An objective comparison of transurethral resection and bladder neck incision in the treatment of prostatic hypertrophy

Transurethral resection has become the operation of choice in almost all cases of benign prostatic enlargement. However, when the gland does not exceed 30 gm. bladder neck incision is easier to perform, results in a lower morbidity, and is less likely to be followed by incontinence and retrograde ejaculation. We studied 2 groups of men with proved obstruction. Complete urodynamic investigation was done on 51 patients before and on 44 patients after the operation. We compared our subjective and objective findings in the 2 groups. The conclusion suggest that bladder neck incision is as effective as transurethral resection in relieving the obstruction of prostatic enlargement in the presence of a small gland.     

Technique of bladder catheterization after transurethral prostatic resection

The obstacle that represents the bladder neck posterior lip after a prostate transuretral resection is, sometimes, the cause of sugtrigonal perforations when a bladder catheterization is performed after the surgery. We explain an easy procedure that allows a safe catheterization, reducing the risk of complications added to those of the surgery.     

A comparison of fluid absorption during transurethral resection and transurethral vaporization for benign prostatic hyperplasia

OBJECTIVES: To compare the absorption of irrigant fluid during transurethral vaporization of the prostate (TUVP) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Thirty patients with clinical benign prostatic hyperplasia were randomly assigned to undergo TURP or TUVP; 1.5% glycine +1% ethanol solution was used as the irrigating solution. The volume of irrigant absorbed during surgery was estimated from the ethanol concentration in the patient's expired breath, sampled every 10 min. RESULTS: In both groups, the estimated absorbed fluid volume increased with the duration of surgery (P < 0.05). At the end of surgery, the mean (median, range) fluid absorption during TUVP was 672 (606, 0-1400) mL and during TURP was 1347 (975, 453-2965) mL; the difference was statistically significant (P < 0.05). CONCLUSION: Although TURP has a greater associated risk of fluid absorption than TUVP there may still be severe fluid absorption with the latter. Even though TUVP is potentially less harmful than TURP in poor-risk patients, ethanol monitoring is beneficial for increasing patient safety.     

Minimal transurethral prostatectomy plus bladder neck incision versus standard transurethral prostatectomy in patients with benign prostatic hyperplasia: a randomised prospective study

OBJECTIVE: To evaluate the effectiveness and complications of the combination of minimal transurethral resection of the prostate and bladder neck incision in comparison with those of the standard transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Forty patients with prostates of 相似文献   

Blood loss during transurethral prostatic resection with continuous bladder irrigation

A total of 120 men with benign prostatic hypertrophy were assigned randomly into three groups. Transurethral prostatic resections were performed in all patients. In Group I the operation was performed with continuous flow bladder irrigation, in Group II with suprapubic flow irrigation (without suction pump) and in Group III without continuous flow irrigation. Blood loss was determined by a colorimetric method. There were no statistically significant changes in blood loss between the groups of patients.     

Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck

PURPOSE: We describe the presentation, clinical characteristics, treatment and followup of a series of women with primary bladder neck obstruction (PBNO). MATERIALS AND METHODS: A patient data base was searched for women who underwent transurethral resection for bladder outlet obstruction diagnosed by videourodynamic study (VUDS) according to the Blaivas-Groutz nomogram for female bladder outlet obstruction between 1993 and 2002. A total of 37 women with obstruction were identified. Patients with neurogenic, traumatic, anatomical or iatrogenic causes of obstruction were excluded. Seven patients remained who had been diagnosed with PBNO, of whom all underwent transurethral bladder neck resection. Office records were reviewed for history, presentation, surgical treatment and clinical outcome. RESULTS: Seven patients were diagnosed with PBNO. Age was 39 to 81 years. Six of 7 patients presented with symptoms of obstruction, including a weak or intermittent stream and urinary hesitancy. These 6 patients had unremarkable physical examination findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. One patient presented with abdominal swelling, which on physical examination was found to be a markedly distended bladder containing more than 1000 cc urine. All patients had overt urethral obstruction on VUDS. In 6 of 7 patients obstruction was clearly at the vesical neck and in 1 the obstruction site was equivocal. Three patients were treated or had previously been treated pharmacologically with alpha-blockers. All patients were subsequently treated with intermittent self-catheterization. All patients then underwent transurethral bladder neck resection at the vesical neck and proximal urethra. Surgical specimens weighed 1 to 5 gm and showed urethral fragments or fibromuscular tissue without specific pathological findings. Followup was 1 to 10 years (median 3) and it included physical examination, uroflowmetry, post-void residual urine measurement and videourodynamic study. Six patients considered themselves cured of lower urinary tract symptoms and 1 was improved. In 1 patient the obstruction site was not clear. One patient had mild stress incontinence under rare circumstances not severe enough to require protective pads. The average change in flow was 6 +/- 10 vs 30 +/- 17 ml per second (p <0.03). The average change in voided volume was 194 +/- 170 vs 416 +/- 206 ml per second (p <0.06). Average change in post-void residual urine was 680 +/- 445 vs 173 +/- 366 ml (p <0.05). CONCLUSIONS: PBNO is an exceedingly rare condition, which is easily treatable when properly diagnosed by VUDS. The presentation of patients in urinary retention in middle age suggests that PBNO may be more common in less apparent forms than has previously been recognized.     

