Transurethral Resection Of The Prostate Procedures Research Articles

Efficacy of a Novel Prophylactic Scheme of Fosfomycin Trometamol in Patients Undergoing Endoscopic Surgery for Benign Prostatic Hyperplasia: Findings from a Prospective Monocentric Single-Arm Study.

This study aimed to assess the efficacy of a novel prophylactic scheme of fosfomycin trometamol in patients undergoing elective HoLEP (holmium laser enucleation of the prostate) or TURP (transurethral resection of the prostate) procedures for treating benign prostatic hyperplasia. Patients affected by benign prostatic hyperplasia and undergoing elective HoLEP or TURP procedures during the period February 2022-June 2023 were prospectively enrolled. Two 3 g oral fosfomycin trometamol doses 12 h apart were administered at 8.00 p.m. on day -1 (i.e., the day before HoLEP or TURP procedure) and at 8.00 a.m. on day 0 (i.e., the day of the surgical procedure). The following outcomes were assessed: prevalence of fever occurring in the first 48 h after surgical procedure; prevalence of urological complications occurring after the surgical procedure; prevalence of proven urinary tract infections (UTIs) and/or bloodstream infections (BSIs) at 14 days post-procedure; and prevalence of emergency department admission for UTI-related sepsis at 14 days post-procedure. Univariate analysis comparing patients with and without proven UTI, BSI, or emergency department admission at 14 days post-procedure was carried out. Overall, 96 patients (median age 70 years) undergoing HoLEP (82.3%) or TURP (17.7%) were prospectively included. Median (IQR) time of surgical procedure after the morning fosfomycin dose was 226.5 min (range 88.5-393.75 min). Fever in the post-surgical 48 h occurred in 3/96 patients (3.1%). Prevalence of proven UTI at 14 days was as low as 1.0% (1/96), whereas no patient had proven BSI or UTI-related sepsis requiring emergency department admission at 14 days. Our findings support the contention that a prophylactic scheme based on two doses of fosfomycin trometamol 12 h apart before surgical intervention may represent a valuable strategy for preventing infectious complications in urologic patients undergoing HoLEP or TURP. Larger definitive confirmatory studies are warranted.

A 27-Year Experience With Day Surgery Transurethral Resection of the Prostate.

Introduction Transurethral resection of the prostate (TURP) is the standard surgical procedure forobstructive symptoms of the lower urinary tract when medical management fails. Progression in TURP procedures has led to reduced catheterization time following transurethral prostatic resection. This study describes the methods and results of TURP performed in the day surgery setting. Materials and methods This retrospective study was performed at a day surgical hospital serving a patient population of more than 200,000 people. Over a 27-year period, a total of 1,123 patients with a mean age of 73.6 years (range: 49 to 91 years) underwent same-day conventional (electrosurgical monopolar) transurethral prostatic resection. Of the procedure, 43 patients (11%) received spinal anaesthesia, and the remainder received general anaesthesia. Results Over the years, there has been an increase in the use of medication to manage bladder outflow obstructive symptoms, which has led to the preoperative post-micturition volumes of urine being increased (>200 ml) at the time of surgical intervention. The mean American Urological Association (AUA) score was 22 (range: 10-35). Due to the reduced bladder tone preoperatively and the noted intraoperative distension of the bladder, early catheter removal is contraindicated in these patients. The mean duration of catheterization was 6.4 days (range: two to 28 days). No patient was readmitted to the hospital for retention of urine. However, 11 patients in the series had re-catheterization due to failure of micturition after the removal of the catheter. No patients were admitted to the hospital for clot retention or sepsis postoperatively. This resulted in the patients being discharged home with a catheter in place, which became our standard practice. Conclusion Conventional transurethral resection of the prostate can be effectively managed in the day surgery setting with minimal morbidity. This improves the patient's quality of life as well as the burden on hospital costs. Additionally, the outpatient nature of day surgery may lead to decreased overall healthcare expenses for both the patient and the healthcare system. As healthcare systems continue to prioritize streamlined and patient-centred approaches, day surgery for TURP emerges as a viable and advantageous option.

