Analysis of the effect of one-stage transurethral prostatectomy for benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of one-stage transurethral prostatectomy for prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility.Methods:The clinical data of 35 patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility admitted to The Second Affiliated Hospital of Zhengzhou University from January 2015 to Octorber 2021 were analyzed.The average age was (74.0±7.9) years old. The average volume of prostate was (77.8±44.5)cm 3. The average total prostate specific antigen(tPSA)was(8.9±8.7)ng/ml. The preoperative international prostate symptom score(IPSS) was (19.1±4.3) and the preoperative quality of life score(QOL)was 5(5, 5). All the patients were treated with one-stage transurethral prostatectomy and suprapubic cystostomy. After removing the cystostomy tube, the post-void resident volume(PVR), the maximum urine flow rate(Q max), IPSS, QOL were recorded, and complications were followed up. Successful treatment is defined as the removal of the cystostomy tube without worsening of upper urinary tract hydronephrosis. Results:All the operations were successfully completed. The success rate of treatment was 85.7%(30/35), and the median time to resume spontaneous urination was 4.0(3.3, 4.5) weeks. The average postoperative Q max was (12.6±2.3)ml/s, and the average PVR was(27.7±9.5)ml. The postoperative IPSS was (5.5±2.4), which was significantly improved compared to preoperative( P<0.001). The postoperative QOL score was 1(1, 2) points, which was significantly lower than preoperative( P<0.001). The patients voiding spontaneously were followed up for 3-69 months, and no complications such as urinary retention, recurrent urinary tract infection and hydronephrosis occurred. Conclusions:One-stage transurethral prostatectomy for patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility has a high success rate and few complications, which greatly improves the quality of life of patients.

Safety and effectiveness of finasteride combined with 1470 nm Semiconductor laser vaporization and resection for Moderate to severe benign prostatic hyperplasia / 中国生化药物杂志

Objective To study the safety and effectiveness finasteride combined with 1470 nm semiconductor laser vaporization and resection for moderate to severe benign prostatic hyperplasia (BPH). Methods A total of 110 consecutives from January to December 2015 were divided randomly into control and observation groups and each of 55 cases; the patients in control group received finasteride combined with transurethral prostatectomy (TURP) and they in observation group adopted finasteride combined with 1470 nm semiconductor laser vaporization and resection, then to compare the differences of surgical success rate,complications rate,mean operation time,blood bloss during and after operation, indwelling catheter time,prostate volume before and after operation; the follow-up time was 12.0 months, the differences of international prostate symptom score (I-PSS), Quality of life score (QOL), peak flow rate (Qmax) peak flow rate (Qmax) and post-void residual (PVR). Results The surgical success rate in the two groups were no statistical difference, the complications rate in observation group was significantly lower (P<0.05). The mean operation time and indwelling catheter time in the two groups were no statistical difference, while the total blood bloss and prostate volume after operation in observation group were both less, and the difference of prostate volume was more (P<0.05). The I-PSS and PVR were lower, QOL and Qmax higher in the two groups after operation, what'more, there were more improvements in observation group (P<0.05). Conclusion It is more prior to finasteride combined with 1470 nm semiconductor laser vaporization and resection for moderate to severe BPH on the Safety and effectiveness than TURP.

Postoperative acquired primary hyperfibrinolysis secondary to bipolar plasmakinetic transurethral resection of the prostate：a case report and review of the literature / 中华泌尿外科杂志

