Bipolar versus monopolar transurethral resection of prostate: randomized controlled study

BACKGROUND AND PURPOSE: Transurethral resection of prostate (TURP) using bipolar electrocautery and physiologic saline is a new technical advancement in the field of surgical management of benign prostatic hyperplasia. The purpose of this study was to assess the efficacy and safety of this new technique and to compare the results with those of conventional monopolar TURP. PATIENTS AND METHODS: This study included 60 patients who were randomized 1:1 to bipolar (group 1) or monopolar (group 2) TURP. Bipolar TURP was performed with the Vista CTR resectoscope and generator (ACMI Corp.). Preoperatively, patients were assessed by symptom score, uroflow, and transrectal sonography, and the two groups were comparable with regard to these measures and age. The preoperative and postoperative parameters studied included resection time, amount of tissue resected, irrigant amount, blood loss, fluid absorption, and change in serum sodium and hemoglobin. Postoperatively, patients were assessed for symptoms, symptom score, and uroflow rate at 1 and 3 months. RESULTS: There was no difference in resected tissue amount, irrigant amount, fluid absorption, duration and amount of postoperative irrigation, or fall in hemoglobin. The mean resection rate was 0.61 g/min in group 1 and 0.74 g/min in group 2. Serum Na dropped by 4.6 Eq/L in group 2, whereas it fell only 1.2 mEq/L in group 1 (P < 0.001). Improvement in symptom and QoL scores and Q(max) were similar in the two groups. Postoperative dysuria was less common with bipolar resection. CONCLUSION: Bipolar resection of the prostate is as effective as monopolar TURP. Moreover, it does not lead to any change in serum Na and causes less postoperative dysuria.     

经尿道前列腺电切术后尿道狭窄的原因分析

目的 分析并探讨经尿道前列腺电切术(TURP)术后尿道狭窄的原因,避免其发生.方法 回顾性分析我院1999年1月至2010年1月收治的23例前列腺电切术后尿道狭窄患者,年龄57~78岁,平均67.8岁;狭窄段尿道长度为1.6~3.5cm(平均2.3cm);最大尿流率为4～14ml/s,平均75ml/s;术后出现狭窄的时间为1个月~17年,平均25个月.其中前尿道狭窄6例,后尿道狭窄15例,膀胱颈口处狭窄2例.对于明确的尿道狭窄患者,针对不同情况分别给予尿道扩张、尿道内冷刀切开、残留前列腺组织切除或瘢痕切除处理.结果 随访3个月~6个月,23例患者中6例前尿道狭窄经定期尿道扩张后症状消失,疗效满意.后尿道狭窄的15例患者,2例采用定期尿道扩张的方法治愈,3例行残留腺体切除后症状逐渐缓解,另外1例因后尿道瘢痕较多,于尿道内行冷刀切开后复发,其余后尿道狭窄患者疗效满意.膀胱颈口处狭窄的2例患者,行膀胱颈口冷刀切开及瘢痕切除后治愈.术后23例患者最大尿流率19~29 ml/s,平均24.4 ml/s.结论 尿道狭窄是TULIP术后常见的并发症,其发生与尿路感染、操作损伤、术后留置尿管过粗、置管时间过长、腺体残留等因素密切相关.     

前列腺电切术后尿道狭窄原因分析及治疗

经尿道前列腺电切术是治疗良性前列腺增生的首选手术方法,但前列腺电切术后尿道狭窄发生率较高,给老年患者带来了巨大痛苦。本文将就经尿道前列腺电切术后尿道狭窄发生原因、预防及治疗措施进行综述。经尿道前列腺电切术后尿道狭窄发生的主要原因有膀胱镜鞘过粗、手术操作暴力、手术切除速率慢、电流返流灼伤、尿路感染等。目前最佳治疗方式仍有许多争议,手术治疗方式主要包括尿道扩张术(金属探条尿道扩张术、高压球囊尿道扩张术等)、腔内尿道狭窄内切开术(钬激光、冷刀尿道狭窄内切开等)、尿道成形术(口腔黏膜、膀胱黏膜、阴茎皮瓣、组织工程移植物)等。     

The role of internal urethrotomy in the prevention of urethral stricture following transurethral resection of prostate.