Predictors of Urethral Stricture After Transurethral Resection of the Prostate Procedure

Transurethral resection of the prostate (TURP) is the most frequently used urology surgical method to manage benign prostate hyperplasia (BPH). Despite the relatively efficacious treatment, urethral stricture (US) may form after TURP. The prevalence of the urethral strictures (US) following TURP ranges from 2.2% to 9.8%. The study aimed to identify the predictors of urethral strictures in patients receiving TURP. This study was a retrospective cohort study on patients underwent TURP in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, between 2015 and 2019. Data were obtained from medical records and urology registry of a minimum 12-month follow-up period. Data on patient demographics, estimated volume of the prostate, total resected prostate, and operating time were extracted. Multiple logistic regression was utilized to determine the odds ratio difference between groups. A total of 451 TURP cases were performed between 2015 and 2019, with 22 (4.87%) cases of post TURP US identified. The mean estimated prostate weight was 45.6 g and resected prostate weight was 20.4 g, with a 0.37 gr/min resection rate. Prostate weight, operating time, and duration of catheterization after surgery were not significantly different statistically. Slower resection rate and smaller resected volume are the statistically significant predictors of increased occurrence of urethral stricture (p<0.05). Lower resection rate is also a predictor for urethral stricture after TURP procedure.

Does histological prostatic inflammation during transurethral resection of the prostate for bladder outlet obstruction affect post‐operative urinary outcomes?

Benign prostate hyperplasia (BPH) is a common cause for bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS) in men. The pathophysiology of BPH is multifactorial and inflammation has been linked with progression of BPH and LUTS. The association between histological prostatitis found at transurethral resection of the prostate (TURP) and adverse post-operative urinary outcomes is not clearly defined. Our aim was to evaluate the association between histological prostatitis and adverse post-operative urinary outcomes following TURP procedure. Patients who had undergone TURP for BPH at a single institution between 2014 and 2018 were included. The study population was divided into three cohorts: those with no histological inflammation, those with any form of inflammation and those specifically with prostatic stromal inflammation. Functional outcomes were assessed by defining a series of measurable post-operative "LUTS events" and comparing these to time-to-event profile using a Kaplan-Meier estimator. A total 198 patients were included (no inflammation n=101; any inflammation n=97, prostatic stromal inflammation n=81). All three groups were comparable in terms of baseline characteristics. The any inflammation group had significantly more adverse post-operative outcomes after TURP compared to the no inflammation group, P=0.0065. The stromal inflammation group had more LUTS events after surgery compared to the no inflammation groups in the first year of follow-up n=0.011; over a 5-year follow-up period the results were not statistically significant, P=0.244. Histological prostatitis is associated with worse urinary outcomes after TURP compared to no inflammation. These results are useful in improving prognostic discussions with patients after TURP.

Effectiveness Of Saddle Block Vs Spinal Anaesthesia In Turp: An Open Label Randomized Control Trial.

One of the most frequent diseases among male gender is benign prostatic hyperplasia. Transurethral resection of the prostate (TURP) is a minimally invasive procedure for resection of prostate through endoscopic technique. Recently there was a debate on role of saddle block in TURP. There we aimed to determine the effectiveness of spinal anaesthesia versus saddle block in terms of hemodynamic stability and vasoprbessor requirement in TURP. This open label randomized control trial was performed at Hamdard University Hospital, Karachi, Pakistan, during 1st October, 2021 to 31st March, 2022. Male patients of age 45-65 years requiring TURP, with well controlled diabetes and hypertension of ASA grade I-II were included into the study and randomly assigned into two study groups. Patients' parameters including blood pressure, heart rate, mean arterial pressure and oxygen saturation (SPO2) were measured at baseline and intraoperative at every fifth minute interval till surgery completion. Patients' other parameters including age, surgery duration and comorbidity were also recorded. Total 60 patients with 30 patients in each group were enrolled into the study. Maximum fall in systolic blood pressure, diastolic blood pressure, pulse rate and mean arterial pressure from baseline was significantly lower in patients receiving saddle block anaesthesia than spinal anaesthesia. Maximum fall in SPO2 was not significantly different among two study groups. Maximum fall in all parameters excluding SPO2 was significant between two groups for initial 20 minutes of the procedure. No statistically significant maximum fall was seen for all of the parameters beyond 20 minutes of the procedure. Vasopressor consumption was significantly lower in saddle block group than spinal anaesthesia. Application of saddle block anaesthesia is effective for TURP procedure with controlled hemodynamic status than spinal anaesthesia. Moreover, saddle block requires less vasopressor consumption than spinal anaesthesia technique.

