Complications following combined transrectal ultrasound-guided prostate needle biopsies and transurethral resection of the prostate

In order to evaluate safety and morbidity aspects of additional systematic prostate biopsies, we have conducted a retrospective review of patients who had undergone transurethral resection of the prostate (TUR-P) combined with additional systemic prostate needle biopsies at the Chang Gung Memorial Hospital. To this end, the records of 80 men presenting consecutively at our institution between February 2001 and January 2004 inclusively were examined. These 80 individuals included patients experiencing obstructive voiding symptoms and those featuring suspicious screening parameters, all of whom were to undergo transurethral resection of the prostate for symptomatic benign prostatic hyperplasia (BPH), all procedures being performed by a single surgeon. A total of 20 (25%) specimens were found to be positive for prostate cancer. Cancer was detected in the transrectal prostate biopsy specimen of 16 of 57 men (28%) who had not undergone a previous prostate biopsy, and for four of 23 (17%) who had undergone at least one previous (benign) biopsy. Mild complications associated with transurethral prostrate resection, such as hematuria and hemospermia, were reported frequently, featuring rates of 10% and 2.5%, respectively; more severe complications being noted far less frequently. Fever, usually of a low grade, was observed post-operatively for six (7.5%) patients, but a prompt return to normal temperature following antibiotic treatment for one day was revealed. Four (5%) patients remained admitted to the hospital for a prolonged period following surgery. A review of the literature concerning transrectal biopsies and TUR-P has shown that surgery-associated complication rates are slightly lower than was the case for our study. Additional systematic prostate biopsies for patients undergoing TUR-P would appear to be a relatively safe treatment procedure. Identification of risk factors for post-surgery complications might further improve the safety of the screening procedure.     

Office based transurethral needle ablation of the prostate with analgesia and local anesthesia

PURPOSE: We evaluated the efficacy and feasibility of performing office based transurethral needle ablation of the prostate with analgesia and local anesthesia. MATERIALS AND METHODS: A total of 56 consecutive patients underwent transurethral needle ablation of the prostate for symptomatic benign prostatic hyperplasia. Oral rofecoxib (50 mg) and ciprofloxacin (250 mg) were administered before the procedure with 25 mg hydroxyzine and 50 to 100 mg meperidine intramuscularly. A combination of 2% lidocaine solution and jelly was used for anesthesia. Patients rated discomfort during anesthesia administration and the procedure using a 10-point scale of 0--no discomfort to 10--the worst pain/discomfort ever experienced in the patient life. Overall satisfaction with the procedure was assessed with a 4-point scale of 1--very satisfactory to 4--very unsatisfactory. Followup was 12 months for uroflow and 36 months for International Prostate Symptom Score. RESULTS: The mean age of 47 patients was 65.4 years. Mean discomfort ratings were 3.6 and 4.9 for anesthesia administration and the procedure, respectively. Average operative time was 34.4 minutes, excluding anesthesia administration. The mean overall satisfaction score was 1.5. The mean preoperative International Prostate Symptom Score was 23.1, which improved to 10.9, 11.2, 12.3, 13.8 and 11.3 at 3, 6, 12, 24 and 36 months, respectively. Mean maximum uroflow improved from 8.2 ml/sec at baseline to 12.8, 13.9 and 13.3 ml/sec at 3, 6 and 12 months, respectively. CONCLUSIONS: Administration of an intramuscular narcotic combined with oral analgesic and topical lidocaine provided adequate pain control for transurethral needle ablation of the prostate, making it a feasible office procedure.     

