RESUMO

As principais complicações pós-operatórias de Ressecção Transuretral da Próstata (RTU-P) são: retenção urinária por coágulos sanguíneos na sonda e a contaminação exógena do sistema urinário por manipulação do profissional de saúde ao realizar a técnica de lavagem vesical. O artigo descreve o desenvolvimento de um protótipo para a manutenção do sistema urinário fechado durante a lavagem vesical e permitir a medição das pressões no interior do cateter vesical de demora (CVD) de três vias com o protótipo durante a técnica da lavagem vesical. Trata-se de uma pesquisa tecnológica baseada no modelo de Processo de Desenvolvimento do Produto de Rozenfeld. Foram realizados testes de funcionalidade por meio de experimentos em ambiente controlado dentro de laboratório. O protótipo apresentou resultados satisfatórios quanto a manutenção do sistema urinário fechado durante a técnica de lavagem vesical. O uso do catéter permitiu a medição das pressões específicas do CVD de três vias em três momentos diferentes: cateter desobstruído, cateter parcialmente obstruído e cateter totalmente obstruído. Os resultados obtidos demonstram que o protótipo pode representar uma ferramenta inovadora na área de urologia. Atendeu as especificações do projeto e possibilitou a manutenção do sistema urinário fechado na lavagem vesical. Além de diminuir os riscos de contaminação do sistema urinário durante a manipulação da técnica. Portanto, o presente estudo demostrou que o protótipo é plenamente seguro quando comparado as pressões exercidas dentro do CVD. Existe a necessidade de realizar testes experimentais em humanos para comprovar a diminuição de contaminação do trato urinário como uso do protótipo.

The main postoperative complications of Transurethral Resection of the Prostate (TURP) are urinary retention by blood clots in the probe and exogenous contamination of the urinary system by manipulation of the healthcare professional when performing the bladder washing technique. The aim of this study was to develop a prototype for keeping the urinary system closed during bladder washes and to measure the internal pressures of the three-way Indwelling Urinary Catheter (IDC) during the bladder washing technique. This was a technological study based on the Rozenfeld's Product Development Process model. Functionality tests were carried out through experiments in a controlled environment in the laboratory. The prototype showed satisfactory results regarding the preservation of the urinary system closed during the bladder washing technique. It was possible to obtain specific pressures from the three-way IDC at three different moments: unobstructed catheter, partially obstructed catheter, and totally obstructed catheter. The results obtained demonstrate that the prototype can represent an innovative tool in the area of urology. It met the project's specifications and preserved the urinary system closed during the bladder washing. Moreover, it reduces the risk of urinary system contamination during the technique manipulation. Therefore, the present study showed that the prototype is fully safe regarding the pressures exerted inside the IDC. There is a need to carry out experimental tests in humans to prove the decrease of urinary tract contamination with the use of this prototype.

RESUMO

Bladder rupture is a rare complication of transurethral resection of the prostate (TURP) or bladder (TURB). Both extra and in- traperitoneal perforation have an incidence of 1.3% in patients undergoing this procedure, and only 17% of these perforations turn out to be intraperitoneal[],[]. It is a serious complication that requires immediate treatment to prevent it from progressing to peritonitis uremia, acidosis, and compartment syndrome.

La rotura vesical es una complicación poco común de la resección transuretral de próstata (RTUP) o vejiga (RTUV). La perforación tanto extra como intraperitoneal tiene una incidencia de 1,3% en los pacientes sometidos a este procedimiento y solo el 17% de dichas perforaciones resultan ser intraperitoneales. Es una complicación grave que requiere tratamiento inmediato para evitar que progrese a peritonitis, uremia, acidosis y síndrome compartimental.