Postoperative Assessment of Cognitive Dysfunction in Patients Undergoing Transurethral resection of the Prostate under Spinal Anaesthesia: A Prospective Cohort Study

Introduction: Postoperative Cognitive Dysfunction (POCD) is a common disorder following surgery that threatens the quality of patients’ lives. POCD is closely associated with perioperative factors such as age, physical state, surgery duration, anaesthesia method, intraoperative hypotension, and infection. Among these factors, age is the only long-term risk factor for POCD. The relationship between anaesthesia depth and the incidence of POCD is debatable. Aim: To assess POCD in patients undergoing Transurethral Resection of the Prostate (TURP) and to examine the association between the duration of surgery and serum sodium levels with cognitive dysfunction. Materials and Methods: A prospective observational study was conducted at the Department of Anesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The study included 100 patients aged over 60 years who were scheduled for TURP surgery under Spinal Anaesthesia. The Mini-Mental State Examination (MMSE) test was performed in the preoperative holding area, and the results were recorded. A decline in cognitive function was defined as a loss of 2 or more points on the MMSE test compared to the preoperative value. Serum sodium levels and MMSE scores were measured before surgery. Serum sodium levels and MMSE scores were also recorded after the 1st hour and 6th hour postoperatively. The data were entered into MS Excel 2007 and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: In the present study, out of 100 subjects, the majority of patients (33%) belonged to the age group of 66-70 years, and most of the study subjects (79%) were classified as American Society of Anesthesiologists (ASA) II status, followed by ASA III status. The mean age of the study participants was 69.3 years. The mean duration of surgery was 45.6 minutes. A statistically significant difference (p<0.05) was observed when comparing the mean serum sodium levels before surgery (138.1±1.5 mmol/L) with those at the 1st hour postoperatively (135.9±1.6 mmol/L) and 6th hour postoperatively (134.4±1.4 mmol/L). The mean MMSE score before surgery and at the 1st hour and 6th hour postoperatively was the same (27.6±0.8), and there was no statistically significant difference between them. The MMSE score did not vary with the serum sodium levels, and this difference was not statistically significant (p>0.05). Conclusion: In the present study, patients undergoing TURP procedures under spinal anaesthesia did not exhibit any POCD, despite a considerable drop in serum sodium levels. It is worth noting that all patients were asymptomatic.

Effect of Surgeon and Facility Volume on Outcomes of Benign Prostatic Hyperplasia Surgery: Implications of Disparities in Access to Care at High-Volume Centers

