Morbidity of radical perineal prostatectomy following transurethral resection of the prostate

Radical prostatectomy in patients who have had prior transurethral resection of the prostate has been reported to result in significant morbidity. From 1974 to 1982, 30 patients who had had previous transurethral resection of the prostate underwent radical perineal prostatectomy for localized prostatic cancer. Operative time and blood loss were similar to a group of patients who had not had prior transurethral resection of the prostate. Over-all, 3 patients (10 per cent) had total incontinence and 3 (10 per cent) had stress incontinence requiring a pad or device. No patient undergoing radical prostatectomy less than 4 weeks or more than 4 months after transurethral resection of the prostate had postoperative incontinence. When radical perineal prostatectomy was performed between 4 weeks and 4 months after transurethral resection of the prostate the incidence of incontinence was 50 per cent. Five patients experienced prolonged perineal urinary drainage, all but 1 of whom healed spontaneously. Of the 6 patients with incontinence 3 had prolonged drainage. No patient had a rectal injury and there was no operative mortality. Two patients died without cancer and 1 has evidence of disease recurrence. We conclude that radical prostatectomy may be performed safely with acceptable morbidity following transurethral resection of the prostate and that if 4 weeks has elapsed since resection it might be advantageous to wait 4 months before performing radical surgery to lessen the risk of incontinence.     

Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and follow-up

INTRODUCTION AND OBJECTIVES: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis. MATERIAL AND METHODS: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data. RESULTS: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53-79 years). The PSA at the time of diagnosis was <4ng/ml in 8 cases; 4-10ng/ml in 16 cases and >10ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19-150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy. CONCLUSIONS: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during follow-up.     

Technical nuances and surgical results of radical retropubic prostatectomy in 150 patients

We reviewed the surgical results of radical retropubic prostatectomy in 150 patients, of whom 37 had undergone transurethral resection of the prostate. The number and type of complications in our series compared favorably to those reported in other series: only 15 of our last 100 patients had complications, most of which were minor. Incontinence occurred in 2 of our last 100 patients and there were no symptomatic urethral strictures. Complications were similar between patients who had and those who had not undergone transurethral resection of the prostate. Several technical considerations that contribute to these results are discussed, especially the use of perineal pressure to facilitate hemostasis and the technique of vesicourethral anastomosis. Radical retropubic prostatectomy is a relatively well tolerated procedure with low morbidity.     

The predictive accuracy of staging transurethral resection of the prostate in the management of stage A cancer of the prostate: a comparative evaluation

The role of staging transurethral resection of the prostate in the management of stage A prostate cancer is controversial. The accuracy of staging transurethral resection, A1/A2 substaging and probability of progression tables for predicting cancer progression was evaluated in untreated patients with stage A adenocarcinoma of the prostate who were followed for at least 5 years. Survival free of disease was predicted correctly in 93% of 52 patients who underwent staging transurethral resection of the prostate, 92% of 96 with the probability tables and in 85% of 96 using a common criteria for A1 and A2 substaging. Staging transurethral resection of the prostate upgraded patient risk in 7% of the low risk patients predicted by the probability tables and 14% of the stage A1 cancer patients. Staging transurethral prostatectomy and the probability of progression tables were more accurate in predicting survival free of disease than the A1/A2 substaging system. Comparison of the predictive accuracy of staging transurethral prostatectomy to that of the probability of progression tables showed no significant difference. There was no additional benefit from combining the 2 methods. When the probability of progression tables are used to predict cancer progression it may be unnecessary to use staging transurethral resection of the prostate in the patient with stage A prostate cancer.     

Surgical outcomes for men undergoing laparoscopic radical prostatectomy after transurethral resection of the prostate

PURPOSE: We reviewed outcomes for men with a history of transurethral prostate resection who underwent laparoscopic radical prostatectomy for prostate cancer. MATERIALS AND METHODS: Between January 26, 1998 and December 2006, 3,061 men underwent laparoscopic radical prostatectomy at our institution. A retrospective review showed that 119 had a history of transurethral prostate resection. These men were compared to randomized matched controls with regard to operative and postoperative outcomes. The matching criteria used to randomly select patients were clinical stage, preoperative prostate specific antigen and biopsy Gleason score. RESULTS: Mean +/- SD age in the groups with and without transurethral prostate resection was 66.2 +/- 5.6 and 60.7 +/- 7.0 years, respectively (p <0.01). Mean estimated blood loss, transfusion rate, pathological prostate volume and reoperation rate were statistically similar between the groups. Mean length of stay for the groups with and without transurethral prostate resection was 6.5 +/- 3.0 and 5.29 +/- 2.3 days, respectively (p <0.01). Mean operative time for the groups with and without transurethral prostate resection was 179 +/- 44 and 171 +/- 38 minutes, respectively (p = 0.02). Positive margins were seen in 21.8% and 12.6% of the patients with and without transurethral prostate resection, respectively (p = 0.02). A total of 64 complications were seen in patients with a history of transurethral prostate resection compared to 34 in those without such a history (p <0.01). CONCLUSIONS: We report that patients with a history of transurethral prostate resection who undergo laparoscopic radical prostatectomy have worse outcomes with respect to operative time, length of stay, positive margin rate and overall complication rate. This subset of patients should be made aware of these potential risks before undergoing laparoscopic radical prostatectomy.     

