Factors influencing morbidity in patients undergoing transurethral resection of the prostate

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Clinical Outcome of Endoscopic Enucleation of the Prostate Compared With Robotic-Assisted Simple Prostatectomy for Prostates Larger Than 80 cm3 in Aging Male

This study investigated and compared the surgical outcomes of using endoscopic enucleation (thulium: YAG laser and bipolar plasma; ThuLEP) with robotic-assisted simple prostatectomy (RASP) in the treatment of prostates larger than 80 cm3. Records were obtained for the period from January 2014 to December 2020 for selected patients with BPO who underwent RASP, ThuLEP, or bipolar transurethral enucleation of the prostate (B-TUEP). Patients were excluded if they had active malignant disease, neurogenic bladder, lower urinary tract syndrome for reasons other than BPO, and a history of prostate surgery. Data of 396 patients who underwent B-TUEP, ThuLEP, and RASP were examined. A total of 112 patients met the including criteria, 85 of whom (B-TUEP: 29; ThuLEP: 41; RASP: 15) completed the final visit. The mean operation time and duration of postoperative hospital stays in the RASP group were significantly longer than those of the B-TUEP and ThuLEP groups. Only 1 patient in the RASP group required blood transfusion. The RASP group was superior to the other groups in voiding improvement including Qmax and IPSS voiding score. The pain score of the ThuLEP group after surgery was significantly lower than that of the other two groups during hospitalization, whereas the QoL scores were identical between the three groups at 2 weeks, 3 months, and 6 months post operation. The rates of returning to ER within the first postoperative month did not differ significantly between the three groups, and all the reasons for return involved minor complications that required no additional invasive treatment. These three surgical methods (B-TUEP, ThuLEP, and RASP) are all effective and safe for treating prostates larger than 80 cm3, with each having its particular advantages. B-TUEP requires the shortest operation time, ThuLEP causes the lowest postoperative pain, and RASP results in superior voiding function improvement.

Monopolar transurethral resection of the prostate using water as the irrigation fluid: Our initial experience

Background

Monopolar transurethral resection of the prostate (M-TURP) has been the gold standard of surgical intervention in patients with benign prostatic hyperplasia with the indication for surgery. This can be achieved using varieties of irrigation fluids.

Objectives

To document our experience with M-TURP using water as irrigation fluid in 123 consecutive patients.

Materials and Methods

A retrospective study of all patients who had M-TURP with water as irrigation fluid was performed between January 2017 and July 2019. Information retrieved from theatre records and case notes includes patient's socio-demographic data, indications for surgery, intra-operative findings, the volume of resected chips and irrigation fluid used, post-operative complications and patient's satisfaction with the outcome of the procedure. These data were analysed using SPSS version 23.

Results

Data from 123 patients were analysed and presented. The age range was 44-96 years with a mean of 69 years. Prostate volume ranges from 13.9 to 276.00 mls with a mean of 95.69 mls while resected prostate volume ranges from 2.0 to 158.0 mls with a mean of 56.68 mls. Volume of the sterile water used as irrigation fluid ranged from 5.0 L to 174.0 L with a mean of 68.7 L. Mean reduction in International Prostate Symptoms Score, improvement in Q-max and reduction in post-void residual urine were 22.1, 16.9 and 141.6 mls, respectively. Transfusion rate was 6.5% while the duration of admission ranges from 1 to 6 days, with a mean of 2.5 days. The overall complication rate was 26.0%. Ninety-six percent were satisfied with the outcome.

Conclusion

M-TURP using water as irrigation fluid is safe and is as good as using the more rather expensive glycine or normal saline in bipolar TURP.

Bipolar Transurethral Enucleation of the Prostate: Is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia?

Background

Bipolar Transurethral Enucleation of the Prostate (B-TUEP) is recommended as a first-choice treatment for benign prostatic obstruction in prostates >80 ml. Differently, B-TUEP is only considered as an alternative option after TURP for smaller prostates (30–80 ml). The aim of our study is to assess the relation between prostate size and surgical outcomes after B-TUEP.

Methods

We performed a retrospective analysis of data collected from 172 patients submitted to B-TUEP. Patients were segregated according to tertiles of prostate volume (PV) (≤60 ml, 61–110 ml, >110 ml). For each group we evaluated enucleation efficacy (enucleated weight/enucleation time), complication rates, urinary and sexual function parameters. Functional and sexual parameters were compared between groups at baseline, 1 and 3 months follow up. Descriptive statistics and linear and logistic regression models tested the association between PV and postoperative complications/outcomes.

Results

Operative time and weight of enucleated adenomas increased along with prostate volumes (all p≤0.01). Enucleation efficacy was higher in men with PV >110 ml compared to other groups (p≤0.001). Length of hospital stay, catheterization time and rates of postoperative complications, such as transfusion and clot evacuation rates and bladder neck/urethral strictures, were comparable between groups. Urinary symptoms improved at 1-and 3-months in each group as compared to baseline evaluation (all p<0.01) but they did not differ according to PV. In each group maximum urinary flow and post-void residual volume significantly improved at 3 months compared to baseline (all p≤0.01), without differences according to PV. Sexual symptoms were similar between groups at each follow up assessment. At multivariable linear and logistic regression analysis, prostate volume was not associated with postoperative functional outcomes and complications. Conversely, patient’s comorbid status and antiplatelet/anticoagulation use were independently associated with postoperative complications.

