TUR Syndrome Research Articles

2021 PROSPECTIVE EVALUATION OF IRRIGANT ABSORPTION DURING PURE TRANSURETHRAL BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE BY EXPIRED BREATH ETHANOL MEASUREMENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20122021 PROSPECTIVE EVALUATION OF IRRIGANT ABSORPTION DURING PURE TRANSURETHRAL BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE BY EXPIRED BREATH ETHANOL MEASUREMENTS Christian Daniel Fankhauser, Lukas John Hefermehl, Benedikt Kranzbühler, Oliver Gross, Marian Severin Wettstein, Nico Grossmann, Janine Corinne Capol, Matthias Zimmermann, Tullio Sulser, Alexander Müller, and Thomas Hermanns Christian Daniel FankhauserChristian Daniel Fankhauser Zürich, Switzerland More articles by this author , Lukas John HefermehlLukas John Hefermehl Zürich, Switzerland More articles by this author , Benedikt KranzbühlerBenedikt Kranzbühler Zürich, Switzerland More articles by this author , Oliver GrossOliver Gross Zürich, Switzerland More articles by this author , Marian Severin WettsteinMarian Severin Wettstein Zürich, Switzerland More articles by this author , Nico GrossmannNico Grossmann Zürich, Switzerland More articles by this author , Janine Corinne CapolJanine Corinne Capol Zürich, Switzerland More articles by this author , Matthias ZimmermannMatthias Zimmermann Zürich, Switzerland More articles by this author , Tullio SulserTullio Sulser Zürich, Switzerland More articles by this author , Alexander MüllerAlexander Müller Zürich, Switzerland More articles by this author , and Thomas HermannsThomas Hermanns Zürich, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral bipolar plasma vaporisation (BPV) has been introduced as a minimal invasive alternative for conventional transurethral resection of the prostate (TURP). Especially high-risk patients may profit from irrigation with isotonic saline and from the excellent haemostatic properties of the so-called “mushroom electrode”. Those characteristics allow for a nearly bloodless operation and prevent the development of a TUR syndrome. However, it is unknown if irrigant absorption per se is prevented during BPV. METHODS A total of 55 consecutive patients were prospectively investigated between 07/2010 and 09/2011 during routine pure BPV using the TURIS HF system (Olympus GmbH, D). Intraoperative irrigation was performed with isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min during the operation using an AlcoQuant 602 alcometer (r-Technik GmbH, D). The volume of irrigant absorbtion was then calculated from these concentrations using an established nomogram. Additionally, intraoperative changes in serum electrolyte and heamoglobin concentrations were recorded. RESULTS The median patients' age was 67 y (48-88 y) and median prostate volume was 41.4 ml (21-89 ml). The median operation time was 70 min (30-140 min) and median irrigation volume 21 l (3-39 l). A total of 9 patients (16.4%) showed a positive ethanol breath test during BPV. The median calculated fluid absorption in those patients was 230 ml (range: 50-2000 ml). Significant changes in electrolyte or haemoglobin concentrations were not detectable. Only one patient with an irrigant absorption of 2 l showed clinical symptoms in form of mild dyspnoea and agitation. The surgeons reported capsular perforation, opening of large prostatic sinuses or a deep bladder neck incision in all patients with detectable fluid absorption. CONCLUSIONS Significant fluid absorption occurs during BPV of the prostate despite the excellent haemostatic properties of the “mushroom electrode”. Isotonic saline irrigation prevents the development of a dreaded TUR-syndrome with serious serum electrolyte changes. However, absorption of large isotonic volumes can also be dangerous especially for patients with e.g. cardiac insufficiency. It is important to know that fluid absorption cannot be monitored by intraoperative electrolyte measurements. Respecting the anatomical boundaries of the prostate seems to play a major role in preventing fluid absorption during BPV. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e815-e816 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Daniel Fankhauser Zürich, Switzerland More articles by this author Lukas John Hefermehl Zürich, Switzerland More articles by this author Benedikt Kranzbühler Zürich, Switzerland More articles by this author Oliver Gross Zürich, Switzerland More articles by this author Marian Severin Wettstein Zürich, Switzerland More articles by this author Nico Grossmann Zürich, Switzerland More articles by this author Janine Corinne Capol Zürich, Switzerland More articles by this author Matthias Zimmermann Zürich, Switzerland More articles by this author Tullio Sulser Zürich, Switzerland More articles by this author Alexander Müller Zürich, Switzerland More articles by this author Thomas Hermanns Zürich, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

