Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection and Evaluation
2.2. Surgical Equipment and Techniques
2.3. BI Calculation
2.4. Postoperative Care
2.5. Follow-Up and Outcome Evaluation
2.6. Statistics
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Parsons, J.K. Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Curr. Bl. Dysfunct. Rep. 2010, 5, 212–218. [Google Scholar] [CrossRef]
- Berry, S.J.; Coffey, D.S.; Walsh, P.C.; Ewing, L.L. The development of human benign prostatic hyperplasia with age. J. Urol. 1984, 132, 474–479. [Google Scholar] [CrossRef]
- Irwin, D.E.; Milsom, I.; Hunskaar, S.; Reilly, K.; Kopp, Z.; Herschorn, S.; Coyne, K.; Kelleher, C.; Hampel, C.; Artibani, W.; et al. Population-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Countries: Results of the EPIC Study. Eur. Urol. 2006, 50, 1306–1315. [Google Scholar] [CrossRef]
- Parsons, J.K.; Bergstrom, J.; Silberstein, J.; Barrett-Connor, E. Prevalence and Characteristics of Lower Urinary Tract Symptoms in Men Aged ≥ 80 Years. Urology 2008, 72, 318–321. [Google Scholar] [CrossRef]
- Chughtai, B.; Forde, J.C.; Thomas, D.D.; Laor, L.; Hossack, T.; Woo, H.H.; Te, A.E.; Kaplan, S.A. Benign prostatic hyperplasia. Nat. Rev. Dis. Prim. 2016, 2, 16031. [Google Scholar] [CrossRef] [PubMed]
- Launer, B.M.; McVary, K.T.; Ricke, W.A.; Lloyd, G.L. The rising worldwide impact of benign prostatic hyperplasia. BJU Int. 2021, 127, 722–728. [Google Scholar] [CrossRef] [PubMed]
- Davidian, M.H. Guidelines for the treatment of benign prostatic hyperplasia. US Pharm. 2016, 41, 36–40. [Google Scholar]
- Gravas, S.; Bachmann, A.; Reich, O.; Roehrborn, C.G.; Gilling, P.J.; De La Rosette, J. Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int. 2011, 107, 1030–1043. [Google Scholar] [CrossRef] [PubMed]
- Hou, C.-P.; Lin, Y.-H.; Juang, H.-H.; Chang, P.-L.; Chen, C.-L.; Yang, P.-S.; Tsui, K.-H. Clinical outcome of transurethral enucleation of the prostate using the 120-W thulium Laser (Vela™ XL) compared to bipolar transurethral resection of the prostate (TURP) in aging male. Aging (Albany NY) 2020, 12, 1888–1898. [Google Scholar] [CrossRef]
- Chen, Y.T.; Hou, C.P.; Juang, H.H.; Lin, Y.H.; Yang, P.S.; Chang, P.L.; Tsui, K.H. Comparison of Outcome and Quality of Life between Thulium Laser (VelaTM XL) Enucleation of Prostate and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). Ther. Clin. Risk Manag. 2022, 18, 145–154. [Google Scholar] [CrossRef]
- Mebust, W.K.; Holtgrewe, H.L.; Cockett, A.T.; Peters, P.C. Writing Committee, the American Urological Association. Transurethral prostatectomy: Immediate and postoperative complications. Cooperative study of 13 participating institutions evaluation 3885 patients. J. Urol. 1989, 141, 243–247. [Google Scholar] [CrossRef]
- Rassweiler, J.; Teber, D.; Kuntz, R.; Hofmann, R. Complications of transurethral resection of the prostate (TURP)—incidence, management and prevention. Eur. Urol. 2006, 50, 969–979. [Google Scholar] [CrossRef]
