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Background: Transurethral resection of prostate is considered as gold standard surgical procedure for treatment of benign enlargement of prostate. It can be performed in two forms- monopolar transurethral resection and bipolar transurethral resection. Aims and Objective: This study was conducted to know which energy source among monopolar and bipolar energy leads to more post-operative morbidity after performing transurethral resection of prostate. Materials and Methods: In this study, total eighty (80) cases were included. They were suffering from lower urinary tract symptoms which were diagnosed to be due to benign enlargement of prostate after careful clinical and radiological examination. In forty cases, transurethral resection of prostate was performed by using monopolar energy source and in another forty cases, resection of prostate by transurethral route was done using bipolar energy source. Results: In our study, we found that development of TURP syndrome was more in monopolar TURP group in which pre-operative weight of prostate was more than 50 grams in comparison to bipolar TURP group in which there was no incidence of development of TURP syndrome in same class. Further, post-operative hospital stay and post-operative urethral catheter in situ was less in bipolar TURP group in terms of days as compared to monopolar TURP group. Conclusion: Our study concludes that Bipolar TURP is better in terms of development of less post-operative morbidity as compared to monopolar TURP. Bipolar TURP must be used extensively in teaching hospitals where students take more time than a seasoned surgeon to perform a surgical procedure and bipolar TURP will come handy in that situation.

Lower urinary tract symptoms (LUTS) in men commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP). This can be performed using either monopolar or bipolar electrosurgery. Bipolar TURP uses saline for irrigation rather than glycine, which drastically reduces the risk of TUR syndrome complications, thus allowing for increased procedure time if needed. The PLASMA system (formally known as TURis) is a bipolar TURP electrosurgery system used to treat LUTS secondary to BPH. National guidance recommending the use of TURis in the UK NHS was issued in 2014 by NICE and we now report the updated contribution from Cedar that was included in the update of that guidance for 2021. The evidence in this review suggests that the PLASMA system could be beneficial to patients in relation to hospitalisation and catheterisation time compared with monopolar TURP (mTURP). However, it appears to be comparable to mTURP for urological outcomes and worse for post-operative haematology outcomes such as decline in sodium and haemoglobin levels. Adverse events, however, occurred much less with PLASMA use.

Transurethral resection of the prostate (TURP) is the most common standard surgical procedure used for benign prostatic hyperplasia. Transurethral resection in saline (TURis) is a bipolar electrosurgery system used to prevent TURP (or TUR) syndrome. The bicarbonate Ringer's solution is not generally used as perfusate for TURP. Hence, we compared the efficacy of the bicarbonate Ringer's solution with that of physiological saline as perfusate during TURP. This prospective, multicenter, cooperative study was conducted on 40 adult patients admitted to a medical college hospital. After obtaining informed consent from all the patients, they were divided into two groups (20 patients per group). For patients of one group, bicarbonate Ringer's solution, and for other group, physiological saline was used as perfusate. Compared to the physiological saline, the electrolyte composition of the bicarbonate Ringer's solution was closer to that of plasma. Hence, the group using bicarbonate Ringer's solution as perfusate was exhibited less variation in plasma electrolytes and blood gas data. The primary endpoints were adverse events of grade 1 or higher according to the JCOG postoperative complication criteria ver. 2.0, unintended diseases, or related signs in patients who underwent the protocol therapy. The secondary endpoints were changes in blood pH, bicarbonate ion level, anion gap (AG), base excess (BE), and chloride (C1), which occurred during and after the surgeries. Therefore, bicarbonate Ringer's solution has superior with that of physiological saline as perfusate during TURP which is directly administered into the blood vessels as an infusion solution.Bicarbonate Ringer's solution is directly administered into the blood vessels as an infusion solution.

Objectives: Nonconductive irrigation fluids used during transurethral resection (TUR) of the prostate can cause fluid overload and dilutional hyponatremia. TUR syndrome is generally defined as seru...

Endourology has undergone fundamental changes over the last 2 decades. Maintaining low intrarenal pressure (IRP) during upper urinary tract procedures is an established concept. However, researchers have not yet studied the concept of reduced intravesical pressures (IVPs) during transurethral (TUR) surgery as thoroughly. Low IVP is supposed to decrease complications as fluid retention, TUR syndrome, and incidence of fever. The study aims to give an overview of the contemporarily existing concepts and specify the term of low IVP to avoid TUR-related complications and optimize TUR-related results. A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were transurethral resection, transurethral enucleation, transurethral vaporization, pressure, fluid absorption, and TUR syndrome. Analyzed mean IVPs during TUR vary between 11 and 35 cmH2O but are mostly kept below 30 cmH2O. Mean maximum IVPs during TUR range from 20 to 55 cmH2O. Maximum IVPs seem to be lower when surgeons utilize continuous flow resection, and irrigation pressures are kept low. The results demonstrate a strong correlation between IVP levels and fluid absorption. IVP increase remains a neglected predictor of transurethral procedure complications, and endourologists should consider its intraoperative monitoring. Further research is necessary to quantify generated pressures and introduce means of controlling them.