Conclusion

According to our findings, B-TUEP should be considered a “size independent procedure” as it can provide symptom relief in men with prostates of all sizes with the same efficacy and safety profile.

Efficacy and safety of holmium laser enucleation of the prostate for elderly patients: surgical outcomes and King's Health Questionnaire

Background

Holmium laser enucleation of the prostate (HoLEP) has been a widely utilized minimally invasive surgical procedure for benign prostate hyperplasia. The current study aimed to compare surgical outcomes and King’s Health Questionnaire (KHQ) assessment scores following HoLEP between younger men and those aged ≥75 years.

Methods

This prospective single-center study compared perioperative complications, postoperative urinary conditions, and KHQ scores (nine categories) between men aged ≥75 years (group A) and men aged <75 years (group B) before and 1, 3, and 6 months after surgery.

Results

A total of 100 patients were included for analysis (group A, n=38 and group B, n=62). No differences in patient backgrounds, perioperative complications, such as perioperative decrease in hemoglobin, postoperative fever, postoperative indwelling catheterization duration, or postoperative hospitalization duration, and KHQ were observed between both groups. Both groups showed significantly better International Prostate Symptom Scores, quality of life, maximum urinary flow rate, and postvoid residual volume 1, 3, and 6 months after HoLEP compared to their respective preoperative levels (P<0.01). Regarding KHQ categories, both groups showed significantly better general health perceptions, impact on life, emotions, and sleep/energy 1 month after HoLEP; role limitations, physical limitations, and social limitations 3 months after HoLEP; and personal relationships and incontinence severity measures 6 months after HoLEP compared to their respective preoperative levels (P<0.05).

Conclusions

HoLEP could be safe and effective even for men aged ≥75 years, comparing complications, urinary condition, and KHQ scores.

The clinical value of holmium laser enucleation of the prostate in octogenarians

OBJECTIVES

With holmium laser enucleation of the prostate (HoLEP) a size-independent method for surgical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) has been introduced. HoLEP offers durable long-term results with reduced perioperative morbidity. As the risk of disease progression increases with age, the main goals, when offering surgery to an elderly population, are reducing perioperative morbidity and preserving quality of life (QoL). We therefore analyzed the impact of age on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS at our tertiary referral center.

METHODS

We retrospectively collected data of 487 patients who underwent HoLEP for LUTS secondary to BPO between 2018 and 2019. Patients were divided into group 1 (<70 years), group 2 (70-79 years), and group 3 (≥80 years). Perioperative parameters, safety, and short-term functional outcomes were assessed and analyzed.

RESULTS

Perioperative Clavien-Dindo grade ≥II complications were seen in 4.1% of patients (20/487). There was no difference in perioperative complications between all age groups (P = .176). Functional outcome was assessed 30 days post surgery. There was significant improvement in median International Prostate Symptom Score of 14, 10, and 8 points for groups 1, 2, and 3 (P < .001), respectively, with constant improvement of median QoL of 3 points for all groups. Median maximum flow rate (Q_max ) showed significant improvement of 14.5, 10.5, and 13 mL/s for groups 1 to 3 (P = .467), respectively.

CONCLUSION

HoLEP offers acceptable perioperative complication rates even in the oldest patient cohort (≥80 years). Therefore, HoLEP is a safe and efficient option even in oldest patients.

Assessment of Complications of Transurethral Resection of the Prostate Using Clavien-Dindo Classification in South Eastern Nigeria

Background:

Benign prostatic hyperplasia is one of the most common diseases in aging males. For men that need surgical treatment, transurethral resection of the prostate (TURP) is the gold standard. The aim of this article is to retrospectively review the complications of TURP over a 3-year period in Nnamdi Azikiwe University Teaching Hospital Nnewi and a Specialist Urology Center in Awka all in Anambra South-East Nigeria using Clavien-Dindo classification.

Patients and Methods:

The study was a retrospective review of consecutive TURPs done over a 3-year period. Patients' information and complications arising from the procedure were collected and graded using the Clavien-Dindo classification with a pro forma designed for the study and analyzed with the Statistical Package for the Social Sciences software version 20.0.

Results:

Ninety-seven patients had TURP during the period of this study. Twenty-nine complications were noted in 24 patients. The postoperative morbidity rate was 24.74%, and no mortality was recorded. Most of the complications were grade 2 (55%), followed by grade 1 and 3 (20.69%) each. Grade 4a complication accounted for only 3.45%. No grade 5 complication was recorded.

Conclusion:

TURP is safe, with minimal life-threatening morbidity even in a resource-poor economy where TURP is gradually gaining grounds.

Reasons to overthrow TURP: bring on Aquablation

PURPOSE

In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE).

METHODS

A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion.

RESULTS

For small-medium prostates (30-80 mL), Aquablation's main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80-150 mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern.

CONCLUSION

The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required.

