진행성 전립선 암환자에서 고식적 경요도전립선절제술의 효용성

김성주,김한석,정재민,최성 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.1

Background : The outcome of patients with advanced prostate cancer underwent palliative transurethral resection of the prostate (TURP) is not well defined in the literature. We determined the preoperative characteristics, operative morbidity and postoperative otucomes of patients with advanced prostate cancer underwent palliative TURP and compared these outcomes to those of patinets underwent TURP for benign prostatic hyperplasia (BPH). Methods : A retrospective review of all patients with advanced prostate cancer underwent palliative TURP between March 2004 and December 2006 was performed. Operative reports and medical records were reviewed. Serum prostate specific antigen grade and stage at diagnosis were compared with findings at TURP. Operative statistics, postoperative outcomes and complication rates were compared between the palliative prostate cancer group and a cohort of 54 patients underwent TURP for BPH group during the same period. The Fisher exact and 1-sample t test were used to determine statistical differences in outcomes between these 2 groups. Results : A total of 21 palliative TURPs were performed in 19 patients with advanced prostate cancer. At prostate cancer diagnosis, mean patient age was 68.0 years (48-77) and mean prostate specific antigen was 32.8ng/ml (1.9-299). Initial hormonal therapy was done in all patients. Mean age at TURP was 72.1 years (48-79) with an average time from prostate cancer diagnosis to at TURP was 8.3 months (1-25 months). Five (35.7%) patients out of 14 who were confirmed by histology were determined to be higher grade at palliative TURP than at initial diagnosis. The mean maximum uroflow rate increased from 7.3 to 9.6 ㎖ at per second (p<0.05) and the International Prostate Symptom Score improved from 22 to 10 (p<0.05) after TURP. Compared with patients underwent TURP for BPH, those treated with palliative TURP were more likely to have failure of the initial voiding trial (p<0.05), and require reoperation (p<0.05), chronic drainage (p<0.05) and re-catheterization for bleeding or obstruction (p<0.05). Conclusions : Palliative TURP can be performed safely in patients with advanced prostate cancer with significant improvement in urinary symptoms. However, the rates of postoperative urinary retention and reoperation of palliative TURP were higher than in patients undergoing TURP for BPH.

급성요폐를 보인 전이 전립선암에서경요도전립선 보존 절제술의 효과

김재식,박영요,심봉석 대한배뇨장애요실금학회 2006 International Neurourology Journal Vol.10 No.2

Purpose: Obstructive voiding difficulties were frequent in the patients with metastatic prostatic cancer, and sometimes acute urinary retention may be developed even though medical treatments. We performed channel transurethral resection of prostate (TURP) as palliative treatment for those patients and reported the results. Materials and Methods: Fifteen patients with metastatic prostatic cancer were taken TURP aiming for relief of infravesical obstruction. All patients were under the anti-androgen hormonal therapy and had sudden onset of acute urinary retention. TURP was done under general or epidural anesthesia. After TURP, 30∼50 cc ballooning urethral Foley catheter was placed for 4 days. We analyzed voiding parameters comparatively before and 3 months after TURP. Results: The mean age of patients was 75.6±5.7 years old. Mean prostatic volume was 47.8±1.4 cc. Mean resected prostatic tissue was 6.4±2.1 cc. All patients had stage D prostatic cancer. Mean serum PSA was 75.2± 73.8 ng/ml and mean gleason score was 7.8±0.9. After TURP, mean international prostatic symptom score (IPSS) was improved from 25.5±2.0 to 13.8±2.0, mean quality of life score (QOL) was improved from 4.4±0.5 to 2.0±0.5, and mean maximum uroflow rate was increased from 5.0±1.1 ml/sec to 6.0±1.6 ml/sec. All patients did not have any complications according to TURP. Conclusion: In patients with metastatic prostatic cancer, channel TURP could be considered as a treatment option to relieve severe obstructive voiding difficulty. (J. Korean Continence Society 2006;10:116-120)