2179 AIM OF STUDY WAS TO COMPARE PLASMA KINETIC (PK) TRANSURETHRAL RESECTION OF PROSTATE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology III1 Apr 20122179 AIM OF STUDY WAS TO COMPARE PLASMA KINETIC (PK) TRANSURETHRAL RESECTION OF PROSTATE Suresh Patankar Suresh PatankarSuresh Patankar Pune, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2352AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of study was to compare bipolar Plasma Kinetic with standard monopolar TURP in terms of catheter time, hospital stay, operating time, blood loss, complications, urinary flow rates and symptom relief, quality of life and International Index of Erectile Function.(IIEF-5) , in large number of patients with 5 years follow up. METHODS A total of 512 patients were randomized to either TURP or PK resection of prostate between January 2004 to December 2005 . All of them were evaluated by detail medical history, physical examination , blood analysis, PSA, urinanalysis and culture, AUA Symptom Score, 3D-TRUS measurement of prostate volume , Omax, IIEF-5 and Quality of Life score. TURP was carried out using a 26 F resectoscope and a single wire loop for resection . Glycine was used as irrigation fluid. For the PK Superpulse system, the dedicated resectoscope was used, and normal saline was used as the irrigation fluid. RESULTS Both groups were comparable in all preoperative parameters. 501 patients had completed 5 years follow-up: 255 (of 261) in the PK group and 246(of 251)in the conventional TURP group. The blood loss observed in PK Superpulse arm (178.62±48.47mL) was significantly less than after conventional TURP (351.56±91.52) (P<0.01). The catheter time in patients operated on PK superpulse was 25.56±7.89 hours, less then that in the conventional TURP arm (40.37±10.48 hours) (P< 0.001). The operative time was less in PK group (74.74±12.34 vs 77±13.80 min, p=0.02). Both procedures resulted in statistically significant improvements in AUA symptom score, Qmax , Quality of life at each postoperative assessment compared with baseline values. All parameters did not differ significantly between the groups at any time. The Hematuria, Clot retension ,Blood transfusion and clinical TUR syndrome, Hyponatremia were statistically less in PK group while no statically difference noted in Capsular perforation ,Urinary tract infection , Urethral stricture and Bladder neck contracture. CONCLUSIONS PK is safe and highly effective technique for relief of BOO which is associated with low rate of side effects.The clinical efficacy of PK is durable and compares favorably with TURP in the mid –term. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e878-e879 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Suresh Patankar Pune, India More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Recent advances in the surgical treatment of benign prostatic hyperplasia

TURP for many years has been considered the gold standard for surgical treatment of BPH. Symptoms relief, improvement in Maximum flow rate and reduction of post void residual urine have been reported in several experiences. Notwithstanding a satisfactory efficacy, concerns have been reported in terms of safety outcomes:intracapsular perforation, TUR syndrome, bleeding with a higher risk of transfusion particularly in larger prostates have been extensivelyreported in the literature.IN THE RECENT YEARS THE USE OF NEW FORMS OF ENERGY AND DEVICES SUCHAS BIPOLAR RESECTOR, HO: YAG and potassium-titanyl-phosphate laserare challenging the role of traditional TURP for BPH surgical treatment.In 1999 TURP represented the 81% of surgical treatment for BPHversus 39% of 2005. Is this a marketing driven change or is there areal advantage in new technologies?We analyzed guidelines and higher evidence studies to evaluate therole of the most relevant new surgical approaches compared to TURPfor the treatment of BPH.In case of prostates of very large size the challenge is ongoing, withminimally invasive laparoscopic approach and most recently roboticapproach. We will evaluate the most recent literature on thisemerging field.

