Transurethral Resection Of The Prostate Surgery Research Articles

Comparative Study of Spinal, Epidural, and Sequential Combined Spinal Epidural Anesthesia in Geriatric Patients for Transurethral Resection of the Prostate.

Sequential combined spinal epidural anesthesia (CSEA) is probably the greatest advancement in the central neuraxial block in this decade for geriatric patients due to the potential advantages ofboth spinal and epidural anesthesia. This study was designed to compare the clinical effects of sequential CSEA versus spinal and epidural anesthesia in geriatric patients undergoing transurethral resection of the prostate (TURP). Ninety patients aged 65 to 80 years were randomly allocated into three groups of 30 each. Group A (n=30) patients were administered spinal anesthesia with 2.5 ml of 0.5% hyperbaric bupivacaine, group B (n=30) received epidural anesthesia with 15 ml of 0.5% isobaric bupivacaine, and group C (n=30) received sequential CSEA with 1 ml of 0.5% hyperbaric bupivacaine and 6 ml of 0.5% isobaric bupivacaine given through epidural route to extend the block up to T10. Patients were observed for hemodynamic parameters, sensory and motor block, total dose required to establish the desired level, and patient satisfaction score. None of the patients were excluded in the study. Group A patients reported rapid onset of sensory block (3.08±11.57 minutes) compared to group B (11.57±1.48 minutes), and group C (5.47±1.25 minutes). The onset of motor block was expeditious in group A (8.08±1.0 minutes) compared to group B (20.33±1.86 minutes) and group C (15.53±1.31 minutes). Patients in group B had maximum hemodynamic stability but with delayed onset and were technically more complex than group A. Patients in group C were hemodynamically more stable than group A. They had a faster onset of action with decreased doses of local anesthetic drug requiredcompared to group B. Sequential CSEA is a safe, effective, andreliable technique that combines the advantages of both spinal and epidural while minimizing their disadvantages. It has the advantage ofstable hemodynamic parameters along with the provision of prolongation analgesia for geriatric patients undergoing TURP surgery.

The Effect of Low-Flow versus High-Flow Anesthesia on Postoperative Cognitive Functions in Geriatric Patients Undergoing TUR-P Surgery

Introduction: This paper investigates the effect of low-flow anesthesia applications on postoperative cognitive function in geriatric age group (≥65 years old) patients who underwent elective transurethral resection of the prostate surgery. Materials and Method: A total of 98 patients aged 65 and over who underwent elective transurethral resection of the prostate surgery under general anesthesia between December 2021 and November 2022 in Hatay Mustafa Kemal University Research Hospital’s Department of Anesthesiology and Reanimation were included in the study. The patients were subjected to a mini mental test the day before the operation and postoperatively at six hours, one day, three days, and seven days. Visual analogue scale scores were evaluated at 3, 6, 12, 24, 48, and 72 hours. The data obtained were compared between the patient groups who underwent low-flow (1 L/min, n: 49) and high flow (4 L/min, n: 49) anesthesia. P< 0.05 was considered statistically significant. Results: A comparison between the postoperative 6thhour, 1st day, 2nd day, 3rd day, and 7th day mini mental testing scores of the low-flow anesthesia and high flow anesthesia groups did not exhibit any notable variations (p: 0.668, 0.785, 0.745, 0.705, respectively). The visual analogue scale scores of the cases at 3, 6, 12, 24, 48, and 72 hours did not differ statistically according to the type of flow applied (p: 0.316, 0.925, 0.651, 0.548, 0.624, 0.466, respectively). Conclusion: It is thought that low-flow anesthesia can be applied safely, but it does not have a significant effect on cognitive functions compared to high flow anesthesia. Keywords: Anesthesia, General; Sevoflurane; Cognitive Dysfunction; Geriatrics.

