Transurethral Resection of the Prostate in Recurrent Acute Bacterial Prostatitis

2014 ◽  
Vol 94 (4) ◽  
pp. 442-444 ◽  
Author(s):  
Karel Decaestecker ◽  
Willem Oosterlinck
Keyword(s):  
Side Effects ◽  
Transurethral Resection ◽  
Bladder Neck ◽  
Infected Tissue ◽  
Bladder Neck Contracture ◽  
Bacterial Prostatitis ◽  
Acute Bacterial Prostatitis ◽  
Disease Free

Objective: To explore the outcome of transurethral resection of the prostate (TURP) in the treatment of refractory recurrent acute bacterial prostatitis. Patients and Methods: From 2004 to 2013, 23 TURP for this indication were performed in 21 patients; two patients underwent it twice. The files of these patients were retrospectively analysed for outcome and side effects. TURP intended to remove as much infected tissue as possible under appropriate antibiotherapy. Results: Twelve patients became free of symptoms during a follow-up of 3-108 months (median 44), two others became disease-free after one and two postoperative attacks, respectively; eight were not cured and had rapid recurrences; three patients had follow-up of a few weeks only. Two failures developed orchiepididymitis shortly after the procedure and one a year later. No incontinence or bladder neck contracture was noted. Conclusion: TURP is an acceptable procedure in the treatment of refractory recurrent bacterial prostatitis. It could cure about two thirds of patients.

scholarly journals Contemporary Outcomes after Transurethral Procedures for Bladder Neck Contracture Following Endoscopic Treatment of Benign Prostatic Hyperplasia

2021 ◽  
Vol 10 (13) ◽  
pp. 2884
Author(s):  
Clemens Rosenbaum ◽  
Malte Vetterlein ◽  
Margit Fisch ◽  
Philipp Reiss ◽  
Thomas Worst ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Median Time ◽  
Transurethral Resection ◽  
Endoscopic Treatment ◽  
Bladder Neck ◽  
Treatment Success ◽  
Prostatic Hyperplasia ◽  
Small Sample ◽  
Repeated Treatment ◽  
Bladder Neck Contracture

Objectives: Bladder neck contracture (BNC) is a bothersome complication following endoscopic treatment for benign prostatic hyperplasia (BPH). The objective of our study was to give a more realistic insight into contemporary endoscopic BNC treatment and to evaluate and identify risk factors associated with inferior outcome. Material and Methods: We identified patients who underwent transurethral treatment for BNC secondary to previous endoscopic therapy for BPH between March 2009 and October 2016. Patients with vesico-urethral anastomotic stenosis after radical prostatectomy were excluded. Digital charts were reviewed for re-admissions and re-visits at our institutions and patients were contacted personally for follow-up. Our non-validated questionnaire assessed previous urologic therapies (including radiotherapy, endoscopic, and open surgery), time to eventual further therapy in case of BNC recurrence, and the modality of recurrence management. Results: Of 60 patients, 49 (82%) and 11 (18%) underwent transurethral bladder neck resection and incision, respectively. Initial BPH therapy was transurethral resection of the prostate (TURP) in 54 (90%) and holmium laser enucleation of the prostate (HoLEP) in six (10%) patients. Median time from prior therapy was 8.5 (IQR 5.3–14) months and differed significantly in those with (6.5 months; IQR 4–10) and those without BNC recurrence (10 months; IQR 6–20; p = 0.046). Thirty-three patients (55%) underwent initial endoscopic treatment, and 27 (45%) repeated endoscopic treatment for BNC. In initially-treated patients, time since BPH surgery differed significantly between those with a recurrence (median 7.5 months; IQR 6–9) compared to those treated successfully (median 12 months; IQR 9–25; p = 0.01). In patients with repeated treatment, median time from prior BNC therapy did not differ between those with (4.5 months; IQR 2–12) and those without a recurrence (6 months; IQR 6–10; p = 0.6). Overall, BNC treatment was successful in 32 patients (53%). The observed success rate of BNC treatment was significantly higher after HoLEP compared to TURP (100% vs. 48%; p = 0.026). Type of BNC treatment, number of BNC treatment, and age at surgery did not influence the outcome. Conclusions: A longer time interval between previous BPH therapy and subsequent BNC incidence seems to favorably affect treatment success of endoscopic BNC treatment, and transurethral resection and incision appear equally effective. Granted the relatively small sample size, BNC treatment success seems to be higher after HoLEP compared to TURP, which warrants validation in larger cohorts.

