Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.

Bipolar Transurethral Resection of the Prostate: Short-Term Outcome Evaluation in Regional Hospital in Senegal

Introduction: Transurethral resection of the prostate is still the most popular procedure that use for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction in developed countries. Bipolar transurethral resection of the prostate (B-TURP) is a recent technique in our urological practice. The aim of this study was to evaluate our preliminary results on the use of a B-TURP in Kolda (Senegal) in a benign prostatic hyperplasia (BPH). Materials and Methods: This was a 15-month, retrospective and descriptive study from June 2021 to August 31, 2022. It examined the records of patients who had BPH requiring surgical treatment and who received Bipolar transurethral resection of the prostate (B-TURP) during the study period at the Kolda Regional Hospital in Senegal. We used a Karl STORZ bipolar endoscopy column with a 26 sheath and 30˚ optics. The parameters studied were the civil status of the patients, the clinical and para-clinical data as well as the operative indications. The data were entered and analyzed using Epi-info 3.5.1.1. Results: A total of 31 patients underwent bipolar transurethral resection of the prostate during the study period. The mean age of patients was 68.5 ± 12.6 years (range, 56 - 77 years). The mean total PSA was 4 ± 2.3 ng/ml (range, 0.5 - 11 ng/ml). The mean prostate size assessed by ultrasound was 54 ± 12.3 ml (range, 30 - 90 ml). The operative indication was dominated by BPH with impact on the upper urinary tract. The mean of bladder irrigation time was 21.4 ± 3.9 hours (range, 12 - 26 hours). In the immediate post-operative period, blood transfusions were performed in 2 patients (6.5%). In the medium-term follow-up, we noted one 1 (3.2%) case of urine retention requiring bladder catheterization. Conclusion: Bipolar Transurethral resection of the prostate B-TURP in saline system is efficacious and safe. The results of this preliminary study of B-TURP are satisfactory with a low complication rate. B-TURP decreases the duration of the hospitalization and the port of the probe. Our perspectives are oriented towards endoscopy of the upper urinary tract.

The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials

Objective Bleeding is one of the most common complications of transurethral resection of the prostate(TURP).Several previous studies reported that administering dutasteride before surgery could reduce perioperative bleeding.We aimed to evaluate the efficacy of preoperative dutasteride treatment in benign prostatic hyperplasia patients undergoing TURP by performing a meta-analysis of relevant randomized controlled trials(RCTs).Methods A comprehensive literature search was performed through the electronic databases including Medline,Cochrane Library,Google Scholar,and ClinicalTrial.gov in October 2020.RCTs evaluating the role of dutasteride for TURP were screened using the eligibility criteria and the quality of RCTs was assessed using the Cochrane Risk of Bias Tool.The heterogeneity was assessed using I2 statistic.The measured outcomes were hemoglobin(Hb)levels,perioperative blood loss,blood transfusion,microvessel density(MVD),and operation time.Data were pooled as mean difference(MD)and odds ratio(OR).Results A total of 11 RCTs consisting of 627 samples from the treatment group and 615 samples from the placebo group were analyzed.Patients that received dutasteride had less reduction in Hb levels(MD−1.10,95%confidence interval[CI]−1.39 to−0.81,p<0.00001).Dutasteride also significantly reduced the operation time(MD−1.79,95%CI−2.97 to−0.61,p=0.003)and transfusion rate after surgery(OR 0.34,95%CI 0.15 to 0.77,p=0.009)compared to the control group.However,the MVD(MD−3.60,95%CI−8.04 to 0.84,p=0.11)and perioperative blood loss in dutasteride administration for less than 4 weeks(MD 46.90,95%CI−144.60 to 238.41,p=0.63)and more than 4 weeks(MD−190.13,95%CI−378.05 to−2.21,p=0.05)differences were insignificant.Conclusion Preoperative administration of dutasteride is able to reduce bleeding during TURP,as indicated by less reduction in Hb level,lower transfusion rate,and less operation time.