The effect of transurethral resection of the prostate on sexual life quality in patient spouses

AbstractThe purpose of this study was to determine the effect of transurethral resection of the prostate (TURP) surgery on quality of sexual life in patients' spouses. A pre/post‐operative test, quasi‐experimental design with no control group was employed. The research was conducted in the urology clinics of two hospitals in the west of Turkey between 30 June and 30 September 2022. It was completed with 172 patient spouses recruited using non‐probability sampling. The study data were collected using an individual information form and the Sexual Quality of Life‐Female questionnaire. The preoperative test applied prior to surgery was administered by the face‐to‐face interview method, while the postoperative test was completed by telephone interviews 8 weeks after the initial data collection. The mean age of the individuals undergoing TURP surgery in this study was 62.69 ± 7.98 years (min 40, max 77), and the mean age of the spouses was 57.91 ± 7.46 (min 39, max 73). Sexual Quality of Life‐Female scores after surgery were significantly higher than the pre‐surgical values (p < 0.001). A significant difference in sex life quality was determined in terms of age, education, employment status, presence of chronic disease, number of children, and ‘love marriages’ (p < 0.05). The sexual life quality of the spouses of patients exposed to TURP surgery increased significantly 8 weeks after the procedure. The quality of sex life was higher among individuals with higher education levels, working individuals, and those who ‘married for love’, but decreased in line with age and number of children.

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.

Acute tubular necrosis after transurethral resection of the prostate: a case report.

We had a 67-year-old male patient who had benign prostate hyperplasia unresponsive to tamsulosin. He underwent TURP surgery. After that, he had acute tubular necrosis because of hemolysis. We performed hemodialysis to decrease serum creatinine level. Acute tubular necrosis is the result of hemolysis. Rapid absorption of large volumes of glycerin may lead to hypotension and acute kidney injury. Using distilled water for irrigation during TURP may lead to severe complications like hypotension and acute tubular necrosis.

Venous Thromboembolism and Bleeding after Transurethral Resection of the Prostate (TURP) in Patients with Preoperative Antithrombotic Therapy: A Single-Center Study from a Tertiary Hospital in China.

Venous thromboembolism (VTE) and postoperative hemorrhage are unavoidable complications of transurethral resection of the prostate (TURP). At present, more and more patients with benign prostate hyperplasia (BPH) need long-term antithrombotic therapy before operation due to cardiovascular diseases or cerebrovascular diseases. The purpose of this study was to investigate the effect of preoperative antithrombotic therapy history on lower extremity VTE and bleeding after TURP. Patients who underwent TURP in the Department of Urology, Xiangya Hospital, Central South University, from January 2017 to December 2021 and took antithrombotic drugs before operation were retrospectively analyzed. The baseline data of patients were collected, including age, prostate volume, preoperative International Prostate Symptom Score (IPSS), complications, surgical history within one month, indications of preoperative antithrombotic drugs, drug types, medication duration, etc. Main outcome measures included venous thromboembolism after TURP, intraoperative and postoperative bleeding, and perioperative blood transfusion. Secondary outcome measures included operation duration and postoperative hospitalization days, the duration of stopping antithrombotic drugs before operation, the recovery time of antithrombotic drugs after operation, the condition of lower limbs within 3 months after operation, major adverse cardiac events (MACEs), and cerebrovascular complications and death. A total of 31 patients after TURP with a long preoperative history of antithrombotic drugs were included in this study. Six patients (19.4%) developed superficial venous thrombosis (SVT) postoperatively. Four of these patients progressed to deep vein thrombosis (DVT) without pulmonary thromboembolism (PE). Only one patient underwent extra bladder irrigation due to blockage of their urinary catheter by a blood clot postoperatively. The symptoms of hematuria mostly disappeared within one month postoperatively and lasted for up to three months postoperatively. No blood transfusion, surgical intervention to stop bleeding, lower limb discomfort such as swelling, MACEs, cerebrovascular complications, or death occurred in all patients within three months after surgery. Short-term preoperative discontinuation may help patients with antithrombotic therapy to obtain a relatively safe opportunity for TURP surgery after professional evaluation of perioperative conditions. The risks of perioperative bleeding, VTE, and serious cardiovascular and cerebrovascular complications are relatively controllable. It is essential for urologists to pay more attention to the perioperative management of these patients. However, further high-quality research results are needed for more powerful verification.

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.

