116 results on '"TUR syndrome"'
Search Results
2. Irrigation Fluids and Their Hazards
- Author
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Liew, Matthew, Tolofari, Sotonye, editor, Moon, Dora, editor, Starmer, Benjamin, editor, and Payne, Steve, editor
- Published
- 2023
- Full Text
- View/download PDF
3. Investigating the Impact of Bladder Tumor Resection Surgery through the Urethra on Serum Osmolality and Electrolyte Levels.
- Author
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Bafghi, Naeimeh Naeimi, Salagegheh, Shirin, Salehi, Jafar, and Bafghi, Neda Naeimi
- Subjects
SURGICAL excision ,TRANSURETHRAL resection of bladder ,TUMOR surgery ,URETHRA surgery ,OSMOLALITY ,TRANSURETHRAL prostatectomy - Abstract
Introduction: Despite being less invasive than open surgery, transurethral tumor resection has notable side effects, particularly electrolyte disorders resulting from systemic absorption of the irrigation fluid. Several studies have examined the effects of changes in irrigation fluid; however, the findings remain contradictory, and uncertainty surrounds the extent of changes in serum electrolytes and osmolality. Therefore, this study aimed to determine these changes. Materials and Methods: This observational cross-sectional study included patients aged 20 to 80 years who underwent transurethral resection of bladder tumors (TURBT) at Bahanr Hospital's treatment center in 2022. Patients with tumor diagnoses were registered for analysis. Following the selection of suitable patients, pertinent data, including demographic parameters (age and gender), were extracted and recorded from patient files. Changes in serum electrolytes and osmolality before and after the procedure were then analyzed. Results: The study investigated 31 patients, consisting of 27 men and 4 women, with an average age of 61.84 ± 10.12 years. The duration of surgery exhibited a significant positive correlation with pre-surgery osmolality (r = -0.357, p < 0.05) and post-surgery osmolality (r = -0.428, p < 0.05), as well as with potassium levels in the department (r = 0.371, p < 0.05). Significant changes in serum levels of sodium, potassium, blood sugar, serum creatinine, and osmolality (p < 0.01) were observed during the hospitalization period. Notably, BUN changes during hospitalization were also significant. Furthermore, the average osmolality decreased from 286.82 before surgery to 284.56 after surgery (p < 0.001) and increased from 284.56 after surgery to 286.66 during recovery (p < 0.05) and 287.08 during the postoperative period (p < 0.05). However, no significant differences were observed between preoperative osmolality and recovery (p = 1), preoperative osmolality and the postoperative period (p = 1), and recovery and the postoperative period (p = 1). Conclusion: The significant increase in potassium and blood sugar levels during hospitalization, despite their inversely related nature, underscores the importance of further investigations to determine the underlying causes [ABSTRACT FROM AUTHOR]
- Published
- 2023
4. Symptomatic absorption of normal saline during transurethral resection of the prostate: a case report
- Author
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Naomi Okuma, Hideki Hino, Madoka Kuroki, Tadashi Matsuura, and Takashi Mori
- Subjects
Transurethral resection ,Hyperchloremic metabolic acidosis ,TUR syndrome ,Anesthesiology ,RD78.3-87.3 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Transurethral resection of the prostate (TUR-P) could incidentally cause hyponatremia, known as TUR syndrome due to intravascular absorption of non-electrolytic irrigation fluid. Recently, normal saline has been used as an irrigation fluid in a new system named TURis (TUR in saline) to prevent TUR syndrome. However, rapid massive absorption of normal saline can also cause other systemic adverse events. Case presentation A 71-year-old man underwent TURis for benign prostatic hyperplasia under spinal anesthesia. The patient lost consciousness which led upper airway obstruction and hypoxia 30 min after the surgery began. Blood gas test indicated hyperchloremic metabolic acidosis. While vasoactive agents were ineffective, the administration of bicarbonate significantly improved the symptoms and restored blood pressure. Conclusion We experienced a case of hyperchloremic metabolic acidosis with decreased level of consciousness and hypotension during TURis. Administration of bicarbonate, but not phenylephrine, was effective for recovering blood pressure.
- Published
- 2022
- Full Text
- View/download PDF
5. Irrigation fluid absorption syndrome during HoLEP: A case study
- Author
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Charlotte Slots, Pieter Uvin, and Emma Van Damme
- Subjects
HoLEP ,TUR syndrome ,Irrigation fluid absorption ,Benign prostate hypertrophy ,Metabolic acidosis ,Hyperchloremia ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
The classical transurethral resection syndrome as described with monopolar prostate resection has become rare since the switch to bipolar resection and even more so since the introduction of HoLEP. We report a case of a 74-year-old male patient who presented with an irrigation fluid absorption syndrome during a HoLEP for benign prostate hypertrophy. Biochemically this presented as metabolic acidosis and hyperchloremia instead of hyponatremia. He was treated with diuretics and had a swift recovery.
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- 2022
- Full Text
- View/download PDF
6. Bipolar TURP decreases post-operative morbidity – A prospective study in a tertiary care hospital from north India
- Author
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Rajesh Kumar Maurya, Vinay Kumar, and Kumar Vineet
- Subjects
transurethral resection of prostate (turp) ,monopolar ,bipolar ,tur syndrome ,saline ,glycine ,prostate ,Medicine - Abstract
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.
