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Patankar SB, Narkhede MM, Padasalagi G, Thakare K. Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept. Asian J Urol 2024; 11:466-472. [PMID: 39139541 PMCID: PMC11318446 DOI: 10.1016/j.ajur.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/15/2023] [Indexed: 08/15/2024] Open
Abstract
Objective To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. Methods One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. Results A total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. Conclusion Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.
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Affiliation(s)
- Suresh B. Patankar
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
| | - Mayur M. Narkhede
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
| | - Gururaj Padasalagi
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
| | - Kashinath Thakare
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
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Dey A, Mamoulakis C, Hasan N, Yuan Y, Shakil A, Omar MI. Emerging Technologies for the Surgical Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Obstruction. A Systematic Review. Eur Urol Focus 2024; 10:400-409. [PMID: 37741783 DOI: 10.1016/j.euf.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
CONTEXT Surgical management of lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) aims at ablating prostate adenoma by resection, enucleation, or vaporisation. Apart from established ablation modes according to the European Association of Urology guidelines, various technologies have emerged as safe/effective alternatives but remain under investigation. OBJECTIVE To explore short-term benefits/harms of emerging technologies for surgical management of LUTS/BPO. EVIDENCE ACQUISITION A systematic literature search was conducted using MEDLINE, EMBASE, and CENTRAL via Ovid up to June 18, 2022. We included randomised controlled trials (RCTs) exploring aquablation, prostatic arterial embolisation (PAE), Rezum, prostatic urethral lift (PUL), and temporary implantable nitinol device (iTIND) versus sham/transurethral resection of the prostate (TURP). EVIDENCE SYNTHESIS We included ten RCTs (1108 men). Aquablation versus TURP: insignificant change in International Prostate Symptoms Score (IPSS; mean difference [MD] 0.0, 95% confidence interval [CI] -2.44 to 2.44), quality of life (QoL; MD 0.30, 95% CI -0.81 to 0.21), maximum urinary flow rate (Qmax; MD -0.30, 95% CI -3.71 to 3.11), retreatment (risk ratio [RR] 0.18, 95% CI 0.02-1.66), and urinary incontinence (UI; RR 0.71, 95% CI 0.26-1.95). PAE versus monopolar TURP (M-TURP): insignificant change in IPSS (MD 3.33, 95% CI -28.39 to 35.05), QoL (MD 0.12, 95% CI -0.30 to 0.54), International Index of Erectile Function (IIEF-5; MD 3.07, 95% CI -1.78 to 7.92), and UI (RR 0.15, 95% CI 0.01-2.86), and significant change in Qmax (MD -9.52, 95% CI -14.04 to -5.0), favouring M-TURP. PAE versus bipolar TURP: insignificant change in IPSS (MD -2.80, 95% CI -6.61 to 1.01), QoL (MD -0.69, 95% CI -1.46 to 0.08), Qmax (MD -3.51, 95% CI -8.08 to 1.06), UI (RR 0.14, 95% CI 0.01-2.51), and retreatment (RR 1.91, 95% CI 0.19-19.63). PUL versus TURP: insignificant change in QoL (MD 0.40, 95% CI -0.29 to 1.09), UI (RR 0.13, 95% CI 0.02-1.05), and retreatment (RR 0.48, 95% CI 0.12-1.86), and significant change in IPSS (MD 3.40, 95% CI 0.22-6.58), and IIEF-5 (MD 3.00, 95% CI 0.41-5.59) and Qmax (MD -9.60, 95% CI -13.44 to -5.76), favouring PUL and TURP, respectively. Rezum and iTIND have not been evaluated in RCTs against TURP to date. CONCLUSIONS Supporting evidence for clinical use of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits/harms should be investigated further in high-quality RCTs. PATIENT SUMMARY This review summarises the evidence for the clinical use of aquablation, prostatic arterial embolisation (PAE), prostatic urethral lift (PUL), Rezum, and temporary implantable nitinol device (iTIND) to manage lower urinary tract symptoms secondary to benign prostatic obstruction. The supporting evidence for the clinical usage of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits and harms should be investigated further in high-quality randomised controlled trials.
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Affiliation(s)
- Anirban Dey
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | | | - Yuhong Yuan
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ambreen Shakil
- Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, UK
| | - Muhammad Imran Omar
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Guidelines Office, European Association of Urology, Arnhem, The Netherlands.
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B-TURP versus HoLEP: Peri-Operative Outcomes and Complications in Frail Elderly (>75 y.o.) Patients: A Prospective Randomized Study. Biomedicines 2022; 10:biomedicines10123212. [PMID: 36551968 PMCID: PMC9776283 DOI: 10.3390/biomedicines10123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The aim of this study was to compare the peri-operative and functional results between trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) in middle-old patients. Materials and Methods: This prospective single-center study included patients over 75 years old treated with B-TURP or HoLEP for BPH associated with LUTS with prostate volume (PV) <100 mL. Primary endpoints were the intra-operative blood loss, percentage of loss of hemoglobin, blood transfusion, complications, and the comparison of functional outcomes. All patients were evaluated at 1, 3, 6, and 12 months of follow-up. Results: Overall, 96 patients undergoing HoLEP and 104 B-TURP were eligible and enrolled for the study. Post-operative results showed statistically significant differences between the two groups, all in favor of HoLEP group, specifically in terms of removed prostate tissue, PV reduction rate, hemoglobin values at 24 h, hemoglobin loss, operative time, length of hospitalization, days of catheterization, and urinary flow rates. There was no significant difference in terms of postvoid residual urine volume, perioperative complication, blood transfusion, International Prostate Symptom Score (IPSS), and IPSS quality of life scores. Conclusions: In middle-old patients, the HoLEP technique represents a prostate size-independent treatment option with a more favorable safety profile defined by less bleeding, lower blood transfusions, and a significantly lower hemoglobin drop than B-TURP.