Transurethral resection of prostate with plasmakinetic energy: 100 months results of a prospective randomized trial

Study Type - Therapy (RCT). Level of Evidence 1b. What's known on the subject? and What does the study add? Standard monopolar transurethral resection of prostate (TURP) remains the gold standard surgical treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. Plasmakinetic offers rapid tissue removal and haemostasis during resection with better vision under saline irrigation while eliminating risk of TUR syndrome. Our results show that Plasmakinetic has similar long-term results to standard TURP. • To compare long-term results of transurethral resection of prostate with PlasmaKinetic(®) energy (Plasmakinetic) and standard transurethral resection of prostate (TURP). • During the 2-year period between 2001 and 2002, 101 patients with lower urinary tract symptoms related to benign prostatic hyperplasia were enrolled into the study. • Patients were randomly assigned to either Plasmakinetic or standard TURP groups using computer-generated simple random tables in a 1:1 ratio. • After the publication of initial results, follow-up continued until December 2010. Patients were called by phone and invited for control at 60th and 100th months. • An International Prostate Symptom Score (IPSS) form was completed and uroflowmetry was performed to show the final status of the operation. • Overall, 67 of 101 patients (34 patients in Plasmakinetic group and 33 patients in TURP group) completed the 100th month control. • IPSS increased to 8.5 ± 1.6 and 9.4 ± 0.9 in the Plasmakinetic group and 7.9 ± 1.3 and 8.7 ± 1.2 in the TURP group at 60 and 100 months, respectively. • Mean maximal flow rate increased to 17.2 ± 3.9 mL/s in the Plasmakinetic group and to 16.9 ± 4.1 mL/s at 12 months in the TURP group but decreased to 15.9 ± 2.5 and 15.8 ± 3.0, respectively (P= 0.34) at 100 months. • Reoperation was performed in six patients in the Plasmakinetic group and four patients in the TURP group at the end of 100th month. • Our 100 months results suggest that Plasmakinetic technology can be used as a first-line treatment instead of monopolar TURP.

MP-05.11 2000 Endoscopic Resections of Prostate Using Bipolar System (Gyrus Plasma Kinetic): Critical Review of Our Experience

Trans Urethral Resection of Prostate (TURP) represents the gold standard of LUTS treatment for Bladder Outlet Obstruction (BOO) caused by Benign Prostate Hypertrophy (BPH). The use of Gyrus Plasma Kinetic system, working with saline solution, significantly reduced the classical complications of the monopolar traditional system (bleeding, TUR syndrome, etc…). The aim of this study is to critically review the clinical efficaciousness of bipolar system in our own department experience.

