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1.
BMJ ; 367: l5919, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727627

RESUMO

OBJECTIVE: To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. DESIGN: Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES: A comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019. STUDY SELECTION: Randomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated. RESULTS: 109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (-0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (-1.90 (-5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference -1.00 (-2.41 to 0.40)), bipolar enucleation (0.87 (-1.80 to 0.07)), and holmium laser enucleation (-0.84 (-1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (-1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes. CONCLUSION: Eight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods. STUDY REGISTRATION: CRD42018099583.


Assuntos
Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Humanos , Masculino , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/métodos , Ressecção Transuretral da Próstata/estatística & dados numéricos , Resultado do Tratamento
2.
Urology ; 134: 199-202, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31563537

RESUMO

OBJECTIVE: To report long-term safety and efficacy data on middle lobe only-transurethral resection of the prostate (TURP) (MLO-TURP). MATERIALS AND METHODS: We evaluated: (1) efficacy: International Prostate Symptom Score, Quality of Life, peak flow rate (Qmax), postvoid residual urine, International Index of Erectile Function and ejaculatory function, which was assessed by the Male Sexual Health Questionnaire. Men were evaluated at 1 month, 6 months, and yearly thereafter. RESULTS: A total 312 men (mean age 61.3 ± 8.6) with significant lower urinary tract symptoms (n = 147) or urinary retention (n = 175 were treated with MLO-TURP from 2005 to 2017. Mean baseline prostate volume was 79.8 g (30-178 g); mean baseline intravesical-prostatic protrusion was 13.6. Improvements in International Prostate Symptom Score, Quality of Life, Qmax and postvoid residual urine were durable throughout the study period. There was no difference in outcomes between monopolar and bipolar MLO-TURPs. Postoperatively, the incidence of ejaculatory dysfunction was 2.6% (N = 8) and there was 1 case of new onset ED (0.3%). There were modest improvement in bother due to ejaculatory function (baseline: 2.4 and at 5 years: 1.27). CONCLUSION: MLO-TURP is a safe and effective treatment for men with lower urinary tract symptoms. Patients experience long-term improvement of symptoms and preserve antegrade ejaculation. In select men with prominent middle lobes, MLO-- should be considered a therapeutic, ejaculation-sparing option.


Assuntos
Ejaculação , Terapia a Laser , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Disuria/etiologia , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Próstata/cirurgia , Qualidade de Vida , Ressecção Transuretral da Próstata/efeitos adversos , Cateterismo Urinário , Retenção Urinária/cirurgia , Infecções Urinárias/etiologia
3.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302622

RESUMO

Transurethral resection of prostate (TURP) is the most common operation performed for obstruction secondary to prostatic enlargement. Though considered as a safe procedure, occasionally life-threatening complications may be seen. Intravesical explosion, secondary to ignition by diathermy of the accumulated mixture of hydrogen, hydrocarbons and higher concentration of oxygen, is a rarely reported complication (only 38 cases reported until). We are reporting a 60-year-old man suffering from benign prostatic hyperplasia in whom during TURP bladder explosion occurred which was suspected early and immediately explored and repaired leading to a favourable outcome.


Assuntos
Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Bexiga Urinária/lesões , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Ruptura
4.
Urology ; 131: 14-20, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31129190

RESUMO

Transurethral resection of prostate (TURP) still remains the "gold standard" surgical treatment for benign prostatic hyperplasia (BPH). In recent years, holmium laser enucleation of prostate (HoLEP) gets more and more popularity in the world. Our objective is to compare the efficacy and safety of HoLEP and TURP for BPH. Eleven studies met our eligibility criteria including 1339 patients. The prostate sizes of the all included studies were smaller than 100 g. Overall, in patients with small to mid-sized prostates, HoLEP offers safer clinical outcomes with less blood drop and potentially better long-term relief of bladder outlet obstruction.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Humanos , Lasers de Estado Sólido/efeitos adversos , Masculino , Prostatectomia/efeitos adversos , Hiperplasia Prostática/patologia , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento
6.
Urology ; 127: 86-90, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30817961

