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BACKGROUND: Benign prostatic hyperplasia (BPH) is a prevalent condition in aging males, leading to bladder outlet obstruction (BOO) and associated urinary symptoms. With increasing life expectancy, the incidence of BPH and its co-morbidities, like inguinal hernia, has risen. This study explores the efficacy of combining transurethral resection of the prostate (TURP) and inguinal hernioplasty in a single surgical session to address both conditions, potentially reducing the need for multiple hospitalizations and surgical interventions. METHODS: This retrospective study at Chi Mei Medical Center included patients from 2014 to 2023 who underwent concurrent TURP and inguinal hernioplasty. A total of 85 patients met the criteria defined for this study. Preoperative, intraoperative, and postoperative characteristics were meticulously documented. Outcomes evaluated included the duration of the surgery, incidence of intraoperative and postoperative complications, duration of Foley catheterization, length of hospital stay, and treatment efficacy. Additionally, we conducted a comparative assessment of the surgical outcomes between two distinct techniques for inguinal hernia repair: open hernioplasty and laparoscopic hernioplasty (LH). RESULTS: In 85 patients who met the criteria, the mean age was 71.1 ± 7.8 years. The study reported no significant intraoperative complications, and postoperative care was focused on monitoring for blood loss, infection, and managing pain. The average postoperative hospital stay was 2.9 ± 1.0 days and the mean duration of catheterization was 51.6 ± 16.7 h, with a minimal complication rate observed during the one-year follow-up. A significant reduction in both operative duration and catheterization interval was observed in patients undergoing LH as opposed to those receiving open hernioplasty. CONCLUSION: Concurrent TURP and inguinal hernioplasty effectively manage BOO due to BPH and inguinal hernias with minimal complications, suggesting a viable approach to reducing hospital stays and surgical interventions. Laparoscopic techniques, in particular, offer benefits in operative efficiency and recovery time, making combined surgery a feasible option for selected patients.

Asunto(s)

Hernia Inguinal , Herniorrafia , Hiperplasia Prostática , Resección Transuretral de la Próstata , Humanos , Masculino , Hernia Inguinal/cirugía , Estudios Retrospectivos , Anciano , Resección Transuretral de la Próstata/métodos , Herniorrafia/métodos , Hiperplasia Prostática/cirugía , Hiperplasia Prostática/complicaciones , Persona de Mediana Edad , Resultado del Tratamiento , Anciano de 80 o más Años , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología

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PURPOSE: Bladder outlet obstruction (BOO) is common in older adults. Many older adults who pursue surgery have additional vulnerabilities affecting surgical risk, including frailty. A clinical tool that builds on frailty to predict surgical outcomes for the spectrum of BOO procedures would be helpful to aid in surgical decision-making but does not currently exist. MATERIALS AND METHODS: Medicare beneficiaries undergoing BOO surgery from 2014 to 2016 were identified and analyzed using the Medicare MedPAR, Outpatient, and Carrier files. Eight different BOO surgery categories were created. Baseline frailty was calculated for each beneficiary using the Claims-Based Frailty Index (CFI). All 93 variables in the CFI and the 17 variables in the Charlson Comorbidity Index were individually entered into stepwise logistic regression models to determine variables most highly predictive of complications. Similar and duplicative variables were combined into categories. Calibration curves and tests of model fit, including C statistics, Brier scores, and Spiegelhalter P values, were calculated to ensure the prognostic accuracy for postoperative complications. RESULTS: In total, 212,543 beneficiaries were identified. Approximately 42.5% were prefrail (0.15 ≤ CFI < 0.25), 8.7% were mildly frail (0.25 ≤ CFI < 0.35), and 1.2% were moderately-to-severely frail (CFI ≥0.35). Using stepwise logistic regression, 13 distinct prognostic variable categories were identified as the most reliable predictors of postoperative outcomes. Most models demonstrated excellent model discrimination and calibration with high C statistic and Spiegelhalter P values, respectively, and high accuracy with low Brier scores. Calibration curves for each outcome demonstrated excellent model fit. CONCLUSIONS: This novel risk assessment tool may help guide surgical prognostication among this vulnerable population.