경요도 전립선절재술 후 시기별 및 수술 적응도에 따른 합병증 발생율에 따른 임상적 고찰 : A Clinical Experience

김홍섭,이종찬,노용수 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

We evaluate morbidity of transurethral resection of prostate(TURP) for benign prostatic hyperplasia, especially late complication beyond 6 months of period after discharge. We experienced 164 TURPs performed by one urologist for 5 years and evaluated factors affecting complications, complication rates at each postoperative period(immediate, predischarge, postdischarge: early and late) and parameters according to operator's adaptation to TURP. The late complication were evaluated by mailed quetionnaires or telephone. The complication rates were 12.2%(20 of 164: prostatic bleeding 14, clot retention 5, etc.) at immediate, 25.0%(41 of 164: urge incontinence 19, urinary retention 7, retrograde ejaculation 6, symptoms) at early and 31.0%(18 of 58: urethral stricture 4, etc.) at late followup period. There were more complications(p<0.05) in following groups: resection time above 60 mins, resected spectimen weight above 40 g. amount of irrigation fluid beyond 20,000 ml. presence of acute urinary retention at admission. No differences(p<0.05) were found in complication rate and TURP parameters according to operator's adaptation except resection time(before 1994 vs. after 1994→43.3mins vs. 34.2mins). Our data shows that there were no significant differences in complication rate and TURP parameters according to operator's adaptation, but relatively high rates of late complications compared with other reports. We suggest that risk factors such as prolonged resection, excessive resection and overusage of irrigation fluid should be avoided during TURP to minimize intraoperative and postoperative complication.

경요도 전립선절제술 후 시기별 및 수술 적응도에 따른 합병증 발생율에 대한 임상적 고찰

김홍섭,이종찬,노용수 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.- No.8

경요도전립선절제술 후 이행대의 크기변화가 혈청 전립선특이항원에 미치는 영향

송기학,문장환,정우주,박관규,장경환,송재만 연세대학교 원주의과대학 2000 원주의대논문집 Vol.13 No.1

전립선비대증 환자의 경요도전립선절제술 후 치료 효과 예측에 있어서 압력-요속검사 및 임상지표의 가치

정필범,이정구 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.12

경요도적 전립선 절제술후 저나트륨증 및 급성신부전을 동반한 폐부종

김경숙,한영진 의과학연구소 1988 全北醫大論文集 Vol.12 No.4

Transurethral resection of the prostate(TURP) is a common surgical procedure of elderly procedure of elderly males, a population that generally carries greater anesthetic risk because they are likely to have existing cardiovascular and/or pulmonary problems. The surgical procedure itself induces absorption of nonelectrolyte irrigating fluid, which can produce circulatory overload, hyponatremia, serum hypoosmolality and the presence of irrigating solute in the serum. We have experienced on cases of serious complications including pulmonary edema due to circulatory overload, acute renal failure, and hyponatremia after TURP. The patient was moribund discharged with agreement of his family. We report this case along with a review of the literature.

하부 요로 폐쇄에 대한 요류 역학적 연구

홍종우,최성협 인제대학교 1990 仁濟醫學 Vol.11 No.2

요류 측정술을 이용하여 전립선 비대증 환자 40례에서 경요도 전립선 절제술후 치료 효과를 평가하여 보고한다. Uroflowmetry has been proposed as a non-invasive screening test and may be used to reveal lower urinary tract dysfunctions, such as benign prostatic hyperplasia, urethral stricture and neurogenic bladder. We tested 40 patient of benign prostatic hyperplasia (BPH) diagnosed with clinical manifestations, IVP and cystoscopy. Group 1 including 15 patients performed both preoperative and postoperative uroflowmetry. Group 2 including 25 patients shown acute urinary retention preoperatively, performed only postoperative uroflowmetry. The results were obtained as follows. 1.In group 1, average preoperative maximum flow rate (MFR) was 7.2 cc/sec and postoperative MFR was 20.1 cc/sec (P<0.01). On flow rate normogram, preoperative MFR of all patients was below -2 standard deviations (SD) and average MFR was -3.1 SD. In postoperative MFR, below -2 SD values showed in 3 patient, -1 SD ~-2 SD in 6, -1 SD ~ mean in 4, above mean values in 2 and average MFR was -1.3 SD. 2.In Group 2, postoperative average MFR was 22.3cc/sec, below -2 SD values showed in 6 patients. -2 SD∼ -1 SD in 5, -1 SD - mean in 8, above mean values in 6 and average MFR was -0.93 SD. 3.MFR values of group 1 increased an average of 2.8 SD in each patient and 80% of patients were improved in uroflowmetry after transurethral resection of prostate (TURP). 4.If MFR of acute urinary retention was below -2 SD in group 2, 76% of patients were improved in uroflowmetry after TURP.