RESUMO

OBJECTIVE: To study the feasibility of transvesical prostate resection and its effect on urethral stricture. MATERIALS AND METHODS: We included 99 patients with symptomatic bladder outlet obstruction who underwent transvesical resection of prostate (TVRP; n = 48) and transurethral (TURP; n = 51) prostatectomy. We examined all the patients by means of digital rectal examination, transrectal ultrasound, and evaluated them by international prostate symptom score, quality of life score, uroflowmetric assessment and PSA level, and established definitive diagnosis. We followed up the patients in first month, third month, and the first year of the operation and monitored once a year in the following years. RESULTS: In this study, totally 99 symptomatic bladder outlet obstruction patients were included (TVRP = 48 and TURP = 51). Mean age of the patients were 66.5 ± 8.2vs 68 ± 9.8years for our patients with TVRP and TURP, respectively. Two groups displayed similar values in terms of improvements in the Qmax and PVR, and there were no statistically significant differences in between. We obtained similar values for resection time and weight of resected prostate tissue in both groups. Urethral stricture was not observed in TVRP group. In TURP group however, stricture was observed in 4 (7.8%) patients in bulbar urethra in sixth month at average. And there was also a concomitant urethral meatal stricture in one of these patients. When the 2 groups were compared, the rate of urethral stricture was statistically significantly higher in the TURP group (P = .001). CONCLUSION: Resection of prostate without using urethra significantly reduces the incidence of urethral stricture due to mucosal damage.


Assuntos
Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Estudos de Viabilidade , Seguimentos , Hematúria/diagnóstico , Hematúria/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Medição de Risco , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Ultrassom Focalizado Transretal de Alta Intensidade/métodos , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/cirurgia , Retenção Urinária/diagnóstico , Retenção Urinária/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia
7.
Urology ; 127: 91-96, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822484

RESUMO

OBJECTIVE: To assess the impact of systemic comorbidities on a validated health phenotype score (ACTIONS: Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea) on outcomes of transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) for symptoms and medication discontinuation. MATERIALS AND METHODS: Comorbidities of men undergoing TURP for BPH from 2004 to 2015 were assessed with the validated ACTIONS phenotype totaling a score from 0 to 2 for each domain (Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea). BPH medication discontinuation, change in International Prostate Symptom Score, postvoid residual, and patient satisfaction were assessed. Descriptive and comparative statistics were calculated with significance set at P <.05. RESULTS: The 319 men had a median age of 74.0 (interquartile range 67-78). Mean ACTIONS score was significantly lower in men who discontinued alpha-blockers or 5-alpha reductase inhibitors compared to those who did not (3.37 ± 2.14vs 4.79 ± 2.75, P <.0001). ACTIONS score <4 was significantly associated with medication discontinuation (P = .0014). Lower scores in Testosterone (P = .04), Neurologic (P = .003), and Sleep apnea (P = .04) domains were significantly associated with medication discontinuation. Total ACTIONS score was not independently associated with changes in International Prostate Symptom Score or postvoid residual. CONCLUSION: Lower ACTIONS score was associated with BPH medication discontinuation after TURP, suggesting men with lower comorbidity burdens do better after the procedure. The ACTIONS phenotype score is easily calculated and may aid the preoperative counseling of men undergoing TURP for BPH.