Asunto(s)

Fragilidad , Complicaciones Posoperatorias , Obstrucción del Cuello de la Vejiga Urinaria , Humanos , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Anciano , Masculino , Medición de Riesgo/métodos , Femenino , Fragilidad/complicaciones , Fragilidad/diagnóstico , Estados Unidos/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano de 80 o más Años , Medicare/estadística & datos numéricos , Procedimientos Quirúrgicos Urológicos/métodos , Procedimientos Quirúrgicos Urológicos/efectos adversos , Estudios Retrospectivos

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INTRODUCTION: Transurethral Resection of Prostate (TURP) is the most common treatment for Benign Prostatic Hyperplasia (BPH). Blood loss during and after transurethral resection of the prostate (TURP) is a potential cause of morbidity and clot retention. Usual practise is to apply traction in every case of TURP to reduce early postoperative hematuria and clot retention. There are very few studies in the literature and they have mainly concentrated on the effect of traction on reducing blood loss but there is scanty data regarding the morbidity associated with the use of traction. Various authors have described their method of traction application. So, in this study, we will compare the result of short term (10 min) traction with standard (4-6 h) traction. MATERIALS AND METHODS: It is a prospective comparative study with 50 participants, conducted at the department of Urology of a tertiary care hospital in eastern India after taking ethical clearance and consent from the patient. The patients attending urology O.P.D. with LUTS and diagnosed as BPH and planned for elective TURP and who had prolonged traction after TURP were excluded. Study period was one and the half year. RESULTS: Post operatively 25 patients were managed with catheter traction while 25 patients were managed with short term traction of 10 min. Pain which is assessed by visual analog scale (VAS) at 2 and 4 h post operatively is statistically significant with p value of <0.05 and cut off of 65 g prostate volume is drawn below which the successful outcome of short term traction is feasible without any complications. CONCLUSION: If hemostatsis is done properly then short term traction is preferable, safe and had fewer complications for prostate volume <65 g in comparison to standard traction TURP comparing the overall factors. Although, VAS score at 2 and 4 h post operatively shows patient experienced less pain even in prostate volume >65 g.

Asunto(s)

Hiperplasia Prostática , Resección Transuretral de la Próstata , Humanos , Masculino , Estudios Prospectivos , Hiperplasia Prostática/cirugía , Factores de Tiempo , Anciano , Persona de Mediana Edad , Tracción/métodos , Catéteres Urinarios , Complicaciones Posoperatorias , Pérdida de Sangre Quirúrgica/prevención & control

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PURPOSE: To identify the urodynamic parameters affecting the clinical outcomes of transurethral resection of the prostate(TURP) surgery for patients with benign prostatic hyperplasia(BPH) by multifactor analysis and establish a regression model with diagnostic values. METHODS: The medical records of patients who underwent TURP surgery for BPH between December 2018 and September 2021 were collected from the urology department of the Second Affiliated Hospital of Kunming Medical University, Kunming, China. The patients' clinical data and urodynamic parameters were collected before surgery. The urodynamic parameters affecting surgical efficacy were identified by multifactor analysis, and a regression model with diagnostic values was established and evaluated. RESULTS: A total of 201 patients underwent TURP, of whom 144 had complete preoperative urodynamic data. Each urodynamic factor was subjected to multifactor analysis, and the bladder contractility index (BCI), bladder outflow obstruction index (BOOI), bladder residual urine, and bladder compliance (BC) were found to be independent influence factors on the efficacy of TURP in patients with BPH. The diagnostic value of the regression model was analyzed by receiver operating characteristics (ROC) analysis, and it was found that the AUC = 0.939 (95% CI 0.886-0.972), for which the sensitivity and specificity were 95.19% and 80%, respectively. CONCLUSIONS: The regression model had high diagnostic sensitivity and specificity in predicting the efficacy of surgery, and the diagnostic value was higher than that of individual urodynamic factors. Therefore, BCI, BOOI, bladder residual urine, and BC should be considered as independent influence factors on the efficacy of TURP surgery for BPH.

Asunto(s)

Hiperplasia Prostática , Resección Transuretral de la Próstata , Obstrucción del Cuello de la Vejiga Urinaria , Retención Urinaria , Masculino , Humanos , Resección Transuretral de la Próstata/métodos , Hiperplasia Prostática/cirugía , Hiperplasia Prostática/diagnóstico , Urodinámica , Resultado del Tratamiento , Próstata/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Retención Urinaria/cirugía