- Published
- 2021
- Full Text
- View/download PDF
7. Symptomatic absorption of normal saline during transurethral resection of the prostate: a case report.
- Author
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Okuma, Naomi, Hino, Hideki, Kuroki, Madoka, Matsuura, Tadashi, and Mori, Takashi
- Subjects
TRANSURETHRAL prostatectomy ,BLOOD pressure ,BENIGN prostatic hyperplasia ,ACIDOSIS ,ABSORPTION ,RETENTION of urine ,INAPPROPRIATE ADH syndrome - Abstract
Background: Transurethral resection of the prostate (TUR-P) could incidentally cause hyponatremia, known as TUR syndrome due to intravascular absorption of non-electrolytic irrigation fluid. Recently, normal saline has been used as an irrigation fluid in a new system named TURis (TUR in saline) to prevent TUR syndrome. However, rapid massive absorption of normal saline can also cause other systemic adverse events. Case presentation: A 71-year-old man underwent TURis for benign prostatic hyperplasia under spinal anesthesia. The patient lost consciousness which led upper airway obstruction and hypoxia 30 min after the surgery began. Blood gas test indicated hyperchloremic metabolic acidosis. While vasoactive agents were ineffective, the administration of bicarbonate significantly improved the symptoms and restored blood pressure. Conclusion: We experienced a case of hyperchloremic metabolic acidosis with decreased level of consciousness and hypotension during TURis. Administration of bicarbonate, but not phenylephrine, was effective for recovering blood pressure. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
8. Bipolar TURP decreases post-operative morbidity - A prospective study in a tertiary care hospital from north India.
- Author
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Maurya, Rajesh Kumar, Kumar, Vinay, and Vineet, Kumar
- Subjects
- *
TRANSURETHRAL prostatectomy , *OPERATIVE surgery , *TERTIARY care , *RETENTION of urine , *URINARY catheters , *PROSTATE hypertrophy , *LONGITUDINAL method - Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
9. Relevance of intravesical pressures during transurethral procedures.
- Author
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Tokas, Theodoros, Ortner, Gernot, Herrmann, Thomas R. W., and Nagele, Udo
- Subjects
- *
INTRAOPERATIVE monitoring , *URINARY organs , *CYSTOMETRY , *FORECASTING , *VAPORIZATION , *ENDOUROLOGY , *IRRIGATION (Medicine) - Abstract
Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
10. Usefulness of bicarbonate Ringer's solution as perfusate during transurethral resection of the prostate
- Author
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Fumiya Hongo, Tsukasa Narukawa, Atsuko Fujihara, Fumimasa Amaya, Teiji Sawa, and Osamu Ukimura
- Subjects
Bicarbonate Ringer's solution ,Transurethral resection of the prostate ,TUR syndrome ,Physiological saline ,Medicine (General) ,R5-920 - Abstract
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.
- Published
- 2021
- Full Text
- View/download PDF
11. Efficacy of Goreisan in Preventing Transurethral Resection Syndrome in Transurethral Resection of the Prostate: A Randomized-Controlled Study.
- Author
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Fujiwara, Atsushi, Nakahira, Junko, Nakano, Shoko, Sawai, Toshiyuki, and Minami, Toshiaki
- Subjects
- *
ALTERNATIVE medicine , *CHI-squared test , *CLINICAL trials , *FISHER exact test , *LONGITUDINAL method , *PROBABILITY theory , *TRANSURETHRAL prostatectomy , *RESEARCH funding , *STATISTICAL sampling , *SODIUM , *TRADITIONAL medicine , *RANDOMIZED controlled trials , *DESCRIPTIVE statistics , *MANN Whitney U Test ,PREVENTION of surgical complications ,JAPANESE herbal medicine - Abstract
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 serum sodium at or below 125 mmol/L with cardiovascular and neurologic symptoms. The aim of this study was to evaluate the effects of Goreisan, a traditional Japanese Kampo medicine, on serum sodium levels and the occurrence of TUR syndrome in patients undergoing TUR of the prostate. Design: This was a randomized-controlled trial. Settings/Location: This trial was conducted at the Osaka Medical College Hospital and Keneikai Sanko Hospital. Subjects: Fifty patients scheduled for TUR of the prostate were included. Interventions: Patients in the Goreisan group (n = 23) received 2.5 g Goreisan orally on the night before surgery and on the morning of surgery. The control group (n = 27) did not receive Goreisan. Surgical procedures, perioperative management, and patient monitoring were otherwise the same in both groups. Outcome Measures: The primary outcome was occurrence of TUR syndrome. The secondary outcome was serum sodium level. Results: Serum sodium remained above 125 mmol/L in all patients, so none of the patients met the criteria for TUR syndrome. However, the Goreisan group had significantly higher intraoperative sodium levels (p < 0.001) and significantly higher intraoperative (p = 0.008) and postoperative (p = 0.02) hemoglobin levels than the control group. Conclusions: These findings indicate that preoperative Goreisan administration can help maintain serum sodium levels in patients undergoing TUR of the prostate. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
12. Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice.
- Author
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Subrata, Sumarno A.
- Subjects
UROLOGICAL nursing ,PROFESSIONAL practice ,TRANSURETHRAL prostatectomy ,FUNCTIONAL status ,EVIDENCE-based medicine ,BENIGN prostatic hyperplasia ,PATIENTS' attitudes ,QUALITY of life ,NURSES ,HEALTH attitudes - Abstract
How can the deterioration of the health‐related quality of life (HRQoL) in patients undergoing transurethral resection of the prostate (TURP) be prevented by urological nurses? The intention of this study is to examine the relevant literature regarding HRQoL among those undergoing TURP. Transurethral resection of the prostate is fully considered as a historical reference‐standard procedure for treating benign prostatic hyperplasia. Even though this method is highly effective and offers significant progress in urinary functioning, it is related to a risk of complications recognized as TURP syndrome which may impact patients' HRQoL. Several studies have discussed the management of TURP syndrome; however, they did not clearly elucidate the comprehensive aspect of HRQoL pertaining to physiological and psychological elements. As a consequence, this clinical condition may cause unpromising outcomes in regard to residual physical and psychological symptoms after TURP. Wilson and Cleary's model of HRQOL was thoughtfully chosen to guide this study. Several themes of the model were discussed as follows: biological and physiological factors, symptoms and general health perceptions, functional status, patient preferences, emotional and psychological factors, and overall quality of life. We generated a model of HRQoL along with nursing care with respect to the patients undergoing TURP. The findings of this study will render a positive contribution to improving TURP outcomes as well as preventing deterioration of patients' HRQoL. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
13. Cardiovascular Collapse During Transurethral Resection of Bladder Tumor: A Case Report.
- Author
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Gomez, Nicole A. Gonzaga, Mitzova-Vladinov, Greta, Yadav, Ramniwas, Lackaye, Amanda, and Fabbro, Michael
- Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
14. Low-pressure monopolar electroresection of the prostate for glands sized > 70 vs. < 70 cc performed with continuous irrigation and suprapubic suction: perioperative and long-term outcome.