Objective To discuss the diagnosis and treatment of the postoperative acquired primary hyperfibrinolysis secondary to bipolar plasmakinetic transurethral resection of the prostate ( BP-TURP ) . Methods A case with benign prostatic hyperplasia was retrospectively reviewed, who was an 88-year-old patient admitted on 14th October, 2013 because of repeated urinary retention for 10 years, and catheter indwelling for 20 days.Blood pressure was 101/59 mmHg on admission (1 mmHg=0.133 kPa).Digital rectal examination showedⅡ°prostate, smooth surface, rubbery and no nodules.Routine blood showed the leucocyte 4.6 ×109/L, neutrophils 0.62, hemoglobin 108 g/L, red blood cells 3.30 ×1012/L, platelet 90 ×109/L.Preoperative coagulation function showed prothrombin time (PT) 12.8 s (10-14), activated clotting time live enzymes (APTT) 34.8 s (21 -37), fibrinogen (FiB-C) 2.38 g/L (2 -4), D-dimer 0.50 mg/L (0-0.55), fibrin degradation products (FDP) 2.0 mg/L ( <5.0).Abdominal ultrasound showed hyperplasia of prostate ( 52 mm ×46 mm ×37 mm ) , protruding into the bladder about 20 mm. Abdominal CT scanning showed bladder diverticulum and stones, hyperplasia of prostate and calcification. The operation time of BP-TURP was 90 min with no significant intraoperative bleeding, and continuous bladder irrigation drainage was clear.Results Four hours after the operation, continuous bladder irrigation drainage became bright red.Seven hours after operation, blood pressure was 83/56 mmHg, and blood routine showed white blood cells 8.1 ×109/L, neutrophils 0.92, red blood cells 2.93 ×1012/L, hemoglobin 95 g/L, platelet 67 ×109/L.Transfusion of 4.5 U red blood cell suspension was administered.The prostatic fossa hemorrhage was suspected and bleeding was not alleviated after adjusting the catheter.Prostatic fossa electro-coagulation hemostasis was performed and bladder neck obvious oozing of blood was detected intraoperatively, and no venous sinus bleeding or obvious blood clots were detected.Four hours after the secondary surgery, continuous bladder irrigation drainage became pink again, and the conservative treatment had no effect.Blood coagulation function showed PT 16.9 s, APTT 43.5 s, FiB-C 0.34 g/L, D-dimer 1.70 mg/L, FDP 57.4 mg/L.The patient was diagnosed as postoperative acquired primary hyperfibrinolysis, and repeat plasma, red blood cell suspension, and tranexamic acid transfusion was administered.Continuous bladder irrigation drainage gradually became clear.Blood coagulation function index gradually returned to normal.Routine urine test showed red blood cells ( microscopy ) 4 -5/HPF. Conclusions After BP-TURP, acquired primary hyperfibrinolysis may occur.The outcome is good after timely diagnosis and effective treatment.

Long-Term Follow-Up Results of Photoselective Vaporization of the Prostate with the 120 W Greenlight HPS Laser for Treatment of Benign Prostatic Hyperplasia

PURPOSE: With the use of 12 months of follow-up data, this study was conducted to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of symptomatic benign prostatic hyperplasia. MATERIALS AND METHODS: Data were collected from 104 patients who were diagnosed with benign prostatic hyperplasia and who underwent PVP with the 120 W Greenlight HPS Laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: The mean age of the patients was 71.1+/-7.7. The baseline mean prostate-specific antigen level was 3.8+/-2.7 ng/ml, the mean prostate size was 43.9+/-20.6 g, the mean preoperative IPSS was 18.4+/-8.5, the mean QoL score was 4.1+/-1.0, the mean Qmax was 9.9+/-5.5 ml/sec, and the mean PVR was 89.6+/-207.1 ml. During surgery, the mean operation time was 21.8+/-11.3 minutes, the mean lasing time was 16.9+/-10.5 minutes, and the mean total applied energy was 170,068+/-63,181 J. At 1 month, significant improvements were observed in total IPSS (11.5+/-6.7, p<0.05), voiding symptom score (6.1+/-5.4, p<0.05), and QoL score (2.2+/-1.5, p<0.05); however, there were no significant improvements in storage symptom score (4.8+/-3.8, p=0.06), Qmax (12.6+/-10.2, p=0.06), and PVR (40.1+/-30.5, p=0.41). However, 3 months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters. CONCLUSIONS: Significant improvements were observed in subjective and objective voiding parameters, which were evident at 3 months after PVP and were sustained throughout a period of 12 months after PVP.

Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

Objective: To assess the impact of the percent of resected tissue on the improvement of urinary symptoms. Materials and methods: The study included a prospective analysis of 88 men with benign prostatic hyperplasia. Patients were divided in three groups according to the percent of resected tissue: Group 1 < 30 percent; Group 2, 30 percent to 50 percent; and Group 3, > 50 percent. Each patient was re-evaluated 3 months after surgery. We assessed the international prostatic symptom score, nocturia and serum prostate specific antigen levels. Results: All patients presented a significant decrease on mean International Prostate System Score (IPSS) (23 to 5.9), Quality of Life (QoL) (4.9 to 1.0) and nocturia (3.2 to 1.9). Variation in the IPSS was 16.7, 16.6 and 18.4 for patients from Group 1, 2 and 3 respectively (P = 0.504). Although the three groups presented a significant decrease in QoL, patients in Group 3 presented a significantly greater decrease when compared to Group 1. Variation in QoL was 3.1, 3.9 and 4.2 for patients from Group 1, 2 and 3 respectively (p = 0.046). There was no significant difference in nocturia variation according to the percent of resected tissue (p = 0.504). Median pre and postoperative PSA value was 3.7 and 1.9 ng/mL respectively. Patients from Group 1 did not show a significant variation (p = 0.694). Blood transfusions were not required in any group. Conclusions:Resection of less than 30 percent of prostatic tissue seems to be sufficient to alleviate lower urinary tract symptoms related to benign prostate hyperplasia. However, these patients may not show a significant decrease in serum PSA level.