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PURPOSE: To perform a post hoc cost-utility analysis of a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS: We conducted a cost-utility analysis over a 5-year period to compare PAE versus TURP from a Spanish National Health System perspective. Data were collected from a randomized clinical trial performed at a single institution. Effectiveness was measured as quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER) was derived from the cost and QALY values associated with these treatments. Further sensitivity analysis was performed to account for the impact of reintervention on the cost-effectiveness of both procedures. RESULTS: At the 1-year follow-up, PAE resulted in mean cost per patient of €2904.68 and outcome of 0.975 QALYs per treatment. In comparison, TURP had cost €3846.72 per patient and its outcome was 0.953 QALYs per treatment. At 5 years, the cost for PAE and TURP were €4117.13 and €4297.58, and the mean QALY outcome was 4.572 and 4.487, respectively. Analysis revealed an ICER of €2121.15 saved per QALY gained when comparing PAE to TURP at long-term follow-up. Reintervention rate for PAE and TURP was 12% and 0%, respectively. CONCLUSIONS: Compared to TURP, in short term, PAE could be considered a cost-effective strategy within the Spanish healthcare system for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, in long term, the superiority is less apparent due to higher reintervention rates.

Asunto(s)

Embolización Terapéutica , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Resección Transuretral de la Próstata , Masculino , Humanos , Próstata/irrigación sanguínea , Hiperplasia Prostática/terapia , Hiperplasia Prostática/cirugía , Embolización Terapéutica/métodos , Resección Transuretral de la Próstata/métodos , Análisis Costo-Beneficio , Resultado del Tratamiento , Arterias , Síntomas del Sistema Urinario Inferior/terapia , Síntomas del Sistema Urinario Inferior/complicaciones

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Background: Transurethral resection of the prostate (TURP) is a widespread, effective way to treat benign prostatic hyperplasia (BPH). Many medical students and junior clinicians increasingly turn to easily accessible online resources to learn this technique, such as videos on YouTube. This study assessed the educational value of YouTube videos about TURP, which are popular among many young surgeons. Methods: We searched YouTube as of August 2, 2022 for videos fulfilling the search terms "transurethral resection of the prostate", "benign prostatic hyperplasia", "BPH", "TURP", "benign prostatic enlargement", "bladder outlet obstruction" and "lower urinary tract symptom". We assessed the educational value of the identified videos using a custom-designed checklist. Results: We identified 47 relevant videos, 20 of which were posted after July 1, 2020. The average number of views was 576,379±208,535 (range, 54-1,385,713). The average quality score of the videos was 7.38±2.53 (range, 4-12) on a 15-point scale, and 20 were judged to be of low educational quality. Quality scores correlated positively with the number of likes (R=0.596, P<0.01). Conclusions: The educational value of most TURP videos on YouTube appears to be low, with most lacking detailed explanations of preoperative preparations and the surgical procedure. High-quality video resources about TURP need to be developed for medical students and junior surgeons. Standard quality criteria should also be developed and disseminated to ensure the production of accurate learning resources for junior clinicians.

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Background: Benign prostatic hyperplasia (BPH) is an age-related condition and its prevalence has increased as China's population ages. Transurethral resection of the prostate (TURP) remains the gold standard for treating moderate to severe BPH. Routine placement of a urinary catheter after TURP is often associated with catheter-related bladder discomfort (CRBD). The development of CRBD is related to an increased synthesis of prostaglandin (PG), and wrist-ankle acupuncture (WAA) can inhibit the expression of PG at the site of inflammation, thus alleviating CRBD symptoms. Here we evaluated the efficacy of WAA in alleviating CRBD in patients undergoing TURP. Methods: A total of 46 patients who underwent elective TURP in Hebei Provincial Hospital of Traditional Chinese Medicine from June 2022 to July 2022 were randomly divided into two groups according to the complete randomization method. The WAA group (n=23) and the control group (n=23). The WAA group received WAA, and the needles were retained for 24 h. The control group was treated with sham needles that did not penetrate the skin, and the needles were also retained for 24 h. At T1 (0 h after entering the ward), T2 (0.5 h after entering the ward), T3 (6 h after entering the ward), and T4 (24 h after entering the ward), CRBD severity score, visual analogue scale (VAS) and vital signs monitor were used for assessment. Accidents were recorded in the case report form. Graded data using Wlicoxon signed rank sum test, repeated measures using repeated measures analysis of variance. Results: A total of 46 patients participated in this study, and 44 patients completed the experiment. At T2, T3, and T4, the severity of CRBD in the WAA group was significantly lower than that in the control group (all P<0.05), and the VAS pain score was significantly lower in the WAA group than in the control group (all P<0.05). In contrast, the vital signs, including mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation, showed no statistical significance (all P>0.05). No accident occurred in both groups. Conclusions: WAA can effectively relieve CRBD symptoms after TURP. WAA deserves further research and assessment for clinical practice. Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR2200061525..

