TUR Syndrome Research Articles

Comparison of Monopolar Versus Bipolar Repeat Transurethral Resection of Bladder Tumours.

To compare the effects of monopolar and bipolar energy sources on efficacy of both techniques and possible complications in bladder cancer patients undergoing repeat Transurethral resection of bladder tumour (re-TURBT). Descriptive study. Place and Duration of the Study: University of Health Science, Izmir Bozyaka Research and Training Hospital, Turkiye, from 2019 to 2021. Patients undergoing re-TURBT were inducted. Patients with residual tumour at initial TURBT, recurrent bladder cancer and patients with a non-urothelial pathology report in initial TURBT were excluded. The primary outcome was the complication ratio of the TURBT which were obturator reflex, bladder wall perforation, coagulum retention, fever, and TUR syndrome. The secondary outcome was the efficacy of the TURBT procedure, such as complete tumour resection, adequate sampling of deep muscle tissue, and sampling of qualified tissues without any thermal damage. One hundred and twenty-three patients were enrolled; 75 patients in re-M-TURBT group and 48 patients in re-B-TURBT group were analysed. Demographic and tumour characteristics, and complication rates according to the Clavien classification, were similar between the two groups (p = 0.302). The catheterisation time was shorter significantly in the bipolar re-TURBT group (median 4 vs. 3 days, respectively, p = 0.025). Monopolar and Bipolar energy sources are techniques that can be used safely in re-TURBT in terms of both appropriate pathology sampling (adequate muscle tissue sampling, cautery artifact) and complication (obturator reflex, hyponatraemia, haemoglobin decrease, bleeding) rates. Bladder Cancer, Monopolar, Bipolar, TURBT, Obtrator reflex, Complications.

Assessing the Safety and Effectiveness of Bipolar Technology in Transurethral Prostate Resection: A study in a Tertiary Care Private Hospital

Background: Benign enlargement of prostate (BEP) is a common affliction among aging males, predominantly emanating from the transition zone of the prostate, resulting in lower urinary tract symptoms. Despite the availability of diverse treatment modalities, transurethral resection of prostate (TURP) has conventionally served as a benchmark intervention. Recently, there has been a growing interest in bipolar energy techniques, spurred by their potential advantages in mitigating complications such as TUR syndrome and surgical bleeding. Objectives: The main aim of the study to evaluate the safety profile (including serum sodium and hemoglobin reductions, clot retention, TUR syndrome, catheterization duration, and hospital stay) and efficacy (resection rate, maximum flow rate increase, and International Prostate Symptom Score reduction) within the bipolar technique for the TURP. Methods & Materials: A prospective observational study was conducted at the Department of Urology, Square Hospitals Ltd, Dhaka, Bangladesh, spanning December 2020 to November 2021. The study employed comprehensive preoperative assessments, including bipolar transurethral resection of the prostate (B-TURP) using Olympus ESG-400 energy platform. Surgical parameters, postoperative monitoring, and statistical analysis were meticulously executed to evaluate outcomes and complications for symptomatic benign enlargement of prostate. Results: In a sample of 50 individuals undergoing bipolar transurethral resection of the prostate (B-TURP), the distribution of ages revealed 66.97±7.95 years as the bipolar system's average age, ranging from 53-82 years. The majority resided in urban areas (62%), with family income predominantly in the 25000-50000 bracket (42%). Preoperative baseline variables, including IPSS, Qmax, serum hemoglobin, and sodium levels, exhibited similar values between groups. Intraoperatively, the mean resection rate was 0.56±0.16 gm/min. Postoperatively, B-TURP resulted in a slight ......

Clinical outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in benign prostatic hyperplasia patients in Rajavithi Hospital

Objective: To evaluate the outcomes and safety of the surgical technique holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) for whom surgeryis indicated. Materials and Methods: The demographic characteristics, duration of surgery, blood transfusion rate, weight of tissue removed, catheterization time and complica- tions were recorded in 25 patients who underwent HoLEP surgery between January 2021 and May 2022 in Rajavithi Hospital. The International Prostate Symptom Score (IPSS), quality of life score (QoL), peak flow rate (Q-max), post-void residual urine volume (PVR), hematocrit (Hct) and prostate-specific antigen (PSA) levels were comparedbefore and after surgery. Results: The mean age of the patients was 71.28±7.54 years. There were statistically significant differences between mean preoperative and postoperative Hct (%) (40.5± 5.9 and 38.4±5.1), p = 0.001. Only 1 in 25 patients had 1 unit of blood transfusion. One month postoperatively the mean PSA had decreased from 4.55 to 1.2 ng/ml (p < 0.001); mean IPSS had improved from 21.0 to 7.0 (p < 0.001); mean QoL score had improved from 4.47 to 1.10 (p < 0.001); mean PVR had decreased from 98.0 to 39.7 ml (p = 0.002) and the mean Q-max had increased from 8.0 to 17.8 ml/sec (p = 0.015). The mean catheterization time was 2.40±0.57 days. There were no serious complications or incidence of TUR syndrome in this study. Conclusion: HoLEP is a safe alternative to the current gold standard transurethral resection of the prostate for BPH patients as there are fewer complications with similar functional outcomes

