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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.
Urology ; 133: 192-198, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31404581

RESUMO

OBJECTIVE: To assess the safety and long-term efficacy of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in the treatment of enlarged prostate in comparison with bipolar transurethral resection of the prostate (B-TURP). MATERIALS AND METHODS: From June 2015 to March 2019, a total of 240 patients with enlarged prostates of more than 80 gm were randomized into 2 groups, each containing 120 patients. Patients in group A were subjected to B-TUERP while those in group B underwent B-TURP. The perioperative data and postoperative outcomes followed at 1, 6, and 24 months after surgery at which points they were analyzed, and a comparison made between the 2 groups. RESULTS: There were no significant differences in the preoperative parameters of the 2 groups. Comparing with B-TURP, B-TUERP had longer operative time (105.09 ± 31.08 vs 61.09 ± 29.28 min), more resected prostatic tissue (50.41 ± 13.07 vs41.12 ± 8.91 g) and had less hemoglobin drop (1.5 vs 2g/dL). In addition, indwelling catheter time, postoperative bladder irrigation duration, and hospital stay were significantly shorter in the B-TUERP group than in the B-TURP group. At 24 month after the procedure, patients with B-TUERP achieved better results of International Prostate Symptom Score (6 vs 7 P = .008), quality of life (1 vs 2, P = .243), maximal flow rate (24.9 ± 5.74 vs 20.09 ± 3.27mL/sec, P = .034), post-voiding residual urine volume (18.64 ± 3.28 vs 24.74 ± 4.02 mL, P = .001), and residual prostate volume (18.64 ± 3.28 vs 20.74 ± 4.02 mL, P < .001). On the other hand, there were no significant differences in postoperative complications between both groups. CONCLUSION: B-TUERP is a more effective modality in the treatment of enlarged prostate compared to B-TURP with almost no variation in safety.


Assuntos
Eletrocirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hiperplasia Prostática/patologia , Fatores de Tempo , Resultado do Tratamento
4.
Urologiia ; (2): 59-63, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162903

RESUMO

The article presents a description of the clinical case. Surgical treatment by plasma transurethral enucleation of the prostate was performed in patients with benign prostatic hyperplasia of giant size - 530 cm3. Observation in the short term showed the absence of functional and organic complications. Comparison with the results of surgical treatment of giant prostate adenoma by classical transurethral enucleation of the prostate, obtained in our urological clinic in 2015, showed a reduction in operating time by 1 hour without a significant increase in blood loss during surgery and without operational complications. The results demonstrate the prospects of the widespread introduction of plasma methods of transurethral operations in urological practice.


Assuntos
Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Humanos , Masculino , Tamanho do Órgão , Hiperplasia Prostática/patologia , Resultado do Tratamento
5.
Curr Urol Rep ; 20(7): 39, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31152253

RESUMO

PURPOSE OF REVIEW: Rezum is a new minimally invasive treatment for benign prostate enlargement using thermal transurethral water vapour therapy. We review the evidence with advantages and disadvantages of this technique. RECENT FINDINGS: There are five studies reported including a randomised control trial looking at the outcomes of Rezum. The outcomes show an IPSS reduction by 45-60%, QoL improvement with a score reduction of 37-59%, the Qmax improvement by 44-72% and the PVR reduction by 20-38%. Convective water vapour therapy using the Rezum system has been shown to have successful outcomes in the treatment of LUTS resulting from BPH. The reported complications are infrequent and often minor, and it seems to be relatively cost-effective.


Assuntos
Hiperplasia Prostática/terapia , Vapor , Ressecção Transuretral da Próstata/métodos , Humanos , Masculino , Hiperplasia Prostática/complicações , Resultado do Tratamento
6.
Urology ; 131: 250-254, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31233812