- Kavanagh, L.E.; Jack, G.S.; Lawrentschuk, N.; Medscape. Prevention and management of TURP-related hemorrhage. Nat. Rev. Urol. 2011, 8, 504–514. [Google Scholar] [CrossRef] [PubMed]
- Freedman, M.; van der Molen, S.W.; Makings, E. Blood loss measurement during transurethral resection of the prostate gland. Br. J. Urol. 1985, 57, 311–316. [Google Scholar] [CrossRef] [PubMed]
- Singh, H.; Desai, M.R.; Shrivastav, P.; Vani, K. Bipolar versus monopolar transurethral resection of prostate: Randomized controlled study. J. Endourol. 2005, 19, 333–338. [Google Scholar] [CrossRef]
- Seckiner, I.; Yesilli, C.; Akduman, B.; Altan, K.; Mungan, N.A. A prospective randomized study for comparing bipolar plasmakinetic resection of the prostate with standard TURP. Urol Int. 2006, 76, 139–143. [Google Scholar] [CrossRef]
- De Sio, M.; Autorino, R.; Quarto, G.; Damiano, R.; Perdonà, S.; di Lorenzo, G.; Mordente, S.; D’Armiento, M. Gyrus bipolar versus standard monopolar transurethral resection of the prostate: A randomized prospective trial. Urology 2006, 67, 69–72. [Google Scholar] [CrossRef]
- Yoon, C.-J.; Kim, J.-Y.; Moon, K.-H.; Jung, H.-C.; Park, T.-C. Transurethral Resection of the Prostate with a Bipolar Tissue Management System Compared to Conventional Monopolar Resectoscope: One-Year Outcome. Yonsei Med. J. 2006, 47, 715–720. [Google Scholar] [CrossRef][Green Version]
- Chen, J.-W.; Lin, W.-J.; Lin, C.-Y.; Hung, C.-L.; Hou, C.-P.; Tang, C.-Y. An Automatic Bleeding-Rank System for Transurethral Resection of the Prostate Surgery Videos Using Machine Learning. Diagnostics 2021, 11, 1767. [Google Scholar] [CrossRef] [PubMed]
- Oken, M.M.; Creech, R.H.; Tormey, D.C.; Horton, J.; Davis, T.E.; McFadden, E.T.; Carbone, P.P. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol. 1982, 5, 649–655. [Google Scholar] [CrossRef]
- Oelke, M.; Bachmann, A.; Descazeaud, A.; Emberton, M.; Gravas, S.; Michel, M.C.; N’Dow, J.; Nordling, J.; de la Rosette, J.J. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur. Urol. 2013, 64, 118–140. [Google Scholar] [CrossRef] [PubMed]
- Liu, C.; Zheng, S.; Li, H.; Xu, K. Transurethral Enucleation and Resection of Prostate in Patients With Benign Prostatic Hyperplasia by Plasma Kinetics. J. Urol. 2010, 184, 2440–2445. [Google Scholar] [CrossRef] [PubMed]
- Herrmann, T.R.; Bach, T.; Imkamp, F.; Georgiou, A.; Burchardt, M.; Oelke, M.; Gross, A.J. Thulium laser enucleation of the prostate (ThuLEP): Transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J. Urol. 2010, 28, 45–51. [Google Scholar] [CrossRef] [PubMed]
- Hahn, R.G.; Fagerström, T.; Tammela, T.; Van Vierssen Trip, O.; Beisland, H.O.; Duggan, A.; Morrill, B. Blood loss and postoperative complications in transurethral resection of the prostate after pre-treatment with dutasteride. BJU Int. 2007, 99, 587–594. [Google Scholar] [CrossRef] [PubMed]