- Author
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Wilhelm, Konrad, Cazana, Ioana Maria, Schoenthaler, Martin, Katzenwadel, Arndt, Spaeth, Johannes, and Miernik, Arkadiusz
- Subjects
- *
PROSTATE diseases , *PERIOPERATIVE care , *TRANSURETHRAL prostatectomy , *URINARY incontinence , *PROSTATE cancer - Abstract
Purpose: To evaluate long-term efficacy and safety of low-pressure transurethral resection of the prostate for prostates < 70 cc (group 1) vs. > 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 < 70 cc. This technique is a potential low-cost alternative for clinics that cannot afford modern laser approaches. Study register number DRKS00006527. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
15. Bipolar TURP decreases post-operative morbidity – A prospective study in a tertiary care hospital from north India
- Author
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Kumar Vineet, Vinay Kumar, and Rajesh Kumar Maurya
- Subjects
medicine.medical_specialty ,prostate ,business.industry ,Tertiary care hospital ,North india ,urologic and male genital diseases ,Post operative morbidity ,bipolar ,saline ,Emergency medicine ,medicine ,tur syndrome ,Medicine ,transurethral resection of prostate (turp) ,General Agricultural and Biological Sciences ,Prospective cohort study ,business ,monopolar ,glycine - Abstract
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.
- Published
- 2021
16. The PLASMA System for Transurethral Resection of the Prostate: A NICE Medical Technologies Guidance Update
- Author
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Laura Knight, Rhys Morris, and Susan Caroline Peirce
- Subjects
Male ,Economics and Econometrics ,medicine.medical_specialty ,Electrosurgery ,medicine.medical_treatment ,Prostatic Hyperplasia ,Urology ,Nice ,Haemoglobin levels ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,Lower Urinary Tract Symptoms ,Prostate ,Lower urinary tract symptoms ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,computer.programming_language ,Transurethral resection of the prostate ,business.industry ,030503 health policy & services ,Health Policy ,Transurethral Resection of Prostate ,General Medicine ,TUR syndrome ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,0305 other medical science ,business ,computer - Abstract
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.
- Published
- 2021
- Full Text
- View/download PDF
17. Minimal Invasive Methods in the Treatment of Benign Prostate Hyperplasia
- Author
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Akif Erbin, Ahmet Yalçın Berberoğlu, and Ömer Sarılar
- Subjects
Benign Prostate Hyperplasia ,Minimal Invasive Methods ,Tur syndrome ,Medicine ,Medicine (General) ,R5-920 - Published
- 2012
18. Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?
- Author
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José Cury, Rafael Ferreira Coelho, Homero Bruschini, and Miguel Srougi
- Subjects
Prostatic hypertrophy ,Transurethral resection of the prostate ,TUR syndrome ,Irrigation fluid ,Morbidity ,Hyponatremia ,Medicine (General) ,R5-920 - Abstract
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.
- Published
- 2008
- Full Text
- View/download PDF
19. Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice
- Author
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Sumarno Adi Subrata
- Subjects
Health related quality of life ,medicine.medical_specialty ,Nursing (miscellaneous) ,Evidence-based practice ,business.industry ,Urology ,TUR syndrome ,Quality of life (healthcare) ,Nephrology ,Medicine ,In patient ,Urological nursing ,business ,Intensive care medicine - Published
- 2019
- Full Text
- View/download PDF
20. Usefulness of bicarbonate Ringer's solution as perfusate during transurethral resection of the prostate
- Author
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Osamu Ukimura, Fumimasa Amaya, Teiji Sawa, Tsukasa Narukawa, Atsuko Fujihara, and Fumiya Hongo
- Subjects
BUN, blood urea nitrogen ,AG, anion gap ,medicine.medical_treatment ,Bicarbonate ,BE, base excess ,Anion gap ,TUR syndrome ,PVI, pleth variability index ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,C1, chloride ,medicine ,Bicarbonate Ion ,030212 general & internal medicine ,PAC, pulmonary artery catheter ,Saline ,Bicarbonate Ringer's solution ,Transurethral resection of the prostate ,Pharmacology ,lcsh:R5-920 ,TUR, Transurethral resection ,business.industry ,Postoperative complication ,TURP, Transurethral resection of the prostate ,General Medicine ,TURis, Transurethral resection in saline ,Physiological saline ,Cre, creatinine ,chemistry ,Anesthesia ,Ringer's solution ,Base excess ,business ,lcsh:Medicine (General) ,030217 neurology & neurosurgery - Abstract
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.
- Published
- 2021
21. Prediction of clinical manifestations of transurethral resection syndrome by preoperative ultrasonographic estimation of prostate weight.
- Author
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Atsushi Fujiwara, Junko Nakahira, Toshiyuki Sawai, Teruo Inamoto, and Toshiaki Minami
- Abstract
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 < 125 mmol/l combined with clinical cardiovascular or neurological manifestations. This study focused on the clinical manifestations only, and recorded specific central nervous system and cardiovascular abnormalities according to the checklist proposed by Hahn. Patients with and without clinical manifestations of TUR syndrome were compared to determine the factors associated with TUR syndrome. Receiver operating characteristic curve analysis was used to determine the optimal cutoff value of estimated prostate weight for the prediction of clinical manifestations of TUR syndrome. Results: This study included 167 patients, of which 42 developed clinical manifestations of TUR syndrome. There were significant differences in preoperative estimated prostate weight, operation time, resected prostate weight, intravenous fluid infusion volume, blood transfusion volume, and drainage of the suprapubic irrigation fluid between patients with and without clinical manifestations of TUR syndrome. The preoperative estimated prostate weight was correlated with the resected prostate weight (Spearman's correlation coefficient, 0.749). Receiver operator characteristic curve analysis showed that the optimal cutoff value of estimated prostate weight for the prediction of clinical manifestations of TUR syndrome was 75 g (sensitivity, 0.70; specificity, 0.69; area under the curve, 0.73). Conclusions: Preoperative estimation of prostate weight by ultrasonography can predict the development of clinical manifestations of TUR syndrome. Particular care should be taken when the estimated prostate weight is > 75 g. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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22. Transurethral resection syndrome in elderly patients: a retrospective observational study.