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BACKGROUND: The oncological risks after benign histology on a transurethral resection of the prostate (TURP) remain largely unknown. Here, the risk of prostate cancer incidence and mortality following a benign histological assessment of TURP is investigated in a population-based setting. METHODS: Between 1995 and 2016, 64,059 men in Denmark underwent TURP without prior biopsy of the prostate; 42,558 of these men had benign histology. The risks of prostate cancer, prostate cancer with a Gleason score ≥ 3 + 4, and prostate cancer-specific death were assessed with competing risks. Specific risks for pre-TURP prostate-specific antigen (PSA) levels at 10 and 15 years were visualized by locally estimated scatterplot smoothing. RESULTS: The median age at TURP was 72 years (interquartile range [IQR], 65-78 years), and the median follow-up was 15 years (IQR, 10-19 years). The 10-year risks of any prostate cancer and prostate cancer with a Gleason score ≥ 3 + 4 and the 15-year risk of prostate cancer death showed clear visual relations with increasing PSA. The 15-year cumulative incidence of prostate cancer-specific death after benign TURP was 1.4% (95% confidence interval [CI], 1.3%-1.6%) for all men and 0.8% (95% CI, 0.6%-1.1%) for men with PSA levels <10 ng/ml. The primary limitation was exclusion due to missing PSA data. CONCLUSIONS: Men with low PSA levels and a benign TURP can be reassured about their cancer risk and do not need to be monitored differently than any other men. Patients with high PSA levels can be considered for further follow-up with prostate magnetic resonance imaging. These findings add to the literature suggesting that normal histology from the prostate entails a low risk of death from the disease. LAY SUMMARY: There is little knowledge about the oncological risks after the surgical treatment of benign prostatic hyperplasia. This study shows a very low risk of adverse oncological outcomes in men with prostate-specific antigen (PSA) levels below 10 ng/ml at the time of transurethral resection of the prostate. Patients with higher PSA levels may need more extensive follow-up.

Asunto(s)

Hiperplasia Prostática , Neoplasias de la Próstata , Resección Transuretral de la Próstata , Anciano , Humanos , Masculino , Próstata/patología , Próstata/cirugía , Antígeno Prostático Específico , Hiperplasia Prostática/patología , Hiperplasia Prostática/cirugía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Resección Transuretral de la Próstata/efectos adversos , Resección Transuretral de la Próstata/métodos

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Background: Benign prostatic hyperplasia (BPH) is one of the most common diseases of ageing men, which increase starting from age 40. Monopolar transurethral resection of the prostate (M-TURP) is the gold standard surgical treatment for BPH between 30 to 80cc. This study is designed to assess complications of TURP based on the Clavien-Dindo post-op complication grading system. Methods: A descriptive prospective study of prevalence of complications of M-TURP from May1, 2019 to April 30, 2021 in Tikur Anbessa Specialized Hospital. In this study, 174 patients were assessed pre-operatively, intra-operatively and post-operatively. All BPH patients with bothersome LUTS, bladder stone, recurrent UTI, recurrent acute urinary retention (AUR), renal insufficiency, or failed medical therapy had undergone TURP. We collected it by revising patient's icare/charts and cell phone call. Results: About 174 patients were studied with mean age were 63 years. Intra op complications were noticed in seventeen (9.8%) patients, the most common one was prostate capsule perforation seen in 9 (5.2%) cases followed by severe bleeding in 3(1.7%) patients which needs transfusion and urethral injury. Urinary tract infections developed in eleven (7.8%) of patients. Bulbar urethral stricture and bladder neck contracture developed in 9 (5.2%) and 3 (1.7%) patients each, respectively. Re TURP was done for 7 (4%) of patients. Conclusion: In this study, the overall complication rate of TURP with Clavien-Dindo grading system was 29.3%. Around 96% of the complications were Clavien-Dindo grade I, II and III; managed conservatively or with minimally invasive surgery. This shows M-TURP is a relatively safe procedure.

