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Int. braz. j. urol ; 47(1): 131-144, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134328


ABSTRACT Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

Humans , Male , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/adverse effects , Quality of Life , Prospective Studies , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-921536


Objective To investigate the clinicopathological features and immunohistochemical expression of P504s,E-cadherin,erythroblast transformation-specific related gene(ERG)and estrogen receptor(ER)in prostate adenocarcinoma in Tibet.Methods The clinical data of 15 patients with prostate adenocarcinoma diagnosed by the Department of Pathology of Tibet Autonomous Region People's Hospital from September 2013 to September 2020 were analyzed retrospectively.All patients were assigned to prognostic grade groups based on Gleason score according to the WHO 2016 criteria.Immunostaining of P504s,E-cadherin,ERG,and ER was performed.Results The age of all 15 patients ranged from 61 to 86 years.The serum prostate specific antigen(PSA)concentration was ≥20 ng/ml in 12 patients and<20 ng/ml in 3 patients.Among the 15 patients,11 underwent needle biopsy,1 transurethral resection of the prostate,and 3 radical prostatectomy.Prognostic grouping results revealed 5 cases in grade groups 1-3,4 cases in grade group 4,and 6 cases in grade group 5.Immunohistochemistrically,15 cases(100%)were positive for P504s,E-cadherin and PSA;one case(7%)was positive for ERG;all cases were negative for P63,ER and CK34βE12.Thirteen cases were followed up for 2-48 months,with 2 cases treated with total prostatectomy and 11 cases with non-surgical treatment.Two cases were lost to follow-up. Conclusions Prostate adenocarcinoma is rare relatively in Tibet.The accuracy of diagnosis can be improved by using multiple immunohistochemical markers.The cases of grades 4 and 5 by pathological confirmed are relatively common in Tibet.P504s and E-cadherin are highly expressed in prostate adenocarcinoma patients in Tibet,while ERG presents low expression,ER is unexpressed.

Adenocarcinoma/genetics , Cadherins/genetics , Child , Child, Preschool , Erythroblasts , Humans , Male , Prostate , Prostatic Neoplasms , Receptors, Estrogen , Retrospective Studies , Tibet , Transurethral Resection of Prostate
Article in Korean | WPRIM | ID: wpr-811289


The prevalence of benign prostatic hyperplasia (BPH) is rising with Korea becoming an aging society. As patients age, their comorbidities and the risks associated with anesthesia increase. Recently, there has been an increasing concern regarding sexual function after surgery. As a result, interest in minimally invasive surgery for BPH that does not require anesthesia or affect sexual function has grown. This review article introduces newly developed minimally invasive surgeries for BPH divided into four categories based on the strategy—mechanical, anatomical, atrophic, and laparoscopic. Here, the mechanisms for each surgical method have been introduced. Furthermore, recent representative studies of these procedures with a focus on randomized controlled trials and meta-analyses have also been reviewed. Side effects related to sexual function have also been mentioned briefly along with the efficacy and indication for robotic BPH surgery, which has recently been attracting attention. However, these newer, minimally invasive procedures require additional comparative randomized controlled trials and long-term results to produce more robust evidence for their use.

Aging , Anesthesia , Comorbidity , Humans , Korea , Lower Urinary Tract Symptoms , Methods , Minimally Invasive Surgical Procedures , Prevalence , Prostatic Hyperplasia , Sexual Dysfunction, Physiological , Transurethral Resection of Prostate
Int. braz. j. urol ; 46(4): 575-584, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134201


ABSTRACT Objective and Hypothesis We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. Materials and Methods A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with <10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). Results Preoperative IPSS and S-IPSS were significantly higher in G1 (p<0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p<0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. Conclusion TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.

Humans , Male , Aged , Transurethral Resection of Prostate , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/drug therapy , Risk Factors , Treatment Outcome , Solifenacin Succinate/therapeutic use , Middle Aged
Int. braz. j. urol ; 46(4): 624-631, 2020. tab
Article in English | LILACS | ID: biblio-1134194


ABSTRACT Purpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP). Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI. Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser "on" time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI. Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.

