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Gaither TW, Patel P, Del Rosario C, Baxter ZC, Pannell S, Dunn M. Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery. Urology 2022; 168:169-174. [PMID: 35697225 DOI: 10.1016/j.urology.2022.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery. MATERIALS AND METHODS We performed a prospective observational cohort study of three surgeons' practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention. RESULTS During the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9). CONCLUSIONS Voiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Parth Patel
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Z Chad Baxter
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Stephanie Pannell
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Matthew Dunn
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
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Teng TC, Shao IH, Hsu YC, Chen Y, Tsao SH, Kang YT, Hsieh ML. Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1747-1756. [PMID: 34616148 PMCID: PMC8487796 DOI: 10.2147/cia.s329468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Transurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding. Patients and Methods Preoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation. Results A total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04–0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66–54.43, p = 0.011). Conclusion Multiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP.
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Affiliation(s)
- Tzu-Chi Teng
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu-Chao Hsu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu Chen
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Shu-Han Tsao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yen-Te Kang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
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Welk B, Reid J, Ordon M, Campbell J, Dixon S. Do 5-alpha reductase inhibitors decrease the risk of recurrent gross hematuria in patients who have had a transurethral prostatectomy? Can Urol Assoc J 2021; 15:214-216. [PMID: 33596169 DOI: 10.5489/cuaj.7135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada.,ICES, Western University, London, ON, Canada.,Division of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Michael Ordon
- ICES, Western University, London, ON, Canada.,Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Campbell
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Stephanie Dixon
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
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Wang HH, Tsao SH, Lin KJ, Chu SH, Hsieh ML. Risk factors in delayed postoperative hematuria after transurethral prostatectomy: The role of preoperative leukocytosis and preliminary antibiotic treatment. FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_215_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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[Evaluation of postoperative symptoms after Greenlight™ photovaporization of the prostate through a dedicated questionnaire]. Prog Urol 2015; 26:108-14. [PMID: 26611569 DOI: 10.1016/j.purol.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/17/2015] [Accepted: 10/03/2015] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate postoperative symptoms after Greenlight™ photovaporisation of the prostate (PVP), through a dedicated questionnaire. METHODS A retrospective study has been conducted between 2008 and 2014. The questionnaire had 5 sections about pain while voiding, hematuria, urgency, incontinence and urinary stream, and was filled at one-month postoperative. The main outcome criterion was pain while voiding. Descriptive statistical analyses were done to identify predictive factors for pain while voiding. RESULTS Out of 169 patients, 22% had no pain while voiding, 37% had moderate pain, 30% acceptable pain and 11% intense pain. Patients with pain were significantly older, (P=0.012), had more urgency (P=0.01) and more often hematuria (P=0.0001). Only 7% of patients had no symptoms of urgency, and urgency was painful or bothering in 57% of cases. Hematuria was frequent, with clots in 21% of cases. Ninety three percent felt improvement of urinary stream. CONCLUSIONS Systematic evaluation of symptoms through a dedicated questionnaire one month after PVP has shown that 41% of patients felt pain while voiding, 57% had urgency and 39% significant hematuria. These results should encourage a more accurate patient information and further studies to better understand postoperative healing after PVP.
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Cornu JN, Madersbacher S. Greenlight Photovaporisation of the Prostate: Now Ready for Prime Time. Eur Urol 2015; 69:103-4. [PMID: 26382087 DOI: 10.1016/j.eururo.2015.08.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/31/2015] [Indexed: 11/29/2022]
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Reply from authors re: Charalampos Mamoulakis. A plea for higher-quality data for GreenLight laser technology in the context of surgical benign prostatic obstruction trials: the GOLIATH study-fact or fiction in the era of evidence-based urology? Eur Urol 2014;65:943-5. Eur Urol 2014; 65:945-6. [PMID: 24388437 DOI: 10.1016/j.eururo.2013.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/11/2013] [Indexed: 11/22/2022]
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