A randomized controlled trial comparing transurethral resection of the prostate,contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: urodynamic effects

PURPOSE: We compared urodynamic and uroflowmetry improvements in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) after transurethral prostate resection, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS: A prospective randomized controlled trial was performed in men with lower urinary tract symptoms suggestive of BPH who met the criteria of the International Scientific Committee on BPH, had a prostate volume of between 20 and 65 ml., and a Sch?fer obstruction grade of 2 or greater. Before and 6 months after treatment urodynamics and free uroflowmetry were performed. RESULTS: A total of 50, 45 and 46 men were randomized to transurethral prostate resection, laser treatment and electrovaporization, respectively. Baseline characteristics were similar in the 3 groups. Detrusor contractility did not change in any of the treatment groups. The average maximum free flow rate increased by a factor of 2.4 after transurethral prostate resection, 2.5 after laser prostatectomy and 2.4 after electrovaporization. The Sch?fer obstruction grade decreased by a factor of 0.3 in all groups. Obstruction (Sch?fer grade greater than 2) was not noted after transurethral prostate resection or electrovaporization but it was evident in 2 patients after laser prostatectomy. Effective capacity increased by a factor of 1.5 or more. The incidence of detrusor instability was decreased by half in all groups. The incidence of significant post-void residual urine volume decreased in all groups. CONCLUSIONS: There were no significant differences in the improvement in urodynamic and uroflowmetry parameters 6 months after treatment when comparing transurethral prostate resection, contact laser prostatectomy and electrovaporization in men with lower urinary tract symptoms suggestive of BPH.     

Transurethral resection versus needle biopsy prior to radical prostatectomy for stage C prostate cancer. Influence on progression and survival

Previous reports have claimed that transurethral resection of the prostate (TURP) preceding definitive radiation therapy for patients with Stage C prostate cancer promotes the risk of distant metastasis and increases the mortality rate. A total of 490 patients with pathologic Stage C adenocarcinoma of the prostate treated by radical prostatectomy were studied. Median time to follow-up was 4.6 years. Comparison was made between patients who had TURP within the six months preceding prostatectomy (n = 54) and those who had needle biopsy (n = 437) prior to operation. No significant differences were noted in local recurrence of disease, systemic progression of disease, disease-free interval, and overall and cause-specific survival, even after adjustment for clinical (adjuvant treatment) and pathologic prognostic variables. Our data suggest that for patients with pathologic Stage C prostate cancer treated by radical surgery, preoperative TURP is not associated with unfavorable outcome.     

Inguinal hernia repair before and after prostatic resection

From 1976 through 1981, 864 men had inguinal hernia repairs and 328 had prostatic resections at our Veterans Administration Hospital. Forty-four patients had symptomatic prostatic obstruction that required either transurethral or open prostatic resection within 12 months of hernia repair. Twenty-seven patients had prostatectomy prior to hernia repair, 16 had hernia repair before prostatic resection, and one had simultaneous procedures. There were no urinary tract infections (UTIs) after hernia repair in patients who had had prostatectomy first, while five patients who had hernia repair before prostatectomy developed UTI after hernia repair (P less than 0.01). The incidence of UTI after hernia repair correlated with the need for and duration of bladder catheterization as a result of prostatic obstruction. Complications after prostatectomy were similar regardless of the order of operation. There were no episodes of incarceration or strangulation in patients awaiting hernia repair after prostatectomy. These results suggest that, when an inguinal hernia and symptomatic prostatic obstruction occur together, the performance of prostectomy before hernia repair lowers the risk of morbidity by decreasing the incidence of UTI after hernia repair. This approach does not expose the patient to any additional risk related to the inguinal hernia.     