Safety of transurethral resection of large prostate.

Benign prostatic hyperplasia is a common benign disease occurs in older men. Some patients can be treated medically but eventually, most of them will need a surgical intervention, and the most commonly applied procedure is transurethral resection of the prostate (TURP). The objective of this study is to assess the feasibility and safety of performing transurethral resection of large prostate (80 g and more). Out of 153 patients reviewed 48 cases included in this study. The main data collected from patients' files and patient interview. The criteria of exclusion were prostate size <80 g and previous history of TURP. The collected data were analyzed by the Statistical Package for the Social Sciences (SPSS). The main results showed that 93.7% of patients did not experience major bleeding postoperatively, neither major drop in hemoglobin level. Moreover, the patient's distribution according to the presence of TUR syndrome was only 2.1% with mild symptoms. No patient had an episode of retention during the hospital stay or in the follow-up. Surgeon experience, systematic resection approach, and strict time of resection are important factors to assure the safety of TURP in large prostate. In cases of huge prostate size >100 g, staged TURP can be offered safely or if patients' obstructive symptoms do not resolve after the first procedure.

What Exactly is the TUR Syndrome and How Should it be Treated?

The introduction of this article reports a mini review of the subject. The TUR syndrome is precisely defined. The pathoaetiology, clinical picture and effective therapy are reported. The TUR syndrome is defined as severe cardiovascular reaction shock induced by massive gain of the sodium-free irrigating fluid such as 1.5% Glycine into the cardiovascular system and is characterized by severe hyponatremia. The main presentation is severe cardiovascular shock and post-operative coma and convulsions, but other manifestations of the multiple organ dysfunction syndrome occur. The correct lifesaving therapy for the TUR syndrome, hyponatremia and ARDS is hypertonic sodium of 5%NaCl and 8.4% NaCo3 .

Symptomatic absorption of normal saline during transurethral resection of the prostate: a case report

BackgroundTransurethral resection of the prostate (TUR-P) could incidentally cause hyponatremia, known as TUR syndrome due to intravascular absorption of non-electrolytic irrigation fluid. Recently, normal saline has been used as an irrigation fluid in a new system named TURis (TUR in saline) to prevent TUR syndrome. However, rapid massive absorption of normal saline can also cause other systemic adverse events.Case presentationA 71-year-old man underwent TURis for benign prostatic hyperplasia under spinal anesthesia. The patient lost consciousness which led upper airway obstruction and hypoxia 30 min after the surgery began. Blood gas test indicated hyperchloremic metabolic acidosis. While vasoactive agents were ineffective, the administration of bicarbonate significantly improved the symptoms and restored blood pressure.ConclusionWe experienced a case of hyperchloremic metabolic acidosis with decreased level of consciousness and hypotension during TURis. Administration of bicarbonate, but not phenylephrine, was effective for recovering blood pressure.

The Comparison Study of Anatomic Vapor-incision Technique (AVIT) Using the 180W-XPS Greenlight Laser and Photoselective Vaporization of the Prostate for the Treatment of Benign Prostatic Hyperplasia

ObjectiveTo prospective compared the preoperative parameters and postoperative functional outcomes between anatomic vapor-incision technique (AVIT) and the photoselective vaporization of prostate (PVP) with Greenlight 180W-XPS. MethodsTotal 174 BPH patients were enrolled in the study and 86 cases, 88 cases were underwent with traditional PVP and AVIT, respectively. The relevant pre-, intra-, and postoperative data were recorded and compared between the both groups. ResultsNo significant differences were observed between both groups in baseline characteristics and no major complications (capsule perforation and TUR syndrome) occurred intraoperatively. In AVIT group, the energy consumption and energy density were greater than those in PVP group. The operative time and laser time were longer in AVIT group than it in PVP group. Compared to the AVIT group, the incidence of irritative symptoms after operation was higher in the PVP group. During the follow-up period, the functional outcomes (IPSS, QoL, prostate volume and PSA level) in both groups were significant improved compared to the baseline. The reduction of prostate volume and PSA level were significant greater in AVIT group than it in PVP group. ConclusionCompared to PVP, AVIT is safe and efficacious treatment for BPH patients with more adenoma removal and more improvements of clinical outcomes. But the long-term follow-up data is needed to evaluate the functional outcomes and retreatment rates.