Background and objective Transurethral resection of the prostate (TURP) has been the undisputed reference standard for elderly men with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE). However, morbidity after TURP remains significant, with increased risks of bleeding and TUR syndrome. In recent years, there has been a gradual increase in the role of laser technology for the treatment of symptomatic BPE. The aim of our study was to evaluate the efficacy and safety of the novel technique Thulim laser enucleation of prostate (ThuLEP) developed for the first time in 2009 by Imkamp et al. in treating symptomatic BPE. Materials and methods Analysis of the data from electronic records, case notes, clinic letters all the patients who had undergone ThuLEP using a 70 W thulium laser (Revolix) for symptomatic outflow obstruction over a 6-year period was done. We looked at the pre-procedure PSA, maximum urinary flow rate (Qmax), Post void residual (PVR) and haemoglobin, comparing it with the postoperative haemoglobin. Results 222 patients underwent ThuLEP procedure performed by 2 surgeons. We found a 159 % improvement in Q max, a 61 % improvement in PVR. No mortalities occurred and only 1 patient required post operative blood transfusion. ThuLEP represents a safe, effective surgical option in patients with symptomatic BPH with relatively little complications, producing significant improvements in both Qmax and PVR. Key words LUTS, BPE, Enucleation, TUR Syndrome, Qmax

ZusammenfassungStörungen des Natriumhaushalts sind häufig auftretende Elektrolytimbalancen. Sowohl sie selbst als auch ihre unsachgemäße Therapie können schwerwiegende Komplikationen nach sich ziehen. Der vorliegende Artikel informiert über die Ätiologie von Störungen des Natriumhaushalts und stellt wichtige therapeutische Prinzipien dar.

Despite innovative modalities, transurethral resection (TUR) procedures are the primary surgical intervention for bladder tumor and enlarged prostate. TUR syndrome, a major complication of TUR procedures, leads to derangement in electrolytes, hemodynamic compromise, and possible cardiac arrest. This case report describes cardiovascular collapse in a 60-year-old male during TUR of a bladder tumor under general anesthesia. The patient developed hypoxia, which progressed to cardiovascular collapse. Electrolyte analysis revealed acute hyponatremia. The patient was resuscitated successfully, transferred to intensive care unit, and discharged from the hospital without any complications. This case report of a cardiovascular collapse during transurethral resection of bladder tumor offers insight of the risks in urologic procedures and highlights the importance of clear communication as well as early recognition and successful management of complications.

We report a case of transurethral resection of prostate (TURP) syndrome. A 80-year-old man with grade III Prostatomegaly was scheduled for transurethral resection of the prostate under spinal anesthesia. Just after the end of the surgery, the patient presented signs of TURP syndrome with bradycardia, arterial hypertension, hypoxemia and dizziness-confusion. The electrolytes analysis revealed an acute hyponatremia (sodium concentration 120.6 mmol/L) and hyperkalemia (potassium concentration 6.48 mmol/L). Medical treatment consisted of hypertonic saline solution 3% and nebulization with levosalbutamol. The presented case describes a typical TURP syndrome, which was diagnosed and treated early. The patient was discharged from hospital without any complications.

The transurethral (TUR) syndrome is caused by absorption of fluid used to irrigate the operating field during endoscopic surgery. The intensivist and the anesthetic team should be able to successfully master this complication, which has good prognosis if diagnosed and treated early. Parts of the pathophysiology and the best treatment of the TUR syndrome have not been clarified until recently.

Transurethral resection (TUR) syndrome is a rare and serious complication of bladder perforation during transurethral resection of bladder tumor (TURBT), secondary to the excessive absorption of electrolytes-free irrigating fluid by extravascular route. Its defined as the combination of clinical cardiovascular and/or neurological manifestations, along with hyponatremia. Herein we report a rare case of 61-year-old patient, who presented a typical and severe TUR syndrome, secondary to intraperitoneal bladder perforation during TURBT, requiring intubation and positive inotropic drugs in the intensive care unit (ICU), and which was successfully managed conservatively. The patient was discharged from the hospital without any complications.

Symptoms related to benign prostatic hyperplasia (BPH) are the most common reason why patients consult a urologist. Despite the rise of new minimally invasive technologies, transurethral resection of the prostate (TURP) remains the most commonly used procedure (at 84 %) to treat BPH patients in Germany. The continued popularity of this procedure can be explained by three main reasons: a robust, simple technique, an until now unsurpassed efficacy and-with regard to the risk-benefit ratio-a low morbidity. Following TURP, the mean Qmax is 19-20 ml/s and the mean IPSS is 6. BPH recurrence occurs in 2-7 % of patients within 8-22 years following TURP. Regarding clinical efficacy, meta-analyses now show relevant differences between monopolar and bipolar (B) TURP. However, B‑TURP seems to be favourable considering potential complications. Clot retention with an incidence of 1-5 % is the most common acute complication and urethral strictures with an incidence of 2-9 % are the most common long-term complications of TURP. TUR syndrome is nowadays a clinical rarity. However, many complications can be avoided by a proper resection technique. TURP is still the standard in surgical BPH therapy.