- Author
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Junko Nakahira, Toshiyuki awai, Atsushi ujiwara, and Toshiaki Minami
- Subjects
- *
CONFIDENCE intervals , *HEMODYNAMICS , *HYPONATREMIA , *IRRIGATION (Medicine) , *PROBABILITY theory , *TRANSURETHRAL prostatectomy , *SYNDROMES , *MULTIPLE regression analysis , *DATA analysis software , *ODDS ratio , *OLD age - Abstract
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 < 0.05 on univariate analyses were included in the multivariate logistic regression model to ascertain their independent effects on TUR syndrome. Results Of the 98 patients studied, 23 had TUR syndrome (23.5%, 95% confidence interval [CI] 14.9-32.0%). Multivariate regression analysis revealed that volume of plasma substitute ≥ 500 ml (odds ratio [OR] 14.7, 95% CI 2.9-74.5), continuous irrigation through a suprapubic cystostomy (OR 4.7, 95% CI 1.3-16.7), and weight of resected mass > 45 g (OR 4.1, 95%CI 1.2-14.7) were associated with significantly increased risks for TUR syndrome (HosmerLemeshow 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. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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23. Efficacy of Goreisan in Preventing Transurethral Resection Syndrome in Transurethral Resection of the Prostate: A Randomized-Controlled Study
- Author
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Junko Nakahira, Shoko Nakano, Atsushi Fujiwara, Toshiyuki Sawai, and Toshiaki Minami
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,law.invention ,Resection ,Postoperative Complications ,Randomized controlled trial ,law ,Prostate ,medicine ,Humans ,Intraoperative Complications ,Transurethral resection of the prostate ,Aged ,Prostatectomy ,Irrigation fluids ,business.industry ,Sodium ,Transurethral Resection of Prostate ,food and beverages ,nutritional and metabolic diseases ,Syndrome ,TUR syndrome ,Middle Aged ,medicine.anatomical_structure ,Complementary and alternative medicine ,Acute hyponatremia ,business ,Dilutional hyponatremia ,Drugs, Chinese Herbal ,Hyponatremia - Abstract
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...
- Published
- 2020
24. Relevance of intravesical pressures during transurethral procedures
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Thomas R. W. Herrmann, Udo Nagele, Theodoros Tokas, and Gernot Ortner
- Subjects
medicine.medical_specialty ,Human studies ,business.industry ,Continuous flow ,Urology ,Urinary Bladder ,030232 urology & nephrology ,Transurethral Resection of Prostate ,Specific adsorption ,TUR syndrome ,Surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Intravesical pressure ,030220 oncology & carcinogenesis ,Pressure ,Medicine ,Humans ,Intrarenal pressure ,business ,Intraoperative Complications - Abstract
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.
- Published
- 2020
25. Irrigation fluid absorption syndrome during HoLEP: A case study.
- Author
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Slots C, Uvin P, and Van Damme E
- Abstract
The classical transurethral resection syndrome as described with monopolar prostate resection has become rare since the switch to bipolar resection and even more so since the introduction of HoLEP. We report a case of a 74-year-old male patient who presented with an irrigation fluid absorption syndrome during a HoLEP for benign prostate hypertrophy. Biochemically this presented as metabolic acidosis and hyperchloremia instead of hyponatremia. He was treated with diuretics and had a swift recovery., (© 2022 Published by Elsevier Inc.)
- Published
- 2022
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26. Thulium Laser Enucleation of the Prostate (ThuLEP) as a Technique for Treatment of BPH: Evaluation of a Six-Year Experience at a Single Institution
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Jane Anderson, Henryk Krasnowski, Katie Lee, Ravine Gill, Mahmood Vazirian-Zadeh, Islam Noaman, and Ho Kj
- Subjects
medicine.medical_specialty ,Blood transfusion ,business.industry ,medicine.medical_treatment ,Enucleation ,Urology ,TUR syndrome ,medicine.disease ,Thulium laser ,medicine.anatomical_structure ,Prostate ,Lower urinary tract symptoms ,medicine ,Single institution ,business ,Transurethral resection of the prostate - Abstract
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
- Published
- 2018
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27. Störungen des Natriumhaushalts
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Florian Dresely
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Gynecology ,medicine.medical_specialty ,business.industry ,Sodium ,030232 urology & nephrology ,chemistry.chemical_element ,030229 sport sciences ,General Medicine ,TUR syndrome ,Critical Care and Intensive Care Medicine ,medicine.disease ,Sodium balance ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,chemistry ,Emergency Medicine ,medicine ,Central pontine myelinolysis ,Hypernatremia ,business ,Hyponatremia ,Homeostasis - Abstract
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.
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- 2018
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28. Benign Prostat Hiperplazisi Tedavisinde Uygulanan Minimal İnvaziv Yöntemler.
- Author
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Erbin, Akif, Yalçın Berberoğlu, Ahmet, Sarılar, Ömer, Binbay, Murat, and Müslümanoğlu, Ahmet Yaser
- Subjects
- *
TRANSURETHRAL prostatectomy , *HEMORRHAGE complications , *PROSTATE surgery , *INTRAVASCULAR ultrasonography , *CATHETERIZATION , *EXTUBATION , *THERAPEUTICS ,HYPERPLASIA treatment - Abstract
Several methods of surgical treatment of benign prostatic hyperplasia have been described. Transurethral resection of the prostate, which was first performed in 1932, still remains the gold standard for surgical treatment. However, beside the risk of bleeding and TUR syndrome, transurethral resection of the prostate has some disadvantages such as need for anesthesia, hospitalization and prolonged catheterization. Because of these disadvantages, minimally invasive surgical methods have come to order more commonly, especially within the last decade. Minimally invasive methods include transurethral microwave therapy, transurethral needle ablation, laser treatments, transurethral ethanol ablation of the prostate, and high-intensity focused ultrasound. These techniques provided significant decreases in the risk of bleeding and TUR syndrome. They are superior to transurethral resection of the prostate in terms of hospitalization and catheterization time. In addition, short-term results of some techniques are comparable to transurethral resection of the prostate. However, because of the fact that the efficacy and safety of transurethral resection of the prostate have been proven for the purposes of long-term results, there is no any minimally invasive surgical method can take the place of transurethral resection of the prostate. In this review, minimal invasive surgical methods were evaluated in the light of current literature. [ABSTRACT FROM AUTHOR]
- Published
- 2012
29. Anästhesie bei endourologischen und roboterassistierten Eingriffen.
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Kiss, T., Bluth, T., and Heller, A.