RESUMO

OBJECTIVE: To present outcomes of a simplified GreenLight laser enucleation of the prostate (GreenLEP) technique and to inform urologists considering incorporation of enucleation into their practice. METHODS: We reviewed all consecutive GreenLEPs by a single surgeon from 2015 to 2018. Baseline patient characteristics, pre-enucleation prostate volume, enucleated adenoma weight, blood loss, lasering time, and energy utilized were recorded. Primary outcomes were urinary flow rate (uroflow) and postvoid residual. Secondary outcomes included International Prostate Symptom Score (IPSS) and prostate-specific antigen change. Primary and secondary outcomes were measured up to 3 years and compared using Student's t test. Adverse event and complication rates were recorded. RESULTS: One hundred and eight patients underwent GreenLEP with mean follow up of 10.2 months. Statistically significant improvements were noted at 3 months in Qmax (237%, P <.01) and Qavg (227%, P <.01), with changes remaining durable through 2 years. Statistically significant improvements were noted at 3 months in International Prostate Symptom Score (-64%, P <.01), postvoid residual (-83%, P <.01), and prostate-specific antigen change (-77%, P <.01). Adverse event and complication rates were comparable to other published enucleation studies. Sexual activity was reported in 36% of patients, all of whom reported retrograde ejaculation. Patients experienced dysuria (6%), stress urinary incontinence (6%), urge urinary incontinence (16%), urethral stricture (6%), bladder perforation (n = 2), prostatic capsular perforation (n = 1), and ureteral injury (n = 1). CONCLUSION: Simplified GreenLEP shows effective and durable results with an acceptable adverse event and complication profile. This technique is optimal for novice enucleators familiar with photoselective vaporization.


Assuntos
Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Urologia ; 86(2): 69-73, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31179883

RESUMO

PURPOSE: The purpose of the study was to investigate the incidence of perioperative hypothermia in urology patients undergoing transurethral resection with either TURis or transurethral resection of the prostate method and to recognize the risk factors that were responsible for the occurrence of hypothermia intraoperatively in these patients. METHODS: It was a randomized prospective study. A total of 168 patients, according to American Society of Anesthesiologists physical status I-III, were scheduled for transurethral resection either with TURis or transurethral resection of the prostate method. We measured the core body temperature before (preoperative), during (perioperative) and after (postoperative) the surgery. Age, body mass index, American Society of Anesthesiologists score, duration of surgery, preoperative prostatic volume, and vital signs were also recorded. RESULTS: The prevalence of inadvertent hypothermia was 64.1% for the TURis group and 60% for the transurethral resection of the prostate group. Hypothermic patients in TURis group were significantly older (87.7 ± 1.7 vs 68 ± 6.7 years, p < 0.05) and had lower body mass index (26.9 ± 3.6 vs 29.2 ± 2.7, p < 0.05), while hypothermic patients in the transurethral resection of the prostate group were significantly older (86 ± 1.1 vs 70 ± 7.4 years, p < 0.05) and had notably higher duration of surgery (140.6 ± 28.9 vs 120.3 ± 14.3 min, p < 0.05) than normothermic patients. CONCLUSION: Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with both TURis and transurethral resection of the prostate method is of high incidence. We recommend monitoring of the temperature of core body of all these patients, especially those with advanced age and lower body mass index.


Assuntos
Hipotermia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Ressecção Transuretral da Próstata , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Masculino , Estudos Prospectivos , Ressecção Transuretral da Próstata/métodos
8.
Urology ; 131: 184-189, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254569

RESUMO

OBJECTIVE: To evaluate the impact of Greenlight 180W photoselective vaporization of the prostate (PVP) and endoscopic enucleation of the prostate (GreenLEP) on ejaculatory and erectile functions. MATERIALS AND METHODS: Between January 2014 and September 2016, 440 men with low urinary tract symptoms or complications related to benign prostate obstruction with prostate >80 g and sexually active, underwent a PVP or GreenLEP performed by experienced surgeons at a single institution. Patients were matched in a 1:1 fashion according to preoperative transrectal ultrasonography prostatic volume and cardiovascular risk factors (smoking, diabetes, and hypertension). RESULTS: One hundred patients in each group were included. Mean prostatic volume were 110 g (95%CI: 101-118) and 107 g (95%CI: 99-115) in the GreenLEP and PVP groups, respectively (P = .68). Mean total energy delivered in the PVP group was 4.42 kJ/g (4.2-4.6). Surgical retreatment was required in 9 patients (10.1%) in the PVP group and none in the GreenLEP group (log rank test: P = .002). Mean prostate specific antigen level and International Prostate Symptom Score score were significantly lower in the GreenLEP group than in the PVP group at 3, 12, and 24 months (P <.001). Preserved antegrade ejaculation was reported in 24 patients (26.9%) in the PVP group vs 1 patient (1.2%) in the GreenLEP group at 12 months (P <.001). In multivariate analysis, age, history of coronary artery disease, and surgical treatment with PVP were independent factors of IIEF-5 decline. CONCLUSION: Despite a poor rate of preserved antegrade ejaculation, GreenLEP was associated with better erectile function outcomes possibly due to greater improvement of low urinary tract symptoms.