Study on the characteristics and some risk factors of transurethral prostatectomy syndrome

Background: Benign hyperplasia prostate is a common disease in older men (over 60 years old). Transurethral resection of benign hyperplasia prostate is a method of improving symptoms with the best results, though with a high rate of complications, in which the most serious complication is transurethral prostatectomy syndrome (TURPS). Objective: The study aimed to describe clinical and para-clinical characteristics of TURPS and to define some risk factors of TURPS. Subject and methods: A descriptive, prospective study was conducted in 200 patients, who underwent TURPS, ASA I-II at the Anesthetic Emergency Department, Viet Duc Hospital from April 2007 to October 2007. To describe TURPS by observing clinical signs and serum sodium. The risks of TURPS were considered as prostate weight, operation time and amounts of used irritants. Results: The incidence of the TURPS was 7% of all resections. Clinical signs of the TURPS were nausea, vomiting, headaches, confusion and disorientation. TURPS was associated with hypotension (42.9%), bradycardia (35.7%), increased CVP (21.4%). The sodium concentration fell below normal in certain patients (64.3%). The amount of 3% Sorbitol (> 20 liters) was an independent risk factor of TURPS, but not the prostate weight or the operation time. Conclusions: The main signs of TURPS included central nervous symptoms (100%), circulatory and respiratory disorders (42.9%, 21.4%, respectively) and hyponatremia (64.3%). Sorbitol 3% > 20 liters was an independent risk factor of TURPS.

Study of the Duration of Pyuria after Transurethral Prostatectomy / 대한비뇨기과학회지

PURPOSE: Persistent pyuria is one of the common complications after transurethral prostatectomy (TURP). Postoperative pyuria has an effect on postoperative voiding symptoms. Thus, postoperative urinalysis and urine culture are reliable indicators when following up voiding symptoms. In our study, possible preoperative, intraoperative and postoperative factors influencing the development and duration of pyuria and bacteriuria after TURP were evaluated. MATERIALS AND METHODS: Between January 2004 and November 2005, 82 patients who underwent TURP due to benign prostatic hyperplasia (BPH) were evaluated. The risk factors of the duration of the postoperative pyuria were divided into preoperative, intraoperative postoperative, and evaluated the differences and correlations according to these risk factors. RESULTS: The average durations of pyuria of 26 and 23 patients under and over the age of 70 were 4.12+/-2.69 and 6.61+/-4.51 weeks, respectively (p= 0.03). The average duration of pyuria of 12 patients with no preoperative pyuria and 37 with preoperative pyuria were 4.97+/-3.12 and 6.25+/-5.55 weeks, respectively (p=0.04). Separating patients according to the resected volume of prostate, the average duration of pyuria of 16 and 33 patients with resected prostate volumes greater than and less than 7g were 3.56+/-2.16 and 6.12+/-4.20 weeks, respectively (p=0.03). The age and average duration of pyuria showed a positive correlation (p=0.031). CONCLISIONS: Significant differences were observed in the duration of pyuria according to age, preoperative pyuria and resected volume of prostate.

Transurethral plasmakinetic vaporization of prostate for benign prostatic hyperplasia:a clinical analysis in 180 eases / 中国基层医药

Objective To investigate the safety and efficacy of transurethral plasmakinetic vaporization of prostate(PKVP)in treating benign prostatic hyperplasia.Methods Totally 180 BPH patients were treated with PKVP from January 2003 to December 2006.Results The weight of the resected prostatic tissue was)52.4? 26.8)g,operating period was)61.2?32.8)minutes,and the amount of bleeding was)70.1?46.3)ml.No transurethral resection syndrome(TURS)and obturator nerve reflex was observed.The patients were followed up for 1～25 months postoperatively,and the maximum urine flow(Qmax)was increased from)6.2?4.1)ml/s preopera- tively to)21.2?4.6)ml/s postoperatively;the international prostate symptom score(IPSS)was decreased from (25.6?4.8)points to)6.8?2.6)points;the residual urine volume was reduced from)67.8?27.3)ml to)17.5 ?7.3)ml;the quality of life(QOL)score was decreased from)5.1?1.5)to)1.8?0.5),and there were signifi- cant differences before and after operation(P