- Subjects
- *
ANESTHESIA , *ENDOUROLOGY , *MEDICAL robotics , *UROLOGY , *DRUG therapy , *SURGICAL robots , *MEDICAL lasers , *PATIENT positioning - Abstract
The improved drug therapy leads to increasingly older patients with complex comorbidities in the discipline of operative urology. Today, improved technical equipment provides new operational capabilities in the field of urology. The prone and lithotomy position during surgery leads to physiological changes that affect anesthesia management. The surgical risk of procedures such as transurethral surgery of the prostate or bladder is being altered by laser surgery and other new technologies. Although the incidence of transurethral resection (TUR) syndrome has been reduced in recent years, the intrusion of irrigation fluid still has to be considered during anesthesia. Robot-assisted surgery has successfully completed the experimental stage and is widely used so that new targets have to be challenged. Ureterorenoscopy is performed with flexible, small caliber ureteroscopes which even allow treatment of renal calculi under analgosedation within short time periods. Percutaneous nephrostomy and litholapaxy are still frequently performed in the prone position. With respect to the risks arising from patient positioning, supine or lateral positioning should be considered in individual cases. A good communication between the surgeon and anesthetist allows deviation from daily routine procedures if special indications require a modified approach. In conclusion, a profound knowledge of the (patho-)physiology of general anesthesia and endourological diseases enables anesthetists to provide a prospective type anesthesia, which should prevent the occurrence of life-threatening incidents. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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30. Bipolar technology for transurethral prostatectomy.
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Ubee, Sarvpreet S., Philip, Joe, and Nair, Manu
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BIPOLAR integrated circuits ,TRANSURETHRAL prostatectomy ,PROSTATE ,HYPERPLASIA ,BLOOD transfusion ,CATHETERIZATION - Abstract
Bipolar electrosurgical technology has gained worldwide attention with various companies introducing devices, such as the Gyrus PlasmaKinetic
trademark Tissue Management System (Gyrus ACMI, MN, USA) and the Olympus®d; 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. INSET: Key issues. [ABSTRACT FROM AUTHOR]- Published
- 2011
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31. Transient acute liver failure complicating transurethral resection syndrome.
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Tuccori, Marco, Guidi, Benedetta, Montagnani, Sabrina, Fornai, Matteo, Antonioli, Luca, Blandizzi, Corrado, and di Paolo, Marco
- Subjects
- *
TRANSURETHRAL prostatectomy , *PROSTATE , *LIVER failure , *ALANINE aminotransferase , *BENIGN prostatic hyperplasia , *ASPARTATE aminotransferase , *FUROSEMIDE - Abstract
Transurethral resection (TUR) syndrome, resulting from dilutional hyponatraemia for excessive absorption of irrigating fluid, represents the most relevant complication of transurethral resection of prostate (TURP). Ethanol is used as a tracer in the irrigant solution to monitor fluid absorption with a breathalyser. An unusual case of transient acute liver failure complicating TUR syndrome is reported. A 54-year-old male patient, without risk factors for the development of toxic hepatitis, was subjected to TURP for treatment of benign prostatic hyperplasia. Fluid absorption (2275 ml), estimated by breathalyser, exceeded maximum allowed absorption (2000 ml) only at the end of the surgical intervention. No signs of possible toxicity were evident in the few hours following the intervention. About 10 h after the end of TURP, the patient developed sweating, vomiting and diarrhoea. Laboratory analysis revealed severe hyponatraemia (116 meq/l) with signs of severe liver impairment (total bilirubin 5.8 mg/dl, alanine aminotransferase 56 500 U/l, aspartate aminotransferase 32 700 U/l), kidney failure (serum creatinine 1.93 mg/dl) and serum ethanol levels of 219 mg/dl (0.2%). The patient was treated with acetylcysteine 150 mg/kg i.v. and furosemide 50 mg i.v. Liver and renal functions improved in few days and recovered completely within 30 days. The TUR syndrome observed in this case was probably extravascular in nature, and could have been identified and prevented by measuring ethanol levels 10 min after ending the surgical procedure. The performance of such a test should be strongly recommended to all surgeons. The clinicians attributed the development of liver impairment in this case to ethanol toxicity. However, further studies are warranted to confirm whether hepatic injury can represent a possible complication of TUR syndrome when ethanol solution is used as irrigant fluid. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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32. Bipolar transurethral resection in saline: The solution to avoid hyponatraemia and transurethral resection syndrome.
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Michielsen, Dirk P. J., Coomans, Danny, Braeckman, Johan G., and Umbrain, Vincent
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- *
TRANSURETHRAL prostatectomy , *PROSTATE , *BENIGN prostatic hyperplasia , *SERUM , *ELECTROLYTES , *SALINE solutions - Abstract
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 < 0.001). Two clinical TUR syndromes were observed in the monopolar group, while none occurred in the bipolar group. Conclusions. Bipolar TURP in saline is a safe technique and obviates the risk of TUR syndrome. Repeated serum analysis of electrolytes after TURIS can be omitted. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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33. Clinical and technical aspects of bipolar transurethral prostate resection.
