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Malshy K, Balen A, Golijanin B, Jentzsch M, Greenberg R, Kazal F, Glebocki R, Danaher K, Spence R, Hyams E, Golijanin D, Pareek G, Eaton S. Optimising postoperative care: Same-day discharge after transurethral resection of the prostate. J Perioper Pract 2024:17504589241251697. [PMID: 38785312 DOI: 10.1177/17504589241251697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
INTRODUCTION This study aims to assess the feasibility and safety of same-day discharge after transurethral resection of the prostate. MATERIALS AND METHODS Five years of records were retrospectively analysed. Length of stay categorised patients into Groups 1 (same-day discharge) and 2 (standard-length discharge). Logistic regression analysis was performed, controlling for clinicodemographic factors. Student's t-test compared continuous bladder irrigation and catheter dwell times. RESULTS A total of 459 patients were identified between 2016 and 2021, 280 in Group 1 and 179 in Group 2, with median ages of 71.0 (interquartile range 36-92) and 72.0 (interquartile range 47-101) years (p = 0.067), respectively. Same-day discharge rates notably increased post-2018 (p = 0.025). Median prostate tissue resected in Group 2 was 7.1g (3.4-12.4g) and in Group 1 was 4.9g (2.4-10.2g; p = 0.034). While continuous bladder irrigation >1 hour was significantly lower in Group 1 than Group 2 (96.8% versus 27.4%; p = 0.0001), catheter dwell times were comparable (70.1 and 70.8 hours, respectively). Control-adjusted results showed a 40% reduction in emergency department representation odds for Group 1 compared with Group 2 (odds ratio = 0.60; 95% confidence interval = 0.37-0.99; p = 0.04). Length of stay was not significantly associated with hospital readmissions (p = 0.11). Continuous bladder irrigation for <1 hour in Group 1 was associated with a reduced emergency department representation (odds ratio = 0.43; 95% confidence interval = 0.197-0.980) but not readmission (odds ratio = 0.413; 95% confidence interval = 0.166-1.104). CONCLUSIONS Same-day discharge post-transurethral resection of the prostate may be a viable and safe option for carefully selected patients.
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Affiliation(s)
- Kamil Malshy
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alejandra Balen
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Borivoj Golijanin
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Rachel Greenberg
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Frances Kazal
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Katherine Danaher
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ryland Spence
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Elias Hyams
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Dragan Golijanin
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Gyan Pareek
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Samuel Eaton
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
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Malshy K, Eigner E, Ochsner A, Morgan J, Nsair A, Golijanin B, Mullerad M. Transurethral Resection of the Prostate in Younger Men: Effectiveness and Long-term Outcomes. Rambam Maimonides Med J 2024; 15:RMMJ.10520. [PMID: 38717182 PMCID: PMC11065095 DOI: 10.5041/rmmj.10520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES This study aims to investigate the efficacy and outcomes of transurethral resection of the prostate (TURP) in the context of younger male patients. METHODS Males aged ≤55 who underwent TURP at Rambam Health Care Campus from January 2011 to August 2023 were retrospectively reviewed. Clinicodemographic characteristics, indications for surgery, uroflowmetry, pressure-flow study, and early and late postoperative outcomes were collected. Patients with urethral or bladder abnormalities were excluded. Chi-square and Fisher's exact tests were employed for bivariate analysis. RESULTS Inclusion criteria were met by 58 men who underwent TURP at a median age of 52 years (interquartile range [IQR] 49.5-54). Median prostate size was 35 mL (24.5-56), with median prostate-specific antigen of 1.4 ng/mL (0.65-3.1). A total of 60% of patients used α-blockers, and 19% used 5α-reductase inhibitors pre-surgery. Overall, 54 (93.1%) had severe lower urinary tract symptoms (LUTS), with 34 (59%) being predominantly emptying and 20 (35%) storage. Most surgeries were performed for refractory LUTS in 38 (66%), followed by urinary retention in 16 (28%). At 6 weeks, 57 (98%) patients were catheter-free. The maximum flow rate and residual volume showed significant improvement from a median of 6.85 mL/s to 17.9 mL/s (P<0.001), and from 120 mL to 10 mL (P=0.0142), respectively. Pathology revealed benign prostatic hyperplasia in 53 (91.4%), and inflammation in 5 (8.5%). A total of 13 auxiliary procedures were required in 12 patients (20.7%) during follow-up: 7 transurethral bladder neck incisions, 3 re-TURP, 1 meatus widening, and 1 patient required artificial urinary sphincter implantation followed by simple cystectomy for end-stage bladder. CONCLUSIONS In young men, TURP showed short-term gains in flowmetry and catheter removal rates, but a sustained need for subsequent procedures in the long run. In this unique population, patients should be carefully selected, and alternative, less aggressive, interventions should be considered.
