Comparative Evaluation of Post-TURP Complications in Patients with BPH Presenting with and Without Acute Urinary Retention

Background Benign prostatic hyperplasia (BPH) is a prevalent urological condition affecting men at an older age. Acute urinary retention (AUR) is a severe symptom of men who develop BPH. TURP is the gold standard as the management of BPH is concerned. Our study tried to compare the post-TURP complications between patients presented with and without AUR. Materials and Methods We enrolled 126 patients, out of which 74 were in the AUR group and 52 in the non-AUR group. The mean age of patients with AUR was 62.51 years, and that for patients without AUR was 61.06 years. Statistical significance was noted in our study in patients with AUR and without AUR regarding the prostate's grading by DRE, the volume of gland, PSA level, post-TURP UTI, recatheterization post TURP, length of hospital stays with p-values 0.000, 0.000, 0.006, 0.004, 0.007, and 0.000, respectively. Statistical significance was not noted in patients with AUR and without AUR with regard to the grading of hypertension, diabetes mellitus, ischemic heart disease, post-op TURP syndrome, post-TURP hematuria, patients needing a blood transfusion, post-TURP sepsis, LUTS, post-TURP stricture, resurgery for clot retention with p values of 0.918, 1.000, 1.000, 1.000, 0.523, 0.642, 1.000, 0.319, 1.000, and 1.000, respectively. Conclusion Our study shows that post-TURP complications such as hematuria, blood transfusion rate, post-op UTI, sepsis, recatheterization, lower urinary tract stricture, resurgery, TUR syndrome, and the length of hospital stay were higher in patients who presented with AUR than in those without AUR. Post-TURP UTI complications, recatheterization rate, and the length of hospital stay were statistically significant in the AUR group compared with the non-AUR group. Therefore, it is better to intervene earlier before the patients develop AUR to minimize the complications and maximize the outcomes.

Urological surgery

This chapter discusses the anaesthetic management of urological surgery. Surgical procedures covered include cystoscopic procedures; transurethral resection of the prostate (TURP) (including TURP syndrome); transurethral resection of bladder tumour (TURBT); prostatectomy (including radical prostatectomy); nephrectomy and partial nephrectomy; radical cystectomy; robot-assisted laparoscopic prostatectomy (RALP); percutaneous stone removal; extracorporeal shockwave lithotripsy, testicular surgery and renal transplantation. It includes pertinent anaesthetic features for a series of additional miscellaneous urological procedures.

A Prospective Study on the Degree of Hyponatremia in Transurethral Resection of Prostate

Background: Systemic uptake of hypotonic fluid during irrigation performed at the time of Transurethral Resection of the Prostate (TURP) may cause electrolyte changes including sodium, potassium and calcium. The present study was aimed to assess the degree of sodium changes during Transurethral Resection of Prostate (TURP). Methods: 50 males aged 54 to 86 years, presented for TURP, were enrolled in the study with ASA classification of I to IV grades. Glycine 1.5% was used with height of irrigation kept at 60 cm. One day preoperatively and one hour postoperative, levels of serum sodium were measured for all the patients. Results: Spinal anaesthesia was given in 31 patients, whereas 19 patients were managed under general anaesthesia, with mean duration time being 72.42 ± 24.77min. The mean size of the resected prostate was 54.82 ± 25.04g. 58% patients developed mild hyponatremia, 4% had asymptomatic moderate hyponatremia and no patient developed severe hyponatremia or TURP Syndrome. The systemic diseases like hypertension, DM, or IHD found to be insignificant. Conclusion: TURP was associated with a high incidence of asymptomatic mild hyponatremia. Duration of operation was one of the most important factors.

Bipolar TURP decreases post-operative morbidity – A prospective study in a tertiary care hospital from north India

Background: Transurethral resection of prostate is considered as gold standard surgical procedure for treatment of benign enlargement of prostate. It can be performed in two forms- monopolar transurethral resection and bipolar transurethral resection. Aims and Objective: This study was conducted to know which energy source among monopolar and bipolar energy leads to more post-operative morbidity after performing transurethral resection of prostate. Materials and Methods: In this study, total eighty (80) cases were included. They were suffering from lower urinary tract symptoms which were diagnosed to be due to benign enlargement of prostate after careful clinical and radiological examination. In forty cases, transurethral resection of prostate was performed by using monopolar energy source and in another forty cases, resection of prostate by transurethral route was done using bipolar energy source. Results: In our study, we found that development of TURP syndrome was more in monopolar TURP group in which pre-operative weight of prostate was more than 50 grams in comparison to bipolar TURP group in which there was no incidence of development of TURP syndrome in same class. Further, post-operative hospital stay and post-operative urethral catheter in situ was less in bipolar TURP group in terms of days as compared to monopolar TURP group. Conclusion: Our study concludes that Bipolar TURP is better in terms of development of less post-operative morbidity as compared to monopolar TURP. Bipolar TURP must be used extensively in teaching hospitals where students take more time than a seasoned surgeon to perform a surgical procedure and bipolar TURP will come handy in that situation.

