Transurethral resection

A greater change in serum sodium may be required if severe signs/symptoms secondary to hyponatremia persist. Another exception may be hyponatremia occurring in the setting after transurethral resection of the prostate (TURP)... 

Unless the sphincter mechanism is compromised by surgery or trauma, SUI is exceedingly rare in males. The most common surgeries predisposing to SUI in males are radical prostatectomy for prostate cancer and transurethral resection of the prostate for benign prostatic hyperplasia. 

SMA-12 Glucose, BUN, uric acid, calcium, phosporous, total TURP Transurethral resection of the prostate... 

Benign prostatic hyperplasia (BPH) (Prascar on/yj.Treatment of symptomatic BPH in men with an enlarged prostate to improve symptoms, reduce acute urinary retention risk, and reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy. 

Transitional cell carcinoma of the bladder is diagnosed in approx 50,000 individuals in the United States each year, and accounts for 10,000 deaths annually. A majority of patients will present with nonmuscle-invasive disease, be treated adequately with transurethral resection (TURBT) with or without intravesical chemotherapy or immunotherapy, and will have only a 10-15% risk (higher for higher grades) of developing muscle-invasive disease. In contradistinction, the natural history of muscle-invasive disease is much more aggressive, with a 5-yr survival of only 50%. 

Henry K, Miller J, Mori M, Loening S, Fallon B. Comparison of transurethral resection to radical therapies for stage B bladder tumors. J Urol 1988 140 964-967. 

Solsona E, Iborra I, Ricos JV, Monros JL, Casanova J, Calabuig C. Feasibility of transurethral resection for msucle infiltrating carcinoma of the bladder long-term follow-up of a prospective study. J Urol 1998 159 95-99. 

Herr HW. Transurethral resection in regionally advanced bladder cancer. Urol Clin North Am 1992 19 695-700. 

Kolozsy Z. Histopathological self-control in transurethral resection of bladder tumours. Br J Urol 1991 67 162-164. 

Serretta V, Lo Greco G, Pavone C, Pavone-Macaluso M. The fate of patients with locally advanced bladder cancer treated conservatively with neoadj u vant chemotherapy, extensive transurethral resection and radiotherapy 10-year experience. J Urol 1998 139 1187-1191. 

Coagulative effect. Permixon, administered to 108 patients at a dose of 320 mg/ day for at least 8 weeks before the procedure of transurethral resection of prostate, produced significantly lower bleeding than in the control (124 vs 287 mL, respectively), and the need of transfusion decreased remarkably. The duration of postoperative catheterization (3 vs 5 days, respectively) and the evaluated hematological parameters (red cells 4.5 vs 4 million, hemoglobin 13.4 vs 11.9 g, hematocrit 40 vs 35%) were significantly lower than in the control group . 

Gambardella, and G. Sepe. Efficacy of pretreatment with Serenoa repens on bleeding associated with transurethral resection of prostate. Minerva Urol Nefrol 2004 56(1) 73-78. 

Besides local toxicity, discussed above, there are numerous other modes of potential adverse interactions involving excipients (19,20). Many of these pose little threat provided the amounts of excipients are constrained to certain levels. Excessive amounts, however, can cause problems, particularly for patients who are intolerant of even modest levels. Commonly used phosphate buffers may cause calcium loss with formation of insoluble calcium phosphates when such buffers are administered in over-ambitious amounts (21). Calcium phosphate precipitation has been noted particularly in nutritional parenteral admixtures for neonates because of the high nutrient requirements. Similarly, renal toxicity has been associated with depletion of zinc and other trace metals caused by large parenteral doses of ethylenediaminete-traacetic acid (EDTA) (22). Excessive absorption of glycine solutions, when used as irrigants during transurethral resections, can cause hyponatremia, hypertension, and confusion (23). The use of preservatives has been associated with cardiac effects in a few patients (24). Premature neonates were found to be at risk for receiving toxic amounts of benzoic acid or benzyl alcohol in bacteriostatic solutions used to flush intravenous catheters (25). 

Thomas D, Hales P. Overhydration during transurethral resection of the prostate using glycine as an irrigating solution. Anesth Intensive Care 1984 12 366-369. 

Adverse events occurred in 31 of 194 patients who received epirubicin 80 mg intravesically compared with 12 of 205 who received placebo after transurethral resection (97). Systemic adverse events (usually cardiac or hematological adverse events or hypersensitivity) generally occurred in under 5% of patients. In two studies of intravesical epirubicin, there were reports of myocardial infarction (9%), stroke (3%), angina pectoris (3%), or... 

Biochemical abnormahties have been reported in trials of intravesical epirubicin. In one trial, liver function tests were impaired in seven of 40 patients who received epirubicin and in 10 of 35 patients who received epirubicin and verapamil concomitantly (101). In another study, liver function tests were impaired in one of 69 patients who received combination prophylaxis with epirubicin 50 mg and BCG 150 mg after transurethral resection (102). 