Humans , Male , Aged , Aged, 80 and over , Prostatic Hyperplasia/surgery , Urinary Incontinence, Stress/surgery , Urinary Incontinence, Stress/etiology , Retrospective Studies , Treatment Outcome , Transurethral Resection of Prostate , Laser Therapy , Lasers, Solid-State/adverse effects , Surgeons , Middle Aged
Iatreia ; 32(2): 102-112, ene.-jun. 2019. tab
Article in Spanish | LILACS | ID: biblio-1002144


RESUMEN Introducción: la resección transuretral de próstata (RTUP), independiente de si es con equipo monopolar o bipolar (RTUP-B), es la cirugía estándar en el manejo quirúrgico de los síntomas del tracto urinario inferior (STUI) o de las complicaciones derivadas de la obstrucción por hiperplasia prostática benigna (HPB). Objetivo: revisar la literatura sobre frecuencia y factores de riesgo para complicaciones de la RTUP con bipolar. Resultados: se hizo una revisión de la literatura mediante la búsqueda en Medline desde 1996 hasta 2017. De 76 artículos revisados, 50 se incluyeron. Estos reportan que la RTUP-B ofrece buenos resultados a largo plazo. Las complicaciones en su mayoría son grado I según la clasificación de Clavien-Dindo y las más frecuentes son la eyaculación retrógrada, hematuria secundaria, retención o infección urinaria y estrechez uretral o contractura del cuello vesical. Los factores de riesgo fueron comorbilidades, gravedad de la enfermedad al momento de la intervención, técnica y habilidad del cirujano, entre otros. Discusión: aunque la mayoría de las complicaciones secundarias a la RTUP-B son leves, definir el momento óptimo para la realización de la cirugía e intervenir los factores de riesgo modificables, podría contribuir a mejorar los resultados de esta técnica quirúrgica.

SUMMARY Introduction: Regardless of the technique used, either bipolar or monopolar, transurethral resection of the prostate (TURP) is considered the cornerstone of surgical management for low urinary tract symptoms (LUTS), and benign prostatic obstruction (BPO). Objective: To review the available literature regarding the frequency of bipolar TURP (B-TURP) complications and the risk factor associated with them. Results: The search was conducted using Medline and studies addressing the research question published between 1996 and 2017 were retrieved. Seventy six article were screened and 50 were included. Those papers reported that B-TURP was associates with good long-term outcomes. According to Clavien-Dindo classification, a high proportion of complications were grade I, and the most frequent ones were: retrograde ejaculation, urine retention, urinary tract infection, bleeding and urethral stricture. Risk factors most commonly associated with these complications were: patient's medical status before surgery, the extent of disease at the time of the procedure, skills and technique of the surgeon, amongst other. Discussion: The majority of the surgical complications associated with B-TURP are mild, and identifying the best moment to conduct the procedure and intervening on modifiable risk factors before surgery, may contribute to improve outcomes of the B-TURP.

Transurethral Resection of Prostate , Postoperative Complications , Intraoperative Complications
Article in English | WPRIM | ID: wpr-764102


PURPOSE: There are no established statistical data available for the comparison of different surgical methods adopted for the resection of benign prostatic hyperplasia (BPH). This study investigates the present status related to BPH surgery in Korea for the past 8 years. METHODS: National-level data from the National Health Insurance Service and National Statistical Office were analyzed in this study. From 2010 to 2017, the trends of surgeries for BPH were reviewed according to the procedure code including transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), or high-power potassium titanyl phosphate (KTP), and this trend also analyzed by age, geographic distribution, and hospital type. RESULTS: Over the past 8 years, there was not much change in the total number of BPH-related surgeries (range, 10,393– 11,072). Although there was not much alteration in the number of conventional TURP (from 6,801 in 2010 to 6,645 in 2017), the number of HoLEP has dramatically increased (from 278 in 2010 to 3,805 in 2017). The number of HoLEP surgeries after 2011 exceeded the number of surgeries using KTP, and the gap is anticipated to rise. The number of surgeries by age group was most common in the 70s and the total number of surgeries is decreasing in all age groups; for HoLEP, the trend is steadily increasing over the age of 60 years. Most of the BPH surgeries were performed in metropolitan areas, such as Seoul, Gyeonggi-do, and Busan, and in larger hospitals compared to smaller hospital settings. CONCLUSIONS: Through the data of the National Health Insurance Service, we could apprehend the present status of BPH-related surgery in Korea. Then, we could know about the trend according to several factors and we think these results will be valuable as academic references as well.