Assuntos

RESUMO

PURPOSE: The purpose of this study was to determine the prevalence of bladder lesions diagnosed during transurethral resection of the prostate (TURP), to identify the associated risk factors, and to correlate the macroscopic descriptions with the pathological findings. METHODS: This was a single-center retrospective case series conducted at a hospital in the city of São Paulo, Brazil. We reviewed the medical and surgical records of patients who underwent TURP between January 2012 and December 2017. RESULTS: The final sample comprised 513 patients, with a mean age of 70.8 years. Bladder lesions were identified during TURP in 109 (21.2%) of the patients, and 90 of those lesions were submitted for pathological examination. The most common macroscopic finding was bullous edema, which was seen in 57 (63.3%) of the 90 lesions examined. The pathological analysis revealed chronic cystitis in 61 lesions (67.8%) and malignant lesions in 16 (17.8%). Of the 57 lesions described as bullous edema, 5 (8.8%) were found to be malignant. CONCLUSIONS: Alterations in the bladder mucosa appear to be more common among elderly patients who use an indwelling urinary catheter for a prolonged period and among patients with recurrent urinary tract infections. In addition, the risk of a bladder lesion being malignant is apparently higher in current and former smokers than in never smokers. Our findings suggest that at-risk patients should undergo biopsy or resection of incidental bladder lesions even if those lesions seem to be benign, due to the low level of agreement between the visual analysis and the pathological examination.

Assuntos

RESUMO

RESUMEN Introducción: la resección transuretral de próstata (RTUP), independiente de si es con equipo monopolar o bipolar (RTUP-B), es la cirugía estándar en el manejo quirúrgico de los síntomas del tracto urinario inferior (STUI) o de las complicaciones derivadas de la obstrucción por hiperplasia prostática benigna (HPB). Objetivo: revisar la literatura sobre frecuencia y factores de riesgo para complicaciones de la RTUP con bipolar. Resultados: se hizo una revisión de la literatura mediante la búsqueda en Medline desde 1996 hasta 2017. De 76 artículos revisados, 50 se incluyeron. Estos reportan que la RTUP-B ofrece buenos resultados a largo plazo. Las complicaciones en su mayoría son grado I según la clasificación de Clavien-Dindo y las más frecuentes son la eyaculación retrógrada, hematuria secundaria, retención o infección urinaria y estrechez uretral o contractura del cuello vesical. Los factores de riesgo fueron comorbilidades, gravedad de la enfermedad al momento de la intervención, técnica y habilidad del cirujano, entre otros. Discusión: aunque la mayoría de las complicaciones secundarias a la RTUP-B son leves, definir el momento óptimo para la realización de la cirugía e intervenir los factores de riesgo modificables, podría contribuir a mejorar los resultados de esta técnica quirúrgica.

SUMMARY Introduction: Regardless of the technique used, either bipolar or monopolar, transurethral resection of the prostate (TURP) is considered the cornerstone of surgical management for low urinary tract symptoms (LUTS), and benign prostatic obstruction (BPO). Objective: To review the available literature regarding the frequency of bipolar TURP (B-TURP) complications and the risk factor associated with them. Results: The search was conducted using Medline and studies addressing the research question published between 1996 and 2017 were retrieved. Seventy six article were screened and 50 were included. Those papers reported that B-TURP was associates with good long-term outcomes. According to Clavien-Dindo classification, a high proportion of complications were grade I, and the most frequent ones were: retrograde ejaculation, urine retention, urinary tract infection, bleeding and urethral stricture. Risk factors most commonly associated with these complications were: patient's medical status before surgery, the extent of disease at the time of the procedure, skills and technique of the surgeon, amongst other. Discussion: The majority of the surgical complications associated with B-TURP are mild, and identifying the best moment to conduct the procedure and intervening on modifiable risk factors before surgery, may contribute to improve outcomes of the B-TURP.

Assuntos

RESUMO

RESUMEN La hiperplasia prostática benigna (HPB) es la neoplasia más común en hombres y puede requerir tratamiento quirúrgico cuando hay retención urinaria, uropatía obstructiva, hematuria a repetición, cistolitiasis o falta de mejoría de los síntomas con las terapias farmacológicas. Las opciones quirúrgicas más frecuentes son la prostatectomía abierta y la resección transuretral de próstata, entre cuyas complicaciones están las infecciones del tracto urinario (ITU) hasta en 12,9 % de los pacientes. Sin embargo, este porcentaje es variable porque no siempre se especifica la diferencia entre ITU y bacteriuria. Los siguientes son factores de riesgo: bacteriuria preoperatoria, tiempo quirúrgico mayor de 60 minutos y manipulación posoperatoria de la sonda vesical. Es importante que los profesionales de la salud que participan en la atención de pacientes con HPB conozcan e intervengan estas complicaciones infecciosas y sus factores de riesgo.