Durability and cost-effectiveness of transurethral needle ablation of the prostate as an alternative to transurethral resection of the prostate when alpha-adrenergic antagonist therapy fails

PURPOSE: We analyzed the adverse event profile, long-term efficacy and cost-effectiveness of transurethral needle ablation of the prostate for lower urinary tract symptoms associated with benign prostatic hyperplasia as an alternative to transurethral resection of the prostate in men with symptoms uncontrolled by medical therapy. MATERIALS AND METHODS: A total of 71 men on a waiting list for transurethral resection of the prostate after failed medical therapy underwent transurethral needle ablation of the prostate. Symptom scores, uroflowmetry and residual urine were measured before and up to 10 years following treatment. Transrectal ultrasound and pressure flow studies were performed before, and 3 and 12 months following treatment, respectively. Treatment failure was defined as lower urinary tract symptoms progression requiring further therapy or associated with deteriorating quality of life assessment. RESULTS: Apart from transient postoperative urinary retention, no significant treatment emergent adverse events due to transurethral needle ablation of the prostate were observed. Treatment failure occurred in 58 men (83%) at a median of 20 months. A total of 36 men (51%) underwent invasive treatment (transurethral resection of the prostate 33, bladder neck incision 2, microwave thermal ablation 1), 2 men (3%) were deemed unfit for anesthesia and now practice clean intermittent self-catheterization, 14 men (20%) reported improvement following resumption of treatment with an alpha-adrenergic antagonist after transurethral needle ablation of the prostate and 6 men (9%) have experienced deterioration in lower urinary tract symptoms with reduction in quality of life assessment (International Prostate Symptom Score 3 or greater) but have declined further intervention. There were 12 men (17%) who remained symptom-free up to 10 years after transurethral needle ablation of the prostate. The estimated additional cost of treatment for lower urinary tract symptoms per man treated with transurethral needle ablation of the prostate during the 10-year followup was $1,377. CONCLUSIONS: Despite documented safety and lack of morbidity, the high re-treatment rate associated with transurethral needle ablation of the prostate renders it relatively expensive when viewed as a long-term alternative to transurethral resection of the prostate for the management of lower urinary tract symptoms associated with benign prostatic hyperplasia in men in whom medical therapy failed. Of men failing alpha-blockade therapy 20% will benefit from a combination of transurethral needle ablation of the prostate and alpha-blockade.     

Prospective multicenter study of transperineal prostatic block for transurethral needle ablation of the prostate

The choice of anesthesia during thermal therapy of the prostate plays a significant role in the morbidity profile, patient convenience, and cost. We report 39 men with symptomatic benign prostatic hyperplasia who underwent transurethral needle ablation of the prostate under transperineal prostatic block. This method of local anesthesia proved safe, convenient, and satisfactory during the procedure.     

Efficacy of transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia

BACKGROUND: We evaluated the efficacy and safety of transurethral needle ablation (TUNA) of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH) as one institute participating in a Japanese clinical trial. METHODS: Thirty-three patients with symptomatic BPH were treated with the TUNA procedure in our institute. The international prostate symptom score (IPSS), quality of life (QOL) score, residual urine volume (RV), prostate volume (PV) and peak urinary flow rates (Qmax) were measured and complications were assessed. RESULTS: We followed and evaluated 30 of the 33 cases. At 12 months there were significant improvements in the IPSS (20.7 to 11.2, P < 0.0001), QOL score (4.9 to 2.1, P < 0.0001), RV (46.6 to 22.6 mL, P < 0.01), PV (37.8 to 30.0 mL3, P < 0.002) and Qmax (8.00 to 11.0 mL/s, P < 0.002). There were no serious complications. CONCLUSION: This trial shows that the TUNA procedure is a safe and efficacious treatment for symptomatic BPH.     

Combined use of transurethral resection and needle biopsy in the diagnostics of carcinoma of the prostate

On suspicion of prostatic tumour, the authors performed a combination of transurethral resection and needle biopsy to form a safe histological diagnosis as well as to apply an adequate therapy. Transurethral resection combined with needle biopsy is to be performed if patients present with dysuric complaints, and if tumour can be suspected on rectal palpation or based on the clinical picture. This intervention ensures an unequivocal diagnosis and eliminates the urinary obstruction. They also dealt with cases, in which only needle biopsy or transurethral resection could help in forming the correct diagnosis.     