经尿道前列腺电切术后膀胱颈部挛缩的治疗

目的探讨经尿道前列腺电切（TURP）术后膀胱颈部挛缩（BNC）的有效治疗方法。方法对75例TURP术后的BNC，采用经尿道膀胱颈部瘢痕切除加颈部切开（BNI），观察疗效。结果术后平均随访25个月，72例（96％）1次治愈，1例再手术后治愈，2例前尿道狭窄经尿扩后治愈。结论TUR＋BNI是治疗TURP术后BNC的有效方法。     

Urethrocystography during and after transurethral prostatic resection.

Ten men were subjected to transurethral electroresection because of prostatic adenoma. All were examined with urethrocystography on 3 occasions, viz. at the end of operation, 4-7 days later and after a further 2-3 months. Peroperative examination for residual adenoma appeared to be of little value, while examination a few days after the operation revealed residual adenomas in 2 cases and possibly also in a third. The cavity left after the operation had the same size at the peroperative and the first postoperative examination, though its outline was sometimes smoother at the latter. During urination the cavity invariably increased in size. At the second postoperative examination the operation cavity was clearly smaller and its outline smoother in 9 of 10 cases. The cavity still expanded during micturition. No passage of contrast medium to the veins was ever demonstrable. At the peroperative examination the contrast medium was not injected under any substantial pressure and the cavity was not exposed to pressure by micturition. Even at the first postoperative examination, when the operation cavity was exposed to pressure by urination, the veins that had been opened at operation had closed so effectively that no contrast medium passed outside the prostatic capsule. Urethrocystography in association with TUR of prostatic adenoma is of interest to the urological surgeon. It provides him with a possibility to check his work very carefully.     

经尿道前列腺电切术后膀胱颈挛缩的防治

目的:探讨经尿道前列腺电切术(TURP)后膀胱颈挛缩(BNC)的防治。方法:回顾性分析68例BNC患者的诊断和治疗临床资料。结果:经尿道行膀胱颈后唇切除,用冷刀切开膀胱颈部,再换用电切刀切除瘢痕组织。术后平均随访36个月,一次手术治愈60例(89%);复发8例(11%),经再次或三次手术治愈。结论:腔内手术治疗TURP术后BNC是一种安全、有效的方法。     

经尿道膀胱颈电切术治疗女性膀胱颈增生(附26例报告)

目的 探讨经尿道膀胱颈电切术治疗女性膀胱颈增生的疗效.方法 1998年2月～2005年3月对26例女性膀胱颈增生行经尿道膀胱颈电切术(transurethral resection of bladder neck,TURBn).从6点开始电切,并向5、7点扩展,切除膀胱颈3～9点增生的组织,深0.5～1.0cm达肌纤维,长度1.0～2.0cm.结果 26例手术过程顺利.术后留置尿管3～5d.26例术前最大尿流率(Qmax)(9.0 6.6)ml/s升至术后(23.0 7.0)ml/s(t=4.213,P=0.004).1例出现短期的尿失禁,无一例发生尿瘘.26例随访0.5～7.0年,平均2.3年,24例拔除尿管后排尿通畅,下尿路梗阻症状消失,最大尿流率(Qmax)＞15ml/s;2例排尿困难较术前明显改善,最大尿流率(Qmax)分别为13、11ml/s.结论 TURBn是治疗女性膀胱颈增生的有效方法.     