SUMMARY Benign prostatic hyperplasia (BPH) is the most common tumor in men and may require surgical treatment when there is urinary retention, obstructive uropathy, recurrent hematuria, cystolithiasis or lack of improvement of symptoms with drug therapies. The most common surgical options are open prostatectomy and transurethral resection of the prostate. Urinary tract infections (UTI) are among the complications of these procedures, and may occur in up to 12.9 % of patients. However, this percentage is variable because the difference between UTI and bacteriuria is not always specified. Risk factors are: preoperative bacteriuria, operating time longer than 60 minutes and handling of postoperative bladder catheter. It is important that health professionals involved in the care of patients with BPH know these infectious complications and their risk factors.

Assuntos

RESUMO

Introducción: La hiperplasia prostática benigna (HPB) es una enfermedad caracterizada por síntomas del tracto urinario inferior (1). Estos síntomas suelen causar un impacto negativo en la calidad de vida del paciente llevándolo a padecer trastornos depresivos (7). Se han encontrado síntomas depresivos hasta en el 22.5% de los pacientes con HPB sin embargo, hay poca evidencia de que estos síntomas disminuyan luego de tratar la HPB (5). Una herramienta útil para medir los síntomas depresivos es la Escala de Medición de Depresión de Hamilton (3). Objetivos: Este estudio pretende evaluar la presencia de síntomas depresivos en pacientes con HPB y comprobar si estos síntomas disminuyen posteriormente al tratamiento quirúrgico para HPB. Métodos. Se utilizó un muestra de 30 pacientes, edad (promedio 67 ± 8 años), sometidos a tratamiento quirúrgico para HPB y quienes presentaran por lo menos un síntoma depresivo según la escala de medición de depresión de Hamilton. Resultados. Todos tuvieron resección transuretral de próstata (RTUP). Previo a la cirugía se encontraron síntomas depresivos en el 76%. Un mes posterior a la cirugía se encontraron síntomas depresivos en 28, sin embargo, se encontró depresión leve en el 23.3% (vs pre op 30%), depresión moderada en el 16.6% (vs pre op 30%) y depresión severa en el 13.3% (vs pre-op 16.6%). La Escala de Medición de Depresión de Hamilton tuvo una puntuación media preoperatoria de 13.93 puntos. Un mes posterior a la cirugía la puntuación media fue de 9.36 puntos. La diferencia fue de 4.56 puntos, lo cual es estadísticamente significativo (P=0.05). Hubo complicaciones quirúrgicas en 3 pacientes quienes tuvieron un aumento en el puntaje postoperatorio y hubo aumento del nivel de depresión. En el estudio 15 refirieron disfunción eréctil previo a la cirugía y únicamente 8 persistieron con disfunción luego de la cirugía. Conclusiones. Los pacientes con HBP constituyen una población en riesgo de padecer síntomas depresivos. Los síntomas depresivos están relacionados con padecer STUI y disfunción eréctil; ambas condiciones afectan la calidad de vida. El tratamiento quirúrgico para tratar la HPB es efectivo en disminuir los síntomas depresivos mejorando la calidad de vida causando mínimos efectos negativos.