经尿道前列腺电切术与汽化切除术的并发症分析

目的 分析经尿道前列腺电切术（TURP）与经尿道前列腺汽化切除术（TVP）术中、术后常见并发症，进一步提高手术安全性和有效性。方法 回顾分析经尿道前列腺切除术4156例，其中TURP1056例，TVP3100例。比较2组患者术中、术后早期和远期并发症的发生率。结果 TURP与TVP平均手术时间分别为62min和54min，平均切除组织21．2g和36．7g。因术中出血而需输血者分别为14．1％和0．2％（P〈0．01），电切综合征（TURS）2．7％和0．9％（P〈0．01），包膜穿孔尿外渗3．7％和0．8％，术后出血2．2％和0．2％，尿路感染4．0％和5．7％，尿道狭窄2．5％和2．8％，膀胱颈部挛缩2．2％和2．1％，勃起功能障碍7．0％和2．3％（P〈0．01），逆行射精为45．0％和45．6％，永久性尿失禁各1例。结论 TURP与TVP均为良性前列腺增生安全而有效的外科治疗方法。但TURP术中出血、TURS、包膜穿孔尿外渗、术后出血、勃起障碍发生率明显高于TVP，而TVP尿道狭窄和膀胱刺激症状发生率略高于TURP组。     

经尿道等离子体双极前列腺电切术与经尿道前列腺电切术的疗效比较研究

目的:对比研究经尿道等离子体双极电切术(transurethral plasmakinetic resection of prostate,PKRP)及经尿道前列腺电切术(transurethral resection of prostate,TURP)的安全性与临床疗效。方法:纳入2010年3月至2012年9月78例有下尿路症状(lower urinary tract symptoms,LUTS)的良性前列腺增生(benign prostatic hyperplasia,BPH)患者,按1:1的比例随机分为两组,一组行PKRP(PKRP组),另一组行TURP(TURP组)。对比两组患者术前、术后(1个月、12个月)国际前列腺症状评分(international prostate symptom scores,IPSS)、最大尿流率(maximum flow-rate,Qmax)、生活质量(quality of life,QOL)、残余尿量(postvoid residual volume,PVR),围手术期基本情况,如手术时间、留置导尿管时间、膀胱冲洗量、住院时间;并发症发生率,如经尿道电切综合征(transurethral resection syndrome,TURS)、输血、尿潴留、尿道狭窄等。结果:两组患者手术时间、术中与术后冲洗液量、术后膀胱冲洗时间、包膜穿孔、尿道损伤、输血、尿潴留、二次手术、尿道狭窄发生率差异无统计学意义(P>0.05),PKRP组留置导尿管时间、住院时间明显少于TURP组。PKRP组无一例发生TURS,TURP组中6例患者发生TURS(P<0.05)。术后1个月、12个月两组患者IPSS、Qmax、QOL、PVR差异均无统计学意义,但两组患者IPSS评分均较术前显著下降,Qmax显著增高,PVR显著减少(P<0.05)。结论:PKRP与TURP具有相同的治疗效果,相较TURP,PKRP具有更短的留置导尿管时间、住院时间,发生TURS的风险更低;因此,PKRP是可供选择的前景良好的治疗BPH的微创术式。     

PlasmaKinetic Superpulse transurethral resection versus conventional transurethral resection of prostate

PURPOSE: To compare the efficacy and safety of the PlasmaKinetic (PK) Superpulse system with that of conventional transurethral resection of the prostate (TURP) in terms of restoration of urinary flow and early postoperative course. PATIENTS AND METHODS: One hundred five men older than 45 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia (BPH) were randomized, 51 undergoing standard TURP with glycine as the irrigation fluid and 53 TURP with the PK Superpulse system with normal saline as irrigant. The operative time, intraoperative blood loss, catheter time, change in serum electrolytes (particularly sodium), and uroflowmetry and American Urological Association (AUA) Symptom Scores were compared. RESULTS: The blood loss as well as the catheter time observed in the PK Superpulse arm were significantly less than those in the conventional-TURP arm. The mortality rate was 0 in both the arms. The mean operative time was less in the PK Superpulse arm, although not significantly so. Hyponatremia was statistically insignificant. Significant changes were observed in the AUA Scores in both arms. CONCLUSION: The PK Superpulse system provides faster removal of tissue in a bloodless field with better views and a safer environment of saline irrigation with efficacy comparable to that of conventional TURP. However, further randomized trials with extended follow-up may be needed to better define the role of the PK Superpulse system in treating patients with symptomatic BPH.     