Rebamipide-loaded chitosan nanoparticles accelerate prostatic wound healing by inhibiting M1 macrophage-mediated inflammation via the NF-κB signaling pathway

A large proportion of benign prostatic hyperplasia (BPH) patients suffer from lower urinary tract symptoms after surgery due to the presence of prostatic urothelium wounds. Rebamipide (RBM) exerts wound healing promotion and anti-inflammatory effects on various tissues, including the urothelium. However, intravesical administration of RBM is hindered due to its low solubility and resulting unsustainable drug concentrations in the bladder. In this study, RBM-loaded chitosan nanoparticles (RBM/CTS NPs) were prepared using the ionic cross-linking method. Physicochemical characteristics and the wound healing promotion effect, as well as in vitro influence on macrophages were evaluated. The results show that RBM/CTS NPs are spherical with uniform size distribution, while slower and sustained in vitro release of RBM is presented. In vivo, faster wound healing and improved re-epithelialization progress were observed after treatment with RBM/CTS NPs in a model of thulium laser resection of the prostate (TmLRP). The degree of local inflammatory response decreased, as confirmed by decreasing numbers of pro-inflammatory M1 phenotype macrophages and levels of IL-1β, IL-6, IL-12 and TNF-α in the urine of canines. We also found that RBM/CTS NPs suppress macrophage M1 polarization induced by lipopolysaccharide and interferon-γ and inhibit the activation of the NF-κB signaling pathway. Therefore, as a novel therapeutic strategy, intravesical administration of RBM/CTS NPs can effectively avoid drug intolerance and drug wastage, accelerating the postoperative wound repairing of the prostatic urethra by suppressing macrophage M1 phenotype polarization.

[Optimizing the management of bladder cancer in older patients]

AIM

To define and present potential improvements for the management of bladder cancer in older patients.

METHOD

Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, treatment, BCG, chemotherapy, cystectomy, and elderly.

RESULTS

The oncological principles of medico-surgical management of bladder cancer do not differ according to age. On the other hand, the patient comorbidities have been likely to alter the tolerance of these treatments. At the NMIBC stages, no adaptation of the standard treatment has demonstrated any interest. At the MIBC stages, the prognosis was improved by geriatric multidisciplinary perioperative management.

CONCLUSION

The indications and principles of surgical treatments must be identical regardless of the patient age. At the NMIBC stages, adjuvant therapy, including BCG therapy, should not be questioned because of the age of the patient. On the other hand, at the localized MIBC stages, neoadjuvant and adjuvant chemotherapy should not be considered as a standard and their indications assessed individually after geriatric assessment.

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

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

Transurethral resection of the prostate achieves favorable outcomes in stroke patients with symptomatic benign prostate hyperplasia

OBJECTIVES

To evaluate the surgical outcomes of stroke patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP) and compare the clinical outcomes between patients with stroke and those without stroke receiving this procedure.

METHODS

This retrospective cohort study analyzed claims data collected during the period of 1997-2012 from Taiwan National Health Insurance Research Database. We enrolled 6625 patients who had persistent lower urinary tract symptoms and underwent TURP for BPH. They were categorized into a stroke (n = 577) and nonstroke (n = 6048) group. Patient characteristics, postoperative clinical outcomes, medication records, and medical expenses were compared.

RESULTS

Compared with the stroke group patients, those in the nonstroke group were younger, had fewer comorbidities, and more favorable postoperative clinical outcomes. Nevertheless, TURP achieved favorable outcomes in stroke patients with symptomatic BPH. In the stroke group, the rate of urinary tract infection (UTI) decreased from 34.7% during 1 year preoperatively to 29.8% during 1 year postoperatively (p = .05). The rate of urinary retention (UR) also decreased from 55.5% during 1 year preoperatively to 22.5% during 1 year postoperatively (p = .05). TURP reduced the overall medical expenses of patients with stroke. Annual patient medical expense during 1 year preoperatively, 1 year postoperatively, 2 years postoperatively, and 3 years postoperatively was NT$659,000, NT$646,000, NT$560,000, and NT$599,000, respectively.

CONCLUSIONS

In patients with stroke, TURP reduces the risks of UTI and UR and annual total medical expense.

A nomogram predicting re-operation due to secondary hemorrhage after monopolar transurethral resection of prostate

We aim to develop a nomogram to predict re-operation due to secondary hemorrhage after Monopolar transurethral resection of the prostate (M-TURP). We identified patients undergoing M-TURP at Peking University First Hospital from 2000 to 2013. Univariate and multivariate logistic regression models were developed to predict the occurrence re-operation due to secondary hemorrhage. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic curve (ROC), and internal validation was performed via bootstrap resampling. Of the 1901 patients who underwent M-TURP during the study period, 9.1% (173 patients) experienced hemorrhage after M-TURP, and they had a 22.0% re-operation rate (38 patients). Benign prostatic hyperplasia (BPH)-related complications (odds ratio, 0.386; 95% CI, 0.177-0.841), percent of resected prostate (OR, 0.156; 95% CI, 0.023-1.060) and suprapubic cystostomy (OR, 0.298; 95% CI, 0.101-0.881) were independently associated with re-operation. The nomogram accurately predicted re-operation (area under the ROC curve 0.718). The negative predictive value was 88.0%, while the positive predictive value was 47.9%. Re-operation due to secondary hemorrhage after M-TURP was associated with no BPH-related complications, lower percent of resected prostate and no suprapubic cystostomy and was accurately predicted with using the nomogram.

Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients

OBJECTIVE

To report procedure process improvements and confirm the preserved safety and short-term effectiveness of a second-generation Aquablation device for the treatment of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) in 47 consecutive patients at a single institution.

PATIENTS AND METHODS

Aquablation was performed in 47 patients with symptomatic BPH at a single institution. Baseline, peri-operative and 3-month urinary function data were collected.