Patient-controlled intravenous fentanyl for cystospasm after transurethral resection of the prostate

Objective： To evaluate the clinical efficacy and safety of patient-controlled intravenous analgesia （PCIA） with fentanyl for cystospasm after transurethral resection of the prostate. Methods： Sixty benign prostatic hyperplasia （BPH） patients scheduled for transurethral resection of the prostate （TURP） under general anesthesia with laryngeal mask airway （LMA） were randomly divided into groups F and S. Group F （n=30） received PCIA device with fentanyl 10 ug/kg＋8 mg ondansetron, and Group S （n=30） received placebo （PCIA device with 8 mg ondansetron）. The visual analog scale （VAS） scores for pain were evaluated at 0, 2, 4, 8, 16, 24, and 48 h by the same staff. And recorded were incidence of cystospasm, side effects, application of hemostatic, duration of drawing Foley catheter and continuous bladder irrigation, time of exhaust after operation, time of post-operative stay and cost of hospitalization. Results： The incidence of cystospasm in Group F was significantly lower than that in Group S in the 48 h after operation （P〈0.05）, the VAS scores for pain in Group F was significantly lower than that in Group S within the 48 h after operation （P〈0.01）. The time of exhaust after operation in Group F was significantly later than in Group S （P〈0.05）. No significant difference was observed in applications of hemostatic, duration of drawing Foley catheter, duration of continuous bladder irrigation, time of post-operative stay and cost of hospitalization between the 2 groups. Conclusion： PCIA with fentanyl （10 ug/kg） relieves pain with little side effect and reduces cystospasm satisfactorily.

Is verumontanum resection needed in transurethral resection of the prostate?

Transurethral resection of the prostate is the mainstay for treatment of bladder outflow obstruction. It is a procedure that involves various complications and has a high success rate. In view of a recent publication presenting the effect of verumontanum resection on functional outcome and possible complications after TURP, the present manuscript presents the available evidence on the subject as well as the possible criticism about the technique suggested by the authors. The results available do not confirm that by resecting the verumontanum there is a clinically significant improvement in the functional outcome, however confirm that continence is not affected. The criticism probably lies in the fact that resecting such a small amount of tissue like the verumontanum(its size probably remains the same with few changes during lifetime) probably does not affect outcome, yet the resection of hyperplastic apical tissue around it may play a role in functional improvement.

Transurethral Resection of the Prostate (TURP): About 146 Cases at Sheikh Zayed Hospital in Nouakchott Mauritania

Introduction: Transurethral resection of the prostate (TURP), entered our service in October 2015, since then it became a part of the service daily activity. The aim of our study is to assess the acceptance of the technic by our patients and by the nursing staff and to analyze the results of our initial experience. Materials and Methods: Retrospective study over 14-month (October 2015 to December 2016);bringing together all the patients who received TURP. The inclusion criteria are to have benefited from a TURP in our service. The exclusion criteria all patients operated by other techniques. It was a monopolar resection of the prostate using a glycocolle loop, the size limit of the prostate was 65 cc or less. A questionnaire on the knowledge of the technique and its acceptance is made. The parameters studied the age of the patient;surgical indications;the course of the operation, the complications and the course. The frequency of TURP compared to other techniques and the demand for this technique by patients. The urinary catheter was left in place for 4 days, the patients were seen again on day 7 after the catheter was removed to assess the urine flow, a question regarding the opinion of the nursing staff was included and analyzed separately. Results: The total number of patients was 146;the mean age was 68.2 years. The main cause of consultation was urine retention 65%. The average duration of the intervention was 56 minutes. The average length of hospital stay was 28 hours. The urinary catheter was removed on day 4. Complications were bleeding in 7% of cases requiring blood transfusions. Failure to remove the indwelling catheter leads to revision via the transurethral route. The TURP syndrome was observed in 2 patients in our early patients but quickly resolved. The outcome was favorable in 75% of cases. Post operating management give satisfaction for nurse and acceptance was a success. Conclusion: TURP is now a routine surgical activity;it seems to have an upright place for BPH in our department;its impact on morbidity was remarkable.

Does dutasteride reduce the bleeding in transurethral resection of the prostate in patients on antiplatelet drugs?