Outcomes of bipolar TURP compared to monopolar TURP: A comprehensive literature review.

Transurethral resection of the prostate (TURP) is the commonest surgical procedure for the treatment of benign prostatic obstruction (BPO). Bipolar-TURP (BTURP) is being increasingly used as compared to the long-established Monopolar TURP (MTURP). In this systematic review, we compared the outcomes of BTURP vs MTURP. A systematic review was conducted using PubMed, EMBASE, Scopus, Google Scholar, and the Cochrane library using relevant search terms from inception of databases till June 2020. Using PRISMA methodology, 18 randomized control trials were reviewed comparing MTURP vs BTURP with a total of 8,393 patients. A significant drop in serum sodium was seen in four studies in MTURP vs BTURP and while there was zero incidence of TUR syndrome in BTURP group, there were 1-16 episodes of TUR syndrome across studies in the MTURP group. A significant fall in hematocrit was seen in three of nine studies with MTURP and one with a significant difference in blood transfusion rates. There were no significant differences in the incidence of clot retention across the studies with 1-5 cases in BTURP group vs 2-12 cases in MTURP group. There were no significant differences related to the duration of catheterization, operative time, resection volume, length of stay, quality of life, postoperative urethral stricture, and sexual function. Although both BTURP and MTURP improve urinary symptoms, BTURP is associated with less risk of hyponatremia, TUR syndrome, and blood loss compared to MTURP. There seems to be no significant difference in length of stay, urethral stricture, quality of life, and operative duration.

Thulium laser enucleation of prostate: Novel therapy for benign prostatic hyperplasia

Background: Transurethral resection of the prostate (TURP) has been the undisputed gold standard treatment for benign prostatic enlargement (BPE). However, morbidity after TURP remains significant with increased risk of bleeding and TUR syndrome. In recent years, the role of laser technology in endoscopic prostatic surgery has gradually increased. In our study, we evaluate the efficacy and safety of a novel technique of Thulium laser enucleation of prostate (THULEP) in the treatment of BPE.Materials and Methods: Five hundred and thirty-six patients with symptomatic benign prostatic hyperplasia (BPH) were treated with THULEP. The inclusion criteria were acute retention of urine with the failure of trial without catheter, dissatisfaction with medical treatment, maximum urinary flow rate (Qmax) <15 ml/s, and International Prostate Symptoms Score (IPSS) >15. Patients were evaluated by Digital rectal examination (DRE), uroflowmetry, IPSS, prostate-specific antigen (PSA), blood and urine routine tests, abdominal ultrasonography, and trans-rectal ultrasonography (TRUS).Results: The efficacy of THULEP was assessed by comparing preoperative variables with postoperative data. IPSS score got reduced from 24 to 3.5, quality of life score improved to 0–1 from 4–5. Qmax improved from mean 7 to 20 ml/s, Postvoid residue reduced from a mean of 110 to 12 ml. Hospital stay was < 36 h in the majority of patients. The average operative time was 45 min. No postoperative blood transfusion was required.Conclusion: THULEP is a safe procedure and has a lesser number of complications. THULEP can replace monopolar TURP as a gold standard for the treatment of BPH.

EDITORIAL COMMENT

For decades, transurethral resection of the prostate (TURP) was the gold standard surgical management for bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). Spinal anesthesia was often favored in order to monitor for TURP (or TUR) syndrome, a major risk of monopolar TURP.1,2 Currently, with many surgical options available for BPH that can be performed with saline irrigation, the incidence of TUR syndrome has drastically decreased. Accordingly, use of spinal anesthesia for outlet procedures is now more dependent on practice patterns, provider preference, or reserved for patients at high risk for general anesthesia.