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Mannem S, Mallikarjuna C, Bhavatej E, Taif NBM, Ravichander O, Syed MG. Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study. Indian J Urol 2022; 38:146-150. [PMID: 35400870 PMCID: PMC8992716 DOI: 10.4103/iju.iju_228_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/30/2021] [Accepted: 02/09/2022] [Indexed: 11/04/2022] Open
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Fukazawa T, Ito H, Takanashi M, Shinoki R, Tabei T, Kawahara T, Keeley FX, Drake MJ, Kobayashi K. Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study. PLoS One 2021; 16:e0261586. [PMID: 34914804 PMCID: PMC8675650 DOI: 10.1371/journal.pone.0261586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background To investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml. Materials and methods 100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml. Results 17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed. Conclusions This is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.
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Affiliation(s)
- Takeshi Fukazawa
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroki Ito
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail:
| | - Masato Takanashi
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Risa Shinoki
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tadashi Tabei
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takashi Kawahara
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Francis X. Keeley
- Bristol Medical School and Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Marcus J. Drake
- Bristol Medical School and Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Kazuki Kobayashi
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
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Sharma G, Sharma AP, Mavuduru RS, Bora GS, Devana SK, Singh SK, Mandal AK. Safety and efficacy of bipolar versus monopolar transurethral resection of bladder tumor: a systematic review and meta-analysis. World J Urol 2020; 39:377-387. [PMID: 32318856 DOI: 10.1007/s00345-020-03201-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Transurethral resection of bladder tumor is the standard of care for the management of patients with bladder mass. Primary objective of this study was to compare safety and efficacy of the two energy modalities used for TURBT (monopolar and bipolar). MATERIALS AND METHODS Systematic literature search of various electronic databases was conducted to include all the randomized studies comparing two groups. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019139987). RESULTS In the present review, eight RCTs including 1147 patients were included. Resection time, hospital stay and catheter duration were significantly shorter with bipolar group. There was no significant difference in incidence of obturator reflex (OR 0.65, CI [0.35, 1.2], p = 0.17), whereas incidence of bladder perforation was significantly higher in the monopolar group (6.4% versus 3.3%, p = 0.01. However, sensitivity analysis including 3 high quality studies revealed equal incidence of bladder perforations. Need for blood transfusion was similar in the two groups but fall in hemoglobin was significantly lower in bipolar group (MD - 0.45 CI [- 0.72, - 0.18], p = 0.0009). Bipolar group was found to have significantly lower incidence of tissue artifacts due to thermal energy on pathological examination (OR 0.27 CI [0.15, 0.47], p < 0.00001). CONCLUSIONS Bipolar and monopolar devices are equally safe in terms of obturator jerk and bladder perforation. Bipolar group was significantly better as compared to monopolar for hospital stay, catheter duration and fall in hemoglobin; however, the clinical relevance of most of these parameters is little.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Aditya Prakash Sharma
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India.
| | - Ravimohan S Mavuduru
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Girdhar Singh Bora
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Sudheer K Devana
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Shrawan K Singh
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Arup K Mandal
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
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Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N'Dow JMO, Chen C, Lam TBL. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 2019; 12:CD009629. [PMID: 31792928 PMCID: PMC6953316 DOI: 10.1002/14651858.cd009629.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is a well-established surgical method for treatment of men with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). This has traditionally been provided as monopolar TURP (MTURP), but morbidity associated with MTURP has led to the introduction of other surgical techniques. In bipolar TURP (BTURP), energy is confined between electrodes at the site of the resectoscope, allowing the use of physiological irrigation medium. There remains uncertainty regarding differences between these surgical methods in terms of patient outcomes. OBJECTIVES To compare the effects of bipolar and monopolar TURP. SEARCH METHODS A comprehensive systematic electronic literature search was carried out up to 19 March 2019 via CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, PubMed, and WHO ICTRP. Handsearching of abstract proceedings of major urological conferences and of reference lists of included trials, systematic reviews, and health technology assessment reports was undertaken to identify other potentially eligible studies. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared monopolar and bipolar TURP in men (> 18 years) for management of LUTS secondary to BPO. DATA COLLECTION AND ANALYSIS Two independent review authors screened the literature, extracted data, and assessed eligible RCTs for risk of bias. Statistical analyses were undertaken according to the statistical guidelines presented in the Cochrane Handbook for Systematic Reviews of Interventions. The quality of evidence (QoE) was rated according to the GRADE approach. MAIN RESULTS A total of 59 RCTs with 8924 participants were included. The mean age of included participants ranged from 59.0 to 74.1 years. Mean prostate volume ranged from 39 mL to 82.6 mL. Primary outcomes BTURP probably results in little to no difference in urological symptoms, as measured by the International Prostate Symptom Score (IPSS) at 12 months on a scale of 0 to 35, with higher scores reflecting worse symptoms (mean difference (MD) -0.24, 95% confidence interval (CI) -0.39 to -0.09; participants = 2531; RCTs = 16; I² = 0%; moderate certainty of evidence (CoE), downgraded for study limitations), compared to MTURP. BTURP probably results in little to no difference in bother, as measured by health-related quality of life (HRQoL) score at 12 months on a scale of 0 to 6, with higher scores reflecting greater bother (MD -0.12, 95% CI -0.25 to 0.02; participants = 2004; RCTs = 11; I² = 53%; moderate CoE, downgraded for study limitations), compared to MTURP. BTURP probably reduces transurethral resection (TUR) syndrome events slightly (risk ratio (RR) 0.17, 95% CI 0.09 to 0.30; participants = 6745; RCTs = 44; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 20 fewer TUR syndrome events per 1000 participants (95% CI 22 fewer to 17 fewer). Secondary outcomes BTURP may carry a similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01 to 4.06; participants = 751; RCTs = 4; I² = 0%; low CoE, downgraded for study limitations and imprecision), compared to MTURP. This corresponds to four fewer events of urinary incontinence per 1000 participants (95% CI five fewer to 16 more). BTURP probably slightly reduces blood transfusions (RR 0.42, 95% CI 0.30 to 0.59; participants = 5727; RCTs = 38; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 28 fewer events of blood transfusion per 1000 participants (95% CI 34 fewer to 20 fewer). BTURP may result in similar rates of re-TURP (RR 1.02, 95% CI 0.44 to 2.40; participants = 652; RCTs = 6; I² = 0%; low CoE, downgraded for study limitations and imprecision). This corresponds to one more re-TURP per 1000 participants (95% CI 19 fewer to 48 more). Erectile function as measured by the International Index of Erectile Function score (IIEF-5) at 12 months on a scale from 5 to 25, with higher scores reflecting better erectile function, appears to be similar (MD 0.88, 95% CI -0.56 to 2.32; RCTs = 3; I² = 68%; moderate CoE, downgraded for study limitations) for the two approaches. AUTHORS' CONCLUSIONS BTURP and MTURP probably improve urological symptoms, both to a similar degree. BTURP probably reduces both TUR syndrome and postoperative blood transfusion slightly compared to MTURP. The impact of both procedures on erectile function is probably similar. The moderate certainty of evidence available for the primary outcomes of this review suggests that there is no need for further RCTs comparing BTURP and MTURP.
