Role Of Prostate Ultrasonography To Predict The Efficacy Of Bipolar Prostatectomy In Benign Prostatic Hyperplasia.

Objectives: To evaluate the role of prostatic ultrasonography in predicting the clinical outcomes of bipolar transurethral resection of the prostate. Method: The prospective study was conducted at the Urology Department, Kafrelsheikh University Hospital, Cairo, Egypt from December 2018 to June 2019, and comprised male patients complaining of lower urinary tractsymptoms due to benign prostatic hyperplasia. The patients were subjected to pelvi-abdominal and transrectal ultrasonography and values were noted for the international prostate symptom score, uroflowmetry, post-void residual urine volume, ejaculatory domain, and the erectile function domain of the international index of erectile function. The safety of the procedure was assessed using the modified Clavien classification of complications. This was followed by cystourethroscopy under spinal anaesthesia, and then by bipolar resection of the prostate by a single experienced urologist. Operating time, length of hospitalisation, intraoperative and postoperative complications, catheterization time, and changes in haemoglobin levels were recorded. All evaluations were done at baseline and postoperatively at 1, 3 and 6 months. Data was analysed using SPSS 21. RESULTS: There were 109 male patients with mean age 65.53±6.27 years, mean body massindex 24.6±1.7kg/m2 . Mean total prostate volume at baseline was 86.32±43.61gm (range: 30-195m). There was a significant decrease postoperatively (p<0.001). This was associated with a concomitant improvement of international prostate symptoms score, uroflowmetry and post-void residual urine volume over six-month follow-up (p<0.001 ). Overall, 63(57.8%) subjects were sexually active, and there was no significant difference in the international index of erectile function score at baseline and postoperatively (p>0.05). CONCLUSIONS: Prostate ultrasonography can be used as a single investigating tool to evaluate the clinical outcomes after bipolar transurethral resection of the prostate.

The State of Evidence in Prostate Artery Embolization.

Prostate artery embolization (PAE) has emerged over the past two decades as a minimally invasive, nonsurgical treatment for benign prostatic hypertrophy (BPH). While the majority of evidence for PAE stems from retrospective cohort studies, several seminal randomized controlled trials have been performed comparing short-term outcomes of PAE to transurethral resection of prostate (TURP) and against a sham procedure. Across clinical trials, PAE demonstrates consistent improvement in urological symptoms and quality of life in patients with BPH with low complication rates. When compared to TURP, the results are comparable, but there is a trend for better outcomes in certain clinical parameters with TURP. PAE is a suitable option for patients who are not surgical candidates, prefer nonsurgical treatment with an earlier return to routine activities, and wish to better preserve sexual function.

Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes.

INTRODUCTION: This study aimed to assess the midterm outcomes and safety of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH). METHODS: A single-center, retrospective review of PAE performed for BPH was performed. Validated International Prostate Symptom Score (IPSS), quality of life (QoL) index, and International Index for Erectile Function (IIEF-5) questionnaires were completed at baseline and at least 12 months post-procedure. Prostate imaging was performed preprocedure as well as 3 months and 12 months post-procedure to assess prostate volume (PV). Uroflowmetry was also performed at baseline and 12 months post-procedure to assess urine flow rate (Qmax) and post-void residual (PVR) volume. Adverse events were graded according to Society of Interventional Radiology (SIR) guidelines. RESULTS: Eighty male patients underwent the PAE procedure (mean age 69 years). Prostate volume decreased significantly from a mean volume 156 to 107 mL after 12 months post-procedure, commensurate with a mean reduction of 27.5% (P < .05). Significant improvements were seen in IPSS (21.8 vs 10.5) and QoL (4.5 vs 2.0) from baseline to 12 months post-procedure (P < .05). There was no significant change in IIEF-5 score. There was a significant reduction in PVR (202 vs 105 mL) and improvement in Qmax (5.9 vs 10.0 mL/s) between baseline and 12 months post-procedure (P < .05). No major complications occurred; 4 minor complications occurred (SIR grade A or B). CONCLUSION: Prostate artery embolization achieved a clinically and statistically significant prostate volume reduction, symptom and QoL improvement, and enhanced uroflowmetry parameters in patients with BPH.

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.