Purpose To evaluate long-term efficacy and safety of low-pressure transurethral resection of the prostate for prostates 70 cc (group 2). Patients and methods In this study patients operated with monopolar TURP between 2009 and 2012 were evaluated retrospectively. During surgery a specially designed trocar (18 Fr) was placed suprapubically and connected to a suction pump to maintain stable low-pressure conditions. After sample size calculations, long-term follow-up was completed for 70 invited patients in each group up to 9/2015. Results Follow-up period was 57 vs. 56 months for group 1 and 2, respectively (p = 0.56). At baseline there was no significant difference in age, IPSS, peak flow, and post void residual (PVR). Mean prostate volume was 47 cc (15–65) vs. 100 cc (70–163). Mean operating time was 55.4 vs. 82.6 min (p = 0.00). Blood transfusion was necessary in 0.0 vs. 2.9% (p = 0.16), and 0.0 vs. 1.4% developed TUR syndrome (p = 0.32). At follow-up mean relative improvement in IPSS was 63 vs. 57% (p = 0.29), QoL 64 vs. 64% (p = 0.93), peak flow 139 vs. 130% (p = 0.85), and PVR 58 vs. 63% (p = 0.80). Long-term complications included recurring adenoma in 1.4 vs. 4.3% (p = 0.31), and stricture in 7.2 vs. 5.8% (p = 0.73). 1 patient in each group reported worsening incontinence symptoms. Conclusions In terms of safety and efficacy, the aforementioned modality of standardized monopolar TURP using suprapubic suction was non-inferior for prostates > 70 cc compared to the same procedure for prostates Study register number DRKS00006527.

Transurethral resection (TUR) of bladder tumor may be complicated with bladder perforation associated with intraperitoneal and retroperitoneal extravasation of irrigation fluid, which may rarely evolve in specific hydroelectrolyte imbalance characterized with hyponatremia, intravascular volume deficit, and renal impairment. Signs and symptoms of cardiovascular dysfunction secondary to hyponatremia, prolonged resection, and intravascular volume deficit may also occur, such as severe hypotension, bradycardia, and cardiac arrest. It is most important to prevent TUR syndrome by using an accurate technique. If bladder perforation occurs, early detection is important for the appropriate treatment.

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6%) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

OBJECTIVE To evaluate the utility of using a tracer of 1% ethanol in 1.5% glycine for the early detection of irrigation fluid absorption during transurethral resection of the prostate (TURP). PATIENTS AND METHODS In all, 126 men undergoing TURP were irrigated with a solution of 1% ethanol and 1.5% glycine; their expired air was tested for ethanol every 20 min, and again at the end of the procedure. Maximum absorption by the breath-ethanol reading was compared with the serum concentration of absorbed glycine (analysed by anion-exchange chromatography). RESULTS Complete data on 120 men were assessed; 75% of the men absorbed irrigation fluid, with glycine levels above the normal range. The sodium levels tended to decrease with increasing glycine levels (Spearman’s rank correlation coefficient, − 0.57; 120 men) and five men (4%) developed clinical features of the TUR syndrome. There was a weak correlation between breath-ethanol levels and serum glycine levels (Spearman’s rank correlation coefficient, 0.54). The experience of the surgeon, the weight of the resected chips, and the operative duration were not significantly predictive of irrigation fluid absorption. CONCLUSIONS A rising breath-ethanol level indicates irrigation fluid absorption. However, irrigating fluid absorption is unpredictable, supporting the case for alternative, potentially safer irrigants.

Resumen Objetivos En este estudio fue nuestra intencion evaluar la relacion entre la reabsorcion de liquido de irrigacion y tres variables: tiempo de la intervencion, volumen de solucion de glicina empleado y peso de los fragmentos, durante la RTU de prostata realizada a baja presion hidraulica. Material y metodo Estudiamos 74 pacientes a los que se realizo RTU de prostata con derivacion suprapubica con vaina de Amplatz 30 ch. Se monitorizo el etanol en aire expirado cada 15 minutos durante la intervencion. Asi mismo se anotaron el tiempo de la intervencion, el volumen de glicina utilizado y el peso de los fragmentos extraidos. Estadisticamente se utilizo el Test de Anova para comparacion de medias. Resultados Un 13,6 % de los pacientes absorbieron liquido de irrigacion en alguna cantidad. El rango de absorcion es de 100 cc hasta 2.000 cc. No se encontro una diferencia estadisticamente significativa entre las medias del tiempo de reseccion, del volumen de glicina y del peso de los fragmentos entre el grupo de pacientes que habia reabsorbido liquido de irrigacion y los que no reabsorbieron. Conclusiones Nuestro estudio pone de manifiesto que el tiempo operatorio, el volumen de liquido de irrigacion y el peso de los fragmentos resecados no influyen en la reabsorcion de liquido de irrigacion cuando se realiza una RTU a baja presion hidraulica.