RESULTS

The mean (range) patient age was 66 (50-79) years, and transrectal ultrasonography-measured prostate volume was 48 (20-118) mL. A median lobe was present in 25 patients (53%) and eight patients had catheter-dependent urinary retention. The mean (range) total procedure time was 35 (13-128) min and the tissue resection time was 4 (1-10) min. Five Clavien-Dindo grade I/II and five Clavien-Dindo grade III complications were recorded in eight patients. The mean (range) hospital stay was 3.1 (1-8) days and the mean (range) duration of urethral catheterization was 1.9 (1-11) days. The mean International Prostate Symptom Score (IPSS) decreased from 24.4 at baseline to 5 at 3 months; IPSS quality-of-life score decreased from 4.5 to 0.3 points; peak urinary flow rate increased from 7.1 to 16.5 mL/s and post-void residual urine volume decreased from 119 to 43 mL (all P < 0.01).

CONCLUSIONS

This study confirmed procedure process improvements resulting from system enhancements, with preservation of safety and effectiveness during use of a second-generation device for the treatment of LUTS attibutable to BPH in the largest single-institution study conducted to date.

Transperineal Laser Ablation for Percutaneous Treatment of Benign Prostatic Hyperplasia: A Feasibility Study

PURPOSE

To assess the feasibility and safety of transperineal laser ablation (TPLA) for treating benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

Institutional review board approval was obtained for this prospective non-randomized trial. Eightteen patients (age 71.7 ± 9.4 years) with urinary symptoms secondary to BPH underwent TPLA under local anesthesia. Under US guidance, up to four 21G applicators were inserted in the prostatic tissue. Each treatment was performed with diode laser operating at 1064 nm changing the illumination time according to prostate size. Primary endpoints were technical success and safety of TPLA. Secondary endpoints included operation time, ablation time, energy deployed, hospitalization time, catheterization time, and change in International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak urinary flow rate (Q _max), post-void residual (PVR), and prostatic volume at 3 months. χ ² and Fisher exact tests were used.

RESULTS

All procedures were technically successful. No complications occurred. Mean operation time was 43.3 ± 8.7 min, mean ablation time 15.9 ± 3.9 min, mean energy deployed 10,522 ± 3290.5 J, mean hospital stay 1.5 ± 0.4 days, and mean catheterization time 17.3 ± 10.0 days. At 3 months, IPSS improved from 21.9 to 10.7 (P < 0.001), QoL from 4.7 ± 0.6 to 2.1 ± 1.2 (P < 0.001), Q _max from 7.6 to 13.3 mL/s (P = 0.001), PVR from 199.9 ± 147.3 to 81.5 ± 97.8 (P < 0.001), and mean prostate volume from 69.8 to 54.8 mL (P < 0.001).

CONCLUSIONS

TPLA is feasible and safe in the treatment of BPH, providing significant clinical results at 3 months.

LEVEL OF EVIDENCE

Case series, Level IV.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Aquablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: 1-Year Results

PURPOSE

We sought to establish the safety and effectiveness of aquablation, a novel, image guided, robotic assisted, water jet tissue ablation technology, for the treatment of benign prostatic hyperplasia.

MATERIALS AND METHODS

We performed a prospective, single arm, multicenter trial at a total of 3 centers in Australia and New Zealand with 1-year followup. Participants were men 50 to 80 years old with moderate to severe lower urinary tract symptoms as determined by urodynamics. All patients underwent aquablation under image guidance. Primary end points included procedural and perioperative safety. The main clinical end point was the change from baseline in I-PSS (International Prostate Symptom Score). Other secondary end points included uroflow measures, prostate volume on transrectal ultrasound and detrusor pressure. Detrusor pressure at maximum flow was only measured at 6 months.

RESULTS

A total of 21 men underwent aquablation at a mean age of 69.7 years (range 62 to 78). Prostate volume was 57.2 ml (range 30 to 102). Procedural duration averaged 38 minutes with a mean aquablation treatment time of 5 minutes. All but 1 subject were catheterized for 1 day only and 19 of 21 were discharged home the day after the procedure. Detrusor pressure at maximum flow decreased from 65 cm H₂O at baseline to 39 cm H₂O at 6 months (p <0.0027). Prostate volume decreased from 57 ml at baseline to 35 ml (p <0.0001). Mean I-PSS score improved from 23.0 at baseline to 6.8 at 12 months (p <0.0001) and maximum urinary flow increased from 8.7 to 18.3 ml per second (p <0.0001). There were no important perioperative adverse events. No urinary incontinence developed and sexual function was preserved postoperatively.

CONCLUSIONS

This phase II study provides early evidence to support the safety and effectiveness of aquablation for symptomatic benign prostatic hyperplasia.

Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: Operative outcomes and surgeon preferences, a real-world scenario

Context:

Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia. Its newly introduced modification, bipolar TURP (B-TURP), promises to overcome its most prominent shortcomings, namely bleeding and dilutional hyponatremia. Literature is conflicting regarding merits of B-TURP over M-TURP.

Aims:

To find a difference, if any, in perioperative outcomes between M-TURP and B-TURP in a real-wold setting.

Settings and Design:

Prospective nonrandomized study.

Subjects and Methods:

Operative outcomes of patients undergoing M-TURP and B-TURP from February 2014 to October 2015 were compared.

Statistical Analysis Used:

Categorical data were compared by Fischer exact test and numerical data were compared by independent samples Mann–Whitney U-test. P <0.05 was considered statistically significant.

