Comparison of the efficacy and safety of transurethral laser versus open prostatectomy for patients with large-sized benign prostatic hyperplasia: A meta-analysis of comparative trials

Leiomyoma of the prostate: A case report and literature review

RATIONALE

Prostate leiomyoma is a rare condition globally, often challenging to diagnose preoperatively, with most cases being definitively identified through postoperative pathology. This benign tumor generally has a good prognosis and is primarily treated with transurethral resection of the prostate in clinical settings. However, there are no established guidelines or therapeutic protocols for managing this disease.

PATIENT CONCERNS

The patient was admitted to our hospital's Department of Urology with complaints of hematuria, urinary frequency, and urgency for 1 month. Pelvic computed tomography revealed an irregular, mass-like high-density shadow posterior to the bladder, indistinctly separated from the prostate. The patient had been diagnosed with renal insufficiency during a physical examination 4 years prior but had not received standardized treatment. Six years ago, the patient underwent electrocision of the prostate at our hospital, and postoperative pathology indicated prostate leiomyoma.

DIAGNOSES

Postoperative pathology confirmed a diagnosis of prostate leiomyoma.

INTERVENTIONS

The patient presented with an enlarged prostate and preoperative hematuria. Holmium laser enucleation of the prostate (HoLEP) was performed. The Foley catheter was removed on the second postoperative day, and the patient was discharged 3 days after surgery.

OUTCOMES

Following discharge, the patient was instructed to undergo reexaminations every 6 months. Current follow-up indicates the patient is in good health, with no recurrence of the mass observed.

LESSONS

Prostate leiomyoma is an extremely rare condition, and the current primary approach for managing prostate smooth muscle tumors involves active patient monitoring, regular evaluations, and timely surgical intervention if clinical symptoms emerge. In this study, we present a new case report of prostatic smooth muscle tumor and review the existing literature to explore treatment options for prostate leiomyoma within this field.

Sudden cardiac arrest in low-risk patient during transurethral resection of the prostate under spinal anesthesia: Acute myocardial infraction a possible cause? Case report

INTRODUCTION AND IMPORTANCY

A patient experienced a sudden cardiac arrest (CA) during a transurethral resection of the prostate (TURP) under spinal anesthesia (SA), despite no conventional risk factors. The incident, which occurred during TURP without significant changes in vital signs or electrocardiogram (ECG), this report, contributes to accidents during SA for TURP in healthy patients.

PRESENTATION OF CASE

A 53-year-old man with BMI 24.1 underwent TURP. SA was administered using bupivacaine 15 mg and fentanyl 10 μg. The patient had normal vital signs & sinus rhythm. However, around a hr. into the procedure, he experienced fatigue, severe chest pain, sweating, & nausea, leading to unconsciousness & CA. The anesthesia and surgical teams initiated cardiopulmonary resuscitation according to American Heart Association guidelines, but CA could not be reversed.

CLINICAL DISCUSSION

The patient showed symptoms of acute MI while undergoing TURP but didn't exhibit typical changes on ECG. Early detection using a 5‑lead ECG or troponin level may not be possible so make it challenging to get definitive diagnosis of MI to start managements. It's highlighted that some individuals might not meet standard MI diagnostic criteria.

CONCLUSION

Diagnosing MI using only a 5-lead ECG can be challenging, as some patients may not exhibit MI findings. Modern monitors that numerically display ST segment depression, along with the availability of continuous 12‑lead ECG in the operating theater, can improve emergency detection. In resource-limited countries, adopting new protocols for MI management is crucial. These protocols should include initiating MI treatments even without a confirmed diagnosis.

The thermal effect of lasers in urology: a review article

Lasers as a technology have a leading role in the modern urological treatment armamentarium. In this article, the application of lasers in different areas of urology is described. The major uses are in urolithiasis, benign prostatic enlargement (BPE), and management of many urological malignancies and other benign pathologies. Lasers have become an established treatment modality in urolithiasis, an acceptable alternative with the least side effect profile in BPE patients, and a novel and promising therapy in many other fields of Urology.

Transurethral versus open enucleation of the prostate in Sweden - a retrospective comparative cohort study

OBJECTIVE

To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical open prostate enucleation (OPE), in patients with benign prostatic obstruction (BPO) > 80 ml in a population in Sweden.  Methods: 54 patients with ultrasound verified BPO > 80 ml and indication for surgery underwent TUEP or OPE between 2013 and 2019. Peri- and postoperative outcome variables regarding voiding efficiency and morbidity from 20 OPE at Skåne University Hospital (SUS) and from the first 34 TUEP performed at SUS and Ystad Hospital were retrospectively assembled. Follow-up data from the first 6 postoperative months were collected by chart review.