Assuntos
Ejaculação , Endoscopia , Ereção Peniana , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
9.
Urology ; 132: 170-176, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31252003

RESUMO

OBJECTIVE: To evaluate the outcomes of thulium laser enucleation of the prostate (ThuLEP) in men aged ≥75 years compared to youngers. Traditional surgery has increased and significant morbidity in older men. Lasers have been introduced as an alternative approach to overcome the morbidity of traditional surgery. MATERIAL: We retrospectively evaluated 412 men who underwent en bloc ThuLEP. Inclusion criteria were lower urinary tract symptoms refractory to medical therapy, maximum urinary flow rate (Qmax) ≤15 mL/s, International Prostate Symptom Score (IPSS) ≥8 and absolute indications for surgery. Prostate volume, prostate specific antigen, IPSS, and Qmax, antiplatelet/anticoagulant therapy, ASA score, operation time, length of catheterization, discharge day, early complications, and reoperations were gathered. Differences between groups were estimated using propensity scores, by fitting a stepwise logistic regression model with age group as the dependent variable. RESULTS: One hundred twenty-nine patients were aged ≥75 years (Group 2). Mean age was 65.6 ± 6.0 years in Group 1 and 79 ± 3.7 years in Group 2. Propensity scores retrieved 206 patients. Median operation, catheterization time, and hospital stay were similar in both groups (55 minutes, 2 and 3 days). Overall, 85.9% of men had no complications, with no differences between the groups (82.5% in Group 1 and 89.3% in Group 2). The incidence of Clavien grade III-IV complications was comparable (3.8% in Group 1, 1% in Group 2). By 1 year, there were no statistically significant differences in IPSS, Qmax, QoL, or reoperation rate between the groups. CONCLUSION: En bloc ThuLEP is a safe and effective treatment even in men aged ≥75 years old.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/cirurgia , Túlio/uso terapêutico , Ressecção Transuretral da Próstata/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Hiperplasia Prostática/complicações , Estudos Retrospectivos , Resultado do Tratamento
10.
Urology ; 132: 177-182, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31252004

RESUMO

OBJECTIVE: To assess blood loss during holmium laser enucleation of the prostate (HoLEP) and investigate the factors influencing it. PATIENTS AND METHODS: Analysis of patients with benign prostatic hyperplasia (BPH) treated with HoLEP at 3 centers. Hemoglobin and hematocrit were measured before surgery and hospital discharge. All blood transfusions performed during and after HoLEP were recorded. Blood loss outcomes were analyzed regarding antithrombotic (antiplatelet/anticoagulant) therapies and drug treatments for BPH and other conditions. RESULTS: The analysis included 963 patients with a mean age of 72 years. Mean (range) prostate size was 102 (40-316) g; 28% of patients were receiving antiplatelets and 11% anticoagulants. Mean (range) prostate-specific antigen was 6.0 (0.3-43.5) ng/dL. Mean (range) operation time was 77 (28-178) minutes. Bladder calculi were found in 54 (5.6%) patients; all of them were successfully treated with cystolitholapaxy. Forty-eight (5%) patients required blood transfusion during or immediately after the HoLEP procedure. Overall, mean (SD) hemoglobin decreased from 14.6 (1.5) g/dL to 12.3 (2.1) g/dL (P <.001), and mean (SD) hematocrit decreased from 44.3% (4.7) to 37.7% (6.5) (P <.001). Neither hemoglobin nor hematocrit decreases were significantly different between patients receiving and not receiving antithrombotic therapy or BPH therapy. CONCLUSION: HoLEP is safe and has no remarkable impact on blood loss. Patients at high risk, such as those receiving antithrombotic therapy, had the same outcome than the rest regarding blood loss, although showed a higher transfusion rate. Operating time may influence hemoglobin decrease; therefore, it should be considered in patients with higher risk of bleeding.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Lasers de Estado Sólido/uso terapêutico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Pract Radiat Oncol ; 9(5): 347-353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30978467