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Affiliation(s)
- Cameron Edwin Alexander
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Malo MF Scullion
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
- European Association of UrologyArnhemNetherlands
| | - Yuhong Yuan
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1280 Main Street WestRoom HSC 3N51HamiltonONCanadaL8S 4K1
| | - Charalampos Mamoulakis
- University General Hospital of Heraklion, University of Crete Medical SchoolDepartment of UrologyHeraklion, CreteGreece
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal InfirmaryUrology DepartmentForesterhillAberdeenScotlandUKAB25 2ZN
| | - Changhao Chen
- Sun Yat‐Sen Memorial Hospital, Sun Yat‐Sen UniversityDepartment of Urology107 Yan‐Jiang RoadGuangzhouChina
| | - Thomas BL Lam
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
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Subrata SA, Istanti YP, Kesetyaningsih TW. Nursing assessment of TURP syndrome: a pilot study. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2018. [DOI: 10.1111/ijun.12158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sumarno A. Subrata
- PhD Student in Nursing, Mahidol University, Thailand; Nursing Lecturer, Faculty of Health Sciences; Muhammadiyah University of Magelang; Indonesia
| | - Yuni P. Istanti
- Sp.Kep.MB (Master of Nursing) Department of Nursing, Faculty of Medicine and Health Sciences; Universitas Muhammadiyah Yogyakarta; Indonesia
| | - Tri W. Kesetyaningsih
- Associate Professor, Department of Medicine, Faculty of Medicine and Health Sciences; Universitas Muhammadiyah Yogyakarta; Indonesia
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Nunes RLV, Antunes AA, Constantin DS. Contemporary surgical treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:711-716. [PMID: 28977110 DOI: 10.1590/1806-9282.63.08.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
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Affiliation(s)
- Ricardo Luís Vita Nunes
- Head of the Benign Prostatic Hyperplasia Department, Sociedade Brasileira de Urologia (SBU). Assistant Physician, Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Head of the Urology Clinic, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Associate Professor, Division of Urology, Head of the Urology Graduate Program, and Coordinator of the Prostate Sector, Division of Urology, FMUSP, São Paulo, SP, Brazil
| | - Davi Souza Constantin
- Preceptor of Urology, Centro de Referência do Homem do Hospital de Transplantes Euryclides de Jesus Zerbini. MD, Urologist, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
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Abou-Taleb A, El-Shaer W, Kandeel W, Gharib T, Elshaer A. Bipolar Plasmakinetic Enucleoresection of the Prostate: Our Experience with 245 Patients for 3 Years of Follow-Up. J Endourol 2017; 31:300-306. [PMID: 28073286 DOI: 10.1089/end.2016.0746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the safety, feasibility, and effectiveness of bipolar transurethral plasmakinetic enucleation of the prostate (PKEP). PATIENTS AND METHODS Between January 2010 and October 2013, 245 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent transurethral enucleation of prostate using bipolar plasma vaporization energy. Patients were evaluated preoperatively by full detailed history, routine preoperative investigation digital rectal examination, serum prostate-specific antigen, abdominal and transrectal ultrasonography, and maximum flow rates (Qmax). RESULTS Patients' ages ranged from 50 to 81 (65.5 ± 6) years with transrectal ultrasound-measured prostate volume of 97.1 ± 36.7 mL resulting in an operating time of 76.9 ± 27.9 minutes, and postoperative irrigation and catheterization times were 3.5 ± 3.2 and 12.7 ± 6.1 hours, respectively. No significant complication occurred intra- or postoperatively. Qmax increased from 7.1 ± 3.2 mL/second preoperative to 18.4 ± 4.2 mL/second (p < 0.001). The International Prostate Symptom Score decreased from 25 ± 6 to 7.9 ± 2.4 (p < 0.01). CONCLUSION This study confirmed that PKEP is a safe, easy to learn, and durable technique suitable for any prostate sizes.
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Affiliation(s)
| | - Waleed El-Shaer
- Department of Urology, Banha University Hospital , Banha, Egypt
| | - Wael Kandeel
- Department of Urology, Banha University Hospital , Banha, Egypt
| | - Tarek Gharib
- Department of Urology, Banha University Hospital , Banha, Egypt
| | - Alaa Elshaer
- Department of Urology, Banha University Hospital , Banha, Egypt
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11
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Avallone MA, Sack BS, El-Arabi A, Charles DK, Herre WR, Radtke AC, Davis CM, See WA. Ten-Year Review of Perioperative Complications After Transurethral Resection of Bladder Tumors: Analysis of Monopolar and Plasmakinetic Bipolar Cases. J Endourol 2017; 31:767-773. [PMID: 28557554 DOI: 10.1089/end.2017.0056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the rate of perioperative complications after plasmakinetic bipolar and monopolar transurethral resection of bladder tumor (BTURB and MTURB). In addition, the study identifies patient and procedure characteristics associated with early complications. PATIENTS AND METHODS Retrospective review was conducted on patients undergoing transurethral resection of bladder tumor procedures at a single institution from 2003 to 2013 to assess the 30-day complication rates associated with BTURB and MTURB. RESULTS Four hundred twenty-seven patients met inclusion criteria and underwent 586 procedures (379 BTURB and 207 MTURB). Baseline patient demographics, tumor stage, and tumor grade were similar in BTURB and MTURB cohorts. The overall complication rate was 34.3% for MTURB and 26.7% for BTURB. The most frequent complications were acute urinary retention (AUR) 11%, hematuria 8%, and urinary tract infection (UTI) 7%. There was no statistical difference in rates of AUR, hematuria, UTI, or readmission for continuous bladder irrigation or hemostasis procedures between BTURB and MTURB cohorts. There was a trend toward lower perforation rate during BTURB (2.6% vs 5.8%). In multivariate logistic regression analysis, MTURB, male gender, and large resections were predictive of overall complications. Male gender was associated with hematuria and AUR. Large bladder tumor resection size was also associated with increased risk of overall complications and AUR. CONCLUSION BTURB was associated with a lower risk of overall complications, but there was no difference in the rate of hematuria in the two cohorts. Male gender and large tumor size are associated with higher risk of early complications.
