Transurethral Resection of the Prostate

For decades, transurethral resection of the prostate (TURP) has been the gold-standard therapy for severe benign prostatic obstruction (BPO). Diagnostic work-up and indications for TURP should follow the European Association of Urology benign prostatic hyperplasia guidelines. Pressure flow studies are not indicated as a routine diagnostic procedure but are highly recommended under certain conditions (eg, unsuccessful TURP, young age, previous pelvic surgery). Various technical improvements such as video-TURP, continuous-flow instruments, and bipolar TURP have substantially decreased the mortality and morbidity of TURP today. In the bipolar transurethral resection era, bleeding remains the most significant intra- and perioperative complication. The short-term and, particularly, long-term efficacy of TURP is unsurpassed, as documented by substantial improvements in symptoms, maximum flow rate, and postvoid residual volume. The retreatment rate of TURP is in the range of 8–12% within a decade after primary surgery, a value reached by many minimally invasive procedures as early as within 1–2 yr. Despite an intense 20 yr of research for a minimally invasive alternative, TURP still is and will most likely remain the reference standard for the surgical management of severe BPO.     

Erectile Dysfunction Following Transurethral Resection of the Prostate

Purpose

We objectively measured the incidence of erectile dysfunction following transurethral resection of the prostate.

Materials and Methods

A total of 56 men completed a questionnaire detailing perceived sexual dysfunction, and underwent nocturnal penile tumescence testing for 3 nights before transurethral resection of the prostate and again at 3 months postoperatively.

Results

Complete data were available for 40 men. No significant difference was found in penile tumescence, number of erectile events and duration of events before and after surgery. Preoperative and postoperative rigidity was statistically different, with a slight improvement after transurethral resection of the prostate (p less than 0.05). A subjective decrease in quality of erection after transurethral resection of the prostate was reported in 27.5 percent of the patients. However, on further questioning, 63.6 percent of these patients equated retrograde ejaculation with decreased potency.

Conclusions

We demonstrated no decrease in objective parameters of erectile function studies following transurethral resection of the prostate. Previous estimates of impotence after transurethral prostatectomy may have been tainted by subjective patient reports equating retrograde ejaculation with erectile dysfunction.     

前列腺增生经尿道汽化切割与电切术的疗效比较

目的 :比较经尿道前列腺汽化切割 (TUVP)与电切术 (TURP)治疗良性前列腺增生 (BPH)病人的疗效。　方法 :2 0 6例BPH病人 (术前估计前列腺重量≤ 6 0 g)被随机分成TUVP(97例 )和TURP(10 9例 ) 2组 ,对病人进行为期 12～ 34(平均 2 0 )个月的随访。　结果 :2组术后第 12、2 4个月国际前列腺症状评分 (I PSS)均较术前下降 (P<0 .0 1) ,膀胱残余尿 (PVR)均较术前减少 (P <0 .0 1) ,最大尿流率 (Qmax)均较术前升高 (P <0 .0 1)。　结论 :TUVP和TURP对增生≤ 6 0g的BPH病人均有良好的治疗作用。TUVP较TURP能缩短手术时间和术后置管时间     

The Diminishing Role of Transurethral Resection of the Prostate

Background  

This study provides an update of patterns in transurethral resection of the prostate (TURP) rates in the United States and the extent of TURP-detected prostate cancer incidence rates.     

Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate

Purpose of Review

Transurethral resection of the prostate (TURP) is the standard surgical therapy for lower urinary tract symptoms (LUTS) due to prostatic enlargement. Following TURP, LUTS may persist in a proportion of patients. Persistent LUTS necessitates proper evaluation and management. In this review, we sought to describe the prevalence, pathophysiology, and predictors of LUTS following TURP, as well as the recommended evaluation and management.

Recent Findings

Among the different techniques utilized for TURP, the prevalence of postoperative LUTS is similar. The chronically obstructed bladder has been shown to vary in its expression of collagen, tissue factors, and receptors when compared to the normal bladder which could contribute to the pathophysiology of LUTS after TURP. Although androgen receptors exist in the urinary epithelium, the role of sex hormones in LUTS remains obscure. GreenLight laser can lead to postoperative irritative voiding symptoms as a result of tissue necrosis.

Summary

A large proportion of patients have persistent LUTS following TURP, with similar incidences between different techniques that can be used to perform TURP. LUTS after TURP should be evaluated with a thorough history and physical, including International Prostate Symptom Score, and urine culture to rule out infection. Noninvasive uroflow, post-void residuals, and subsequent urodynamic study or cystoscopy can be utilized as needed. Further research is necessary to be able to more precisely predict the patients who will experience no improvement in or worsening of LUTS following TURP.