Results:

The mean size of prostate operated by bipolar technology was significantly greater than those operated by monopolar technology (38.12 ± 9.59 cc vs. 66.49 ± 22.95 cc; P < 0.001). The mean fall in postoperative serum sodium concentration was 0.99 ± 0.76 mEq/L for the B-TURP group as compared to 3.60 ± 2.89 mEq/L for the M-TURP group (P < 0.001). The mean drop in postoperative hemoglobin concentration (P = 0.28) was statistically insignificant, even though larger glands were operated by B-TURP. There were three instances of the transurethral resection (TUR) syndrome in the M-TURP group whereas no TUR syndrome occurred in the B-TURP group.

Conclusions:

In spite of various contrary viewpoints in literature, surgeons prefer to operate on larger prostates using bipolar technology. B-TURP definitely reduces the incidence of bleeding and dilutional hyponatremia, making it a contender to replace M-TURP as the new gold standard.

Holmium Laser Enucleation of the Prostate is Safe for Patients Above 80 Years: A Prospective Study

Purpose:

To evaluate the effect of age on the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the treatment of symptomatic benign prostatic hyperplasia (BPH).

Methods:

A total of 579 patients underwent HoLEP procedure performed by a single surgeon (SJO) between December 2009 and May 2013. The perioperative and functional outcomes of patients in the age groups of 50–59 (group A, n=44), 60–69 (group B, n=253), 70–79 (group C, n=244), and ≥80 years (group D, n=38) were compared. The Clavien-Dindo system was used to evaluate clinical outcomes. The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual (PVR) urine volume, and urinary continence were used to assess functional outcomes.

Results:

In this study, the patients ≥80 years had significantly higher presence of hypertension (P=0.007), total prostate volumes (P=0.024), transitional zone volume (P=0.002), American Society of Anesthesiologists scores (P=0.006), urinary retention (P=0.032), and anticoagulation use (P=0.008) at preoperative period. Moreover, the mean values of operation time, enucleation time, morcellation time, and enucleation weight were higher in group D compared with other group patients (P=0.002, P=0.010, P<0.01, and P=0.009, respectively). Patients aged ≥80 years had a longer hospital stay time (2.9±1.8 days) than other groups (group A, 2.3±0.7 days; group B, 2.3±0.7 days vs. group C, 2.4±0.7 days; P=0.001). All groups were similar in regard to the incidence of complications (Clavien-Dindo grade) post operatively (P>0.05). All the patients in the present study showed improvement in functional outcomes after HoLEP. By the sixth month, there were no significant differences in IPSS, quality of life, Qmax, and PVR among the groups (P>0.05).

Conclusions:

Compared with younger patients, the patients aged ≥80 years had a similar overall morbidity and 6-month functional outcomes of HoLEP. HoLEP is a safe and effective treatment for BPH among the elderly.

Benign Prostatic Hyperplasia Treatment by Transurethral Enucleation of the Prostate Using a 2-μm Laser

This study investigates the efficacy of benign prostatic hyperplasia (BPH) treatment by prostate transurethral enucleation using a 2-μm laser. A total of 107 patients with BPH were treated by prostate transurethral enucleation using a RevoLix 2-μm laser surgery system. Bleeding volume, operation time, catheterization time, voiding situation, maximum urinary flow rate, and hospital stay were observed. The mean operation time was 74 min ± 12 min (range 45 to 150 min), the mean follow-up period was 2 to 6 months, the mean catheter time was 5 days, and the mean peak urinary flow rate increased from 6.3 ± 0.6 to 17.5 ± 1.5 mL/s. The International Prostate Symptom Score and quality of life significantly declined (p < 0.01). No significant differences were observed in the hemoglobin and blood electrolytes before and after operation. Prostate transurethral enucleation using a 2-μm laser is safe and efficient for BPH treatment.

Aquablation - image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience

OBJECTIVE

To assess the safety and feasibility of aquablation in a first-in-man study. Aquablation is a novel minimally invasive water ablation therapy combining image guidance and robotics (AquaBeam(®) ) for the targeted and heat-free removal of prostatic tissue in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

A prospective, non-randomised, single-centre trial in men aged 50-80 years with moderate-to-severe LUTS was conducted. Under real-time image-based ultrasonic guidance, AquaBeam technology enables surgical planning and mapping, and leads to a controlled heat-free resection of the prostate using a high-velocity saline stream. Patients were evaluated at 1, 3, and 6 months after aquablation.

RESULTS

In all, 15 patients were treated with aquablation under general anaesthesia. The mean (range) age was 73 (59-86) years and prostate size was 54 (27-85) mL. A substantial median lobe was present in six of the 15 patients. The mean International Prostate Symptom Score (IPSS) was 23 and the maximum urinary flow rate (Qmax ) was 8.4 mL/s at baseline. The mean procedural time was 48 min with a mean aquablation treatment time of 8 min. All procedures were technically successful with no serious or unexpected adverse events (AEs). All but one patient had removal of catheter on day 1, and most of the patients were discharged on the first postoperative day. No patient required a blood transfusion, and postoperative sodium changes were negligible. There were no serious 30-day AEs. One patient underwent a second aquablation treatment within 90 days of the first procedure. The mean IPSS score statistically improved from 23.1 at baseline to 8.6 at 6 months (P < 0.001) and the Qmax increased from 8.6 mL/s at baseline to 18.6 mL/s at the 6-month follow-up (P < 0.001). At 6 months, the mean detrusor pressure at Qmax decreased to 45 cmH2 0 from 66 cmH2 0 at baseline (P < 0.05), and the mean prostate size was reduced to 36 mL, a 31% reduction in size vs baseline (P < 0.001). No cases of urinary incontinence or erectile dysfunction were reported.

