Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: A propensity score-matched analysis / 亚洲男科学杂志(英文版)

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.

Application of transesophageal doppler mornitoring in early diagnosis and treatment of transurethral resection syndrome in patients undergoing transurethral resection prostate / 临床麻醉学杂志

Objective To explore the value of transesophageal doppler in transurethral resection prostate.Methods Thirty-six patients (aged 60-85 years, falling into ASA grade Ⅰ-Ⅲ) of benign prostatic hyperplasia for undergoing transurethral resection prostate were enrolled.Through multifunction monitor, CVP, Narcotrend index(NI) were monitored before anesthesia induction (T0), 20 minutes after anesthesia induction (T1), after irrigating fluid of 5 000 ml (T2) and 10 000 ml (T3) and 15 000 ml (T4) and 20 000 ml (T5).By transesophageal doppler, FTc(corrected flowtime), SV(stroke volume), ΔPV(peak flow vaviable quantity) were monitored at T1-T5.Results CVP at T1-T5 were not significantly changed compared with that at T0.Compared with T1, FTc, SV at T3-T5were significantly increased and ΔPV at T2-T5were significantly decreased (P<0.05).CVP levels correlated significantly with both FTc (r=0.702, P<0.01) and SV (r=0.595, P<0.01).CVP negatively correlated significantly with ΔPV (r=-0.351, P<0.05).Furthermore, FTc correlated significantly with the concentrationof Na+(r=0.672,P<0.01).No patient had serum sodium ion concentration less than 125 mmol/L.Conclusion FTc of transesophageal doppler is as accurate as central venous pressure in monitoring hemodynamic changes, and even more sensitive than CVP.It is useful in early diagnosis and treatment of TURS.

Applications of syphon system in transurethal resection of prostate / 中国内镜杂志

Objective To explore the availability and safety of conducting low-pressure TURP assisted by a home-made cystometry and warning system.Methods 167 benign prostatic hyperplasia (BPH) patients admitted from Jan 2014 to Jan 2016 were randomly assigned into cystostomy group (group A) and non-cystostomy group (group B). In group A (n = 85), 42 patients (group A1) were performed percutaneous cystostomy + TURP, and 43 (group A2) were performed continuous flushing sheath TURP. In group B (n = 82), 42 patients (group B1) were received percutaneous cystostomy + TURP, and 40 (group B2) were received continuous lfushing sheath TURP. In group A, bladder pressure was monitored in real time with a cystometry and was monitored by bladder puncture using a home-made siphon, ensuring low bladder pressure throughout TURP. Serum Na+ levels were measured before and after operation in all four groups. The operation time, the intraoperative bleeding, the weight of resected prostates and the time before which urine turned clear were recorded. The IPSS, maximum lfow rate (Qmax), postvoid residual volume (PVR) and life quality score (QOL) were evaluated.Results While no significant differences were found between group A1 and A2, there were significant differences between group B1 and B2, indicating cystostomy group was safer than non-cystostomy group. When compared group A1 with B1, or group A2 with B2, it showed that the safe operation time to perform prostate tissue resection was longer in cystostomy group; the weight of the resected prostates was heavier; the time before which urine turned clear were shorter; and the IPSS improvement was better. These findings presented better therapeutic effects in cystostomy group than in non-cystostomy group.Conclusions This home-made cystometry and warning system could timely detect high bladder pressure state during TURP, making it possible to avoid of high pressure, ensuring low bladder pressure lfushing during the operation, lengthening the safe operation time, increasing tissue resection ratio, reducing transurethral resection syndrome, thus helping TURP to be safer.

Transurethral Resection Syndrome Occurred by Bladder Perforation during Transurethral Resection: A case report / 대한마취과학회지

A transurethral resection of the prostate (TURP) is often performed to treat benign prostatic hypertrophy or prostatic carcinoma. Transurethral resection syndrome (TURS) is a rare but serious complication of TURP that has two different causes: (1) intravascular absorption of the irrigation fluid through the open prostatic venous sinus (TURP syndrome); and (2) intraperitoneal extravasation of the irrigation fluid through perforation of the bladder. In general, a laparotomy, repair of injury, or conservative approach such as bladder drainage, percutaneous drainage of the abdomen combined with medical treatment are performed to manage TURS attributed to the latter mechanism. We report a patient with TURS, who showed a gradual onset of hyponatremia after bladder perforation and intraperitoneal extravasation of the irrigation fluid, and was treated successfully using a conservative approach.