Delivery of Health Care , Humans , Korea , Lasers, Solid-State , National Health Programs , Potassium , Prostate , Prostatectomy , Prostatic Hyperplasia , Seoul , Transurethral Resection of Prostate
VozAndes ; 30(2): 27-33, 2019.
Article in Spanish | LILACS | ID: biblio-1050570


La resolución quirúrgica de la hiperplasia prostática benigna se modifca conforme el acceso a las diferentes tecnologías en salud. Las complicaciones del abordaje endoscópico versus el convencional son similares. El Objetivo de este estudio fue analizar retrospectivamente los resultados de la cirugía convencional y la resección endoscópica monopolar de la hiperplasia de próstata en un hospital terciario del Ecuador. Pacientes y Métodos: Estudio retrospectivo, analítico. Fueron incluidos en el estudio 232 pacientes con diagnóstico histopatológico de hiperplasia prostática benigna atendidos en el servicio de urología del hospital Luis Vernaza en el período enero 2015 ­ diciembre 2016. Los pacientes fueron divididos en 2 subgrupos de acuerdo con el abordaje terapéutico ­ quirúrgico: prostatectomía convencional (n = 120) y resección endoscópica (n = 112). Resultados: Mediante estadística inferencial se comprobó una relación estadísticamente signifcativa entre el tipo de abordaje terapéutico con el tiempo quirúrgico (p= <0.001) y con el índice de sangrado (p= <0.001) y entre la edad y el tiempo quirúrgico (p= <0.001). Las complicaciones más importantes fueron: hemorragia inmediata (n=9) e infecciones de la herida (n=10) para la cirugía convencional y hemorragia inmediata (n=2) y sepsis (n=3) para la cirugía endoscópica. La media de tiempo quirúrgico fue 103.03 min y 75.14 min respectivamente. Conclusión: El desarrollo tecnológico ha traído la certeza de que la cirugía endoscópica tiene menores complicaciones, disminuye los tiempos quirúrgicos. Siendo una opción por considerar frente a la cirugía tradicional para la hiperplasia de próstata

Surgical resolution of benign prostatic hyperplasia is modifed as access to different health technologies. Complications of endoscopic versus conventional approach are similar. The objective of this study was to retrospectively analyze the results of conventional surgery and monopolistic endoscopic resection of prostate hyperplasia in a tertiary hospital in Ecuador. Patients and Methods: Retrospective, analytical study. 232 patients diagnosed with benign prostatic hyperplasia were included in the study in the urology service of the Luis Vernaza hospital in the period January 2015 ­ December 2016. Patients were divided into 2 subgroups according to the therapeutic­surgical approach: conventional prostatectomy (n.120) and endoscopic resection (n. 112). Results: By inferential statistics, a statistically signifcant relationship was found between the type of therapeutic approach with the surgical time (p. 0.001) and with the bleeding index (p. 0.001) and between age and surgical time (p. 0.001). The most important complications were: immediate bleeding (n-9) and wound infections (no. 10) for conventional surgery and immediate bleeding (n-2) and sepsis (no. 3) for endoscopic surgery. The surgical mean time was 103.03 min and 75.14 min respectively. Conclusions: Technological development has brought the certainty that endoscopic surgery has fewer complications, decreases surgical times. Being an option to consider against traditional prostate hyperplasia surgery

Humans , Male , Female , Prostate , Prostatectomy , Hematuria , Urinary Fistula , Transurethral Resection of Prostate
Oncol. (Guayaquil) ; 28(3): 202-209, 30 de Diciembre 2018.
Article in Spanish | LILACS | ID: biblio-1000326


