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Effekt av transuretral mikrobølgebehandling (TUMT) sammenlignet med transuretral reseksjon av prostata (TUR-P) ved benign prostatahyperplasi. Forenklet metodevurdering
No full textHovedbudskap
Folkehelseinstituttet fikk i oppdrag å innhente forskning som sammenligner forskjellen i effekten mellom transuretral mikrobølgebehandling (TUMT) med transuretral reseksjon av prostata (TUR-P) for menn med benign prostatahyperplasi og behov for kirurgisk behandling.
Vi inkluderte én systematisk oversikt som oppsummerte funn fra seks randomiserte kontrollerte studier. Kort oppsummert:
• Det er muligens liten eller ingen klinisk viktig forskjell i IPSS-prostatasymptomskår mellom TUMT og TUR-P.
• TUR-P har muligens bedre effekt enn TUMT på dysuri, resturin, uringjennomstrømming og forbedring av prostataproblemer målt AUA- og Madsen-Iversen-skår.
• TUMT er muligens bedre enn TUR-P for utfallene retrograd ejakulasjon og blod i urin.
• TUMT er trolig bedre enn TUR-P for utfallene TUR-P syndrom, blodoverføring og strikturer i urinrør eller blærehals.
• Det er usikkert om det er forskjell mellom TUR-P og TUMT målt på utfallene ansamling av koagulert blod i urinblæren, behov for rebehandling, ereksjonsforstyrrelser eller urinveisinfeksjon.
Resultatene antyder at noen sammenligninger går i favør av TUR-P, mens andre går i favør av TUMT. Alle resultatene er imidlertid beheftet med usikkerhet, og vi har gjennomgående lav til moderat tillit til dokumentasjonen.Key messages
The Norwegian Institute of Public Health was commissioned to summarize key findings from systematic reviews about the difference in effectiveness of Microwave Thermotherapy (TUMT) compared to Transurethral Resection of the Prostate (TURP) for men with benign prostatic hyperplasia.
We identified one systematic review including six randomised controlled studies. Briefly, the results showed that:
• There may be little or no difference in prostata symtom score (IPSS) improvement between TUMT and TURP .
• TURP may be better in improving dysuria, urinary retention, urin flow and prostate problems (AUA and Madsen-Iversen score) than TUMT .
• TUMT may perform better than TURP on the outcomes retrograde ejaculation and blood in the urine.
• TUMT probably reduces the proportion of patients experiencing TURP syndrome, strictures or blood transfusion, as compared to TURP.
• It is uncertain whether there is a difference between TURP and TUMT measured in clot retention, re-treatment, erectile dysfunction or incidence of urinary tract infection.
Comparisons of TUMT and TURP are ambiguous. Some results seem to favour TURP whereas others favour TUMT. All results are associated with uncertainty, and we generally haw low to moderate confidence in the evidence.publishedVersio
A severe case of TUR-P syndrome
Get PDFGünümüzde benign prostat hipertrofisinde (BPH), lazer kullanımı gibi alternatif cerrahi tedaviler geliştirilmesine rağmen klasik transüretral prostat rezeksiyonu (TUR-P) yöntemi hala altın standart olarak görülmektedir. Ancak bu yöntemin uygulandığı olguların %1,1’inde TUR-P sendromu gelişebilmektedir. Spinal anestezi altında 66 yaşında, 82 kg ağırlığındaki olgumuzda intraoperatif dönemde hemodinami stabil seyrederken baş ağrısı ve bulantı şikayetinin ardından görme bozukluğu, solunum sıkıntısı, hipotansiyon ve konvülzyon gelişti. Her iki akciğerde dinlemeyle bilateral krepitan ralleri olan hastanın çekilen akciğer grafisinde bilateral interstisyel infiltrasyonlar tespit edildi. Yapılan tetkiklerde hiponatremi ve trombositopeni tespit edilen hastaya TUR-P sendromu tanısı konularak tedavisi düzenlendi. Sonuç olarak rejyonal anestezi hastanın mental durumunun değerlendirilmesini sağlayarak TUR-P sendromunun erken tanı ve tedavisine olanak sağlar. Ancak anestezi doktorunun bu sendromu tanımada deneyimli ve dikkatli olması gerektiğini düşünüyoruz.At the present time despite the development of new treatment modalities like laser usage; traditional transurethral prostate resection is the gold standard in benign prostatic hypertrophy. However, TUR-P syndrome may develop in 1.1% of these cases. In our patient who was 66years old and 82 kg weight, although the hemodynamics was normal intraoperatively under spinal anesthesia, respiratory difficulty, hypotension and convulsion were developed after headache and nausea. In auscultation there were crepitant rales and there were bilateral interstitial infiltrations on chest radiography. In laboratory tests hyponatremia and thrombocytopenia were detected, the patient was diagnosed as TUR-P and the treatment was commenced. In conclusion, regional anesthesia allows the evaluation of mental status of the patients and provides early diagnosis and treatment of TUR-P syndrome. However, we suggest that the anesthesia doctor should have experience and attention in recognizing this syndrome