- Sandfeldt, L.; Bailey, D.M.; Hahn, R.G. Blood loss during transurethral resection of the prostate after 3 months of treatment with finasteride. Urology 2001, 58, 972–976. [Google Scholar] [CrossRef]
- Fagerström, T.; Nyman, C.R.; Hahn, R.G. Bipolar transurethral resection of the prostate causes less bleeding than the monopolar technique: A single-centre randomized trial of 202 patients. BJU Int. 2010, 105, 1560–1564. [Google Scholar] [CrossRef]
- Dasgupta, R.; Grabe, M. Preoperative antibiotics before endourologic surgery: Current recommendations. J. Endourol. 2009, 23, 1567–1570. [Google Scholar] [CrossRef]
- Gilleran, J.P.; Thaly, R.K.; Chernoff, A.M. Rapid communication. Bipolar PlasmaKinetic transurethral resection of the prostate: Reliable training vehicle for today’s urology residents. J. Endourol. 2006, 20, 683–687. [Google Scholar] [CrossRef]
- Schrier, S.L.; Mentzer, W.C.; Landaw, S.A. Approach to the adult patient with anemia. UpToDate 2016, 2016, 1–33. [Google Scholar]
- Cheshier, S.H.; Prohaska, S.S.; Weissman, I.L. The effect of bleeding on hematopoietic stem cell cycling and self-renewal. Stem. Cells Dev. 2007, 16, 707–717. [Google Scholar] [CrossRef]
- Mina, S.H.; Garcia-Perdomo, H.A. Effectiveness of tranexamic acid for decreasing bleeding in prostate surgery: A systematic review and meta-analysis. Cent. European J. Urol. 2018, 71, 72–77. [Google Scholar] [PubMed]
- Zhu, Y.; Zhuo, J.; Xu, D.; Xia, S.; Herrmann, T.R. Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: A systematic review and meta-analysis. World J. Urol. 2015, 33, 509–515. [Google Scholar] [CrossRef] [PubMed]
- Peng, B.; Wang, G.-C.; Zheng, J.-H.; Xia, S.-Q.; Geng, J.; Che, J.-P.; Yan, Y.; Huang, J.-H.; Xu, Y.-F.; Yang, B. A comparative study of thulium laser resection of the prostate and bipolar transurethral plasmakinetic prostatectomy for treating benign prostatic hyperplasia. BJU Int. 2013, 111, 633–637. [Google Scholar] [CrossRef] [PubMed]
- Bozzini, G.; Seveso, M.; Melegari, S.; de Francesco, O.; Buffi, N.; Guazzoni, G.; Provenzano, M.; Mandressi, A.; Taverna, G. Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): A randomized prospective trial to compare intra and early postoperative outcomes. Enucleación con láser de tulio (ThuLEP) frente a resección transuretral de la próstata en solución salina (TURis): Un ensayo prospectivo aleatorizado para comparar resultados intra y postoperatorios tempranos. Actas Urol. Esp. 2017, 41, 309–315. [Google Scholar]
- Zhao, C.; Yang, H.; Chen, Z.; Ye, Z. Thulium Laser Resection Versus Plasmakinetic Resection of Prostates in the Treatment of Benign Prostate Hyperplasia: A Meta-Analysis. J. Laparoendosc. Adv. Surg. Tech. A 2016, 26, 789–798. [Google Scholar] [CrossRef]
- Hauser, S.; Rogenhofer, S.; Ellinger, J.; Strunk, T.; Müller, S.C.; Fechner, G. Thulium laser (Revolix) vapoenucleation of the prostate is a safe procedure in patients with an increased risk of hemorrhage. Urol Int. 2012, 88, 390–394. [Google Scholar] [CrossRef]