Transurethral needle ablation of the prostate: outcome at 1 year

BACKGROUND: Urologists continue to search for alternatives to transurethral prostatectomy that carry a lower potential for complications. PATIENTS AND METHODS: Twenty-five patients on the public waiting list for transurethral resection of the prostate, all spontaneously voiding, underwent transurethral needle ablation of the prostate (TUNA). Eight patients had a simultaneous bladder neck incision (BNI). Follow-up with International Prostate Symptom Scores and flow rate measurement was performed at 6 weeks, 7 months, and 1 year. RESULTS: A statistically significant increase in flow rate and fall in symptom scores occurred out to 1 year after TUNA. Despite this result, six patients (24%) were not satisfied with their outcome and underwent a second endoscopic operation. CONCLUSION: In our hands, TUNA produced an unsatisfactory clinical result.     

A population-based study of prostatectomy: outcomes associated with differing surgical approaches

Data from the universal health insurance system in Manitoba, Canada were used to describe the short-term (2 years) and long-term (8 years) outcomes associated with prostatectomy for nonmalignant conditions (all 2,699 procedures were performed from 1974 to 1976). In a system with high quality urological care (more than 90 per cent of the procedures were performed by urologists) no superior operative results for transurethral procedures were found. Postoperative mortality rates following transurethral prostatectomy were similar to or higher than rates for open procedures, and the rate of repeat prostatectomy, was considerably higher following transurethral resection. Dilation for urethral stricture was most common after suprapubic prostatectomy and least common after retropubic prostatectomy. Patients were followed for 8 years and those who underwent transurethral prostatectomy required an additional prostatic operation at a constant rate (2 per cent per year). By the end of the followup period 16.8 per cent of the transurethral prostatectomy patients had undergone a second prostatectomy compared to 7 per cent or less of those who initially underwent an open procedure.     

Multifactorial analysis of the pyuria after transurethral prostatectomy]

Multifactorial analysis on 395 patients revealed important factors which prolong the pyuria after transurethral prostatectomy. They were the age of the patient, anemia and leukocytosis before surgery. These are factors which relate with the defense mechanism of the patient. Local factors, such as the duration of indwelling urethral catheter, the size of the prostate or prostatic bed and preoperative infection, were not so important for prolonging the pyuria after transurethral prostatectomy. The time of the resection and weight of the prostate had an intimate relation each other, and the former was the more important factor. The use of antimicrobials probably controlled these local risk factors, thus making them unimportant in the prolongation of the pyuria after transurethral prostatectomy.     

Risk of urinary incontinence following radical prostatectomy

Of 143 prostatic cancer patients treated with radical prostatectomy 38 had undergone transurethral resection of the prostate before the prostatectomy. After radical prostatectomy 5 per cent of the patients who did not have a resection and 8.1 per cent of those who did were severely incontinent. This difference is not statistically significant.     

A randomized controlled trial comparing transurethral resection of the prostate,contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: analysis of subjective changes,morbidity and mortality

PURPOSE: We analyze subjective changes, morbidity and mortality in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH) after transurethral resection of the prostate, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS: A prospective, randomized controlled trial was conducted on men with lower urinary tract symptoms, who met the criteria of the International Scientific Committee on BPH, had a prostate volume between 20 and 65 ml., and had Sch?fer's obstruction grade 2 or greater. Objective morbidity was recorded for up to 12 months. Subjective morbidity was measured by a questionnaire completed by patients. Subjective changes were quantified using the International Prostate Symptom Score, Symptom Problem Index, Quality of Life question and BPH Impact Index. These indexes and the morbidity questionnaire were measured weekly for the first 6 weeks postoperatively and then at 3, 6 and 12 months. RESULTS: Transurethral prostatic resection was analyzed in 50 men, laser treatment in 45 and electrovaporization in 46. Baseline characteristics, and changes in the symptom scores up to 12 months postoperatively were similar. Perioperative blood loss and perforation were greatest in the resection group, and retention was greatest in the laser group. During the first 6 postoperative weeks there was less pain and less hematuria after resection, and less incontinence after laser prostatectomy. CONCLUSIONS: Subjective changes are similar for transurethral prostatic resection, contact laser and electrovaporization. In the first 6 weeks after treatment there are only slight differences in pain, hematuria and incontinence among the therapies.     

Transurethral prostatectomy using Vista bipolar radiofrequency system: comparison with conventional transurethral resection of the prostate

To assess the efficacy and safety of transurethral prostatectomy using Vista system, between 2002 and 2004, patients with symptomatic BPH without suspected cancer were treated using the Vista device. The therapeutic effect was retrospective studied compared with patients who were received by TURP. Bipolar resection using the Vista device exhibits a statistically difference in maximum urinary flow rate, RUV, IPSS and QOL(P < .05) 3 and 6 months after operation, and no transurethral resection syndrome occurred. TURP also exhibits a statistically difference in maximum urinary flow rate, RUV, IPSS and QOL(P < .05), but TURS occurred in 2 patients. Compared with TURP, the Vista device shows a statistically less blood loss (P < .05), and longer operation time in prostate enlarged III(0)(P < .05). The Vista system seems to be effective and safe, and especially fit the patients who have a bigger prostate and high risk factors. It appears to be an effective treatment for BPH. Long-term results should be evaluated.     

