The role of repeat transurethral resection in stage A1 carcinoma of the prostate

Between 1983 and 1987 repeat transurethral resection (TUR) was performed in 20 patients with a diagnosis of stage A1 prostatic carcinoma. The average weight of the resected tissue in the repeat TUR was 8.81 g (range 3-20 g). In 5 of 20 cases (25%) residual prostatic cancer was identified. By adding the number of foci with cancer obtained at the initial operation with the repeat TUR, 16 cases (80%) remained as A1 and 4 cases (20%) were reclassified (upstaged) to A2. The usefulness of this technique in the restaging of patients with incidental carcinoma of the prostate is analyzed.     

Stop-flow measurement of detrusor contractility in bladder outflow obstruction

Detrusor contractility was evaluated by measuring the increase in isometric pressure during a stop test in 25 men with benign prostatic hyperplasia. Before transurethral prostatic resection (TUR), a low pressure increase (delta P det iso) was associated with a large volume of residual urine. After TUR both the speed and the amplitude of isometric detrusor contractions during the stop test increased. A pre-operative low detrusor pressure increase was correlated with a great improvement in flow rate after TUR. The value of the stop-flow test was limited, however, since improvement in other urodynamic parameters could not be predicted.     

非肌层浸润性膀胱癌合并良性前列腺增生患者同期行经尿道电切手术的疗效和安全性分析

目的 探讨合并BPH的非肌层浸润性膀胱癌患者同期行经尿道电切(TUR)手术的疗效和安全性.方法 合并BPH的非肌层浸润性膀胱癌患者46例(A组)同期行TURBt和TURP治疗,非肌层浸润性膀胱癌仅行TURBt的男性患者69例(B组)作为对照组.A组年龄54～80岁,平均69岁;肿瘤单发37例、多发9例,肿瘤直径0.5 ～3.5 cm,平均2.8 cm.B组55～82岁,平均70岁;肿瘤单发54例、多发15例;肿瘤直径0.5～24.0 cm,平均2.9 cm;2组比较差异无统计学意义(P＞0.05).结果 2组均顺利完成手术.随访24 - 96个月,平均44个月.2组复发率分别为50.0％( 23/46)、50.7％ (35/69),首次无复发间期分别为20、18个月,肿瘤进展率分别为6.5％、7.2％,2组差异均无统计学意义(P＞0.05).A组术后发生前列腺窝内膀胱癌复发2例、B组l例,均为T1G3肿瘤.结论 同期行TUR手术治疗浅表性、低级别膀胱肿瘤合并BPH患者安全可行,但对于T1G3患者应慎重.     

Alterations in host responsiveness in patients with prostatic cancer following cryosurgery or transurethral resection.

Anesthesia, stress, trauma or the operation per se have been reported to result in alterations of host resistance in a wide range of diseases. The effect of such changes on the thymolymphatic system of patients with prostatic cancer is not known. While evaluating in vitro parameters of cellular immunologic responsiveness in patients with prostatic cancer, we have observed a depression two to seven days following cryosurgery or transurethral resection (TUR) of the proliferation of phytohemagglutinin (PHA)-stimulated peripheral blood lymphocytes (PBL). Contrary to the reduced proliferation of PBL cultured in autologous and homologous serum from patients receiving TUR, patients receiving cryosurgery, while also showing reduction in autologous serum, showed increased responsiveness when cultured in homologous serum. Although transient, depression of lymphocyte proliferation, particularly if involving tumor-cloned T-cells, may provide reduced surveillance to potential metastatic tumor cells leading to an alteration of tumor-host homeostasis. The potential of reduced surveillance, at least in the case of TUR, appears to be supported by observations that patients dying from prostatic cancer at our institution had an antecedent TUR. Identifying those patients with changes in responsiveness before surgery, as well as those prone to develop or undergo further reductions in responsiveness after surgery, would appear to be relevant in the management of patient with prostatic as well as other malignancies. Pre- and/or postoperative immunotherapy in such patients may be indicated.     