     

Results of Transurethral Resection Plus Adjuvant Intravesical Chemotherapy for Superficial Bladder Cancer

Background : We analyzed the results of conservative therapy for superficial bladder cancer to determine the risk factors for recurrence and progression.
Methods : Between May 1984 and February 1997, 111 patients with primary superficial bladder cancer were treated by a transurethral resection with or without intravesical instillation of chemotherapy, or for patients with concomitant carcinoma in situ (CIS), bacillus Calmette-Guerin. We examined the relationship between tumor stage, grade, incidence of concomitant CIS and recurrence-free survival according to pathologic findings and the drugs instilled.
Results : The incidence of concomitant CIS in pTI, grade 3 tumors was significantly higher than that in pTa, grade 1 tumors (42% vs. 3%, P= 0.006). The 5-year recurrence-free survival rate of all patients was 73%. There was no significant difference in recurrence-free survival and pathologic stage, tumor grade, presence of concomitant CIS, or drugs used for instillation. However, the recurrence-free survival in patients with 5 tumors was significantly lower than in patients with less than 5 tumors. Of the 111 patients, only 3 patients demonstrated disease progression and underwent a radical cystectomy, while 1 patient with a pTI b, grade 3 tumor developed a tumor in the ureter. No patient died of bladder cancer.
Conclusion : Our results indicate that the prognosis of superficial bladder cancer patients with a high-stage, high-grade (pTI, grade 3) tumor is favorable when treated by a transurethral resection and intravesical instillation. Bacillus Calmette-Guerin therapy is useful to prevent the recurrence of tumors with concomitant CIS.     

Ejaculatory Duct Obstruction after Transurethral Resection of the Prostate

Transurethral resection of the prostate is currently the most commonly employed surgical procedure for benign prostatic hyperplasia. Although several complications after the procedure have been well documented, ejaculatory duct obstruction is a rare complication. We describe this unusual complication in a 77-year-old male who presented with severe pain and a feeling of fullness in the lower abdomen and with dry ejaculate on three occasions after undergoing post-transurethral resection of the prostate. The patient’s post-ejaculatory urinalysis demonstrated no sperm. Transrectal ultrasonography also showed no dilatation of the bilateral seminal vesicles or ejaculatory ducts. However, ejaculatory duct obstruction was finally diagnosed on vasovesiculography. The patient was successfully treated with transurethral resection of the ejaculatory duct and remained asymptomatic 6 months postoperatively. Although transrectal ultrasonography is currently widely used to evaluate ejaculatory duct obstruction, we suggest that vasovesiculo-graphy is still a feasible and useful tool that provides detailed anatomic information for the advanced confirmation of ejaculatory duct obstruction in patients with a high suspicion of ejaculatory duct obstruction who have normal transrectal ultrasonography findings.     

经尿道前列腺电切术后尿失禁原因的尿流动力学分析

目的 :探讨尿流动力学检查在诊断经尿道前列腺电切术 (TURP)后尿失禁中的作用。　方法 :37例TURP术后尿失禁患者接受了尿流动力学检查 ,包括膀胱压力容积测定 (CMG)、压力 流率分析、静态尿道压力描计(RUPP)及应力性漏点压 (SLPP)测定 ,必要时结合膀胱尿道造影。　结果 :16例患者诊断为运动急迫性尿失禁 ,2例诊断为感觉急迫性尿失禁 ,17例诊断为压力性尿失禁 ,2例诊断为充溢性尿失禁。　结论 :通过尿流动力学能够准确判断TURP术后尿失禁类型 ,从而为选择正确的治疗方法提供客观依据     

经尿道前列腺电切术后出血再手术原因分析及防治

目的探讨经尿道前列腺电切术后出血的原因及预防措施。方法回顾分析2002年1月至2011年5月本院74例经尿道前列腺电切术后大出血的临床资料。结果其中43例经保守治疗有效,31例术后出血比较严重,行再次手术止血,发现膀胱颈口出血6例,前列腺窝出血25例;动脉出血23例,静脉出血7例,创面广泛渗血1例。经再次手术以及术后适当的措施治疗,均未再出血。结论经尿道前列腺电切术后出血原因是多方面的,术前、术中、术后及时准确处理是减少术后出血的关键。     

Testing to Predict Outcome After Transurethral Resection of the Prostate

Purpose

We assessed the ability of routine clinical tests to predict outcome following transurethral resection of the prostate.

Materials and Methods

A total of 556 men randomized into a trial of surgery versus watchful waiting was evaluated preoperatively with symptom interview, quality of life assessment, uroflowmetry, urinalysis, standard chemistry panel, post-void residual urine determination and cystoscopy. The ability to predict avoidance of postoperative complications, and improvement in quality of life and genitourinary symptoms was assessed in the 249 men randomized to undergo transurethral resection of the prostate.

Results

Patients with the highest symptom scores were most likely to have symptom improvement and those most bothered by the symptoms were most likely to have improvement in quality of life. No objective tests measuring physiological parameters made clinically significant contributions toward predicting these outcomes. Lower obstructive symptom scores and larger perioperative infusions of intravenous fluids were associated with a greater chance of complications.