Introducción: El cáncer de próstata es una neoplasia en la cual la comunicación y el conocimiento de la población puede ayudar al diagnóstico temprano y tratamiento temprano. El objetivo de este estudio fue investigar que conocen los pacientes y acompañantes sobre los procesos de comunicación educativa para la salud en cáncer de próstata. Métodos: El presente estudio descriptivo, fue realizado en el Instituto Oncológico Nacional "Dr Juan Tanca Marengo" Solca-Guayaquil. Se utilizó una encuesta de salud sobre el conocimiento de la entidad nosológica, el conocimiento de los métodos diagnósticos y la predisposición a acudir a charlas educativas. La muestra fue calculada en 80 encuestas a familiares, acompañantes y pacientes del Instituto. Resultados: Se registraron 80 encuestas. Sobre el cáncer de próstata el 52.5 % de los encuestados declara no tener conocimiento alguno sobre el mismo, un 31.25 % asegura tener poco conocimiento sobre el cáncer de próstata, y el 16.25 % declara tener un conocimiento apropiado sobre el cáncer de próstata. Sobre el diagnóstico de Cáncer de Próstata el 58.75 % de los encuestados no sabe cómo se diagnostica, un 22.5% % está informado someramente y un 18.75 % tiene conocimiento del diagnóstico. Conclusión: En este reporte se evidencia el desconocimiento sobre cáncer de próstata que tienen los encuestados sobre su concepto y diagnóstico

Introduction: Prostate cancer is a neoplasm in which communication and knowledge of the population can help early diagnosis and early treatment. The objective of this study was to investigate what patients and companions know about the processes of educational communication for health in prostate cancer. Methods: The present descriptive study was carried out in the National Drugs Institute "Dr Juan Tanca Marengo" Solca-Guayaquil. A health survey was used on the knowledge of the nosological entity, the knowledge of the diagnostic methods and the predisposition to attend educational talks. The sample was calculated in 80 surveys to relatives, companions and patients of the Institute. Results: 80 surveys were registered. Regarding prostate cancer, 52.5% of the respondents declare to have no knowledge about it, 31.25% claim to have little knowledge about prostate cancer, and 16.25% declare to have an appropriate knowledge about prostate cancer. About the diagnosis of Prostate Cancer, 58.75% of respondents do not know how it is diagnosed, 22.5%% is briefly informed and 18.75% have knowledge of the diagnosis. Conclusion: This report shows the lack of knowledge about prostate cancer that respondents have about their concept and diagnosis.

Humans , Prostatic Neoplasms , Communication , Masculinity , Sex Ratio , Transurethral Resection of Prostate , Education
Säo Paulo med. j ; 136(5): 484-487, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-979373


ABSTRACT CONTEXT: Inflammatory myofibroblastic tumors are a rare type of soft-tissue tumor. Inflammatory myofibroblastic tumors are characterized by rearrangements involving the anaplastic lymphoma kinase gene locus on 2p23. Case Report: We report the case of a 67-year-old Chinese male who presented with dysuria and fever. Magnetic resonance imaging showed an irregular prostatic mass with an isointense signal and obscure boundary. Histopathological evaluation showed that the mass consisted mainly of spindle-shaped cells. Immunohistochemical evaluation showed that the tumor cells were negative for anaplastic lymphoma kinase. CONCLUSIONS: Inflammatory myofibroblastic prostate tumors are rare lesions with unclear etiology. The pathological diagnosis is very important.

Humans , Male , Aged , Prostatic Neoplasms/enzymology , Prostatic Neoplasms/pathology , Soft Tissue Neoplasms/enzymology , Soft Tissue Neoplasms/pathology , Anaplastic Lymphoma Kinase/analysis , Prostatic Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/diagnostic imaging , Biopsy , Immunohistochemistry , Magnetic Resonance Imaging , Transurethral Resection of Prostate
National Journal of Andrology ; (12): 345-348, 2018.
Article in Chinese | WPRIM | ID: wpr-689752


