BPH (Benign Prostatic Hyperplasia), Prostate, TURP(Transurethral Resection of Prostate)
Conditions
Keywords
TURP, BPH, Prostate, Blandy, Nesbit
Brief summary
Transurethral resection of the prostate (TURP) is still the gold standard for surgical management of enlarged prostate. However, many techniques and minimally invasive procedures are now in the comparative track with Bipolar resection as Laser enucleation. Multiple drawbacks of Classic TURP problems related to large prostate management as the retreatment after Bipolar resection, another issue that prolonged operative time, Loss of orientation during resection due to rotation of one of the 2 kissing lobe, Bleeding of the 1st lobe resection side make the 2nd lobe resection harder and lengthier, Median lobe resection or bladder neck resection is done at last to avoid sub-trigonal injury. however, due to median lobe obstruction, irrigation is poor during all the resection. length of learning curve, the modification of early median lobe resection carry the risk of sub-trigonal injury. So, this study is a trial to analyze the effect of new technique in resection of large prostate with good orientation and less time of operation.
Interventions
PROCEDURENesbit technique
it is composed of development of trough at the right prostatic lobe (at 10 o'clock) from the bladder neck proximally down to a level just above the external urethral sphincter distally, then deepening the trough until the prostatic capsule, performing haemostasias then resection of lateral lobes in halves, upper right, lower right, upper left and at last lower left respectively with haemostasias in-between. Then resection of the median lobe if present. Final haemostasias then ensues before insertion of the triple way catheter with normal saline irrigation.
PROCEDURECorkscrew technique
the Corkscrew technique was performed by resection starting at 3 o'clock and carried on in a clockwise manner till 3 o'clock again. Prostate was resected from bladder neck downwards to the verumontanum after dividing the gland, imaginary, into 3 zones or thirds, proximal, middle and distal zone. The gland was resected zone by zone in this corkscrew manner. Once the proximal third is resected and hemostasis done, the middle third resection is done in the same manner, The process is repeated for the distal third. Hemostasis was performed instantly.
Sponsors
Menoufia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Healthy volunteers
No
Inclusion criteria
* BPH causing LUTS with prostate volume between 60 and 100 ml (either by TRUS or CT). * PSA level below 4 ng/ml. * IPSS score of 10 and above.
Exclusion criteria
* previous history of prostatic biopsy. * previous history of acute urinary retention.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Weight of resected tissue | within one hour postoperatively | The weight of resected tissue measured in grams using laboratory scale device. |
| Resection time | the operative time | Resection time measured in minutes by documenting the time of resection start and time of resection end. |
| Complication rate | the operative time | Complication rate is measured by number of complications occurred. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in International Prostate symptom score (IPSS) | one month postoperatively | The change in International Prostate Symptom Score (IPSS) is measured by difference between preoperative and postoperative IPSS. IPSS is measured by IPSS scoring system in form of numbers, where minimum score is 0 representing no symptoms and maximum score is 35 representing the most sever symptoms. |
| Change in hemoglobin level | One day postoperatively | The change in hemoglobin is measured by difference between preoperative and postoperative hemoglobin level. Hemoglobin level is assessed using Complete Blood Count and measured by g/dl. |
| Change in Qmax | One month postoperatively | The change in IPSS score is measured by difference between preoperative and postoperative Qmax. Qmax (maximum flow rate) is measured using uroflowmetry and measured by ml/sec. |
| Change in postvoid residual volume | One month postoperatively | The change in postvoid residual volume is measured by difference between preoperative and postoperative postvoid residual volume. postvoid residual volume is assessed using pelviabdominal ultrasound and measured by centimeter cubic. |
Countries
Egypt
Outcome results
None listed