Bipolar versus Monopolar Transurethral Resection of Prostate in Treatment of Benign Prostatic Enlargement

Introduction: Bipolar transurethral resection (B-TURP) is an effective modality for surgery of Benign Prostatic Obstruction, and has been widely studied for its efficacy and safety against the well-established method; Monopolar Transurethral resection (M-TURP). Objectives: The study aimed to assess the feasibility of B-TURP over M-TURP in terms of hospital stay, resection time, resected tissue volume, changes in hemoglobin and sodium, blood transfusion required, complications like TUR syndrome, clot retention and hemorrhagic episodes. Methodology: An analytical study was done in cases who underwent TURP from August 2018 to August 2020. Parameters like hospital stay, resection time, resected tissue volume, changes in hemoglobin and sodium, blood transfusion required, complications like TUR syndrome, clot retention and hemorrhagic episodes were compared in between B-TURP and M-TURP. Statistical analysis was done using SPSS 22.0 software. Results: Seventy-three patients were compared in this study; 33 had undergone B-TURP and 40 patients had undergone M-TURP. Total hospital stay was slightly lesser in B-TURP. The post-operative Hb in M-TURP was significantly lesser than B-TURP (11.10±1.321 vs 12.24±1.225, P&lt;0.001). Although the drop in hemoglobin was statistically significant in both the groups, the hemoglobin drop was slightly lesser in B-TURP. The mean difference in pre and post-operative hemoglobin was 1.148 in M-TURP and 0.181 in B-TURP. TUR syndrome was significantly higher in M-TURP (6,8.2% vs 0, 0%; P=0.029). There was no significant difference in between resection time, post-operative sodium, post-operative hemorrhagic episodes, clot retention and blood transfusions. Conclusion: Bipolar TURP is safe and effective for transurethral resection of prostate with relative shorter hospital stay, lesser bleeding and TUR syndrome in comparison to Monopolar TURP.

Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study.

BackgroundTo investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml.Materials and methods100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml.Results17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed.ConclusionsThis is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.

Comparative Evaluation of Post-TURP Complications in Patients with BPH Presenting with and Without Acute Urinary Retention

AbstractBackground Benign prostatic hyperplasia (BPH) is a prevalent urological condition affecting men at an older age. Acute urinary retention (AUR) is a severe symptom of men who develop BPH. TURP is the gold standard as the management of BPH is concerned. Our study tried to compare the post-TURP complications between patients presented with and without AUR.Materials and Methods We enrolled 126 patients, out of which 74 were in the AUR group and 52 in the non-AUR group. The mean age of patients with AUR was 62.51 years, and that for patients without AUR was 61.06 years. Statistical significance was noted in our study in patients with AUR and without AUR regarding the prostate's grading by DRE, the volume of gland, PSA level, post-TURP UTI, recatheterization post TURP, length of hospital stays with p-values 0.000, 0.000, 0.006, 0.004, 0.007, and 0.000, respectively. Statistical significance was not noted in patients with AUR and without AUR with regard to the grading of hypertension, diabetes mellitus, ischemic heart disease, post-op TURP syndrome, post-TURP hematuria, patients needing a blood transfusion, post-TURP sepsis, LUTS, post-TURP stricture, resurgery for clot retention with p values of 0.918, 1.000, 1.000, 1.000, 0.523, 0.642, 1.000, 0.319, 1.000, and 1.000, respectively.Conclusion Our study shows that post-TURP complications such as hematuria, blood transfusion rate, post-op UTI, sepsis, recatheterization, lower urinary tract stricture, resurgery, TUR syndrome, and the length of hospital stay were higher in patients who presented with AUR than in those without AUR. Post-TURP UTI complications, recatheterization rate, and the length of hospital stay were statistically significant in the AUR group compared with the non-AUR group. Therefore, it is better to intervene earlier before the patients develop AUR to minimize the complications and maximize the outcomes.

The TUR Syndrome Re-Incarnating as ARDS after Saline use as Irrigating Fluid in Endoscopic Surgery

The TUR Syndrome Re-Incarnating as ARDS after Saline use as Irrigating Fluid in Endoscopic Surgery

MONOPOLAR VS BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE REGARDING THE INCIDENCE OF POSTOPERATIVE URETHRAL STRICTURE: A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTIONBenign prostatic hyperplasia (BPH) is a very common illness affecting aged men, about half of patients will at some time need surgical intervention.Monopolar TURPis considered as the gold standard for the surgical treatment of BPH. Multiple studies showed higher complication rates in M-TURP operations in patients with large prostate volumes. The risk of hemorrhage is also higher specially in patients with blood disorders. Bipolar TURP, an electric current completes its circuit outside the body of the patients. This permits the use of saline as irrigating fluid, preventing the TUR syndrome and hyponatremia. Addionally B-TURP is associated with less bleeding and less operative time.The incidence of urethral stricture after transurethral resection of prostate (TURP) ranges from 2.2 to 9.8%. Most of the cases occurs within 6 months of transurethral surgery. Presentation is likely with weak flow, infection or acute urinary retention.The exact etiology of urethral stricture after TURP is still unknown. Suggested causes after TURP include infection, mechanical trauma, prolonged indwellingcatheter time,local anesthesia, and electrical injury.

