F or many decades, transurethral resection of the prostate (TURP) has been considered the 'gold standard' surgical treatment 1 for lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH) or cancer and its complications. Mebust et al., 2 in a review of 3885 patients, reported a risk of 2% of developing TUR syndrome, with 3.9% of patients requiring a postoperative blood transfusion, 6.5% failing to void (presumably as a result of initial detrusor failure), and secondary haemorrhage in 3.3%. This paper quoted an overall procedural mortality of 0.23%. Alternative methods of treatment have, therefore, been sought, and over the past 15 years there has been an increasing usage of pharmacological therapy (e.g. 5α-reductase inhibitors, α 1 -receptor antagonists)3,4 and attempts to devise minimally invasive surgical alternatives (e.g. transurethral microwave thermotherapy). 5,6 Not surprisingly, therefore, the number of TURPs performed is in decline; a 43% decrease was observed in the US between 1987 and 1994 6 and this decline has also been recorded in Europe. 7 This study was undertaken to see if TURPs were being performed less frequently over a specific time period in a busy district hospital in the UK. It would also be possible to see whether the indications for TURP had changed and indeed whether TURP was now being performed on a different population than it had been. These data would also enable an assessment of the different rates of complications over the time periods analysed. Results: There was a decline in the number of TURPs performed of 31.6% over the 10-year period, with more being carried out because of urinary retention. In 2000, the patient was older and the operative procedure took statistically longer than 10-years earlier, but the weight of prostate tissue resected, patient satisfaction and complication rates were similar. Conclusions: At present, TURP is in decline, with urinary retention being the commonest indication. The population at present is older but this does not carry additional co-morbidity. The weight of resection has not altered, although surgery currently takes longer to perform.
handbook of the British Association of Urological Surgeons (1998). A hypothetical situation in the opening statement proposed 'a patient with an indwelling catheter is to undergo TURP' . The type, timing and duration of prophylactic antibiotic usage were elicited by circling the appropriate response from a choice of several possibilities. RESULTSIn all, 250 questionnaires were returned; 98% of respondents recognized the importance of the prophylactic use of antibiotics in catheterized patients undergoing TURP, and routinely use them. Most urologists (53%) use more than one dose, with most of these preferring a second dose on catheter removal (60%). CONCLUSIONThe magnitude and diversity of response suggests uncertainty about the appropriate prophylaxis in such patients, and the need for further studies to clarify this situation.
We retrospectively reviewed clinicopathologic data of 772 consecutive patients who underwent RP between 2009 and 2017, excluding patients who received adjuvant therapy and those without a nadir PSA level less than 0.2 ng/ml. We examined all PSA values measured during the actual follow-up. Meanwhile, we estimated the PSA value when we observed the "optimal PSA follow-up schedule" at each timing of virtual follow-up. BCR was defined as an elevation of PSA to greater than 0.2 ng/ml. We considered that the ideal PSA range for detection of BCR should be set at 0.2 to 0.4 ng/mL in order to start salvage treatment without delay. Therefore, the primary objective of this study was to examine whether BCR could be detected before PSA exceeded 0.4 ng/mL when we complied with the "optimal PSA followup schedule". We also compared the frequency of virtual follow-up (PSA measurement) to that of actual.RESULTS: During the mean follow-up period of 5.8 years, 115 (14.9%) patients developed BCR and the frequency of virtual follow-up was significantly lower than the actual frequency (5.8 vs 13.5 times, p<0.001). However, BCR was overlooked (detecting BCR when PSA exceeded 0.4 ng/ml) in 17 (2.2%) patients, which was higher than the actual frequency of 12 (1.6%) patients. Therefore, we modified the follow-up schedule as shown in the lower of Table, which resulted in a significantly lower follow-up frequency (7.4 times, p<0.001) and less incidence of overlooking of BCR (7 patients, 0.9%).CONCLUSIONS: This external validation study revealed that the "modified optimal PSA follow-up schedule after RP" could reduce the frequency of PSA measurement with a limited risk of overlooking BCR. We believe this schedule could decrease medical expenses and the burden on both physicians and patients.
90.6% (n 29) received oral maltodextrins 2 hours before the procedure, no bowel preparation was performed in 81.3% (n 26), all patients received intravenous antibiotic and antithrombotic prophylaxis. in the postoperative period, comprehensive holistic care and control were provided in accordance with best practices; a satisfaction survey was used, guaranteeing quality care and continuous improvement in the processes. Conclusion: The multidisciplinary work of ERAS team and the nursing care that is provided to the person, holistically in the three phases; before, during and after the colorectal surgery has given results and improvements of patients. Especially satisfaction, an irrevocable element because in the Civil Hospital of Guadalajara Fray Antonio Alcalde "The health of our people is the supreme law" (La Salud del Pueblo es la Suprema Ley).
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