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Affiliation(s)
- Michael A Avallone
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Bryan S Sack
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Ahmad El-Arabi
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - David K Charles
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - William R Herre
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew C Radtke
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Carley M Davis
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - William A See
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
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12
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Tan GH, Shah SA, Ali NM, Goh EH, Singam P, Ho CCK, Zainuddin ZM. Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate. Investig Clin Urol 2017; 58:186-191. [PMID: 28480344 PMCID: PMC5419110 DOI: 10.4111/icu.2017.58.3.186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to determine the urethral stricture (US) rate and identify clinical and surgical risk factors associated with US occurrence after transurethral resection of the prostate using the bipolar Gyrus PlasmaKinetic Tissue Management System (PK-TURP). MATERIALS AND METHODS This was an age-matched case-control study of US occurrence after PK-TURP. Retrospective data were collected from the hospital records of patients who had a minimum of 36 months of follow-up information. Among the data collected for analysis were prostate-specific antigen level, estimated prostate weight, the amount of prostate resected, operative time, history of urinary tract infection, previous transurethral resection of the prostate, and whether the PK-TURP was combined with other endourological procedures. The resection rate was calculated from the collected data. Univariate and multivariate analyses were performed to identify clinical and surgical risk factors related to US formation. RESULTS A total of 373 patients underwent PK-TURP between 2003 and 2009. There were 13 cases of US (3.5%), and most of them (10 of 13, 76.9%) presented within 24 months of surgery. Most of the US cases (11 of 13, 84.6%) occurred at the bulbar urethra. Multivariable logistic regression analyses identified slow resection rate as the only risk factor significantly associated with US occurrence. CONCLUSIONS The US rate of 3.5% after PK-TURP in this study is comparable to contemporary series. A slow resection rate seems to be related to US occurrence. This should be confirmed by further studies; meanwhile, we must be mindful of this possibility when operating with the PK-TURP system.
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Affiliation(s)
- Guan Hee Tan
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurayub Md Ali
- Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Eng Hong Goh
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Praveen Singam
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Zulkifli Md Zainuddin
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Gielchinsky I, Pode D, Duvdevani M, Yutkin V, Landau EH, Hidas G, Gofrit ON. The Transparency of Irrigation Fluids Used in Endoscopic Surgery. J Endourol 2017; 31:701-704. [PMID: 28385032 DOI: 10.1089/end.2016.0894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Transurethral surgery has been traditionally done using the nonelectrolyte, isotonic 1.5% glycine solution as irrigation fluid. The emergence of modern technologies, which can be applied with electrolyte solutions, such as bipolar resection and LASER evaporation, as well as the worry of transurethral resection (TUR) syndrome have driven urologists away from glycine toward the use of physiologic solution. Differences in the transparencies of these fluids have not been studied. MATERIALS AND METHODS The ability to resolve two bars at 1 mm apart using a 30° cystoscope lens immersed in different solutions was studied. Physiologic solution, distilled water (DW), and 1.5% glycine solutions containing increasing concentrations of blood, from 0.5% to 2%, were tested. Solutions containing 2% blood were inspected with magnification and microscopy. RESULTS One-millimeter resolution was reached in as much as 2% blood in 1.5% glycine solution and as much as 1% blood in DW, but in none of the blood-saline solutions. Magnified and microscopic views of 2% blood solutions showed an even distribution of red blood cells (RBCs) in physiologic solution, clumps of RBCs in 1.5% glycine, and an almost complete hemolysis in DW. CONCLUSIONS Glycine solution increases the transparency compared to physiologic solution or DW owing to the clumping of RBCs. When the risk of TUR syndrome is low, as in resection of bladder tumors or small prostates, we propose that 1.5% glycine solution should be preferred over saline, owing to its improved visibility.
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Affiliation(s)
- Ilan Gielchinsky
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
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Prospective randomized study comparing monopolar with bipolar transurethral resection of prostate in benign prostatic obstruction: 36-month outcomes. World J Urol 2017; 35:1595-1601. [DOI: 10.1007/s00345-017-2023-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/11/2017] [Indexed: 11/26/2022] Open
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15
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[S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia]. Urologe A 2016; 55:195-207. [PMID: 26518304 DOI: 10.1007/s00120-015-3983-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.
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Elsakka AM, Eltatawy HH, Almekaty KH, Ramadan AR, Gameel TA, Farahat Y. A prospective randomised controlled study comparing bipolar plasma vaporisation of the prostate to monopolar transurethral resection of the prostate. Arab J Urol 2016; 14:280-286. [PMID: 27900218 PMCID: PMC5122807 DOI: 10.1016/j.aju.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare the safety and efficacy of bipolar transurethral plasma vaporisation (B-TUVP) as an alternative to the ‘gold standard’ monopolar transurethral resection of the prostate (M-TURP) for the treatment of benign prostatic hyperplasia (BPH) in a prospective randomised controlled study. Patients and methods In all, 82 patients indicated for prostatectomy were assigned to two groups, group I (40 patients) underwent B-TUVP and group II (42 patients) underwent M-TURP. The safety of both techniques was evaluated by reporting perioperative changes in serum Na+, serum K+, haematocrit (packed cell volume), and any perioperative complications. For the efficacy assessment, patients were evaluated subjectively by comparing the improvement in International Prostate Symptom Score and objectively by measuring the maximum urinary flow rate (Qmax) and post-void residual urine volume (PVR) before and after the procedures. Results In group II, there was a significant perioperative drop in serum Na+ (from 137.5 to 129.4 mmol/L) and haematocrit (from 42.9% to 38.2%) (both P < 0.001). Moreover, one patient in group II had TUR syndrome. The remote postoperative complication rate was (15%) in group I and comprised of stress urinary incontinence (5%), bladder outlet obstruction (5%), and residual adenoma (5%). In group II, the remote postoperative complication rate was (4.8%), as two patients developed urethral stricture. There were statistically significant improvements in micturition variables postoperatively in both arms, but the magnitude of improvement was statistically more significant in group II. Conclusion B-TUPV seems to be safer than M-TURP; however, the lack of a tissue specimen and the relatively high retreatment rate are major disadvantages of the B-TUVP technique. Moreover, M-TURP appears to be more effective than B-TUPV and its safety can be improved by careful case selection and adequate haemostasis.
