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THE EFFECT OF TRANSITION ZONE RESECTION RATE OF TRANSURETHRAL RESECTION OF PROSTATE(TURP) ACCORDING TO THE PROSTATE VOLUME
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THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Wednesday, April 29, 2009
Benign Prostatic Hyperplasia: Surgical Therapy & New Technology (I) Moderated Poster 65 Wednesday, April 29, 2009
10:30 am - 12:30 pm
1930 INFLUENCE OF DECREASING TUR-P FREQUENCY ON RESECTION EFFICIENCY IN A UNIVERSITY SETTING Christian Hampel*, Christopher Knapp, Rolf Gillitzer, Christoph Wiesner, Joachim W Thüroff, Mainz, Germany INTRODUCTION AND OBJECTIVES: The establishment of alphablockers as conservative therapy for Benign Prostatic Syndrome (BPS) 15 years ago caused a marked reduction in the frequency of TUR-P. In our institution, the resection frequency decreased by 50%. We investigated the influence of decreasing TUR-P numbers on technical expertise and resection efficiency using a retrospective analysis of our operated BPS patients. METHODS: Two representative years (1993, 2004) of the eras before and after introduction of alphablockers were chosen for TUR-P patient analysis. Preoperative prostate volume (measured by transvesical ultrasound) was associated with resected tissue weight and operation time. Together with postoperative complications these data were assigned to the responsible surgeons. Statistical analysis employed Wilcoxon and Mann-Whitney-Test. RESULTS: Median sonographical prostate volume was 38 ml in 1993 and 60 ml in 2004 (p<0.001). The median resected tissue amounts increased from 25 to 30 g (p<0.001). 412 TUR-Ps in 1993 were performed by 12 surgeons, whereas 243 operations were distributed among 17 urologists in 2004. 66.4% of the estimated prostate volume were resected in 1993. This value decreased to 58.4% in 2004 (p=0.002). At the same time, operation time increased (1993: ½ 42 min, 2004: ½ 61 min, p<0,001), leading to a decreased global resection efficiency (resected tissue per time) in 2004 (0.46 g/min) compared to 1993 (0.76 g/min; p<0.001). Perioperative morbidity (blood loss, transfusion rate, TURsyndrome rate) did not change significantly between 1993 and 2004. CONCLUSIONS: In 1993, many more TUR-Ps were performed by a smaller team of urologists. Hence, the experience of the 2004 surgeons could only be reduced. On the other hand, surgical demands were increasing with the sonographical prostate volumes, leading to a generally lower resection efficiency. However, perioperative morbidity remains unchanged at a very low level, as well as the durability of the surgical deobstruction is still warranted by the high percentage of resected prostate volume. Source of Funding: None
1931 THE EFFECT OF TRANSITION ZONE RESECTION RATE OF TRANSURETHRAL RESECTION OF PROSTATE(TURP) ACCORDING TO THE PROSTATE VOLUME Jae il Chung*, Jang Ho Yoon, Ho Seop Kwak, Won-ik Seo, Pil-moon Kang, Busan, Korea South, Republic of Korea INTRODUCTION AND OBJECTIVES: TURP was the gold standard for the treatment of benign prostatic hyperplasia (BPH). BPH is the enlargement of the transition zone; so a TURP was the resection of the enlarged transition zone. The transition zone resection rate(TZRR) is important if a good result is expected. The effect of the transition zone resection rate of TURP was evaluated according to the prostate volume. METHODS: From the January 2000 to December 2006, 140 patients with symptomatic BPH that had undergone TURP by one surgeon were enrolled in this retrospective study. 65 patients with BPH less than 60cc (Group I), and 75 patients with BPH equal or greater than
60cc (Group II) were evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry, and post voiding residual urine volume (PRV) before and after the TURP. The total prostate volume, transition zone volume (TZV), TZRR (resected prostate volume/preoperative TZ volume), total volume of resected prostate, operating time, period of hospital stay, and complications were assessed. RESULTS: In group I and II, TZV was 21.3±6.9cc and 38±19.5cc (p=0.43), respectively. The resected prostate volume were 16.5±7.1gm in group I and 26.6±10.3gm in group II (p=0.050). TZRR was equal, at 0.8±0.3, in both groups. The postoperative IPSS, voiding volume, PRV and maximal flow rate (Qmax) were significantly improved in both groups. Overall, the IPSS, VV, and PRV were significantly improved after TURP when TZRR was more than 0.5. However, objective parameter of obstruction, the Qmax was significantly improved when the TZRR was more than 0.7. There were no significant differences in the period of hospital stay and complications between the two groups. CONCLUSIONS: With TURP, the transition zone resection rate was important, without concern of the prostate size. Also, to obtain good results, more than 70% of enlarged transition zone has to be resected. Source of Funding: None