- Berger, A.P.; Bartsch, G.; Deibl, M.; Alber, H.; Pachinger, O.; Fritsche, G.; Rantner, B.; Fraedrich, G.; Pallwein, L.; Aigner, F.; et al. Atherosclerosis as a risk factor for benign prostatic hyperplasia. BJU Int. 2006, 98, 1038–1042. [Google Scholar] [CrossRef] [PubMed]
- Berger, A.P.; Horninger, W.; Bektic, J.; Pelzer, A.; Spranger, R.; Bartsch, G.; Frauscher, F. Vascular resistance in the prostate evaluated by colour Doppler ultrasonography: Is benign prostatic hyperplasia a vascular disease? BJU Int. 2006, 98, 587–590. [Google Scholar] [CrossRef]
- Sugaya, K.; Kadekawa, K.; Unten, Y.; Nishijima, S.; Ashitomi, K.; Yamamoto, H. Relationship of blood flow in the common iliac vein to lower urinary tract disease. J. Med. Ultrason (2001) 2019, 46, 223–229. [Google Scholar] [CrossRef]
- Li, Y.H.; Li, G.Q.; Guo, S.M.; Che, Y.N.; Wang, X.; Cheng, F.T. Clinical analysis of urinary tract infection in patients undergoing transurethral resection of the prostate. Eur. Rev. Med. Pharmacol. Sci. 2017, 21, 4487–4492. [Google Scholar]
- Geavlete, B.; Bulai, C.; Ene, C.; Checherita, I.; Geavlete, P. Bipolar vaporization, resection, and enucleation versus open prostatectomy: Optimal treatment alternatives in large prostate cases? J. Endourol. 2015, 29, 323–331. [Google Scholar] [CrossRef] [PubMed]
- Kloping, Y.P.; Yogiswara, N.; Azmi, Y. The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials. Asian J. Urol. 2022, 9, 18–26. [Google Scholar] [CrossRef] [PubMed]
- Zhu, Y.P.; Dai, B.; Zhang, H.L.; Shi, G.H.; Ye, D.W. Impact of preoperative 5α-reductase inhibitors on perioperative blood loss in patients with benign prostatic hyperplasia: A meta-analysis of randomized controlled trials. BMC Urol. 2015, 15, 47. [Google Scholar] [CrossRef] [PubMed]
- Ren, J.; Lai, S.; Jiang, Z.; Xu, X.; Diao, T.; Thiruchelvam, N.; Zhang, G. A Systematic Review and Meta-Analysis of the Effects on Dutasteride Treatment for Reducing Surgical Blood Loss during Transurethral Resection of the Prostate. Urol. Int. 2017, 98, 456–465. [Google Scholar] [CrossRef]
Variables | Mean ± SD | P.C. | p-Value |
---|---|---|---|
Pre-op | |||
Age (years) | 67.7 ± 8.7 | −0.127 | 0.072 |
PSA (ng/mL) | 5.9 ± 6.13 | 0.029 | 0.685 |
Cr (mg/dL) | 1.02 ± 0.57 | 0.132 | 0.061 |
Prostate volume, total (mL) | 53.2 ± 21.2 | 0.042 | 0.552 |
Prostate volume, T zone (mL) | 24.7 ± 14.7 | 0.009 | 0.897 |
IPSS score, total | 24.4 ± 4.7 | −0.051 | 0.471 |
IPSS score, voiding | 15.2 ± 3.3 | −0.025 | 0.772 |
IPSS score, storage | 9.2 ± 4.3 | −0.046 | 0.521 |
Qmax (mL/s) | 8.4 ± 3.8 | −0.081 | 0.275 |
VV (mL) | 193.4 ± 108.0 | −0.004 | 0.953 |
PVR (mL) | 112.4 ± 151.0 | 0.006 | 0.932 |
Medication duration (months) | 27.7 ± 40.6 | −0.022 | 0.760 |
Peri-op | |||
Tissue enucleated percentage (%) | 86.5 ± 46.7 | −0.253 | <0.001 * |
Operation time (min) | 84.9 ± 40.6 | −0.008 | 0.910 |