Modern surgical practice and anaesthetic vigilance has reduced the incidence of profound metabolic disturbance associated with absorption of irrigation fluid during endoscopic transurethral resection (TUR) of the prostate. We describe the critical care management of a patient with severe TUR syndrome, who was successfully managed with continuous veno-venous haemofiltration for the treatment of profound electrolyte disturbance, intravascular volume correction, and treatment of irrigation-fluid glycine toxicity. We examine the rationale for rapid and controlled correction of hyponatraemia in TUR syndrome.

This discussion will focus on the technical aspects of electrosurgical techniques used in the surgical treatment of BPH. The core principle of electrosurgery is the application of electrical current to tissue results in heating of the tissue and desired effects on the tissue. The given effect on the tissue largely depends on the rate of temperature rise in tissue, which can be controlled by adjusting the settings of the electrosurgical generator. Tissue effects include cutting, coagulation, vaporization, desiccation, and fulguration. Monopolar techniques require a large dispersive pad located on the patient, while bipolar techniques feature both active and return electrodes built into the resectoscope. Bipolar resection can be carried out in a saline medium, which for all practical purposes removes the risks of TUR syndrome and dilutional hyponatremia observed with monopolar TURP.

Investigation of water-excretory renal activity in patients with benign hyperplasia of prostate gland before surgery in order to several high risk group according to the development of transurethral resection syndrome has been carried out., Проведено исследование водовыделительной деятельности почек у пациентов с доброкачественной гиперплазией предстательной железы накануне оперативного вмешательства с целью выявления группы риска по развитию синдрома трансуретральной резекции., Проведено дослідження водовидільної діяльності нирок у пацієнтів на доброякісну гіперплазію передміхурової залози напередодні оперативного втручання із метою виявлення групи ризику за розвитком синдрому трансуретральної резекції.

Background Transurethral resection of the prostate (TURP) involves the risk of transurethral resection (TUR) syndrome owing to hyponatremia. Irrigation fluid type, duration of operation, and weight of resected mass have been evaluated as risk factors for TUR syndrome. The purpose of the present study was to identify risk factors related to TUR syndrome in the elderly. Methods After obtaining approval from the Institutional Review Board, data on all elderly males (aged 70 years and older) who underwent TURP under regional anesthesia over a 6-year period at our institution were retrospectively reviewed. TUR syndrome was defined as evidence of a central nervous system disturbance such as nausea, vomiting, restlessness, confusion, or even coma with a circulatory abnormality both intra- and post-operatively. Patients were divided into two groups, positive and negative, for the occurrence of the syndrome. Data such as previous medical history, preoperative and postoperative serum data, weight of resected mass, duration of operation, irrigation fluid drainage technique, anesthetic technique, operative infusion and transfusion volume, and neurological symptoms were collected. Only observational variables with p 45 g (OR 4.1, 95% CI 1.2–14.7) were associated with significantly increased risks for TUR syndrome (Hosmer-Lemeshow test, p = 0.94, accuracy 84.7%). Conclusions These results suggest that the use of a plasma substitute and continuous irrigation through a suprapubic cystostomy must be avoided during TURP procedures in the elderly.

Intravesical pressure was measured continuously during 35 transurethral prostate resections using a fine suprapubic catheter. Absorption of irrigating fluid was detected by tagging it with ethanol and sampling the expired breath using an alcohol meter. Higher mean (SD) intravesical pressure was demonstrated in those patients who absorbed irrigating fluid (19.1 (7.7) mmHg) than in those who did not (12.4 (6.5) mmHg; p = 0.00004). Higher peak pressures were also demonstrated among absorbing patients. Traditional risk factors for fluid absorption, such as operator experience and resectate mass, were found to correlate with pressure exposure over time. Exposure to supranormal bladder pressure over time is the final common path for all causes of absorption. Vesical pressure monitoring may be a valuable feedback tool during difficult resections or operator training.

Objective: To evaluate the safety and suitability of sorbitol-mannitol solution (Purisole®, Fresenius, Germany) as a fluid for irrigation during electrosurgical resection

Transurethral Prostate Resection (TUR) opens large venous network and allows irrigation fluid to be absorbed into systemic circulation. The absorption of 2000 ml or more fluid causes a syndrome known as TUR-P syndrome and presents with head ache, restlessness, confusion, cyanosis, dyspnea, arrhythmia, hypotension and convulsions. The most important point in treatment is early diagnosis. When suspected, serum sodium levels of the patients should be measured. In cases with large prostate whose operation is estimated to last long, perioperative sodium measurement should be made routinely. Compared to general anesthesia, regional anesthesia decreases the incidence of postoperative venous thrombosis and the probability of symptoms being masked. Regional anesthesia enables earlier recognition and faster and more efficient treatment of TUR syndrome.