CONCLUSIONS

These preliminary results from this initial study show aquablation of the prostate is technically feasible with a safety profile comparable to other BPH technologies. The combination of surgical mapping by the operating surgeon and the high-velocity saline provides a promising technique delivering a conformal, quantifiable, and standardised heat-free ablation of the prostate. Advantages of this technique include reduction in resection time compared with other endoscopic methods, as well as the potential to preserve sexual function.

Frequency of Electrolyte Derangement after Transurethral Resection of Prostate: Need for Postoperative Electrolyte Monitoring

Objective. To determine the electrolyte derangement following transurethral resection of prostate (TURP). Methods. All patients undergoing TURP from June 2012 to April 2013 were included. Preoperative electrolytes were performed within a week of procedures. Monopolar TURP using 1.5% glycine was performed. Serum Na⁺ and K⁺ were assessed within 1 hour postoperatively and subsequently if clinically indicated. Results. The study included 280 patients. Sixty-six patients (23.6%) had electrolyte derangement after TURP. Patients with deranged electrolytes were older (mean age of 73.41 ± 4.08 yrs. versus 68.93 yrs. ± 10.34) and had a longer mean resection time (42.5 ± 20.04 min versus 28.34 ± 14.64 min). Mean weight of tissue resected (41.49 ± 34.46 g versus 15.33 ± 9.74 g) and volume of irrigant used (23.55 ± 15.20 L versus 12.81 ± 7.57 L) were also significantly higher in patients with deranged electrolytes (all p = 0.00). On multivariate logistic regression analysis preoperative sodium level was found to be a significant predictor of postoperative electrolyte derangement (odds ratio 0.267, S.E. = 0.376, and p value = 0.00). Conclusion. Electrolyte derangement occurs in older patients, with larger amount of tissue and longer time of resection and higher volume of irrigant, and in those with lower serum preoperative sodium levels.

Perioperative use of cyproterone acetate with transurethral resection of large prostate: preliminary results

PURPOSE

To assess the impact of short-term treatment with cyproterone acetate (CPA) on intraoperative and early postoperative complications of transurethral resection of relatively large prostate.

PATIENTS AND METHODS

We recruited patients with prostate size of 60-90 g and randomized them into two equal groups. The first one had 50 mg of CPA orally twice a day (bds) for 2 weeks before the operation and maintained it for an extra week postoperatively. The other group received placebo. All patients underwent monopolar transurethral prostatectomy (M-TURP) and the prostatic chips were stained for CD34 specific for nascent blood vessels.

RESULTS

Ninety-five patients were included. Mean patient age was 60.88±2.5 years and mean prostate size was 72.76±7.21 g. CPA was well tolerated with no serious adverse effects. The mean resection time and the mean weight of the resected tissue were comparable between the two groups. Intraoperative blood loss, fluid absorption, and blood loss per gram of resected tissue (259.47±78.27 mL, 787.38±300.56 mL, and 14.87±4.02 mL/g and 327.25±98.97 mL, 937.4±350.2 mL, and 17.08±5.55 mL/g, respectively) were significantly lower in the treatment group (p<0.05). In addition, excessive postoperative bleeding was encountered in one case in the treatment group and in seven in the control (p<0.05). Finally, the histopathological study revealed that the mean microvessel density in each of the suburethral portion and the hyperplastic nodules of the prostate was significantly lower in the CPA group (p<0.001).

CONCLUSION

The perioperative use of CPA with M-TURP of a relatively large prostate may help in decreasing the perioperative bleeding and fluid absorption that usually take place during this procedure.

Age-stratified outcomes of holmium laser enucleation of the prostate

OBJECTIVE

To present the first age-stratified assessment of outcomes after holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms resulting from prostate enlargement.

PATIENTS AND METHODS

We retrospectively analysed and compared the morbidity, and the peri-operative and functional outcomes of patients aged 50-59, 60-69, 70-79 and ≥80 years. Complications at 30 days were stratified using the Clavien system. Functional outcomes were assessed using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR) and urinary continence.

RESULTS

A total of 311 patients underwent HoLEP for obstructive voiding symptoms from August 2007 to June 2011, of whom 22 patients were aged 50-59 years, 91 were aged 60-69 years, 153 were aged 70-79 years, and 45 were aged ≥80 years. The overall morbidity rates were similar among the age groups (20, 24.4, 21.6 and 22.1% for groups 1, 2, 3 and 4, respectively), as were the incidence of significant complications (Clavien grade ≥ III), change in serum haemoglobin level, and length of hospital stay. Patients ≥80 years did have a longer catheterization time (3.4 days) than patients aged 50-59 years (1.68 days). By 1 year there were no significant differences in urinary continence, IPSS, Qmax , or PVR among the age groups.

CONCLUSIONS

Overall morbidity, hospital stay, and 1-year functional outcomes of HoLEP were similar among all age groups. This study shows that HoLEP is a safe and effective treatment for benign prostatic hyperplasia regardless of age.