scholarly journals Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate

2016 ◽  
Vol 42 (2) ◽  
pp. 302-311 ◽  
Author(s):  
Huang Tao ◽  
Yu Yong Jiang ◽  
Qi Jun ◽  
Xu Ding ◽  
Duan Liu Jian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urethral Stricture ◽  
Transurethral Resection ◽  
Bladder Neck ◽  
Transurethral Resection Of Prostate ◽  
Bladder Neck Contracture

Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of benign prostatic hyperplasia

2017 ◽  
Vol 5 (1) ◽  
pp. 5-9 ◽  
Author(s):  
A.S. Grechenkov ◽  
◽  
P.V. Glybochko ◽  
Yu.G. Alyaev ◽  
D.V. Butnaru ◽  
...  
Keyword(s):  
Risk Factors ◽  
Benign Prostatic Hyperplasia ◽  
Urethral Stricture ◽  
Transurethral Resection ◽  
Bladder Neck ◽  
Prostatic Hyperplasia ◽  
Bladder Neck Contracture

scholarly journals Bladder Neck Contracture after Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia Treated with a Thermo-Expandable Metal Stent (Memokath® 045)

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Jan Wen ◽  
Bettina Nørby ◽  
Palle Jörn Sloth Osther
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Transurethral Resection ◽  
Bladder Neck ◽  
Simple Procedure ◽  
Prostatic Hyperplasia ◽  
Double Cone ◽  
Metal Stent ◽  
Bladder Neck Contracture ◽  
Recurrence Rates ◽  
Correct Position

Bladder neck contracture following transurethral resection of the prostate is a rare but feared complication. Treatment is often challenging with significant recurrence rates. In this report, we present a complicated case treated with a simple procedure. A 75-year-old male developed urinary retention due to bladder neck contracture after transurethral resection of the prostate. He was initially treated with several transurethral incisions, but the obstruction recurred few months after each incision. At urethroscopy, the bladder neck was completely obstructed. Using both retrograde and antegrade endoscopy, it was possible to place a through-and-through guidewire, after which the length of the stricture could be measured. Subsequently, the stricture was slightly dilated, and a double-cone thermo-expandable metal stent (Memokath 045) could be placed. The correct position was monitored with antegrade and retrograde endoscopy, securing the proximal cone expanded above the stricture and the distal cone above the sphincter. The patient was discharged the same day with spontaneous voiding and minimal residual urine. Twenty-one months after stent placement, the patient still had no complaints of his urination. Thus, the double-cone thermo-expandable metal stent, Memokath 045, may be a durable option for treatment of complicated bladder neck contracture after TURP for benign prostatic hyperplasia.

scholarly journals Transurethral Resection of Bladder Neck in the Management of Primary Bladder Neck Obstruction in Female: Our Preliminary Experience in Bangladesh

2020 ◽  
Vol 17 (1) ◽  
pp. 23-28
Author(s):  
AHM Manjurul Islam ◽  
Md Shahidul Islam ◽  
Md Anwar Hossain ◽  
Abm Mobasher Alam ◽  
Shahi Farzana Tasmin
Keyword(s):  
Renal Impairment ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Transurethral Resection ◽  
Bladder Neck ◽  
Bladder Neck Obstruction ◽  
Primary Bladder ◽  
Primary Bladder Neck Obstruction

