##plugins.themes.bootstrap3.article.main##

Transurethral resection of the prostate (TURP) is the gold standard of surgical therapy of benign prostatic hyperplasia (BPH) for prostates <100 ml. This study was carried out to describe our experience with and outcome of staged TURP for large prostates (>100 ml). A review of the records of all the patients who underwent staged TURP for large BPH at a specialist urology center. They had two-stage monopolar resection using a size 26F continuous flow resectoscope and 5% Dextrose water irrigation. Staged-TURP were performed by a single Consultant Urologist under spinal anesthesia. Patients’ age, Co-morbidities, Prostate-specific Antigen (PSA), Abdominal Ultrasound scan (USS) estimated prostate volume, Pre-operative Packed Cell Volume (Pre-op PCV), Post-operative Packed Cell Volume (Post-op PCV), Resection Weight for 1st stage (RW I), Resection Weight for 2nd stage (RW II), Resection Time for 1st stage (RT I), Resection Time for 2nd stage (RT II), blood transfusion were obtained and analyzed. Follow up was for a minimum of 9 months and the outcome and development of complications noted. Statistical analysis was done using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM, Chicago, USA). Means and percentages were calculated, and paired sample T test was used to compare variables between 1st stage and 2nd stage. P value < 0.05 was considered significant. Twenty-five patients with a mean age of 72.32±7.98 years were analyzed. Most (88%) were on indwelling Foley’s urethral catheter before surgery. The mean PSA and prostate volume were 25.61±22.08 ng/ml and 221.56±62.78 cm3. There were significant differences between Pre-op PCV and Post-op PCV (p<0.001); RWI and RWII (p<0.001); and RTI and RTII (p<0.001). Nineteen patients (76%) received perioperative transfusion. Most patients voided satisfactorily following catheter removal except one who developed acute urinary retention (AUR). No cases of TUR syndrome, post-operative sepsis, DVT or PE and urethral stricture were recorded. Staged TURP is safe and effective treatment modality for patients with large prostates in the absence of more recent endoscopic options.