Objective To design a practical system for non-invasively monitoring fluid balance during transurethal resection of the prostate (TURP) and other endoscopic procedures. Materials and methods Load cell transducers are incorporated into a platform placed under the operating table. Output is passed to a digital weighmeter and then to a portable computer. The raw data is filtered using software written by the authors (GAL) and the output displayed both numerically and graphically on the computer screen. The device was tested under laboratory conditions and then assessed in the clinical setting. Results The device proved stable in both the laboratory and clinical settings. Examples of the common patterns generated during TURP are presented. The prototype has been used routinely in our practice to warn the surgeon and anaesthetist of fluid overload and has been used to monitor fluid balance in several studies. Conclusions This instrument provides a practical method of monitoring total fluid balance during TURP. It can be used with either general or regional anaesthesia and provides information not otherwise available. It provides an early warning of significant changes in total fluid balance, particularly irrigant fluid absorption. Use of this device serves to prevent development of the TUR syndrome, a potentially fatal complication of endoscopic surgery. Our ultimate aim is to produce a refined version that is simple, compact and cheap enough to be used routinely in all urological theatres. The cost of a single episode of intensive care for a patient developing iatrogenic complications from irrigant absorption would offset the cost of such a device.

TURP has been considered the gold standard for surgical treatment of BPH for many years. Symptoms relief, improvement in maximum flow rate and reduction of post void residual urine have been reported in several experiences. Nevertheless, concerns have been reported in terms of safety outcomes: intracapsular perforation, TUR syndrome, bleeding. In the recent years the use of new forms of energy and devices such as bipolar resector, Ho: YAG and potassium-titanyl-phosphate laser are challenging the role of traditional TURP for BPH surgical treatment. In 1999 TURP represented 81% of surgical treatment for BPH versus 39% in 2005. We have analyzed guidelines and recent literature to evaluate the role of the most relevant new surgical approaches compared to TURP for the treatment of BPH.

TURP for many years has been considered the gold standard for surgical treatment of BPH. Symptoms relief, improvement in Maximum flow rate and reduction of post void residual urine have been reported in several experiences. Notwithstanding a satisfactory efficacy, concerns have been reported in terms of safety outcomes:intracapsular perforation, TUR syndrome, bleeding with a higher risk of transfusion particularly in larger prostates have been extensivelyreported in the literature. In the recent years the use of new forms of energy and devices suchas bipolar resector, Ho: YAG and potassium-titanyl-phosphate laserare challenging the role of traditional TURP for BPH surgical treatment. In 1999 TURP represented the 81% of surgical treatment for BPHversus 39% of 2005. Is this a marketing driven change or is there areal advantage in new technologies? We analyzed guidelines and higher evidence studies to evaluate therole of the most relevant new surgical approaches compared to TURPfor the treatment of BPH. In case of prostates of very large size the challenge is ongoing, withminimally invasive laparoscopic approach and most recently roboticapproach. We will evaluate the most recent literature on thisemerging field.

Bipolar electrosurgical technology has gained worldwide attention with various companies introducing devices, such as the Gyrus PlasmaKinetic™ Tissue Management System (Gyrus ACMI, MN, USA) and the Olympus(®) UES-40 Surgmaster generator (Olympus, Tokyo, Japan), which is aimed at minimizing the morbidity of standard monopolar transurethral resection of the prostate (TURP), whilst also maintaining efficacy and durability. The Gyrus PlasmaKinetic System effectively controls bleeding, resulting in a clear operative field; it greatly reduces risk of transurethral resection syndrome, thus providing a new option among minimally-invasive surgical treatments for benign prostatic hyperplasia. In a meta-analysis of head-to-head comparisons between the monopolar and bipolar TURP, the operation times, transfusion rates, retention rates after catheter removal and urethral complications did not differ significantly. Irrigation and catheterization duration was significantly longer with monopolar TURP.

PURPOSE OF REVIEW Electrosurgical transurethral resection (TUR) of the prostate (TURP) has dominated symptomatic benign prostatic hyperplasia (s-BPH) surgical treatment for almost a century. We analysed recent TURP publications, with emphasis on durability, morbidity, new technology advantages, future generation training and malignant disease. RECENT FINDINGS TURP has declined due to medical therapy, but transcends other surgical challengers by proven outcomes durability over a decade. Adopting the modified-Clavien system may aid future morbidity comparisons. Properly used bipolar technology reduces major bleeding and seemingly abolishes TUR syndrome, but requires further study in anticoagulated patients. Residents are disturbingly short of TURP exposure, consequently experiencing more complications. Solutions include switching to ablative laser prostatectomy (which may carry higher long-term retreatment rates), adoption of bipolar technology, or simulator development and implementation. Concurrently performed transurethral resection of bladder tumor-TURP seems oncologically acceptable (in selected cases); incidentally detected significant prostate cancer at TURP may have declined, whereas TURP for prostate cancer may indicate the need for earlier androgen deprivation. SUMMARY TURP is still rightly the dominant, most widely performed, versatile and cost-effective surgical treatment for s-BPH, reducing morbidity further with technical and technological developments. A better evidence base is required for newer technologies through large well designed multicentre-multinational randomized controlled trials incorporating standardized morbidity and long-term outcomes reporting.