Objectives: To determine the effectiveness of transurethral resection of bladder neck in the management of primary bladder neck obstruction (PBNO) in female Patients and Methods: This prospective study has been done with thirty female patients aged from 27 to 48 years who were presented with difficult micturition or urinary retention. These patients had unremarkable physical findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. Patients associated with cystocele, meatal stenosis, stricture urethra, urethral caruncle and urethral diverticula that may lead to mechanical bladder outflow obstruction were excluded from the study. Preoperative investigations include uroflowmetry, ultrasonography, serum creatinine, urethrocystoscopy with simultaneous “water flow test” was done. Seven patients presented with obstructed voiding symptom without renal impairment (serum creatinine, mean±SEM 1.24±0.04) and were initially treated with á-blocker (category A). Among the other 23 patients those had renal impairment 18 presented with near retention and these patients were on indwelling catheterization before operation (category B, serum creatinine, mean±SEM 2.72±0.13).Rest of the 5 patients presented with nausea, vomiting, and disorientation in addition to near retention and were put on haemodialysis along with indwelling catheterization to reach near normal creatinine level before operation(category C, serum creatinine, mean±SEM,9.34±0.96 ). PBNO causing voiding difficulty were diagnosed in all the cases and were undergone transurethral bladder neck resection (BNR). Three months after operations, their pre- and post-operative symptoms were analyzed, and serum creatinine levels, ultrasonographic findings (MCC, PVR), uroflowmetric study were compared. Results: Twenty-nine (96.33%) Patients become symptom free. Their average pre- and post-operative values of MCC (Maximum Cystometric Capacity), PVR (Post Voidal Residual urine), Qmax (Peak urinary flow during uroflowmetric study, Serum creatinine level were changed from 679.50 to 482.17ml, from 574.50 to 29.37ml, from 8.43 to 29.37ml/sec, from 3.48 to 1.13 mg/dl respectively. One patient (3.33%) did not continent ever postoperatively. One patient had become dry after using pad for stress incontinent for one month only. Serum creatinine level of category C patient did not reach to the normal level (post operative creatinine level Mean±SEM,2.8±0.15)within this three moths follow up period. Conclusions: Our short term follow-up suggests that judicious Transurethral BNR is effective in relieving voiding difficulty due to primary bladder neck obstruction in female. A thorough gynaecological, neurological and urological examination is essential along with uroflowmetric, ultrasonographic and cystoscopic study to reach a correct diagnosis and making a treatment plan. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.23-28

scholarly journals Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis

2015 ◽  
Vol 60 (3) ◽  
pp. 1854-1858 ◽  
Author(s):  
Ibai Los-Arcos ◽  
Carles Pigrau ◽  
Dolors Rodríguez-Pardo ◽  
Nuria Fernández-Hidalgo ◽  
Antonia Andreu ◽  
...  
Keyword(s):  
Side Effects ◽  
Oral Therapy ◽  
Alternative Therapy ◽  
Multidrug Resistant ◽  
Chronic Bacterial Prostatitis ◽  
Content Type ◽  
Bacterial Prostatitis ◽  
Patient Side

This is a retrospective study of 15 difficult-to-treat (i.e., exhibiting previous failure, patient side effects, or resistance to ciprofloxacin and co-trimoxazole) chronic bacterial prostatitis infections (5 patients with multidrug-resistantEnterobacteriaceae[MDRE]) receiving fosfomycin-tromethamine at a dose of 3 g per 48 to 72 h for 6 weeks. After a median follow-up of 20 months, 7 patients (47%) had a clinical response, and 8 patients (53%) had persistent microbiological eradication; 4/5 patients with MDRE isolates achieved eradication. There were no side effects. Fosfomycin-tromethamine is a possible alternative therapy for chronic bacterial prostatitis.

scholarly journals A two staged treatment procedure for the difficult to treat bladder neck contractures with concomitant incontinence. In the search of a solution to a complex problem

2015 ◽  
Vol 87 (3) ◽  
pp. 233
Author(s):  
Ioannis Adamakis ◽  
Evangelos Fragkiadis ◽  
Ioannis Katafigiotis ◽  
Giorgos Kousournas ◽  
Konstantinos Stravodimos ◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Bladder Neck ◽  
Scar Tissue ◽  
Complex Problem ◽  
Control Group ◽  
Artificial Sphincter ◽  
Number Of Patients ◽  
Fibrotic Scar ◽  
Staged Treatment