Asunto(s)

Hiperplasia Prostática , Resección Transuretral de la Próstata , Infecciones Urinarias , Adulto , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Próstata/cirugía , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/efectos adversos , Resección Transuretral de la Próstata/métodos , Resultado del Tratamiento , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología

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Background: To assess the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for patients with prostate volume less than 100 mL or 100 g. Methods: We searched PubMed, Embase, Cochrane Library and Web of Science from inception to July 2021 to collect randomized controlled trials. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies by using the Cochrane risk of bias tool. Review Manager 5.3 software was used for meta-analysis. We synthesised effect estimates using risk ratios (RR), mean difference (MD), and standardized mean differences (SMD). Results: A total of eight studies were included, involving 764 patients, 384 patients in the HoLEP group and 380 patients in the TURP group. The meta-analysis showed that the catheterization time (SMD =-1.44; 95% CI: -2.17 to -0.70; P=0.0001), hospital stay (SMD =-1.01; 95% CI: -1.58 to -0.44; P=0.0005), haemoglobin loss (MD =-0.29; 95% CI: -0.52 to -0.07; P=0.01), and transfusion rate (RR =0.16; 95% CI: 0.05-0.49; P=0.001) in the HoLEP group were lower than those in the TURP group. In addition, the 12-month postvoid residual volume (PVR) of the HoLEP group (MD =-9.93 95% CI: -18.59 to -1.27; P=0.02) were superior to the TURP group. Although the operation time of the HoLEP group was longer (MD =17.89; 95% CI: 9.18-26.60; P<0.0001), more tissues were removed (SMD =0.47; 95% CI: 0.10-0.85; P=0.01). Discussion: Compared with TURP, HoLEP has a shorter catheterization time and hospital stay, with more tissue removed, a lower blood transfusion rate and better results in the short-term follow-up after surgery. Therefore, HoLEP has better efficacy and safety in the treatment of small- and medium-sized benign prostatic obstruction. Our results found that HoLEP is also suitable for patients with prostate volume <100 mL/100 g, suggesting that it is necessary to redefine the prostate size that is best for HoLEP. Overall, the certainty of evidence was assessed to be moderate to low due to potential risk of bias and inconsistent outcome indicators in some studies. More data on the efficacy of HoLEP and TURP on small- and medium-sized prostates are needed to determine the optimal prostate volume of HoLEP.

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Introduction: Benign prostatic hyperplasia (BPH) is worldwide condition in male patients after the fourth decade. Most patients present with lower urinary tracts symptoms related to BPH. Transurethral resection of the prostate (TURP) is considered the standard treatment for decades. Presentation of case: A 56-year-old male patient presented with three months of lower urinary tract symptoms with one time a life of complete urinary retention. Ultrasound showed an enlarged prostate (90 cc). We performed transurethral resection of the prostate. One week later, he presented with complete loss of vision in the right eye with pain in the left leg. Left lower limb ultrasound revealed deep venous thrombosis. Brain MRI demonstrated left occipital lobe infarction. We started anticoagulants therapy. Three days later, he reclaimed his vision acuity completely. Clinical discussion: Cerebrovascular accident after transurethral resection of prostate is considered an extremely rare event in urological practice. Full work-up to detect the cause should be performed. In most cases, cardiac anomalies are the main responsible of such events. Conclusion: Loss of vision is a rare entity after TURP surgery. Anticoagulant therapy should be started once the diagnosis of occipital lobe infarction is confirmed.

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Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in aging males. Transurethral resection of the prostate (TURP) surgery is performed by a cystoscope passing through the urethra and scraping off the prostrate piece by piece through a cutting loop. Although TURP is a minimally invasive procedure, bleeding is still the most common complication. Therefore, the evaluation, monitoring, and prevention of interop bleeding during TURP are very important issues. The main idea of this study is to rank bleeding levels during TURP surgery from videos. Generally, to judge bleeding level by human eyes from surgery videos is a difficult task, which requires sufficient experienced urologists. In this study, machine learning-based ranking algorithms are proposed to efficiently evaluate the ranking of blood levels. Based on the visual clarity of the surgical field, the four ranking of blood levels, including score 0: excellent; score 1: acceptable; score 2: slightly bad; and 3: bad, were identified by urologists who have sufficient experience in TURP surgery. The results of extensive experiments show that the revised accuracy can achieve 90, 89, 90, and 91%, respectively. Particularly, the results reveal that the proposed methods were capable of classifying the ranking of bleeding level accurately and efficiently reducing the burden of urologists.

