A nomogram predicting re-operation due to secondary hemorrhage after monopolar transurethral resection of prostate.

We aim to develop a nomogram to predict re-operation due to secondary hemorrhage after Monopolar transurethral resection of the prostate (M-TURP). We identified patients undergoing M-TURP at Peking University First Hospital from 2000 to 2013. Univariate and multivariate logistic regression models were developed to predict the occurrence re-operation due to secondary hemorrhage. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic curve (ROC), and internal validation was performed via bootstrap resampling. Of the 1901 patients who underwent M-TURP during the study period, 9.1% (173 patients) experienced hemorrhage after M-TURP, and they had a 22.0% re-operation rate (38 patients). Benign prostatic hyperplasia (BPH)-related complications (odds ratio, 0.386; 95% CI, 0.177-0.841), percent of resected prostate (OR, 0.156; 95% CI, 0.023-1.060) and suprapubic cystostomy (OR, 0.298; 95% CI, 0.101-0.881) were independently associated with re-operation. The nomogram accurately predicted re-operation (area under the ROC curve 0.718). The negative predictive value was 88.0%, while the positive predictive value was 47.9%. Re-operation due to secondary hemorrhage after M-TURP was associated with no BPH-related complications, lower percent of resected prostate and no suprapubic cystostomy and was accurately predicted with using the nomogram.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis.

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Correlation of benign prostatic obstruction-related complications with clinical outcomes in patients after transurethral resection of the prostate.

We aim to investigate the correlation of benign prostatic obstruction (BPO)-related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO-related complications and 1078 (46.3%) had BPO-related complications. Compared with patients without BPO-related complications, those with BPO-related complications were older (p = 0.001) and usually had other urologic comorbidities (p = 0.003). Additionally, they tended to have more tissue resected (p < 0.001), a higher American Society of Anesthesiologists grade (p = 0.002), and larger prostates (p < 0.001). Nonetheless, there was no obvious difference in surgical complications between both groups (p > 0.05). Among patients with BPO-related complications, compared with the bladder stone group, only the bladder stone+ group tended to have a greater urinary infection risk after transurethral resection of the prostate. Compared with patients with one or two BPO-related complications, those with three BPO-related complications tended to have a higher risk of pulmonary embolism and acute coronary syndrome (p < 0.05). Despite the widespread use of medication, patients with BPO-related complications were older and had larger prostates; however, transurethral resection of the prostate is still considered a safe and recommended surgical treatment. Nevertheless, those with three or more complications were at a higher risk of severe complication after surgery, and active surgical intervention is needed once BPO-related complications develop.

[The effect of Yunnan Baiyao on reduction of intra-operative bleeding of the patients undergoing transurethral resection of prostate].

OBJECTIVE: To investigate the effect of Yunnan Baiyao on reduction of intra-operative bleeding of the patients undergoing transurethral resection of prostate (TURP). METHODS: A randomized placebo-control double-blind multi-center trial was conducted. 203 patients with benign prostate hyperplasia (BPH), aged 50 - 80, who were to undergo TURP were randomly divided into 2 groups: Yunnan Baiyao group, given 500 mg Yunnan Baiyao four times daily since the third day before the operation for 3 days, and placebo group, given empty capsules for 3 days. The amount of intra-operative bleeding, bleeding index and bleeding intensity were compared. The side effect of Yunnan Baiyao was also evaluated. RESULTS: The amount of intra-operative bleeding of the Yunnan Baiyao group was 147 ml +/- 144 ml, significantly less than that of the control group (182 ml +/- 157 ml, P < 0.05). The amount of intra-operative bleeding of the per protocol (PP) population in the Yunnan Baiyao group (n = 58) was 146 ml +/- 116 ml, significantly less than the PP population in the control group (n = 66) (220 ml +/- 207 ml, P = 0.0361). When the weight of the resected prostate tissue was more than 20 gram, the amount of intraoperative bleeding, bleeding index, and bleeding intensity of the ITT population in the Yunnan Baiyao group (n = 60) were all significantly lower than those of the ITT population in the control group (n = 68) (all P < 0.05); the bleeding intensity of the PP population in the Yunnan Baiyao group was 2.4 ml/min +/- 1.8 ml/min, significantly lower than that of the PP population in the control group (3.6 ml/min +/- 3.7 ml/min, P = 0.0072); the bleeding index of the PP population in the Yunnan Baiyao group was 4.7 ml/g +/- 4.6 ml/g, significantly lower than that of the PP population in the control group (7.1 ml/g +/- 8.3 ml/g, P = 0.025). No side effect was found in the 2 groups. CONCLUSION: Yunnan Baiyao is effective on reducing the amount of intraoperative bleeding of TURP without side effect.