Can fine needle aspiration biopsy detect incidental prostatic carcinoma (T1) prior to TUR?

The purpose of this study was to find out whether randomly taken fine needle aspiration biopsy (FNA) can detect incidental prostatic carcinoma prior to transurethral resection (TUR) and what are the effects of local tumor stage and grade on detection rate. Biopsies were taken from 344 patients, who came to hospitals for elective TUR without clinical evidence of prostatic carcinoma. Histologic examination of the TUR material showed prostatic carcinoma in 49 cases (14%). Sufficient material for cytologic examination was found in 343 cases. Of the 16 cases of T1a carcinoma in histologic examination, cytology found only 1, which was a G3 carcinoma. Of 33 T1b carcinoma in histologic examination, cytology found 6 and an additional 7 were suspect findings. Out of 6 G3 tumors in histologic examination, cytology showed 4. In our hands the proportion of false-negative cytologic findings in randomly taken FNA was so large that routine use of random FNA prior to TUR or as a screening procedure cannot be recommended, but positive FNA finding can be regarded as cancer.     

Blood loss during and following transurethral resection

Blood loss measurement in transurethral prostatic surgery (TUR) has been studied with the following objectives: (1) to measure the total lost volume (during surgery and 48 hours postoperatively); (2) to compare surgical bleeding and coagulogram alterations in benign prostatic hypertrophy (BPH) and prostatic carcinoma (CaP); (3) to establish the relationship between blood loss, duration of the procedure, and amount of resected tissue. The method of Jansen was used to measure blood loss, and the "coagulogram" included the following parameters: hematrocrit; prothrombin, recalcification, thrombin, and partial thromboplastin times; fibrinogen; platelets and fibrin split products. The study is based on TUR performed on 75 patients from whom a mean weight of 25.68 grams was resected resulting in a mean total bleeding volume of 305 ml. Blood loss over 400 ml was associated with surgical durations of 60 minutes or with resection of over 40 grams of tissue. There was a slight tendency for fibrinolysis in prostatic cancer, which could explain the relatively higher amount of blood loss observed in these cases.     

Metastasis of the epididymis disclosing cancer of the prostate. Apropos of a case

The authors present a patient who had prostatic carcinoma metastatic to the epididymis. The patient was asymptomatic except for painless swelling in the right epididymis. The laboratory radiographic and physical examination of the patient were normal. The prostate was clearly demarcated, homogeneous and solid. Surgery was performed in two stages. In the first stage semi-castration was performed. Histopathological analysis of the biopsy material showed prostatic carcinoma metastatic to the epididymis. There were no metastases in the testis. In the second stage, TUR of the prostate was performed. To our knowledge prostatic carcinoma metastatic to the epididymis has not been described previously.     

Clinical statistics on inpatients and operations at the Department of Urology, the Center for Adult Diseases, Osaka, 1984-1988

Statistical observation on inpatients and operations at our department between January 1984 and December 1988 revealed the following results: 1) The total number of inpatients was 1962 (male: 1658, female: 304). The most frequent diseases were bladder cancer (30.0%), benign prostatic hypertrophy (19.2%), prostatic cancer (10.6%) and renal cancer (6.7%). 2) The total number of operations was 1699. The most frequent operations were transurethral resection (TUR) of bladder tumor (22.8%), TUR prostate (20.7%), TUR biopsy (6.5%) and total cystectomy (5.4%).     

