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.

Long-term symptomatic outcome after transurethral resection of the prostate: A urodynamics-based assessment.

OBJECTIVES: To examine the long-term outcomes of transurethral resection of the prostate. METHODS: We retrospectively collected the data of patients who had undergone transurethral resection of the prostate before December 2010. Patients had been evaluated by urodynamics and the International Prostate Symptom Score preoperatively, and they were re-evaluated by using the International Prostate Symptom Score at the minimum 7 years after transurethral resection of the prostate. Patients who received any treatments to improve voiding symptoms were defined as having a relapse of voiding dysfunction. The Schäfer nomogram was used to assess the degree of obstruction and detrusor contractility. We assessed the change in International Prostate Symptom Score over time depending on obstruction (Schäfer grade 3-6) versus no obstruction (Schäfer grade 0-2), and normal detrusor contractility (strong and normal) versus detrusor underactivity (weak and very weak). Relapse rates of voiding dysfunction were determined using the Kaplan-Meier method. RESULTS: A total of 39 patients were included. The mean age at transurethral resection of the prostate was 69.8 years, and the mean observation period after transurethral resection of the prostate was 114 months. During the observation period, eight patients (21%) were categorized as relapse of voiding dysfunction and the mean time to relapse was 4.2 years. Patients categorized as no obstruction or detrusor underactivity had a higher recurrence rate of voiding dysfunction with a statistical significance between those with versus without obstruction. Except for patients with relapse of voiding dysfunction, improvement of the International Prostate Symptom Score was maintained over a period of 10 years after transurethral resection of the prostate. CONCLUSIONS: Favorable long-term symptomatic outcome after transurethral resection of the prostate is likely in patients with urodynamic obstruction. Patients without urodynamic obstruction are likely to have a relapse of voiding symptoms and require additional treatments in the long term.

[Age-related androgen deficiency and benign prostatic hyperplasia: how to improve the rehabilitation of patients after transurethral surgery?]

RELEVANCE: Age-related androgen deficiency often coexists with benign prostatic hyperplasia (BPH), which requires surgical treatment. At the same time, severe lower urinary tract symptoms secondary to BPH are considered a relative contraindication to testosterone replacement therapy. The aim of this study was to evaluate the importance of correcting age-related androgen deficiency in patients with benign prostatic hyperplasia after transurethral operations. MATERIALS AND METHODS: The study comprised 60 patients with androgen deficiency (plasma testosterone levels below12.1 nmol/L) detected during preoperative workup for BPH surgery. All patients were operated on within 30 days after the study enrollment. During that time prior to surgery, all patients received tamsulosin 0.4 mg once daily to prevent acute urinary retention. In all cases, bipolar transurethral resection (TUR) of the prostate was performed. The patients were divided into two groups of 30 men. The patients of the study group received 50 mg of testosterone as a 1% topical gel Androgel from the time of diagnosis and for 12 weeks postoperatively. In the control group, the patients were managed without testosterone replacement therapy. The primary endpoint of the study was the libido scores measured by the AMS and IIEF-5 scales. Secondary endpoints were total testosterone level by the end of treatment, the incidence of hemorrhagic and infectious complications after surgery, I-PSS and QoL scores, prostate volume and urinary flow rate. RESULTS: In the study group, AMS score, IIEF-5 score and testosterone level were 48, 15 and 4.2 nmol/L preoperatively, and 21, 22 and 18 nmol/L after treatment completion, respectively. In the control group post-treatment values did not differ from baseline. The incidence of bleeding complications was 3% in the study group and 10% in the control group; the incidence of postoperative prostatitis was 6 and 13%, respectively. There were no differences in the prostate volume and urinary flow rate. I-PSS scores and quality of life indices were not statistically significantly better in the study group. No adverse events associated with the use of Androgel were observed. CONCLUSION: Detection of age-related androgen deficiency should be included in the preoperative evaluation of patients with BPH. Correcting androgen deficiency results in greater effectiveness and safety of the surgery and leads to a more favorable postoperative course. Testosterone replacement therapy after transurethral resection of the prostate enables achieving sexual and social rehabilitation of patients.

Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials.

BACKGROUND: Urinary incontinence is common immediately after prostate surgery. Men are often advised to do pelvic-floor exercises, but evidence to support this is inconclusive. Our aim was to establish if formal one-to-one pelvic floor muscle training reduces incontinence. METHODS: We undertook two randomised trials in men in the UK who were incontinent 6 weeks after radical prostatectomy (trial 1) or transurethral resection of the prostate (TURP; trial 2) to compare four sessions with a therapist over 3 months with standard care and lifestyle advice only. Randomisation was by remote computer allocation. Our primary endpoints, collected via postal questionnaires, were participants' reports of urinary incontinence and incremental cost per quality-adjusted life year (QALY) after 12 months. Group assignment was masked from outcome assessors, but this masking was not possible for participants or caregivers. We used intention-to-treat analyses to compare the primary outcome at 12 months. This study is registered, number ISRCTN87696430. FINDINGS: In the intervention group in trial 1, the rate of urinary incontinence at 12 months (148 [76%] of 196) was not significantly different from the control group (151 [77%] of 195; absolute risk difference [RD] -1·9%, 95% CI -10 to 6). In trial 2, the difference in the rate of urinary incontinence at 12 months (126 [65%] of 194) from the control group was not significant (125 [62%] of 203; RD 3·4%, 95% CI -6 to 13). Adjusting for minimisation factors or doing treatment-received analyses did not change these results in either trial. No adverse effects were reported. In both trials, the intervention resulted in higher mean costs per patient (£180 and £209 respectively) but we did not identify evidence of an economically important difference in QALYs (0·002 [95% CI -0·027 to 0·023] and -0·00003 [-0·026 to 0·026]). INTERPRETATION: In settings where information about pelvic-floor exercise is widely available, one-to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be effective or cost effective. The high rates of persisting incontinence after 12 months suggest a substantial unrecognised and unmet need for management in these men. FUNDING: National Institute of Health Research, Health Technology Assessment (NIHR HTA) Programme.