Urethral stricture is the commonest late complication of transurethral prostatectomy. Although internal urethrotomy is widely practised to prevent structures, there are no reports of any controlled trials of the procedure. A prospective trial of internal urethrotomy, using the Otis urethrotome, in 210 consecutive transurethral prostatectomies is presented. Patients were divided into 2 groups, those undergoing urethrotomy before TUR ("Trial group") and those undergoing TUR without urethrotomy ("Control group"), and they were followed for a minimum of 6 months. The incidence of stricture in the control group was significantly greater than in the trial group (P less than 0.01). Analysis of all other variables revealed no difference between the 2 groups and it is concluded that internal urethrotomy does prevent stricture formation and that it should be undertaken routinely before transurethral resection.     

经尿道前列腺电切与双极等离子电切对前列腺电切术后尿道狭窄的影响

目的研究经尿道前列腺电切术（TURP）和双极等离子电切术（PKRP）治疗前列腺增生（BPH）与术后尿道狭窄的关系。方法对59例接受TURP患者,36例接受PKRP患者的临床资料进行回顾性研究,分析手术时间、术后冲洗时间、留置尿管时间、术后住院时间、术后6个月尿常规白细胞数等指标与相应的尿道狭窄发生率的关系。结果术前两组一般情况比较无统计学差异（P〉0.05）;手术时间、术后冲洗时间、留置尿管时间、术后住院时间、术后6个月尿常规白细胞数,PKRP组明显优于TURP组（P〈0.05）。术后6个月中,TURP组有10例发生尿道狭窄（16.9%）,而PKRP组则仅为1例（2.8%）（P〈0.05）。Logistic回归分析,TURP组术后留置尿管时间是影响尿道狭窄的主要危险因素,PKRP组各指标对尿道狭窄的发生无明显差异。结论 TURP术后留置尿管时间是导致尿道狭窄的主要因素。PKRP术后尿道狭窄发生率明显低于TURP,有良好的应用前景。     

The importance of internal urethrotomy a. m. Otis for the incidence of urethral stricture following transurethral prostatectomy

The most frequent late postoperative complication of transurethral prostatectomy (TURP) is the formation of urethral stricture. Several studies indicate that the number of strictures can be reduced by performing internal urethrotomy a.m. Otis just before TURP. We compared the incidence of urethral stricture in 218 patients, who in 1982 had TURP without preceding internal urethrotomy a.m. Otis as against 183 patients, who in 1983 had TURP with preceding internal urethrotomy a.m. Otis. In 1982 (−Otis group) the incidence of urethral stricture was 7.3%, and in 1983 (+Otis group) it was 4.4%. This difference is not significant, but the tendency and results from other studies make us recommend the method until a larger controlled trial has been performed.     

间歇自我尿道扩张治疗TURP术后尿道狭窄患者的护理

目的探讨间歇自我尿道扩张术在经尿道前列腺电切术(TURP)术后尿道狭窄患者中的应用效果及护理要点。方法对23例TURP术后尿道狭窄患者行间歇自我尿道扩张术治疗,第1周2次/d,第2~4周1次/d,第5~8周2次/周,第9~12周1次/周。观察患者尿路感染等并发症。比较患者治疗前后最大尿流率、生活质量评分和尿白细胞计数等。结果 23例患者,随访时间1~24个月,其中2例(8.7%)在随访1个月内发生尿路感染,经口服抗生素后痊愈。治疗后患者最大尿流率和生活质量评分显著高于治疗前(均P0.01);治疗前后尿白细胞计数差异无统计学意义(P0.05)。结论间歇自我尿道扩张技术用于治疗TURP术后尿道狭窄安全、简便,短期临床效果满意。随访过程中注重操作技巧培训,预防并发症发生、督导完成疗程是保证治疗护理效果的关键。     

Intraurethral brachytherapy for prevention of recurrent urethral stricture after internal urethrotomy or transurethral resection of scar.

BACKGROUND PURPOSE: Restricture after internal urethrotomy is the major limitation to the long-term success of the procedure. The objective of this study was to evaluate the effect of intraurethral brachytherapy after internal urethrotomy or transurethral scar resection on recurrent urethral stricture. PATIENTS AND METHODS: From January 1998 to June 1999, catheter-based intraurethral brachytherapy with 192-iridium was performed in 17 patients with recurrent urethral stricture to prevent restricture after internal urethrotomy or transurethral resection of scar. The radiation was repeated within 3 days after surgery to reach a total dosage of 1000 to 1500 cGy. RESULTS: During the follow-up (range 14-27 months; mean 20 months), two patients had dysuria, including one patient with an atonic detrusor muscle. The other patient needed self-dilation. Fifteen patients presented normal voiding. The stricture recurred 3 months later in only one patient, so the restricture rate is 7%. No significant complication was observed associated with brachytherapy during the follow-up. CONCLUSION: Intraurethral brachytherapy after internal urethrotomy or transurethral resection of scar is a safe and effective treatment for recurrent urethral strictures.     