Assuntos
Antagonistas Adrenérgicos alfa/administração & dosagem , Sintomas do Trato Urinário Inferior/epidemiologia , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Agentes Urológicos/administração & dosagem , Idoso , Estudos de Coortes , Comorbidade , Seguimentos , Humanos , Incidência , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Fenótipo , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Medição de Risco , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Agentes Urológicos/efeitos adversos , Suspensão de Tratamento
8.
Trials ; 20(1): 142, 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782183

RESUMO

BACKGROUND: Transurethral resection of the prostate (TURP) and Greenlight laser vaporisation (GL) of the prostate are frequently performed urological procedures. For TURP, a single-dose antimicrobial prophylaxis (AP) is recommended to reduce postoperative urinary tract infections. So far, no international recommendations for AP have been established for GL. In a survey-based study in Switzerland, Germany and Austria, urologists reported routinely extending AP primarily for 3 days after both interventions. We therefore aim to determine whether single-dose AP with cotrimoxazole is non-inferior to 3-day AP with cotrimoxazole in patients undergoing TURP or GL of the prostate. METHODS/DESIGN: We will conduct an investigator-initiated, multicentre, randomised controlled trial. We plan to assess the non-inferiority of single-dose AP compared to 3-day AP. The primary outcome is the occurrence of clinically diagnosed symptomatic urinary tract infections which are treated with antimicrobial agents within 30 days after randomisation. The vast majority of collected outcomes will be assessed from routinely collected data. The sample size was estimated to be able to show the non-inferiority of single-dose AP compared to 3-day AP with at least 80% power (1 - ß = 0.8) at a significance level of α = 5%, applying a 1:1 randomisation scheme. The non-inferiority margin was determined in order to preserve 70% of the effect of usual care on the primary outcome. For an assumed event rate of 9% in both treatment arms, this resulted in a non-inferiority margin of 4.4% (i.e. 13.4% to 9%). To prove non-inferiority, a total of 1574 patients should be recruited, in order to have 1416 evaluable patients. The study is supported by the Swiss National Science Foundation. DISCUSSION: For AP in TURP and GL, there is a large gap between usual clinical practice and evidence-based guidelines. If single-dose AP proves non-inferior to prolonged AP, our study findings may help to reduce the duration of AP in daily routine-potentially reducing the risk of emerging resistance and complications related to AP. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03633643 . Registered 16 August 2018.


Assuntos
Antibacterianos/administração & dosagem , Anti-Infecciosos Urinários/administração & dosagem , Antibioticoprofilaxia/métodos , Terapia a Laser/métodos , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/cirurgia , Ressecção Transuretral da Próstata/métodos , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Infecções Urinárias/prevenção & controle , Antibacterianos/efeitos adversos , Anti-Infecciosos Urinários/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Esquema de Medicação , Estudos de Equivalência como Asunto , Humanos , Terapia a Laser/efeitos adversos , Masculino , Estudos Multicêntricos como Assunto , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico , Suíça , Fatores de Tempo , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia
9.
Medicine (Baltimore) ; 98(3): e13897, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653095

RESUMO

To analyze whether different volumes of tissue resected during transurethral resection of the prostate (TURP) would associate with the subsequent development of prostate cancer.This population-based retrospective cohort study recruited 49,206 patients with benign prostate hyperplasia (BPH) undergoing TURP between 2005 and 2012. Patients were recruited from the Taiwan National Health Insurance Research Database. Patients were separated into three groups, based on different volumes of tissue resected during TURP (5-15 g, 15-50 g, >50 g).Of the 49,206 patients, 633 patients were diagnosed with new onset of prostate cancer following TURP. Older age was a risk factor contributing to the onset of prostate cancer (P = .0196) and different volumes of tissue resected were significantly related to the incidence of postoperative prostate cancer (P = .0399). The group of patients with a smaller volume of prostate resected had a higher risk of prostate cancer with a hazard ratio (HR) of 1.221 (95% confidence interval [CI]: 1.035, 1.440; P = .0179). However, the risk in the group of patients with a larger volume of prostrate resected was not significantly different, with an HR of 1.277 (95% CI: 0.981, 1662; P = .0690). The incidence of prostate cancer in Taiwanese males over 30 years of age has previously been reported to be 0.0560%; the mean incidence was 0.2282% in our present study.This study shows that BPH patients who had a smaller volume of tissue resected during TURP show a higher incidence of prostate cancer postoperatively. Currently, no clear mechanism is shown to demonstrate the relationship between resected prostate weight and the incidence of tumors. Patients with a larger prostate volume might have lower urinary tract symptoms earlier and then seek professional help. It is possible that surgical procedures might remove the potentially carcinogenic prostate tissue and thus reduce the risk of an aggressive tumor developing in the future.


