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.

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.

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.

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.

Early channel transurethral resection of the prostate for patients with urinary retention after brachytherapy

Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP （cTURP） within six months post-implant for patients with refractory urinary retention. Methods： One hundred and ninety patients with localized prostate cancer of clinical stages Tlc to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. Results： The median interval between prostate brachytherapy and cTURP was three months （range 1.5 to 5.0 months） There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months （range 6 to 26 months） after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen （PSA） of the patients who underwent cTURP was 0.42 ng/ml （range 0.08 to 0.83 ng/ml） at the end of their follow-up. Conclusions： Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.

Innovative endoscopic enucleations of the prostate--Xie’s Prostate Enucleations

In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vapor enucleation and resection of the prostate(TVERP),transurethral vapor enucleation of the prostate(TVEP),and ultrasound-navigated TVEP(US-TVEP)are new,innovative endoscopic enucleation procedures.These procedures are named Xie’s Prostate Enucleations(Xie’s Procedures for short).Current clinical data indicate that Xie’s Procedures are safe and effective treatment options for patients with BPH,especially for patients with larger prostates.Further prospective,randomized clinical trials compared with traditional transurethral resection of prostate(TURP)are still needed.

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.

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Management of BPH then 2000 and now 2016-From BPH to BPO

The diagnosis and treatment of benign prostatic obstruction(BPO)is based on a number of well-known lower urinary tract symptoms(LUTS)feared by all ageing males with functional testes.The ascent of modern urology turned this disease from lethal into an annoying but treatable health problem in the previous century.We are able to relieve the great majority of patients from their bothersome symptoms to a respectable quality of life by medication or removal of the obstructive part of the enlarged prostate.We can be proud of some progress made in the new millennium to reach a correct diagnosis and subsequent choice of treatment aiming for quality of life and cost-efficiency for public health.Still it remains symptomatic treatment and we expect the new generation of urologists to close some gaps in our knowledge on the regulation of prostatic growth to focus on prevention and elimination of the disease in the foreseeable future.

Volumetric Overload Shocks: Why Is Starling’s Law for Capillary Interstitial Fluid Transfer Wrong? The Hydrodynamics of a Porous Orifice Tube as Alternative

Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric overload shock type one is induced by sodium-free fluids such as glycine, glucose, mannitol and sorbitol and is characterized with acute dilutional hyponatraemia. Volumetric overload shock type 2 is induced with sodium-based fluids normal saline and plasma substitutes used for resuscitation of the critically ill and has no serological marker. It presents with the multiple vital organs dysfunction or failure syndrome or the adult respiratory distress syndrome. Hypertonic sodium is an effective treatment when given early adequately. The underlying pathophysiology is discussed. An alternative to Starling’s law for the capillary interstitial fluid transfer is given. Hydrodynamic of a porous orifice tube akin to capillary with a surrounding Chamber akin to the interstitial fluid space demonstrated a rapid dynamic magnetic field-like fluid circulation between the surrounding chamber and the lumen of the G tube that represent an adequate replacement for Starling’s law.

Emphysematous sloughed floating ball after prostate water vaporization Rezum:A case report

BACKGROUND Rezūm™water vapor therapy is a new minimally invasive endoscopic technology for the management and treatment of benign prostatic hyperplasia.CASE SUMMARY A 63-year-old male presented to our department with severe dysuria,frequency,urgency,and interrupted stream 2 mo after receiving Rezūm™therapy.The symptoms were caused by a retained floating emphysematous necrotic sloughed tissue.We also discovered a persistent bacterial infection that was resistant to parenteral antimicrobial therapy.The treatment of the patient included surgical removal of the necrotic tissue.CONCLUSION Despite the good safety profile and minimal adverse events related to Rezūm™therapy,major complications can still occur.

Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and metaanalysis

BACKGROUND Prostate artery embolization(PAE)is a promising minimally invasive therapy that improves lower urinary tract symptoms(LUTS)related to benign prostatic hyperplasia(BPH).Transurethral resection of the prostate(TURP)is the gold standard therapy for LUTS/BPH.AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH.Sources included PubMed,Embase,Cochrane library databases,and Chinese databases before June 2022.A systematic review and meta-analysis were conducted.Outcome measurements were combined by calculating the mean difference with a 95%confidence interval.Statistical analysis was carried out using Review Manager 5.3.RESULTS Eleven studies involving 1070 participants were included.Compared with the TURP group,the PAE group had a similar effect on the International Index of Erectile Function(IPSS)score,Peak urinary flow rate(Qmax),postvoid residual volume(PVR),Prostate volume(PV),prostatic specific antigen(PSA),The International Index of Erectile Function short form(IIEF-5)scores,and erectile dysfunction during 24 mo follow-up.Lower quality of life(QoL)score,lower rate of retrograde ejaculation and shorter hospital stay in the PAE group.There was no participant death in either group.A higher proportion of haematuria,urinary incontinence and urinary stricture was identified in the TURP group.CONCLUSION PAE may be an appropriate option for elderly patients,patients who are not candidates for surgery,and patients who do not want to risk the potential adverse effects of TURP.Studies with large cases and long follow-up time are needed to validate results.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate： a propensity score-matched analysis

We aim to reassess the safety of the monopolar transurethral resection of the prostate （M-TURP） without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit （10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively） were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier （4.6 days vs 5.2 days）, required shorter postoperative stays in the hospital （5.1 days vs 6.0 days）, and were at lower risk of operative complications （5.7% vs 9.2%）, especially bleeding requiring blood transfusion （2.9% vs 6.1%）. Similar findings were observed in cohorts of prostates of 30-80 ml and prostates 〉80 ml. Furthermore, among patients with a resection weight 〉42.5 g or surgical time 〉90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Search trends in the treatment for benign prostatic hyperplasia:A twenty-year analysis