Monopolar Transurethral Resection of the Prostate; Experience in a Tertiary Centre in Nigeria

Aim and Objectives: To determine the perioperative, short-term success and complications of TURP. Study Design: Retrospective study. Place and Duration of Study: The study was carried out at the Division of Urology, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria, from January 2017 to December 2020. Methodology: This was a retrospective study, where the records of men who had TURP and were followed up for a year were reviewed. The data included the patients’ age, size of the prostate gland (grams), duration of surgery(mins), blood transfusion, clot retention, length of catheterisation (silicon catheter) in days, hospital stay (days), postoperative infection, postoperative incontinence, re-operation, bladder neck stenosis, urethral stricture and TURP syndrome. Results: Forty-five patients who had TURP from January 2017 to December 2020 were studied. The patients mean age was 66.33±7.60. The mean prostate size was 60.76±20.26. The mean duration of surgery, catheter duration and hospital stay were 58.89±11.93, 3.56±1.44 and 4.38±2.10, respectively. The overall complication was 3.5%. Postoperative infection was the commonest complication (epididymo-orchitis 11.1% and urosepsis 2.2%). Other complications included clot retention 4.4%, TURP syndrome 2.2%, bladder neck stenosis 2.2% and urge incontinence 2.2%. There was no urethral stricture, re-operation or bladder rupture. No mortality was recorded. Conclusion: This study showed that most TURP complications were minor and within acceptable rates. Its attraction includes short hospital stay and short duration of catheterisation. Overall, TURP performed within our institution were generally safe and well-tolerated.

Clinical analysis of the MyoSure hysteroscopic tissue removal system of endometrial polyps in women with an intact hymen

Background To investigate the clinical efficacy of the MyoSure hysteroscopic tissue removal system in the treatment of endometrial and cervical polyps in women with an intact hymen. Methods Retrospective analysis was performed on the clinical data of 32 patients treated with the MyoSure hysteroscopic tissue removal system for endometrial and cervical polyps. Results All the patients successfully completed the procedure. No intraoperative complications, such as cervical trauma, uterine perforation or TURP syndrome, were reported. The surgical time ranged from 5 to 35 min, with an average time of 19.3 min, and the intraoperative blood loss ranged from 2 to 50 ml with an average blood loss of 10.8 ml. After surgery, all patients were shown to have intact hymens. No residual polyp tissues were observed under the microscope, and abnormal uterine bleeding was relieved. Conclusions The MyoSure hysteroscopic tissue removal system can be a safe and effective treatment for endometrial and cervical polyps in women with an intact hymen.

FRESH GRADUATE UROLOGIST IN EASTERN INDONESIA: FIRST YEAR SURGERY EXPERIENCE

Objective: In present days, endourology is the hallmark of urology, including in developing countries. This study reviews the surgical experiences of a urology practitioner in the first year of his practice in the underdeveloped province in Indonesia. Material & Methods: This research is a descriptive study that retrieval patients data from the medical record during June 2018 - May 2019. Results: Total of 401 operations were obtained. There were 328 male (81.8%) and 73 female (18.2%) with the average of patients age were 52+17.77 years old. The most common diagnoses were BPH 113 cases (28.2%). bladder stone 83 cases (20.7%), and ureteral stone 52 cases (13%). The most common surgical procedures performed were TURP 120 operations (29.9%), Ureterorenoscopy (URS) 64 operations (16%), and Vesicolithotripsy 58 operations (14.5%). The upper tract procedures were 84 operations (20.9%), mainly URS 64 operations (16%). Whereas the lower procedures were 317 operations (79.1%) mainly TURP 120 operations (29.9%). The complications were bleeding post-TURP 5 cases which require blood clot evacuation (1.2%), bleeding post open nephrolithotomy 1 case which requires blood transfusion (0.2%), and TURP syndrome 1 case (0.2%) with mortality 2 patient (0.4%). All kidney stones were handled by open surgery due to lack of PCNL and ESWL set devices. Conclusion: First year urologist who are interested in serving in such areas may benefit from prioritizing the availability of upper and lower set to performed basic standard care for surgical urology without leaving the hallmark of urology.

Metabolic and endocrine

This chapter deals with a plethora of metabolic and endocrine abnormalities from an anaesthetic perspective. Major biochemical cation derangements are covered including high and low sodium, potassium, calcium, and magnesium levels. Guidelines are also presented for the management of anaphylaxis/severe allergy, diabetic ketoacidosis, and hyperosmolar non-ketotic coma, malignant hyperthermia, porphyric crisis, thyrotoxic storm, phaeochromocytoma, Addisonian crisis, disseminated intravascular coagulopathy, hypoglycaemia, acute liver failure, sickle cell crisis, TURP syndrome, and hypothermia. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential metabolic and endocrine-related situation are given and elaborated upon. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.