前列腺脓肿外科处理的系统评价

目的：系统评价近10年前列腺脓肿诊治,为临床提供参考。方法：检索PubMed2000．0l～2011．04前列腺脓肿诊治文献,纳入合格文献,系统评价其外科处理。结果：病例数≥5例16个研究纳入行定量荟萃分析,均为回顾性病例分析,研究质量低。总计311例（5～77）患者,年龄分布10天～83岁,发病低龄化。病原体包括真菌、细菌两类,后者以G＋球菌（葡萄球菌属）为主,次为p杆菌（克雷伯菌属）,少见病原体亦有发病．地区差异明显。易感因素概括为局部与全身因素两类,分别以糖尿病、肝硬化与下尿路操作、尿路感染最常见。诊断涉及症状评估、体格检查、病原体鉴定、影像学检查（TRUS、骨盆CT、MRI）等。治疗包括一般处理、抗生素疗法与外科引流。手术径路有经皮经会阴、经直肠与经尿道。经会阴／经直肠行EUS、TRUS或c’F引导下细针穿刺抽吸、留置导管引流或切开引流;经尿道行TUR、TURP或TuIP引流;穿刺抽吸失败转为经尿道或经会阴切开引流;部分病例行尿流改道。无对比研究而未能比较何种术式更优。除死于严重并发症外,均结局良好。结论：应基于临床评估,结合TRUS／盆腔CT与实验室检查确诊前列腺脓肿。抗生素使用宦有病原学依据。视具体情况个体化处理：保守治疗;EUS、TRUS或CT引导下穿刺抽吸、留置导管引流;经尿道微创引流;若脓肿穿破前列腺包膜或肛提肌宜经会阴切开引流。外科引流以“准确、彻底、无残留”为原则。术后应密切随访。     

Transrectal longitudinal ultrasonography of prostatic abscess

A definite diagnosis of prostatic abscess sometimes is difficult to make. We report 2 cases of prostatic abscess diagnosed with the aid of transrectal longitudinal ultrasonography by electronic linear scanning. Transperineal aspiration of the abscesses was performed easily and correctly with this echographic technique.     

“TUR syndrome” after transurethral resection of the prostate using suprapubic drainage

In a retrospective study of 522 consecutive patients who were subjected to transurethral resection of the prostate with suprapubic trocar technique, six patients were suspected of having transurethral prostatic resection syndrome. The majority of the transurethral resections were performed by surgical or urological trainees. Only two patients fulfilled the criterion for TUR syndrome caused by absorption of irrigating fluid and defined as an electrolyte dilution corresponding to a plasma sodium level below 120 mmol/l. In the present paper the symptomatology and treatment of TUR syndrome are outlined with reference to the literature. The trocar technique clearly has minimized the risk of TUR syndrome, which emphasizes the value of the method.     

Papillary adenocarcinoma of the prostate: report of 3 cases

We report here 3 cases of papillary adenocarcinoma of the prostate. In all 3 cases, the tumors were discernible on cystourethroscopy and transurethral biopsy established the diagnosis, whereas no significant finding was found on digital rectal examination. Although androgen deprivation therapy was administered in all cases, different surgical procedures were employed according to the stage in each case. In case 1, since the papillary tumor was confined within the prostatic urethra, complete resection was accomplished by transurethral resection (TUR). In case 2, since pelvic lymph nodes metastases were found, local radiation therapy was added. In case 3, since the patient had vesical invasion of tumor total cysto-prostatectomy was performed. Papillary adenocarcinoma of the prostate originates from the prostatic duct, resulting in existence at the "central portion" of the prostate gland. Cystourethroscopy and transurethral biopsy is helpful for diagnosis of this disease, whereas rectal digital examination is useless. As a surgical procedure for the primary site, TUR may be efficient for tumors confined within the prostatic urethra, although more extensive surgery may be necessary for those with a more invasive profile.     

Transurethral resection of the prostate in benign prostatic hypertrophy

Transurethral resection (TUR) is generally accepted as the best treatment for benign prostatic hypertrophy. In spite of the improvement of instruments in recent years, TUR requires skill and experience to be mastered. The irrigating fluid system, operating table and chair, and other equipment in our clinic are reported. These instruments are important to carry out smooth TUR. We use the Stern-McCarthy resectoscope in our clinic, because we prefer a finger-controlled instrument to a spring-cutting instrument. The outline of our technique for TURP and results of 314 clinical cases are reported.     