Comparison of Epidural Analgesia Effect Between Morphine and Hydromorphone for Patients after Electrotomy of Prostate / 医药导报

Objective To observe analgesia effect of morphine hydrochloride and hydromorphone hydrochloride in patients after transurethral resection of prostate. Methods Patients after transurethral resection of the prostate (TURP) were randomly divided into 2 groups, morphine hydrochloride group (n=45) and hydromorphone hydrochloride group (n=47). Analgesia, sedation efficacy and adverse reactions were evaluated at 6 and 24 h after they received epidural postoperative analgesia by using VAS score and Ramsay score. Results In 6 h, hydromorphone hydrochloride group had a better pain tolerance and feeling than morphine hydrochloride group (P0.05).There were no differences in adverse reactions between the two groups ( P>0. 05 ) . Conclusion Hydromorphone has a better effect than morphine in epidural analgesia in 6 h.

The clinical research of suprapubic small cut method combined with transurethral resection prostate on the treatment of benign prostatic hyperplasia complicated with bladder stones / 中国综合临床

Objective To explore the clinical effect of suprapubic small cut method combined with transurethral resection prostate(TURP) on the treatment of benign prostatic hyperplasia(BPH) complicated with bladder stones.Methods Sixty patients with BPH complicated with bladder stones ≥ 3 cm in the People's Hospital of Futian Affiliated to Guangdong Medical College from January 2013 to September 2014 were selected as the study group,and another 60 patients with BPH complicated with bladder stones＜3 cm during the same period were selected as the control group.The cases in the study group were treated with suprapubic small cut method combined with TURP,and the cases in control group were treated with transurethral method combined with TURP.The intraoperative indicators (including the time used for crushed stone,total operation time,blood loss,conversion to laparotomy,blood transfusion and bladder perforation),residual bladder stones and complications of postoperative were compared.Results The operations of the two groups of patients were successfully,and there was no conversion to laparotomy and either bladder perforation.The stone removal time and total operative time of patients of the study group were shorter than of the control group,the difference was statistically significant((12.20±3.55) min vs.(24.05±7.68) min,(62.31± 10.49) min vs.(82.46± 16.75)min;t =10.849,7.897;P＜0.001).The intraoperative blood loss and the cases of blood transfusion of patients of the study group were less than the control group,but the prevalence of urinary tract infection were higher(6vs.4),but the difference was not statistically significant(P＞0.05).Residual stones were more commonly in the control group than in the study group (study group:0,control group:6 cases),the difference was statistically significant(x2 =6.316,P=0.012).Conclusion BPH complicated with bladder stones can be treated by the suprapubic small cut method combined with TURP or transurethral method combined with TURP,but suprapubic small cut method combined with TURP is safer and more effective,which is worthy of popularization and application in clinic.

The efficacy and safety evaluation of tolterodine tartrate in treating patients with early overactive bladder symptoms after transurethral resection prostate / 中国医师进修杂志

ObjectiveTo evaluate the efficacy and safety of tolterodine tartrate in treating patients with early overactive bladder(OAB) symptoms after transurethral resection prostate (TURP).Methods Thirty-one patients who received TURP and were found OAB at recent follow-up were enrolled and divided by random digits table method into study group ( 16 cases) and control group ( 15 cases).The patients in study group were treated with 2 mg tolterodine tartrate twice a day for four weeks,while the changes of OAB in control group were observed.The OAB symptoms score (OABSS),maximum flow rate(Qmax),24 h urination and adverse reactions during the period of medication of two groups before and after treatment were recorded and observed.Results The second evaluation,all the indexes except Qmax in study group improved significantly compared with those of the first evaluation in study group and control group the second evaluation.The indexes included urination times[(6.8 ± 1.0) times vs.( 12.5 ± 1.5) times,(11.8 ± 1.2)times],urgency times[(1.4 ± 1.1) times vs.(4.1 ±2.2) times,(4.1 ±2.3) times],urine volume [(214 ±36) ml vs.( 177 ± 46) ml,( 178 ± 44) ml ],nocturia times [ ( 1.9 ± 0.7) times vs.(2.9 ± 1.3 ) times,(2.8 ±1.4) times ],urge incontinence times [ (0.6 ± 0.5 ) times vs.( 1.6 ± 1.0) times,( 1.5 ± 1.0) times ].OABSS in study group the second evaluation was significantly lower than that in the first evaluation in study group and the second evaluation in control group [ (3.6 ± 1.8 ) scores vs.( 7.6 ± 3.3 ) scores,(7.4 ± 3.2) scores,P ＜ 0.01 or ＜ 0.05 ].There was no statistical significance in all the indexes in control group between the first evaluation and the second evaluation (P ＞ 0.05).There were 2 cases with adverse reactions which performed as dry mouth which could be tolerant.ConclusionTolterodine tartrate is efficient and safe in treating patients with early OAB symptoms after TURP.