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BACKGROUND: Combination of transurethral resection of the prostate (TURP) and flexible and rigid ureteroscopy (URS/RIRS) is a successful approach for patients with benign prostatic hyperplasia (BPH) and ureteral calculus (UC), and the sequence is URS/RIRS followed by TURP. This research aims to compare TURP followed by URS/RIRS with URS/RIRS followed by TURP in terms of clinical efficiency and safety. METHODS: From June 2009 to June 2021, 173 patients with BPH and upper urinary tract stones were recruited through the Harrison International Peace Hospital and were divided into intervention (TURP followed by URS/RIRS) and control groups (URS/RIRS followed by TURP). We collected demographic data, primary outcomes including urinary function, and secondary outcomes including surgical parameters and complications. SPSS 21.0 was used to analyze data. RESULTS: When comparing the surgical parameters, the intervention group showed better results than the control group regarding surgery time and length of hospitalization. When comparing urinary function and complications, there were no differences between the intervention and control groups. CONCLUSIONS: Although the intervention of TURP followed by URS/RIRS had similar clinical effects compared with URS/RIRS followed by TURP in the control group; the intervention saves surgery time, and decreases the length of stay and medical costs. It may therefore be a good choice for patients with BPH and UC.

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PURPOSE: To perform a post hoc analysis of patient-incurred costs in a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Patients older than 60 years with indication of TURP were randomized to PAE or TURP procedure. After intervention and hospital discharge, patients were follow-up during 12 months The associated patient costs were categorized according to the study period: pre-intervention, intervention, hospitalization, and follow-up. Several items for both groups were analyzed within each study period. RESULTS: The mean total costs per patient were lower for PAE (€ 3,192.87) than for TURP (€ 3,974.57), with this difference of € 781.70 being significant (p = 0.026). For most evaluated items, the mean costs were significantly higher for TURP. No significant differences were observed in the mean costs of PAE (€ 1,468.00) and TURP (€ 1,684.25) procedures (p = 0.061). However, the histopathology analysis, recovery room stay, and intraoperative laboratory analysis increased the interventional costs for TURP (€ 1,999.70) compared with PAE (€ 1,468.00) (p < 0.001). No cost differences were observed between PAE (€ 725.26) and TURP (€ 556.22) during the 12 months of follow-up (p = 0.605). None of patients required a repeat intervention during the study period. CONCLUSIONS: Considering the short-term follow-up, PAE was associated with significantly lower costs compared with TURP. Future investigations in the context of routine clinical practice should be aimed at comparing the long-term effectiveness of both procedures and determining their cost-effectiveness. LEVEL OF EVIDENCE: Level 1 (a-c).

Asunto(s)

Embolización Terapéutica , Hiperplasia Prostática , Resección Transuretral de la Próstata , Arterias , Análisis Costo-Beneficio , Humanos , Masculino , Hiperplasia Prostática/cirugía , Resultado del Tratamiento

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BACKGROUND: In China, the incidence of benign prostatic hyperplasia (BPH) is rising with the average lifespan of men. Transurethral resection of the prostate (TURP) is recognized as the gold standard for surgical treatment of BPH. Continuous bladder irrigation (CBI) is often required after operation. The irrigation rate is often manually adjusted based on the color of the drainage fluid, but it is difficult to know how much to adjust it based on color. To better adjust the irrigation rate and reduce related complications, we developed and evaluated a post-TURP CBI rate adjustment card. METHODS: A total of 103 BPH patients who underwent post-TURP CBI at our hospital between April and July 2020 were enrolled in this study and were assigned to the control group (n=49) or the experimental group (n=54) according to the different hospital areas. In the control group, the CBI rate was adjusted based on the clinical evaluation of the color of the drainage fluid; in the experimental group, the CBI rate was adjusted based on the color of drainage fluid evaluated with our homemade post-TURP CBI rate adjustment card. RESULTS: The incidence of bladder spasm, the incidence of clot-related catheter blockage, the volume of irrigation solution used, and the irrigation time were significantly lower or shorter in the experimental group than in the control group. The patient satisfaction score was significantly higher in the experimental group (P<0.05). CONCLUSIONS: For BPH patients receiving post-TURP CBI, the homemade post-TURP CBI rate adjustment card can provide objective data for clinical care, reduce postoperative complications, and improve patient satisfaction. Therefore, it should be more widely used in clinical practice.