Objective: To examine the efficacy of a two staged treating strategy with the use of a non-permanent urethral ALLIUM<sup>®</sup> stent for the management of recurrent bladder neck stenosis and subsequently the use of an artificial sphincter AUS800<sup>®</sup> by AMS for the management of the incontinence. Materials and Methods: We progressively identified patients eligible for the study creating a population of cases with recurrent bladder neck stenosis and concomitant incontinence occurring after the last intervention for the stenosis. Efficacy for the treatment of the stenosis was defined as no recurrence both prior and post to the sphincter placement and efficacy for the treatment of the incontinence was defined as continence (0-1pads) after the sphincter placement. Results and Limitations: 14 white males with a mean age of 66.21, ranging from 59 to 73 years consisted the population of the study. All patients had severe stress incontinence following the last transurethral resection. The efficacy of the treatment of the bladder neck stenosis was 93% (13/14) while the efficacy for the treatment of the incontinence was 100%. A single patient had a recurrent bladder neck stenosis after the artificial sphincter placement and was treated with transurethral resection using a long pediatric 13 F resectoscope at 12 months. Our limitations is the absence of a control group and the small number of patients enrolled, with a relatively short time of follow up. Conclusions: In our series we propose the use of a non-permanent urethral ALLIUM<sup>®</sup> stent for 6 months in order to control the growth of fibrotic scar tissue, a further 6 months follow up for recurrence, and then placement of an artificial sphincter. The results are very promising both on stabilizing the vesicourethral stenosis, and on patient safety and tolerability.

Long-Term Follow-up of Rituximab Treatment of Non-Familial Idiopathic Thrombotic Thrombocytopenic Purpura (TTP).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3513-3513
Author(s):  
Jens Chemnitz ◽  
Jens Uener ◽  
Michael Hallek ◽  
Christof Scheid
Keyword(s):  
Side Effects ◽  
Maintenance Therapy ◽  
Plasma Exchange ◽  
Standard Therapy ◽  
Recurrent Disease ◽  
Adamts13 Activity ◽  
Long Term Follow Up ◽  
Disease Free

Abstract Abstract 3513 Poster Board III-450 Introduction Rituximab is an accepted treatment modality for patients with TTP refractory to plasma exchange or recurrent disease. While initial treatment response rates are at a high level, long-term follow-up of patients treated with Rituximab is not accessible to date. However this data implies important information, since overall and progression free survival, side effects and a possible need for a maintenance therapy must be taken in consideration. Methods 12 patients with TTP refractory to plasma exchange or with recurrent disease treated with Rituximab at the haematology department of the University of Cologne between 2000 and 2008 were re-examined. All patients suffered from non-familial idiopathic TTP, cases with secondary TTP following stem cell transplantation or underlying diseases such as cancer or rheumatologic disorders were excluded. Additional to physical examination, ADAMTS13 activity and the presence of an ADAMTS13 inhibitor were analyzed. Results The median age of the patients was 43.2 years and 75% of the patients were female. The majority of patients received Rituximab either because of refractory disease or severe allergic reactions during standard therapy with plasma exchange. 4 patients suffered from relapsing disease after standard therapy with plasma exchange during the first episode. Dose schedule of Rituximab treatment consisted of 4 times 375 mg/m2 per week in parallel to continuing plasma exchange when possible. No acute severe side effects were seen after application of Rituximab. The median follow-up was 48.8 months, ranging from 10 to 98 months. All patients had an initial complete response after Rituximab treatment. At the time of re-examination, all 12 patients presented in good clinical condition, thus overall survival accounted 100%. 10 patients remained long-term disease free after initial therapy with Rituximab, two patients had recurrent disease but responded to subsequent Rituximab treatment. One patient is treated with ongoing maintenance therapy with Rituximab consisting of 375 mg/m2 every 4 weeks and remains disease free under these conditions. In our patient cohort, no long-term side effects of Rituximab treatment were noted. ADAMTS13 enzyme activity at time of re-evaluation was impaired in 50% of the patients, however no patient had an enzyme activity of less then 5%. Inhibitors against ADAMTS13 at time of re-evaluation were detected in three patients. Conclusions Rituximab is a safe and effective treatment for patients with non-familial idiopathic TTP after failure of standard therapy with plasma exchange. More than 80% of patients remain disease free during long-term follow-up, and relapses can be treated with subsequent Rituximab. Maintenance therapy is an option for frequent relapsing patients. ADAMTS13 activity might be reasonable to analyze on a regular basis to identify patients who benefit from pre-emptive Rituximab treatment. Disclosures: No relevant conflicts of interest to declare.

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