Introduction: Benign Prostatic Hyperplasia (BPH) is a condition that leads to inferior urinary tract symptoms (1). These symptoms often cause a negative impact on the quality of life leading to depressive symptoms (7). Depressive symptoms are present in up to 22.5% of patients with BPH, however, there is limited evidence that these symptoms decrease with HPB treatment (5). A useful tool to measure depressive symptoms is the Hamilton Depression Rating Scale (HDRS) (3). Objective: Main purpose of the study is to assess the prevalence of depressive symptoms in patients with BPH and determine whether these symptoms decreased after a corrective surgery. Methods: A sample of 30 male patients, average age 67 ± 8 years old, with surgical treatment indication for BPH, with at least one depressive symptom according to the HDRS was obtained. Results: All patients in the study underwent transurethral resection of the prostate (TURP). Prior to surgery, depressive symptoms found in 76.6%. A month post-surgery depressive symptoms found in 28, however mild depression was present in 23.3% (vs pre-op 30%) moderate depression in 16.6% (vs pre-op 30.0%) and severe depression in 13.3% (vs pre-op 16.6%). Measurement with HDRS had a mean preoperative score 13.93 points; a post-surgery month the average score was 9.36. The difference was 4.56 points; which is statistically significant (P = 0.05). Three patients had surgical complications and they had an increase in postoperative score and also increased in the level of depression. In the study 15 patients reported erectile dysfunction prior to surgery; out of these patients only 8 persisted with dysfunction after surgery. Conclusions: BPH patients is a population at risk for developing depressive symptoms. Depressive symptoms are related to developing lower urinary tract symptoms and erectile dysfunction; both conditions affecting the quality of life. Surgery to treat BPH is effective in reducing depressive symptoms by improving the quality of life and with minimal adverse effects.

RESUMO

OBJECTIVES: To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery. METHODS: We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders. RESULTS: Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters. CONCLUSIONS: This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.

Assuntos

RESUMO

Acute abdominal compartment syndrome is most commonly associated with blunt abdominal trauma, although it has been seen after ruptured abdominal aortic aneurysm, liver transplantation, pancreatitis, and massive volume resuscitation. Acute abdominal compartment syndrome develops once the intra-abdominal pressure increases to 20-25mmHg and is characterized by an increase in airway pressures, inadequate ventilation and oxygenation, altered renal function, and hemodynamic instability. This case report details the development of acute abdominal compartment syndrome during transurethral resection of the prostate with extra- and intraperitoneal bladder rupture under general anesthesia. The first signs of acute abdominal compartment syndrome in this patient were high peak airway pressures and difficulty delivering tidal volumes. Management of the compartment syndrome included re-intubation, emergent exploratory laparotomy, and drainage of irrigation fluid. Difficulty with ventilation should alert the anesthesiologist to consider abdominal compartment syndrome high in the list of differential diagnoses during any endoscopic bladder or bowel case.

RESUMO

Acute abdominal compartment syndrome is most commonly associated with blunt abdominal trauma, although it has been seen after ruptured abdominal aortic aneurysm, liver transplantation, pancreatitis, and massive volume resuscitation. Acute abdominal compartment syndrome develops once the intra-abdominal pressure increases to 20-25 mm Hg and is characterized by an increase in airway pressures, inadequate ventilation and oxygenation, altered renal function, and hemodynamic instability. This case report details the development of acute abdominal compartment syndrome during transurethral resection of the prostate with extra- and intraperitoneal bladder rupture under general anesthesia. The first signs of acute abdominal compartment syndrome in this patient were high peak airway pressures and difficulty delivering tidal volumes. Management of the compartment syndrome included re-intubation, emergent exploratory laparotomy, and drainage of irrigation fluid. Difficulty with ventilation should alert the anesthesiologist to consider abdominal compartment syndrome high in the list of differential diagnoses during any endoscopic bladder or bowel case.

A síndrome compartimental abdominal aguda é mais comumente associada a trauma abdominal fechado, embora tenha sido observada após ruptura de aneurisma da aorta abdominal, transplante de fígado, pancreatite e reanimação com volume maciço. A síndrome compartimental abdominal aguda surge quando a pressão intra-abdominal aumenta para 20-25 mm Hg e é caracterizada pelo aumento das pressões das vias aéreas, ventilação e oxigenação inadequadas, função renal alterada e instabilidade hemodinâmica. Este relato de caso descreve o desenvolvimento da síndrome compartimental abdominal aguda durante a ressecção transuretral de próstata com ruptura da bexiga extra e intraperitoneal sob anestesia geral. Os primeiros sinais da síndrome compartimental abdominal aguda nesse paciente eram pressões de pico elevadas das vias aéreas e dificuldade para fornecer volumes correntes. O manejo da síndrome de compartimento inclui reintubação, laparotomia exploratória de emergência e drenagem de líquidos de irrigação. A dificuldade na ventilação deve alertar o anestesiologista para que considere a síndrome compartimental abdominal em primeiro lugar na lista de diagnósticos diferenciais durante qualquer caso de endoscopia de bexiga ou intestino.