References

  1. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, De La Rosette Jean J M C H, EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004; 46(5):547–554.
     Google Scholar
  2. Reich O, Gratzke C, Stief CG. Review-Bladder Outlet Obstruction Techniques and Long-Term Results of Surgical Procedures for BPH. Eur Urol. 2006;49(2006):970–978.
     Google Scholar
  3. Stolzenburg J-U, Ho KM., Schwalenberg T, Hohenfellner R. Transurethral Resection of the Prostate. In: Manual Endourology. 2005. p. 77–87.
     Google Scholar
  4. Lee A, Lee HJ, Foo KT. Can men with prostates sized 80 mL or larger be managed conservatively? Investig Clin Urol. 2017;58(5):359–364.
     Google Scholar
  5. Riedinger CB, Fantus RJ, Matulewicz RS, Werntz RP, Rodriguez JF, Smith ND. The impact of surgical duration on complications after transurethral resection of the prostate: an analysis of NSQIP data. Prostate Cancer Prostatic Dis. 2019 May;22(2):303-3088.
     Google Scholar
  6. Gupta NP, Nayyar R. Management of large prostatic adenoma: Lasers versus bipolar transurethral resection of prostate. In: Indian Journal of Urology. Wolters Kluwer -- Medknow Publications; 2013. p. 225–235.
     Google Scholar
  7. Mehmet Yucel, Bekir Ara, Soner Yalcinkaya, Namik Kemal Hatipoglu and Erol Aras. Conventional monopolar transurethral resection of the prostate in patients with large prostate (≥80 grams). Cent European J Urol. 2013; 66(3): 303-308
     Google Scholar
  8. Kuntz RM, Lehrich K, Ahyai SA. Holmium Laser Enucleation of the Prostate versus Open Prostatectomy for Prostates Greater than 100 Grams: 5-Year Follow-Up Results of a Randomised Clinical Trial. Eur Urol. 2008;53(1):160–168.
     Google Scholar
  9. Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R, et al. Holmium Laser Enucleation of the Prostate Versus Open Prostatectomy for Prostates >70 g: 24-Month Follow-up. Eur Urol. 2006;50(3):563–568.
     Google Scholar
  10. Zhang Y, Du C-J, Xu G, Chen J-M, Jing X. Transurethral holmium laser enucleation for prostate adenoma greater than 100 g. Zhonghua Nan Ke Xue. 2007;13(12):1091–1093.
     Google Scholar
  11. Palmisano F, Boeri L, Fontana M, Gallioli A, De Lorenzis E, Zanetti SP, et al. Incidence and predictors of readmission within 30 days of transurethral resection of the prostate: A single center European experience. Sci Rep. 2018; 8(1):1–7.
     Google Scholar
  12. Oranusi C, Nwofor A, Mbonu O. Correlation between international prostate symptom score and uroflowmetry in patients with benign prostatic hyperplasia. Niger J Clin Pract. 2017; 20:454-458.
     Google Scholar
  13. Salako AA, Badmus TA, Owojuyigbe AM, David RA, Ndegbu CU, Onyeze CI. Open Prostatectomy in the Management of Benign Prostate Hyperplasia in a Developing Economy. Open J Urol. 2016; 06(12):179–189.
     Google Scholar
  14. Gill H. Racial Disparities in the Treatment of Benign Prostatic Hyperplasia. Med Surg Urol. 2015;4(4):157.
     Google Scholar
  15. Alhasan SU, Aji SA, Mohammed AZ, Malami SS. Transurethral resection of the prostate in Northern Nigeria, problems and prospects. BMC Urol. 2008; 8(1):18.
     Google Scholar
  16. Marmiroli R, Antunes AA, Reis ST, Nakano E, Srougi M. Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: Analysis of 100 cases from a high-volume urologic center. Clinics. 2012 Dec;67(12):1415–1418.
     Google Scholar
  17. Persu C, Georgescu D, Arabagiu I, Cauni V, Moldoveanu C, Geavlete P. TURP for BPH. How large is too large? J Med Life. 2010;3(4):376–380.
     Google Scholar
  18. Fowler JE, Bigler SA, Kilambi NK, Land SA. Relationships between prostate-specific antigen and prostate volume in black and white men with benign prostate biopsies. Urology. 1999;53(6):1175–1178.
     Google Scholar
  19. Chukwujama, Oguike T, Azike J. Transurethral resection of the prostate a 3 year experience. Niger J Surg. 2011; 17(1):15-18.
     Google Scholar
  20. Kaplan SA, Reis RB, Staimen VB, Te AE. Is the ratio of transition zone to total prostate volume higher in African-American men than in their Caucasian or Hispanic counterparts? British Journal of Urology. 1998; 82:804-807
     Google Scholar
  21. Nnabugwu II, Ugwumba FO, Udeh EI, Ozoemena OF. Learning transurethral resection of the prostate: A comparison of the weight of resected specimen to the weight of enucleated specimen in open prostatectomy. Niger J Clin Pract. 2017; 20(12):1590–1595.
     Google Scholar
  22. Nakahira J, Sawai T, Fujiwara A, Minami T. Transurethral resection syndrome in elderly patients: a retrospective observational study. BMC Anaesthesiol. 2014;12:30.
     Google Scholar
  23. Akpayak I, Shuaibu S, Onowa V, Nabasu L, Galam Z. Monopolar transurethral resection of the prostate for benign prostatic hyperplasia: What are the outcomes and complications in our patients? Niger J Med. 2017;26(2):173.
     Google Scholar
  24. George C, Haque PD, Mammen KJ. Incidence, clinical manifestations and outcome of TUR (transurethral resection) syndrome in patients undergoing TURP under spinal anaesthesia: results from clinical observations in a cohort of 50 patients at a tertiary care centre in North India. Int Surg J. 2017; 5(1):243–247.
     Google Scholar
  25. McGowan-Smyth S, Vasdev N, Gowrie-Mohan S. Spinal Anesthesia Facilitates the Early Recognition of TUR Syndrome. Curr Urol. 2015;9(2):57–61.
     Google Scholar
  26. Mbaeri, Abiahu JA, Obiesie EA, Odo C, Oranusi KC, Nwofor AME, et al. Assessment of complications of transurethral resection of the prostate using Clavien-Dindo classification in South Eastern Nigeria. Niger J Surg. 2020; 26(2):142-146.
     Google Scholar
  27. Rahman MM, Gupta SD, Mridha NI, Wahid M, Begum F. Comparative Study Between Outcome of Early and Conventional Catheter Removal After Transurethral Resection of Prostate. Bangladesh J Urol. 2017;20(2):82–86.
     Google Scholar
  28. Khan A. Day care monopolar transurethral resection of prostate: Is it feasible? Urol Ann. 2014;6(4):334–339.
     Google Scholar
  29. Nielsen KK, Nordling J. Urethral stricture following transurethral prostate prostatectomy. Urology. 1990 Jan 1;35(1):18-24.
     Google Scholar
  30. Komura K, Inamoto T, Takai T, Uchimoto T, Saito K, Tanda N, Minami K, Oide R, Uehara H, Takahara K, Hirano H. Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial. BJU Int. 2015 Apr 1;115(4):644-652.
     Google Scholar