Tag Archive | "TURP"

Post Prostate Surgery Pelvic Floor Exercises Ineffective in Improving Male Incontinence

According to a two randomized trials reported in The Lancet one-to-one pelvic floor exercise therapy for urinary incontinence after prostate surgery is no more effective than standard care.

Cathryn Glazener, PhD, from the University of Aberdeen, United Kingdom, and colleagues, reported that urinary incontinence is common immediately after prostate surgery.  As a result men are often advised to do pelvic floor exercises, but evidence to support this had been inconclusive.  The study sought to establish if formal one-to-one pelvic floor muscle training reduces incontinence.  It was supported by the National Institute of Health and Health Technology Assessment Programme.

The first trial enrolled men in the United Kingdom who had incontinence six weeks after radical prostatectomy, and the second trial enrolled men in the United Kingdom who had incontinence six weeks after transurethral resection of the prostate (TURP).  These trials compared the effect of four one-to-one therapy sessions during a three-month period to standard are and lifestyle advice only.

In trial 1, the rate of urinary incontinence at 12 months in the intervention group was not significantly different from that in the control group. Findings were similar in trial 2. These findings were unchanged by adjustment for minimization factors or by treatment-received analyses.  There were no adverse effects reported in either trial.

The authors conclude that one-to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be physically effective or cost effective.

Limitations of this study include incomplete blinding and lack of objective measures of incontinence.

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Resection and Vaporatization Treatments for BPH about Equally Safe

Carlos Capitan, MD, and colleagues at the Hospital Universitario Fundacion Alcorcon, Universidad Rey Juan Carlos in Madrid have found that improvements in symptoms of benign prostatic hyperplasia are similar after treatment by transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP) by laser, and complication rates are the same.  Length of stay, however, is significantly shorter with laser treatment.  PVP results in a higher preservation of ejaculation than TURP.  The team published their findings in European Urology.

They used a randomized trial to determine the efficacy and safety of GreenLight HPS 120-W laser PVP compared with TURP in 100 patients with lower urinary tract symptoms due to BPH.

On average, hospital stay was 2 days shorter in the PVP group than in the TURP group.

At a two-year post-treatment follow-up, International Prostate Symptom Scores (IPSS) had dropped significantly and by almost the same degree in both groups, but improvements were seen more rapidly in the laser group.  Similar patterns were seen in changes of quality-of-life scores, which were nearly identical in both groups at two years.  The authors report that retrograde ejaculation was recognized in 65% of patients treated by TURP and in 34.7% of patients treated by PVP.

Complication rates were statistically equivalent in the two arms.  Three PVP patients were readmitted to the hospital, and two developed a urethral stricture.  In the TURP group, two patients were readmitted, six developed a urethral stricture, and two developed bladder neck sclerosis.

In summary, the team found that GreenLight HPS 120-W laser PVP is just as effective as TURP in symptom reduction, and the complication rate is about the same.

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Alternative Procedure is Available for Treating Enlarged Prostate

According to Dr. Joao Martins Pisco, lead author of a study presented on March 29, 2011 at the annual meeting of the Society of Interventional Radiology in Chicago, a new treatment called prostatic artery embolization (PAE) may be used in certain patients with prostates larger than 60 cubic centimeters and who have serious lower urinary tract symptoms and weakened urinary stream.

Enlarged prostate, also known as benign prostate hyperplasia, is a non-cancerous condition that affects millions of aging men.  This condition occurs when the prostate gland slowly enlarges and presses on the uretha, which constricts the flow of urine.  It is characterized by unpleasant symptoms including a weak or slow urine flow, a constant and urgent need to urinate, not being able to fully empty the bladder, and having to get up repeatedly at night to urinate.

The surgery that has generally been used to treat enlarged prostate, transurethral resection of the prostate (TURP), is used for men whose prostates are smaller than 60 to 80 cubic centimeters.  The procedure requires general anesthesia and a hospital stay.

In contrast, there is no size limitation for PAE, which requires only local anesthesia.  Researchers say that the procedure lowers the risk of other side effects including blood loss and retrograde ejaculation, which happens when semen leaks into the bladder.  PAE can also be an outpatient procedure.

According to the study, PAE helped the majority of 67 patients who received the treatment.  Sixty-six of the men who had not responded to medications experienced improvements in symptoms and a reduction in prostate volume.  After nine months, none of these men experienced sexual dysfunction, and a quarter continued to report improvements.

PAE, however, remains controversial and few doctors are trained in this procedure.  Authors of the study reported that there was not a great an improvement in improved flow rate of urine in patients who underwent PAE, which would indicate the performance of the bladder and urethra, as those who underwent TURP.

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