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Affiliation(s)
- Kamil Malshy
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Etan Eigner
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
| | - Anna Ochsner
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - John Morgan
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ameer Nsair
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
| | - Borivoj Golijanin
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Amu OC, Affusim EA, Nnadozie UU, Nwachukwu CD. Outcome of transurethral resection of the prostate (TURP) using 5% dextrose water as irrigant. Niger J Clin Pract 2023; 26:1568-1574. [PMID: 37929537 DOI: 10.4103/njcp.njcp_278_23] [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] [Indexed: 11/07/2023]
Abstract
Background TURP remains the gold standard for simple prostatectomy presently. Different fluids have been used for irrigation while performing monopolar TURP. The choice of irrigation fluid depends on a lot of factors. Aim We sought to find out if the outcome of monopolar TURP using 5% dextrose water in our setting compares with findings in other studies using different fluids as irrigation fluid in monopolar TURP. Materials and Methods This was a prospective study of 220 patients who had monopolar TURP using 5% dextrose water as irrigation fluid from 2015 to 2020. Results The study was completed by 220 patients. The mean age was 66.25 yrs. The mean weight of prostate was 53.2 g, and mean resected weight was 30.10 g using a mean irrigation volume of 45.35 liters, 5% dextrose water over a mean resection time of 66.08 mins. The mean changes in International Prostate Symptom Score/quality of life score (IPSS/QOLS) were statistically significant. Early complications recorded were postoperative hematuria with clot retention (1.4%), urinary tract infection (UTI) (13.2%), and secondary hemorrhage (10%). TURP syndrome was not recorded. Late complications seen within 2 years follow-up were transient urinary incontinence (6.4%), urethral stricture (4.1%), and bladder neck contracture (2.3%). There was no repeat TURP for residual adenoma within this period. Conclusion TURP using 5% dextrose water has comparable outcomes to other irrigation fluids for monopolar TURP. It is a good alternative to any other irrigation fluid.
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Affiliation(s)
- O C Amu
- Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - E A Affusim
- Department of Surgery, College of Medicine, Odumegwu Ojukwu University Awka, Anambra, Nigeria
| | - U U Nnadozie
- Department of Surgery, Federal University Teaching Hospital, Abakiliki, Ebonyi, Nigeria
| | - C D Nwachukwu
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Obi AO, Odo C, Ogolo DE, Okeke CJ, Ulebe AO, Afogu EN. Open prostatectomy for benign prostatic hyperplasia: A critical analysis of patient presentation and surgical outcomes in a contemporary series. Niger J Clin Pract 2023; 26:1326-1334. [PMID: 37794546 DOI: 10.4103/njcp.njcp_55_23] [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] [Indexed: 10/06/2023]
Abstract
Background Open prostatectomy (OP) is still a valid treatment option for benign prostatic hyperplasia (BPH), but it needs to be constantly reevaluated in the context of minimally invasive treatments (MITs). Aim Our purpose is to present contemporary data on patient presentation and surgical outcomes of OP with which other OP series and MITs can be compared. Methods A retrospective study of all OP was carried out in our institution from January 2011 to December 2020. All patients had a thorough preoperative workup and optimization of comorbidities before surgery. Data were collected in a predesigned pro forma and analyzed. Results The mean age of the 148 patients studied was 66.2 (±7.9) yrs. The mean duration of symptoms before surgery was 32.2 (±33.7) mos. The mean preoperative prostate volume was 118.0 (±67.1) cm3. There was a 54.4% comorbidity rate with diabetes mellitus (DM) topping the list (16.0%). An incidental prostate cancer rate of 6.1% was found. The overall complication rate was 45.3%. Perioperative hemorrhage requiring blood transfusion (BT) was the most common complication (26.1%). There was no significant difference in age, duration of surgery, and prostrate volume between subjects with and without BT (P > 0.05). Wound infection was significantly associated with diabetes (P = 0.043, OR = 3.507, 95% CI = 1.042-11.805). The reoperation rate was 1.4%, and mortality rate was 0.7%. The International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, and post-void residual urine (PVR) volume were significantly improved (P < 0.001). Conclusion OP was found to be a safe and effective procedure for the relief of bladder outlet obstruction (BOO) secondary to BPH. However, it was associated with high morbidity and low reoperation rate.
