Complicaciones infecciosas después de prostatectomía abierta y resección transuretral de próstata en pacientes con hiperplasia prostática benigna / Postoperative infectious complications after open prostatectomy and transurethral resection of the prostate in patients with benign prostatic hyperplasia

RESUMEN La hiperplasia prostática benigna (HPB) es la neoplasia más común en hombres y puede requerir tratamiento quirúrgico cuando hay retención urinaria, uropatía obstructiva, hematuria a repetición, cistolitiasis o falta de mejoría de los síntomas con las terapias farmacológicas. Las opciones quirúrgicas más frecuentes son la prostatectomía abierta y la resección transuretral de próstata, entre cuyas complicaciones están las infecciones del tracto urinario (ITU) hasta en 12,9 % de los pacientes. Sin embargo, este porcentaje es variable porque no siempre se especifica la diferencia entre ITU y bacteriuria. Los siguientes son factores de riesgo: bacteriuria preoperatoria, tiempo quirúrgico mayor de 60 minutos y manipulación posoperatoria de la sonda vesical. Es importante que los profesionales de la salud que participan en la atención de pacientes con HPB conozcan e intervengan estas complicaciones infecciosas y sus factores de riesgo.

SUMMARY Benign prostatic hyperplasia (BPH) is the most common tumor in men and may require surgical treatment when there is urinary retention, obstructive uropathy, recurrent hematuria, cystolithiasis or lack of improvement of symptoms with drug therapies. The most common surgical options are open prostatectomy and transurethral resection of the prostate. Urinary tract infections (UTI) are among the complications of these procedures, and may occur in up to 12.9 % of patients. However, this percentage is variable because the difference between UTI and bacteriuria is not always specified. Risk factors are: preoperative bacteriuria, operating time longer than 60 minutes and handling of postoperative bladder catheter. It is important that health professionals involved in the care of patients with BPH know these infectious complications and their risk factors.

Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy?

PURPOSE: To compare the perioperative, short-term and long-term postoperative results of radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robotic assisted laparoscopic prostatectomy (RALP) in the most recent studies evaluable. MATERIALS AND METHODS: Using PubMed we have undertaken a search based on references from major and recent articles with considerable sample sizes. RESULTS: The operative blood loss and the risk of transfusion were lower in the laparoscopic and robotic-assisted approaches. The surgical duration was shorter in the open and robotic group. Regarding the positive margins, continence and potency no substantial differences between the RRP, LRP, and RALP were found. CONCLUSIONS: Our results suggest that no one surgical approach is superior in terms of functional and early oncologic outcomes. Potential advantages of any surgical approach have to be confirmed through longer-term follow-up and adequately designed clinical studies.

Prostatectomia aberta: modificações da técnica de Freyer e retirada precoce da sonda: [carta ao editor] / Opened prostatectomy: modified technical Freyer's prostatectomy and very soon catheter removal: [letter to the editor]

Introdução e objetivos: Prostatectomia transvesical (PTV) é uma operação simples e fácil de ser realizada. Sua principal indicação é no grande adenoma prostático associado ou não à patologia vesical. Realizamos algumas modificações técnicas que permitiram um maior controle do sangramento, alta hospitalar no terceiro dia de pós-operatório e sem sonda vesical. Material e métodos: Entre 2001 e 2005, 102 pacientes com grandes adenomas prostáticos foram submetidos à prostatectomia transvesical suprapúbica modificada pelo mesmo cirurgião. A idade média dos pacientes foi 67,8 anos (59 a 82 anos). O peso médio do adenoma foi 81,5g. A abertura da bexiga na sua região fúndica é pequena o suficiente para passar dois ou três dedos ou um espéculo vaginal tamanho médio. A bexiga é fechada por uma sutura contínua. O fio de categute, por não ultrapassar as camadas da bexiga, evita a comunicação da luz vesical com o espaço de retzius, favorecendo a cicatrização rápida da mucosa vesical. Hemostasia mais eficaz foi obtida com a realização de pontos em ?X? pegando parte da cápsula a partir do colo vesical e aplicados às 3, 5, 7 e 9 horas. Resultados: As modificações descritas permitiram a retirada da sonda no terceiro dia de pós-operatório. Não houve aumento das complicações. Foi diminuído o custo hospitalar e amenizado o sofrimento do paciente com o menor tempo de uso da sonda. Conclusões: A seleção adequada do paciente associada às modificações técnicas adotadas resolveram os dois maiores problemas da PTV: maior tempo de internação e uso da sonda vesical.