RESULTS

Intraoperative bleeding during TUEP was less than in OPE (225 ml vs. 1,000 ml). TUEP took longer surgery time than OPE (210 vs. 150 min.). Within 30 days postoperatively, bleeding occurred less often after TUEP (23% vs. 40%), requiring one fourth of the blood transfusions given after OPE. After TUEP, patients had shorter hospitalisation (3 days vs. 7 days) and catheterisation time (3 days vs. 12 days). During the 6-month follow-up period, incontinence and UTI defined as symtomatic significant bacteriuria (urinary culture) were observed as main complications after TUEP and OPE. Functional outcome data availability (International Prostate Symptom Score [IPSS] questionnaire, uroflowmetry, residual urine) were limited.

CONCLUSIONS

Treatment with TUEP during the learning curve led to less bleeding, shorter hospitalisation- and catheterisation time than treatment with OPE. However, surgery time was shorter with OPE. There were no major differences between the groups concerning mid-term functional outcomes, with the reservation of an inconsistent follow-up.

Prostatic Leiomyoma: An Uncommon Diagnosis Found in Clinically Suspected Cases of Severe Benign Prostatic Hyperplasia Without Elevated Serum Total Prostate-Specific Antigen Levels

Leiomyomas of the prostate are uncommon benign tumors. We report the case of a 67-year-old man who underwent an emergent, open prostatectomy for symptomatic relief of clinically severe benign prostatic hyperplasia (BPH). Ultrasound showed a severe prostatic enlargement with urinary tract obstruction. Gross pathology findings showed a 134-g prostate gland containing a 2.5-cm-long, well-circumscribed lesion. Histological findings showed a bland, smooth muscle neoplasm with positive staining for smooth muscle markers. No necrosis, nuclear atypia, or mitoses are identified. In such cases, gross and microscopic examination of adequately sampled lesions is necessary to assure a conclusive diagnosis and to exclude overt stromal malignancies, such as leiomyosarcoma.

Efficacy and safety profile of GreenLight laser photoselective vaporization of the prostate in ≥ 75 years old patients: results from the Italian GreenLight Laser Study Group

BACKGROUND

Benign Prostatic Obstruction (BPO) is the most common non-malignant urological condition among men and its incidence rise with age. Among prostate treatments, GreenLight laser seems to reduce bleeding and would be safer in the aging population.

AIMS

We aimed to compare the functional outcomes and safety profile of < 75 years old (Group A) and ≥ 75 years old (Group B) patients.

METHODS

In a multicenter setting, we retrospectively analyzed all the patients treated with GreenLight Laser vaporization of the prostate (PVP).

RESULTS

1077 patients were eligible for this study. 757 belonged to Group A (median age 66 years) and 320 to Group B (median age 78 years). No differences were present between the two groups in terms of prostate volume, operative time, hospital stay, PSA decrease over time after surgery, complications and re-intervention rate with a median follow-up period of 18 months (IQR 12-26). Nevertheless, focusing on complications, GreenLight laser PVP demonstrated an excellent safety profile in terms of hospital stay, re-intervention and complications, with an overall 29.6% complication rate in older patients and only two cases of Clavien III. Functional outcomes were similar at 12 month and became in favor of Group A over time. These data are satisfactory with a Qmax improvement of 111.7% and an IPSS reduction of 69.5% in older patients.

DISCUSSION AND CONCLUSIONS

GreenLight laser photoselective vaporization of the prostate is a safe and efficient procedure for all patients, despite their age, with comparable outcomes and an equal safety profile.

Continuous Psychological Nursing Based on Grey Clustering Algorithm in Patients after Transurethral Resection of Prostate

Objective

To explore the effect of continuous psychological nursing based on the grey clustering algorithm on erectile function, bad psychological emotion, and complications in patients after transurethral resection of prostate (TURP).

Methods

98 patients who underwent TURP were randomly divided into observation and control groups (routine nursing). The observation group first used the grey clustering algorithm to evaluate the psychological intelligence, found patients with abnormal psychological behavior, and then implemented continuous psychological nursing combined with pelvic floor muscle exercise. The patients were followed up for 4 months. The International Index of Erectile Function-5 (IIEF-5), the incidence of complications, the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA) scores, and the nursing satisfaction were analyzed and compared between these two groups.

Results

The grey clustering algorithm can accurately reflect the characteristics of patients' psychological changes. After targeted nursing, compared with the control group, the IIEF-5 in the observation group was higher [(24.87 ± 1.85) vs. (22.24 ± 1.47), P < 0.05], the incidence of total complications was lower (10.20% vs. 26.53%, P < 0.05), the score of HAMA was lower [(6.11 ± 2.57) vs. (10.98 ± 2.29), P < 0.05], the score of HAMD was lower [(6.97 ± 2.85) vs. (11.35 ± 2.19), P < 0.05], and the nursing satisfaction was higher (100% vs. 85.71%, P < 0.05).

Conclusion

Mental intelligence evaluation based on the grey clustering algorithm combined with pelvic floor muscle exercise can significantly improve the rehabilitation effect of erectile function in patients after TURP, reduce the incidence of postoperative complications, and alleviate patients' anxiety and depression.