Incidentally Detected Adenocarcinoma Prostate in Transurethral Resection of Prostate Specimens: a Hospital Based Study from India

Varghese, Jophy,Kuruvilla, Priya Mariam,Mehta, Nisarg,Rathore, Ranjeet Singh,Babu, Manas,Bansal, Devesh,Pillai, Biju,Sam, Mohan P,Krishnamorthy, H Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.4

Background: Awareness about prostate cancer has increased in the community, and prostate cancer screening examinations, including prostate specific antigen (PSA) assays, are now widely available. Prior to the PSA era, up to 27% of prostate cancers were detected incidentally at the time of transurethral resection of prostate (TURP). After PSA testing became widely available, the incidence of incidentally detected carcinoma prostate in TURP specimens without prior diagnosis reduced to 5-13%. However, the incidence of incidentally detected carcinoma prostate has been reported to vary across the globe since various factors can influence the identification of this malignancy in TURP specimens. In this paper, we focus on rates of incidentally detected prostate cancer in TURP specimens in our hospital and correlate it with various parameters. Materials and Methods: This retrospective study of histopathological findings of biopsy specimens was conducted for patients undergoing TURP during a period of 5 years from April 2010. The inclusion criteria were patients diagnosed with benign prostatic hyperplasia (BPH) (digital rectal examination (DRE) not showing any abnormally hard areas and normal age adjusted PSA values). Patients with elevated PSA, abnormal DRE, documented urinary tract infection and proved adenocarcinoma prostate (CaP) were excluded from the study. The total weight of prostatectomy specimen, occurrence of carcinoma prostate in the chips, percentage of total tissue resected showing malignancy and Gleason's scores were recorded. Results: A total of 597 patients belonging to the inclusion criteria were studied. The incidence of occult CaP in the study group was 5.2 % (31/597). Out of these, 8 belonged to T1a and 23 belonged to T1b stages. The age group 70 - 79 years had the maximum incidence of occult CaP. It was observed that the clinical grading of prostate did not have a bearing on the incidence of occult CaP whereas the weight of resected specimen correlated with the incidence of CaP. The incidence of occult CaP was greater with low volume prostates (<20 g). (P=0.15). Conclusions: The rate of incidentally detected adenocarcinoma prostate in patients undergoing TURP for clinically diagnosed BPH was found to be only 5.2 % in our study which is low when compared with similar studies done elsewhere. The age of the patient and weight of the resected specimen correlated with incidence of occult prostate cancer. The clinical grading of prostate by DRE however, demonstrated no correlation.

Efficacy and Safety of Laser Surgery and Transurethral Resection of the Prostate for Treating Benign Prostate Hyperplasia: a Network Meta-analysis

Wang, Li,Yu, Qiu-Yan,Liu, Yan,Zhu, Zhen-Li,Huang, Yuan-Wei,Li, Ke Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.9

Background: Traditional meta-analyses or systematic reviews of randomized controlled trials (RCTs) have been used to compare laser surgeries and transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BHP), but they cannot provide a hierarchy regarding efficacy and safety of treatment. Objective: We therefore performed a network meta-analysis (NMA) to compare and create hierarchies for efficacy and safety of TUPR and laser surgeries for BPH. Materials and Methods: We searched for reports of RCTs published up to April 25, 2015. After methodological quality assessment and data extraction, we performed an NMA to compare TURP and laser surgeries for BPH. Results: We ranked the treatments of TURP and laser surgeries for BPH. For IPSS at 6 months, holmium laser resection of the prostate (HoLRP) ranked the first-best and at 12 months, holmium laser enucleation of the prostate (HoLEP). For Qmax at 6 and 12 months, HoLEP ranked the first-best; for operative time it was TURP; for cathedral removal time, diode laser enucleation of the prostate (DiLEP) ranked the first-best. Conclusions: Although TURP is considered the gold standard for treating BPH, it is not better in terms of efficacy and safety compared with the laser surgery. Our NMA created hierarchies for the 9 types of surgery in terms of efficacy and safety, which should help clinicians choose the best approach for the individual patient.