Urethrocystography during and after transurethral prostatic resection

Volume determinations of the whole prostate and of adenomas by transrectal ultrasound in patients with clinically benign prostatic hyperplasia: correlation of resected weight, blood loss and duration of operation

OBJECTIVE

To study whether transrectal ultrasound (TRUS) volume determinations of the whole prostate and of the adenomas alone correlate to resected weight, operation time and blood loss in patients operated upon with transurethral resection of the prostate because of presumed benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

The whole prostate and the transition zone, which corresponds to the adenomas, were measured separately in 159 patients with presumed BPH, pre-operatively and 4 months post-operatively.

RESULTS

The transition zone volume correlated well with the resected weight (r = 0.91; P < 0.0001), the blood loss (r = 0.67; P < 0.0001) and the operation time (r = 0.67; P < 0.0001). Four months post-operatively a reduction of the total prostate volume was recorded which corresponded well with the resected weight (r = 0.91; P < 0.0001).

CONCLUSION

TRUS with high resolution 7 MHz probes successfully estimated the size of the whole prostate and that of the adenomas alone. The transition zone volume predicted the expected resection weight of adenomas and to some extent the duration of the operation and the blood loss. These calculations may be used for more accurate pre-operative planning. Together with its superior detection rate for prostate cancer, TRUS seems to be a powerful tool in the pre-operative morphological assessment of patients with prostatism.

Transurethral electroresection of prostatic adenoma. Early results

In 1972 and 1973 all together 186 men were operated upon with transurethral electroresection of prostatic adenoma. During the period no adenomectomies were performed by "open" methods. All the patients were operated upon by one surgeon. The early results of the operation were analysed. The operation appeared to imply only a very small strain on the patients. None of the men died during their stay in hospital. The men spent on the average 5 days in hospital after the operation. This figure includes those men in whom the adenoma removed was large, i.e. 88 cases in which the operative specimens weighed 30 to 124 g. The need of blood transfusions was small during and after the operation. Transfusions were never necessary in those cases where the operative specimens were small. In the 88 cases where specimens were large 25% required blood transfusion. Most patients had urinary incontinence for a few days to four months after the operation. They were afterwards all continent except 4 who were completely incontinent postoperatively. In all of these cases incontinence was due, at least partly, to cerebral lesions. It is claimed that with the irrigation fluid used, i.e. isotonic water solution of sorbitol and acetic acid, there is no need to limit the operation time and therefore not the size of the adenomas which can be resected. The surgeon can work quietly and without haste until the entire adenoma has been removed.