Assuntos
Próstata/anatomia & histologia , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/patologia , Ressecção Transuretral da Próstata/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Período Pós-Operatório , Próstata/patologia , Hiperplasia Prostática/patologia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/etiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Ressecção Transuretral da Próstata/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/tendências
10.
J Chemother ; 31(1): 15-22, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30508403

RESUMO

Transurethral resection of the prostate (TURP) is one of the most common urological procedures. With the increasing rate of multiresistant infections including urosepsis, it is essential for all surgeons to adhere to the relevant international guidelines to prevent infectious complications. The aim of this prospective, multinational, multicentre study was to evaluate compliance with recommended infection control measures regarding TURP procedures. The study was performed as a side questionnaire to the annual Global Prevalence Study of Infections in Urology (GPIU) between 2006 and 2009. Patients that had undergone TURP were eligible. Baseline data about hospitals and patients were collected. The questionnaire contained questions regarding preoperative microbiological investigations, catheter care and performance of perioperative antibiotic prophylaxis. A total of 825 men were included from 138 participating centres from Africa, Asia, Europe and South America. Only 50.1% of the patients received perioperative antibiotic prophylaxis with a median duration of 3 days (interquartile range [IQR] = 1-7 days). Preoperative urine culture was taken in 59.2%. The catheter was replaced in 1 week prior to the surgery only in 38.3% of cases. Compliance with the recommended infection control measures regarding TURP were only moderate, despite high grade recommendations in relevant international Guidelines. Stronger guideline adherence is necessary to improve patient care decrease antibiotic consumption in line with antibiotic stewardship in surgical practices.


Assuntos
Antibioticoprofilaxia/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Ressecção Transuretral da Próstata/métodos , Adulto , Idoso , Antibioticoprofilaxia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Ressecção Transuretral da Próstata/efeitos adversos
11.
Int Urol Nephrol ; 51(1): 9-15, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30402718

RESUMO

OBJECTIVES: The present study aimed to investigate the influence of urine on re-epithelialization in canine prostatic urethra after prostatectomy and explore possible causes. METHOD: We established two groups of prostatic canine models. The first group contained urine that canines underwent the surgery by two-micron laser resection of the prostate-tangerine technique (TmLRP-TT), and no transurethral catheter was required. The second group was without urine that canines accepted the surgery by TmLRP-TT add ureter skin ostomy urine bypass. Histopathology of re-epithelialization of repair in trauma in canine prostatic urethra was observed by hematoxylin and eosin (HE) staining, and immunochemistry was used to determine the expression of transforming growth factor-ß1 (TGF-ß1). Human prostate epithelial line (BPH-1) cells were cultured with or without urine and the abilities of proliferation and migration were tested by CCK-8 and transwell assays, respectively. RESULTS: The histology displayed that there was distinct proliferation of prostatic cell under the wound after 3 days, re-epithelialization began after 9 days, and finished after 28 days at urine group. The TGF-ß1 like-IR in prostatic epithelium cells and fibroblast cells under the wound at urine group were strikingly increased as compared with the cells at no urine group after 3, 9, and 11 days, respectively (p < 0.05). In CCK-8 and Transwell assays, an increase of cells' proliferation and migration was detected in urine culture group compared with no urine culture group (p < 0.05). CONCLUSION: Urine may speed up the re-epithelialization process for prostatic urethra wounds by promoting proliferation and migration of prostate epithelial cells.