ObjectiveMinimally invasive treatments for benign prostatic hyperplasia (BPH) have seen an increase in usage in recent years. We aimed to determine what types of events may influence patient search habits related to surgical BPH treatments.MethodsGoogle Trends was used to determine the frequency of searches for different minimally invasive and prostatic ablative treatments for BPH in the United States. The procedures including transurethral resection of the prostate (TURP), Aquablation therapy (Aquablation), Greenlight laser therapy (Greenlight), transurethral needle ablation, transurethral microwave thermotherapy, Urolift (prostatic urethral lift [PUL]), Rezum, iTind, holmium laser enucleation of the prostate, simple prostatectomy, and prostatic artery embolization were compared.ResultsFrom January 1, 2004 to February 28, 2023, the number of internet search queries have increased for TURP, PUL, Rezum, prostatic artery embolization, and holmium laser enucleation of the prostate. There has been a slight decrease in searches for Greenlight, transurethral needle ablation, transurethral microwave thermotherapy, iTind, simple prostatectomy, and Aquablation.ConclusionDespite increased searches of alternatives, TURP remains the most searched BPH procedure. Additionally, search habits may be influenced by several factors including government approval, corporate acquisition, and marketing campaigns. It is important for physicians to understand the types of events that may cause patients to inquire about certain treatments for better quality health information and clinical visits.

Predictive Factors for a Successful Day Case Benign Prostatic Hyperplasia Surgery: A Review

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. Materials and Methods: During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. Results: TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. Conclusion: TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.

Photoselective green-light laser vaporisation vs. TURP for BPH. meta-analysis

This study sought to evaluate the efficacy and safety of photoselective vaporisation （PVP） vs. transurethral resection of the prostate （TURP） for patients with benign prostatic hyperplasia （BPH）. Eligible studies were identified from electronic databases （Cochrane Library, PubMed and EMBASE）. The database search, quality assessment and data extraction were performed independently by two reviewers. Efficacy （primary outcomes： maximum urinary flow rate （Qmax）, international prostate symptom score （IPSS）, postvoid residual urine （PVR） and quality of life （QoL）; secondary outcomes： operative time, hospital time and catheter removal time） and safety （complications, such as transfusion and capsular perforation） were explored by using Review Manager 5.0. Six randomized controlled trials （RCTs） and five case-controlled studies of 1398 patients met the inclusion criteria. A meta-analysis of the extractable data showed that there were no differences in I PSS, Qmax, QoL or PVR between PVP and TU RP （mean difference （MD）： prostate sizes 〈 70 ml, Qmax at 24 months, MD=0.01, P=0.97; IPSS at 12 months, MD=0.18, P=0.64; QoL at 12 months, MD=-0.00, P=0.96; PVR at 12 months, MD=0.52, P=0.43; prostate sizes 〉70 ml, Qmax at 6 months, MD=-3.46, P=0.33; IPSS at 6 months, MD=3.11, P=0o36; PVR at 6 months, MD=25.50,P=-0.39）. PVP was associated with a shorter hospital time and catheter removal time than TURP, whereas PVP resulted in a longer operative time than TURP. For prostate sizes 〈70 ml, there were fewer transfusions, capsular perforations, incidences of TUR syndrome and clot retentions following PVP compared with TURP. These results indicate that PVP is as effective and safe as TURP for BPH at the mid-term patient follow-up, in particular for prostate sizes 〈70 ml. Due to the different energy settings available for green-light laser sources and the higher efficiency and performance of higher-quality lasers, large-sample, long-term RCTs are required to verify whether different energy settings affect outcomes.

Prostatic surgery associated acute kidney injury

Acute kidney injury(AKI) is associated with extended hospital stays,high risks of in-hospital and long-term mortality,and increased risk of incident and progressive chronic kidney disease.Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy,older age,and preexistent chronic kidney disease.Nonetheless,precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking.Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures.Whereas severe AKI after prostate surgery in general appears to be unusual,AKI associated with transurethral resection of the prostate(TURP) syndrome and with rhabdomyolysis(RM) after radical prostatectomy have been frequently described.The purpose of this review is to discuss the current knowledge regarding the epidemiology,risk factors,outcomes,prevention,and treatment of AKI associated with prostatic surgery.The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.

A novel mouse model simulating transurethral laser vaporization prostatectomy

Benign prostatic hyperplasia(BPH)is a common disease in elderly men,and transurethral laser prostatectomy(TULP)has been widely used in the clinic to remove bladder outlet obstruction caused by BPH.Previous animal models for wound repair after prostatectomy have many limitations,and there have been no previous reports of a mouse model of TULP.Therefore,this study aimed to establish a novel mouse model of TULP.Twelve healthy adult Kunming(KM)mice received transurethral laser vaporization prostatectomy with a 200-μm thulium laser.The mice were sacrificed,and wound specimens from the prostatic urethra and bladder neck were harvested at 1 day,3 days,5 days,and 7 days after surgery.Hematoxylin-eosin(HE)and immunohistochemistry were applied to confirm the establishment of the mouse TULP model.One day after the surgery,urothelium expressing uroplakin(UPK)was absent in the urethral wound site,and a large number of necrotic tissues were found in the wound site.There was no UPK-positive urothelium in the wound 3 days after surgery.At 5 days after surgery,monolayer urothelium expressing UPK was found in the wound site,indicating that the re-epithelization of the wound had been completed.On the 7th day after surgery,there were multiple layers of urothelium with UPK expression,indicating that the repair was completed.It is feasible to establish a mouse TULP model by using a microcystoscope system and a 200-μm thulium laser.