经尿道前列腺电切术后膀胱颈挛缩的防治

目的探讨腔内治疗经尿道前列腺电切术（TuRP）后膀胱颈挛缩（BNC）的疗效。方法回顾性分析TURP32例BNC患者,经尿道置入电切镜切除膀胱颈后唇组织,再用冷刀切开膀胱颈．然后再换用电切刀彻底切除疤痕组织。结果32例患者术后症状明显改善,最大尿流率16．2±4．0ml／s和平均尿流率6．8±2．0ml／s均高于术前（P〈0．05）。术后平均随访28个月,一次性手术治愈28例,复发4例,经再次或三次手术治愈。结论经尿道腔内手术治疗TURP术后BNC是一种安全,疗效确切的微创手术方法。     

Fatal gas embolism during transurethral incision of the bladder neck under spinal anesthesia

We report a case of fatal gas embolism during transurethral incision of the bladder neck under spinal anesthesia in a 76-yr-old man. We confirmed the diagnosis of venous gas embolism by aspiration of frothy blood through the double-lumen central venous catheter and by observation on the transesophageal echocardiogram of a massive gas embolism in the right atrium and right ventricle with obstruction of right ventricle outflow. This report is presented in an attempt to remind anesthesiologists of this unusual but potentially fatal complication that may occur during common transurethral surgery. IMPLICATIONS: We report a patient undergoing transurethral incision of the bladder neck who developed a fatal gas embolism. This report is presented in an attempt to remind anesthesiologists of this unusual but potentially fatal complication that may occur during common transurethral surgery.     

Severe mannitol-induced hyponatremia complicating transurethral prostatic resection.

A case is presented in which the absorption of mannitol irrigation solution across prostatic veins resulted in severe hyponatremia in a patient undergoing transurethral prostatic resection. Since hyposmolality of the extracellular fluid was not seen because of the presence of mannitol the patient was asymptomatic despite a rapid decrease in the serum sodium concentration to 99 mEq./l. The importance of distinguishing dilutional hyponatremia from hyponatremia with normal or elevated osmolality is discussed.     

等离子与汽化电切术治疗前列腺增生的效果及术后膀胱颈挛缩的影响因素

目的 探究经尿道等离子前列腺电切术(TUPKRP)与经尿道前列腺汽化电切术(TUVP)治疗前列腺增生(BPH)的效果,并分析术后膀胱颈挛缩(BNC)的影响因素。方法 前瞻性的选取2018年1月至2020年1月我院泌尿外科收治的90例BPH患者作为研究对象。数字表法随机分成对照组(45例,TUVP)和观察组(45例,TUPKRP),对比两组患者治疗前、治疗3个月后的临床资料,以是否发生BNC为分组依据,分析术后BNC的影响因素。结果 组内比较,两组患者治疗3个月后IPSS、PSA、表皮生长因子(EGF)及前列腺素E2(PGE2)均显著低于治疗前(P<0.05),Q_max显著高于治疗前(P<0.05);组间同时点比较,治疗后观察组患者IPSS、PSA、EGF及PGE2均显著低于对照组患者(P<0.05),且Q_max显著高于对照组患者(P<0.05)。发生BNC组患者合并前列腺炎、冲洗温度<34℃、导管灌注量≥40 ml以及TUVP术式占比均显著高于未发生BNC组患者(P<0.05);且Logistic分析结果显...     

The transurethral resection of prostatic adenoma

The paper presents the analysis of 255 patients aged 39-89 yrs who sustained transurethral resection of prostatic adenoma between 1985 and 1988. The choice of the surgery technique depended on the direction of adenoma growth the weight of its tissue and the presence of associated diseases of the lower urinary tract. At present, the allowable weight of the removed tumor is increased from 30 to 60 g while the mean operation time is decreased from 50 +/- 10 to 35 +/- 5 minutes. The authors arrived at the conclusion that the aforementioned technique was of high performance and low-rate traumatism, thus widening the limits of the disease surgical treatment, decreasing the incidence of early (13.7 per cent) and late (2.7 per cent) complications and death rates (1.9 per cent). Besides, the duration of postsurgical hospital stay decreased (5 +/- 1.5 days in noncomplicated cases and 12 +/- 3 days in complicated ones).