Clinical efficacy of acupuncture on the morphine-related side effects in patients undergoing spinal-epidural anesthesia and analgesia.

OBJECTIVE: To investigate the effects of acupuncture on the morphine-related side effects (nausea, vomiting, itchiness and gastrointestinal disorders) in patients undergoing anesthesia and analgesia and try to find the clinical mechanism of acupuncture. METHODS: Patients scheduled to have transurethral prostatic resection: enrolled in the study (69 patients), characterized as Grade II or III by the American Society of Anesthesiologists physical status classification, were randomly assigned to three groups, 23 patients in each group: the placebo group (control group), non-anesthesia area (NAA) group, and the anesthesia area (AA) group. After spinal anesthesia, all patients received Patients Controlled Epidural Analgesia. The vital signs, bowel sounds, visual analogue scales, itchiness, nausea and vomiting, and time for first exhaust post operation were observed. RESULTS: Altogether, nine cases were eliminated, three in each group. Finally, sixty cases completed this study,: twenty in each group. There was a significant decrease of bowel sounds after morphine spinal anesthesia in the three groups. Compared with the control or AA group, the bowel sound recovered after acupuncture, the incidences of nausea and vomiting, itchiness, and time for first exhaust after operation decreased in the NAA group (P<0.05). There was a significant decrease of the incidence for itchiness in the NAA group compared with

[Convalescence and sick leave following transurethral prostatectomy]. / Rekonvalescens og sygemelding efter transuretral prostatektomi.

Recovery after transurethral prostatectomy (TUR-P) is characterized by lower urinary tract symptoms (LUTS) and haematuria often affecting the patient's social life negatively. Procedure-specific information reduces the patient's anxiety postoperatively. When giving advice on level of activity during recovery, the risk of haematuria is the most important factor. Since bleeding ceases in 95% of cases within three weeks, patients should avoid hard physical activity for three weeks. Normal activity can be resumed immediately, although bothersome LUTS may be a limiting factor. Equivalent advice should be given with regard to the need for sick-leave.

Developing a pelvic floor muscle training regimen for use in a trial intervention.

This paper explains the rationale behind the intervention used for a large multi-centred randomised controlled trial for men following transurethral resection of prostate or radical prostatectomy. It shows the content of the protocol used and explains why this particular protocol of pelvic floor muscle exercises and urge suppression techniques was chosen for men in the intervention group. The trial will evaluate whether this intervention will be effective for men with urinary incontinence and sexual dysfunction after prostate surgery. ISRCTN number: ISRCTN87696430.

Resección transuretral de próstata: ¿es posible el retiro de sonda antes de un día? / Prostatic transuretral resection: is it possible the catheter retirement before one day?

La resección transuretral (RTU) de próstata es considerada el gold standard en el tratamiento del adenoma de próstata hoy en día. A mayor experiencia del centro que realiza esta cirugía los resultados permiten un retiro de la sonda cada vez más precoz. La literatura reporta muy pocos trabajos en los que se intenta el retiro antes de 24 horas. Presentamos nuestra serie preliminar de pacientes. Material y Método: Se incluyeron pacientes sometidos a resección transuretral de próstata por patología benigna entre mayo y agosto del año 2004, intervenidos por el mismo equipo quirúrgico, que no tuvieran mayor patología médica asociada y adenomas de un peso estimado no superior a 60 gramos. Resultados: Se intentó el retiro precoz de sonda Foley antes de cumplir 24 horas de postoperatorio en 17 pacientes. La edad promedio de los pacientes fue de 68 años. La estimación de peso promedio por ecografía abdominal fue de 57 gramos y por ecografía transrectal de 43 gramos. La duración promedio de horas de irrigación usada en estos pacientes fue de 11 horas y el retiro de sonda se realizó en promedio a las 20 horas con 22 minutos. En todos los pacientes el resultado fue exitoso, no hubo ningún caso de hematuria significativa en el postoperatorio inmediato ni en el seguimiento a 30 días. Tampoco hubo casos de retención de orina completa. Entre los pacientes se incluyeron 2 casos de cervicotomía o RTU mínima por disfunción de cuello. El promedio de gramos de chips extraídos fue de 18 gramos, cifra significativa comparada con otras series internacionales. En un comienzo los pacientes fueron dados de alta al día siguiente del retiro de sonda. Una vez comprobado el éxito de nuestro protocolo se dieron de alta después del mediodía del mismo día del retiro. Conclusiones: el retiro precoz de sonda antes de un día, en la RTU de próstata, es posible en pacientes seleccionados con excelentes resultados y muy baja tasa de complicaciones.