RESUMO

PURPOSE: To determine the genitourinary (GU) toxicity outcomes in prostate cancer patients treated with stereotactic body radiation therapy (SBRT) who have undergone a prior transurethral resection of prostate (TURP) and compare it to a similar non-TURP cohort. MATERIALS AND METHODS: Fifty prostate cancer patients who had undergone a single TURP, had a good baseline urinary function, and had been subsequently treated with SBRT were chosen from a prospectively maintained database. These were propensity score matched to a similar non-TURP cohort treated during the same period. Matching was done for diabetes mellitus and volume of radiation therapy. Acute GU and late GU toxicity were scored using the Radiation Therapy Oncology Group (RTOG) criteria. Stricture and incontinence were scored using Common Terminology for Common Adverse Events version 4.0. RESULTS: Median follow-up for the entire cohort was 26 months (non-TURP vs TURP, 30 months vs 22 months, P = .34). The median duration between TURP and start of SBRT was 10 months. There was no significant difference between non-TURP versus TURP cohort in terms of RTOG acute GU toxicities grade ≥2 (8% vs 6%, P = .45), RTOG late GU toxicities grade ≥2 (8% vs 12%, P = .10), stricture rates (4% vs 6%, P = .64), and incontinence rates (0% vs 4%, P = .15). The median duration of time to late toxicity was 16 months vs 10 months (P = .12) in non-TURP and TURP cohort, respectively. CONCLUSIONS: Although modestly increased as compared with non-TURP patients, GU toxicities remains low with SBRT in post-TURP patients. SBRT can be safely performed in carefully selected post-TURP prostate cancer patients.


Assuntos
Próstata/patologia , Radiocirurgia/métodos , Ressecção Transuretral da Próstata/métodos , Humanos , Masculino , Análise por Pareamento , Pontuação de Propensão , Estudos Prospectivos
12.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936357

RESUMO

A 61-year-old man presented with urinary retention with obstructive uropathy (urea/creatinine: 126/9.2 mg/dL) secondary to a large prostatic haematoma while being medically managed for benign enlargement of the prostate. The patient did not have any fever or local symptoms and the prostate was enlarged and non-tender on examination. Ultrasound and MRI of the pelvis showed a 9.4×10.4×11.1 cm sized prostatic haematoma seen displacing and compressing the urinary bladder anteriorly with bilateral hydroureteronephrosis. The patient was managed with per-urethral catheterisation, haemodialysis and injectable antibiotics. Percutaneous pigtail placement into the prostatic haematoma led to gradual drainage of the haematoma with improvement in the renal parameters. Definitive surgery in the form of transurethral resection of the prostate was done at a later date. Intraoperatively multiple encapsulated cavities containing organised clots were deroofed. On follow-up, the patient did well and had good urinary flow and normal renal parameters.


Assuntos
Antibacterianos/uso terapêutico , Hematoma/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/diagnóstico por imagem , Ressecção Transuretral da Próstata/métodos , Retenção Urinária/etiologia , Hematoma/complicações , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/cirurgia , Hiperplasia Prostática/patologia , Hiperplasia Prostática/cirurgia , Resultado do Tratamento , Ultrassonografia , Cateterismo Urinário , Retenção Urinária/diagnóstico por imagem
13.
Arch Ital Urol Androl ; 91(1): 22-24, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932425