2099 DOES MONOPOLAR TRANSURETHRAL PROSTATECTOMY USING WATER IRRIGATION RESULT IN CLINICALLY SIGNIFICANT HYPONATREMIA?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology1 Apr 20112099 DOES MONOPOLAR TRANSURETHRAL PROSTATECTOMY USING WATER IRRIGATION RESULT IN CLINICALLY SIGNIFICANT HYPONATREMIA? Ernesto III Arada and Allen Porin Ernesto III AradaErnesto III Arada Quezon City, Philippines More articles by this author and Allen PorinAllen Porin Quezon City, Philippines More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this era of bipolar transurethral prostatectomy in saline (TURIS), monopolar transurethral prostatectomy (TURP) with non-electrolytes still has a place. During monopolar TURP, irrigating fluids like glycine and water are invariably absorbed and may cause hyponatremia. In developing countries, water irrigation is still widely used in monopolar TURP because it is more economical than glycine. Our aim is to determine if water irrigation during monopolar TURP results in clinically significant hyponatremia, TUR syndrome and other complications. METHODS Data from 70 male patients was analyzed prospectively. All patients underwent monopolar TURP using water irrigation for obstructing enlarged prostates under spinal anesthesia. Serum sodium was taken immediately after TURP and compared with preoperative levels. Hyponatremia was defined as decrease in serum sodium of 5 nmol/l or more in comparison to preoperative values. Signs and symptoms of hyponatremia were recorded after TURP. Hyponatremia was also correlated with resection time, specimen weight and blood loss. RESULTS Mean age of patients was 68.54 years (range: 50–85). All 70 patients had mean resection time of 57.55 minutes (Range: 15–130); mean specimen weight of 49.73 grams (Range: 15–149); and mean blood loss of 262.78 ml (Range: 50–1000). Only 24 patients (34%) went over one hour of TURP. Preoperatively, all patients had normal CBC, serum creatinine and serum sodium levels. Pre-TURP mean serum sodium was 140.64 nmol/l (Range: 135–148). Post-TURP mean serum sodium was 138.35 nmol/l (Range: 127–147). Hyponatremia after TURP developed in 14 patients (20%). The 14 post-TURP hyponatremic patients had mean resection time of 63.69 minutes, mean specimen weight of 50.33 grams and mean blood loss of 209.09 ml. These hyponatremic patients were also noted to have longer resection times, similar specimen weights and lower blood loss compared to the 56 post-TURP normonatremic patients undergoing monopolar TURP. Only one hyponatremic patient (7%) showed signs of TUR syndrome without further consequence. The other 13 hyponatremic patients (93%) did not show any clinical signs or symptoms of hyponatremia like vomiting, seizures or changes in sensorium. No postoperative fever or signs of urinary infection were also observed. CONCLUSIONS Our study showed that one-fifth of patients developed hyponatremia after monopolar transurethral prostatectomy using water irrigation. However, majority of these hyponatremic patients did not develop clinically significant signs and symptoms of hyponatremia. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e838-e839 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ernesto III Arada Quezon City, Philippines More articles by this author Allen Porin Quezon City, Philippines More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-term followup after electrocautery transurethral resection of the prostate for benign prostatic hyperplasia.

Introduction. For decades, transurethral resection of the prostate (TURP) has been the “gold standard” operation for benign prostatic hyperplasia (BPH) but is based mainly on historic data. The historic data lacks use of validated measures and current TURP differs significantly from that performed 30 years ago. Methods. Men who had undergone TURP between 2001 and 2005 were reviewed. International prostate symptom score (IPSS), quality of life (QOL) and peak urinary flow rate (Q max⁡), and postvoid residual (PVR) were recorded. Operative details and postoperative complications were documented. Patients were then invited to attend for repeat assessment. Results. 91 patients participated. Mean follow-up time was 70 months. Mean follow-up results were IPSS—7; QoL—1.5; Q max⁡—23 mL/s; PVR—45 mL. These were an improvement from baseline of 67%, 63%, 187%, and 80%, respectively. Early complication rates were low, with no blood transfusions, TUR syndrome, or deaths occurring. Urethral stricture rate was higher than anticipated at 14%. Conclusion. This study shows modern TURP still produces durable improvement in voiding symptoms which remains comparable with historic studies. This study, however, found a marked drop in early complications but, conversely, a higher than expected incidence of urethral strictures.

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

Conventional monopolar resection or bipolar resection in saline for the management of large (>60 g) benign prostatic hyperplasia: An evaluation of morbidity

The objective of this study was to compare the efficacy and safety of bipolar transurethral resection in saline (TURIS) and conventional monopolar transurethral resection (TURP) in men with voiding difficulties due to high volume (>60g) benign prostatic hyperplasia. Between May 2005 and January 2009, 66 men with bladder outlet obstruction due to large benign hyperplasia (BPH) (>60 g) underwent transurethral resection, either by Olympus monopolar or Olympus bipolar TURIS technique. Perioperative and outcome data were recorded and compared. There was no significant difference in patient age, prostate size, PSA, uroflow rate, post voiding residual urine, operation time, catheterization time, and hospital stay. In the monopolar TURP group, an important drop in serum sodium was observed (3.12 mmol/L), statistically significantly different (p = 0.012) from the 1.30 mmol/L drop in the bipolar TURIS group. One case of clinical TUR syndrome was observed in the conventional monopolar TURP group. Early and late complications such as clot retention, urinary retention, bladder neck stenosis, and urethral stricture were identical in both groups. The bipolar TURIS device is a valid treatment option for patients with BPH-related voiding disorders due to high volume BPH. Obviating the risk of TUR syndrome, this minimally invasive procedure may be a good surgical option in the urologist's armamentarium.