Transurethral resection of the prostate (TUR-P) and associated risk of infective endocarditis
No full textPurpose: Bacteremia is a well-known complication to surgery and may result in infective endocarditis (IE). Transurethral resection of the prostate (TUR-P) may give rise to bacteremia, but the associated risk of IE is not well described. We aimed to examine risk of infective endocarditis following TUR-P. Methods: We examined risk of IE following TUR-P between 2010 and 2020 in comparison with an age-matched (match-ratio 1:1) cohort from the background population. Patients were considered exposed to TUR-P related IE 6 months after TUR-P. Comparisons were estimated using cumulative incidences and multivariable time-dependent Cox regression models. Results: A total of 25,781 males underwent TUR-P (11.4% diagnosed with prostate cancer). Median age was 70.7 years (25–75 percentiles, 64.9–76.3 years). In the TUR-P group, 901 (3.5%) patients had bacteremia and 44 (0.2%) patients developed IE within 6 months following index. The most common microorganism in IE-cases was Enterococcus faecalis (72.7%). The incidence of IE was higher < 6 months after TUR-P (34.64 (25.78–46.55)) IEs per 10,000 person years) than 6–12 months after TUR-P (8.37 (5.46–12.84) IEs per 10,000 person years). TUR-P was associated with a higher hazard ratio of IE within 6 months (age-adjusted HR 8.16, 95% CI 3.06–21.79), but not 6–12 months after TUR-P (adj. HR 2.15 (0.91–5.07)). Conclusions: TUR-P was associated with an eight-fold higher risk of IE compared with age-matched controls within 6 months after surgery. Although the absolute risk was low, TUR-P seems to be a significant risk factor for IE and this warrant consideration for development of better prophylactic interventions.</p
Results of transurethral resection of prostate plus incision (TUR-P+I) for benign prostatic hypertrophy
Get PDFTUR-P法に前立腺切開術を併用することにより尿流の良好な改善を見た.排尿時の前立腺部の可動性がより改善される為と考えられた.多数例での検討, 長期成績の検討が望まれるThe results of 14 patients treated by TUR-P+I and 15 patients by TUR-P between September 1991 and August 1993 were reviewed to evaluate the effects of TUR-P+I. Tur-P+I is a combined technique of channelling TUR-P and transurethral incision of the bladder neck and the prostate. After receiving modest TUR of the adenoma, the bladder neck and anatomical capsule of the prostate was incised by electroresectoscope at 6 o'clock position from the bladder neck toward to verumontanum. Before operation, the maximum floor rate, average flow rate, and residual urine volume were measured, which were respectively 9.9 +/- 5.6 ml/s (M+SEM), 4.4 +/- 2.3 ml/s, and 130 +/- 80 ml in TUR-p+I group, and 11.6 +/- 2.9 ml/s, 4.3 +/- 1.8 ml/s, and 60 +/- 60 ml (p < 0.01) in TUR-P group. The operation time and resected tissue weights were similar in both groups; 68 +/- 16 min and 11 +/- 5.2 g in TUR-P+I group, and 72 +/- 25 min and 11 +/- 6.5 g in TUR-P group. The post-operative maximum flow rate, average flow rate and residual urine volume were respectively improved to 19.0 +/- 5.7 ml/s, 9.3 +/- 3.7 ml/s, and 20 +/- 20 ml in TUR-P+I group, and 14.6 +/- 6.1 ml/s (p = 0.057), 6.6 +/- 2.6 ml/s (p < 0.05), and 30 +/- 30 ml (not significant) in the TUR-P group. Neither significant blood loss nor complications were experienced in either procedure. It is suggested that TUR-P+I could be a safe and effective alternative of TUR-P. Longer follow-up and the prospective study are required to establish the value of the current combined technique
Symptomatologie und Lebensqualität nach transurethraler Resektion der Prostata (TUR-P)
No full textProblemstellung: Erfassung von Daten zur Symptomatik (S) und Lebensqualität (LQ) bei Patienten mit Benigner Prostatahyperplasie (BPH) im prä- und postoperativen Verlauf. Vergleich mit alternativen Verfahren, insbes. Finasterid.