Conclusions

Symptom analysis and quality of life assessment are most useful in selecting patients for transurethral resection of the prostate. Objective diagnostic tests are of limited additional benefit.     

经尿道前列腺剜除术与电切术疗效比较

目的:探讨普通电切镜下经尿道前列腺剜除术与电切术的疗效.方法:对75例前列腺生患者行经尿道前列腺剜除术治疗(TUEP组),110例经尿道前列腺电切术治疗(TURP组).结果:TUEP组术中出血量(前列腺重量<0 g)、手术时间均明显少于TURP组(P<0.05),增生腺体切除重量明显高于TURP组(P<0.05).术后12个月,最大尿流率、国际前列腺症状评分,生活质量评分等组间比较差异无统计学意义(P>0.05).结论:TUEP术与TURP术相比较,TUEP手术安全性更好,术中出血量少(前列腺重量<0 g)手术时间快、切除增生腺体更彻底.     

经尿道等离子前列腺剜除术和电切术治疗前列腺增生症的比较

目的比较经尿道等离子前列腺剜除术和电切术的疗效。方法2003年10月~2006年7月,在127例前列腺增生症患者中,计算机随机数字法分组。1例神经源性膀胱患者,3例剜除术失败的患者退出试验。62例行经尿道等离子前列腺剜除术,61例行经尿道等离子前列腺电切术。比较手术腺体切除量、手术时间、术中出血量。结果剜除组术中出血少[(78.5±46.2)ml vs(115.0±43.5)ml,t=4.511,P=0.000],切除腺体多[(60.5±29.3)g vs(45.9±30.5)g,t=2.709,P=0.008]。两组手术时间相近[(93.4±35.5)min vs(81.3±46.3)min,t=1.629,P=0.106]。术后3个月前列腺症状评分、生活质量指数、最大尿流率、残余尿量以及并发症发生率(2/61 vs 5/62)差异无显著性。结论治疗前列腺增生症,经尿道等离子前列腺剜除术和电切术比较,剜除术腺体切除更彻底、出血少。     

经尿道前列腺电切术后膀胱颈挛缩多因素分析

目的 :对经尿道前列腺电切术 (TURP)后膀胱颈挛缩 (BNC)发生的各种可能因素进行分析 ,探讨减少该并发症的途径。　方法 :对 10 17例行TURP患者中发生BNC的 2 4例进行统计学分析 ,在手术方法、前列腺电切重量、单位时间前列腺组织电切重量、置管时间、高频发生器类型及有无糖尿病、尿潴留及前列腺炎等方面进行比较 ,了解其可能发生的因素。　结果 :TURP术后BNC发生率明显高于开放手术病例 ,小前列腺、单位电切时间长、高频发生器功率大及术前前列腺炎患者易发生BNC(P <0 .0 5 ) ,而术前尿潴留、糖尿病及术后置管时间对BNC发生无明显影响 (P >0 .0 5 )。　结论 :小前列腺、前列腺炎及电流损伤是发生BNC的重要因素 ,患者的选择及熟练精确的电切技术可减少BNC的发生。     

经尿道前列腺电切术后的治疗

目的 总结经尿道前列腺电切(TURP)术后治疗经验.方法 328例TURP患者分成2组,A组126例术后给予杜冷丁50mg或曲马多100mg肌注,B组202例术后留置尿管期口服盐酸特托罗定2mg,1次/d,肛纳消炎痛栓,3次/d,共3～5d.拔管后口服盐酸坦索罗辛0.2mg,1次/d和尿道灌药(阿米卡星2支加2%利多卡...     

经尿道前列腺电切术后发生膀胱颈挛缩的多因素分析

目的 对经尿道电切术(TURP)后发生膀胱颈挛缩(BNC)的可能因素进行分析,探讨减少和预防该并发症的方法.方法 对1120例行TURP的患者中31例发生BNC的数据进行统计学分析,在前列腺体积、手术熟练程度、置尿管时间及有无术前尿潴留、前列腺炎、糖尿病等方面进行比较,了解其可能发生的因素.结果 BNC在小前列腺、单位电切时间长及合并前列腺炎的患者中发生率高(P＜0.05),而术前尿潴留、糖尿病对BNC发生无明显影响(P＞0.05).结论 前列腺体积小(＜30ml)、电流损伤及前列腺炎是发生BNC的重要因素.     

Benign Mimickers of Prostate Adenocarcinoma on Needle Biopsy and Transurethral Resection

Prostate needle biopsy currently is the gold standard method for the diagnosis, management, and prognosis of prostate cancer. Obtaining an accurate diagnosis is crucial for pursuing proper patient management. This article discusses histologic mimickers of prostate carcinoma highlighting microscopic features that are helpful to reach a correct diagnosis and emphasizing potential diagnostic pitfalls.