The Efficacy of Transurethral Resection of Prostate in Patients with Large Prostate (over 100 g): Comparison with Open Prostatectomy

PURPOSE: We performed transurethral resection of prostate(TURP) in benign prostatic hyperplasia(BPH) patients with large prostate greater than 100 g and evaluated the efficacy of TURP compared with open prostatectomy. MATERIALS AND METHODS: From June 1998 to January 2006, all 26 patients with symptomatic BPH patients with large prostate greater than 100 g were entered into the study. 7 patients underwent open prostatectomy (open group) and the other 19 patients underwent TURP(TURP group). The pre-operative evaluation included International Prostate Symptom Score(IPSS), quality of life(QoL), peak urinary flow rate(Qmax), satisfaction index and transrectal ultrasonography, operation time, weight of resected tissue, postoperative hospital stay and complications were noted. RESULTS: Between two groups there were no statistically significant differences in pre-operative data. In open group resected tissue was larger than TURP group, however, hospital stay and operation time were longer, and operation-related complications happened more frequently than TURP group. There were no statistically significant differences in postoperative IPSS, QoL, Qmax and satisfaction index between the two groups. CONCLUSION: Compared with open prostatectomy, TURP can be safely performed for treating symptomatic BPH greater than 100 g in size.

Staged Transurethral Resection of Prostate for Large Benign Prostatic Hyperplasia: A Comparative Study with Open Prostatectomy / 대한비뇨기과학회지

PURPOSE: Although open prostatectomy is usually considered when the prostate gland is greater than 50cc, it needs an incision and relatively longer hospital days and has a potential for intraoperative hemorrhage. For these reasons, we performed staged transurethral resection of the prostate (TURP) consecutively instead of open prostatectomy for benign prostatic hyperplasia (BPH) patient with a prostate larger than 50cc. MATERIALS AND METHODS: Among total 30 BPH patients with a prostate larger than 50cc in volume, 14 patients underwent immediate repeat TURPs (group A) and 16 patients underwent suprapubic prostatectomies (group B). Preoperative international prostate symptom score (IPSS), uroflowmetry, pressure-flow study, operative data, postoperative immobilization period because of hematuria and other complications were reviewed. IPSS and uroflowmetry were followed up to 6 months after operation. RESULTS: There were no statistically significant differences in age, preoperative IPSS and Qmax between the two groups. At 6 months after the operation mean Qmax and IPSS were improved in both groups significantly, and while Qmax was higher in the group B, there was no significant difference in decreasing IPSS. In the group A, hospital stay and immobilization period were shorter and there was no patient who needed transfusion because of bleeding or suffered from TUR symdrome. In contrast, 9 (75%) patients needed transfusion because of bleeding in the group B. CONCLUSIONS: Staged TURP is a valuable surgical method with respect to absence of incision, effective symptom improvement, short hospital stay and postoperative immobilization perod and low risk of complications such as bleeding and TUR syndrome in symptomatic BPH patient who has a prostate volume over 50cc.