<p><b>Objective</b>To evaluate the effectiveness and safety of low-concentration hydrogen peroxide solution (HPS) for continuous bladder irrigation after transurethral resection of the prostate (TURP).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 148 cases of benign prostatic hyperplasia (BPH) treated by TURP from January 2013 to January 2016. Seventy-six of the patients received postoperative continuous bladder irrigation with 0.15% HPS (group A) and the other 72 with normal saline (group B). We compared the two groups of patients in their postoperative hemoglobin (Hb) levels, duration of bladder irrigation, frequency of catheter blockage, time of catheterization, and length of hospital stay.</p><p><b>RESULTS</b>There were no statistically significant differences between the two groups of patients preoperatively in the prostate volume, International Prostate Symptoms Score, maximum urinary flow rate, postvoid residual urine, or levels of serum PSA and Hb (P > 0.05). At 48 hours after operation, a significantly less reduction was observed in the Hb level in group A than in group B ([3.38 ± 2.56] vs [7.29 ± 6.58] g/L, P < 0.01). The patients of group A, in comparison with those of group B, also showed remarkably shorter duration of postoperative bladder irrigation ([32.57 ± 5.99] vs [46.10 ± 8.79] h, P < 0.01), lower rate of catheter blockage (3.3% vs 11.8%, P < 0.01), shorter time of catheterization ([3.74 ± 0.79] vs [4.79 ± 0.93] d, P < 0.01), and fewer days of postoperative hospital stay ([4.22 ± 0.81] vs [4.67 ± 0.88] d, P < 0.01).</p><p><b>CONCLUSIONS</b>Low-concentration HPS for continuous bladder irrigation after TURP can reduce blood loss, catheter blockage, bladder irrigation duration, catheterization time, and hospital stay, and therefore deserves a wide clinical application.</p>

Anti-Infective Agents, Local , Catheter Obstruction , Humans , Hydrogen Peroxide , Length of Stay , Male , Postoperative Hemorrhage , Postoperative Period , Prostatic Hyperplasia , Blood , General Surgery , Quality of Life , Retrospective Studies , Therapeutic Irrigation , Methods , Transurethral Resection of Prostate , Treatment Outcome , Urinary Bladder , Urinary Bladder Neck Obstruction , Urinary Retention
National Journal of Andrology ; (12): 133-137, 2018.
Article in Chinese | WPRIM | ID: wpr-775207


Objective@#To compare the safety and effectiveness of shovel-shaped electrode transurethral plasmakinetic enucleation of the prostate (PKEP) with those of plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH).@*METHODS@#We retrospectively analyzed the clinical data about 78 BPH patients received in Shanghai Ninth People's Hospital from June 2016 to January 2017, 39 treated by shovel-shaped electrode PKEP and the other 39 by PKRP. We observed the patients for 6 months postoperatively and compared the effects and safety of the two surgical strategies.@*RESULTS@#No statistically significant difference was observed between the PKEP and PKRP groups in the operation time ([69.3 ± 8.8] vs [72.2 ± 7.9] min, P = 0.126), but the former, as compared with the latter, showed a markedly less postoperative loss of hemoglobin ([3.9 ± 2.8] vs [13.9 ± 5.2] g/L, P 0.05) and other postoperative complications.@*CONCLUSIONS@#Both PKEP and PKRP are effective methods for the treatment of BPH, but PKEP is worthier of clinical recommendation for a better safety profile, more thorough removal of the prostate tissue, less blood loss, shorter hospital stay, and better improved quality of life of the patient.

China , Electrodes , Equipment Design , Humans , Male , Prostatic Hyperplasia , General Surgery , Quality of Life , Retrospective Studies , Transurethral Resection of Prostate , Methods , Treatment Outcome
National Journal of Andrology ; (12): 138-141, 2018.
Article in Chinese | WPRIM | ID: wpr-775206