The factors affecting occurrence of urethral stricture after transurethral resection of the prostate

<b>Objectives: </b>Urethral stricture is one of the complex subjects of urology in terms of high recurrence rates, patient care, treatment difficulties and follow-up.<b> </b>We aimed to evaluate factors associated with the occurrence of urethral stricture after TUR-P (Transurethral resection of the prostate) surgery.<br /> <b>Material and methods: </b>In our clinic<b>, </b>301 patients who underwent TUR-P surgery for benign prostatic hyperplasia (BPH) were analyzed retrospectively. The patients who developed urethral stricture after TUR-P were named Group-1, did not develop were named Group-2. In addition, the patients were compared in terms of demographic and perioperative data. <br /> <b>Results: </b>Urethral stricture was observed in 21 (6.97%) of the patients and not in 280 (93.03%) of them. There was no significant difference between the two groups in terms of age (p=0.913), resectoscope size (p=0.932), energy source type (p=0.932), energy source power (p=0.838), urethral catheter type (p=0.776), urethral catheter size (p=0.973), urethral catheter duration (p=0.797) and urethral catheter traction (p=0.887). Resection time was significantly higher in patients with urethral stricture (53.1±10.8 min vs. 42.2±9.7 min, p<0.001). The preoperative urinary tract infection (UTI) rate was significantly higher in patients with urethral stricture. (76.2% vs 40.0%, p=0.001). The optimum cut-off value for resection time associated with the risk of urethral stricture after TUR-P was 38.5 minutes, with an AUC of 0.812 (95% CI 0.738–0.885).<br /> <b>Conclusion: </b>Prolonged resection time and even if treated, preoperative UTI increases the risk of urethral stricture after TUR-P surgery. However, if the resection time is not long, patients are more protected from developing urethral stricture.

Frequency of Erectile Dysfunction after Transurethral Resection of Prostate

Background: The most effective treatment for symptomatic benign prostatic hyperplasia is surgery. When a patient is diagnosed with BPH and surgery is scheduled, the urologist will usually do transurethral resection of the prostate (TURP) to alleviate symptoms due to its positive results. The effect of TURP on sexual function, on the other hand, is yet unknown and debated.Objective: The purpose of this study was to determine the incidence of ED in sexually active adult males.Materials and Methods: The following are the materials and procedures that were used to complete this project. A total of 165 individuals between the ages of 40 and 65 years old with LUTS symptoms were included in the study. Patients with uncontrolled diabetes, a big prostate, bladder stones, or complicated urethral illness, such as corrected hypospadia or repaired urethral stricture disease, were excluded from the study. Every patient had TURP surgery and was cared for according to our ward routine until he was discharged. Results: The study's participants ranged in age from 40 to 65, with a mean age of 57.50 3.10 years. The majority of the 114 patients (69.09%) were between the ages of 56 and 65. Pre-operative IIEF-5 scores were 18.53 5.24, while post-operative IIEF-5 scores were 15.06 2.50. Patients with ED following TURP were observed in 29 (17.58%) of sexually active adult males, with mild ED in 13 (44.83%), moderate ED in 09 (31.03%), and severe ED in 07 (24.14%).Keywords: benign prostatic hyperplasia, transurethral resection of prostate, erectile dysfunction.

Cerebrovascular accident after transurethral resection of the prostate: A rare complication.

IntroductionBenign prostatic hyperplasia is considered a worldwide disease among males in middle age. Transurethral resection of the prostate (TURP) is a wide used intervention for this condition. A few reports mentioned cerebrovascular accidents after TURP.Presentation of caseA 65-year-old male presented with recurrent urinary retention in the past two years. Clinical examination showed a full urinary bladder with abdominal discomfort. Abdominal ultrasound revealed an enlarged prostate (90 ml) with approximately 500 ml of urine. After that, we performed transurethral resection of the prostate (TURP). The surgery was uneventful. After three days of discharge, he presented with a loss of vision in the left eye and left lower limb pain. Computed tomography of the brain showed right occipital lobe infarction. Ultrasound of the left lower limb revealed deep venous thrombosis. Echocardiography showed a patent foramen ovale. As a result, he had deep venous thrombosis with patent foramen ovale that led to infarction. We started with anticoagulants for two weeks. Later, he reclaimed his vision completely.Clinical discussionCerebral vascular accidents are a rare complication of transurethral resection of the prostate. Early recognition and diagnosis of this condition will lead to good results. Searching for cardiac anomalies is the first step to reaching the diagnosis.ConclusionUrologists should suspect cardiac anomalies in patients who underwent TURP surgery and develop cerebrovascular accidents. Collaboration with other specialties is considered basic to help with this complication.