GreenLight HPS 120-W Laser Vaporization Versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia: A Randomized Clinical Trial with Midterm Follow-up

BackgroundPhotoselective vaporization (PVP) with the GreenLight HPS 120-W laser (GLL) was recently introduced for treatment of benign prostatic hyperplasia (BPH). ObjectiveTo compare results of GLL PVP and transurethral resection of the prostate (TURP) for treatment of BPH. Design, setting, and participantsA total of 120 patients with BPH were randomly assigned to two equal groups: TURP or PVP. MeasurementsBoth groups were compared regarding all relevant preoperative, operative, and postoperative parameters. Functional results in terms of improvement of International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR) urine were assessed at 1, 3, 6, 12, 24, and 36 mo. A total of 55 and 54 patients completed 36 mo of follow-up in the TURP and PVP groups, respectively. Results and limitationsBaseline characteristics were comparable. Mean operative time was significantly shorter for TURP. Compared to preoperative values, there was significant reduction in hemoglobin and serum sodium levels at the end of TURP only. A significant difference in favor of PVP was achieved regarding the duration of catheterization and hospital stay. In the PVP, no major intraoperative complications were recorded and none of the patients required blood transfusion. Among TURP patients, 12 (20%) required transfusion, 3 (5%) developed TUR syndrome, and capsule perforation was observed in 10 patients. There was dramatic improvement in Qmax, IPSS, and PVP compared with preoperative values and the degree of improvement was comparable in both groups at all time points of follow-up. Storage bladder symptoms were significantly higher in PVP. By the end of 36 mo, five patients in TURP and six in PVP were lost to follow-up. A redo procedure was required in one TURP patient and six PVP patients (p<0.05). Two TURP patients and four PVP patients developed bladder neck contracture (p>0.05) treated by bladder neck incision; none in either group experienced urethral stricture or urinary incontinence. ConclusionsCompared with TURP, 120-W GLL PVP is safe and effective in treatment of BPH.

The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials

Transurethral incision of the prostate gland (TUIP) is perceived as a less morbid surgical alternative to standard transurethral resection of the prostate gland (TURP) for treatment of symptomatic mild to moderate benign prostate enlargement (BPE). We aimed to evaluate comparative clinical effectiveness of the two procedures. Systematic review and meta-analysis of short- and long-term data from randomised controlled trials comparing TUIP with TURP. This review considered data from 795 randomised participants across 10 RCTs of moderate to poor quality 8 of which stated an upper limit for prostate size. No difference in the degree of symptomatic improvement was seen between the two procedures. Improvement in peak urine flow rate was lower for TUIP compared to TURP whilst the rate of blood transfusion and TUR syndrome was higher after TURP. Urinary retention, urinary tract infection, strictures and incontinence did not differ between the two approaches, although clinically important differences could not be ruled-out. TUIP was associated with a shorter duration of operation and length of hospital stay but a higher re-operation rate. TUIP and TURP appear to offer equivalent symptomatic improvement for men with mild to moderate BPE. Choosing TUIP involves a trade-off between the lower risk of peri-operative morbidity and the higher risk of subsequent re-operation.