Assuntos
Movimento Celular , Proliferação de Células , Células Epiteliais/fisiologia , Complicações Intraoperatórias , Próstata , Reepitelização/fisiologia , Ressecção Transuretral da Próstata , Uretra , Urina/fisiologia , Animais , Células Cultivadas , Cães , Humanos , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/fisiopatologia , Masculino , Próstata/patologia , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Fatores de Crescimento Transformadores/metabolismo , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/métodos , Uretra/lesões , Uretra/fisiopatologia , Cicatrização/fisiologia
12.
World J Urol ; 37(2): 299-308, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29967947

RESUMO

PURPOSE: Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management. METHODS: A systematic review of the literature was carried out on the PubMed database using the following MESH terms: "Prostatic Hyperplasia/surgery" and "Ejaculation", in combination with the following keywords: "ejaculation preservation", "photoselective vaporization of the prostate", "photoselective vapo-enucleation of the prostate", "holmium laser enucleation of the prostate", "thulium laser", "prostatic artery embolization", "urolift", "rezum", and "aquablation". RESULTS: The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively. CONCLUSIONS: Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.


Assuntos
Ejaculação , Hiperplasia Prostática/cirurgia , Disfunções Sexuais Fisiológicas/prevenção & controle , Ressecção Transuretral da Próstata/efeitos adversos , Obstrução do Colo da Bexiga Urinária/cirurgia , Transtornos Urinários/prevenção & controle , Técnicas de Ablação , Embolização Terapêutica , Endoscopia , Humanos , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Próstata/irrigação sanguínea , Próstata/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Implantação de Prótese , Disfunções Sexuais Fisiológicas/etiologia , Vapor , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/terapia , Transtornos Urinários/etiologia
13.
Urologia ; 85(4): 150-157, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30426880

RESUMO

OBJECTIVE:: To identify risk factors for urethral stricture and/or bladder neck contracture after transurethral resection of benign prostatic hyperplasia. MATERIALS AND METHODS:: We performed a retrospective analysis of 402 patients, which underwent a monopolar transurethral resection of the prostate in the urology clinic of Sechenov First Moscow State Medical University for prostatic hyperplasia during the period 2011-2014. Urethral stricture and (or) bladder neck contracture in the postoperative period were diagnosed in 61 (15.27%) patients; 34 patients (8.6%) had urethral stricture, 20 (4.97%) bladder neck contracture, and 7 (1.7%) had a combination of urethral stricture and bladder neck contracture. In 341 of cases (84.73%), no late postoperative complications were observed. A total of 106 of the 341 patients met the inclusion criteria, hence, containing all the information necessary for analysis such as the volume of the prostate, the duration of the surgery, the size of the endoscope, data on concomitant diseases, analysis prostatic secretion, and so on. Thus, two groups were formed. Group 1 (106 patients) is the control group in which urethral strictures and/or bladder neck contractures did not occur in the long-term postoperative period and group 2 (61 patients), in which was observed the formation of these complications. To calculate the statistical significance of the differences for categorical data, Fisher criterion was used. For quantitative variables, in the case of normal data distribution, an unpaired t-test or one-way analysis of variance was used; for data having a distribution different from normal, a Mann-Whitney rank test was used. RESULTS:: Regression analysis established the significance of the influence of four factors on the development of scar-sclerotic changes of urethra and bladder neck: the tool diameter 27 Fr ( p < 0.0001), presence of prostatitis in past medical history ( p < 0.0001), prostate volume ( p = 0.003), and redraining of the bladder ( p = 0.0162). CONCLUSION:: The relationship between the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, and repeated drainage of the bladder using the urethral catheter with the risk of developing scar-sclerotic changes in the urethra and/or bladder neck are statistically reliable and confirmed as a result of regression analysis.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/métodos , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Obstrução do Colo da Bexiga Urinária/epidemiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
14.
Medicine (Baltimore) ; 97(45): e13119, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407328