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Affiliation(s)
| | | | | | | | | | - Yasser Farahat
- Sheikh Khalifa General Hospital, Dubai, United Arab Emirates
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17
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Bipolar Button Transurethral Enucleation of Prostate in Benign Prostate Hypertrophy Treatment: A New Surgical Technique. Urology 2015; 86:407-13. [DOI: 10.1016/j.urology.2015.03.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/29/2015] [Accepted: 03/31/2015] [Indexed: 01/24/2023]
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18
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Abdallah MM, Badreldin MO. A short-term evaluation of the safety and the efficacy of bipolar transurethral resection of the prostate in patients with a large prostate (>90 g). Arab J Urol 2015; 12:251-5. [PMID: 26155365 PMCID: PMC4487266 DOI: 10.1016/j.aju.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of bipolar transurethral resection of the prostate (TURP) in patients with a large prostate (>90 g), as a significant recent modification of TURP is the incorporation of bipolar technology, which uses the same technique as monopolar TURP but with normal saline as the irrigant. PATIENTS AND METHODS Forty patients with a prostate of >90 g and who were considered at risk for monopolar TURP were treated by bipolar TURP. The operative duration, resection time, resected tissue weight, resection rate, resection ratio, amount of irrigation fluid used, the decrease in intraoperative haemoglobin level, haematocrit and serum sodium levels, and the blood loss were recorded. The follow-up data were analysed. RESULTS The mean (SD) operative duration was 116.3 (25.52) min, the resection time was 106.5 (25.69) min, the resected volume was 78.9 (20.58) g, the decrease in haemoglobin levels was 1.67 (0.46) g/dL, the mean serum sodium decline was 2.60 (0.68) mmol/L, and the blood loss was 532 (101.2) mL. The blood loss/g of resected tissue was 6.85 (0.70) mL. The mean (SD) postoperative bladder irrigation time was 2.0 (0.32) days, the catheterisation time was 3.25 (0.55) days and the postoperative hospital stay was 3.25 (0.55) days. CONCLUSION Bipolar technology makes it possible to use TURP to treat patients with very large prostates and who are at risk when treated by the standard monopolar technology, with a satisfactory safety profile and with favourable efficacy.
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Affiliation(s)
- Mohamed M Abdallah
- Urology Department, Menoufiya University Hospital, Menoufiya University, Egypt
| | - Mohamed O Badreldin
- Urology Department, Menoufiya University Hospital, Menoufiya University, Egypt
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19
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Bipolar Transurethral Resection of the Prostate: Darwinian Evolution of an Instrumental Technique. Urology 2015; 85:1143-1150. [DOI: 10.1016/j.urology.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 12/31/2014] [Accepted: 01/03/2015] [Indexed: 11/21/2022]
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20
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Bipolar Versus Monopolar Transurethral Resection of the Prostate: A Prospective Randomized Trial Focusing on Bleeding Complications. J Urol 2015; 193:1371-5. [DOI: 10.1016/j.juro.2014.08.137] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 11/22/2022]
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21
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Falahatkar S, Mokhtari G, Moghaddam KG, Asadollahzade A, Farzan A, Shahab E, Ghasemi A, Allahkhah A, Esmaeili S. Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP. Int Braz J Urol 2015; 40:346-55. [PMID: 25010300 DOI: 10.1590/s1677-5538.ibju.2014.03.08] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/04/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80 mL, serum PSA < 4 ng/mL, IPSS ≥ 20, Qmax ≤ 10 mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. RESULTS Both groups were similar in patient age, prostate volume, preoperative IPSS and Qmax. The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Qmax. But the TUVP group had significantly lower IPSS and higher Qmax than TURP group. CONCLUSIONS Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | | | - Ahmad Asadollahzade
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Alireza Farzan
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Elaheh Shahab
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Ali Ghasemi
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Aliakbar Allahkhah
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
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Plasmakinetic Enucleation of the Prostate vs Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia: Comparison of Outcomes According to Prostate Size in 310 Patients. Urology 2014; 84:904-10. [DOI: 10.1016/j.urology.2014.06.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/25/2014] [Accepted: 06/20/2014] [Indexed: 12/15/2022]
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23
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The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients. Int Urol Nephrol 2014; 46:2071-7. [PMID: 25134941 DOI: 10.1007/s11255-014-0803-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (>65 years) has not ever been studied before. PATIENTS AND METHODS A retrospective analysis of patients' medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic™ (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed. RESULTS Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11-38), 22.1 ± 11.2 (R: 11-59) months, respectively (p < 0.001). When compared with SP, mean catheter removal time (p < 0.001) and median hospitalization time (p < 0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p < 0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p < 0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p > 0.05). Thirty-three patients had perioperative complications according to the modified Clavien-Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy. CONCLUSIONS BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month's results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.