ObjectiveTo report the effect of surgeon and facility volume on outcomes of transurethral resection of the prostate (TURP) and laser treatment of benign prostatic hyperplasia (BPH). We also investigate disparities in access to care by identifying demographic predictors of receipt of treatment at high-volume facilities. MethodsWe used New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) data. We included 18,041 (41.4%) and 25,577 (58.6%) adult patients that underwent TURP and laser procedures in the outpatient setting between January 2005 and December 2018, respectively. Average annual surgeon and facility volumes were broken down by tertile. The effect of volume on short-term outcomes (30-day and 90-day readmission) was examined using mixed-effect logistic regression models. Cox-proportional-hazard models were used to assess the association between volume and long-term stricture development and reoperation. Demographic predictors of treatment at high-volume facilities were assessed using multinomial logistic regression. ResultsHigh-volume facilities were more likely to offer laser procedures compared to low-volume facilities. Higher facility and surgeon volume were associated with lower odds of 30 and 90-day readmissions compared to low-volume facilities. There was no difference in reoperation and stricture development between surgeon volume groups. Medicaid insurance, Hispanic ethnicity, and Black race were inversely associated with treatment at high-volume facilities. ConclusionHigher surgeon and facility volumes were associated with lower odds of readmission. Higher facility volume was associated with lower hazards of reoperation and developing strictures. Medicaid insurance and non-white race were associated with lower odds of treatment at high-volume facilities, highlighting racial and socioeconomic disparities in access to high-volume BPH surgery facilities.

Bipolar radiofrequency thermotherapy vs. transurethral resection of the prostate: Effect on nocturia as a result of benign prostatic obstruction.

The purpose of this study was to investigate and compare the effects of radiofrequency thermotherapy (RF) thermotherapy and transurethral resection of the prostate (TURP) on nocturia and associated quality of life in patients diagnosed with benign prostatic obstruction (BPO) under medical treatment who have complaints of persistent nocturia. The results of patients who underwent RF thermotherapy and TURP procedures between February 2019 and February 2022 were examined, and their three-month results were compared based on their uroflowmetry values, International Prostate Symptom Score (IPSS) values, nocturia frequency, and Nocturia Quality of Life Questionnaire scores. While the frequency of nocturia in the RF thermotherapy group that was 4.5±1.6 before the procedure decreased to 2.3±1.4 after the procedure (p=0.002), this value in the TURP group decreased from 5.1±2.42 to 3.9±2.1 (p=0.044). RF thermotherapy was found to be more effective than TURP (p<0.005). Significantly, more noticeable improvements were observed in most nocturia-related next-day complaints and nocturia-related concerns in the RF thermotherapy group than the TURP group. It was observed that RF thermotherapy had a more acceptable effect on obstructive complaints in comparison to TURP, and it could be more effective on nocturia and associated quality of life. RF ablation treatment may be offered as an appropriate option to treat nocturia complaints in suitable patients.

Comparison of effectiveness and postoperative complications of different surgical methods in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis based on randomized controlled trials.

BackgroundMore and more new surgical procedures for the treatment of benign prostate hyperplasia (BPH) are proposed creatively. However, the existing clinical evidence shows that the effectiveness and safety of various procedures exist inconsistent.MethodsThe randomized controlled trials comparing the international prostate score, length of hospital stay, maximum urinary flow rate, operation time, and complication rates of prostatic artery embolization (PAE), Greenlight-XPS Laser prostate vaporization procedure (GLL PVP), diode laser enucleation of prostate (DILEP) and plasmakinetic resection of the prostate (PKRP), transurethral resection of the prostate (TURP) in patients with BPH were screened out in databases. The primary outcome was pooled using a restricted maximum likelihood-based random-effect model and inverse variance-based fixed-effect model. Cochrane Q statistics and I2 statistics were computed to quantify between-study heterogeneity. The risk of bias of each included study was assessed using the revised Cochrane risk of bias tool.ResultsThis meta-analysis ultimately included 14 original research papers, with 1,940 participants enrolled. Eight studies were considered to be at moderate risk of bias, while the others were at mild risk of bias. Although the improvement in functional outcome of the DILEP procedure was equivalent to that of the PKRP procedure, the DILEP procedure group had fewer hospital stays than the PKRP group (P=0.01). In addition, even though the performance of the GLL PVP procedure in the improvement of functional outcome was inferior to the counterpart of TURP (P=0.64), it had a much fewer hospital stays (P=0.01). Moreover, there is still insufficient evidence for the improvement of subjective functional indicators of postoperative patients with PAE compared with TURP [international prostate symptom score (IPSS): P=0.73; IPSS QoL: P=0.91], but achieved less satisfactory objective functional outcomes (Qmax: P=0.06; PVR: P=0.00).DiscussionNew surgical procedures such as GLL PVP, PAE, and DILEP were safer than traditional TURP procedures. However, it is not superior to traditional surgery in the improvement of clinical symptoms. In clinical practice, the pros and cons of the new operation and the traditional operation should be carefully weighed, and the operation that is most suitable for the patient's condition should be selected.

