Shrestha B, Baidhya J L
Department of Urology and General Surgery, B & B Hospital, Gwarko, Lalitpur, Nepal.
Kathmandu Univ Med J (KUMJ). 2010 Apr-Jun;8(30):203-7. doi: 10.3126/kumj.v8i2.3559.
Transurethral resection of the prostate underwent significant technical improvements during the last decades, with major impact on the incidence of intra and postoperative complications.
The objective of the study was to analyse the early complications and to predict immediate outcomes of transurethral resection of prostate (TURP) in a single tertiary care institute.
We prospectively evaluated 100 patients undergoing transurethral resection of prostate at B and B Hospital, Gwarko, Lalitpur, Nepal, from August 2008 till April 2009. Case records containing 32 variables concerning preoperative status, operative details, complications and immediate outcome were recorded for each patient.
The cumulative short-term postoperative significant morbidity was 10% and the peroperative morbidity was 6%. The most relevant postoperative complication was failure to void (24%). Among significant postoperative morbidities, surgical revision had to be performed in two patients (2%), open prostatectomy in one patient, transurethral resection (TUR) syndrome in 5% and significant urinary tract infection in 2%. Among significant intra operative morbidity, we had one case with bladder perforation, significant cardiac arrhythmia requiring prompt attention in 4% and TUR syndrome during resection in 1%. We did not have any mortality related to the procedure during the study period. The resected tissue averaged 25.67 gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 4% of patients. Urine peak flow rate (Q-max) increased to 12.88 ml per second from 9.24 ml per second and average fl ow rate increased to 7.36 ml per second from 5.03 ml per second. The postoperative mean residual urine measured by ultrasound decreased to 28.46 ml from preoperative 86.59 ml.
TURP has, for decades, been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia though significant morbidities can be associated with the procedure. Meticulous preoperative workup and proper selection of the patients for the procedure significantly improve the outcome after transurethral resection of the prostate.
在过去几十年中，经尿道前列腺切除术经历了重大技术改进，对术中及术后并发症的发生率产生了重大影响。
本研究的目的是分析一家三级医疗机构中经尿道前列腺切除术（TURP）的早期并发症，并预测其近期疗效。
我们前瞻性评估了2008年8月至2009年4月期间在尼泊尔拉利特布尔瓜尔科的B&B医院接受经尿道前列腺切除术的100例患者。记录了每位患者包含32个关于术前状态、手术细节、并发症及近期疗效变量的病例记录。
术后短期累积严重并发症发生率为10%，术中并发症发生率为6%。最相关的术后并发症是排尿困难（24%）。在严重的术后并发症中，两名患者（2%）需行手术修正，一名患者行开放性前列腺切除术，5%发生经尿道切除（TUR）综合征，2%发生严重尿路感染。在严重的术中并发症中，有1例膀胱穿孔，4%出现需及时处理的严重心律失常，1%在切除过程中发生TUR综合征。研究期间未发生与该手术相关的死亡病例。切除组织平均重25.67克。4%的患者经组织学检查诊断为前列腺偶发癌。尿流率峰值（Q-max）从每秒9.24毫升增至每秒12.88毫升，平均流速从每秒5.03毫升增至每秒7.36毫升。术后超声测量的平均残余尿量从术前的86.59毫升降至28.46毫升。
数十年来，TURP一直是良性前列腺增生继发下尿路症状的标准手术治疗方法，尽管该手术可能伴有严重并发症。细致的术前检查和对患者进行恰当的手术选择可显著改善经尿道前列腺切除术后的疗效。