The Results of Benign Prostatic Hyperplasia Treatment by Transurethral Resection, Open Prostatectomy, and TUMT(Transurethral Microwave Thermotherapy) / 대한비뇨기과학회지

We noticed the treatment results of each of them after having treated the seventy-nine cases of benign prostatic hyperplasia with TUMT (N=32, Term ; 92.6-93.3), TUR-P (N=31, Term; 91.4-93.3), open prostatectomy (N=16, Term; 91.4-93.3). However, there was a difficulty to get to statistical reliability, for there was a little gap between the term of survey and the period of treatment of three groups. The results are following. In the TUMT, the maximal flow rate was improved from 8.2ml/s to 13.3ml/s and Madsen score dropped from 13.6 to 5.3, in the TUR-P they were 8.4ml/s to 16.5ml /s and 14.5 to 5.3 respectively, and in the open prostatectomy 6.8ml/s to 20.0ml/s and 15.8 to 5. 3 respectively. The degree of satisfaction of the patients themselves with each prescription was 46.9% in the TUMT. 67.7% in the TUR-P and 81.2% in the open prostatectomy. But 18.8% and l6.l% of the patients thought TUMT and TUR-P respectively ineffective. The conclusion is that open prostatectomy presented the better results than TUMT or TUR-P in the degree of satisfaction of patients and uroflowmetry during the survey period. And even though TUMT have presented lesser degree of satisfaction then TUR-P up to now, if the exact indications for the use of TUMT are found and the mechanical improvements undergo, then a number of benign prostatic hyperplasia cases seem to be treated in more safety and with lesser cost and time by TUMT instead of TUR-P.

Postoperative long-term follow-up of benign prostatic hyperplasia on viewpoint of quality of life / 대한비뇨기과학회지

As a part of ongoing effort to evaluate alternative treatments for benign prostatic hyperplasia (BPH}. we compared the outcomes of transurethral resection of prostate(TURP) with those of open prostatectomy(OP). To identify effect of TURP on high mortality due to cardiac death. We compared long-term mortality and the causes of death after each surgical procedures. From Jan 1981 to Dec. 1990, surgical management was underwent on 338 patients with BPH in Pusan National University Hospital. Of 338 patients. survival was identified in 70 of OP group and 166 of TURP group. Direct interview was possible in 50 of OP group and 135 of TURP group. Mean age and follow-up were 69.8 years old and 89.5 months in OP group and 68.7 years old and 45.4 months in TURP group. Both OP and TURP were effective in improving subjective voiding symptoms including comprehensive symptom and Boyarsky symptom score, but, no significant difference was observed between them. Postoperative convalescence period was significantly shorter in TURP group compared to OP group. The incidence of sexual dysfunction including loss of libido and poor erection was similar between two surgical groups, but the incidence of retrograde ejaculation was higher in TURP group than OP group. Postoperative mortality and leading causes of death were no difference between two groups. Conclusively, we could not find the significant differences between OP group and TURP group as to symptom improvement, long-term mortality and morbidity, and effectiveness on patient`s consent. Although we confess that further evaluation is needed for precise and objective results, such results show postoperative improvement of voiding symptoms, quality of life and long-term outcomes that may not depend on surgical options.

A Comparative Analysis of Operative Methods on Benign Prostatic Hyperplasia: Transurethral Resection and Open Surgery / 대한비뇨기과학회지

A comparative analysis was made in 115 cases of TUR and 38 cases of open surgery in benign prostatic hyperplasia from March 1982 to December 1988.The results were as follows: The mean duration of operation was 84 min in TUR and 112 min in open surgery. The mean weight of resected tissues was 15.9em in TUR and 34.8gm in open surgery. The number of patients who needed transfusion were 74 of 115 in TUR(64%) and 35 of 38 in open surgery. Mean periods of postoperative hopitalization wee 9.1 days in TUR and 15.3 days in open surgery. Intraoperative complications were massive bleeding(5.2%), perforation of prostatic capsule(2.6%), hyponatremia(0.9%) in TUR and massive bleeding( 10.5%) in open surgery. Postoperative complications were unable to void, bleeding, incontinence, epididymitis, pyelonephritis and urethral stricture in TUR and bleeding. incontinence, epididymitis, pyelonephritis, vesicocutaneous fistula and wound infection in open surgery. Total complication rate was 26.1% in TUR and 28.9% in open surgery.