RESUMO

BACKGROUND: Perioperative inadvertent hypothermia in elderly urology patients undergoing transurethral resection of the prostate (TURP) is a well-known serious complication, as it increases the risk of myocardial ischemia, blood loss, and surgical wound infection. We conducted this prospective randomized controlled trial to evaluate the combined effect of a forced-air warming system and electric blanket in elderly TURP patients. METHODS: Between January 2015 and October 2017, we recruited 443 elderly male patients undergoing elective TURP with subarachnoid blockade (SAB). These were randomly divided into 3 groups: group E (intraoperative warming using electric blankets set to 38°C; n = 128); group F (intraoperative warming using a forced-air warmer set to 38°C; n = 155) and group FE (intraoperative warming using a forced-air warmer plus electric blankets, both set to 38°C; n = 160). The primary outcome was shivering and their grades. Hemodynamic changes, esophageal temperature, recovery time, incidences of adverse effects, and patient and surgeon satisfaction were also recorded. RESULTS: Baseline characteristics showed no significant differences when compared across the 3 groups (P >.05). Compared with groups E and F, both HR and mean arterial pressure (MAP) in group FE were significantly decreased from T6 to T10 (P <.05). Compared with groups E and F, esophageal temperature in group FE increased significantly from T5 to T10 (P <.05). Compared with group E, esophageal temperature in group F was significantly increased from T5 to T10 (P <.05). Compared with groups F and FE, post-anesthesia care unit (PACU) recovery time was longer in group E, while compared with group F, PACU recovery time was shorter in group FE (P <.05). Compared to patients in groups E and F, those in group FE had a significantly lower incidence of arrhythmia and shivering (P <.05). The number of patients with shivering grades 0 to 3 was higher in group E than in other groups, while the number of patients with shivering grade 2 was significantly higher in group F than in group FE (P <.05). Patient and surgeon satisfaction scores were higher in group FE than in groups E and F (P <.05). CONCLUSIONS: Use of a forced-air warming system combined with an electric blanket was an effective method with which to retain warmth among elderly TURP patients.


Assuntos
Hipotermia/terapia , Complicações Intraoperatórias/etiologia , Reaquecimento/métodos , Ressecção Transuretral da Próstata/métodos , Idoso , Raquianestesia/efeitos adversos , Temperatura Corporal , Terapia Combinada/métodos , Hemodinâmica , Humanos , Hipotermia/etiologia , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Próstata/cirurgia , Reaquecimento/efeitos adversos , Tremor por Sensação de Frio , Ressecção Transuretral da Próstata/efeitos adversos
15.
Med Princ Pract ; 27(6): 582-584, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30308505

RESUMO

OBJECTIVE: To report on a case of intravesical explosion during transurethral resection of the prostate (TURP) which was managed laparoscopically and to review the relevant literature. CLINICAL PRESENTATION AND INTERVENTION: During TURP, a loud explosion was heard, and a jolt was felt in the abdomen. A bladder tear was seen endoscopically. Systematic laparoscopic exploration showed no injury to abdominal organs apart from the irregular large bladder tear which was repaired laparoscopically. The patient had an uneventful recovery. CONCLUSION: Bladder explosion during TURP is an extremely rare and serious complication. It should be considered as a blast injury and systematic exploration of abdominal organs and vessels should be performed. The severity and urgency of the condition should not preclude the use of laparoscopy for exploration and repair.


Assuntos
Traumatismos por Explosões/etiologia , Laparoscopia/efeitos adversos , Próstata/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Bexiga Urinária/lesões , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
BMC Urol ; 18(1): 87, 2018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30314492

RESUMO

BACKGROUND: The impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP). METHODS: We performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after. RESULTS: A total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001). CONCLUSIONS: Both TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.