Valrubicin (a novel A-trifluoroacetyl, 14-valerate derivative of doxorubicin) is currently licensed in the USA for intravesical use in prophylaxis in patients with BCG-refractory carcinoma in situ after transurethral resection. It has a similar toxicity profile to that of epirubicin and doxorubicin (113). 

Oosterlinck W, Kurth KH, Schroder F, Bultinck J, Hammond B, Sylvester R. A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical... 

In 1990, the US Food and Drug Administration approved the marketing of BCG Live (intravesical) for use in the treatment of primary or relapsed carcinoma in situ of the urinary bladder, with or without associated papillary tumors. BCG is not recommended for treatment of papillary tumors that occur alone. The drug is marketed by Connaught Laboratories as TheraCys and by Organon as TiceBCG. The manufacturers recommend a 6-week induction course of weekly intravesical BCG, usually starting 1-2 weeks after biopsy or after transurethral resection of papillary tumors. Follow-up... 

Krege S, Giani G, Meyer R, Otto T, Rubben H. A randomized multicenter trial of adjuvant therapy in superficial bladder cancer transurethral resection only versus transurethral resection plus mitomycin C versus transurethral resection plus Bacillus Calmette-Guerin. Participating Clinics. J Urol 1996 156(3) 962-6. 

An 86-year-old man, who was taking captopril 25 mg bd and bendroflumethiazide 25 mg/day for hypertension, had a transurethral resection of the prostate under spinal anesthesia, and developed profound bradycardia and hypotension with disturbances of consciousness during transfer to the recovery room (18). Initial treatment with atropine produced rapid improvement in cardiovascular and cerebral function. A further hypotensive episode, without bradycardia, occurred about 1 hour later, but responded rapidly to methoxamine. He made a full recovery overnight. 

After transurethral resection of his prostate, a 68-year-old man developed immune thrombocjdopenic purpura (platelet count 1 x 10 /1) (14). He had self-medicated with cranberry juice for 10 days before the operation and had also taken amlodipine and aspirin. He had oral petechiae, bleeding gums, hematuria, and bruises. He recovered within 3 days of being given human immunoglobulin and oral prednisolone, and 18 months later his platelet count was still normal. 

Olsson J, Nilsson A, Hahn RG. Symptoms of the transurethral resection syndrome using glycine as the irrigant. J Urol 1995 154(l) 123-8. 

Norlen H, Dimberg M, Allgen LG, Vinnars E. Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. II. Isotonic 2.2% glycine solution as an irrigating fluid. Scand J Urol Nephrol 1990 24(2) 95-101. 

Mannitol is an osmotic diuretic that has been used in acute oliguric renal insufficiency, acute cerebral edema, and the short-term management of glaucoma, especially to reduce intraocular pressure before ophthalmic surgery. Other indications include promotion of the excretion of toxic substances by forced diuresis, bladder irrigation during transurethral resection of the prostate, and oral administration as an osmotic laxative for bowel preparation. Mannitol is used as a diluent and excipient in pharmaceutical formulations and as a bulk sweetener. 

The first study where the SCS was applied to MRS analysis of prostate biopsies was undertaken at the IBD in Winnipeg.42 Proton MRS (Bruker Instruments, 8.5 T were performed at 37°C on specimens of benign (n = 66) and malignant (n = 21) human prostate tissue specimens collected from transurethral resection of the prostate and radical prostatectomy from 50 patients. Typical spectra of malignant prostate tissue and benign prostate hyperplasia (BPH) are shown in Fig. 5.42 The spectral data were subjected to visual inspection analysis and multivariate analysis, specifically LDA. 

The metabolic clearance rate of PSA follows a two-compartment model with initial half-lives of 1.2 and 0.75 hours for free PSA and total PSA and subsequent half-lives of 22 and 33 hours. Because of this relatively long half-life, 2 to 3 weeks may be necessary for the serum PSA to return to baseline levels after certain procedures, including transrectal biopsy, transrectal ultrasonography, transurethral resection of the prostate, and radical prostatectomy. Prostatitis and acute urinary retention can also elevate PSA concentration. Although the digital rectal examination has no clinically important effects on serum PSA levels in most patients, in some it may lead to a twofold elevation. 

Pharmaceutical treatments for this common but annoying condition include finasteride (trade name Proscar) and terazosin (trade name Hytrin). Surgical procedures include the TURP procedure (transurethral resection of the prostate) and balloon dilation. 

Agarwal R, Emmett M. The post-transurethral resection of prostate syndrome Therapeutic proposals. Am J Kidney Dis 1994 24 108-111. 

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