OBJECTIVETo analyze the impact of transurethral resection of the prostate (TURP) on erectile function and the factors influencing postoperative erectile function.

METHODSAltogether 64 male patients aged 53 -75 (mean 66.5) years underwent TURP for prostatic hyperplasia. Before and 3 months after surgery, we observed the nocturnal penile tumescence of the patients and analyzed their scores on the 5-item version of the International Index of Erectile Function (IIEF-5) and the Self-Rating Anxiety Scale (SAS).

RESULTSIntraoperative prostatic capsule perforation and postoperative stress were significantly related to postoperative erectile dysfunction (P < 0.05). The mean score of IIEF-5 was significantly decreased (P < 0.01) while that of SAS remarkably increased (P < 0.01) after TURP as compared with those before surgery. The frequency of nocturnal penile tumescence was reduced at 3 months after surgery, but with no statistically significant difference.

CONCLUSIONIntraoperative prostatic capsule perforation and postoperative stress obviously affect postoperative erectile function.

Aged ; Erectile Dysfunction ; etiology ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; adverse effects

Benign prostatic hyperplasia (BPH) is a common problem among elderly males. Surgical resection of the hyperplastic tissue to relieve urinary tract obstruction remains a major option for the treatment of BPH. Operations, whether open prostatectomy, transurethral resection of the prostate, or transurethral laser resection of the prostate, will inevitably affect the sexual function of the patient. With the increased attention to patients' quality of life, more and more importance is being attached to the changes in post-BPH sexual function. This review covers the sexual function changes induced by different surgical methods and assesses the possible risk factors of BPH surgery.
Erectile Dysfunction ; etiology ; Humans ; Male ; Prostatectomy ; adverse effects ; Prostatic Hyperplasia ; surgery ; Risk Assessment ; Risk Factors ; Transurethral Resection of Prostate ; adverse effects

PURPOSE: To report the 5-year follow-up results of a randomized controlled trial comparing bipolar transurethral resection of the prostate (TURP) with standard monopolar TURP for the treatment of benign prostatic obstruction (BPO). MATERIALS AND METHODS: A total of 220 patients were randomized to bipolar plasmakinetic TURP (PK-TURP) or monopolar TURP (M-TURP). Catheterization time was the primary endpoint of this study. Secondary outcomes included operation time, hospital stay, as well as decline in postoperative serum sodium and hemoglobin levels. All patients were assessed preoperatively and followed-up at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Parameters assessed included quality of life, transrectal ultrasound, serum prostate-specific antigen level, postvoid residual urine volume, maximum urinary flow rates (Qmax), and International Prostate Symptom Score. Patient baseline characteristics, perioperative data including complications, and postoperative outcomes were compared. Complication occurrence was graded according to the modified Clavien classification system. RESULTS: PK-TURP was significantly superior to M-TURP in terms of operation time, intraoperative irrigation volume, resected tissue weight, decreases in hemoglobin and sodium, postoperative irrigation volume and time, catheterization time, and hospital stay. At 5 years postoperatively, efficacy was comparable between arms. No differences were detected in safety outcomes except that the clot retention rate was significantly greater after M-TURP. CONCLUSION: Our results indicate that PK-TURP is equally as effective in the treatment of BPO, but has a more favorable safety profile in comparison to M-TURP. The clinical efficacy of PK-TURP is long-lasting and comparable with M-TURP.
Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostate/*surgery ; Transurethral Resection of Prostate/adverse effects/*methods ; Treatment Outcome

For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.
Humans ; Male ; Middle Aged ; Prostate/surgery* ; Prostatic Hyperplasia/surgery* ; Transurethral Resection of Prostate/adverse effects* ; Urethra/surgery* ; Urethral Stricture/etiology*

OBJECTIVETo compare the impacts of transurethral resection of the prostate (TURP), transurethral electrovaporization of the prostate (TUEVP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) on male sexual function.

METHODSWe identified randomized controlled trials on the influence of TURP, TUEVP and HoLEP on the sexual function of BPH patients, and performed meta-analysis on the included data using Revman 5.0.25.

RESULTSNine randomized controlled trials involving 1 050 BPH patients were included in the meta-analysis. The baseline of the study was comparable. TURP affected erectile function less than TUEVP (P = 0.04), but the two had no significant difference in their influence on ejaculatory function. Nor was any significant difference found between HoLEP and TURP in their influence on either erectile or ejaculatory function at 12 and 24 months after surgery.

CONCLUSIONTUEVP induces a higher incidence of erectile dysfunction than TURP, but its influence on ejaculatory function is not significantly different from the latter. HoLEP and TURP have no significant difference in their influence on erectile function and ejaculatory function.

Erectile Dysfunction ; etiology ; Humans ; Male ; Prostatic Hyperplasia ; surgery ; Randomized Controlled Trials as Topic ; Transurethral Resection of Prostate ; adverse effects ; methods

OBJECTIVETo study the mechanism and feasibility of transurethral electrochemical therapy for the treatment of benign prostatic hyperplasia (BPH).

METHODSBetween March 1998 and March 2000, specifically designed devices and catheters for electrochemical therapy were applied to 6 prostate specimens obtained by suprapubic prostatectomy in order to treat BPH patients with urinary retention for whom surgery was contraindicated. Sixteen patients (with a mean age of 77.3 years old) underwent electrical treatment totaling 160-220 coulombs under topical urethral anesthesia for 68-132 min. The catheters remained inside the patient for 7-10 d.