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Faul, Peter, Schlenker, Boris, Gratzke, Christian, Stief, Christian G., Reich, Oliver, and Gustaw Hahn, Robert
- Subjects
- *
TRANSURETHRAL prostatectomy , *URINARY organs , *URETHRA diseases , *URINARY catheterization , *PATIENT-professional relations - Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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34. Is using ethanol–glycine irrigating fluid monitoring and ‘good surgical practice’ enough to prevent harmful absorption during transurethral resection of the prostate?
- Author
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Collins, Justin W., Macdermott, Seamus, Bradbrook, Richard A., Keeley Jr., Frank X., and Timoney, Anthony G.
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- *
TRANSURETHRAL prostatectomy , *ALCOHOL , *GLYCINE , *PROSTATE , *CHROMATOGRAPHIC analysis , *URETHRA surgery - Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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35. A comparison of the effect of 1.5% glycine and 5% glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection.
- Author
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Collins, Justin W., MacDermott, Seamus, Bradbrook, Richard A., Keeley, Francis X., and Timoney, Anthony G.
- Subjects
- *
TRANSURETHRAL prostatectomy , *GLYCINE , *GLUCOSE , *BLOOD testing , *SERUM , *BLOOD plasma , *PATHOLOGICAL physiology - Abstract
To examine changes in the pathophysiology and frequency of the transurethral resection (TUR) syndrome with two irrigation fluids, as variable amounts of irrigation fluid are absorbed during TUR of the prostate (TURP), and although polar solutes are required to prevent an effect on diathermy, the solutes may have effects when absorbed. Between December 2001 and March 2003, 250 patients were included in a prospective randomized trial comparing glycine 1.5% with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, temperature change, biochemistry including a glycine assay, and peri-operative symptoms. Blood samples were taken immediately before and immediately, 5 and 24 h after TURP. Irrigating fluid absorption during TURP was measured with 1% ethanol as a marker and breath ethanol measurements. Operative details were recorded, including the type of anaesthesia (with or with no sedation), resection time and weight of resected tissue. Peri-operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of ≤ 125 mmol/L with two or more associated symptoms or signs of TUR syndrome. Five (2%) patients had TUR syndrome; all five were irrigated with glycine, although this difference was not statistically significant ( P = 0.06). Of the five men, three had hypotension, four were tired, one was nauseous, two had parasthesia, two had ‘uneasiness’, one had blurred vision and two were confused; none had chest pain. There was a large variation between the groups in the level of glycine assayed immediately after TURP; a high glycine level was associated with the TUR syndrome ( P = 0.01). There was no difference between the groups in levels of sodium, potassium, urea, creatinine, osmolality, calcium, haematocrit, albumin serum levels or peri-operative blood loss (defined as a change from before to after TURP in haemoglobin level, accounting for transfusions). An increase in serum glycine was associated with TUR syndrome; there were large variations in the amounts of glycine absorbed, reaching levels many times the upper limit of normal. In other studies, glycine was reportedly toxic, and that the levels recorded were many times the upper limit of normal may have both immediate and long-term effects. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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36. Validation of the ethanol breath test and on-table weighing to measure irrigating fluid absorption during transurethral prostatectomy.
- Author
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Shipstone, D.P., Inman, R.D., Beacock, C.J.M., and Coppinger, S.W.V.
- Subjects
- *
BREATH tests , *TRANSURETHRAL prostatectomy - Abstract
Objective To determine the agreement between on-table weighing and the ethanol breath test in measuring the fluid absorption of patients during transurethral prostatectomy (TURP), and to assess the practicality of on-table weighing in the clinical setting. Patients and methods The absorption of irrigating fluid by the patient during TURP can lead to adverse sequelae, including cardiac stress. Despite modern techniques irrigant may still be absorbed and therefore methods to detect absorption are important. Most methods are impractical or inaccurate, but the expired ethanol technique and continuous on-table weighing are more promising. TURP was undertaken in 44 men (mean age 71 years) using continuous flow 1.5% glycine/1% ethanol as the irrigating solution. Intraoperative irrigant absorption was calculated by the ethanol breath test, using published formulae. Absorption measured by the weighing machine was calculated as (weight gain + blood loss - fluid given), and blood loss by the Hemocue method. Results The mean (sd) resected weight was 23 (14) g at a mean resection rate of 0.74 g/min. The mean (range) absorption using the balance was 456 (- 343 to 2486) mL, and using the ethanol breath test was 435 (44–2750) mL, with the mean of the differences being - 17 mL, with a 95% confidence interval (CI) of - 81 to -40, the 95% limits of agreement being - 389 to 356 mL (95% CI - 458 to - 337 and 297 to 418 mL). Conclusions Both methods are comparable and measure irrigating fluid absorption to levels of accuracy that are useful clinically. Either method could (and should) be used in routine practice. [ABSTRACT FROM AUTHOR]
- Published
- 2002
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37. How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method.
- Author
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Hultén, J.O.
- Subjects
- *
TRANSURETHRAL prostatectomy , *URETHRA surgery , *UROLOGY - Abstract
Objective To evaluate the effect of basic measures to minimize the absorption of irrigating fluid during transurethral resection of the prostate (TURP) to the planned end-point, using the ethanol method to guide the surgeon. Patients and methods Forty-six patients underwent TURP with intermittent irrigation using sterile water and 2% ethanol. The ethanol content in the expired breath of the patients was assessed every 5 min using a breath-alcohol monitor. In 25 patients no absorption was indicated but 21 showed some absorption according to the ethanol analyses. The operator was then immediately alerted, paused briefly to determine the route of absorption and to take advantage of blood clots to seal off leakage sites. On resuming the resection, attention was given to the pressure gradients in the operating field, based on bladder compliance and the flow in the irrigating jet. Repeated ethanol analyses were used to assess the result and to guide the surgeon's efforts. Results No operation had to be terminated prematurely; the mean absorption in the 21 patients in whom any ethanol was detected was 121 (75–230) mL. In 14 patients absorption occurred once, in six twice and in one there were three small absorption events. The group with absorption did not differ significantly from that with no absorption in operative duration (mean 48 and 47 min), resected weight (mean 32.8 and 31.6 g) or blood loss (mean 550 and 483 mL). Conclusions If the surgeon is alerted at the first positive ethanol reading, effective measures to minimize absorption can be taken early. Regular use of the ethanol method as an alarm system should permit TURP with a minimum of absorption and avoid an early interruption or premature termination of surgery because of absorption. [ABSTRACT FROM AUTHOR]
- Published
- 2002
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38. Does intraprostatic vasopressin prevent the transurethral resection syndrome?