Background The aim of this study was to assess the effect of a 4-week dutasteride treatment on reducing the intraoperative and postoperative bleeding,as well as the amount and duration of irrigation required to clear the urine after transurethral resection of the prostate(TURP)≥50 g in men receiving the antiplatelet drug(APD).Materials and methods This double-blind randomized clinical trial included patients with a prostate size≥50 g who were indicated for TURP and were already receiving APD.The study was conducted in the Urology Department of Cairo University over a 12-month period.Routine preoperative laboratory investigations were performed in all patients.Moreover,baseline prostate size,serum prostate-specific antigen level,and International Prostate Symptom Score were estimated.The patients were randomly divided into 2 equal groups(groups A and B).Group A,the dutasteride group,received dutasteride(0.5 mg)once daily for 4 weeks.Group B,the placebo group,received a placebo capsule once daily for 4 weeks.Both groups underwent bipolar TURP.Fifteen patients were excluded from the study;9 patients from group A and 6 patients from group B,either due to drug intolerability or loss follow-up.Results The mean blood loss was insignificant between the 2 groups immediately after and 24 hours after surgery(Δhemoglobin:1.41±0.63 g/dL vs.1.48±0.54 g/dL,2.12±0.70 g/dL vs.2.31±0.78 g/dL,respectively,p=0.631,p=0.333;Δhematocrit:2.97%±1.51%vs.3.16%±1.36%,4.96%±1.87%vs.5.73%±4.39%,respectively,p=0.610,p=0.380).However,there were significant differences in duration of indwelling urethral catheter(5.10±0.55 days vs.5.80±1.79 days,p=0.048),duration of bladder irrigation(13.60±2.85 hours vs.16.33±6.62 hours,p=0.044),and the amount of saline used for bladder irrigation(11.03±2.30 L vs.13.87±6.13 L,p=0.046)between group A and group B.respectively.Conclusions Treatment with dutasteride for 4 weeks before TURP in men receiving APD did not significantly reduce intraoperative or postoperative bleeding after TURP but could significantly reduce the duration of indwelling catheter placement,as well as the duration and amount of saline irrigation.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

Objective:To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate(TURP)and correlate its incidence with intra-operative urethral mucosal injury during TURP.Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study.Methods:One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant.The prostate size,operative time,intra-operative mucosal rupture,catheter time,catheter traction duration,uroflowmetry,and post-operative stricture rate were compared.Results:A total of 150 patients underwent TURP,including 74 patients undergoing monopolar TURP(one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate)and 75 patients undergoing bipolar-TURP,all of which were performed using a 26 Fr sheath resectoscope.The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups.Out of 149 patients,nine patients(6.0%)developed urethral stricture.The severity of the injury(urethral mucosal injury)correlated with the likelihood of developing a subsequent complication(stricture urethra).Patients with stricture had significantly larger prostate volume than patients without stricture(65.0 mL vs.50.0 mL;p=0.030).Patients with stricture had longer operative time than patients without stricture(55.0 min vs.40.0 min;p=0.002).In both procedures,formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury.Conclusion:Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.

Study on the Treatment of Benign Prostate Hyperplasia Combined with Underactive Bladder Detrusor Contraction by Transurethral Plasma Enucleation of the Prostate

Objective: Exploring the clinical efficacy of transurethral plasma enucleation of the prostate in the treatment of benign prostatic hyperplasia with underactive bladder detrusor contractility. Methods: Retrospective analysis of the clinical data of 68 patients with benign prostatic hyperplasia and underactive detrusor muscle contractility treated by our department from July 2021 to July 2022. The above patients all met the diagnosis of benign prostatic hyperplasia, excluding prostate cancer and urethral stricture. Urodynamics showed a decrease in the contractile force of the bladder detrusor muscle, and the surgical equipment used Olympus bipolar plasma resection equipment method. Divide the above patients into two groups: the experimental group of 34 patients who underwent transurethral plasma enucleation of the prostate and the control group of 34 patients who underwent transurethral plasma resection of the prostate. Evaluate the preoperative clinical baseline level and postoperative observation indicators of the two groups of patients, and compare the statistical differences between the two groups. Results: Both groups of patients successfully completed the surgery, and there were no serious complications such as rectal or bladder perforation during the surgery, with less bleeding. The postoperative QOL, IPSS, Qmax, and residual urine volume of patients undergoing transurethral plasma enucleation and resection of the prostate were significantly improved compared to those before surgery (P 0.05). Conclusion: Transurethral enucleation of the prostate has good efficacy and safety in the treatment of benign prostatic hyperplasia combined with weakened detrusor muscle contractility. Compared with traditional electric resection surgery, the efficacy is more significant. In terms of the main complications of the surgery, although there are slightly more patients with temporary urinary incontinence after prostate enucleation, there is no statistically significant difference compared to after electric resection, and they can recover to normal in the short term.