Comparison Between the Results of Transurethral Resection and Open Prostatectomy for the Benign Prostatic Hypertrophy of 20 gm or More / 대한비뇨기과학회지

Among the 65 patients undergoing transurethral resection of the prostate from 1985 to 1988, the complication incidence was significantly higher in 25 patients whose weight of resected prostate was above 20 gm than in 40 patients below 20 gm (p<0.05). So to choose mote proper surgical method, the results of operation, motality and morbity of these 25 TURP patients were compared with 35 open prostatectomy patients whose weight of resected prostate was between 20 gm and 60 gm during same period. The mean incidence of complication for open prostatectomy (60%) was nearly twice that of the TURP (32%) (p<0.05). The age of the patient had no significant influence on the incidence of complication in both groups. In case of the weight of resected prostate below 40 gm complication incidence for the TURP (26.3%) was significantly lower compared with open prostatectomy(66.7%) (p<0.05), but in case of above 40 gm there was no significant difference in both groups. In case of the length of resection below 120 min complication incidence was significantly low in TURP (21.4%) compared with open prostatectomy (61.5%) (p<0.05), but in case of above 120 min. there was no significant difference in both groups. In the open prostatectomy there was no increase in complication incidence by the weight of the gland and the operation time, but in TURP, complicat,40 gm incidence was definitely increased when either weight of the resected prostate was above 40 gm or length of resection was above 120 minutes. Therefore, it seems that TURP is preferable surgical method for benign prostatic hypertrophy unless open surgery is necessarily indicated.

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

The results of TUR and open surgery in benign prostatic hyperplasia were compared in 72 cases of TUR and 48 cases of open surgery from July 1980 to June 1987. The results were as follows; 1. Mean operation time was shorter in TUR than open surgery(106.9min. in open surgery, 87.4min. in TUR). 2. Mean weight of resected prostate was heavier in open surgery than TUR(57.5gm in open surgery, 18.1gm in TUR). 3. Mean blood loss during operation was widely different between two groups(547.2ml in open surgery, 281.6ml in TUR), and no blood was required in 19.4% of TUR. 4. Mean hospitalization and catheter indwelling periods were shorter in TUR than open surgery(mean hospitalization ; 13 days in open surgery and 8.6 days in TUR). 5. Total complication rate was 25.1% in open surgery and 20.8% in TUR, the most predominant complication was rebleeding in open surgery and urinary incontinence in TUR.

Benign Prostatic Hyperplasia: 5-Year Experience / 대한비뇨기과학회지

Three hundred and ninety patients with benign prostatic hyperplasia managed at Seoul National University Hospital during a 5 year period from 1981 to 1985 were analyzed retrospectively. Most patients experienced urinary retention(60.3%) or had significant residual urine(l2.O %). Azotemia was found in 41 patients(10.5%) and bacteriuria in 67 patients(l7.2%). Intravenous pyelography was performed routinely in most of patients but it did not contribute significantly for the management. 217 transurethral(55.6%), 124 suprapubic(31.8%), and retropubic resections(12.6%) were done according to size of prostate, patient`s general condition and surgeon`s preference by 27 operators including 20 senior residents. The mean weight of resected tissue was 14.5gm in TUR and 36.1gm in open resection. The mean perioperative transfusion was l.2 pints in TUR and 2.2 pints in open resection. Overall morbidity of prostatectomy was l7.4% and there was no difference between TUR and open resection. Excessive bleeding was the major complication which developed in 6.9% of TUR and 6.4% of open resection. Initial azotemia, bacteriuria and old age over 80 years did not increase the operative morbidity. In TUR, 30gm or more of resceted adenoma and/or 90min or more of resection time increased the morbidity significantly. Prophylactic antibiotics decreased the postoperative urinary tract infection. The antibiotics were continued until 5~7 days after removal of catheter, and an additional antibiotics were not necessary even in the presence of microscopic pyuria which persistence for longer time. In 351 patients(90.9%), voiding problem was improved but in 39 patients(10%), it was persisted. Uroflowmetry was useful to evaluated the outcome of the resection. Maximum improvement in the flowrate was found 3 month postoperatively and the result was same in the patients with TUR and open resection.