Transurethral Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia:Report of 332 Cases / 中国微创外科杂志

Objective To discuss the efficacy and safety of transurethral plasmakinetic resection of the prostate(PKRP) for benign prostatic hyperplasia(BPH).Methods A British made Bipolar plasmakinetic resection system(Gyrus) was employed in this series.Started from the 6 o’clock point,the middle lobe of the prostate was resected,followed by the left and right lobes,which were resected down to the prostate capsule.And then the bladder neck was cut down.The apical tissues were resected to the anterior border of the seminal colliculus.After the operation,a F22 three-channel catheter was indwelled for 3 to 5 days after the operation,and a balloon was place in the bladder neck.Results The procedure was completed successfully in all of the cases with a mean operation time of(85.0?12.0) min,and a median blood loss 115.0 ml(30 to 650).Ten patients received blood transfusion during the operation(200 to 400 ml).No case showed transurethral resection syndrome or obturator nerve reflex.Fourteen patients developed inflammatory stricture of the anterior ureter and was then cured by dilating the urinary tract;15 cases showed transient urinary incontinence and was cured after pelvic floor muscle training for 1 to 3 weeks.Follow-up was available in the patients for 1 to 6 months,during which the mean Qmax of the patients significantly increased compared to that preoperation [from(7.6?2.4) ml/s to(22.6?3.4) ml/s,t=13.582,P=0.000),and the IPSS and life quality score markedly decreased [from 27.3?1.5 and 4.3?0.4 to 7.0?1.2 and 2.1?0.8;t=16.394 and 9.761,P=0.000 and 0.005,respectively] Conclusion PKRP is an effective and safe treatment for BPH.

Transurethral resection syndrome during transurethral vaporization of the prostate / 医学研究生学报

Objective:To summarize the influencing factors and the preventative strategies of transurethral resection syndrome(TURS) in transurethral vaporization of the prostate(TVP). Methods:Among the consecutive 1360 patients who underwent TVP from Feb 1998 to 2004 Dec,using Circon vaporization device and vaporizaton-resection electrode,irrigating with 5% GS,TURS occured in 12 cases.The clinical materials were reviewed retrospectively. Results:At the end of operation,serum sodium declined and blood glucose rose apparently in the TURS cases.Of the 12 patients,mean operative time was 136 min(90-180min),prostate volume were Ⅲ?(50-75 g),perforation of the prostate capsule occurred in 8 cases,chill occued in 8 cases.TURS occurrence rate was relatively high in the high risk cases.The 12 patients were cured. Conclusion:The risk of TURS that still exists during TVP is relevant to: perforation of the prostate capsule,operative time,irrigating pressure,the high risk cases,prostate volume and(so on.)

Transurethral resection syndrome during transurethral vaporization of the prostate: Report of 27 cases / 中国微创外科杂志

Objective To summarize the causes, diagnosis and treatment of transurethral resection syndrome (TURS) during the transurethral vaporization of the prostate (TUVP). Methods Among 322 consecutive patients who underwent TUVP, TURS happened in 27 patients (8.4%). Their clinical data on the operation, monitoring and treatment were retrospectively reviewed. Results Of the 27 patients, the mean operative time was 95 min (52~170 min), the mean blood loss was 251 ml (100~700 ml), and the mean weight of resected prostate was 36.1 g (16~82 g). During the operation the prostatic capsule was perforated in 21 patients (78%). Postoperatively, all the patients had yawning, hypotension and bradycardia. Their serum sodium concentrations during TURS were 122.3?9.6 mmol/L, which was 16.3?4.5 mmol/L lower than before the operation, with significant difference ( t=)14.211,P90 min). Close attention and assessment of the patient’s) vital signs and mental status can increase the early detection and treatment of TURS.