ConclusionsReduction of LUTS in the PAE group was similar to that in the TURP group at 12 months, with fewer complications secondary to PAE. Long-term follow-up is needed to compare the durability of the symptomatic improvement from each procedure.

Update on Prostatic Artery Embolization

Background: Prostatic artery embolization (PAE) has emerged as a treatment option in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Management guidelines addressing PAE remain mixed with recommendations for more long-term trials comparing the procedure to standard therapies. Materials and Methods: This review presents PAE indications and technical considerations. To evaluate recent updates to the PAE evidence base, a limited literature search of the last 2 years was conducted. Three recent randomized controlled trials (RCTs), comparing PAE to either transurethral resection of the prostate (TURP) or sham procedure, were identified and analyzed. Results: PAE and TURP performed similarly in significant reductions in international prostate symptoms score (IPSS) and Quality of life (QoL) scoring at 3 and 12 months. The majority of improvement after PAE occurred within a few months, with potentially greater effect in patients with larger prostates and severe symptoms. TURP was generally superior in functional outcomes such as peak urinary flow (Qmax), prostate volume (PV) reduction and post void residual (PVR), although TURP patients underperformed in Qmax improvement in one trial. PAE was superior to sham procedure in all relevant outcomes at 6 months. Overall, complication rates were lower with PAE than with TURP. Conclusions: PAE and TURP produced similar significant improvements in LUTS. Functional improvements favored TURP while complication rates favored PAE. Clinical improvement after PAE significantly surpassed initial placebo effects of sham procedure. Further comparative studies with longer term follow-up are still needed.