1932 RESULTS OF ONE THOUSAND CONSECUTIVE BIPOLAR TRANSURETHRAL RESECTION IN SALINE SYSTEM(TURIS) Franco Bertolotto, Angelo Naselli, Francesco Germinale, Carlo Introini, Paolo Puppo*, Genoa, Italy INTRODUCTION AND OBJECTIVES: In order to reduce the risks of the monopolar circuit, resectoscopes are today commercially available which, by behaving like electric dipoles, allow the patient to be excluded from the circuit. In the literature many papers confirm the equivalence in clinical outcome between mono and bipolar resection, but there is currently concern about the incidence of urethral stricture with the bipolar equipment METHODS: We reviewed the clinical records of the first 1000 consecutive bipolar TUR, performed with TURis equipment (Olympus ®), to asses safety on an large cohort of patients with a follow up of at least 6 months. Between January 2006 and October 2007, 376 TURP, 144 TUIP and 480 TURB were consecutively performed. Resection time, haemoglobin drop between the preoperative values and the values of the 2nd post-operative day, incidence of the obturator reflex, the catheterization time, the length of hospital stay, incidence of urinary retention, number of patients requiring blood transfusions and the incidence of urethral stricture were reported. RESULTS: -TURP: The median prostate volume was 52 mL, resection time 42 min and resected tissue 24.6 grams; the median decline between the preoperative and the post-operative day 2 value of haemoglobin was 0.9, the median catheterization time was 3 days whereas the median hospital stay was 4 days. Blood clot urinary retention occurred in 11 patients (2.9%). 7 patients (1.8%) required a blood transfusion. 5 patients (1.3%) were unable to void after initial removal of the catheter the third day after surgery and needed re catheterization. The incidence of urethral stricture was 15/376 (3.9%). -TUIP: The average time for performing a TUIP was 16 minutes. There was no measurable post-operative haemoglobin decline. The median catheterization time was 1 day and hospital stay 2 days Only 2 strictures (1.3%) were recorded. -TURB: The average resection time was 21.5 min. A median of 3.4 g of tissue was resected. The median postoperative drop in heamoglobin was 0.6 g/dL. The involuntary stimulation of the obturator nerve occurred in 6 patients (1.2%). Urethral stricture occurred in 12 patients (2.5%). 10 patients (2%) experienced blood clot urinary retention. 4 patients (0.8%) required blood transfusion. CONCLUSIONS: TURis offers results comparable to the monopolar technology without increasing the incidence of urethral stricture wich occurred overall in 34 cases (3.4%). Remarkably, none of the patients operated experienced a TUR syndrome or died due to the surgical intervention. Source of Funding: None
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Wednesday, April 29, 2009
Benign Prostatic Hyperplasia: Surgical Therapy & New Technology (I) Moderated Poster 65 Wednesday, April 29, 2009
10:30 am - 12:30 pm
1930 INFLUENCE OF DECREASING TUR-P FREQUENCY ON RESECTION EFFICIENCY IN A UNIVERSITY SETTING Christian Hampel*, Christopher Knapp, Rolf Gillitzer, Christoph Wiesner, Joachim W Thüroff, Mainz, Germany INTRODUCTION AND OBJECTIVES: The establishment of alphablockers as conservative therapy for Benign Prostatic Syndrome (BPS) 15 years ago caused a marked reduction in the frequency of TUR-P. In our institution, the resection frequency decreased by 50%. We investigated the influence of decreasing TUR-P numbers on technical expertise and resection efficiency using a retrospective analysis of our operated BPS patients. METHODS: Two representative years (1993, 2004) of the eras before and after introduction of alphablockers were chosen for TUR-P patient analysis. Preoperative prostate volume (measured by transvesical ultrasound) was associated with resected tissue weight and operation time. Together with postoperative complications these data were assigned to the responsible surgeons. Statistical analysis employed Wilcoxon and Mann-Whitney-Test. RESULTS: Median sonographical prostate volume was 38 ml in 1993 and 60 ml in 2004 (p<0.001). The median resected tissue amounts increased from 25 to 30 g (p<0.001). 412 TUR-Ps in 1993 were performed by 12 surgeons, whereas 243 operations were distributed among 17 urologists in 2004. 66.4% of the estimated prostate volume were resected in 1993. This value decreased to 58.4% in 2004 (p=0.002). At the same time, operation time increased (1993: ½ 42 min, 2004: ½ 61 min, p<0,001), leading to a decreased global resection efficiency (resected tissue per time) in 2004 (0.46 g/min) compared to 1993 (0.76 g/min; p<0.001). Perioperative morbidity (blood loss, transfusion rate, TURsyndrome rate) did not change significantly between 1993 and 2004. CONCLUSIONS: In 1993, many more TUR-Ps were performed by a smaller team of urologists. Hence, the experience of the 2004 surgeons could only be reduced. On the other hand, surgical demands were increasing with the sonographical prostate volumes, leading to a generally lower resection efficiency. However, perioperative morbidity remains unchanged at a very low level, as well as the durability of the surgical deobstruction is still warranted by the high percentage of resected prostate volume. Source of Funding: None