Transurethral Prostatectomy Using a 22F Continuous Running Irrigation System Resectoscope / 대한비뇨기과학회지

PURPOSE: The twenty-six F sized continuous running irrigation transurethral resection (TUR) system has showed a relatively high risk for inducing postoperative urethral stricture in Korean men. We evaluated the efficacy and safety of recently available 22F continuous running irrigation TUR system for treating benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS: A total of seventy patients with severe symptomatic BPH underwent transurethral prostatectomy (TURP). The 26F system was used in 31 cases and the 22F system was used in 39 patients. The total resection weight, the resection rate, and the intraoperative and immediate postoperative complication rates were compared between the 2 groups. The patients were followed for 2 weeks, 4 weeks and 3 months postoperatively to check for the development of urethral stricture. RESULTS: The total resection weight was 14.8+/-9.5gm in the 22F group and 11.2+/-10.2gm in the 26F group (p>0.05). The resection rates were 0.24+/-0.10gm/min and 0.19+/-0.11gm/min, respectively. The rate of urethral stricture requiring any type of management was 15.4% (6/39) in the 22F group and 38.7% (12/31) in the 26F group (p<0.05). Visual internal urethrotomy was performed in 2.6% (1/39) and 9.7% (3/31) of the patients, respectively. Other complications were 1 capsular perforation, 1 TUR syndrome, 1 epididymitis and 1 delayed bleeding in the 22F group, and 1 intraoperative fever and 1 epididymitis in the 26F group. CONCLUSIONS: TURP using the 22F continuous running irrigation system enabled the surgeon to resect prostate adenoma with a similar speed and effectiveness as compared with the 26F system, and it significantly reduced the risk of urethral stricture. Performing TURP with using this system can be considered as a first line therapy for the BPH patients who require surgery.

The value of immediate postoperative cystogram in transurethral prostatectomy

Twenty-five consecutive cystograms were performed immediately following transurethral prostatectomy. The value of routine post-operative cystograms was demonstrated. It enables the resectionist to confirm not only visible perforations, but also enables him to diagnose occult extravasations. Significant vascular absorption can also be demonstrated. These findings forewarn the Resectionist of any likely post-operative complication. The management of bladder perforation and urinary extravasation was also discussed. (Summary)

Risk Factors Influencing Complications following Transurethral Prostatectomy for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

A retrospective analysis of 108 patients who had undergone transurethral prostatectomy for benign prostatic hyperplasia between January 1988 and December 1992 was performed to evaluate risk factors influencing intraoperative and postoperative morbidity and mortality. Of 108 patients complications occurred in 32 cases, with the morbidity rate of 29.6% but no death occurred. The most common postoperative complication was bleeding in 9 cases(8.3%) followed by incontinence in 7 cases(6.5%), capsular perforation in 4 cases(3.7%), failure to void in 4 cases(3.7%) and urethral stricture in 4 cases(3.7%). Risk factors which increased the morbidity of transurethral prostatectomy were age greater than 75 years and the presence of associated medical disease(p<0.05) but a resection time of more than 90 minutes, weight of resected tissue more than 30 gram and amounts of irrigating solution of more than 20 L did not increase the postoperative morbidity significantly. In conclusion, meticulous preoperative and postoperative cares are necessary because poor general condition increase the postoperative complications and long-term, prospective randomized studies are required to evaluate risk factors influencing postoperative morbidity after transurethral prostatectomy.