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BACKGROUND: Transurethral resection of the prostate (TURP) was considered the golden standard to treat benign prostatic hyperplasia (BPH) for decades. However, TURP was associated with low efficiency to alleviate the lower urinary tract symptoms (LUTS) and a significantly higher risk of bladder neck contracture (BNC) for patients with small-volume BPH. Our study aims to compare the therapeutic effect of a transurethral split of the prostate (TUSP) with TURP for patients with small-volume BPH (<30 mL). METHODS: In this study, 101 small-volume BPH patients were randomly divided into two groups (TUSP and TURP group). The patient's baseline characteristics and perioperative outcomes were recorded. The follow-up was done at six months, one year and two years after surgical treatment. RESULTS: No significant differences were observed between the two groups for the baseline characteristics, including age, prostate volume, prostate-specific antigen (PSA) level, concurrent disease, post-void residual (PVR), maximum urinary flow rate (Qmax), international prostate symptoms score (IPSS), and quality of life (QoL) score. The operative time and hemoglobin decrease were significantly lower in the TUSP group compared to the TURP group. However, no significant differences were observed between both groups for catheterization time, postoperative hospital stay, and incidence of transurethral resection syndrome (TURS). However, of the late complications, the incidence of BNC in the TUSP group was significantly lower than the TURP group. No significant differences were found between both groups for other complications, including postoperative bleeding, micturition urgency, micturition frequency, micturition pain, urinary tract infection, recatheterization, transient incontinence, and continuous incontinence. Follow-up results showed that the IPSS of the TUSP group was significantly lower than the TURP group, while the Qmax of the TUSP group was significantly higher than the TURP group. CONCLUSIONS: This study shows that TUSP may be an efficient and safe treatment for small-volume BPH (<30 mL) with a lower incidence of postoperative BNC and better longtime clinical outcomes than TURP. It suggested that TUSP could be an ideal treatment choice for small-volume BPH.

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BACKGROUND: There is paucity of an optimal method to detect fluid absorption and hemorrhage during urological endoscopic surgery. We designed an endoscopic surgical monitoring system (ESMS) and estimated its performance to establish a practical instrument that can monitor the blood loss and fluid absorption accurately and non-invasively during urological endoscopic surgery. METHODS: Our system employed the strain gauge transducers to detect the inflows and outflows of the irrigating solutions and the photoelectric sensor to determine the hemoglobin concentration of the collected irrigating fluid. The amount of blood lost and the volume of fluid absorbed during endoscopic surgery could be calculated by computer program. The accuracy and validity of this system were validated in simulated experiment and clinical study of 200 patients who underwent transurethral resection of the prostate (TURP). RESULTS: The relative errors for fluid absorption detection were between 0.07% and 1.00% and the coefficient of variation in serial analysis ranged from 0.78% to 3.86%. Furthermore, the relative errors for blood loss detection were between 0.06% and 1.33% and the coefficient of variation in serial analysis ranged from 0.86% to 3.94%. In clinical study for TURP, the mean fluid absorption was 644 mL and blood loss was 238 mL. CONCLUSIONS: We provide the accuracy and validity of ESMS. It provides an early and real time detection and warning of irrigation fluid absorption and blood loss to make endoscopic surgical procedure safer for the patient.

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INTRODUCTION: The effect of prostate artery embolization (PAE) on male sexual function is currently the subject of debate in the literature. The main purpose of this study was to define changes in all domains of sexual activity after PAE, using the international index of erectile function score (IIEF-15). METHODS: A single-center retrospective study was conducted on 129 patients (mean age of 65.5 ± 7 years), who underwent PAE from February 2014 to January 2017 for symptomatic benign prostatic hyperplasia (BPH). Fifty consecutive patients fulfilling the inclusion criteria were evaluated before and after PAE follow-up using the IIEF-15, IPSS, prostate volume (PV) and cardiovascular risk factor and BPH drugs. The IIEF-15 domains analyzed were: erectile function (EF) ejaculation and orgasm (Ej/O), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A paired sample t test or Wilcoxon signed-rank test was used to compare IIEF-15 between baseline and follow-up. RESULTS: The study showed nonsignificant change in IIEF-15 total score (58.0 ± 13.8 SD; p = 0.71) and the five domains (EF 24.5 ± 7.0 SD, p = 0.82; EJ/O 8.2 ± 2.3 SD, p = 0.50; SD 7.2 ± 2.7 SD, p = 0.57; IS 10.3 ± 3.0 SD, p = 0.77; OS 8.2 ± 2.7 SD; p = 0.11) after PAE. We also found a significant improvement in IPSS score after PAE. CONCLUSION: Based on the IIEF-15 questionnaire, PAE was showed to allow good urinary symptoms results and no deterioration in sexual function.