Microwave surgical treatment of the prostate: clinical application of microwave surgery as a tool for improved prostatic electroresection

Microwave surgery as a tool for improved prostatic electroresection is introduced. Prior to electroresection the prostate was coagulated with 2,450 MHz of microwave which was emitted from the bipolar electrode of a specially designed probe. We conducted a comparative study of 35 patients with bladder neck obstruction. There was a microwave coagulation group treated with subsequent transurethral resection (TUR) and a conventional TUR group. Both groups were analyzed for the amount of blood loss, irrigant absorption and the frequency of complications. Both during and following surgery, the former group had a significant reduction in blood loss and had no complications. We conclude that the combination procedure of microwave coagulation and TUR can minimize the disadvantage of formal TUR and may be of value in the treatment of patients with both prostatic obstruction and of hemorrhagic diathesis as well as in high risk patients.     

Evaluation of cellular immunologic responsiveness in the clinical management of patients with prostatic cancer. II. Effect of oestrogen, cryosurgery and transurethral resection on thymic-dependent lymphocytic blastogenesis.

The effect of oestrogen, cryosurgery and transurethral resection (TUR) of the prostate on the blastogenic response of thymic-dependent peripheral blood lymphocytes (PBL) to the non-specific mitogen, phytohaemagglutinin (PHA) was evaluated as one in vitro criteria of each of these treatment modalities on the cellular immunologic responsiveness of 24 patients with prostatic cancer. A depression 5 days following receipt of oestrogen and 2-7 days following cryosurgery or TUR of the responsiveness of PHA-stimulated PBL was observed. Oestrogen-induced aberrations of responsiveness may not only be of relevance in prostatic cancer patients, but also suggested association between uterine cancer and prolonged administration of diethylstilboesterol and the development of vaginal tumours in offspring found in association with maternal ingestion during pregnancy. Particularly striking was that contrary to the reduced responsiveness of PBL cultured in autologous and homologous serum from patients receiving TUR, patients receiving cryosurgery, while also showing reduction in autologous serum, showed increased responsiveness when cultured in homologous serum. Although transient, depression of lymphocyte responsiveness, particularly if involving tumour-cloned T cells, may provide reduced surveillance to potential tumour cells leading to an alteration of tumour-host homeostasis. The potential of reduced tumour surveillance at least in the case of TUR, appears to be supported by observations that patients expiring from prostatic cancer at our institution had an antecedent TUR. The possibility of identifying those patients possessing aberrations of responsiveness prior to therapy, as well as those prone to develop or undergo further reduction in their responsiveness following the presently evaluated treatment modalities would appear to be of real and relevant concern in the management of the patient with prostatic, as well as other types of malignant neoplasms. The possibility of pre-operative and/or post-operative immunotherapy in such patients may be indicated pending further study.     

Clinical evaluation of surgical treatment for benign prostatic hypertrophy

Prostatectomy was performed on 300 patients at our Hospital for the period of 5 years from January 1978 to December 1982. Among those cases, clinical evaluation was made on 290 patients whose medical records were available. Ages of the subjects ranged from 53 to 92 years with an average age at 71.6. Retropubic prostatectomy (RPP) was performed on 81 cases, and suprapubic prostatectomy (SPP) and transurethral resection of prostate (TUR) on 39 and 170 cases, respectively. Surgery was made on 206 cases under epidural anesthesia, 82 cases under spinal anesthesia, and 2 cases under general anesthesia. Preoperative laboratory tests showed abnormalities in 62% of the total. The most frequent preoperative complications were circulatory abnormality and urinary tract infection. Average surgical time was 78.6 min. for RPP, 69.8 min. for SPP, and 76.9 min. for TUR. Average blood volume transfused during operation was 446.3 ml for RPP, 430.8 ml for SPP, and 80.7 ml for TUR. Average period of catheter retention after surgery was 9.2 days for RPP, 10.1 days for SPP, and 4.9 days for TUR. Average postoperative admission period was 18.6 days for RPP, 20.6 days for SPP, and 14.1 days for TUR. Average weight of the isolated adenoma was 41.8 g for RPP, 30.2 g for SPP, 11.5 g for TUR. Postoperative complications such as epididymitis, traumatic infection, and hepatic dysfunction were often found. Latent prostatic carcinoma found in the isolated adenoma was found in 11 cases (3.8%). The presence of anomalies in preoperative laboratory findings did not influence the frequency of postoperative complications.     