Post-op hospital stays (days) | 2.2 ± 0.6 | 0.053 | 0.455 |
Characteristics | Bleeding Index | T | p-Value | ||
---|---|---|---|---|---|
Mean | SD | ||||
Thulium laser usage | No | 11.20 | 11.39 | 4.36 | <0.001 * |
Yes | 5.73 | 6.27 | |||
Admitted with catheter | No | 8.41 | 9.77 | 1.16 | 0.248 |
Yes | 6.35 | 5.33 | |||
U.R in the past 3 months | No | 8.35 | 9.79 | 0.56 | 0.577 |
Yes | 7.58 | 8.07 | |||
Age (years) | <80 | 8.36 | 9.60 | 2.432 | 0.019 * |
≥80 | 5.59 | 3.98 | |||
Prostate volume (mL) | <80 | 7.71 | 8.74 | −1.43 | 0.152 |
≥80 | 10.36 | 11.63 | |||
Qmax | <10 | 9.08 | 10.51 | 2.68 | 0.008 * |
≥10 | 6.08 | 5.40 | |||
Comorbidities | |||||
DM | No | 7.67 | 9.07 | −1.25 | 0.212 |
Yes | 9.67 | 9.74 | |||
HTN | No | 7.67 | 9.86 | −0.67 | 0.505 |
yes | 8.54 | 8.51 | |||
CAD | No | 7.94 | 9.31 | −0.73 | 0.466 |
yes | 9.65 | 8.42 | |||
CHF | No | 8.11 | 9.32 | 0.25 | 0.802 |
yes | 7.06 | 4.71 | |||
Arrythmia | No | 8.00 | 9.33 | −0.47 | 0.641 |
yes | 9.20 | 8.00 | |||
Stroke | No | 7.76 | 9.08 | −1.67 | 0.096 |
yes | 11.65 | 10.31 | |||
CRI | No | 8.02 | 9.28 | −0.39 | 0.695 |
yes | 9.06 | 8.75 |
Outcomes | Bleeding Index | X2 | p-Value | |||
---|---|---|---|---|---|---|
Low | Medium | High | ||||
Days of post-op hospital stays | ≤2 days | 43(89.6%) | 91(88.4%) | 37(72.6%) | 7.765 | 0.079 |
3 days | 3(6.3%) | 9(8.7%) | 11(21.6%) | |||
≥4 days | 2(4.1%) | 3(2.9%) | 3(5.8%) | |||
Urethral stricture | No | 46(95.8%) | 96(93.2%) | 48(94.1%) | 0.38 | 0.925 |
Yes | 2(4.2%) | 7(6.8%) | 3(5.9%) | |||
UTI within 1 months | No | 39(81.2%) | 63(61.2%) | 35(68.6%) | 6.07 | 0.046 * |
Yes | 9(18.8%) | 40(38.8%) | 16(31.4%) | |||
UR within 1 months | No | 46(95.8%) | 95(92.2%) | 46(90.2%) | 1.134 | 0.287 |
Yes | 2(4.2%) | 8(7.8%) | 5(9.8%) | |||
Return to ER within 1 month | No | 42(87.5%) | 89(86.4%) | 45(88.2%) | 0.109 | 0.962 |
Yes | 6(12.5%) | 14(13.6%) | 6(11.78%) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Weng, S.-C.; Tsao, S.-H.; Tsai, H.-Y.; Juang, H.-H.; Lin, Y.-H.; Chang, P.-L.; Chen, C.-L.; Hou, C.-P. Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes. Diagnostics 2023, 13, 592. https://doi.org/10.3390/diagnostics13040592
Weng S-C, Tsao S-H, Tsai H-Y, Juang H-H, Lin Y-H, Chang P-L, Chen C-L, Hou C-P. Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes. Diagnostics. 2023; 13(4):592. https://doi.org/10.3390/diagnostics13040592
Chicago/Turabian StyleWeng, Shu-Chuan, Shu-Han Tsao, Han-Yu Tsai, Horng-Heng Juang, Yu-Hsiang Lin, Phei-Lang Chang, Chien-Lun Chen, and Chen-Pang Hou. 2023. "Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes" Diagnostics 13, no. 4: 592. https://doi.org/10.3390/diagnostics13040592
APA StyleWeng, S.-C., Tsao, S.-H., Tsai, H.-Y., Juang, H.-H., Lin, Y.-H., Chang, P.-L., Chen, C.-L., & Hou, C.-P. (2023). Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes. Diagnostics, 13(4), 592. https://doi.org/10.3390/diagnostics13040592