Material und Methodik: Patienten mit einer operationspflichtigen BPH. Erfassung mit Fragebogen der Finasterid-Studiengruppe präoperativ und bis 5 Jahre postoperativ. Erfassung von Harnflußrate, Restharnbildung, Morbidität und Mortalität.
Ergebnisse: Obstruktive S: 87% Verbesserung. Irritative S: 60% Verbesserung. Allgemeine LQ: 20% Verbesserung. Symptomspezifische LQ: 50% bis 72%. Max. Harnfluß: Verbesserung 300%. Restharn:
Verbesserung 90%. Komplikationen: 4% Harnröhrenstrikturen, 4% Streßharninkontinenz 0-I . 17% Nachresektionen.
Diskussion und Schlußfolgerung: Deutliche Überlegenheit der TUR-P gegenüber allen medikamentösen Verfahren. Nur einige Laser- und Vaporisationsverfahren gleichwertig. Bestätigung der TUR-P als 'Goldener Standard'
Development of nursing risk inventory and evaluation of efficiency in TUR-P (Transurethral Resection of the Prostate) syndrome
No full textBüşra Şahin, Doktora TeziGiriş: Prostatın Transüretral Rezeksiyonu (TUR-P), Benign Prostat Hiperplazi’sine bağlı mesane obstrüksiyonunun cerrahi tedavisinde uygulanan bir ameliyat yöntemidir. TUR-P sırasında, geniş venöz sinüs pleksusları sıklıkla açılır ve irrigasyon sıvısının emilimi TUR-P sendromu adı verilen hastalarda nörolojik ve dolaşım değişikliklerin hemşire tarafından incelenmesi önemlidir. Amaç: Bu çalışmanın amacı, TUR-P sendromunda hemşirelik risk değerlendirme envanterinin geliştirilmesi ve etkinliğinin değerlendirilmesidir. Gereç ve Yöntem: Bu çalışma, doktora tez kapsamında kesitsel ve metodolojik olarak Aralık 2019 – Eylül 2021 tarihleri arasında Aydın Adnan Menderes Üniversitesi Uygulama ve Araştırma Hastanesi Üroloji Ameliyathane Salonunda 154 hasta ile gerçekleştirildi. Araştırma verileri “Hasta Tanılama Formu” ve ‘’TUR-P Sendromu Hemşirelik Risk Değerlendirme Envanteri” ile toplandı. Envanter kapsamında ameliyathanede TUR-P ameliyatı başlamadan önce, 30. ve 60. dakikasında dolaşım belirtileri nabız, solunum, saturasyon, sistolik ve diyastolik kan basıncı, vücut sıcaklığı ve nörolojik belirtileri görme bozukluğu, yer, kişi ve zaman oryantasyon durumu, bulantı ve kusma durumu bilgileri alındı. Envanterde hastanın TUR-P sendromu açısından nörolojik ve dolaşım boyutu ile ilgili durumlarına göre riskli hastalar belirlendi. Hastaların ameliyat öncesi, sırası ve sonrası kan laboratuvar değerleri hasta dosyasından alındı. Bulgular: Çalışma kapsamında madde havuzunda yer alan ifadelerin/gösterge/belirtilerin ölçmeye çalıştığımız yapıyı ne derece ölçebildiğini belirlemek amacıyla uzman görüşüne başvuruldu. Fleiss Kappa katsayısı 0,81 olarak bulundu. Ölçme aracının yapı geçerliğine ilişkin delil sunmak amacıyla farklı gruplar tekniğinden yararlanıldı. Bu aşamada hastanın laboratuvar sonuçları esas alınarak 5 farklı uzmandan hastaları 0=Risk yok ve 1=Risk var şeklinde sınıflamaları istendi. Daha sonrasında TUR-P sendromu riski olan ve olmayanların ölçme aracında yer alan hastanın nörolojik ve dolaşım bulguları arasında karşılaştırmalar yapıldı. Envanterin ayırıcılığını test etmek amacıyla diskriminant analizi yapıldığında kanonik korelasyon özdeğeri= 0,475 ve Wilks’ Lambda = 0,774 bulundu. Kanonik korelasyon değerinin karesi alındığında (0,225), bağımlı değişkendeki varyansın %22,5’inin açıklandığı anlamına gelmektedir. Buna göre envanterin diskriminant fonksiyonu elde edildi. Diskriminant fonksiyonunun mutlak değerine göre hastanın TUR-P sendromu risk durumuna karar verilebilecektir. Sonuç ve Öneriler: TUR-P ameliyat sürecinde hastanın izlenmesi ve takibinde sorumlulukları olan hemşirelerin TUR-P ameliyatı olan hastaların TUR-P sendromu riskini değerlendirebileceği bir envanterin olması, ameliyat sırası ve sonrası hastanın hemşirelik bakım sürecini planlamak ve ortak dil oluşturmak açısından oldukça önemlidir. Geliştirilen TUR-P Sendromu Hemşirelik Risk Değerlendirme Envanteri TUR-P sendromu riskini değerlendirmek için geçerli ve güvenilir bir ölçme aracıdır