1931 THE EFFECT OF TRANSITION ZONE RESECTION RATE OF TRANSURETHRAL RESECTION OF PROSTATE(TURP) ACCORDING TO THE PROSTATE VOLUME Jae il Chung*, Jang Ho Yoon, Ho Seop Kwak, Won-ik Seo, Pil-moon Kang, Busan, Korea South, Republic of Korea INTRODUCTION AND OBJECTIVES: TURP was the gold standard for the treatment of benign prostatic hyperplasia (BPH). BPH is the enlargement of the transition zone; so a TURP was the resection of the enlarged transition zone. The transition zone resection rate(TZRR) is important if a good result is expected. The effect of the transition zone resection rate of TURP was evaluated according to the prostate volume. METHODS: From the January 2000 to December 2006, 140 patients with symptomatic BPH that had undergone TURP by one surgeon were enrolled in this retrospective study. 65 patients with BPH less than 60cc (Group I), and 75 patients with BPH equal or greater than
60cc (Group II) were evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry, and post voiding residual urine volume (PRV) before and after the TURP. The total prostate volume, transition zone volume (TZV), TZRR (resected prostate volume/preoperative TZ volume), total volume of resected prostate, operating time, period of hospital stay, and complications were assessed. RESULTS: In group I and II, TZV was 21.3±6.9cc and 38±19.5cc (p=0.43), respectively. The resected prostate volume were 16.5±7.1gm in group I and 26.6±10.3gm in group II (p=0.050). TZRR was equal, at 0.8±0.3, in both groups. The postoperative IPSS, voiding volume, PRV and maximal flow rate (Qmax) were significantly improved in both groups. Overall, the IPSS, VV, and PRV were significantly improved after TURP when TZRR was more than 0.5. However, objective parameter of obstruction, the Qmax was significantly improved when the TZRR was more than 0.7. There were no significant differences in the period of hospital stay and complications between the two groups. CONCLUSIONS: With TURP, the transition zone resection rate was important, without concern of the prostate size. Also, to obtain good results, more than 70% of enlarged transition zone has to be resected. Source of Funding: None
1932 RESULTS OF ONE THOUSAND CONSECUTIVE BIPOLAR TRANSURETHRAL RESECTION IN SALINE SYSTEM(TURIS) Franco Bertolotto, Angelo Naselli, Francesco Germinale, Carlo Introini, Paolo Puppo*, Genoa, Italy INTRODUCTION AND OBJECTIVES: In order to reduce the risks of the monopolar circuit, resectoscopes are today commercially available which, by behaving like electric dipoles, allow the patient to be excluded from the circuit. In the literature many papers confirm the equivalence in clinical outcome between mono and bipolar resection, but there is currently concern about the incidence of urethral stricture with the bipolar equipment METHODS: We reviewed the clinical records of the first 1000 consecutive bipolar TUR, performed with TURis equipment (Olympus ®), to asses safety on an large cohort of patients with a follow up of at least 6 months. Between January 2006 and October 2007, 376 TURP, 144 TUIP and 480 TURB were consecutively performed. Resection time, haemoglobin drop between the preoperative values and the values of the 2nd post-operative day, incidence of the obturator reflex, the catheterization time, the length of hospital stay, incidence of urinary retention, number of patients requiring blood transfusions and the incidence of urethral stricture were reported. RESULTS: -TURP: The median prostate volume was 52 mL, resection time 42 min and resected tissue 24.6 grams; the median decline between the preoperative and the post-operative day 2 value of haemoglobin was 0.9, the median catheterization time was 3 days whereas the median hospital stay was 4 days. Blood clot urinary retention occurred in 11 patients (2.9%). 7 patients (1.8%) required a blood transfusion. 5 patients (1.3%) were unable to void after initial removal of the catheter the third day after surgery and needed re catheterization. The incidence of urethral stricture was 15/376 (3.9%). -TUIP: The average time for performing a TUIP was 16 minutes. There was no measurable post-operative haemoglobin decline. The median catheterization time was 1 day and hospital stay 2 days Only 2 strictures (1.3%) were recorded. -TURB: The average resection time was 21.5 min. A median of 3.4 g of tissue was resected. The median postoperative drop in heamoglobin was 0.6 g/dL. The involuntary stimulation of the obturator nerve occurred in 6 patients (1.2%). Urethral stricture occurred in 12 patients (2.5%). 10 patients (2%) experienced blood clot urinary retention. 4 patients (0.8%) required blood transfusion. CONCLUSIONS: TURis offers results comparable to the monopolar technology without increasing the incidence of urethral stricture wich occurred overall in 34 cases (3.4%). Remarkably, none of the patients operated experienced a TUR syndrome or died due to the surgical intervention. Source of Funding: None