Continuous Veno-Venous Haemofiltration in the Management of Severe Hyponatraemia Associated with Transurethral Resection of Prostate Syndrome

Modern surgical practice and anaesthetic vigilance has reduced the incidence of profound metabolic disturbance associated with absorption of irrigation fluid during endoscopic transurethral resection (TUR) of the prostate. We describe the critical care management of a patient with severe TUR syndrome, who was successfully managed with continuous veno-venous haemofiltration for the treatment of profound electrolyte disturbance, intravascular volume correction, and treatment of irrigation-fluid glycine toxicity. We examine the rationale for rapid and controlled correction of hyponatraemia in TUR syndrome.

Effectiveness and Safety of Photoselective Vaporization of the Prostate with the 120 W HPS Greenlight Laser in Benign Prostatic Hyperplasia Patients Taking Oral Anticoagulants

Purpose

To examine the effectiveness and safety of photoselective vaporization of the prostate (PVP) with the 120 W high-performance system (HPS) Greenlight laser procedure in benign prostatic hyperplasia (BPH) patients taking oral anticoagulant medications.

Materials and Methods

This study was conducted on BPH patients taking oral anticoagulant medications form March 2009 to December 2010. Group I consisted of patients who stopped oral anticoagulant medications before surgery (n=30), and group II consisted of patients who continued oral anticoagulant medications before surgery (n=30). PVP applying the 120 W HPS Greenlight laser was done, and followed up for 12 weeks. Follow-up variables were International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and hemoglobin level change.

Results

At 12 weeks after surgery, we confirmed the improvement in the IPSS score of Group I compared with preoperative scores. The quality of life (QoL) score, Qmax and PVR were also improved. respectively, both of which were significantly improved. In Group II, similarly, the total IPSS score, the voiding symptom score, and the storage symptom score were improved in comparison with the preoperative scores. The QoL score, Qmax and the PVR were improved in comparison with the preoperative scores. During the 12-week follow-up period, no major postsurgical complications requiring transfusion, rehospitalization, etc. were observed.

Conclusions

The 120 W HPS Greenlight laser PVP procedure can be performed effectively and safely in BPH patients, even those who cannot stop oral anticoagulant medications despite requiring surgery.

Perioperative management of transurethral surgery for benign prostatic hyperplasia: a nationwide survey in Japan

OBJECTIVES

Various types of minimally invasive surgical treatments, including transurethral resection of prostate (TURP), are being carried out in Japan for patients with benign prostatic hyperplasia (BPH). The aim of the present study was to elucidate the current status of perioperative care for these treatments by carrying out a nationwide survey.

METHODS

Assisted by the Japanese Endourology and ESWL Association, perioperative data from 157 institutions participating in this survey were collected and analyzed.

RESULTS

This survey included 3918 patients undergoing TURP, 242 TUR in saline (TURis), 638 holmium laser enucleation of the prostate (HoLEP), 90 holmium laser ablation (HoLAP) and 241 photoselective vaporization (PVP). Mean operative time was shorter in TURP (71 min) and longer in HoLEP (127). Although no transfusions were required in cases undergoing HoLAP or PVP, blood was frequently transfused in those undergoing TURis (25.6%), TURP (10.2%) and HoLEP (7.8%), and the difference was significant. During the hospital stay, the incidence of TUR-syndrome, postoperative bleeding requiring bladder irrigation, acute urinary retention/difficulty on micturition and pad use at discharge was highest in TURP (2.3%), TURis (7.9%), HoLAP (16.7%) and HoLEP (15.1%), respectively. Two patients undergoing TURP died (0.05%). The shortest mean postoperative hospital stay was for PVP (1.6 days, even if the readmission rate within 90 days was the highest in this same group; 6.2%). Perioperative care during hospital stay varied among the five types of procedures.

CONCLUSIONS

This survey provides useful documentation on the current status of minimally invasive treatments for BPH in Japan. Complication rates for TURP are not significantly higher as compared with other procedures. Thus, TURP can still be considered as the gold standard for BPH treatment.

Analysis of the factors causing bladder irritation after transurethral resection of the prostate

Purpose

Approximately 20% to 30% of patients with benign prostatic hyperplasia (BPH) require medication or supplementary treatment for their continuous irritative bladder symptoms after transurethral resection of the prostate (TURP). The purpose of this study was to identify any factors related to continuous bladder irritation in patients after TURP.

Materials and Methods

Of all patients who underwent TURP from January 2000 to December 2007, 160 who underwent long-term follow-up were selected for this study. The International Prostate Symptom Score (IPSS) was assessed 12 months after TURP, and the patients were divided into two groups: one group with an irritative bladder symptom score on the IPSS of 7 or less (non-irritative group) and another group with an irritative bladder symptom score on the IPSS of 8 or greater (irritative group). Preoperative urodynamic study variables, preoperative and postoperative IPSS, and the shape of the prostate upon transrectal ultrasonography (TRUS) were analyzed.

Results

Of the 160 patients, 93 patients were assigned to the non-irritative group, and 67 were assigned to the irritative group. Initial irritative bladder symptoms were significantly different between the two groups (p<0.05). Also, a retrourethral enlarged prostate was more frequently observed upon TRUS in the irritative group. Symptoms of urinary frequency, incontinence, and urgency were significantly greater in the irritative group. Although there was no significant difference in the preoperative quality of life between the two groups, postoperative quality of life was significantly worse in the irritative group.