Objective@#To explore the strategies of preserving urinary continence in transurethral plasmakinetic enucleation of the prostate (PKEP) for benign prostate hyperplasia (BPH).@*METHODS@#We treated 65 BPH patients by PKEP with preservation of urinary continence (UC-PKEP), which involved protection of the external urethral sphincter in the beginning of surgery, proper preservation of the anterior lobe of the prostate to protect the internal urethral sphincter in the middle, and preservation of the integrity of the bladder neck towards the end. We compared the postoperative status of urinary continence of the patients with that of the 54 BPH cases treated by complete plasmakinetic enucleation of the prostate (Com-PKEP).@*RESULTS@#All the operations were performed successfully with the urinary catheters removed at 5 days after surgery. In comparison with Com-PKEP, UC-PKEP achieved evidently lower incidence rates of urinary incontinence at 24 hours (31.49% vs 13.85%, P 0.05), and 3 months (3.70% vs 0%, P >0.05) after catheter removal. Compared with the baseline, the maximum urinary flow rate (Qmax) was significantly improved postoperatively in both the Com-PKEP ([7.43 ± 3.26] vs [20.58 ± 3.22] ml, P <0.05) and the UC-PKEP group ([8.04 ± 2.28] vs [20.66 ± 3.08] ml, P <0.05).@*CONCLUSIONS@#Transurethral PKEP is a safe and effective method for the management of BPH, during which the strategies of avoiding blunt or sharp damage to the external urethral sphincter in the beginning, properly preserving the anterior lobe of the prostate in the middle and preserving the integrity of the bladder neck towards the end may help to achieve rapid recovery of urinary continence.

Humans , Male , Organ Sparing Treatments , Methods , Postoperative Period , Prostatic Hyperplasia , General Surgery , Quality of Life , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urethra , Urinary Bladder , Urinary Catheterization , Urinary Incontinence
Clinics ; 73: e264, 2018. tab
Article in English | LILACS | ID: biblio-890740


OBJECTIVES: To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery. METHODS: We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders. RESULTS: Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters. CONCLUSIONS: This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.

Humans , Male , Middle Aged , Aged , Aged, 80 and over , Prostatic Hyperplasia/surgery , Blood Loss, Surgical/prevention & control , Transurethral Resection of Prostate/adverse effects , 5-alpha Reductase Inhibitors/therapeutic use , Time Factors , Blood Transfusion , Preoperative Care/methods , Logistic Models , Risk Factors , Cohort Studies , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Emergency Service, Hospital , Hematuria/etiology , Hematuria/prevention & control
Medwave ; 18(1): e7134, 2018.
Article in English, Spanish | LILACS | ID: biblio-909743


INTRODUCCIÓN: La resección transuretral es el método de elección para la resolución endoscópica de la uropatía obstructiva baja por hiperplasia benigna de la próstata menor a 80cc. Tradicionalmente esta ha sido realizada con asas de resección que utilizan energía monopolar. El uso de energía bipolar ha desplazado la tecnología precedente en el último tiempo. Se dispone a evaluar la eficacia y seguridad de ambas tecnologías para la técnica. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 13 revisiones sistemáticas que en conjunto incluyen 32 estudios primarios, de los cuales 31 corresponden a ensayos aleatorizados. Concluimos que, si bien podrían no existir diferencias de eficacia entre ambas técnicas, la utilización de energía bipolar disminuye la incidencia de síndrome post resección transuretral y probablemente disminuye el riesgo de sangrado que requiere transfusión.

INTRODUCTION: Transurethral resection is currently considered as standard endoscopic treatment for lower urinary tract obstruction due to benign hyperplasia under 80 cc. Monopolar resection loops has been traditionally used but bipolar energy has recently displaced precedent technology. The purpose of this summary is to evaluate the efficacy and safety of both technologies. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 13 systematic reviews including 32 primary studies, among them 31 randomized trials. We concluded although there may be no difference in terms of efficacy among both techniques, the use of bipolar energy reduces the incidence of transurethral resection syndrome and probably reduces the risk of bleeding that requires red blood cell transfusion.

Humans , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Lower Urinary Tract Symptoms/surgery , Randomized Controlled Trials as Topic , Blood Loss, Surgical/prevention & control , Databases, Factual , Treatment Outcome
Rev. medica electron ; 39(3): 495-506, may.-jun. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902189