A Complication Arising as a Result of a Severe COVID-19 Infection: Prostatic Infarction

A 57-year-old male patient diagnosed with coronavirus disease nearly 2 months ago and started to be treated was admitted to intensive care after 2 weeks due to the deterioration of his general condition. The patient’s general condition improved during 3 weeks of intensive care, and he was moved to the regular unit, and his catheter was removed. Three days after being discharged from the hospital, the patient went to the emergency department due to urethral bleeding and inability to urinate. The patient had urethrorrhagia and globe vesical. A cystofix was inserted as a catheter could not be inserted. Following the urology consultation, it was decided to perform a transurethral resection of the prostate surgery. The prostate was found to be fully infarcted during the operation. Three days after the surgery, his catheter was removed, and the patient urinated spontaneously. He was then discharged. It was understood that prostatic infarctions may arise as a result of COVID-19 infection.

Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate.

We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.

Impact of statin use on perioperative bleeding in patients with benign prostatic hyperplasia who underwent monopolar TURP

Objective: We aimed to evaluate the effect of statin use on bleeding complications in benign prostate hyperplasia (BPH) patients who underwent transurethral resection of the prostate (TURP).Material and Methods: This prospective case-control study included patients with benign prostatic hyperplasia (BPH) who underwent TURP surgery. Seventy-six patients were included (30 statin users and 74 statin non-users). Data including patient age, preoperative laboratory values(complete blood count, prostate-specific antigen (PSA) levels, prostate volume, international normalized ratio (INR), activated partial thromboplastin time (aPTT)), intraoperative characteristics(amount of resected prostate tissue, blood transfusion, duration of surgery, duration of urinary catheterization) and postoperative features(serum complete blood count, and length of hospital stay)were collected. Patients who underwent TURP with or without statin use were compared with hematocrit and bleeding complications. Results: There was no difference between the groups regarding the degree of reduction in hematocrit and platelet count. In both groups, postoperative hematocrit and platelet counts were significantly lower than preoperative values. There was no significant difference between the groups regarding age, PSA, prostate volume, histopathological diagnosis, transurethral resection (TUR) volume, INR, PT, aPTT, number of red blood cell (RBC) units transfused, duration of surgery, irrigation time, hematocrit, and platelet count. TUR volume, frequency of anticoagulant use, duration, and length of hospital stay were statistically higher in the statin user groupConclusion: Our results showed that statin use did not impact bleeding in patients with BPH who underwent TURP. Considering the widespread use of statins, during surgery the effects of bleeding, we need more information on further studies to light.

An Automatic Bleeding-Rank System for Transurethral Resection of the Prostate Surgery Videos Using Machine Learning.

Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in aging males. Transurethral resection of the prostate (TURP) surgery is performed by a cystoscope passing through the urethra and scraping off the prostrate piece by piece through a cutting loop. Although TURP is a minimally invasive procedure, bleeding is still the most common complication. Therefore, the evaluation, monitoring, and prevention of interop bleeding during TURP are very important issues. The main idea of this study is to rank bleeding levels during TURP surgery from videos. Generally, to judge bleeding level by human eyes from surgery videos is a difficult task, which requires sufficient experienced urologists. In this study, machine learning-based ranking algorithms are proposed to efficiently evaluate the ranking of blood levels. Based on the visual clarity of the surgical field, the four ranking of blood levels, including score 0: excellent; score 1: acceptable; score 2: slightly bad; and 3: bad, were identified by urologists who have sufficient experience in TURP surgery. The results of extensive experiments show that the revised accuracy can achieve 90, 89, 90, and 91%, respectively. Particularly, the results reveal that the proposed methods were capable of classifying the ranking of bleeding level accurately and efficiently reducing the burden of urologists.

Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

BackgroundBench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. ObjectiveTo validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participantsHolmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysisThe video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitationsA total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) ConclusionsBased on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summaryAn increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.

Enucleation vs. Resection: A Matched–pair Analysis of TURP, HoLEP and Bipolar TUEP in Medium–sized Prostates

To evaluate efficacy and safety of holmium laser enucleation of the prostate (HoLEP), bipolar enucleation of the prostate (bTUEP) and transurethral resection of the prostate (TURP) in medium-sized prostates (50cc). We present a retrospective analysis of 2230 patients treated for lower urinary tract symptoms. We analysed perioperative parameters, short-term clinical outcomes and adverse events in matched-pair cohorts. Both HoLEP and bTUEP were superior in terms of efficacy compared to TURP (surgery time: 51min and 50min vs. 60min; P < 0.001; tissue retrieval percentage: 71.4% and 70% vs. 50%; P < 0.001) and showed stronger improvement of LUTS (change IPSS: -15 and -14 vs. -10; P=0.008). Furthermore, urodynamic parameters (Qmax: +15 ml/s and +19 ml/s vs. +12 ml/s; P < 0.001; PVR: -100 ml and -95 ml vs. - 80ml; P < 0.008) were significantly more improved after enucleation than after TURP. All techniques showed an equally low complication rate (6.9% and 6.9% vs. 10.3%; P=0.743). No relevant difference of clinical outcomes was identified between HoLEP and bTUEP. Both resection and enucleation are efficient and safe procedures in patients with medium-sized prostates (50cc), but irrespective of the technical approach, transurethral enucleation is superior to TURP in terms of perioperative and functional outcomes.

Does finasteride affect blood loss during monopolar transurethral resection of the prostate?

Objectives To evaluate the effect of preoperative finasteride on the surgical blood loss during monopolar transurethral resection of the prostate (TURP). BackgroundBenign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in elder men. Prophylactic measures have been employed to reduce perioperative bleeding, including preoperative 5α-reductase inhibitors administration. Finasteride and dutasteride can block the conversion of testosterone to dihydrotestosterone and have been used to treat BPH and BPH-related hematuria.Patients and methodsWe conducted a randomized controlled study at the Urology Department of Menoufia University Hospital, comparing the preoperative use of finasteride 5 mg over the intraoperative bleeding during TURP. A total of 90 patients with BPH with prostate size varying between 40 and 90 g assigned for a monopolar TURP surgery were randomly allocated into three groups: the first group as control, the second group used finasteride 5 mg for 2 weeks before surgery, and the third group used finasteride 5 mg for 4 weeks before surgery.ResultsThere was an insignificant difference between the three groups regarding age or associated comorbidities. Calculated blood loss was lower for the second and third groups in comparison with the control one (P = 0.046).ConclusionResults of our study elicit that treatment with finasteride for even 2 weeks before surgery significantly reduces surgical bleeding.

Automated Classification of Blood Loss from Transurethral Resection of the Prostate Surgery Videos Using Deep Learning Technique

Transurethral resection of the prostate (TURP) is a surgical removal of obstructing prostate tissue. The total bleeding area is used to determine the performance of the TURP surgery. Although the traditional method for the detection of bleeding areas provides accurate results, it cannot detect them in time for surgery diagnosis. Moreover, it is easily disturbed to judge bleeding areas for experienced physicians because a red light pattern arising from the surgical cutting loop often appears on the images. Recently, the automatic computer-aided technique and artificial intelligence deep learning are broadly used in medical image recognition, which can effectively extract the desired features to reduce the burden of physicians and increase the accuracy of diagnosis. In this study, we integrated two state-of-the-art deep learning techniques for recognizing and extracting the red light areas arising from the cutting loop in the TURP surgery. First, the ResNet-50 model was used to recognize the red light pattern appearing in the chipped frames of the surgery videos. Then, the proposed Res-Unet model was used to segment the areas with the red light pattern and remove these areas. Finally, the hue, saturation, and value color space were used to classify the four levels of the blood loss under the circumstances of non-red light pattern images. The experiments have shown that the proposed Res-Unet model achieves higher accuracy than other segmentation algorithms in classifying the images with the red and non-red lights, and is able to extract the red light patterns and effectively remove them in the TURP surgery images. The proposed approaches presented here are capable of obtaining the level classifications of blood loss, which are helpful for physicians in diagnosis.