Urinary and sexual function changes in benign prostatic hyperplasia patients before and after transurethral columnar balloon dilatation of the prostate

BACKGROUND Transurethral columnar balloon dilatation of the prostate(TUCBDP) is a new surgical treatment, but its efficacy remains controversial because of limited clinical application.AIM To investigate the clinical effect of TUCBDP for benign prostatic hyperplasia(BPH).METHODS Overall, 140 patients with BPH who underwent surgical treatment were included in the study. A random number table was used to divide the participants into study and control groups(n = 70 per group). The study group underwent TUCBDP. The prostate resection surgical time, intraoperative blood loss, bladder irrigation time, catheter indwelling time, length of hospital stay, International Prostate Symptom Score(IPSS), maximum urine flow rate(Qmax), residual urine volume(RUV), changes in the International Erectile Function Score(ⅡEF-5) score, serum prostate-specific antigen(PSA), quality of life(QOL) score, and surgical complications were compared in both groups.RESULTS The operation time, intraoperative blood loss volume, bladder flushing time, urinary catheter indwelling time, and length of hospital stay were significantly lower in the study group than in the control group(P < 0.05). There were no significant differences in the IPSS, Qmax, and RUV measurements between the study and control groups(P > 0.05). However, at 3 mo post-surgery, the IPSS and RUV measurements were both lower(P < 0.05) and Qmax values were higher(P < 0.05) compared to the pre-surgery results in both groups. The ⅡEF-5 scores before and 3 mo after surgery were not significantly different between the study and control groups(P > 0.05). At 1 mo after surgery, the ⅡEF-5 score was higher in the study group than in the control group(P < 0.05). The serum PSA levels and QOL scores before treatment and at 1 and 3 mo after treatment were not significantly different between the study and control groups(P > 0.05). However, lower serum PSA levels and QOL scores were observed after 1 and 3 mo of treatment compared to pre-treatment levels in the study group(P < 0.05). The surgical complication rate of the study group(4.29%) was lower than that of the control group(12.86%;P < 0.05).CONCLUSION TUCBDP for BPH and transurethral resection of the prostate can achieve better results, but the former method is associated with less surgical trauma.

Role of Hiraoka's transurethral detachment of the prostate combined with biopsy of the peripheral zone during the same session in patients with repeated negative biopsies in the diagnosis of prostate cancer

BACKGROUND Persistent suspicion of prostate cancer(PCa)due to a rising prostate-specific antigen(PSA)level after repeated negative biopsies is a serious challenge in clinical practice.AIM To determine the role of Hiraoka’s transurethral detachment of the prostate(TUDP)combined with biopsy of the peripheral zone during the same session in patients with repeated negative biopsies in the diagnosis of PCa.METHODS We retrospectively evaluated the records of 10 patients who were eligible for inclusion in our hospital between December 2012 and August 2017.Patient demographics,a family history of PCa,the number of biopsies,prostate volume,pathological examination,and perioperative PSA level were obtained.RESULTS Two of 10 patients were pathologically diagnosed with PCa after surgery;the Gleason scores were 4+4 and 4+3,respectively.Both patients subsequently underwent laparoscopic radical prostatectomy.The median PSA levels preoperatively,and 3 mo and 1 year postoperatively in the other eight patients who were diagnosed with benign prostate hyperplasia after surgery were 19.10 ng/mL,1.10 ng/mL,and 1.15 ng/mL,respectively.The adjusted P values of the 3-mo and 1-year post-operative PSA level vs pre-operative PSA level were 0.003 and 0.026,respectively.None of the patients had increased PSA levels or PCa detected after a median 35 mo of follow-up.CONCLUSION TUDP combined with peripheral zone biopsy may improve the detection rate of PCa in patients with repeated negative biopsies.The PSA level declined rapidly in patients who had negative pathological examinations after TUDP,which remained stable 1 year after surgery.