Functional results after GreenlightLaser Vaporization (GL-PVP) and Transurethral Resection of the Prostate (TUR-P). A single-center-analysis
No full textHintergrund: Die benigne Prostatahyperplasie (BPH) ist eine chronische Erkrankung des älteren Mannes, welche mit einer subvesikalen Obstruktion einhergehen und dadurch eine untere Harnwegssymptomatik (Lower Urinary Tract Symptoms, LUTS) auslösen kann. Neben der medikamentösen Therapie existieren für therapierefraktäre oder hochsymptomatische Patienten verschiedene operative Behandlungsmöglichkeiten. Den Goldstandard stellt nach wie vor die Transurethrale Resektion der Prostata, kurz TUR-P genannt, dar. Bei diesem Verfahren stehen Komplikationen wie eine Blutung oder eine Verdünnungshyponatriämie (TUR-Syndrom) im Vordergrund.
Ziel: Die Photoselektive Vaporisation der Prostata mithilfe des XPS GreenLight-Lasers (GL-PVP) ist eine junge und sich seither entwickelnde Alternative zur Behandlung des Benignen Prostata Syndroms. Ziel dieser Doktorarbeit war es die Effektivität und Sicherheit der GL-PVP zu evaluieren und mit TUR-P zu vergleichen.
Material und Methodik: 814 Patienten, welche an der Universitätsmedizin Charité zwischen Juni und 2010 und Februar 2015 einer GL-PVP oder TUR-P unterzogen wurden, erhielten im August 2015 eine Befragung (IPSS, OAB-q-SF, Patientenzufriedenheit, Komplikations- und Reoperationsraten). Zu sämtlichen GL-PVP-Patienten (n=375) sowie TUR-P-Patienten, welche den Fragebogen ausgefüllt zurückgesendet haben (n=114), wurden retrospektive klinische Daten erhoben. Der GL-PVP-Arm wurde zusätzlich nach Operationsjahr und Prostatavolumen in Kohorten aufgeteilt und diese einzeln evaluiert. Es wurden für sämtliche Parameter Median sowie 1. und 3. Quartile (Interquartilsabstand) oder relative Häufigkeit berechnet. Für Patienten mit vorliegenden Follow-Up-Daten wurde der Vergleich zwischen GL-PVP und TUR-P aufgestellt. Mithilfe von SPSS wurden die Daten auf Signifikanz untersucht, als signifikant wurde ein p<0,05 eingestuft.
Ergebnisse: GL-PVP- und TUR-P-Kohorten waren in ihren Basischarakteristika Alter, Prostatavolumen, PSA, präoperatives Restharnvolumen und Katheterisierungsrate vergleichbar. Es bestand ein signifikanter Unterschied bei dem präoperativen IPSS-Wert (22+4 GL- PVP gegenüber 19+3 TUR-P, p=0,02). Die Operationsdauer unterschied sich zwischen GL-PVP- und TUR-P-Arm (68 Minuten) nicht. Es trat während GL-PVP eine geringere Rate an intraoperativen Blutungen auf (5% GL-PVP gegenüber 14% TUR-P, p=0,01). Katheterisierungsdauer (1d nach GL-PVP gegenüber 2d nach TUR-P, p=<0,001) sowie Hospitalisationsdauer (2d nach GL-PVP 4d nach TUR-P, p=<0,001) waren im GL-PVP Arm signifikant niedriger. Das Follow-Up betrug im Mittel 27 Monate für GL-PVP-Patienten und 36 Monate für TUR-P-Patienten (p=0,02). Der postoperative IPSS (beide Kohorten 5+1, p=0,64), OAB-q-SF und die Patientenzufriedenheit sowie die postoperative Komplikationsrate unterschieden sich zwischen GL-PVP- und TUR-P- Kohorten nicht signifikant.