Transurethral Resection of the Prostate Syndrome: Almost Gone but Not Forgotten

Transurethral resection of the prostate (TURP) syndrome is a rare but potentially fatal syndrome with multifactorial pathophysiology that is now better understood. Unfortunately, despite this improved understanding, it is not yet obsolete and still remains a risk. Many reviews of TURP syndrome have been presented from an anesthetic perspective; this review reflects more the urologic perspective with emphasis on the importance of multidisciplinary management of this complex syndrome. We present a review of TURP syndrome that specifically assesses advances in the understanding of risk factors, pathophysiology, and techniques used to prevent this syndrome. The databases Medline, Embase, Cochrane Controlled Trial Register, and Database of Abstracts of Reviews of Effects were systematically reviewed from inception to April 2009 for the keywords TUR (P), TUR (P) syndrome, and transurethral resection of prostate. There was no language restriction for our search. Randomized controlled trials, review articles and case series were included in our search. Our review showed a declining trend in the incidence of TURP syndrome despite TURP remaining the gold standard for the management of benign prostatic obstruction. Technologic advances using an array of laser techniques, the use of bipolar circuitry, together with advances in training techniques have helped minimize the risk of development of this syndrome. This review demonstrates the complexity of TURP syndrome. Even with a greater understanding of the pathophysiology, it highlights the unpredictability of the syndrome from presenting symptoms, preventative measures, and management. TURP syndrome cannot be protocol driven and the need for vigilance, a high index of suspicion, intensive monitoring, and a multidisciplinary approach is vital.

The Effects Of Bipolar And Monopolar Resectoscope On Hemodynamic And Plasma Electrolytes In Transurethral Resection Procedures

In our study, we compared the effects of monopolar and bipolar resectoscope use on hemodynamics, serum electrolytes, and length of hospital stay of patients who is undergoing TUR-P with spinal anesthesia. After approval of the Faculty Ethical Committee and the written consent of the patients, 60 patients are randomly allocated into two groups that is planned to perform TUR-P with bipolar resectoscope (Group B)(n=30) group and monopolar resectoscope (Group M)(n=30), respectively. Spinal anesthesia had been performed to all patients. Blood pressure, heart rate and respiratory rate were monitorized with five minutes periods during the operation. Serum Na+, K+, Cl-, Hb ve Hct values measured before the operation, at 30. minute of the operation, 1., 24. h after the operation. Urethral catheterization time and length of hospital stay had been recorded. In Group M , blood pressure of the patients at 25th and 30th minutes had been decreased significantly comparison to the control values (p&lt;0.05). Serum Na+ values at intraoperative 30th min, postoperative 1st, 24th h of the patients in group M had been reduced significantly in comparison with the preoperative values; serum K+, Hb, Hct values at the postoperative 1st, 24th hours reduced significantly in comparison with the preoperative values (p&lt;0.05). However, none of the patients in Group M had TUR syndrome. We observed that, in bipolar TURP method duration of the operation and length of hospital stay were found significantly short, as well as hemodynamic stability and electrolyte balance were found better than in monopolar TURP method.

Effect of Short-term Dutasteride Therapy on Prostate Vascularity in Patients With Benign Prostatic Hyperplasia: A Pilot Study

In this study we assessed the possible influence of dutasteride (types 1 and 2 isoenzymes of 5-alpha-reductase inhibitors) on prostate tissue vascularity. We also attempted to evaluate whether preoperative treatment with dutasteride could help to avoid excessive bleeding in patients undergoing transurethral resection of prostate (TUR-P). This pilot study has 3 phases. All patients enrolled in the study had a prostate-specific antigen < 4 ng/mL and normal digital rectal examination. In the first phase we included 10 patients with benign prostatic hyperplasia treated with alpha-blockers. The end point of this phase was to choose the preset that could exclude noise signals and be reproducible. In the second phase, we included 32 patients in whom color Doppler sonography (CDS) was performed before and 6 weeks after treatment with 0.5 mg dutasteride per day. We counted every discrete color Doppler signal (CD-spot). To compare the CDS data, we used the Student t test, and P < .05 was considered significant. Afterward, 46 patients joined the third phase. Patients were assigned to the control and study groups according to sequentially numbered sealed envelopes. Patients in the study group received 0.5 mg dutasteride 6 weeks before TUR-P. In the first phase: color Doppler preset with pulse repetition frequency of 0.3 kHz was chosen as the most sensible. In the second phase, a significant decline in CD-spots count was detected in 23 (72%) patients (P < .05) and was more distinctive in the periurethral zone. In the third phase, only 43 of the patients continued with TUR-P (in 3 patients, voiding symptoms improved). Operating time and volume of irrigation fluid were significantly different (50.55 minutes/42.65 minutes, P = .014; 8.03/13.10 L, P = .047). Six weeks of dutasteride treatment may reduce prostate tissue vascularity in the periurethral area proximal to the verumontanum. The third phase of our study confirmed that preoperative treatment with dutasteride could improve operative performance and avoid TUR syndrome.