Short-term surgical outcomes after Monopolar- versus Bipolar Transurethral Resection of the Prostate

Abstract Background Transurethral resection of prostate (TURP) is currently the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), as this procedure results in the best improvement in symptoms and urine flow rate (1). Aim of the Work to compare between the two techniques used for transurethral resection of the prostate; Monopolar versus Bipolar resection as regards short term surgical outcomes, perioperative complications and early changes in quality of life.. Patients and Methods Randomized controlled study with simple randomization (1:1) of 80 patients with BPH candidate for transurethral resection of the prostate, 40 patients underwent M-TURP, and other 40 patients underwent B-TURP, their age mean age of paients included in our study 57-61 years old, mean prostate size 68-71 gm. Results Comparing intra-operative data in monopolar and bipolar TURP groups, our study reported that there was statistically significant decrease in volume of irrigation and operative time in B-TURP group in comparison to M-TURP group. although intra-operative complications; bleeding, electrolytes disturbance, fever and LUTS were lower in BTURP group; however, did not reach statistically significant. In M-TURP group ,there was statistically significance increase in change Hb, and time of post-oprative irrigation, IPSS in compared to B-TURP group. While in respect to PVR, time of catheterization and hospital stay, there was no statistically significant difference data among the two studied groups. Conclusion Bipolar TURP represents a promising endoscopic treatment for patients with BPH with decrease in volume of irrigation and reduced operative time, and less incidence of TUR syndrome, intraoperative bleeding, and postoperative complications .However, further investigations are needed with larger, preferably randomized multicentric controlled trials to confirm the results of this study in the future.

The TUR Syndrome May Vanish from Urology but will be ReIncarnating as ARDS after Saline Use as Irrigating Fluid in Endoscopic Surgery

Objective: To demonstrate the TUR syndrome characterized with hyponatraemia (HN) will no longer be seen after using saline as irrigating fluid in urology, but it has re-incarnated as the acute respiratory distress syndrome (ARDS) presenting with the same clinical picture of the multiple organ dysfunction syndrome (MODS). Material and Methods: A focussed objective and relevant narrative review of other eminent authors’ work and mine are used here. Results: The TUR syndrome characterized with HN will no longer occur in urology after the use of saline as irrigating fluid in endoscopic surgery. It has reincarnated as ARDS presenting with the same MODS clinical picture. It is induced by VO caused by iv fluid infusions. This induces cardiovascular shock (VOS) that cause ARDS. The latter is already common in clinical practice due to the excessive us of IV fluids in the management of shock, acutely ill patients, and prolonged major surgery as iatrogenic complication of fluid therapy. The wrong Starling’s law dictates the current faulty rules on fluid management of shock that mislead physicians into giving too much fluid. The correct replacement is the hydrodynamics of the porous orifice (G) tube which should be the new scientific basis for fluid therapy in shock management. The currently available hypertonic sodium therapy of 5%NaCl and/or 8.4%NaCo3 is lifesaving therapy for HN, the TUR syndrome and ARDS. Conclusion: The TUR syndrome may seem to have been eradicated in urology with the use of saline as irrigating fluid in endoscopic surgery. However, it has reincarnated as ARDS with the same clinical picture of MODS. It is an iatrogenic complication of fluid therapy dictated by the wrong Starling’s law for which the hydrodynamic of the G tube is the correct replacement that should be the new scientific basis for a new policy on fluid management of shock.