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.

Prostatic Artery Embolization Versus Transurethral Resection of the Prostate: A Post Hoc Cost Analysis of a Randomized Controlled Clinical Trial

PurposeTo perform a post hoc analysis of patient-incurred costs in a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP).Materials and MethodsPatients older than 60 years with indication of TURP were randomized to PAE or TURP procedure. After intervention and hospital discharge, patients were follow-up during 12 months The associated patient costs were categorized according to the study period: pre-intervention, intervention, hospitalization, and follow-up. Several items for both groups were analyzed within each study period.ResultsThe mean total costs per patient were lower for PAE (€ 3,192.87) than for TURP (€ 3,974.57), with this difference of € 781.70 being significant (p = 0.026). For most evaluated items, the mean costs were significantly higher for TURP. No significant differences were observed in the mean costs of PAE (€ 1,468.00) and TURP (€ 1,684.25) procedures (p = 0.061). However, the histopathology analysis, recovery room stay, and intraoperative laboratory analysis increased the interventional costs for TURP (€ 1,999.70) compared with PAE (€ 1,468.00) (p < 0.001). No cost differences were observed between PAE (€ 725.26) and TURP (€ 556.22) during the 12 months of follow-up (p = 0.605). None of patients required a repeat intervention during the study period.ConclusionsConsidering the short-term follow-up, PAE was associated with significantly lower costs compared with TURP. Future investigations in the context of routine clinical practice should be aimed at comparing the long-term effectiveness of both procedures and determining their cost-effectiveness.Level of evidence: Level 1 (a-c)

Patient related factors affecting in-hospital costs of a TURP procedure

Introduction: Treatment costs of lower urinary tract symptoms secondary to benign prostatic enlargement (BPE) are a substantial economic burden that will continue to increase in the future as a result of the ageing male population and increasing health awareness. The true costs for surgical interventions against BPE have been difficult to quantify as treatment costs strongly depend on the performance setting and may also vary among different healthcare systems, regions and institutions. The purpose of this study was to disclose the in-hospital costs and main expense items associated with a transurethral resection of the prostate (TURP). Methods: A cohort of men subjected to TURP due to BPE was analysed during a 3-year period (2017–2019). All in-hospital expenses were registered using an electronic spreadsheet. Patient background and perioperative variables were registered using retrospective chart reviews. Results: A total of 122 men were available for final analysis. Of these, 70 men were operated on due to bothersome LUTS and 52 men due to urinary retention. The mean and median (inter quartile range) cost per patient was €4025 and €3702 (2961 − 4390), respectively. The main drivers of total cost were length of stay, the surgical procedure and anaesthesia related costs. Factors associated with increasing total cost per patient were increasing age, prostate volume, presence of urinary retention, occurrence of complications, increasing catheter time and length of stay. Conclusion: The main factor that influences total cost for an elective TURP procedure is the occurrence of postoperative complications. Our findings firmly underscore the indispensability to employ every possible means to avoid and prevent complications of any kind.