Stellenwert der Transurethralen Resektion der Prostata (TUR-P) bei der Behandlung der symptomatischen benignen Prostataobstruktion (BPO): Eine Analyse zur Effektivität und Komplikationsrate bei 1015 Patienten

1015 patients with benign prostatic hyperplasia who underwent transurethral resection (TURP) within the last seven years were analysed concerning indication, complications and results by evaluation of quality. The actual value of TURP should also be compared with that of alternative procedures of treatment. The transfusion rate (0.69 %), TUR syndrome (0.78 %) and the urinary infection rate (1.1 %) are all very low. In 4.7 % a re-operation was necessary, mostly due to significant haematuria. The mortality rate perioperatively was 0.1 %. With regard to the voiding outcome, the uroflow relatively improved in 131 % and post-void residual urine diminished in 81 %. The low rate of complications, high efficiency and satisfaction of the patients are of importance also for the evaluation of alternative procedures. At the present time these modes of treatment do not have the potential to substitute for TURP.

Is The Ability to Perform Transurethral Resection of the Prostate Influenced by the Surgeon’s Previous Experience?

PURPOSETo evaluate the influence of the urologist’s experience on the surgical results and complications of transurethral resection of the prostate (TURP).PATIENTS AND METHODSSixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist’s experience: a urologist having done 25 transurethral resections of the prostate (Group I – 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II – 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III – 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure.RESULTSThere were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6%) presented with TUR syndrome, without a significant difference between the groups.CONCLUSIONThe senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon’s experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Transurethral Resection of Prostate in Benign Prostatic Hyperplasia Patients with Large Prostate Volume

Purpose: We investigated the safety and efficacy of transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH) more than 60cc by single surgeon for the relief of infravesical obstruction. Materials and Methods: We evaluated 211 patients treated with TURP in BPH with large prostate by single surgeon. Each group was divided by prostate volume (group 1; 60-69.9, group 2; 70-79.9, group 3; 80-89.9, group 4; 90-99.9, group 5; >100cc of prostate volume). Various parameters such as International Prostate Symptom Score (IPSS), maximal flow rate (Qmax.), postvoid residual volume (PVR), prostate volume, adenoma volume, resection time, resection prostate volume, irrigation fluid volume and complications were evaluated and compared. Results: Age of each group was not significantly different. Prostate volume, adenoma volume, resection time, Resection volume, irrigation volume of each groups were different significantly. But, resection volume/resection time and irrigation volume/resection time were not different significantly. Mean resection volume/resection time was 1.34g/min, and mean irrigation volume/resection time was 315.8ml/min. And intraoperative and postoperative complications of each group were not different. Mean postoperative change of Hb was 2.0±1.1g/dl. Postoperative parameters (IPSS, Qmax, PVR) were improved significantly. Only 2 patients needed transfusion in group 5. No urinary incontinence and TUR syndrome in each group was observed. Conclusions: TURP by experienced surgeon is a safe and effective treatment in BPH patients with large prostates for relief of infravesical obstruction. (Korean J Urol 2008;49:906-911) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Diode laser treatment of human prostates – Clinical 6-month experience