Schlussfolgerung: GL-PVP weist gegenüber TUR-P eine vergleichbare Operationszeit sowie Patientenzufriedenheit auf. Bei GL-PVP-Patienten sind intraoperatives Blutungsrisiko sowie Katheterisierungs- und Hospitalisationsdauer gegenüber TUR-P reduziert.Background: Benign prostatic hyperplasia (BPH) is a chronic disease of the elderly man, which can cause a urethral obstruction and thereby lead to lower urinary tract symptoms (LUTS). Patients who don’t show sufficient response to conservative treatment or patients with severe symptoms can be offered several operative treatment techniques. Transurethral resection of the prostate (TUR-P) remains the gold standard despite its common risks of bleeding incidents and fluid overload with consecutive hyponatremia (TUR-syndrome).
Purpose: Photoselective vaporization of the prostate using the XPS GreenLight laser (GL-PVP) is an evolving alternative. The purpose of the trial was to analyze surgical parameters, postoperative outcome and complication rates of GL-PVP and to compare the results to TUR-P.
Material and Methods: 814 patients who underwent GL-PVP or TUR-P between June 2010 and February 2015 received a questionnaire (IPSS, OAB-q-SF, patient satisfaction, complication and reintervention rates) in August 2015. Clinical data was retrospectively collected for all GL-PVP patients (n=375) and the TUR-P patients (n=114) who returned the questionnaire. The GL-PVP branch was additionally split into cohorts by operation year and prostate volume, which were analyzed separately. For each parameter median value as well as 1st and 3rd quartile (interquartile range) or relative probability were determined. For patients with follow-up data, the comparison between GL-PVP and TUR-P was drawn. The data were statistically analyzed by SPSS; p<0.05 was considered significant.
Results: The baseline characteristics age, prostate volume, PSA, pre-operative post void residual urine, rate of indwelling catheter were comparable between GL-PVP and TUR-P cohorts. The median IPSS was higher in patients undergoing GL-PVP (22+4 GL-PVP versus 19+3 TUR-P; p=0.02). The median procedure time was comparable between GL-PVP and TUR-P (68 min). The risk for intraoperative bleeding incidents was lower in the GL-PVP cohort (5% GL-PVP versus 14% TUR-P versus, p=0,01). Catheterization time (1d GL-PVP versus 2d TUR-P, p=<0,001) as well as hospitalization time (2d GL-PVP versus 4d TUR-P, p=<0,001) were significantly lower in the GL-PVP group. The median follow-up was 27 months for GL-PVP and 36 months for TUR-P (p=0,02). Postoperative IPSS showed no difference (5+1; p=0.64) and the OAB-q-SF scores were comparable. Both patients groups stated subjective satisfactory results. There was no significant difference in postoperative complications or re-intervention rate.
Conclusion: GL-PVP is comparable to TUR-P in terms of operation time and patient satisfaction. GL-PVP shows shorter hospitalization and catheterization time as well as a lower risk of intraoperative bleeding incidents
Transurethral electrovaporization of the prostate (TUV-P): comparative study with transurethral resection (TUR-P)
Get PDFTUV-Pを行った27例を対象とした.TUV-Pはその効果でTURと同等であり, カテーテル留置期間を短縮できる等の利点を認めた.但し, TUV-PはTURに比し術後尿路感染の期間の延長を認める傾向が示された.ローラーバーとローラーループを比較すると, 手術時間でローラーループ型電極が優れているA total of 27 patients with benign prostatic hyperplasia were treated by transurethral electrovaporization of the prostate (TUV-P). A roller bar electrode was used for 13 patients and a roller loop electrode for 14. Therapeutic efficacy and complications of TUV-P were compared with those of transurethral resection of the prostate (TUR-P) performed before TUV-P was started (24 patients). The improvements in subjective symptom scores and objective voiding parameters after 3 months were not significantly different between the TUV-P and TUR-P groups. Furthermore, the improvements were similar between TUV-P using the roller bar and the roller loop. No patients treated by TUV-P had TUR syndrome or received blood transfusion, while blood transfusion was performed in 4 patients treated by TUR-P. Postoperative duration of urethral catheterization and hospital stay was significantly shorter in the TUV-P group than in the TUR-P group. The operative time for TUV-P (roller bar) was 1.6 min per g. preoperative prostate volume, while that for TUV-P (roller loop) and TUR-P was 2.1 and 1.9 min/g, respectively. From our experience, TUV-P was as effective as TUR-P for relieving bladder outlet obstruction with fewer complications. Furthermore, the operative time could be shortened with a roller loop
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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