Introducción: en la actualidad se han descrito diversos modelos de raquianestesia con bupivacaína a dosis diferentes, asociadas o no con fentanilo, que proveen de una anestesia segura y eficaz, disminuyen la intensidad de dolor posquirúrgico, preservan la función cognoscitiva, y reduce las complicaciones atribuidas a la lidocaína hiperbárica por neurotoxicidad. Objetivo: evaluar el efecto de bajas dosis de bupivacaína con fentanilo para anestesia subaracnoidea en pacientes sometidos a resección transuretral de próstata. Materiales y Métodos: se realizó un estudio descriptivo cuantitativo, longitudinal, prospectivo en 200 pacientes programados para dicha cirugía e indicación de anestesia subaracnoidea con bupivacaína, los cuales fueron distribuidos de forma aleatoria en cuatro grupo. Resultados: tanto el bloqueo sensitivo como motor fue más rápido en los pacientes de los Grupos B (3,0; 11,2) y (7,1; 8,3), Grupo C (5,0; 9,4) y (6,2; 9,4) y Grupo D (6,1; 8,3) y (4,7; 10,9); mientras que el Grupo A fue de (6,0; 8,5) y (9,9; 11,7), respectivamente. Se observó que en la totalidad de los pacientes de los Grupos C y D se obtuvo anestesia de buena calidad. Conclusiones: la administración intratecal de 7,5 mg de bupivacaina con 25 µg de fentanilo produjo anestesia satisfactoria, disminuyó el periodo de latencia, mantuvo mejor estabilidad hemodinámica, prolongó la analgesia postoperatoria y se asoció a menor incidencia de complicaciones peri operatorias (AU).

Introduction: currently, several models of spinal anesthesia with bupivacaine in different doses, associated or not to fentanyl, have been described providing a safe and efficacious anesthesia, reducing the intensity of the postsurgical pain, preserving the cognitive function, and reducing the complications attributed to hyperbaric lidocaine due to its neurotoxicity. Aim: to assess the effect of low doses of bupivacaine with fentanyl as subarachnoid anesthesia in patients undergoing a prostate trans-urethral resection. Materials and Methods: a prospective, longitudinal, quantitative, descriptive study was carried out in 200 patients programmed for that kind of surgery and with the indication of subarachnoid anesthesia through bupivacaine; they were randomly distributed in four groups. Outcomes: both, the sensory block and the motor one were faster in the patients of the Group B (3,0; 11,2) and (7,1; 8,3), Group C (5,0; 9,4) and (6,2; 9,4) and Group D (6,1; 8,3) and (4,7; 10,9); while in the patients of the Group A they were (6,0; 8,5) y (9,9; 11,7) respectively. It was observed a good quality anesthesia in all the patients of the Groups C and D. Conclusions: the intrathecal administration of 7,5 mg of bupivacaine with 25 µg of fentanyl produced a satisfactory anesthesia, reduced the latency period, kept a better hemodynamic stability up, extended the post-surgery analgesia and was associated to fewer incidences of perioperative complications (AU).

Humans , Male , Female , Bupivacaine/therapeutic use , Fentanyl/therapeutic use , Anesthesia, Spinal/methods , Transurethral Resection of Prostate/methods , Observational Studies as Topic , Anesthesia, Local/methods
Int. braz. j. urol ; 43(2): 245-255, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-840815


ABSTRACT Objective To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP) prospectively. Materials and Methods Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA). Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist. Results The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002). The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (p<0.01). The senior urologist had a mean operative efficiency and enucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month’s parameter compared with preoperative values (p<0.001). Conclusions PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results.

Humans , Male , Aged , Aged, 80 and over , Prostate/surgery , Mentors , Transurethral Resection of Prostate/education , Transurethral Resection of Prostate/methods , Learning Curve , Postoperative Complications , Prostatic Hyperplasia/surgery , Quality of Life , Time Factors , Prospective Studies , Reproducibility of Results , Analysis of Variance , Follow-Up Studies , Treatment Outcome , Lasers, Solid-State/therapeutic use , Operative Time , Middle Aged
Article in English | WPRIM | ID: wpr-633116


INTRODUCTION: Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of Hematuria Meter Application, a mobile device software program.OBJECTIVE: The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counter per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.METHODS: Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine teh agreement of the applicatin readings with RBC/hpf and inter-observer agreement among the observers.RESULTS: From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT.The agreements of the Hematuria Meter Application readings with RBCs/hpf counted with Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post operative day, ICC was 0.999 (p-value 0.000).CONCLUSION: The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.

Humans , Male , Microscopy , Hematuria , Reproducibility of Results , Electrosurgery , Transurethral Resection of Prostate , Urologists , Erythrocyte Count , Physicians