Two-Stage TURP as an Option for Treatment of Large Prostates in Resource Poor Environments

Transurethral resection of the prostate (TURP) is the gold standard of surgical therapy of benign prostatic hyperplasia (BPH) for prostates &lt;100 ml. This study was carried out to describe our experience with and outcome of staged TURP for large prostates (&gt;100 ml). A review of the records of all the patients who underwent staged TURP for large BPH at a specialist urology center. They had two-stage monopolar resection using a size 26F continuous flow resectoscope and 5% Dextrose water irrigation. Staged-TURP were performed by a single Consultant Urologist under spinal anesthesia. Patients’ age, Co-morbidities, Prostate-specific Antigen (PSA), Abdominal Ultrasound scan (USS) estimated prostate volume, Pre-operative Packed Cell Volume (Pre-op PCV), Post-operative Packed Cell Volume (Post-op PCV), Resection Weight for 1st stage (RW I), Resection Weight for 2nd stage (RW II), Resection Time for 1st stage (RT I), Resection Time for 2nd stage (RT II), blood transfusion were obtained and analyzed. Follow up was for a minimum of 9 months and the outcome and development of complications noted. Statistical analysis was done using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM, Chicago, USA). Means and percentages were calculated, and paired sample T test was used to compare variables between 1st stage and 2nd stage. P value &lt; 0.05 was considered significant. Twenty-five patients with a mean age of 72.32±7.98 years were analyzed. Most (88%) were on indwelling Foley’s urethral catheter before surgery. The mean PSA and prostate volume were 25.61±22.08 ng/ml and 221.56±62.78 cm3. There were significant differences between Pre-op PCV and Post-op PCV (p&lt;0.001); RWI and RWII (p&lt;0.001); and RTI and RTII (p&lt;0.001). Nineteen patients (76%) received perioperative transfusion. Most patients voided satisfactorily following catheter removal except one who developed acute urinary retention (AUR). No cases of TUR syndrome, post-operative sepsis, DVT or PE and urethral stricture were recorded. Staged TURP is safe and effective treatment modality for patients with large prostates in the absence of more recent endoscopic options.

Bipolar TURP in high-risk patients with large prostate gland: our experience

Background: The present gold standard monopolar-TURP is associated with a number of complications and has less safety margin in comorbid patients. Bipolar TURP is a modification of conventional M-TURP and has the potential to overcome its most prominent shortcomings with better safety profile in patients with comorbidities. Aim of the study was to evaluate the efficacy of bipolar-TURP in terms of operative and postoperative parameters.Methods: This prospective study was conducted in the department of urology SKIMS Srinagar, from April-2019 to October 2020. Forty-five patients with one or more comorbidities and BHP, with a prostate weight ≥60 gm was evaluated. Operative and postoperative parameters were recorded and patients followed with IPSS and uroflowmetry for a period of 6-months.Results: Of 45 patients who underwent B-TURP, pre-operative parameters were mean age(years) 66.59±9.88, mean prostate size (gm) 77.42±18.4, mean IPSS of 26.3±2.9, mean serum PSA (ng/dl) of 2.32±0.88, mean Qmax (ml/s)of 7.71±2.41 and PVRU of 113.45±16.5 ml. Operative and post-operative parameters were, mean operative time(min) of 68.14±29.6, TUR syndrome in none, mean change in Na+ of -0.98±0.75 meq/l, mean change in Hb of -1.66±0.68 g/dL, mean irrigation time (hours) 24.53±5.46, clot retention in 3 (6.66%) patients, transfusion in 2 (4.44%) patients, mean postoperative catheter time(hours) 69.5±10.5 and mean hospital stay 3.6±1.61 days. Two (4.44%) patients developed stricture urethra and were managed with urethral dilatation. IPSS and Qmax at 6-weeks were 10.2±2.18 and 16.22±2.31 ml and at 6-months were 6.43±1.16 and 19.12±3.14 ml respectively.Conclusions: B-TURP seems to be a more sensible choice for patients with underlying comorbidities or implanted cardiac devices.

The PLASMA System for Transurethral Resection of the Prostate: A NICE Medical Technologies Guidance Update.

Lower urinary tract symptoms (LUTS) in men commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP). This can be performed using either monopolar or bipolar electrosurgery. Bipolar TURP uses saline for irrigation rather than glycine, which drastically reduces the risk of TUR syndrome complications, thus allowing for increased procedure time if needed. The PLASMA system (formally known as TURis) is a bipolar TURP electrosurgery system used to treat LUTS secondary to BPH. National guidance recommending the use of TURis in the UK NHS was issued in 2014 by NICE and we now report the updated contribution from Cedar that was included in the update of that guidance for 2021. The evidence in this review suggests that the PLASMA system could be beneficial to patients in relation to hospitalisation and catheterisation time compared with monopolar TURP (mTURP). However, it appears to be comparable to mTURP for urological outcomes and worse for post-operative haematology outcomes such as decline in sodium and haemoglobin levels. Adverse events, however, occurred much less with PLASMA use.