RESUMO

INTRODUCTION: The aim of this study was to report our experience in the management of hematospermia observed in 16 patients suffering from xanthogranulomatous prostatitis. METHODS: Recurrent episodes of hematospermia were the onset symptom in all patients, and in 25% of patients it was combined with fever. All patients reported PSA value elevation and the digital rectal examination (DRE) revealed an increase of the gland size and of its consistency in all cases. In all patients, the hematospermia was treated with the oral administration of two tablets of pollen extract in a single (1 g) dose daily for 30 days. RESULTS: Sixteen patients were observed between 2008 and 2016, referring hematospermia, progressive lower urinary tract symptoms (LUTS), and serum PSA level increase. To exclude the prostate cancer presence all patients were submitted to transperineal TRUS guided biopsy. In all the patients complete resolution of hematospermia was achieved treatment with pollen extract. All patients were subsequently treated for LUTS (alpha-adrenergic blockers), but none reported any significant improvement of symptoms. Basing on these pieces of evidence, after 90 days of alpha-blockers therapy, all patients underwent bipolar TURP. Histological examination of resected prostatic tissue revealed in all patients the diagnosis of xanthogranulomatous prostatitis. CONCLUSIONS: Patients with xanthogranulomatous prostatitis especially experience irritative symptoms, sometimes combined with fever or hematospermia. Hematospermia as the onset symptom has not been reported so far. The administration of the pollen extract for 30 days was associated with a complete resolution of hematospermia.


Assuntos
Hemospermia/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Pólen/química , Prostatite/terapia , Antagonistas Adrenérgicos alfa/administração & dosagem , Biópsia , Exame Retal Digital , Febre/etiologia , Hemospermia/diagnóstico , Hemospermia/etiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Antígeno Prostático Específico/sangue , Prostatite/complicações , Prostatite/diagnóstico , Ressecção Transuretral da Próstata/métodos
14.
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
15.
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
16.
Rev. esp. patol ; 52(1): 54-56, ene.-mar. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-182668

RESUMO

The presence of foreign bodies in a prostate transurethral resection may pose a histopathological challenge. A 65-year-old white man with urinary obstructive symptoms was subjected to a transurethral resection. Histopathology showed a squamous cell carcinoma affecting prostatic ducts and multiple foreign bodies; their differential diagnosis was between iodine-125 seeds and Schistosoma sp. eggs, as both can show oval morphology and terminal spines. The seeds are irregular, homogeneous and solid, unlike Schistosoma eggs that are heterogeneous, with a lytic appearance and some embryonated or calcified. The seeds are located in prostatic ducts inducing periductal fibrosis whereas the Schistosoma sp. eggs are found in the stroma inducing desmoplasia and granulomas. The seeds are associated with a lymphoplasmacytic infiltrate while the eggs are surrounded by eosinophils


La presencia de cuerpos extraños en una resección transuretral de próstata puede suponer un desafío histopatológico. Un varón de 65 años con síntomas de obstrucción urinaria fue sometido a una resección transuretral. El estudio histopatológico demostró un carcinoma de células escamosas de conductos prostáticos y múltiples cuerpos extraños planteando el diagnóstico diferencial entre semillas de iodo-125 y huevos de esquistosoma. Ambos pueden tener morfología oval y espinas terminales. Las semillas son irregulares, homogéneas y sólidas, a diferencia de los huevos de esquistosoma que son heterogéneos, de apariencia lítica, y otros embrionados o calcificados. Las semillas se localizan en los ductos prostáticos induciendo fibrosis periductal mientras que los huevos están en el estroma induciendo desmoplasia y granulomas. Las semillas se asocian a infiltrado linfoplasmocítico mientras que los huevos están rodeados por eosinófilos


Assuntos
Humanos , Masculino , Idoso , Neoplasias da Próstata/patologia , Ressecção Transuretral da Próstata/métodos , Corpos Estranhos/patologia , Schistosoma/isolamento & purificação , Neoplasias da Próstata/cirurgia , Esquistossomose/complicações , Carcinoma de Células Escamosas/patologia
17.
Minerva Urol Nefrol ; 71(3): 286-293, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30700082

