Transurethral vapor resection of prostate is a good alternative for prostates >70 g

Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis

PURPOSE AND OBJECTIVE

To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP).

METHODS

A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle-Ottawa Scale, respectively.

RESULTS

62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10-0.22), 0.09 (95% CI 0.04-0.19 and 0.10 (95% CI 0.06-0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04-4.62) and TURP (RR 2.40, 95% CI 1.03-5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities.

CONCLUSION

PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.

Low-pressure monopolar electroresection of the prostate for glands sized > 70 vs. < 70 cc performed with continuous irrigation and suprapubic suction: perioperative and long-term outcome

Purpose

To evaluate long-term efficacy and safety of low-pressure transurethral resection of the prostate for prostates < 70 cc (group 1) vs. > 70 cc (group 2).

Patients and methods

In this study patients operated with monopolar TURP between 2009 and 2012 were evaluated retrospectively. During surgery a specially designed trocar (18 Fr) was placed suprapubically and connected to a suction pump to maintain stable low-pressure conditions. After sample size calculations, long-term follow-up was completed for 70 invited patients in each group up to 9/2015.

Results

Follow-up period was 57 vs. 56 months for group 1 and 2, respectively (p = 0.56). At baseline there was no significant difference in age, IPSS, peak flow, and post void residual (PVR). Mean prostate volume was 47 cc (15–65) vs. 100 cc (70–163). Mean operating time was 55.4 vs. 82.6 min (p = 0.00). Blood transfusion was necessary in 0.0 vs. 2.9% (p = 0.16), and 0.0 vs. 1.4% developed TUR syndrome (p = 0.32). At follow-up mean relative improvement in IPSS was 63 vs. 57% (p = 0.29), QoL 64 vs. 64% (p = 0.93), peak flow 139 vs. 130% (p = 0.85), and PVR 58 vs. 63% (p = 0.80). Long-term complications included recurring adenoma in 1.4 vs. 4.3% (p = 0.31), and stricture in 7.2 vs. 5.8% (p = 0.73). 1 patient in each group reported worsening incontinence symptoms.

Conclusions

In terms of safety and efficacy, the aforementioned modality of standardized monopolar TURP using suprapubic suction was non-inferior for prostates > 70 cc compared to the same procedure for prostates < 70 cc. This technique is a potential low-cost alternative for clinics that cannot afford modern laser approaches.

Study register number

DRKS00006527.

Plasmakinetic vaporization versus transurethral resection of the prostate: Six-year results

OBJECTIVE

Benign prostate hyperplasia (BPH) is becoming more prevalent in parallel to the changing demographic structures of the community. Transurethral resection is still considered the most effective treatment. Due to advances in technology, different treatment modalities are being attempted. In our study, we compared the long-term results of standard transurethral resection of prostate (TURP) with plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK).

MATERIAL AND METHODS

Of the 75 patients who were admitted to our outpatient clinic between 2001 and 2003 with lower urinary tract complaints and who were randomized into two groups (transurethral resection (TUR) and PKVP), 36 were enrolled to study and completed a follow-up period of 72 months.

RESULTS

Both groups were equal in terms of age and preoperative parameters. The preoperative maximum uroflow rate (Qmax) in the PKVP group was 6 (2.3) mL/s and the rates were 21.8 (3.4) and 20.1 (3.1) during the control visits at 36 and 72 months, respectively. For the PKVP group, these rates were 6 (3.1), 14.4 (2.6), and 15.6 (2.8), respectively. In terms of the international prostate symptom score (IPSS), for the TUR group, these values were 22 (3.8), 5.7 (1.2), and 7.9 (2.6). For the PKVP group, the respective values were 21 (3.4), 7.6 (1.4), and 11 (2.4). The IPSS and Qmax values measured at the 36(th) and 72(nd) months for both groups were significantly different from each other (p<0.05).

CONCLUSION

Compared to standard TURP, PKVP was found to be unsuccessful in the treatment of BPH when long-term outcomes were considered.

Living status in patients over 85 years of age after TUVRP

INTRODUCTION

To evaluate surgical risk and post-operative quality of living status in patients over 85 years of age after transurethral vaporization resection of the prostate (TUVRP).

METHODS

Sixty patients over 85 years of age underwent TUVRP were compared with 228 patients less than the age of 80 years. Group A was 60 patients greater than 85 years of age, Group B was 137 patients from 71 to 79 years of age, and Group C was 91 patients from 60 to 70 years of age.

RESULTS

In Group A, pre-operative ASA grade was higher than the other two groups, compared with Group C, p < 0.01. Operating time was 40.03 ± 18.90 min, compared in the three groups, p > 0.05. Follow-up was obtained in 49 (81.67%) patients; of them 10 patients were deaths with a survival time of 22.90 ± 11.14 months. In the 39 survivors, post-operative IPSS score was 11.17 ± 6.9, compared with Group B, p > 0.05 and Group C, p < 0.01. Quality of Life (QOL) index was 1.11 ± 0.80, compared with Group B, p < 0.001 and Group C, p < 0.01. Barthel Index score in 16 patients was >60 and the score was 82.81 ± 8.56 pre-operatively. The patients with >60 were increased to 19 cases and the score was improved to 90.93 ± 7.58 (p < 0.001) in follow-up.

CONCLUSION

Surgical risk in patients over 85 years of age was higher than patients less than the age of 80 years. A safety TUVRP could improve their voiding function and activities of daily living.