Bladder Perforation during Transurethral Resection of Bladder Tumor Is Not an Innocent Accident: Literature Review Based on a Clinical Case Experience

Urothelial Carcinoma (UC) is one of the most frequent cancers worldwide. Transurethral Resection of Bladder Tumor (TURBT) is a standard treatment in the disease’s early stages, with bladder perforation being a possible and classical complication. However, extravesical tumor seeding resulting from perforation is a rare phenomenon. We hereby report the case of a 76-year-old man with a history of smoking diagnosed with high-grade T1 urothelial carcinoma. TURBT was performed and bladder perforation occurred during the procedure. Radical cystectomy after neoadjuvant chemotherapy failed to reveal an invasive tumor. However, the patient experienced peritoneal recurrence with liver metastasis 3 years following the operation. This case left physician wondering whether the bladder perforation and the resulting tumor seeding are the cause behind the late peritoneal recurrence of an early-stage urothelial carcinoma.

The Clinical Effect of Bipolar Transurethral Resection in Saline of Benign Prostate Hyperplasia with Long Term Follow-Up

Transurethral resection of the prostate (TURP) is considered as the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Long-term follow-up of the clinical effect of bipolar transurethral resection of the prostate (B-TURP) in saline for BPH is required. Objective: To compare, with long term follow-up, the efficacy and safety of B-TURP in the treatment of BPH with prostate gland volumes of 45 ml, and larger than 60 ml. Materials and Methods: From January 2006 to December 2016, 318 patients with a mean age of 69.45 ± 8.37 years and a median prostate volume of 42 cm3 (56.51 - 32.47) were treated with B-TURP by single urologist (SP) at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. We retrospectively analyzed the perioperative status of patients’ status follow-up for at least 6 months and up to 5 years. Post-void residual (PVR) and maximum flow rate (Qmax) were assessed preoperatively and postoperatively. Operative time, length of catheterization and hospitalization and complications were all reported. Results: The main indication for B-TURP was failure of medication (81.13%). Perioperative results showed no statistical significance among the groups in terms of catheterization days and the hospitalization length. During the follow-up, the improvement of postoperative parameters was compared with preoperative subscales, at different periods from baseline and after 24, 36, 48, and 60 months post treatment. PSA, Q max, PVR, and average flow rate were significantly different from pre-operation data (p Conclusion: With long-term follow-up, B-TURP is a safe and effective technique for BPH management with prostate gland 45 ml and larger than 60 ml.

Effect of internal iliac artery chemotherapy after transurethral resection of bladder tumor for muscle invasive bladder cancer

Objective： To evaluate the clinical effect of transurethral resection of bladder tumor（TUR-BT） combined with internal iliac artery chemotherapy and intravesical instillation therapy for muscle invasive bladder cancer（MIBC）.Methods： From February 2007 to April 2014, 62 patients with MIBC were treated with TUR-BT combined with intravesical instillation therapy, with or without internal iliac artery chemotherapy, and the chemotherapy regimen is gemcitabine and cisplatin（GC）. The bladder preservation and survival rate as well as cancer-specific survival（CSS） rate and overall survival（OS） rate of the two groups were compared.Results： Sixty-two patients were followed-up for 26-102 months with an average of 58.4±3.1 months. Recurrence-free survival（RFS） at 2-year for TUR ＋ GC group and TUR group were 77.8% and 53.8%, respectively. Bladder preserved rate（BPR） at 3-year for TUR ＋ GC group and TUR group were 94.4% and 80.8%. CSS rate at 2-year for TUR ＋ GC group and TUR group were 94.4% and 84.6%. The diseasefree survival（DFS） at 1-year for TUR ＋ GC group and TUR group were 83.3% and 61.5%, and 77.8% and 53.8% for the 2nd year. OS at 2-year for TUR ＋ GC group and TUR group were 88.9% and 92.3%.Conclusions： TUR-BT and intravesical instillation therapy combined with internal iliac artery chemotherapy for MIBC had a better outcome at RFS, BPR and DFS than the treatment without internal iliac artery chemotherapy, and no difference in OS and CSS.