Assuntos

RESUMO

Acute abdominal compartment syndrome is most commonly associated with blunt abdominal trauma, although it has been seen after ruptured abdominal aortic aneurysm, liver transplantation, pancreatitis, and massive volume resuscitation. Acute abdominal compartment syndrome develops once the intra-abdominal pressure increases to 20-25 mmHg and is characterized by an increase in airway pressures, inadequate ventilation and oxygenation, altered renal function, and hemodynamic instability. This case report details the development of acute abdominal compartment syndrome during transurethral resection of the prostate with extra- and intraperitoneal bladder rupture under general anesthesia. The first signs of acute abdominal compartment syndrome in this patient were high peak airway pressures and difficulty delivering tidal volumes. Management of the compartment syndrome included re-intubation, emergent exploratory laparotomy, and drainage of irrigation fluid. Difficulty with ventilation should alert the anesthesiologist to consider abdominal compartment syndrome high in the list of differential diagnoses during any endoscopic bladder or bowel case.

Assuntos

RESUMO

OBJECTIVE: To evaluate the effectiveness and applicability of Holmium laser enucleation of the prostate (HoLEP) - in the treatment of benign prostatic hyperplasia (BPH) - in comparison to transurethral resection of the prostate (TURP). METHODS: Patients with symptomatic prostatic hyperplasia and candidates for surgical treatment were selected. Both procedures were explained and they had choosen HoLEP or TURP. At the hospital were collected: age, date of birth, international prostate symptom score, urinary peak flow rate, prostate volume, post-voiding residual urine, globular volume and serum PSA. At the procedure operating time, morcellating time (HoLEP), bladder mucosal injury and intercurrences were collected. At the first postoperative day, globular volume and sodium. Besides that were observed the catheter indwelling time and hospital stay and after 90 days, urinary peak flow rate and international prostate symptom score. Statistical analisys have been done partially by Sinpe(r) and also by a professional team. RESULTS: Twenty patients in HoLEP group and 21 at TURP were operated. Baseline urinary peak flow rate was 8 ml/s in both groups and preoperative international prostate symptom score was 22 in HoLEP and 20 in TURP, very similar. Operative time was 85 minutes in HoLEP and 60 in TURP, p<0.05. Hospital stay was 47 hours for HoLEP and 48 hours to TURP, p<0.05. At 90 day the urinary peak flow rate was raised to 21.5 ml/s in HoLEP group and to 20 ml/s in TURP and the median of international prostate symptom score had been reduced to score 3 in both groups. CONCLUSION: HoLEP is a feasible technique and is as effective as TURP on symptomatic prostatic hyperplasia surgical treatment.