Management of large prostatic adenoma: Lasers versus bipolar transurethral resection of prostate

Transurethral resection of prostate (TURP) has long been the most commonly performed surgical procedure for the management of benign prostate enlargement (BPE), but has several associated limitations. Over the years, laser techniques have developed as major contenders as alternative therapies for BPE. However, simultaneously, TURP has also flourished and with relatively recent development of resection in saline (bipolar TURP), the tussle between laser techniques and TURP has further gained momentum. A systematic search was performed on Medline using the various Medical subject headings related to the surgical management of BPE including TURP, bipolar, lasers, holmium laser enucleation of prostate (HoLEP), photo-selective vaporization of prostate (PVP), etc., All articles types including meta-analysis randomized controlled trials, review articles, guidelines from various urological associations, single center studies from 2002 onward were considered for review. Bipolar TURP, HoLEP, and PVP provide equivalent outcomes for large prostate adenoma (<60 g). For extremely large glands (<150 g), HoLEP is a very efficacious endoscopic alternative to open prostatectomy and has proven long-term results over more than a decade. Bipolar TURP and PVP are attractive with a minimal learning curves and equivalent short term durability. Surgical management of large prostate should be individualized based upon patient's comorbidities and surgeon's expertise.

[Endoscopic prostate resection by bipolar gyrus resector for prostates over 80 ml: our experience after a 12-month follow-up]

INTRODUCTION

The open surgery approach is the gold standard for the treatment of prostatic adenoma with a volume over 80 mL.

PATIENTS AND METHODS

We studied 180 patients from June 2004 to June 2011, affected by prostatic adenoma >80 mL, and who underwent endoscopic resection performed with bipolar technique by a single operator. We considered the following data: surgery duration, bleeding, absorption of irrigating fluids, resected tissue quantity, clinical stay, and catheterization time. Resections up to the surgical capsule were performed with bipolar Gyrus resector and the fragments were collected with prostate Ellik-type conveyor. Next step was the positioning of the bladder catheter with cystoclysis. We evaluated early and late complications and performed clinical reassessment of the patients at 1, 3, 6 and 12 months.

RESULTS

Surgery average time was 118 min. The average resected tissue volume was 92 g. The post-surgery hemoglobin was 13.2 g/dL. In 15 patients a revision of the lodge was performed within 24 hours after resection; no blood transfusions were performed. The catheter was removed after 3.2 days and the average recovery time was 4 days. There were eight cases of cicatricial stenosis of the bladder neck treated with endoscopic laparotomy. There were no cases of post-TURP syndrome. The IPSS parameters varied from 20.7 to 3.8, the IIEF5 from 19.3 to 21.2. The average QoL decreased from 4 to 1.5, Qmax from 22.2 7.7 mL/sec. The total PSA values decreased from 6.39 ng/mL to 1.0 ng/mL.

CONCLUSIONS

TURP for prostatic adenomas greater than 80 mL in volume, is a valid alternative in terms of efficacy and safety to open surgery, considered the gold standard treatment.

Effect of ageing on the efficacy efficiency of TUVRP

INTRODUCTION

To evaluate the effect of ageing on the efficacy of transurethral vaporization resection of the prostate (TUVRP).

METHODS

The clinical outcomes of 285 patients treated by TUVRP were retrospectively analyzed. Patients were divided into three groups by age, Group A with 91 patients less than ≤70 years of age, Group B with 127 patients from 71 to 79 years of age, and Group C with 67 patients greater than ≥80 years of age.

RESULTS

Prostate volume was 53.1 ± 24.1 ml in Group A, 67.8 ± 39.7 ml in Group B and 60.0 ± 43.9 ml in Group C (p < 0.001). More co-existent systemic diseases were identified in Group C than in the other two groups (p < 0.001). American Society of Anesthesiologists (ASA) grade increased with age (p < 0.001). Urological comorbidities associated with BPH, operating time, IPSS score, and QOL index were not different among the three groups. A significant difference was observed in before and after surgery IPSS score, QOL index, and maximum urinary flow rate (Qmax), in all three groups (p < 0.05). Post-operative Qmax decreased with age (p < 0.05).

CONCLUSION

TUVRP was safe and effective for the patients greater than 80 years of age, similarly to younger patients. Advanced aged was not a contraindication for surgery, and did not increase the difficulty of the procedure.

Lasers are superfluous for the surgical management of benign prostatic hyperplasia in the developing world

Lasers have been given much hype as regards their use in surgical management of benign prostatic hyperplasia (BPH). Transurethral resection of prostate (TURP), especially with its modifications still remains the gold standard treatment for BPH, owing to its efficacy and proven advantages over laser prostatectomy. Cost, unproven long-term durability, steep learning curve, and no advantages of laser prostatectomy over TURP and its modifications, make lasers superfluous in the surgical management of BPH in developing countries.

Photoselective vaporization of the prostate using the 120-W lithium triborate laser in enlarged prostates (>120 cc)

OBJECTIVE • To evaluate experience with high power LBO laser for large prostates

PATIENTS AND METHODS

• Prospective database of 288 men treated with PVP from November 2006-2009 • 33 men identified to have transrectal ultrasound measured prostate size >120 cc • All but 9 men not in urinary retention or on anticoagulant medications • Average ASA Score 2.25 (range 1-4) with 11 having an ASA Score of 3 or more

RESULTS

• Mean operating time and laser time 109 and 86 minutes respectively • IPSS, QoL and Qmax changes from baseline to 3 months for those not in retention were 24 to 8.6, 5.0 to 1.8 and 7.5 mL/s to 19.6 mL/s respectively • Post void residual in these men fell from a mean of 235 mL to 88 mL • Average fall in PSA was 38% for 22 men with paired PSA data • Post operative urinary retention in 4 men resolved. 2 late onset clot urinary retention

CONCLUSION

• Early results demonstrate PVP to be safe and efficacious on early follow up in a high risk group of patients with significantly enlarged prostates, anticoagulation and urinary retention.