Stricture prophylaxis in transurethral prostatectomy

In a prospective study 317 patients with prostatic hypertrophy, admitted for transurethral prostatectomy (TUR P), were randomized into three different groups: (1) urethral dilation and TUR P; (2) urethrotomy according to Otis and TUR P, and (3) TUR P alone. The number of postoperative urethral strictures significantly decreased in the Otis group and significantly increased in the dilatation group as compared with the control group.     

气压弹道联合超声碎石术和经尿道前列腺汽化电切术治疗良性前列腺增生合并膀胱结石

目的探讨前列腺增生合并膀胱结石有效的治疗方法。方法采用瑞士EMS第3代超声/弹道碎石清石系统(LithoClast Master)和经尿道前列腺汽化电切术(transurethral resection of the prostate,TURP)治疗前列腺增生合并膀胱结石33例。结果33例均一次手术成功,碎石时间15~65min平均35min;前列腺电切时间50~110min,平均85min。术中术后均无输血,无电切综合征、膀胱穿孔、结石残留等并发症。术后5d拔除尿管,无排尿困难、尿失禁等。病理结果均为良性前列腺增生。术后3个月,国际前列腺症状评分由(23.4±5.2)分下降至(7.4±1.2)分(t=3.732,P=0.000),最大尿流率由(5.4±1.5)ml/s升至(18.6±3.2)ml/s(t=2.491,P=0.015),生活质量评分由(3.9±1.2)分降至(2.0±0.7)分(t=2.454,P=0.014)。结论瑞士EMS第3代超声/弹道碎石清石系统和经尿道前列腺汽化电切术能有效治疗良性前列腺增生合并膀胱结石。     

Transitional cell carcinoma in prostate after intravesical instillation of Bacillus Calmette-Guerin

We report 3 cases of prostatic involvement of transitional cell carcinomas (TCCs). All cases presented positive urinary cytology after intravesical instillation of Bacillus Calmette-Guerin (BCG) and then random biopsy of bladder and transurethral resection (TUR)-biopsy of prostatic urethra were performed. TUR-biopsy demonstrated TCC in the prostate, although random biopsy failed to detect tumors in the bladder in all cases. Case 1 was treated with cystourethrectomy with ileal conduit, case 2 was treated with cystourethrectomy with bilateral ureterocutaneostomy and case 3 was treated with cystectomy with orthotopic ileal neobladder reconstruction. All cases are alive with no evidence of disease. TUR-biopsy of prostatic urethra should be perfomed when patients present positive urinary cytology after BCG instillation therapy, because prostatic involvement of TCC associated with bladder carcinoma in situ is not rare.     

Urodynamics of the lower urinary tract in patients with prostatic adenoma and cancer before and after transurethral surgery

Combined urodynamic investigation, including uroflowmetry, cystomanometry and intraurethral pressure profile (IPP) assessment, was carried out in 25 patients with prostatic adenomas and carcinomas, selected to undergo transurethral electroresection (TUR). The same combined investigation was repeated 2 months after TUR in 14 of 25 patients. The study of lower urinary urodynamics made use of Diza-2100 (Denmark) measuring system, recording maximum and mean volumetric urinary flow rate, volume and duration of micturition. The quantity of residual urine was also determined; the bladder was filled with CO2 at the rate of 50 ml/min for retrograde cystomanometry. In IPP assessment, the rate of catheter removal from the bladder was 1 mm/sec, and the rate of gas perfusion was 10 ml/min. Post-TUR follow-up revealed an increase of volumetric micturition rate to normal values, a drop in maximum intravesical pressure, and a reduction of functional length of the urethra and its prostatic segment, demonstrating that TUR is a very effective method of treatment for prostatic adenomas and carcinomas, involving little injury, and that the examined parameters of lower urinary urodynamics are objective indicators of treatment efficiency.