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Tang Y, Li J, Pu C, Bai Y, Yuan H, Wei Q, Han P. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol 2014; 28:1107-14. [PMID: 24754254 DOI: 10.1089/end.2014.0188] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of monopolar (M-TURP) and bipolar (B-TURP) transurethral resection of the prostate in benign prostatic hypertrophy (BPH) patients. MATERIALS AND METHODS Eligible randomized controlled trials (RCTs) were identified from electronic databases without language restrictions. Database search, quality assessment, and data extraction were independently performed. The primary postoperative outcomes of topical M-TURP and B-TURP were maximum flow rate (Qmax) and/or International Prostate Symptom Score (IPSS). Safety was estimated by TUR syndrome; need for transfusion; clot retention; bladder neck contracture (BNC); urethral stricture (US); and catheter removal time. Efficacy and safety were investigated using the Review Manager. RESULTS Thirty-one trials met the inclusion criteria. Pooled analysis revealed significant difference in efficacy between the M-TURP and B-TURP groups. Safety analysis revealed significant improvement in the TUR syndrome with B-TURP than with M-TURP. Pooled analysis revealed that clot retention was significantly higher in M-TURP than in B-TURP. Moreover, pooled analysis revealed no significant difference between both groups in the blood transfusion frequency or late complications (urethral strictures) and bladder neck constriction. CONCLUSIONS This systematic review indicates that B-TURP was significantly better in the result of Qmax and for decreasing the incidence of TUR syndrome and clot retention. No significant differences were observed in the nature of adverse events such as transfusions, retention after catheter removal, and urethral complications between both groups. Thus, B-TURP is the next generation "gold standard" for benign prostatic obstruction (BPO) because it is associated with a lower rate of clinically relevant complications such as TUR syndrome and clot retention.
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Affiliation(s)
- Yin Tang
- Department of Urology, West China Hospital, Sichuan University , Chengdu, P.R. China
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25
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Mamoulakis C, Sofras F, de la Rosette J, Omar MI, Lam TBL, N'Dow JMO, Ubbink DT. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd009629.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Charalampos Mamoulakis
- University Hospital of Heraklion, University of Crete Medical School; Department of Urology; Heraklion Crete Greece
| | - Frank Sofras
- University Hospital of Heraklion, University of Crete Medical School; Department of Urology; Heraklion Crete Greece
| | - Jean de la Rosette
- Academic Medical Center, University of Amsterdam; Department of Urology; Amsterdam Netherlands
| | - Muhammad Imran Omar
- University of Aberdeen; Academic Urology Unit; Health Sciences Building (second floor) Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - Thomas BL Lam
- University of Aberdeen; Academic Urology Unit; Health Sciences Building (second floor) Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal Infirmary; Urology Department; Foresterhill Aberdeen Scotland UK AB25 2ZN
| | - Dirk T Ubbink
- Academic Medical Centre, University of Amsterdam; Quality Assurance & Process Innovation, and Department of Surgery; J1b-215 Academic Medical Centre Meibergdreef 9, PO Box 22700 Amsterdam Netherlands 1100 DE
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Kramer MW, Abdelkawi IF, Wolters M, Bach T, Gross AJ, Nagele U, Conort P, Merseburger AS, Kuczyk MA, Herrmann TRW. Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer. MINIM INVASIV THER 2014; 23:206-13. [DOI: 10.3109/13645706.2014.880065] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shum CF, Mukherjee A, Teo CPC. Catheter-free discharge on first postoperative day after bipolar transurethral resection of prostate: Clinical outcomes of 100 cases. Int J Urol 2013; 21:313-8. [DOI: 10.1111/iju.12246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 07/08/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Cheuk Fan Shum
- Department of Urology; Khoo Teck Puat Hospital; Singapore
| | - Amit Mukherjee
- Department of Urology; Khoo Teck Puat Hospital; Singapore
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Park SK, Cho WJ, Choi YS. Fluid extravasation caused by bladder perforation during bipolar transurethral resection using saline solution -a case report-. Korean J Anesthesiol 2013; 65:163-6. [PMID: 24024001 PMCID: PMC3766784 DOI: 10.4097/kjae.2013.65.2.163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/20/2012] [Accepted: 12/22/2012] [Indexed: 11/10/2022] Open
Abstract
Transurethral resection of the prostate is the gold standard in the operative management of benign prostatic hyperplasia. Bipolar transurethral resection of the prostate using saline solution is a safe technique and reduces the risk of transurethral resection syndrome. This report discusses a rare complication of bipolar transurethral resection of the prostate: the extravasation of 0.9% saline solution into intraperitoneal and retroperitoneal cavities due to bladder perforation, resulting in respiratory difficulties.
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Affiliation(s)
- Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
| | - Woo-Jin Cho
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
| | - Yun-Suk Choi
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
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Mamoulakis C, Ubbink DT, Sofras F, N'Dow JMO, de la Rosette JJMCH. Re: Huang et al.: Bipolar transurethral resection of the prostate causes deeper coagulation depth and less bleeding than monopolar transurethral prostatectomy (Urology 2012;80:1116-1120). Urology 2013; 81:1113-5. [PMID: 23608435 DOI: 10.1016/j.urology.2013.01.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 11/28/2022]
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Mamoulakis C, Schulze M, Skolarikos A, Alivizatos G, Scarpa RM, Rassweiler JJ, de la Rosette JJ, Scoffone CM. Midterm Results from an International Multicentre Randomised Controlled Trial Comparing Bipolar with Monopolar Transurethral Resection of the Prostate. Eur Urol 2013; 63:667-76. [DOI: 10.1016/j.eururo.2012.10.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
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Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int 2013; 112:109-20. [DOI: 10.1111/j.1464-410x.2012.11662.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andreas Skolarikos
- Second Department of Urology; Sismanoglio Hospital; University of Athens Medical School; Athens; Greece
| | - Michael Schulze
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn; Germany
| | - Cesare M. Scoffone
- Department of Urology, San Luigi Hospital; University of Turin; Orbassano; Turin; Italy
| | - Jens J. Rassweiler
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn; Germany
| | - Gerasimos Alivizatos
- Second Department of Urology; Sismanoglio Hospital; University of Athens Medical School; Athens; Greece
| | - Roberto M. Scarpa
- Department of Urology, San Luigi Hospital; University of Turin; Orbassano; Turin; Italy
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[Transurethral resection of the prostate and current modifications (bipolar, electrovaporization)]. Urologe A 2013; 52:331-8. [PMID: 23459921 DOI: 10.1007/s00120-012-3088-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transurethral resection of the prostate (TURP) is the surgical standard which is truly minimally invasive by using a natural orifice and is also of durable efficacy. The use of TURP removes tissue from benign prostatic hyperplasia (BPH) and leads to clinically relevant improvement in symptoms and quality of life as well as in micturition parameters and obstruction. Tissue is removed by high frequency (HF) current with synchronous hemostasis. Many modifications of TURP, such as the use of video, have become generally accepted and improved the standard. Other modifications were developed because the balance between cutting and hemostasis needed improvement in favor of hemostasis. Several modifications of TURP, such as modulation of HF pulses, band loops and bipolar resection and new procedures, such as vaporization and enucleation showed improved hemostasis. These modifications and procedures, however, have not yet replaced standard TURP but have become established as additional options.