Assuntos
Endoscopia/efeitos adversos , Disfunção Erétil/etiologia , Lasers de Estado Sólido/uso terapêutico , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Idoso , Endoscopia/instrumentação , Endoscopia/métodos , Disfunção Erétil/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
17.
Radiat Oncol ; 13(1): 209, 2018 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-30355359

RESUMO

BACKGROUND: To evaluate long-term IPSS score and urinary quality of life after radiotherapy for prostate cancer, in patients with prior history of surgical treatment for benign prostatic hyperplasia (BPH). METHODS: In this retrospective study, we reviewed medical records of patients treated in our department, between 2007 and 2013 with surgery for BPH followed by radiotherapy for localized prostate cancer. Patients were contacted to fill in IPSS questionnaire and they were also asked for urinary quality of life. Predictive factors known to be associated with bad urinary function were also analysed. RESULTS: Fifty-nine patients were included in our study. Median age was 70 years. Median follow-up was 4.6 years. Median radiotherapy dose was 78 Gy (5 × 2 Gy/week). Thirty patients (48.5%) received hormone therapy in combination with RT. Main surgery indications were urinary symptoms (65%) and urinary retention (20%). Five-year biochemical-disease free survival was 75% and 5-year clinical relapse free survival was 84%. At the time of the study, the IPSS after radiotherapy was as follows: 0-7: 77.6%; 8-19:20.7%; 20-35: 1.7%. Urinary quality of life was satisfactory for 74.2% of patients. After multivariate analysis, a high dose of RT and a medical history of hypertension were associated with a poorer quality of urinary life (p = 0.04). CONCLUSION: External radiotherapy remains an appropriate treatment option without a major risk for deterioration in urinary function in patient with antecedent surgery for BPH. High dose of RT and a medical history of hypertension were associated with a poorer quality of urinary life.


Assuntos
Hiperplasia Prostática/complicações , Neoplasias da Próstata/radioterapia , Qualidade de Vida , Radioterapia de Intensidade Modulada/efeitos adversos , Ressecção Transuretral da Próstata/efeitos adversos , Retenção Urinária/patologia , Doenças Urológicas/patologia , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/patologia , Dosagem Radioterapêutica , Estudos Retrospectivos , Resultado do Tratamento , Retenção Urinária/etiologia , Micção , Doenças Urológicas/etiologia
18.
BMC Anesthesiol ; 18(1): 136, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261833

RESUMO

BACKGROUND: To examine the response to an α2receptor agonist used as a sedative for patients using long-term selective α1 blockers. METHODS: Sixty-nine consecutive patients undergoing transurethral prostate resection or holmium laser resection of the prostateunder spinal anesthesia were divided into two groups; group N (n = 37), which did not receive α1 blockers, and group T (n = 32), which was administered tamsulosin for at least 1 month before the study. Bispectral index scores, Modified Observer's Assessment of Alertness/Sedation scale scores, heart rate, and mean blood pressure were obtained under sedation using dexmedetomidine for 30 min during surgery. RESULTS: The only significant difference found between the groups were mean bloodpressure 15 min after the first loading dose injection of dexmedetomidine. Differencesbetween both groupswere noted at 15 min(group T: 100.2 ± 12.9 mmHg; group N: 90.0 ± 17.5 mmHg; P = 0.08), 20 min (group T: 99.8 ± 12.3 mmHg; group N: 87.4 ± 15.0 mmHg; P < 0.00), 25 min (group T: 99.3 ± 13.4 mmHg; group N: 85.4 ± 13.8 mmHg; P < 0.00), and 30 min (group T: 98.8 ± 13.1 mmHg; group N: 84.5 ± 13.5 mmHg; P < 0.00). CONCLUSIONS: The use of α2 agonists is appropriate during surgery for benign prostatic hyperplasia patients using tamsulosin, and there is no need to alter the dose. Alertness with anesthesia involving α2 agents was maintained for patients using long-term tamsulosin and patients who did not use tamsulosin. TRIAL REGISTRATION: The study was retrospectively registered with the Clinical Research Informational Service ( KCT0002967 , July 2, 2018).