Does transurethral resection of the prostate promote metastatic disease?

Previously published data have suggested that transurethral resection of the prostate might promote the subsequent appearance of metastatic disease. To confirm or deny these observations 145 patients underwent radical prostatectomy, after having had the disease diagnosed either by transurethral resection of the prostate or transrectal needle biopsy. Of the 145 patients 6 were excluded from analysis since they had had transurethral resection of the prostate and transrectal needle biopsy. In 33 patients the disease was diagnosed by transurethral resection of the prostate only and in 106 it was diagnosed by transrectal needle biopsy only. The relative distribution of Gleason grade and the positive versus negative margins among the 2 populations were similar. Using time to first evidence of distant disease as the endpoint of the study no difference in failure rates could be detected between the 2 populations. It is concluded that transurethral resection of the prostate does not enhance the appearance of metastatic disease.     

Changes in serum prostate-specific antigen following prostatectomy in patients with benign prostate hyperplasia

PURPOSE: To investigate how prostatectomy for patients with benign prostate hyperplasia (BPH) affected the serum prostate-specific antigen (PSA) levels. METHODS: In 193 patients who underwent prostatectomy for BPH, serum PSA levels were measured before and three months after the operation. The total prostate weight measured by transrectal ultrasonography (TRUS) and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in PSA levels after the operation. RESULTS: The transition zone volume measured by TRUS could well estimate the weight of the surgical specimen in patients who underwent subcapsular prostatectomy and transurethral resection of the prostate. The concentration of preoperative serum PSA showed a significant correlation with the prostatic volume and with the transition zone volume. Removal of 1 g of BPH tissue reduced serum PSA levels by an average of 0.18 ng/mL. The change in serum PSA levels after the prostatectomy correlated with the total prostatic gland volume and with the transition zone volume. CONCLUSIONS: The elevated PSA levels in patients with BPH were caused by the enlargement of the transition zone. After the resection of the adenoma, PSA levels should be expected to decrease to the normal range.     

Can stage A1 tumor extent be predicted by transurethral resection tumor volume, per cent or grade? A study of 64 stage A1 radical prostatectomies with comparison to prostates removed for stages A2 and B disease

We studied 64 totally embedded radical prostatectomy specimens of stage A1 prostate cancer. The transurethral resection specimens were studied and compared to previously studied stages A2 and B cancer in which tumor volumes also were calculated. At radical prostatectomy 6% of the specimens had no residual cancer, 74% had minimal cancer and 20% had substantial cancer. Although most stages A2 and B tumors were larger, there was overlap among all stages. Transurethral resection tumor volume, per cent and grade were not statistically correlated with either radical prostatectomy residual tumor volume, or whether tumor was classified as minimal or substantial. Gleason sum 2 to 4 versus 5 to 7 tumor on transurethral resection showed no difference in predicting radical prostatectomy residual tumor or minimal versus substantial tumor status. Because 20% of all stage A1 cancers have substantial tumor at radical prostatectomy unpredictable by transurethral resection, radical prostatectomy remains an option for young men with stage A1 prostate cancer.     

Effect of preoperative antibiotic therapy on bacterial prostatitis after transurethral prostatectomy

Transurethral prostatectomy was performed on 237 patients who required no preoperative antimicrobial therapy and on 182 patients with symptoms of urinary tract infection who received preoperative antimicrobial therapy. At operation all patients were asymptomatic. Data are presented on the incidence of infected prostates, bacteriuria at operation, and postoperative morbidity for the two groups. The findings refute the concept that the chronically infected prostate is resistant to antimicrobial therapy. Transurethral prostatectomy in an infected field was found to increase morbidity. The data suggest that an appropriate preoperative antimicrobial regimen be administered to patients undergoing transurethral prostatectomy with asymptomatic bacteriuria.     

经尿道前列腺切除术后并发症再入院分析

目的探讨经尿道前列腺切除术后出现较严重并发症需再入院原因. 方法分析1998年6月～2003年6月我院收治的经尿道前列腺电切术(14例)、电汽化术(3例)、激光切除术(9例)及钬激光前列腺剜除术(1例)后再入院共27例的临床资料. 结果再入院原因为术后膀胱内大出血4例,尿潴留15例,尿道狭窄3例,膀胱颈挛缩2例,严重尿频2例,尿失禁1例. 结论经尿道前列腺切除的各种手术方式均可产生后期严重并发症,应予重视.