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Xiong W, Sun M, Ran Q, Chen F, Du Y, Dou K. Learning Curve for Bipolar Transurethral Enucleation and Resection of the Prostate in Saline for Symptomatic Benign Prostatic Hyperplasia: Experience in the First 100 Consecutive Patients. Urol Int 2013; 90:68-74. [DOI: 10.1159/000343235] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022]
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[Endoscopic prostate resection by bipolar gyrus resector for prostates over 80 ml: our experience after a 12-month follow-up]. Urologia 2012; 79 Suppl 19:30-6. [PMID: 23371270 DOI: 10.5301/ru.2012.9735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 11/20/2022]
Abstract
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.
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Peng B, Yao MH, Wu R, Xie J, Xu HX. The clinical value of sonourethrography after bipolar transurethral plasmakinetic prostatectomy. MINIM INVASIV THER 2012; 22:122-6. [PMID: 22924472 DOI: 10.3109/13645706.2012.713365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bo Peng
- Department of Urology, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Ming-Hua Yao
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Rong Wu
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Juan Xie
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
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Xie CY, Zhu GB, Wang XH, Liu XB. Five-year follow-up results of a randomized controlled trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate. Yonsei Med J 2012; 53:734-41. [PMID: 22665339 PMCID: PMC3381470 DOI: 10.3349/ymj.2012.53.4.734] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/26/2011] [Accepted: 10/04/2011] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To report the 5-year follow-up results of a randomized controlled trial comparing bipolar transurethral resection of the prostate (TURP) with standard monopolar TURP for the treatment of benign prostatic obstruction (BPO). MATERIALS AND METHODS A total of 220 patients were randomized to bipolar plasmakinetic TURP (PK-TURP) or monopolar TURP (M-TURP). Catheterization time was the primary endpoint of this study. Secondary outcomes included operation time, hospital stay, as well as decline in postoperative serum sodium and hemoglobin levels. All patients were assessed preoperatively and followed-up at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Parameters assessed included quality of life, transrectal ultrasound, serum prostate-specific antigen level, postvoid residual urine volume, maximum urinary flow rates (Q(max)), and International Prostate Symptom Score. Patient baseline characteristics, perioperative data including complications, and postoperative outcomes were compared. Complication occurrence was graded according to the modified Clavien classification system. RESULTS PK-TURP was significantly superior to M-TURP in terms of operation time, intraoperative irrigation volume, resected tissue weight, decreases in hemoglobin and sodium, postoperative irrigation volume and time, catheterization time, and hospital stay. At 5 years postoperatively, efficacy was comparable between arms. No differences were detected in safety outcomes except that the clot retention rate was significantly greater after M-TURP. CONCLUSION Our results indicate that PK-TURP is equally as effective in the treatment of BPO, but has a more favorable safety profile in comparison to M-TURP. The clinical efficacy of PK-TURP is long-lasting and comparable with M-TURP.
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Affiliation(s)
- Chang-Ying Xie
- Department of Urology, Daqing Oilfields General Hospital, Daqing, Heilongjiang, China
| | - Guang-Bin Zhu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Urology, Daqing Oilfields General Hospital, Daqing, Heilongjiang, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiang-Bin Liu
- Department of Urology, Daqing Oilfields General Hospital, Daqing, Heilongjiang, China
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Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ. REPLY. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11234_2.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ. REPLY. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11001_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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39
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Introducing a Large Animal Model to Create Urethral Stricture Similar to Human Stricture Disease: A Comparative Experimental Microscopic Study. J Urol 2012; 187:1101-9. [DOI: 10.1016/j.juro.2011.10.132] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Indexed: 12/11/2022]
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40
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Mamoulakis C, Sofras F, de la Rosette J, Omar MI, Lam TBL, N'Dow JMO, Ubbink DT. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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41
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Sharib J, Truntzer J, Young J, Jordan G, Gelman J. Panurethral stricture after photovaporization of the prostate for benign prostatic hyperplasia. J Endourol 2011; 26:520-3. [PMID: 22201339 DOI: 10.1089/end.2011.0527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report the development of panurethral stricture disease and other lower urinary tract abnormalities as a complication of photovaporization of the prostate (PVP). PATIENTS AND METHODS We evaluated three patients who were referred for the treatment of urethral stricture disease after PVP. Evaluation included antegrade cystoscopy, urethroscopy, retrograde urethrography, and cystourethrography. RESULTS All three patients had panurethral stricture disease, and a low capacity bladder with bilateral vesicoureteral reflux had developed in one patient as a complication of PVP. CONCLUSIONS Although not previously reported, a potential complication of PVP is devastating panurethral stricture disease.
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Affiliation(s)
- Jeremy Sharib
- Department of Urology, University of California, Irvine, Orange, California 92868, USA
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42
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Metcalfe C, Poon KS. Long-term results of surgical techniques and procedures in men with benign prostatic hyperplasia. Curr Urol Rep 2011; 12:265-73. [PMID: 21484456 DOI: 10.1007/s11934-011-0193-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with the aging male. Surgical management of lower urinary tract symptoms attributed to BPH has progressed over time as urologic surgeons search for more innovative and less invasive forms of treatment. Transurethral resection of the prostate (TURP) has long been the "gold standard" to which all other forms of treatment are compared. There are several different methods of surgical treatment of BPH, including whole gland enucleation/intact removal, vaporization, and induction of necrosis with delayed reabsorption as well as hybrid techniques. As with any form of surgical intervention, long-term results define success. Long-term follow-up consists of examining overall efficacy with attention to associated adverse events. TURP has the luxury of the longest follow-up, while less invasive forms of treatment starting to acquire long-term data. There are several surgical options for BPH; newer methods do show promise, while the "gold standard" continues to demonstrate excellent surgical results.