Spinal Anesthesia with a Low Dose of Hyperbaric Bupivacaine plus Fentanyl versus Hyperbaric Bupivacaine for Transurethral Resection of Prostate surgery: Hemodynamic Effects, Duration of Analgesia and Motor Block

Background: Spinal anesthesia is the most prevalent anesthetic method used for transurethral resection of the prostate (TURP) surgery. Lower motor block and fewer side effects can be achieved by lower doses of anesthesia. Aim: The present study aimed to compare the effects of Spinal anesthesia with a low dose of hyperbaric bupivacaine plus fentanyl with hyperbaric bupivacaine for TURP surgery on hemodynamic effects, duration of analgesia, and Motor block. Method: This randomized-controlled study was conducted on 62 patients undergoing TURP surgery within 2017-18. BF group received 0.5% hyperbaric bupivacaine(1mg) 0.2 ml+fentanyl (20µg) 0.4 ml+5% dextrose 1.4ml, while B group received 0.5% hyperbaric bupivacaine (10mg)2ml. Bromage scale and Visual Analog Scale of pain and Nausea were used. The obtained data were analyzed in SPSS software version (20). Results: Groups were homogenous in terms of demographic characteristics. The time to reach the sensory level of T10 was significantly longer in the BF group, compared to the B group (P<0.001). The motor block score was less in the BF group than the B group. The mean total recovery time of the sensory block to L5 in the BF group was significantly lower than that of the BF group (P<0.001). The mean score of nausea severity during surgery was significantly lower in the BF group, compared to the B group (P=0.02). The hemodynamic stability was higher in the BF group. Implications for Practice: A combination of 1mg bupivacaine with 20μg fentanyl could be used for anesthesia in TURP surgery as an effective method to provide sufficient analgesic effects, as well as lower motor block and side effects.

Dural sac cross-sectional area is a highly effective parameter for spinal anesthesia in geriatric patients undergoing transurethral resection of the prostate: a prospective, double blinded, randomized study

BackgroundSpinal anesthesia is optimal choice for transurethral resection of the prostate (TURP), but the sensory block should not cross the T10 level. With advancing age, the sensory blockade level increases after spinal injection in some patients with spinal canal stenosis. We optimize the dose of spinal anesthesia according to the decreased ratio of the dural sac cross-sectional area (DSCSA), the purpose of this study is to hypothesis that if DSCSA is an effective parameter to modify the dosage of spinal anesthetics to achieve a T10 blockade in geriatric patients undergoing TURP.MethodsSixty geriatric patients schedule for TURP surgery were enrolled in this study. All subjects were randomized divided into two groups, the ultrasound (group U) and the control (group C) groups, patient receive either a dose of 2 ml of 0.5% isobaric bupivacaine in group C, or a modified dose of 0.5% isobaric bupivacaine in group U. We measured the sagittal anteroposterior diameter (D) of the dural sac at the L3–4 level with ultrasound, and calculated the approximate DSCSA (A) according to the following formula: A = π(D/2)2, ( π = 3.14). The modified dosage of bupivacaine was adjusted according to the decreased ratio of the DSCSA.ResultsThe cephalad spread of the sensory blockade level was significantly lower (P < 0.001) in group U (T10, range T7–T12) compared with group C (T3, range T2–T9). The dosage of bupivacaine was significantly decreased in group U compared with group C (P < 0.001). The regression times of the two segments were delay in group U compared with group C (P < 0.001). The maximal decrease in MAP was significantly higher in the group C than in group U after spinal injection (P < 0.001), without any modifications HR in either group. Eight patients in group C and two patients in group U required ephedrine (P = 0.038).ConclusionsThe DSCSA is a highly effective parameter for spinal anesthesia in geriatric patients undergoing TURP, a modified dose of local anesthetic is a critical factor for controlling the sensory level.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1800015566).on 8, April, 2018.