OBJECTIVE: To compare serum sodium changes and the incidence of transurethral resection (TUR) syndrome after monopolar transurethral resection of the prostate (TURP) and bipolar transurethral resection in saline (TURIS) for symptomatic benign prostatic hyperplasia. MATERIAL AND METHODS: Between January 2005 and August 2009, 550 consecutive patients with symptomatic benign prostate hyperplasia underwent TURP, by either a monopolar or bipolar technique. Preoperative and postoperative blood parameters were analysed to compare preoperative and postoperative electrolyte concentrations. RESULTS: Over 56 months, 265 patients underwent a conventional monopolar TURP and 285 patients had a bipolar TURIS (Olympus). Patient profiles regarding age, operation time, resection weight and resection speed were similar in both groups. A drop in sodium of 2.5 mmol/l was measured in the conventional monopolar resection group. The decline of 1.5 mmol/l in the bipolar group, although smaller, was still statistically significant (p = 0.001). With longer operation times (> 1 h) the difference between the groups became more important (p 1 h) the difference between the groups became more important (p 1 h) the difference between the groups became more important (p

This review aims to provide an overview and critical assessment of the developments in transurethral electroresection in non-conductive and conductive irrigants. In the 1970s, measurements of the electric pathway in saline were performed for different locations of the neutral electrode. It was then concluded that the current pathway and the possible hazards of burn injuries to the patient should be investigated separately for each arrangement of the neutral electrode. The position and shape of the neutral electrode have decisive effects on the current flow in the patient. Thus, different electrode arrangements of the various bipolar resection systems need to be analysed separately. Furthermore, not only electrical power, but also conductivity and quality of the lubricant gel have to be considered as critical factors with regard to electrothermal injuries of the urethra. The supposedly better cutting quality seems to be based more on subjective observations than on scientific valid data. When performing "bipolar" TUR it is necessary to consider all electrotechnical and clinical aspects, particularly with regard to the potential risk of thermoelectrical urethral damage.

Summary Previous studies suggest that severe symptoms of the ‘TUR syndrome’ occur from transurethral prostatic resection only when the volume of irrigant absorbed exceeds 2000 ml. An ethanol-containing irrigating fluid was used in this study of 100 transurethral resections so that the irrigant absorption could be monitored by measuring ethanol in expired air. Fluid absorption was found in 41 patients, and in nine of them the volume of irrigant absorbed exceeded 1000 ml. Four of these operations were terminated promptly when the ethanol monitoring indicated rapid massive absorption that threatened to exceed 2000 ml. There were few and only mild adverse effects of the irrigant by following this regimen. It is concluded that ethanol monitoring makes it possible to prevent the TUR syndrome by selective termination of those operations in which large amounts of irrigant is absorbed.

Introduction – 78 Preoperative Preparation – 78 Anaesthesia – 78 Strong Indications for Surgery (according to the EAU-Guidelines) – 78 Relative Indications – 78 Limitations and Risks – 78 Contraindications – 78 Instruments – 79 Operative Technique (Step by Step) – 79 Operative Tips – 80 Postoperative Care – 81 Common Complications – 81 TUR Syndrome – 81 Postoperative Complications – 81 Late Complications – 82 New Development – 82 References – 82 Image Gallery – 83