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Embolización Terapéutica/métodos , Disfunción Eréctil/prevención & control , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/terapia , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/terapia , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Próstata/irrigación sanguínea , Estudios Retrospectivos , Conducta Sexual/fisiología , Encuestas y Cuestionarios , Resultado del Tratamiento

RESUMEN

OBJECTIVES: To evaluate perioperative parameters, early functional outcomes, and the safety profile in a matched-pair analysis of lower urinary tract symptom (LUTS) patients treated with holmium laser enucleation of the prostate (HoLEP) or transurethral resection of the prostate (TURP). METHODS: We conducted a retrospective, matched-pair analysis of 2011 men treated for LUTS in our institution from 2013 to 2017. In the final analysis, 197 patients (HoLEP n = 97; TURP n = 98) were matched for prostate size (50 cc), age, and body mass index, and both cohorts were compared for demographic parameters, clinical outcomes, and adverse events according to the Clavien-Dindo classification. RESULTS: The perioperative assessment revealed a significantly higher tissue retrieval percentage of 75.4% (interquartile range [IQR] 64-81.2) after HoLEP in comparison to 47.3% (IQR 40-54.7) after TURP (P <.001). A shorter surgery time was reported for TURP with a median time of 55.5 minutes (IQR 48-70.5), whereas the median time for HoLEP was 62 minutes (IQR 51-85) (P =.006). The median improvements in International Prostate Symptom Score (IPSS) were 11 points (IQR 5.5-17) and 7 points (IQR 3-14) for HoLEP and TURP, respectively (P =.007). Peak urinary flow rate (Qmax ) increased more after HoLEP (12.0 mL/s; IQR 7-23) than after TURP (8.5 mL/s; IQR 5-18.25) (P =.028). With an overall incidence of adverse events of 6% (n = 6) compared to 16% (n = 16%), significantly fewer complications occurred after HoLEP than after treatment with TURP (P <.05). CONCLUSIONS: HoLEP is not only an attractive alternative for the enucleation of larger prostates, but it must be considered a size-independent technique with the potential to outdo the current reference method TURP.

Asunto(s)

Enucleación del Ojo , Láseres de Estado Sólido/uso terapéutico , Síntomas del Sistema Urinario Inferior , Próstata/patología , Hiperplasia Prostática , Resección Transuretral de la Próstata , Anciano , Enucleación del Ojo/instrumentación , Enucleación del Ojo/métodos , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/métodos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/terapia , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Tempo Operativo , Tamaño de los Órganos , Evaluación de Procesos y Resultados en Atención de Salud , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatología , Estudios Retrospectivos , Resección Transuretral de la Próstata/efectos adversos , Resección Transuretral de la Próstata/métodos , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/terapia

RESUMEN

Objectives: To determine the utility of ultrasonography (US)-derived parameters (e.g. prostate volume [PV], bladder wall thickness [BWT], post-void residual urine volume [PVR], and intravesical prostatic protrusion [IPP]) and uroflowmetry for identifying bladder outlet obstruction (BOO) by correlating them with the results of pressure-flow urodynamic studies (UDS). Patients and methods: In all, 164 patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), from May 2016 to December 2018, were included in this study. All had International Prostate Symptoms Score (IPSS), Quality-of-Life (QOL) index, uroflowmetry (including maximum urinary flow rate [Qmax]) and PVR measured by transabdominal US. Pressure-flow UDS were performed on all men and BOO was defined by a BOO Index (BOOI) >40. Men with a Qmax of ≥12.0 mL/s were considered to have 'good' flow. Results: Amongst the 164 men, the mean (SD) age, PV, BWT and Qmax were 66.72 (9.88) years, 51.91 (13.24) mm, 5.07 (0.91) mm, and 8.46 (3.59) mL/s, respectively. In all, 91 (55.49%) patients had BOO with a BOOI >40 and nine (5.49%) had equivocal BOO with a BOOI of 20-40. The IPP was a statistically significant predictor (P < 0.001) of BOO compared with other variables in the initial evaluation. In patients with BOO confirmed by the pressure-flow UDS, IPP Grade III was associated with a higher BOOI than was Grade I and II (P < 0.001). Conclusion: BWT, PV and PVR in conjunction with IPP are good predictors of clinically significant BOO due to BPH. Abbreviations: AUC: area under the curve; BOOI: BOO Index; BPO, benign prostatic obstruction; BWT, bladder wall thickness; IPP: intravesical prostatic protrusion; Pdet: detrusor pressure; PV: prostate volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QOL: quality of life; ROC: receiver operating characteristic; (TA)US: (transabdominal) ultrasonography; UDS: urodynamic studies.