RESULTSIrreversible destructive changes occurred within cathodal tissue, while carbonization occurred within anodic tissue. The radius of tissue change was 7-8 mm and 1-2 mm, respectively. In vivo trial: 11 (69%) patients could be weaned off the catheters with satisfactory urination. Three months after therapy, the mean international prostate symptom score (IPSS) was 14.5, mean peak flow rate was 10.5 ml/s, and mean residual urine was 39 ml. No serious complications were observed.

CONCLUSIONTransurethral electrochemical treatment is potentially a minimally invasive alternative for treatment of BPH, especially for elderly patients at high risk.

Aged ; Aged, 80 and over ; Electric Stimulation Therapy ; adverse effects ; Electrochemistry ; Humans ; Male ; Prostatic Hyperplasia ; therapy ; Transurethral Resection of Prostate

Trauma and surgery sometimes cause erectile dysfunction because of injury to pelvic nerves and cavernous nerves of the penis. The ideal treatment is to make the injured nerves regenerate themselves and erectile function recover completely. This paper reviews the recent advances in the studies of erigentes regeneration and plerosis following injury in order to find the best method to enhance erigentes regeneration.
Erectile Dysfunction ; therapy ; Humans ; Male ; Penile Erection ; physiology ; Penis ; innervation ; Peripheral Nerve Injuries ; Regeneration ; Transurethral Resection of Prostate ; adverse effects

OBJECTIVE: To evaluate the cause and treatment of dysuria post trans-urethral resection of prostate (TURP). METHODS: The clinical data and the treatment of 22 cases of dysuria post TURP were analyzed retrospectively. RESULTS: All cases including 3 cases of glandular and extraneous material residual, 5 cases of urethrostenosis, 7 cases of bladder neck contracture, and 7 cases of detrusor muscle weakness, were cured after the treatment. CONCLUSION The main causes of dysuria post TURP were glandular residual, urethrostenosis, bladder neck contracture, and detrusor muscle weakness. Correct preoperative diagnosis and treatment during/post operation are the key to the prevention of dysuria post TURP.
Aged ; Dysuria ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Retrospective Studies ; Transurethral Resection of Prostate ; adverse effects

Enhanced recovery after surgery (ERAS) measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia (BPH). This study was performed on patients with BPH who required surgical intervention. From July 2019 to June 2020, the ERAS program was applied to 248 patients, and the conventional program was applied to 238 patients. After 1 year of follow-up, the differences between the ERAS group and the conventional group were evaluated. The ERAS group had a shorter time of urinary catheterization compared with the conventional group (mean ± standard deviation [s.d.]: 1.0 ± 0.4 days vs 2.7 ± 0.8 days, P < 0.01), and the pain (mean ± s.d.) was significantly reduced through postoperative hospitalization days (PODs) 0-2 (POD 0: 1.7 ± 0.8 vs 2.4 ± 1.0, P < 0.01; POD 1: 1.6 ± 0.9 vs 3.5 ± 1.3, P < 0.01; POD 2: 1.2 ± 0.7 vs 3.0 ± 1.3, P < 0.01). No statistically significant difference was found in the rate of postoperative complications, such as postoperative bleeding (P = 0.79), urinary retention (P = 0.40), fever (P = 0.55), and readmission (P = 0.71). The hospitalization cost of the ERAS group was similar to that of the conventional group (mean ± s.d.: 16 927.8 ± 5808.1 Chinese Yuan [CNY] vs 17 044.1 ± 5830.7 CNY, P =0.85). The International Prostate Symptom Scores (IPSS) and quality of life (QoL) scores in the two groups were also similar when compared at 1 month, 3 months, 6 months, and 12 months after discharge. The ERAS program we conducted was safe, repeatable, and efficient. In conclusion, patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.
Male ; Humans ; Prostatic Hyperplasia/complications* ; Quality of Life ; Transurethral Resection of Prostate/adverse effects* ; Treatment Outcome ; Enhanced Recovery After Surgery

OBJECTIVETransurethral electrovaporization of the prostate (TVP) for benign prostatic hyperplasia (BPH) has proven to be efficacious with lower morbidity than transurethral resection of the prostate (TURP) on clinical studies. However, no histopathologic data are available to support the clinical findings in human studies. The following study was done using a canine model in an effort to evaluate these histopathologic changes.

METHODSNine canines received antegrade electrovaporization or resection of the prostate, via an open cystoma, using Storz series resectoscope and video equipment. The dogs were sacrificed and their prostates harvested at 0 week (immediately after operation), 1 week or 5 weeks after electrovaporization or resection. The prostates were evaluated grossly as well as histologically for cavitary defects and depth of necrosis.

RESULTSProstate examination revealed superficial necrosis (less than 1.8 mm deep) at 0 week following the 270 watts operation, and less than 3 mm deep necrosis with acute inflammation and focal hemorrhage at 1 week. The depths of necrosis were less than 1.3 mm and 2.2 mm at 0 week and 1 week after the 180 W electrovaporizion. And the 120 W resection resulted in necrosis 1.1 mm and 1.6 mm deep at most, which was localized in the vaporized prostate only, with no histopathologic change in the surrounding tissues. Epithelial stratification was underway by the fifth week, but with inflammation.

CONCLUSIONTVP in the canine model showed only shallow necrosis at the site of the vaporization. These data provide a histopathologic rationale for the minimal morbidity and efficacious nature of this technique demonstrated in clinical studies.

Animals ; Disease Models, Animal ; Dogs ; Electrosurgery ; adverse effects ; Male ; Prostate ; injuries ; pathology ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; adverse effects ; Urinary Bladder ; surgery