OBJETIVO: Avaliar a eficácia e a aplicabilidade da enucleação prostática com Holmium Laser (HoLEP), no tratamento da hiperplasia prostática benigna (HPB), comparando-a à ressecção transuretral da próstata (RTUp). MÉTODOS: Ambos os procedimentos eram explicados aos pacientes com indicação de tratamento cirúrgico e eles escolhiam qual procedimento seria realizado, HoLEP ou RTUp. Eram coletados dados da internação, dados clínicos, escore de sintomas e pico de fluxo urinário. No ato operatório registravam-se tempo cirúrgico, tempo de morcelamento (nos casos de HoLEP), lesão vesical ou intercorrências. Noventa dias após a operação era feita uma nova avaliação do pico de fluxo urinário e escore de sintomas. A análise estatística foi realizada em parte pelo programa Sinpe(r) e também por uma equipe profissional. RESULTADOS: Foram operados 20 pacientes no grupo HoLEP e 21 no RTUp. O pico de fluxo urinário pré-operatório foi 8ml/s em ambos os grupos. O escore de sintomas pré-operatório foi 22 no grupo HoLEP e 20 no RTUp. O tempo operatório foi 85 minutos no grupo HoLEP e 60 minutos no RTUp, p<0,05. A internação hospitalar foi 47 horas para o grupo de HoLEP e 48 horas para RTUp, p<0,05. Na avaliação em 90 dias o fluxo urinário aumentou para 21,5ml/s no grupo HoLEP e para 20ml/s no RTUp e a mediana do escore de sintomas reduziu para 3 em ambos os grupos.CONCLUSÃO:O HoLEP é técnica tão eficaz quanto RTUp, no tratamento da HPB. A enucleação prostática com Holmium laser (HoLEP) é técnica eficaz no tratamento da HPB e pode ser aplicável, pois produz resultados, em termos de eficácia e aplicabilidade, comparáveis à RTUp.

Assuntos

RESUMO

Acute kidney injury (AKI) is associated with extended hospital stays, high risks of in-hospital and long-term mortality, and increased risk of incident and progressive chronic kidney disease. Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy, older age, and preexistent chronic kidney disease. Nonetheless, precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking. Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures. Whereas severe AKI after prostate surgery in general appears to be unusual, AKI associated with transurethral resection of the prostate (TURP) syndrome and with rhabdomyolysis (RM) after radical prostatectomy have been frequently described. The purpose of this review is to discuss the current knowledge regarding the epidemiology, risk factors, outcomes, prevention, and treatment of AKI associated with prostatic surgery. The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.

RESUMO

Introdução: A HD está presente em aproximadamente 50% dos pacientes com OIV devido HPB e 30% dos casos não apresentarão melhora após o tratamento cirúrgico. Até o momento, nenhuma característica clínica pode predizer acuradamente quais pacientes serão beneficiados. Neste estudo nós analisamos o papel de seis marcadores moleculares na resolução da HD após a RTUP. Método: Um estudo prospectivo e controlado analisou 43 pacientes com OIV devido HPB, submetidos a RTUP de 2011 a 2012. O grupo controle foi composto por espécimes de músculo vesical de 10 pacientes com menos de 60 anos, submetidos a prostatectomia radical devido câncer de próstata, apresentando IPSS menor que 8 e volume prostático menor que 30 gramas. Todos os pacientes realizaram estudo urodinâmico no pré-operatório e com 6 meses de pós-operatório. Nós analisamos a presença, o período de início (primeira vs segunda metade do enchimento vesical) e a amplitude (< 40 vs > 40 cmH2O) das CVIs, assim como sua resolução após 6 meses de tratamento cirúrgico. Uma biópsia de músculo vesical foi efetuada no final da RTUP para análise do perfil de expressão gênica do NGF, NGFr, VEGF, CD-105, CHRM2 e CHRM3. Para este propósito foi utilizado a técnica de qRT-PCR. Além disso, correlacionamos variáveis clínicas pré-operatórias com a evolução da HD no pós-operatório. Resultados: A idade média dos pacientes foi 63 anos (50 a 75). A HD estava presente em 21 (48,8%) pacientes. De acordo com aferições pré-operatórias, a média de expressão gênica do NGF foi 3,3 vezes maior nos pacientes que iniciaram CVI precocemente quando comparados àqueles que iniciaram as contrações na fase final de enchimento vesical (p=0,047). A presença e a amplitude das CVIs não apresentaram correlações estatísticas com os genes estudados. Em relação a resolução da HD, a média de expressão de CHRM2 foi 2 vezes maior entre os pacientes que evoluíram com melhora da HD (p=0,072). Após 6 meses da RTUP, 77,8% dos pacientes que possuíam...