Abstract Objectives Laser-assisted vaporization of prostate tissue by means of the KTP laser is in clinical use. Alternative laser sources are available but are lacking clinical experience. In this study, the capability, feasibility, and post-operative outcome of vaporization of prostate by means of a diode laser were investigated. Methods The light (λ=1470 nm, 50 W) of a diode laser (Biolitec AG, Jena, Germany) was fed into a side-fire fiber introduced through a 24F continuous-flow cystoscope and thus transmitted to prostate tissue. Normal saline was used for irrigation with additive of 1% ethanol for observation of TUR syndrome. The study includes 10 men suffering from bladder outlet obstruction due to benign prostatic hyperplasia (BPH) (prostate volume range: 35–78 ml). The prostatic lobes were vaporized within the prostatic capsule. Depending on the vaporized tissue the exposure time was in the range of 1220–4000 s (mean: 2397±757 s) during which a mean of 121±38 kJ (range: 61–200 kJ) of energy was delivered. Post-operative outcome and voiding were evaluated during a follow-up of 6 months. Results During surgery no significant blood loss or any fluid absorption occurred. Catheters were removed in the mean after 50 h (range: 18–168 h). All patients excepted two, were satisfied with their voiding outcome. After removing the catheter the mean peak urine flow rate significantly (p=0.05) increased from 8.9±2.9 ml/s pre-operatively to 15.7±5 ml/s post-operatively. No evidence of urgency, dysuria, hematuria, or incontinence was observed. Two patients required re-catheterization and consecutive TURP. After 1 month as well as after 6-month follow-up, 8/10 patients are still satisfied with the outcome. Conclusion This first and limited experience showed that 50 W-1470 nm-diode-laser vaporization prostatectomy is feasible and appears to be safe and effective for quickly relieving bladder outlet obstruction due to BPH. Long-term efficacy and durability should be evaluated in a randomized clinical trial with long-term follow-up.

POS-02.71: Comparative randomized study on the efficaciousness of treatment of BOO due to BPH in patients having till 100 gr prostate using endoscopic gyrus prostate resection versus opsu. Preliminary data

The Trans Urethral Resection of Prostate (TURP) represent the gold standard of LUTS treatment for Bladder Outlet Obstruction (BOO) caused by Benign Prostate Hypertrophy (BPH). The use o Gyrus Plasma Kinetic system, working with saline solution, significantly reduced the classical complications of the monopolar traditional system (bleeding, TUR syndrome, etc.). The aim of this study is to compare the clinical efficaciousness of Gyrus Plasma Kinetic technique versus the traditional Open Surgery (OPSU) in the treatment of voluminous BPH (till 100 gr in weight).

Improvement in Mortality and Morbidity in Transurethral Resection of the Prostate over 17 Years in a Single Center

Various improvements in the technique of transurethral resection of the prostate (TURP) have helped to reduce morbidity and mortality over the years. In this retrospective study, developments in the perioperative course in a single center were analyzed. A retrospective chart analysis was performed on 399 patients undergoing TURP in our institution between 1987 and 1997, summarized as group 1, and 550 patients operated on between 1997 and 2004, summarized as group 2. Personal data, preoperative findings, intraoperative and postoperative complications, and outcomes in the two groups were compared. Average patient age, preoperative peak flow, residual volume, size of the prostate, and operation time did not differ statistically, whereas the amount of resected tissue was slightly higher in group 1 (30.1 g v 26.5 g). The mortality rate dropped from 0.5% in group 1 to 0 in group 2. Intraoperative bleeding necessitating transfusion (20.3% v 3.8%), capsule perforation (17.3% v 6.2%), and postoperative urinary-tract infections (37.1% v 6.2%) were significantly reduced in group 2. The incidence of TUR syndrome (2.0% v 1.6%) and severe anaesthesiology complications (1.8% v 0.9%) were only insignificantly lower in group 2. Postoperative bleeding, recatheterization, reintervention, and nonspecific complications remained unchanged, while the incidence of grade II or III stress incontinence and the postoperative hospital stay were reduced in group 2. Our study gives data on a contemporary TURP series and outlines a development toward fewer perioperative complications.