铥激光前列腺汽化切除术与传统经尿道前列腺电切术疗效比较及术后尿道狭窄相关因素分析

目的:比较铥激光前列腺汽化切除术与经尿道前列腺电切术(TURP)术疗效及术后尿道狭窄相关因素分析。方法:收集2015年6月至2016年6月我院接受手术治疗的BPH患者210例,分为TURP组(n=126)和铥激光组(n=84),分别应用TURP和铥激光治疗,对比两种术式的治疗效果;术后随访半年,应用Logistic回归分析术后半年发生尿道狭窄的危险因素。结果:铥激光组患者的手术时间(53.2±21.6)min与TURP组患者(78.6±27.5)min相比明显缩短,术后膀胱冲洗时间(26.1±3.7)h与TURP组患者(31.5±2.9)h相比明显缩短,留置尿管时间(3.7±1.5)d与TURP组患者(5.3±1.7)d相比明显缩短,术后住院时间(5.5±1.4)d与TURP组患者(7.9±2.1)d相比也明显缩短,术后6个月尿白细胞铥激光组(24.9±11.7)个/μl较TURP组(32.1±12.6)个/μl更少,术后并发症发生率铥激光组(3.6%,3/84)较TURP组(11.9%,15/126)更低,其中尿道狭窄发生率铥激光组(1.2%,1/84)较TURP组(7.9%,10/126)明显更低,差异有统计学意义(P0.05);Logistic回归分析显示术前尿白细胞数、术后留置尿管时间、手术方式是术后尿道狭窄的独立危险因素。结论:铥激光手术相比TURP,疗效确切,术后恢复快,安全性高,术后尿道狭窄发生率低,术后尿道狭窄的主要风险因素有尿路感染、术后留置尿管时间及手术方式,应注意选择最佳术式、术后合理置管及预防尿道感染,从而减少尿道狭窄的发生。     

Rotoresection versus transurethral resection of the prostate: short-term evaluation of a prospective randomized study

PURPOSE: We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate. MATERIALS AND METHODS: A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean+/-SD patient age was 60.76+/-5.85 years in the rotoresection and 64.24+/-6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer's grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis. RESULTS: At 6 months International Prostate Symptom Score decreased from 26.2+/-4.06 to 5.32+/-1.52 in the rotoresection group and from 22.84+/-4.56 to 7+/-1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87+/-2.24 to 25.29+/-10.39 ml per second in the rotoresection group and from 9.44+/-2.29 to 25.2+/-5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2+/-16.58 to 17.24+/-7.61 ml in the rotoresection group and from 40.6+/-16.93 to 18.28+/-8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84+/-26.8 cm H2O and 4.24+/-0.97 to 38.8+/-18.8 cm H2O and 1.24+/-0.93 in the rotoresection group, and from 63.04+/-21.08 cm H2O and 3.48+/-0.65 to 34.16+/-12.7 cm H2O and 1+/-0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p=0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group. CONCLUSIONS: Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.     

Transurethral resection versus transurethral incision of the prostate. A prospective randomized study

In this ongoing study, patients with an estimated prostate size of no more than 20 gm are randomized to undergo either transurethral resection of the prostate (TURP) or transurethral incision (TUIP) at the 6 o'clock position. To date, 93 patients have been included, and 3 months postoperatively, 80 to 90 per cent of the patients in each group reported improvement. There was also a significant decrease in symptom scores and a significant increase in maximum urinary flow rate, with great variation within each group but without difference between the groups. In both groups, there appears to be some deterioration over time. Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly in favor of TUIP. Loss of ejaculation was reported by 37 per cent of patients after TURP and by 13 per cent after TUIP (not statistically significant). There was no difference between the groups in the need for further surgery. Therefore, TUIP is recommended as an alternative to TURP in patients with small prostates.     

Development of urethral stricture after transurethral prostatectomy: A retrospective study

A total of 103 patients who were diagnosed to have benign prostatic hyperplasia (BPH) without preoperative urethral stricture and underwent transurethral prostatectomy (TURP) were evaluated retrospectively from patient charts. The incidence of urethral stricture development was calculated as 11.65% (12 out of 103 patients). Among the aetiologic factors analyzed, the most important ones appeared to be postoperative infection, age of the patient, duration of postoperative catheterization and histology of the disease, in the order of significance in the development of urethral stricture after TURP.     

Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial

OBJECTIVE: Thulium laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. To our knowledge we report the first prospective, randomized study comparing TmLRP-TT and standard TURP for symptomatic BPH. METHODS: From November 2004 to December 2005, 100 consecutive BPH patients were randomized for surgical treatment with TmLRP-TT (n=52) or TURP (n=48). All patients were preoperatively assessed with subjective symptoms score, International Index of Erectile Function questionnaire, and complete urodynamic evaluation. Preoperative and perioperative parameters at 1-, 6-, and 12-mo follow-up were also evaluated. All complications were recorded. RESULTS: TmLRP-TT was significantly superior to TURP in terms of catheterization time (45.7+/-25.8h vs. 87.4+/-33.8h, p<0.0001), hospital stay (115.1+/-25.5h vs. 161.1+/-33.8h, p<0.0001), and drop in hemoglobin (0.92+/-0.82 g/dl vs. 1.46+/-0.65 g/dl, p<0.001), whereas it required equivalent time to perform (46.3+/-16.2 vs. 50.4+/-20.7 min, p>0.05). TmLRP-TT and TURP resulted in a significant improvement from baseline in terms of subjective symptoms scoring and urodynamic finding, but no significant difference was found between the two groups. Late complications were also comparable. CONCLUSIONS: TmLRP-TT is an almost bloodless procedure with high efficacy and little perioperative morbidity. TmLRP-TT is superior to TURP in safety and is as efficacious as TURP in 1-yr follow-up. It is a promising technology in the clinical practice field.     

Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a randomized clinical trial

Objective

To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), for treatment of benign prostatic hyperplasia (BPH).

Methods

A total of 164 cases of BPH were selected from patients who were hospitalized between January 2010 and December 2011. Patients had received either HoLEP or TURP treatment. Clinical data were collected from the perioperative period, 1 month after surgery, and 12 months after surgery.

Results

There was no significant difference between the two groups in the maximum urinary flow rate (Q _max), postvoid residual volume (PVR), international prostate symptom score (IPSS), or quality-of-life score (QOL score) at 1 month after surgery (p = 0.56, p = 0.346, p = 0.536 and p = 0.145, respectively). However, after 12 months, patients from the HoLEP group demonstrated better scores in Q _max, PVR, IPSS, and QOL than those from the TURP group (p = 0.037, p = 0.003, p < 0.001 and p = 0.019, respectively). The two groups had comparable operation time (p = 0.105), catheterization time (p = 0.173), and length of hospital stay (p = 0.395), but were statistically different in the weight of resected prostate tissue (p < 0.001), bladder irrigation time (p < 0.001), hemoglobin levels (p = 0.011), and blood sodium levels (p = 0.002) after surgery.

Conclusions

Compared to TURP, HoLEP was safer and had better long-term efficacy as assessed by multiple quantitative measures. Therefore, HoLEP may present a better option in the treatment of BPH.     

Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: a randomized study

Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).     

Pelvic floor muscle training before transurethral resection of the prostate: a randomized, controlled, blinded study

OBJECTIVE To evaluate the effect of preoperative pelvic floor muscle training (PFMT) in men scheduled for transurethral resection of the prostate (TURP) in a randomized, single-blind study. MATERIAL AND METHODS: Fifty-eight men with benign prostatic obstruction were included, and 49 completed the study (training group, n=26; control group, n=23). The preoperative training included a 1-h individual lesson, three 1-h group lessons and a home training programme. Postoperatively and before discharge from hospital both groups received verbal instructions regarding PFMT. Pelvic floor muscle function was assessed by anal examination before and 4 weeks after surgery by one physiotherapist who was blinded to the randomization. The primary outcome parameter was the total score on the Danish Prostatic Symptom Score questionnaire. Secondary outcome measures were other subjective and objective voiding and incontinence parameters and four tests of the pelvic floor muscle: function; strength; static endurance; and dynamic endurance. RESULTS: Baseline characteristics were similar in the two groups. Improved static endurance occurred in the training group but not in the control group (p=0.004). Regarding dynamic endurance, a difference in favour of training developed between the groups (p=0.049). Many men produced results that were outside the test scales. At follow-up at 2 and 4 weeks and 3 months there were no differences between the groups in any of the lower urinary tract parameters. CONCLUSIONS: Preoperative PFMT produced a significant improvement in pelvic floor muscle endurance after TURP, but clinically relevant storage or voiding improvements did not occur. Pelvic floor muscle assessment tests need to be sex-specific.