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Affiliation(s)
- Charles Metcalfe
- Department of Urologic Sciences, University of British Columbia, Richmond, BC, Canada
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43
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Muslumanoglu AY, Yuruk E, Binbay M, Akman T. Transurethral resection of prostate with plasmakinetic energy: 100 months results of a prospective randomized trial. BJU Int 2011; 110:546-9. [DOI: 10.1111/j.1464-410x.2011.10770.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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44
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Homma Y, Gotoh M, Yokoyama O, Masumori N, Kawauchi A, Yamanishi T, Ishizuka O, Seki N, Kamoto T, Nagai A, Ozono S. JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol 2011. [DOI: 10.1111/j.1442-2042.2011.02861.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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45
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Zhu G, Xie C, Wang X, Tang X. Bipolar plasmakinetic transurethral resection of prostate in 132 consecutive patients with large gland: three-year follow-up results. Urology 2011; 79:397-402. [PMID: 22035765 DOI: 10.1016/j.urology.2011.08.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/15/2011] [Accepted: 08/27/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the safety, efficacy, and medium-term durability of bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia in a prospective study. METHODS From March 2007 to May 2008, 132 consecutive patients underwent PK-TURP at our institution. All patients were assessed perioperatively and followed up at 1, 3, 6, 12, 18, 24, and 36 months postoperatively. The parameters included the International Prostate Symptom Score, quality of life scores, maximal urinary flow rates, transrectal ultrasonography, postvoid residual urine volume, and serum prostate-specific antigen level. RESULTS The mean patient age was 64.55±4.03 years. The prostate volume was 79.66±12.36 g. The operative time was 78.83±17.41 minutes, and the resected weight was 58.12±7.29 g. The catheterization time was 69.00±17.99 hours, and the hospital stay was 117.00±17.99 hours. The decrease in hemoglobin and sodium was 1.55±0.48 g/dL and 1.57±0.38 mmol/L, respectively. A significant improvement occurred in the maximal urinary flow rate (22.34±3.1 mL/s), International Prostate Symptom Score (2.90±1.60), and quality of life (1.12±0.60) at the 3-year follow-up compared with baseline (P<.001). Of the 132 patients, 6 (4.5%) required reoperation. CONCLUSION PK-TURP represents an effective surgical intervention for the treatment of bladder outlet obstruction for large prostates. Furthermore, the functional results at 3 years demonstrated durability. Therefore, the PK-TURP technique could play an important role in the surgical treatment of patients with symptomatic benign prostatic hyperplasia with a large prostate gland.
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Affiliation(s)
- Guangbin Zhu
- Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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46
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Tremp M, Hefermehl L, Largo R, Knönagel H, Sulser T, Eberli D. Electrosurgery in urology: recent advances. Expert Rev Med Devices 2011; 8:597-605. [PMID: 22026625 DOI: 10.1586/erd.11.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inadequate hemostasis is one of the most important causes of morbidity and mortality following urological surgery. Despite the long-term usage of coagulation, there is an ongoing development of new devices, including bipolar transurethral resection of the prostate or new vessel-sealing devices. A thorough understanding of the advantages and disadvantages of these new instruments can improve the operative experience for both the urologist and patient. The optimal coagulation system should be small, efficient, easy to handle and with low heat spread. In this article, we analyze different electrothermal coagulation systems and modern tissue-sealing devices in urological applications with the aim to substantiate the advantages and disadvantages of each technique in terms of efficacy and safety.
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Affiliation(s)
- Mathias Tremp
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, CH-8091 Zurich, Switzerland
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47
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Ebbing J, Schostak M, Steiner U, Stier K, Neymeyer J, Miller K, Baumunk D. Novel low-cost prostate resection trainer-description and preliminary evaluation. Int J Med Robot 2011; 7:367-73. [DOI: 10.1002/rcs.407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2011] [Indexed: 11/08/2022]
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48
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Mamoulakis C, Skolarikos A, Schulze M, Scoffone CM, Rassweiler JJ, Alivizatos G, Scarpa RM, de la Rosette JJ. Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJU Int 2011; 109:240-8. [DOI: 10.1111/j.1464-410x.2011.10222.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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49
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Huang X, Shi HB, Wang XH, Zhang XJ, Chen B, Men XW, Yu ZY. Bacteriuria After Bipolar Transurethral Resection of the Prostate: Risk Factors and Correlation With Leukocyturia. Urology 2011; 77:1183-7. [DOI: 10.1016/j.urology.2010.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 08/10/2010] [Accepted: 08/13/2010] [Indexed: 11/27/2022]
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50
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Michielsen DPJ, Coomans D. Urethral strictures and bipolar transurethral resection in saline of the prostate: fact or fiction? J Endourol 2010; 24:1333-7. [PMID: 20583960 DOI: 10.1089/end.2009.0575] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the incidence of urethral strictures after monopolar transurethral resection of the prostate (TURP) and bipolar transurethral resection in saline (TURIS) for symptomatic benign prostatic hyperplasia. PATIENTS AND METHODS Between January 2005 and January 2009, 518 patients with symptomatic benign prostate hyperplasia underwent either monopolar or bipolar resection. In a randomized trial, the incidence of urethral strictures after both treatment modalities was analyzed. RESULTS Over 48 months, 255 patients were treated with conventional TURP and 263 patients with TURIS. Patient related, operation, and hospitalization characteristics were similar in both groups. After a mean follow-up of 32.1 months (range 50-7 months), the incidence of urethral strictures was 2.4% in the TURP group. After a comparable period of 31.4 months (range 50-7 months), the incidence in the TURIS group was 1.5%. No statistically significant difference was obtained (P = 0.539). These values were compared with the results of other randomized controlled trials with the same or other bipolar technology. No statistically significant difference in urethral structures was noticed between monopolar and bipolar resections (P = 0.739). CONCLUSIONS With a stricture incidence of 1.5%, bipolar transurethral prostate resection has a low stricture rate, comparable with monopolar TURP (2.4%).
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