Analyse des coûts de la photovaporisation prostatique au laser Greenlight versus résection transurétrale de la prostate : intérêt de la prise en charge ambulatoire

To compare the costs associated with GreenLight XPS 180W photoselective vaporization of the prostate (PVP) for an outpatient versus standard transurethral resection of the prostate (TURP) with a three nights hospitalization in a French private hospital. A retrospective cost minimization analysis was performed between 2017 and 2019 in a French private hospital for the hospital stays associated with TURP and PVP procedures for benign prostatic hyperplasia (BPH). The peri-operative cost-benefit assessment of the two procedures was analyzed from the establishment's point of view according to the micro-costing method. 871 surgical treatment for BPH had been performed during the period of the study, including 743 photoselective laser vaporization (85%). The average length of stay of patients undergoing TURP was 3,7 days versus 0,9 days for PVP including 64,7% ambulatory. The cost-benefit was more of 500€ per patient in favor of ambulatory PVP compared with TURP in conventional three nights hospitalization for level 1 hospital stays. In this private hospital center, ambulatory PVP seemed more cost-effective than TURP with a three nights hospitalization for a severity level 1 patient. The financial profit for the establishment was mostly due to reduction of the main length of stay and ambulatory care. 3.

Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: a population-based cohort study.

To evaluate the incidence and predictors of hospital readmission and emergency department (ED) visits in patients with benign prostatic hyperplasia treated by transurethral resection of the prostate (TURP). We conducted a retrospective cohort study using a linked administrative dataset from Calgary, Canada. Participants were men who underwent their first TURP procedure between 2015 and 2017. We examined patient demographics, and type of surgery (elective or urgent). Comorbidities were scored using the Charlson comorbidity index (CCI). The primary outcomes were unplanned hospital readmissions and ED visits at 30, 60 and 90 days after TURP. The secondary aim was to identify potential predictors across these groups. We identified 3059 men, most of whom underwent elective TURP (83%). The mean (sd) patient age was 71.0 (10.0) years. A total of 224 patients (7.4%) were readmitted to the hospital within 30days, 290 (9.5%) within 60days, and 339 (11.1%) within 90days of discharge. The frequency of return visits within 30, 60 and 90 days of TURP were 21.4%, 26% and 28.6%, respectively. The most responsible diagnoses for ED visit within 90days were haematuria (15.4%) and retention of urine (12.8%). Multivariable analysis showed that age (odds ratio [OR] 1.61, P < 0.001), surgery type (OR 2.20, P < 0.001), and CCI score (OR 2.03, P < 0.001) were independently associated with odds of readmission and ED visits at all time points. Older age, poorer health and urgent surgery predicted return to ED or readmission after TURP; efforts should be made to improve selection, counselling and preoperative optimization based on these risks.

The cost-effectiveness of transurethral resection of the prostate vs thulium laser transurethral vaporesection of the prostate in the UNBLOCS randomised controlled trial for benign prostatic obstruction.

To determine the cost-effectiveness of the current 'gold standard' operation of transurethral resection of the prostate (TURP) compared to the new laser technique of thulium laser transurethral vaporesection of the prostate (ThuVARP) in men with benign prostatic obstruction (BPO) within the UK National Health Service (NHS). The trial was conducted across seven UK centres (four university teaching hospitals and three district general hospitals). A total of 410 men aged ≥18years presenting with either bothersome lower urinary tract symptoms (LUTS) or urinary retention secondary to BPO, and suitable for surgery, were randomised (whilst under anaesthetic) 1:1 to receive the TURP or ThuVARP procedure. Resource use in relation to the operation, initial inpatient stay, and subsequent use of NHS services was collected for 12months from randomisation (equivalent to primary effectiveness outcome) using hospital records and patient questionnaires. Resources were valued using UK reference costs. Quality adjusted life years (QALYs) were calculated from the EuroQoL five Dimensions five Levels (EQ-5D-5L) questionnaire completed at baseline, 3- and 12-months. Total adjusted mean costs, QALYs and incremental Net Monetary Benefit statistics were calculated: cost-effectiveness acceptability curves and sensitivity analyses addressed uncertainty. The total adjusted mean secondary care cost over the 12months in the TURP arm (£4244) was £9 (95% CI -£376, £359) lower than the ThuVARP arm (£4253). The ThuVARP operation took on average 21min longer than TURP. The adjusted mean difference of QALYs (0.01 favouring TURP, 95% CI -0.01, 0.04) was similar between the arms. There is a 76% probability that TURP is the cost-effective option compared with ThuVARP at the £20000 per QALY willingness to pay threshold used by National Institute for Health and Care Excellence (NICE). One of the anticipated benefits of the laser surgery, reduced length of hospital stay with an associated reduction in cost, did not materialise within the study. The longer duration of the ThuVARP procedure is important to consider, both from a patient perspective in terms of increased time under anaesthetic, and from a service delivery perspective. TURP remains a highly cost-effective treatment for men with BPO.