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Affiliation(s)
- A O Obi
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi; Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi; Urology Department, Alpha Urology Centre, Enugu, Nigeria
| | - C Odo
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
| | - D E Ogolo
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
| | - C J Okeke
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
| | - A O Ulebe
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
| | - E N Afogu
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
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Soyster ME, Agarwal D, Slade A, Sahm E, Large T, Rivera M. Impact of American Society of Anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications. Prostate 2023; 83:316-322. [PMID: 36415930 DOI: 10.1002/pros.24463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTIONS The American Society of Anesthesiologists Physical Status Classification System (ASA) is a validated risk stratification method for patients undergoing surgery. There is an increased prevalence of benign prostatic hyperplasia and comorbidities in our aging population. The role of ASA related to postoperative complications in patients undergoing holmium laser enucleation of the prostate (HoLEP) has not been described. METHODS A review of our database was performed for patients who underwent HoLEP from July 2018 to December 2020. Patients were stratified based on ASA score. Preoperative, perioperative, and complication data were analyzed using SAS analytics software. RESULTS Of 472 patients undergoing HoLEP, 320 (67.8%) were ASA 3-4 patients. There was a statistically significant difference found in age (72.3 ± 9.8 vs. 69.1 ± 9.0 years, p < 0.001), body mass index (BMI) (29.0 ± 5.9 vs. 27.3 ± 4.2, p = 0.004), and use of antiplatelet/anticoagulant medications (14.6% vs. 2.6%, p < 0.001) in the ASA 3-4 group. There was no significant difference between prostate volume (p = 0.158) or catheter-dependent urinary retention (p = 0.376). No difference was found in enucleation time (52.76 ± 24.8 vs. 54.16 ± 23.7 min, p = 0.587), OR specimen weight (70.24 ± 58.5 vs. 81.53 ± 65.9, p = 0.094). or intraoperative complications (2.8% vs. 1.3%, p = 0.330). There were higher postoperative complications in the ASA 3-4 group (12.8% vs. 7.9%, p = 0.03), but no difference in Clavien ≥3 complications (p = 0.068). ASA 3-4 patients had similar postoperative international prostate symptom score (p = 0.159). CONCLUSION HoLEP is feasible and effective in patients who are ASA 3-4. The high-risk cohort had an increased rate of low-grade complications. Patients with an ASA score of 3-4 should be counseled regarding a higher rate of low-grade complications.
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Affiliation(s)
- Mary E Soyster
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Deepak Agarwal
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Austen Slade
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Erica Sahm
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
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Burtt G, Springate C, Martin A, Woodward E, Zantek P, Al Jaafari F, Muir G, Misrai V. The Efficacy and Safety of Laser and Electrosurgical Transurethral Procedures for the Treatment of BPO in High-Risk Patients: A Systematic Review. Res Rep Urol 2022; 14:247-257. [PMID: 35757198 PMCID: PMC9215288 DOI: 10.2147/rru.s361956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). Methods We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints. Results A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP. Conclusions Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.
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Affiliation(s)
| | | | - Alison Martin
- Reviews Department, Crystallise Ltd, Essex, UK
- Correspondence: Alison Martin, Director and Head of Reviews, Crystallise Ltd, 17 High Street, Stanford-le-Hope, Essex, SS17 0HD, United Kingdom, Tel +44 1268 543470, Email
| | | | | | | | - Gordon Muir
- King's College Hospital NHS Trust, London, UK
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Mbaeri TU, Abiahu JA, Obiesie EA, Odo C, Oranusi KC, Nwofor AME, Orakwe JC. Assessment of Complications of Transurethral Resection of the Prostate Using Clavien-Dindo Classification in South Eastern Nigeria. Niger J Surg 2020; 26:142-146. [PMID: 33223813 PMCID: PMC7659755 DOI: 10.4103/njs.njs_20_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia is one of the most common diseases in aging males. For men that need surgical treatment, transurethral resection of the prostate (TURP) is the gold standard. The aim of this article is to retrospectively review the complications of TURP over a 3-year period in Nnamdi Azikiwe University Teaching Hospital Nnewi and a Specialist Urology Center in Awka all in Anambra South-East Nigeria using Clavien-Dindo classification. PATIENTS AND METHODS The study was a retrospective review of consecutive TURPs done over a 3-year period. Patients' information and complications arising from the procedure were collected and graded using the Clavien-Dindo classification with a pro forma designed for the study and analyzed with the Statistical Package for the Social Sciences software version 20.0. RESULTS Ninety-seven patients had TURP during the period of this study. Twenty-nine complications were noted in 24 patients. The postoperative morbidity rate was 24.74%, and no mortality was recorded. Most of the complications were grade 2 (55%), followed by grade 1 and 3 (20.69%) each. Grade 4a complication accounted for only 3.45%. No grade 5 complication was recorded. CONCLUSION TURP is safe, with minimal life-threatening morbidity even in a resource-poor economy where TURP is gradually gaining grounds.
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Affiliation(s)
- Timothy Uzoma Mbaeri
- Department of Surgery, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Joseph Amauzo Abiahu
- Department of Surgery, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | | | - Chinonso Odo
- Department of Surgery, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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