Conclusions

The shape of the prostate and the preoperative irritation score correlated significantly with the postoperative severity of irritative bladder symptoms. Therefore, physicians should be cautious when performing TURP in patients with a retrourethral enlarged prostate and severe irritative symptoms.

Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics

PURPOSE

We evaluated transurethral enucleation and resection of the prostate in patients with urinary symptoms due to benign prostatic hyperplasia using the Plasmakinetic™ system.

MATERIALS AND METHODS

We retrospectively analyzed the records of 1,100 patients who underwent transurethral enucleation and resection of the prostate between January 2003 and February 2009 at our institution. We assessed the International Prostate Symptom Score, quality of life score, peak flow rate and post-void residual urine volume preoperatively, 1, 3, 6 and 12 months postoperatively, and yearly thereafter. Enucleation and resection time, enucleated tissue weight, catheterization time, hospital stay and long-term complications were recorded.

RESULTS

No patient had significant blood loss or signs of the transurethral resection syndrome. Mean±SD patient age was 66.7±7.3 years and mean followup was 4.3 years. Mean preoperative prostate weight was 67.7±12 gm (range 35 to 256), mean enucleation time was 15.5 minutes (range 10 to 38), mean resection time was 46 minutes (range 20 to 65) and mean resected tissue weight was 42.8±7.7 gm (range 23 to 219). Mean catheter time was 1.8±0.4 days and mean hospital stay was 5.3±2.3 days. Transurethral enucleation and resection of the prostate induced significant, pronounced, immediate and lasting improvement in the International Prostate Symptom Score, quality of life, maximum urinary flow and post-void residual urine volume. Postoperative complications included meatal stenosis in 9 cases, incontinence in 56, urethral stricture in 12 and bladder neck contracture in 10.

CONCLUSIONS

Transurethral enucleation and resection of the prostate appears to be the modern alternative to transurethral resection of the prostate and open prostatectomy for bladder outlet obstruction due to benign prostatic hyperplasia. It may be done in glands up to 250 gm.

Effects of short-term dutasteride and Serenoa repens on perioperative bleeding and microvessel density in patients undergoing transurethral resection of the prostate

OBJECTIVE. To evaluate the effects of short term use of dutasteride and Serenoarepens before transurethral resection of the prostate (TURP) on the amount of intraoperative blood loss and microvessel density (MVD) of prostatic stromal and suburethral tissues in the patients with benign prostatic hyperplasia.

PATIENTS AND METHODS

The study involved 75 male patients who planned to have a TURP. The patients were randomly divided into three groups. The control group comprised 21 patients. Group 2 comprised 27 patients who used dutasteride 5 mg/day, and group 3 comprised 27 patients who used S. repens 160 mg/day for 5 weeks before the operation. The amount of intraoperative haemorrhage was calculated. Total blood loss, total blood loss/time, total blood loss/weight of resected tissue and total blood loss/weight/time were calculated for each patient and all were recorded. Sections from the prostatic stromal and suburethral tissues were examined for suburethral and prostatic MVD.

RESULTS

The total amount of intraoperative blood loss, total blood loss/time, total blood loss/weight of resected tissue, total blood loss/weight/time, serum haemoglobin level change, prostatic MVD and suburethral MVD of the groups were compared. No significant statistical differences were found between the groups for any of these variables (p > 0.05).

CONCLUSIONS

Dutasteride and S. repens therapies were not superior to control in terms of the decrease in total blood loss during TURP. Moreover, MVD showed no statistical differences in the treatment groups compared with the control group.

Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients

PURPOSE

Transurethral resection of the prostate has for decades been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia, the most common benign neoplasm in men. To generate a contemporary reference for evolving medical and minimally invasive therapies we analyzed complications and immediate outcomes of transurethral prostate resection in a statewide multicenter study.

MATERIALS AND METHODS

We prospectively evaluated 10,654 patients undergoing transurethral prostate resection in the state of Bavaria, Germany from January 1, 2002 until December 31, 2003. Case records containing 54 items concerning preoperative status, operation details, complications and immediate outcome, were recorded for each patient.

RESULTS

The mortality rate for transurethral prostate resection was 0.10%. The cumulative short-term morbidity rate was 11.1%. The most relevant complications were failure to void (5.8%), surgical revision (5.6%), significant urinary tract infection (3.6%), bleeding requiring transfusions (2.9%) and transurethral resection syndrome (1.4%). The resected tissue averaged 28.4 gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 9.8% of patients. Urinary peak flow rate increased significantly to 21.6 +/- 9.4 ml per second (baseline 10.4 +/- 6.8 ml per second, 1 tail p <0.0001), while post-void residual decreased to 31.1 +/- 73.0 ml (baseline 180.3 +/- 296.9 ml, 1-tail p <0.0001).

CONCLUSIONS

In a large scale evaluation comprising 44 mostly nonacademic urological departments in Bavaria, unique real-world data for transurethral prostate resection were prospectively generated. This most contemporary information should be of use to potential patients and facilitate subsumption of emerging surgical and nonsurgical benign prostatic hyperplasia treatment options.

Improvement in mortality and morbidity in transurethral resection of the prostate over 17 years in a single center

BACKGROUND AND PURPOSE

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

Our study gives data on a contemporary TURP series and outlines a development toward fewer perioperative complications.