三种经尿道前列腺切除术治疗良性前列腺增生的疗效比较

目的比较良性前列腺增生（BPH）的三种经尿道手术治疗效果。方法分别采用经尿道前列腺电切术（TURP）、经尿道双极等离子前列腺切除术（PKRP）和经尿道铥激光前列腺切除术（TmLRP）治疗BPH共137例。结果三种术式患者手术前后前列腺症状评分（IPSS）、生活质量评分（QOLs）、残余尿（RUV）、最大尿流率（Qmax）比较均得到显著改善（P〈0．01），疗效满意。前列腺重量（PW）〈40g时，TmLRP组手术时间明显短于PKRP和TURP组（P〈0．01）。PW〉50g时，TmLRP组手术时间明显长于PKRP和TURP组（P〈0．01）。TmLRP和PKRP组术中出血少，术后膀胱冲洗时间、留管时间及住院时间均短于TURP组（P〈0．01）。站论三种经尿道手术方法均是治疗BPH的有效手段，TmLRP和PKRP比TURP更安全，术中及术后并发症更少。     

Ambulatory transurethral resection of the prostate

Despite the plethora of new treatment modalities for patients with benign prostatic hyperplasia, conventional transurethral resection of the prostate remains the most effective procedure in terms of patient satisfaction and urodynamic improvement. Traditional nursing and surgical techniques have dictated that it requires an inpatient hospital stay. This pilot study looks at the feasibility of performing the operation as a day-case procedure on a group of selected patients.     

经尿道前列腺电汽化术的合并症

报告５７例前列腺增生症患者在经尿道前列腺电汽化术（ＴＵＶＰ）治疗中发生６例次（１０．５％）合并症，其中ＴＵＲ综合征１例（１．８％），术后继发膀胱出血１例（１．８％），术后膀胱颈挛缩２例（３．５％）及尿道外口狭窄２例（３．５％）。分析了其发生原因并提出防治措施，所有患者预后良好     

Systematic prostate biopsy before transurethral resection of the prostate

PURPOSE: With the aim of evaluating the clinical significance of systematic prostate biopsy before transurethral resection of the prostate (TUR-P), clinical data were reviewed retrospectively in patients who had underwent prostate biopsy prior to scheduled TUR-P. PATIENTS AND METHODS: Between July, 1994 and June, 2000, TUR-P was scheduled in a total number of 456 patients with clinically diagnosed benign prostatic hyperplasia (BPH). RESULTS: In 218 (47.8%) out of 456 cases, prostatic biopsy was conducted prior to TUR-P due to abnormally elevated serum prostate specific antigen (PSA) levels of 4.0 ng/ml or more, revealing only 22 (10.1%) cases of prostatic cancer. Between these 22 cases with biopsy proven prostatic cancer and 189 cases with BPH confirmed both by biopsy and following TUR-P, statistically significant differences were noted in age (p < 0.05), prostate volume (p < 0.0001) and PSA density (p < 0.01). CONCLUSION: Considering the low positive rate of preoperative prostatic biopsy, it might be suggested that a considerable number of biopsy could be avoided in patients with clinically diagnosed BPH. Based on the results obtained from this study, prostatic biopsy might be unnecessary before TUR-P for those with prostate volume greater than 60 ml or PSA density less than 0.15.     

Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months

PURPOSE: To compare the efficacy and safety of transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) during an 18-months follow-up. PATIENTS AND METHODS: A series of 59 patients older than 40 years were included in this study. The entry criteria were prostate size <70 g, maximum urinary flow rate (Q(max)) <15 mL/sec, International Prostate Symptom Score (IPSS) >13, and no suspicion of prostate cancer according to the clinical or laboratory findings. Of the patients, 26 (44%) were treated with TUNA and 33 (56%) with TURP. At 3 and 18 months of follow-up, Q(max), postvoiding residual volume (PVR), IPSS, and the quality of life (QOL) score were compared with the baseline values. The results were also compared in patients undergoing TUNA v TURP. RESULTS: Improvements in Q(max), PVR, IPSS, and QOL score were statistically significant for both groups at 3 and 18 months of follow-up. The increase in the mean Q(max) of the TURP group was higher than that in the TUNA group, whereas no significant differences were found in the two groups regarding improvements in IPSS and QOL score. There were no complications associated with the TUNA procedure, while 16 retrograde ejaculation, 4 erectile impairment, 2 urethral stenosis, and 1 urinary incontinence cases were observed after TURP. CONCLUSIONS: The TUNA procedure is an effective and safe minimally invasive treatment with negligible adverse effect for selected patients with symptomatic BPH compared with TURP. It should be considered as an alternative treatment option for younger patients who want to preserve sexual function.     

腔内分部剜切术与经尿道前列腺等离子双极电切术治疗前列腺增生症的疗效分析

目的比较腔内分部剜切术与经尿道前列腺等离子双极电切术(TUPKP)治疗良性前列腺增生症(BPH)的安全性和疗效。方法收集BPH手术患者285例,分别行腔内分部剜切术(165例)与TUPKP(120例)。分析两组患者的手术时间、术中失血量、术后冲洗时间;比较两组手术患者术前、术后(第1天)血红蛋白及红细胞压积,记录两组手术短期并发症发生率;术前及术后(3个月)测定最大尿流率(Qmax)和残余尿量(RUV),记录术前、术后国际前列腺症状评分(IPSS)及生活质量(QOL)评分并给予比较。结果分部剜切组平均手术时间[(66.5±10.0)min]与TUPKP组[(65.4±10.1)min]差异无统计学意义;在术中失血量、术后冲洗时间方面,分部剜切组较TUPKP组比较有统计学意义。结论腔内分部剜切术具有可操作性强、术中出血少、术后冲洗时间短及术后尿失禁发生率低等优点,是治疗BPH患者安全、有效的手术方式之一。     

经尿道前列腺电切与汽化切除术的疗效比较

目的 对比分析经尿道前列腺电切(TURP)和经尿道前列腺汽化切除术(TUVRP)的疗效和手术并发症.方法 良性前列腺增生(BPH)患者637例,随机分为TURP组(298例)和TUVRP组(339例).患者术前最大尿流率(Qmax)和国际前列腺症状评分(IPSS)分别为(9.8±2.3)、(10.1±2.1)ml/s和15.3±3.1、15.1±3.7.比较2组患者手术时间、失血量、血钠变化及手术并发症发生率.结果 2组手术均顺利,无手术死亡病例.TURP和TUVRP组术后Qmax分别为(19.0±2.9)和(18.0±2.3)ml/s,IPSS 5.0±1.4和8.05±1.6,与术前比较差异均有统计学意义(P<0.01),2组问Qmax差异无统计学意义(P0.05)、IPSS差异有统计学意义(P<0.05).TURP组手术时间(52±16)min,肉眼血尿持续(9.0±2.3)d,继发性出血6例(2.0%),尿路感染14例(4.7%),下尿路症状(LUTS)26例(8.7%),暂时性尿失禁6例(2.0%),膜部尿道狭窄4例(1.3%);TUVRP组分别为(68±19)min,(12.0±3.6)d,19例(5.6%),38例(11.2%),59例(17.4%),13例(3.8%),16例(4.7%);以上各项2组间比较差异均有统计学意义(P值均<0.05).TURP组术中失血量(126±29)ml,切除组织(31±8)g,手术前后血钠差(8±6)mmol/L,发生TURS 3例(1%);TUVRP组分别为(122±38)ml,(33±9)g,(7±7)mmol/L,2例(0.6%);以上各项2组间比较差异均无统计学意义(P值均0.05).结论 TURP和TUVRP均为治疗BPH的有效手术方法,TURP手术并发症发生率更低.