Comparison of local povidone-iodine antisepsis with parenteral antibacterial prophylaxis for prevention of infective complications of TURP: a prospective randomized controlled study.

OBJECTIVE: To determine whether antisepsis with povidone-iodine solution applied at the external urethral meatus confers protection against infective complications following transurethral resection of the prostate (TURP) and compare that with antibacterial prophylaxis. METHODS: A total of 167 patients with sterile urine undergoing TURP for benign prostatic hyperplasia (BPH) were prospectively randomized into three groups. Group A, had gauze soaked in saline applied at the urethral meatus (control group). In group B, the gauze was soaked in povidone-iodine instead of saline and group C had a single 1 g i.v. injection of cephradine at induction of anaesthesia with no treatment for the meatus. Bacteraemia, post-operative bacteriuria and other infective complications were compared in the three groups. Associations of bacteriuria at catheter removal and intra-operative bacteraemia with infective complications and with long term bacteriuria were also studied. RESULTS: Bacteriuria rate at catheter removal was not significantly different in the three groups. However, intraoperative bacteraemia and bacterial growth at the external urethral meatus was significantly lower in group C. Bacteriuria at catheter removal was significantly associated with bacterial growth at the meatus but not with long term bacteriuria at 3 months. Bacteriuria at catheter removal could not accurately predict infective complications. CONCLUSION: Post-TURP bacteriuria appears to be preceded by bacterial growth at the external urethral meatus. Antisepsis with povidone-iodine solution application at the meatus does not confer adequate protection against meatal bacterial growth as that obtained by prophylactic antibacterials. Nonetheless, neither antibacterial prophylaxis nor local antisepsis could reduce bacteriuria rate in this study.

Risk factors associated with sexual dysfunction after transurethral resection of the prostate.

BACKGROUND: The effect of transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) on sexual function continues to be a controversial issue. The aim of this study was to evaluate sexual functions in Saudi patients suffering from BPH before and after TURP. PATIENTS AND METHODS: The influence of TURP on libido, erection and ejaculation was prospectively studied in 179 patients undergoing TURP for BPH. The risk factors studied for erectile dysfunction (ED) were old age, polygamy, comorbidities, late presentation, intraoperative bleeding, intraoperative capsular perforation and bacteriuria. Patients reporting ED underwent intracavernosal injection (ICI) of 20-40 AA(1/4)g of prostaglandin E1 (PGE1) before and/or after surgery. RESULTS: Before surgery, ED was present in 33/179 patients (18%) and was significantly associated with old age and comorbidities but not with polygamy or late presentation. In the patients with normal erection before surgery, dry ejaculation, ED and diminished libido developed after TURP in 71/134 (53%), 20/137 (15%), and 22/137 (16%), respectively. Postoperative ED was significantly associated with diminished libido (P=0.001), but not with postoperative dry ejaculation. The only significant risk factor associated with ED following TURP was capsular perforation. The response to ICI before and after TURP was comparable. CONCLUSION: ED associated with TURP is most likely of neurogenic origin due to capsular perforation, or of psychogenic nature as suggested by the significant association with diminished libido.