Infective Endocarditis Following TURP Procedures: A Case Report and Review of Literature

A common treatment and management of BPH is transurethral resection of the prostate (TURP) with at least 150,000 TURPs performed per year in the United States. Rates of bacteremia following TURP can be as low as 1% when antimicrobial prophylaxis is given. Patients can develop many common sequelae as a result of bacteremia secondary to TURP including bacteriuria and urinary tract infection; however, more serious complications such as endocarditis are quite rare (~1 in 4200 cases). Here we present a case of a 67 year-old-male with BPH who underwent two TURP procedures; both with appropriate antibiotic prophylaxis who was subsequently diagnosed with endocarditis

Effects of prophylactic intravenous dexamethasone versus pethidine for prevention of post-spinal anesthesia shivering for patients who underwent transurethral resection of the prostate under spinal anesthesia: Prospective cohort study

BackgroundShivering is commonly observed as a complication after Regional Anesthesia. Pethidine has been thought as a standard for prevention and treatment of shivering but it is not without side effects. Studies showed that dexamethasone also has promising effect with fewer side effects even though there are controversies. ObjectiveTo compare the effect of prophylactic dexamethasone and pethidine on prevention of post-spinal anesthesia shivering for patients who underwent transurethral resection of the prostate (TURP) at Dagmawi Minilik second hospital from October 26 to January 24/2020. MethodsAn institutional-based prospective cohort study was conducted on 64 patients who fulfilled inclusion criteria and underwent TURP. A convenient sampling technique was used to recruit study participants. Independent sample t-test statistics and Mann-Whitney U test were used for quantitative data that was distributed normally and none normally respectively. A Chi-square test was used to compare differences in categorical data. P-value <0.05 was considered as statistically significant. ResultThe incidence and severity of shivering was comparable between pethidine and dexamethasone group (p value > 0.05). There was no statistically significant difference in the meantime to the first onset of shivering between dexamethasone (65 min) and pethidine (81 min) group (p = 0.23).The median consumption of total antishivering medication was comparable between dexamethasone (54.2 mg of tramadol) and pethidine (68.8 mg of tramadol) group (p = 0.21). ConclusionDexamethasone (4 mg) is equally effective as pethidine (25 mg) that of standard antishivering drugs. The use of dexamethasone (4 mg) as an alternative of pethidine as a prophylaxis for the prevention of shivering for patients undergoing TURP procedures under spinal anesthesia.

The morbidity associated with a TURP procedure in routine clinical practice, as graded by the modified Clavien-Dindo system

Background: Transurethral resection of the prostate (TURP) is considered the reference surgical method of treating benign prostatic enlargement (BPE) causing obstruction. The procedure still carries a significant risk of perioperative morbidity according to previous reports. The aim of the present study was to disclose complications after TURP undertaken in routine clinical practice at a non-academic center.Methods: All patients with BPE submitted to TURP from January 2010 to December 2012 were evaluated for complications occurring during hospital stay, after discharge up to the end of the third post-operative month and finally for any late endourological re-interventions undertaken up to five years after TURP. All complications were graded according to the Clavien-Dindo system.Results: In total, 354 men underwent a TURP during the study period. In total, 47% had pre-operative urinary retention. Significant co-morbidity was seen in 17% of men (ASA III–IV). Spinal anaesthesia was applied to 312 men (88%). During hospital stay, major complications, graded as Clavien-Dindo ≥ III, was seen in only eight men (2.3%). Minor complications occurred in 91 men (26%). Between hospital discharge and follow-up visit major complications were noted in 12 men (3.4%). Minor complications occurred in 79 men (22%). The only factor that was associated with an increased risk of a major complication was general anaesthesia. Late complications, requiring an endourological re-intervention, occurred in 30 men (9.7%).Conclusion: TUR-P in routine clinical practice was associated with a low incidence of severe complications. TUR syndrome was very rare. Within five years a small proportion of men require the transurethral intervention to be redone.