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Anestésicos/administração & dosagem , Lasers de Estado Sólido/uso terapêutico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Feminino , Hólmio , Humanos , Cuidados Intraoperatórios/métodos , Lasers de Estado Sólido/efeitos adversos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Próstata/patologia , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/tratamento farmacológico , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento
19.
Urology ; 121: 147-152, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30222994

RESUMO

OBJECTIVE: To compare in daily practice efficacy and safety of standard 180-Watt GreenLight laser photoselective vaporization (PVP) and Thulium laser Vaporesection of the prostate (ThuVEP). MATERIALS AND METHODS: All men were evaluated with prostate volume, prostate-specific antigen, International Prostate Symptom Score, and maximum urinary flow. Patient global impression of improvement was evaluated with patient global impression of improvement scale for 6 months. Antiplatelet/anticoagulant therapy, operation time, 24-hour hemoglobin drop , length of catheterization, discharge day, early complications, and reoperation after 30 days were gathered. Differences between interventions were estimated using propensity scores to adjust for different patients characteristics. The propensity scores were estimated by fitting a stepwise logistic regression model with intervention type as the dependent variable and all the covariates. RESULTS: Five hundred five men underwent the surgical procedures (291 PVP and 214 ThuVEP). Mean age was 69.6 years. Mean prostate volume was 54 mL. Median operation time was 55 minutes. Median catheterization time was 2 days in both series. After matching, the postoperative stay was similar in both groups (2 days). Hemoglobin drop for 24 hours was statistically significantly lower in PVP (-0.5 vs -0.8 g/dL, P .002). Most of the complications were mild-to-moderate and comparable among groups. Δ Maximum urinary flow was similar 6-month after surgery before and after matching, whereas PVP group had a better improvement 12-month after surgery. 96.4% of all patients had an improvement of their symptoms, with no difference between groups, before and after matching. CONCLUSION: Our study demonstrated that PVP and ThuVEP are similar in term of complications and outcomes, with high patients' satisfaction.


Assuntos
Terapia a Laser , Fotocoagulação/métodos , Complicações Pós-Operatórias , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Idoso , Pesquisa Comparativa da Efetividade , Humanos , Itália , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Tamanho do Órgão , Satisfação do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Próstata/diagnóstico por imagem , Próstata/patologia , Próstata/cirurgia , Antígeno Prostático Específico/análise , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/instrumentação , Ressecção Transuretral da Próstata/métodos
20.
Urology ; 122: 147-151, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30218692

RESUMO

OBJECTIVE: To present our transurethral enucleation with bipolar energy (TUEB) technique, wherein the enucleated adenoma is resected while keeping it attached near the verumontanum avoiding the need of a morcellator, and to evaluate the safety and short-term outcomes of our technique of TUEB for the treatment of symptomatic benign prostatic hypertrophy (BPH). METHODS: This was a retrospective evaluation of prospectively maintained database of patients with symptomatic BPH who underwent TUEB from January 2016 to September 2017. Patients with a minimum follow-up period of 6 months were included in the study. All patients were assessed using the international prostate symptom score (IPSS), uroflometry (Q-max), and transrectal ultrasonography (TRUS) of the prostate. TUEB was indicated for patients with total prostate volumes >60 g on TRUS. Postoperative outcome measures, including urinary incontinence, Q-max, and IPSS, were recorded at each follow-up visit. RESULTS: A total of 103 patients underwent TUEB. The mean patient age was 64 ± 7 years, and the median operative time was 54 minutes (interquartile range [IQR]: 44-66). The median resected prostate weight was 39 g (IQR: 28-54 g), corresponding to approximately 87% of the assessed transitional zone volume. The mean postoperative hemoglobin drop of 1.08 ± 0.28 g/dL was clinically insignificant. There was significant improvement in the IPSS and Q-max postoperatively, when compared to baseline parameters (P < .05). CONCLUSION: Our TUEB technique is safe and effective in treating symptomatic BPH with acceptable complications and favorable short-term outcomes. TUEB allows near-complete enucleation of a prostate adenoma, followed by resection, thus avoiding the need for a morcellator.


Assuntos
Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Próstata/diagnóstico por imagem , Próstata/cirurgia , Estudos Retrospectivos , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/instrumentação , Resultado do Tratamento , Ultrassonografia , Urodinâmica
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