Clinical Observation and Comparison Between the Results of Transurethral Resection and Open Prostatectomy on the Benign Prostatic Hypertrophy / 대한비뇨기과학회지

The results of the transurethral resection and open prostatectomy undergone on 87 cases of the benign prostatic hypertrophy from January 1980 to July l986 were reviewed and compared. The following results were obtained. l. TURP was performed in 52 cases of the benign prostatic hypertrophy and open prostatectomy in 35 cases. 2. Mean operation time was shorter in TURP than in open prostatectomy (77.7min. in TURP, 123.3 min. in open prostatectomy). 3. Mean weight of the resected tissue was 7.9gm in TURP and 37.3gm in open prostatectomy. 4. Mean amount of the transfused blood was 51ml in TURP and 627ml in open prostatectomy, and blood transfusion in TURP was required only in a few cases (7.7%). S. Mean duration of the postoperative catheter indwelling was shorter in TURP than in open prostatectomy(6.1 days in TURP, 11.1 days in open prostatectomy). 6. Mean duration of the postoperative hospital stay in TURP was shorter than in open prostatectomy (8.7 days in TURP, l5.4 days in open prostatectomy). 7. Most frequent complications were transient urinary incontinence and rebleeding, and their incidences were slightly higher in open prostatectomy than in TURP.

The Use of Botropase in Suprapubic Transvesical Prostatectomy / 대한비뇨기과학회지

From April, 1980, to April, 1965, 24 male inpatients with suprapubic transvesical prostatectomy due to benign prostatic hypertrophy(B.P.H) were entered in the study. They were randomized into three groups. Intraoperative blood losses were evaluated by weighing the aspirated blood and the blood retained by the gauze tampones. New antihemorrhagic agent, Botropase(Bothrops Jararaca venom extract) was administered intramuscularly or intravenously in 8 cases of suprapubic transvesical prostatectomy due to B.P.H and following result were obtained. 1. Botropase(Bothrops Jararaca venom extract) was found to be useful to lead to reduction of local hemorrhage without any thrombophilic effect on the coagulation and fibrinolytic system. 2. Postoperative hematuria is significantly reduced by the administration of an antifibrinolytic agent. 3. In patients with a high thromboembolic risk, variation of the intra- and postoperativecoagulation and fibrinolytic activities should be carefully assessed; This is in under to prevent with the correct treatment thromboembolic accidents or disseminated intravascular coagulation syndromes. 4. No serious side effects were observed.

Treatment of the Benign Prostatic Hypertrophy: A Comparison between the Results of Treatment by Transurethral Resection and the Results of Open Surgery / 대한비뇨기과학회지

The results of 97 transurethral resections of the benign prostatic hypertrophy are compared with 78 open prostatectomies performed from 1971 through 1981. The following results are obtained as below: 1. 33.0% of the patients subjected to TUR and 39.7% of the patients subjected to the open surgery were associated with one or more other genito-urinary or systemic diseases. 2. Weight of the resected prostate was markedly heavier in open surgery than TUR; the mean weight was 53.8 gm. for open surgery and 17.1 gm. for TUR. 3. Less amount of the operative blood loss in TUR was encountered than open surgery; the mean amount of blood loss per patient was 113.6 ml. for TUR and 437.0 ml. for open surgery. 4. Operation time was shorter in TUR than in open surgery; the mean time was 74.8 min. for TUR and 120.2 min. for open surgery. 5. Postoperative complications were significantly fewer in TUR than in open surgery. There seemed no relation between age and complication. In TUR incidence of complications was increased when the operation time was above 60 min. but no relation was found in open surgery between the operation time and complication. 6. Overall mortality rate for prostatectomy was 1.1% ; for TUR 1.0% and for open surgery 1.3%. 7. Duration of the postoperative catheterization was remarkably shorter in TUR than open surgery; the mean duration was 5.9 days for TUR and 10.5 days for open surgery. 8. Duration of the hospital stay was fairly shorter in TUR than in open surgery; the mean duration was 12.2 days for TUR and 18.4 days for open surgery.