Objetivos: En este estudio fue nuestra intención evaluar la relación entre la reabsorción de líquido de irrigación y tres variables: tiempo de la intervención, volumen de solución de glicina empleado y peso de los fragmentos, durante la RTU de próstata realizada a baja presión hidráulica. Material y método: Estudiamos 74 pacientes a los que se realizó RTU de próstata con derivación suprapúbica con vaina de Amplatz 30 ch. Se monitorizó el etanol en aire expirado cada 15 minutos durante la intervención. Así mismo se anotaron el tiempo de la intervención, el volumen de glicina utilizado y el peso de los fragmentos extraídos. Estadísticamente se utilizó el Test de Anova para comparación de medias. Resultados: Un 13,6 % de los pacientes absorbieron líquido de irrigación en alguna cantidad. El rango de absorción es de 100 cc hasta 2.000 cc. No se encontró una diferencia estadísticamente significativa entre las medias del tiempo de resección, del volumen de glicina y del peso de los fragmentos entre el grupo de pacientes que había reabsorbido líquido de irrigación y los que no reabsorbieron. Conclusiones: Nuestro estudio pone de manifiesto que el tiempo operatorio, el volumen de líquido de irrigación y el peso de los fragmentos resecados no influyen en la reabsorción de líquido de irrigación cuando se realiza una RTU a baja presión hidráulica. Objetives: In this study it was our intention to evaluate the relation between the reabsorption of irrigating fluid and three variables: time of the intervention, volume of solution of glicina employee and weight of the fragments, during the RTU of prostate fulfilled to low hydraulic pressure. Material and method: We Study 74 patients that RTU of prostate was performed with suprapúbica derivation with Amplatz's pod 30 ch. The ethanol was monitored in expired air every 15 minutes during the intervention. Likewise we annotated the time of the intervention, the volume of glicina used and the weight of the fragments extracted. Statistically Anova's text was in use for comparison of averages. Results: 13,6 % of the patients absorbed irrigating fluid in some quantity. The range of absorption belongs to 100 cc until 2.000 cc. We did not find a statistically significant difference in the averages of time of resection, volume of glicina and weight of the fragments between the group of patients that had absortion of irrigating fluid and they that didn't had. Conclusions: Our data show that the operative time, the volume of irrigating fluid and the weight of the resected fragments do not influence the reabsorption of liquid of irrigation when a RTU is realized to low hydraulic pressure.

Objective: to determine the effectiveness of transurethral electrovaporisation of prostate for the relief of obstructive prostatic disease in Nigeria. Methods: Consecutive patients presenting with obstructive prostatic disease with prostate size of less than 40gm were treated by transurethral electrovaporisation of prostate using a 5mm rollerball electrode. Results: A total of 27 patients were entered into the study, 7(26%) had clinically malignant prostates; 2 patients (7%) had immediate post operative retention requiring resection of residual prostate. No patients exhibited the clinical features of TUR syndrome, all patients were discharged by the 4th post operative day and required no blood trnsfusions. Conclusions: Transurethral electrovaporisation is effective for treatment of obstructive prostatic disease, benign or malignant. using the 5mm rollerball instead of the recommended vaportrode still confers benefit over TURP. TEVP confers all the benefits of TURP with less mobidity. Key words: Transurethral, Vaporisation, Prostate, Nigeria. Resume Objectif: Determiner l'efficacite du “Transuurethral” par electro-evaporisation de la prostate pour soulager le mai de l'epidemie de la prostate obstructive au Nigeria. Methode: Des patients se presentants successivement avec l'eoidemic de la prostate obstructive dont la taille de la prostate mesurait un peu moins de 40mg ont ete traites par “Transuretthral” electrovaporisation de la proste en utilisant une “rollerball” electrode de 5mm. Resultats: L‘etude a ete experiments sur un total de 27 patients, dont 7 (soit 27%) presentaient des prostates cliniquement malignes, 2 patients (soit 7%) ont eu retention post-operative necessitant re-operation de la prostate residuelle. Aucun patients n'exhibaient anomalies cliniques du “syndrom de TUR”. Tous les patients ont ete decharges (relaches) au 4eme jour post-operatoire et ne necessitaient pas de trannfusion sanguine. Conclusions: Le “Transurethral” par electro-evaporisation est effective pour traiter l'epidemie de la prostate obstructive que se soit benine ou maligne. En faisant usage du “rollerball” electrode wen lieu du “vaportrode” recommende tout en conferant le benefice du “TURP” “TEVP” confere tous les benefices du “TURP” avec moins d'effets morbides. West African Journal of Medicine Vol.23(2) 2004: 139-141

Benign prostatic hyperplasia (BPH) is a common problem among older men. Transurethral resection of the prostate (TURP) is a common surgical procedure for treatment of BPH. Typically, TURP is performed using monopolar electric current and a wire electrode; however, the irrigating solution used during this procedure has the potential to cause transurethral resection (TUR) syndrome. A new technology uses bipolar electrosurgery, which creates less risk of electrical shock, and saline irrigation, which eliminates the risk for TUR syndrome.

Background This study aimed to investigate the relationship between preoperative estimated prostate weight on ultrasonography and clinical manifestations of transurethral resection (TUR) syndrome. Methods The records of patients who underwent TUR of the prostate under regional anesthesia over a 6-year period were retrospectively reviewed. TUR syndrome is usually defined as a serum sodium level of 75 g.