Benign Prostatic Hyperplasia: A Comparative Study of Transurethral Resection and Open Surgery / 대한비뇨기과학회지

The results of 114 transurethral resection of the benign prostatic hyperplasia were compared with that of 41 open surgery from the period of January 1988 to June 1993. In a review of the medical history, 70.2% of the patients subjected to TUR and 63.4% of the patients subjected to open surgery were associated with one or more other systemic diseases. 17.5% of the patients in TUR and 19.5% of the patients in open surgery were associated genitourinary diseases. On the basis of the systemic disease in the anesthetic records, patients were classified according to wide variety of risk strata. Postoperative complication rate in cases of with or without anesthetic risk was 48.3 % and 43.5% in TUR, and 87.1 % and 80.0% in open surgery respectively. There seemed to be no relation between anesthetic risk and complication. The mean operation time was shorter in the patients subjected TUR than the patients subjected to open surgery. The mean duration of the postoperative catheterization and hospitalization were shorter in the patients with TUR than compared to the patients with open surgery Total complication rate was significantly lower in TUR than open surgery( 47.4% in TUR. 85.4% in open surgery). Mean weight of resected prostate was heavier in open surgery than TUR. The urinary retention necessitating reoperation was 3.5% in TUR. Pre- and postoperative mean maximum flow rates were 8.6+/-2.6 and 17.2+/-6.7ml/sec in TUR, and 8.4+/-3.2 and 18.2+/-6.7ml/sec in open surgery. Pre- and postoperative mean Boyarsky symptoms score were 15.27 and 7.43 in TUR, and 15.52 and 7.67 in open surgery. The results of mean maximum flow rates and mean Boyarsky symptoms score were same in the patients with TUR and open surgery.

Factors Affecting the Morbidity after Transurethral Prostatectomy for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Medical records of 570 patients underwent transurethral prostatectomy from 1985 to 1991 were reviewed to analyze the factors affected morbidity after transurethral prostatectomy retrospectively. Transurethral prostatectomy constituted 16.9% of the urologic operation during above periods and there were benign disease in 513 patients(90%), and carcinoma in 57 patients(10%). Age of the patients ranged from 48 to 93 years old with a mean age of 68.3. Of the patients, 298 patients (52.3%) had significant pre-existing medical problems. The resected net tissue weight ranged from 3 to 73 grams, with a mean of 11.8 grams. The mean operation time was 53 minutes with a range from 25 minutes to 126 minutes. The mortality was 0.36% and the operative morbidity was 20.3%. Increased morbidity was found in patients with a resection time of more than 90 minutes, used glycine of more than 20,000ml and resected weight of more than 31 grams (P<0.05) But age greater than 80 years, azotemia, urinary tract infection, serum Na+ change and pre-existing disease did not increased the operative morbidity. Voiding symptom was improved in 551 patients(96.7%) but in 19 patients(3.3%). persistent voiding difficulty was found. postoperatively at three months The causes of voiding difficulty were as follows ; 10 incontinence patients, 8 detrusor areflexia patients and 1 urethral stricture patient. In conclusion, transurethral prostatectomy is one of the most common operations today with a very low mortality and the overall postoperative results are excellent. Further studies, such as a randomized trial, will be necessary to evaluate the long-term outcome of transurethral prostatectomy further.

Clinical effect of transurethral resection of the prostate / 대한비뇨기과학회지

A clinical study was made on 330 cases of transurethral prostatectomy that were performed at the Department of Urology. Seoul Eulji General Hospital. Seoul and Daejeon Eulji General Hospital, Daejeon during the period from August, 1984 to July, 1992. Transurethral prostatectomy was per- formed on 309 cases of benign prostatic hyperplasia and 21 cases of prostatic cancer. 1. The mean age of all patients was 67.1 years(50-85 years) and the group of seventh decade was most common (40.5% in BPH and 55% in prostatic cancer). 2. The mean weight of resected prostatic tissue was 9.7 grams(3-45 grams) and the mean length of resection time was 68.6 minutes(30-125 minutes). The mean weight of resected tissue per minute was 0.23 grams. 3. The mean duration of postoperative urethral catheter indwelling was 6.3 days(2-14 days) and the mean period of postoperative hospitalization was 8.4 days(3-19 days). 4. Total complication rate was 15.5% and complications were as follows; failure to void(4.6%) bleeding(3.9%), incontinence(2.7%), urethral stricture(1.8%), secondary resection due to in- adequate resection(1.2%), extravasation(0.9%), epididymitis(0.3%), hyponatremia(0.3%), etc. One patient was dead due to deterioration of associated disease postoperatively. 5. We undertook follow-up assessment of voiding symptom with Boyarsky symptom score system on 148 cases of BPH group. The mean obstructive and irritative symptom scores decreased 84 % and 48%, respectively. We also evaluated the urinary flow rate in 102 cases of 148 cases and the mean peak flow rate improved 98%. The observed changes in symptom score and urinary flow rate was statistically and clinically significant(p<0.01).