- Author
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Sharma, D.P. and Harvey, A.B.
- Subjects
- *
TRANSURETHRAL prostatectomy , *VASOPRESSIN - Abstract
Objective To determine whether intraprostatic vasopressin (IPVP) prevents the transurethral resection (TUR) syndrome during prostatectomy. Patients and methods The study comprised 36 consecutive patients (mean age 68 years) with prostates clinically assessed as ≥ 20 g who underwent standard transurethral prostatectomy (TURP). Ten units of vasopressin in 0.5 mL were diluted with 9.5 mL isotonic saline and injected into the prostate transrectally before TURP. Blood samples were taken before and immediately after TURP to measure serum sodium concentration and free haemoglobin levels. The TURP irrigant used was cooled, boiled water maintained at 70–80 cmH2O pressure during resection. Twenty patients had alcohol added to the irrigant and their breath alcohol assessed at 10-min intervals during TURP. All patients had their pulse rate, blood pressure and sensorium monitored continuously. Extreme care was taken to avoid and/or identify capsular damage during resection. Results The mean weight of tissue resected was 36 g and the mean resection time 24 min. There was no significant change in clinical variables during TURP. In 19 patients the breath alcohol changes were insignificant. Changes in free haemoglobin were not significant, but the levels decreased after TURP in four patients, caused by the dilution consequent on the infusion of 800–1000 mL isotonic saline during surgery. Serum sodium concentrations showed only insignificant decreases, except in one patient whose breath alcohol suggested the absorption of 500 mL of irrigant. This patient's serum sodium concentration decreased by 9 mmol/L; 1 L of 5% dextrose was infused during the procedure and capsular damage was recognized early during TURP. Conclusion Insignificant volumes of irrigant entered the circulation of the patients during TURP with water irrigation and IPVP. The greatest risk factor for fluid entry during TURP is capsular damage. IPVP decreases bleeding and therefore improves visibility, so allowing the early identification of capsular damage. IPVP seems therefore to be of help during TURP by decreasing bleeding and allowing insignificant volumes of irrigant to enter the vasoconstricted vessels; it appears to prevent the TUR syndrome. [ABSTRACT FROM AUTHOR]
- Published
- 2000
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39. Ethanol‐glycine irrigating fluid for transurethral resection of the prostate in practice.
- Author
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Okeke, A.A., Lodge, R., Hinchliffe, A., Walker, A., Dickerson, D., and Gillatt, D.A.
- Subjects
- *
IRRIGATION (Medicine) , *TRANSURETHRAL prostatectomy , *GLYCINE - Abstract
Objective To evaluate the usefulness of a tracer of 1% ethanol in 1.5% glycine in the early detection of irrigation fluid absorption during transurethral resection of the prostate (TURP). Patients and methods Patients (120) undergoing TURP were irrigated with 1% ethanol in 1.5% glycine solution and their expired air tested for alcohol every 10 min during the procedure. Results In all, 112 patients were assessed; over half of the patients absorbed the irrigation fluid and they had a significantly lower postoperative serum sodium concentration (P < 0.002). Fourteen patients (12.5%) absorbed over 500 mL and two (1.8%) developed clinical features of the TUR syndrome. The experience of the surgeon, the weight of resected chips and the operative duration were not significantly predictive of absorption. Conclusion A tracer amount of ethanol in the irrigant is reliable for detecting absorption. Irrigating fluid absorption was unpredictable, thus supporting the case for routine monitoring. [ABSTRACT FROM AUTHOR]
- Published
- 2000
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40. Cardiovascular Collapse During Transurethral Resection of Bladder Tumor: A Case Report
- Author
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Amanda Lackaye, Ramniwas Yadav, Greta Mitzova-Vladinov, Nicole A. Gonzaga Gomez, and Michael Fabbro
- Subjects
Male ,medicine.medical_specialty ,business.industry ,Prostatic Hyperplasia ,Syndrome ,TUR syndrome ,Middle Aged ,medicine.disease ,Intensive care unit ,Surgery ,Resection ,law.invention ,Hemodynamic compromise ,Medical–Surgical Nursing ,Urinary Bladder Neoplasms ,Acute hyponatremia ,law ,medicine ,Bladder tumor ,Humans ,Major complication ,Hyponatremia ,business - Abstract
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.
- Published
- 2019
41. TUR syndrome - A report
- Author
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Adiveeth Deb, Kumar Vineet, and Vinay Kumar
- Subjects
Bradycardia ,medicine.medical_specialty ,Hyperkalemia ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,urologic and male genital diseases ,lcsh:RC870-923 ,Hypoxemia ,03 medical and health sciences ,0302 clinical medicine ,Prostate ,medicine ,Prostatomegaly ,Transurethral resection of the prostate ,Levosalbutamol ,business.industry ,TUR syndrome ,medicine.disease ,lcsh:Diseases of the genitourinary system. Urology ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine.symptom ,business ,Endourology ,medicine.drug - Abstract
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.
- Published
- 2019
42. What the Intensive Care Physician Should Know About the Transurethral Resection Syndrome
- Author
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Robert G. Hahn
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Intensive care physician ,medicine ,Intensivist ,Endoscopic surgery ,Good prognosis ,TUR syndrome ,Complication ,business ,Resection - Abstract
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.
- Published
- 2019
- Full Text
- View/download PDF
43. Transurethral resection syndrome: A rare complication of intraperitoneal bladder perforation during transurethral resection of bladder tumor
- Author
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Lounis Benslimane, Hachem El Sayegh, Zayd El Boukili El Makhoukhi, Ahmed Ibrahimi, Yassine Nouini, and Idriss Ziani
- Subjects
Transurethral resection of bladder tumor ,medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,Glycine ,Bladder Perforation ,TUR syndrome ,lcsh:Diseases of the genitourinary system. Urology ,lcsh:RC870-923 ,medicine.disease ,Intensive care unit ,Transurethral resection syndrome ,Surgery ,Resection ,law.invention ,Bladder perforation ,law ,medicine ,Bladder tumor ,Intubation ,Hyponatremia ,business ,Complication ,Endourology - Abstract
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.