Irrigating fluid is used in urologic endoscopy to dilate the target organ and clear the visual field of debris and blood. The introduction of nonphysiologic fluid can offer limited advantages, but it also severely increases the risks. Hypotonic liquid (eg, water) improves visibility by lysing red blood cells and can be used for electrosurgery. However, it can result in disastrous consequences if it enters the blood stream. Our independent experience in reviewing nonreported legal cases stemming from the use of water as an endourologic irrigant has emphasized the importance of the choice of irrigating fluid and the associated risks. The absorption of large amounts of hypotonic irrigant during transurethral resection of the prostate (TURP) leads to a spectrum of cardiovascular and neurologic derangements collectively known as the transurethral resection (TUR) syndrome. Before the introduction of nonhemolytic irrigating fluid, the TUR syndrome accounted for most of the morbidity and mortality associated with TURP. Arguably, the single greatest advancement in TURP was the recognition of Creevy 1 that irrigation with distilled water was the cause of hemolysis and shock after intravascular absorption. In 3500 patients, Creevy showed that the use of glycine for irrigation during TURP reduced perioperative mortality from 4% to 0.85%. 2,3 This significant reduction in morbidity and mortality with the use of nonhemolytic irrigating solutions was firmly validated 13 years later by an analysis of 20,000 TURPs at the Mayo Clinic. 4 The recent

Dilutional hyponatraemia with symptoms (TUR syndrome) may occur not only in association with transurethral prostatic resection, but also in other operations in which electrolyte-free irrigating fluid is used. This case report describes a patient who developed the TUR syndrome after blood clots had been removed from the bladder with the aid of a transurethral resectoscope.

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. The learning curve remains an obstacle, preventing more widespread adoption of this procedure. This paper provides an outline of the HoLEP technique as is currently used at two centers in hopes of easing the initial learning curve. TECHNICAL CONSIDERATIONS: Detailed descriptions of the major steps of the HoLEP procedure are provided with attention to critical steps such as identification of the surgical capsule, median and lateral lobe enucleation, and morcellation of enucleated tissue. CONCLUSIONS: HoLEP is a promising alternative for the surgical treatment of BPH which allows complete removal of intact lobes of the prostate. Obstruction is relieved immediately with superior hemostasis, no risk of TUR syndrome, and a minimal hospital stay.

The TUR syndrome is a clinical disorder consisting of circulatory, gastrointestinal, and neurologic signs that are infrequently seen in some patients undergoing endoscopic surgery of the prostate gland with the use of nonconductive irrigating fluids. Several theories of its pathogenesis have been proposed. The condition may occasionally be associated with bilateral profound loss of vision. We report a patient with the TUR syndrome who suffered bilateral temporary blindness and speculate on the etiology of the visual loss and localization of the dysfunction along the visual pathway.

Easily manipulable, noninvasive techniques for the immediate recognition of absorption of irrigating solution in transurethral prostate resections have not previously been available. For this reason, a way was sought to bring about an improvement in this situation: changes in the thoracic ground impedance were studied perioperatively by use of impedance cardiography during 16 transurethral resections. Furthermore, measurement of central venous pressure and arterial blood gases was done simultaneously as well as registration of myocardial function by systolic time intervals. Most important among the changes caused by absorption of irrigating solution which were registered with impedance cardiography are a significant increase in cardiac output and a considerable decrease in arterial oxygen pressure. Furthermore, a strong correlation was found between the increase of central venous pressure and the decrease of thoracic ground impedance. The relation of the preejection period to the left ventricular ejection time showed a significant increase due to impairment of myocardial function. The results show that impedance cardiography can monitor the time and extent of absorption of irrigating solution exactly and immediately and thus allows immediate therapy. This noninvasive technique can thus be used for perioperative supervision of the patient during transurethral prostate resections.

The ethanol concentration in the expired breath (EB–ethanol), the volumetric fluid balance and the serum sodium concentration were measured in the course of 60 transurethral resections of the prostate in which the irrigating fluid was 1.5% glycine + 1% ethanol. Measurement of EB–ethanol indicated absorption of irrigant at a rate of more than 150 ml in 10 min, as measured volumetrically. There was a significant direct linear relationship between EB–ethanol and the cumulative volume of irrigant absorbed (R2 = 0.83); this correlation was stronger when the duration of absorption was taken into account (R2 = 0.90). EB–ethanol was inversely related to the overall change in the serum sodium concentration during the operation (R2 = 0.88). Symptoms that are recognized components of the TUR syndrome developed in 8 of the 13 patients absorbing more than 1 1 of irrigant, while the ethanol exerted no adverse effects. The results of the study indicate that 1% ethanol is a suitable marker for monitoring irrigant absorption by means of the expired breath test in routine transurethral surgery. At this concentration the sensitivity of the test is adequate for detecting absorption, while the ethanol is less toxic than the irrigant fluid itself.

Intravesical pressure was studied in 20 patients during transurethral resection (TUR) of the prostate using the Iglesias resectoscope with continuous irrigation and suction. The suction pressure (50 cm H2O) was considerably lower than that suggested by Iglesias. The amount of irrigant was thereby appreciably diminished and blocking of the outlet system was avoided. The intravesical pressure averaged 35 cm H2O during resection, which is less than in conventional resection, and 15 cm during evacuation of tissue chips. Signs of TUR syndrome were not seen. We consider the new resectoscope to be a considerable improvement for TUR.