Safety of Overnight Hospitalization after Transurethral Resection of Prostate

Background: Monopolar transurethral resection of prostate has long been a standard method of managements of benign prostatic hyperplasia. The safe and superior efficacy of transurethral resection of prostate (TURP) always argues strongly for maintaining it as the primary mode of therapy for patients with benign prostatic hyperplasia (BPH). There is a trend toward early catheter removal after transurethral resection of prostate (TURP) even to the extent of performing it as a day case. We explored the safety and feasibility of early catheter removal and discharging the patient without catheter after TURP. Materials and methods: Forty patients who underwent monopolar TURP were included in a prospective study. The decision to remove catheters on the first morning after surgery was based on the color of the catheter effluent, absence of clots, normal vital signs and adequate urine output. Patients who voided successfully were discharged on the same day as catheter removal. Results: Among the forty patients whose catheters were removed on first postoperative day, 38 patients (95%) voided successfully, and were discharged on the same day. However, two out of forty patients (5%) were recatheterized due to urethral discomfort during micturition. The catheter was removed on the next day. Mean overall duration of catheterization was 18.36 hours, and overall length of patient hospitalization was 21.68 hours. Conclusions: Overnight hospitalization and early catheter removal after transurethral prostatectomy are an appropriate, safe and effective way of patient care with minimal morbidity.

Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor

Objective： To observe the advantage of total intravenous anesthesia for transurethral resection of bladder tumor （TURBT）. Methods.. Sixty ASA Ⅰ-Ⅱ patients undergoing TURBT were randomly assigned to 2 groups. Spinal anesthesia with 0. 75% pure bupivacaine （8-12 rag） was applied to patients in Group Ⅰ （n= 30）. Patients in Group Ⅱ （n=30） received total intravenous anesthesia with continuous infusion of Propofol and Remifentanil ; and a laryngeal mask was used to ensure the airway and ventilation. BP, HR, SPO2 and pertinent side effects were monitored and recorded. Results ： The patients in group Ⅱ experienced more stable hemodynamics than those in group Ⅰ . Obturator nerve reflex was observed in 15 （50. 0%） patients in Group Ⅰ , but none （0%） in Group Ⅱ （P〈0. 01）. Conclusion.. Total intravenous anesthesia with laryngeal mask is a safe, reliable, controllable and simple manual for patient undergoing TURBT.

The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention

In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate （PK-TURP） for patients with benign prostatic hyperplasia （BPH） with acute urinary retention （AUR）. We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR （n = 348） and non-AUR groups （n = 778）. After the urethral catheters were removed, the urine white blood cell （WBC） count in the AUR group significantly increased compared with the non-AUR group （P〈 0.01）. However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group （P 〈 0.001）. A total of 87.1% （303/348） patients in the AUR group and 84.1% （654/778） patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group （P 〈 0.01）. The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3-12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.

Efficacy and safety of bipolar plasma vaporization of the prostate with ＂button-type＂ electrode compared with transurethral resection of prostate for benign prostatic hyperplasia

Background Transurethral resection of prostate （TURP） has been considered as the standard treatment for benign prostatic hyperplasia （BPH）. However, issues that have not yet been overcome for TURP include bleeding and absorption of irrigation fluid. Thus, novel improvement of the surgery is necessary. This study aimed to evaluate the efficacy and safety of bipolar plasma vaporization of the prostate （BPVP） with ＂button-type＂ electrode against standard TURP for BPH.

Validity of virtual reality simulator in training of transurethral resection of prostate

Objective To assess the face and construct validity of a full procedural transurethral prostate resection simulator ( TURPSimTM ) in training of transurethral resection of prostate. Methods Ten experienced and thirteen inexperienced urologists ( TURP experience ≥ 30 and