Objective: Non-inhibited contractions (NIC) are present in about 50% of patients with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) and 30% of cases persist after surgery. To date, no clinical characteristic can predict accurately which patients are going to improve. We analyzed the role of six detrusor molecular markers in the resolution of NIC after transurethral resection of the prostate (TURP). Methods: We performed a prospective and controlled analysis of 43 patients with BOO due to BPH who underwent TURP from 2011 to 2012. The control group comprised 10 bladder specimens from patients younger than 60 years who underwent radical prostatectomy with an IPSS < 8 and prostate volume < 30 grams. All patients underwent urodynamic analysis pre and post operatively after 6 months. We analyzed the presence, time to occurrence (first vs second half of the filling phase) and grade (<40 vs >40 cmH2O) of NIC as well as its resolution after 6 months of surgery. A biopsy of the bladder muscle was performed at the end of TURP for analysis of nerve growth factor receptor (NGFr), nerve growth factor (NGF), vascular endothelial growth factor (VEGF), endoglin (CD105), muscarinic cholinergic receptor 2 (CHRM2) and muscarinic cholinergic receptor 3 (CHRM3) genes expression. For this purpose, we used the quantitative real time polymerase chain reaction method (qRT-PCR). Results: Mean patient age was 63 years (50 to 75). NIC were present in 21 (48.8%) patients. According to pre-operative measures, NGF gene expression was 3.3 times greater in patients who presented early NIC as compared to those who presented late contractions (p=0.047). The presence or grade of NIC failed to present statistical correlations with the genes. With regard to the outcome, CHRM2 expression was 2.0 times greater among patients who presented resolution of NIC (p=0.072). After 6 months of TURP, 77,8% of patients with DO resolution had increased expression...

Assuntos

RESUMO

La resección transuretral de próstata es un procedimiento común para tratar patologías urinarias obstructivas benignas. Al material obtenido se le practica estudio histológico para confirmar la naturaleza benigna, pero en algunos casos se ha encontrado como hallazgo incidental un adenocarcinoma en estadios tempranos. No se sabe con claridad cuánto material debe procesarse o si la cantidad de tejido examinado aumenta la posibilidad de encontrar cáncer. El objetivo de este trabajo es determinar la frecuencia de adenocarcinoma incidental de próstata en pacientes sometidos a RTU por causa benigna. Reune 196 casos de RTU en los que se procesó en una segunda fase todo el tejido restante obtenido, describiendo las variables edad, peso del espécimen, número de láminas procesadas, niveles de PSA y categoría diagnóstica, la cual fue clasificada como negativa para maglinidad, PIN alto de grado y adenocarcinoma de próstata estadios T1a y T1b. Se encontró que la frecuencia de cáncer próstata en pacientes a quienes se les realizó RTU por hiperplasia prostática benigna en el Hospital de San José fue muy baja, dos pacientes de 71 y 80 años, además de otro que corresponde a una neoplasia intraepitelial de alto grado (PIN de AG) con niveles normales de PSA, lo que evidencia que la frecuencia es menor que la reportada en la literatura internacional.

Transurethral resection of the prostate (TURP) is a common procedure performed to treat benign urinary obstruction conditions. The specimen obtained undergoes hystologic work-up to confirm benign nature, but in some cases, an early-stage adenocarcinoma is found incidentally. It is not clearly known how much material must be processed or if the amount of tissue examined increases likelihood of finding cancer. The purpose of this work is to determine the frequency rate of incidental prostatic adenocarcinoma in patients who undergo TURP for a benign cause. It gathers 196 cases of TURP in which all the remaining tissue obtained underwent a second phase work-out, considering variables as age, weight of specimen, number of slides processed, PSA levels and diagnostic category, which was classified as negative for malignancy, high-grade prostatic intraepithelial neoplasia (PIN) and prostatic adenocarcinoma in stages T1a and T1b. It was evidenced that the frequency of prostate cancer in patients who underwent TURP for benign prostatic hyperplasia at the San José Hospital was very low, consisting of two patients 71 and 80 years old, as well as one that corresponds to a high-grade prostatic intraepithelial neoplasia (PIN of AG) with normal PSA levels, which evidences that our frequency rate is smaller than that reported in international literature.

Assuntos

RESUMO

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Assuntos