Correlation between testosterone level, serum prostate-specific antigen level, and diabetes mellitus with grade inflammation of the prostate

Introduction: Benign Prostate Hyperplasia is the most common degenerative disease in men, characterized by an increase in prostate epithelial and stromal cells, that leads to impairment of urinary flow. The risk factor of BPH was uncertain, some studies showed that reduced testosterone level leads to BPH. Evidence suggests that modifiable factors may influence the risk of BPH, such as diabetes mellitus, PSA level, and inflammation. Pro-inflammatory mediators regulate the proliferation and differentiation of prostate tissue. This study aimed to determine correlation between testosterone level, PSA level, and blood glucose and grade inflammation of prostate.Methods: An analytic cross sectional study was done in 72 BPH patients of Sanglah Hospital Urology clinic. All samples underwent PSA level, testosterone, blood glucose measurement before transurethral resection of the prostate procedure. The grade inflammation of prostate was then determined by pathologist. All data obtained were analyzed by univariate, bivariate, and multivariate analysis using SPSS version 20.0 statistical software.Results: Seventy-two samples included in this study with age range from 50 to 84 years old. Grade inflammation of prostate was significantly correlated with PSA level with p-value 0,006 and prevalence ratio (PR) 2 with 95% CI (1.129-3.544). Testosterone level was not significantly correlated with grade inflammation of prostate (PR 1.233; 95% CI: 0.804-1.891; p=0.334). Blood glucose level and grade inflammation of prostate showed PR 1.943 with 95% CI (1.542-2.447) with p-value 0.058, but after multivariate analysis the p-value was 0.022.Conclusion: Grade inflammation of prostate was significantly correlated with blood glucose level and serum PSA level.

Ejaculation Preserving Technique in TURP Is it safe?

Background: The treatment of bladder outlet obstruction in patients diagnosed with benign prostatic hyperplasia using the transurethral resection of the prostate procedure often presents with retrograde ejaculation as a complication due to bladder neck stenosis. Objective:To determine the safety and ease of use of the ejaculation preservation technique of the transurethral resection of the prostate procedure. Patients and Methods: The study was done in Samarra city in Iraq, included 30 patients between the ages of 50 and 62 years. The resection of the prostate was done a centimeter above the verumontanum in order to preserve the paraculcular tissue. The patients were assessed for the degree of ejaculate using the Ejaculation Projection Score. The patients were also evaluated for erectile function using the International Index of Erectile Function and for urinary retention using the International Prostate Symptom Score. The assessments were done preoperative, 4 months and 36 months after the ejaculation-preserving transurethral resection of the prostate procedure. Results: The maximum flow rate increased from 5.4ml/s to 21±5.2ml/s (n=29, p-value<0.001). IPSS improve from 24 to 5±2.5 (n=29, p-value<0.001). The quality of life score improved from 5.7 to 1.4±1.0 (n=29, p-value<0.001). The residual urine volume reduced from 150ml to 23± 14 (n=29, p-value<0.001). The erectile function reduced from 4 to 3.7 while the EPS reduced from 3.5±0.5 to 3.3+-0.5 (p-value=0.57). 96.7% of the patients ejaculated postoperatively. Statistical analysis was done with SPSS version 15 for windows, P value and T test for significance of results being P value < 0.05. Conclusion: There is evidence to show that the ejaculation preserving technique of the transurethral resection of the prostate is safe and secure to use. It protects anterograde ejaculation while reducing urine retention.