- Published
- 2021
- Full Text
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44. Die transurethrale Resektion der Prostata
- Author
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C Füllhase
- Subjects
medicine.medical_specialty ,business.industry ,Acute complication ,Prostatectomy ,Urology ,Incidence (epidemiology) ,medicine.medical_treatment ,030232 urology & nephrology ,TUR syndrome ,urologic and male genital diseases ,medicine.disease ,Resection ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Lower urinary tract symptoms ,030220 oncology & carcinogenesis ,Medicine ,Clinical efficacy ,business ,Transurethral resection of the prostate - Abstract
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.
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- 2016
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45. Computer-controlled monitoring of bladder pressure in the prevention of 'TUR syndrome': a randomized study of 53 cases.
- Author
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Hubert, J., Cormier, L., Gerbaud, P.F., Guillemin, F., Pertek, J.P., and Mangin, P.
- Abstract
Objective To evaluate the performance of a computer-controlled monitor of bladder pressure in the prevention of transurethral resection (TUR) syndrome. Patients and methods The in vitro pressure loss in catheters and endoscopes of different size was measured for irrigant flow rates of 0-500 mL/min to calibrate them before surgery. The calibrations were used in a computerized monitoring system designed to control bladder pressure during TUR of the prostate (TURP). The performance of the system was assessed in a randomized study of 53 patients with a prostate adenoma or carcinoma (Group A, 27 unmonitored patients; Group B, 26 monitored patients). The primary criterion for evaluating the absorption of irrigating fluid was the level of glycine in the blood. Results When patients with capsule perforation were included in the analysis, there was no statistically significant difference in mean glycine absorption between the groups, although glycine levels were highest in Group A, particularly in those cases with perforation (four in Group A; two in Group B). When the results for patients with capsule perforation were excluded from the analysis, there was a significant difference in the incidence of irrigant absorption between the groups. The extent of absorption was not related to the duration of operation (which was shorter in Group B) nor to the weight of resection chippings. Conclusion The continuous computerized monitoring of bladder pressure during TURP effectively reduced the absorption of irrigant fluid, making the procedure safer for the patient and easier for the surgeon. [ABSTRACT FROM AUTHOR]
- Published
- 1996
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46. Monopolar Transurethral Resection of Prostate
- Author
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Dilip Kumar Mishra and Madhu S. Agrawal
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Prostate ,Urology ,Medicine ,TUR syndrome ,business ,Resection - Published
- 2018
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- View/download PDF
47. Low-pressure monopolar electroresection of the prostate for glands sized 70 vs. 70 cc performed with continuous irrigation and suprapubic suction: perioperative and long-term outcome
- Author
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Konrad Wilhelm, Arndt Katzenwadel, Ioana Maria Cazana, Johannes Spaeth, Arkadiusz Miernik, and Martin Schoenthaler
- Subjects
Nephrology ,Male ,Blood transfusion ,medicine.medical_treatment ,030232 urology & nephrology ,Prostatic Hyperplasia ,0302 clinical medicine ,Postoperative Complications ,Prostate ,Prospective Studies ,Aged, 80 and over ,Transurethral Resection of Prostate ,Organ Size ,Middle Aged ,Urinary Bladder Neck Obstruction ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Original Article ,TUR-P ,Adenoma ,medicine.medical_specialty ,Suction ,Urology ,Operative Time ,Electrosurgery ,TUR syndrome ,Prostate resection ,03 medical and health sciences ,Lower Urinary Tract Symptoms ,Lower urinary tract symptoms ,Internal medicine ,medicine ,Pressure ,Humans ,Transurethral resection of the prostate ,Aged ,Retrospective Studies ,Low-pressure resection ,business.industry ,Prostatic Neoplasms ,Perioperative ,medicine.disease ,Surgery ,Urinary Incontinence ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
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.
- Published
- 2017
48. Usefulness of bicarbonate Ringer's solution as perfusate during transurethral resection of the prostate.
- Author
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Hongo F, Narukawa T, Fujihara A, Amaya F, Sawa T, and Ukimura O
- Abstract
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., Competing Interests: The authors declare that they have no competing interests., (© 2021 Published by Elsevier Inc.)
- Published
- 2021
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49. Transurethral Resection Syndrome Caused by Bladder Perforation during Transurethral Resection of Bladder Tumor: A Report of 2 Cases
- Author
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Nan Seol Kim
- Subjects
Bradycardia ,medicine.medical_specialty ,business.industry ,Bladder Perforation ,TUR syndrome ,medicine.disease ,Extravasation ,Surgery ,Resection ,medicine ,Bladder tumor ,Intravascular volume status ,medicine.symptom ,business ,Hyponatremia - Abstract
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.
- Published
- 2012
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50. Is using ethanol-glycine irrigating fluid monitoring and 'good surgical practice' enough to prevent harmful absorption during transurethral resection of the prostate?
- Author
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Justin W. Collins, Anthony G. Timoney, R. A. Bradbrook, Seamus MacDermott, and F.X. Keeley
- Subjects
Male ,medicine.medical_specialty ,Urology ,Sodium ,medicine.medical_treatment ,Glycine ,Prostatic Hyperplasia ,chemistry.chemical_element ,Therapeutic irrigation ,Absorption (skin) ,Prostate ,Humans ,Medicine ,Prospective Studies ,Therapeutic Irrigation ,Aged ,Transurethral resection of the prostate ,Rank correlation ,Aged, 80 and over ,Ethanol ,business.industry ,Transurethral Resection of Prostate ,Middle Aged ,TUR syndrome ,Surgery ,medicine.anatomical_structure ,chemistry ,Anti-Infective Agents, Local ,business - Abstract
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.
- Published
- 2006
- Full Text
- View/download PDF
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