Clinical observation of transurethral prostatectomy / 대한비뇨기과학회지

A clinical observation was made on the 204 consecutive patients who had underwent transurethral resection of the prostate(TURP) between Jan. 1987 and Dec. 1992 focusing on uroflowmetry and complications. The uroflowmetries using flow rate nomogram were performed on 75 patients preoperatively and postoperatively. The preoperative maximum flow rats was 9.6+/-4.9 ml/sec(-2.5 SD) and postoperative maximum flow rate was 18.1+/-8.7 ml/sec (-1.0 SD). Uroflowmetry was convenient and helpful to evaluate the results after TURP. Early complications were voiding difficulty(7.8%), delayed bleeding(4.4%), bleeding requiring transurethral fulguration(2.0%), TUR syndrome(2.0%) and epididymitis(1.0%). The early postoperative morbidity was 16.2% and risk factors for early morbidity were resection time longer than 90 minutes, age more than 80 years. associated neurogenic bladder and prostatic cancer on biopsy. Delayed complications were urethral stricture(3.5%), urinary incontinence(2.0%), and obstruction requiring re-TURP(1.5%). Delayed morbidity was 6.9% and the only risk factor for delayed morbidity was resection time longer than 90 minutes. Careful attention to risk factors and surgical details is needed to reduce the amountand significance of the postoperative morbidity.

Complications of transurethral prostatectomy / 대한비뇨기과학회지

A clinical observation was made on the 22l consecutive patients who had underwent transurethral resection of the prostate(TURP) between Jan. 1984. and Dec. 1989 in the Department of Urology, Yeungnam University Hospital focussing on immediate and delayed complications. The operation was done by 3 urologists(P. K. S). The mean resection time of all patients was 98 minutes between 1984 and 1986(n=83) and 74 minutes between 1987 and 1989(n=138). The mean weight of resected prostatic tissue was 15.0 gm between 1984 and 1986 and 17.9 gm between l987 and 1989.The most common immediate complication was voiding difficulty (7.2%), the remainders were in order of nonspecific sepsis (3.2%), delayed bleeding (3.2%), bleeding requiring T-U fulguration tl.8%), post-TUR syndrome (1.4%) and epididymitis (1.4%). The immediate postoperative morbidity was 18.2% and risk factors for immediate morbidity after TURP were age than TO years. associated neurogenic bladder and prostatic cancer on biopsy. The most common delayed complication was obstruction requiring TURP(2.3%), the remainders were in order of urethral stricture(1.8%). urinary incontinence(0.9%), pulmonary embolism(0.9%), deep vein thrombosis(0.9%). The delayed morbidity was 6.8% and the only risk factor for delayed morbidity after TURP was resection time longer than 90 minutes. There were no deaths within 3 months of surgery, but operative morbidity rate still remains significantly high. Careful attention to surgical details and indications is needed to reduce the amount and significance of the postoperative morbidity.

Increased fibrinolysis and changes in blood coagulation during epidural block for transurethral prostatectomy.

Epidural analgesia is the choice of anesthesia for transurethral prostatectomy (TURP). Unfortunately, this technique may increase fibrinolysis as well as decrease in fibrinogen and platelets count, which might cause deleterious bleeding problem during the procedure performed under epidural block. The present study was therefore undertake to assess the degree of increased fibrinolysis and changes in coagulation profiles during epidural anesthesia for TURP. Twenty patients aged from 57 to 83 years were studied. Group 1 of 7 patients did not receive antifibrinolysin (transamin) after 20 minutes following epidural block. Group 11 of 13 patients did not receive transamin intravenously. Blood samples were drawn for euglobulinlysis time (ELT), fibrinogen, platelets, haemoglobin, prothrombin time (PT) and partial thromboplastin time (PTT). The sampling periods included pre-epidural block as baseline values, 10 and 45 minutes after epidural block and the last was obtained immediately after the completion of surgery. The study revealed the same degree of increased fibrinolysis in both groups tested ten minutes after epidural analgesia and throughout the entire operation. There were no statistical significant changes in fibrinogen level, PT and PTT. The platelet counts decreased from the baseline values in group 1 more than group 11, but the quantities were within normal ranges. The results indicated that fibrinolysis following epidural analgesia for TURP increased in the same degree in all patients if either they received transamin or not. Furthermore, the increased fibrinolytic activity did not lead to a problem of blood loss in this study.