RESUMO

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of bipolar plasmakinetic enucleation of the prostate (BPEP) and bipolar plasmakinetic transurethral resection of prostate (B-TURP) for patients on oral anticoagulants (OA) and/or platelet aggregation inhibitors (PAI) with benign prostatic obstruction (BPO) and having a gland size of >60 g. METHODS: Patient database of our hospital for the period of May 2012 to September 2017 was retrospectively reviewed for BPH patients with a gland size of >60 g who either underwent BPEP or B-TURP and were on OA and/or PAI. Patient demographic, perioperative, and follow-up data were analyzed. RESULTS: There were no significant differences between the two surgical groups preoperatively. The mean operative time was lower in the BPEP group however, no statistical difference was found between them (P=0.77). There was significant difference in the mean resected tissue weight (52.11±17.92 vs. 77.19±17.78 g, P value ≤0.001), irrigation time and total hospital stay in favor of BPEP group. The blood loss observed in the B-TURP group and BPEP group was 2.57±0.36 and 1.45±0.44 g/dL, respectively, which was statistically significant (P<0.033). Eight and three patients of B-TURP and BPEP groups needed blood transfusion respectively. All patients were followed up for 12 months postoperatively. Both groups resulted in a significant improvement from baseline in terms of IPSS, QoL, Q-max, and PVRU volume values. No significant difference was found between them, however. CONCLUSIONS: Both procedures are safe and effective options in patients who are on OA and/or PAI but BPEP is better in terms of low clot retention rate, less irrigation time and decreased hospital stay.


Assuntos
Anticoagulantes/efeitos adversos , Inibidores da Agregação de Plaquetas/efeitos adversos , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Seguimentos , Humanos , Complicações Intraoperatórias/induzido quimicamente , Complicações Intraoperatórias/epidemiologia , Tempo de Internação , Masculino , Duração da Cirurgia , Estudos Retrospectivos
18.
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
19.
Urol Int ; 102(3): 306-310, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30731471

RESUMO

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is becoming the new standard procedure for treating benign prostatic hyperplasia (BPH), a common condition in aging men. Most studies have focused on proving its efficacy in treating large prostates. In this study, we compared its efficacy in treating small (< 80 mL) and large (> 80 mL) prostates. METHODS: This prospective study included 119 patients with BPH who underwent HoLEP by the same surgeon between June 2015 and December 2017. They were divided into 2 groups according to their prostate volumes (≤80 mL: Group 1; > 80 mL: Group 2). Various pre- and postoperative parameters were compared within and between the groups. RESULTS: International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, and voiding time (VT) significantly decreased, and the peak urinary flow rate (Qmax), average urinary flow rate (Qave), and quality of life (QoL) score significantly increased postoperatively in both groups. The postoperative changes in IPSS, QoL score, Qmax, Qave, VT, PVR volume, and hemoglobin levels were not significantly different between the groups. In addition, no significant difference was observed in postoperative complications between the groups. CONCLUSIONS: Our results indicate that HoLEP is an effective procedure for treating both small and large prostates.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Hólmio , Humanos , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Hiperplasia Prostática/psicologia , Qualidade de Vida , Resultado do Tratamento
20.
Investig Clin Urol ; 60(1): 35-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30637359

RESUMO

Purpose: To evaluate patients' tolerance to indwelling urinary catheters (IUCs) before and after reducing their balloon volumes. IUCs are a source of discomfort or pain. Materials and Methods: All consecutive patients hospitalized in our department with IUCs were included during the study period with some exclusion. Each patient was his/her own control before and two hours after reduction of the balloon volume (RBV) by half using two types of assessments, a visual analog scale for pain and a catheter-related bladder discomfort (CRBD) symptom questionnaire. Results: Forty-nine patients were included in our study that completed the assessments. The mean scores for pain before and after RBVs were 2.80 and 2.02, respectively. The difference was significant (p<0.05). The mean grades of the CRBD before and after RBVs were 1.02 and 0.75, respectively. The difference was significant (p<0.05). Conclusions: A 50% RBV has shown a significant amelioration in tolerating the catheter.


Assuntos
Cateteres de Demora/efeitos adversos , Dor Pós-Operatória/etiologia , Doenças da Bexiga Urinária/etiologia , Cateteres Urinários/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Complicações Pós-Operatórias , Estudos Prospectivos , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata/métodos , Neoplasias da Bexiga Urinária/cirurgia , Cateterismo Urinário/instrumentação , Incontinência Urinária de Urgência/etiologia , Adulto Jovem
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