| 1. |
- Abuhasanein, Suleiman, et al.
(författare)
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A rare case of a necrotized urethral prolapse in a postmenopausal woman with acute urinary retention
- 2021
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Ingår i: Luts-Lower Urinary Tract Symptoms. - : Wiley. - 1757-5664 .- 1757-5672. ; 13:4, s. 505-508
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Tidskriftsartikel (refereegranskat)abstract
- Case Urethral prolapse (UP) is a rare condition with unknown etiology. We reported on an 86-year-old woman with a normal BMI and cystocele, presented with acute urinary retention and perineal pain. A residual urine of 950 mL was measured and released by an indwelling catheter. The physical examination revealed 2 x 3 cm severely sore and purple polyp around the urethral meatus with signs of necrosis. A diagnosis of a strangulated urethral prolapse was stated. Outcome The patient was admitted to the Department of Urology, and treated with surgical excision using the four-quadrant excisional technique. The histopathological examination revealed a non-keratinized, inflammatory squamous epithelium. At a follow-up visit, the patient remained asymptomatic and a complete anatomical resolution was achieved. Conclusion UP is an uncommon, sometimes misdiagnosed condition. The management is controversial and to date no consensus exists. This clinical picture is sufficient for diagnosis and surgical excision of the prolapsed urethral mucosa is reasonable if there are signs of strangulation.
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| 2. |
- Sagen, Erik, 1979, et al.
(författare)
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Defining and discriminating responders from non-responders following transurethral resection of the prostate
- 2018
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 52:5-6, s. 437-444
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Tidskriftsartikel (refereegranskat)abstract
- © 2019, © 2019 Acta Chirurgica Scandinavica Society. Background: Transurethral resection of the prostate (TURP) is the reference standard surgical treatment for lower urinary tract symptoms (LUTS) related to benign prostatic enlargement. The aim of this study was to investigate the response rate following TURP in two distinctly different patient categories; men with bothersome LUTS and men in urinary retention (UR) requiring catheterisation. Methods: In total, 355 men underwent TURP due to LUTS or UR. Responders in the LUTS group were defined as having an International Prostate Symptom Score ≤7 or >50% loss compared to baseline, a Q max ≥ 15 mL/s or >50% gain compared to baseline, a post-void residual ≤100 mL or a bother score ≤2. Patients fulfilling at least one out of the four criteria were defined as responders. In the UR group, responders were defined as being catheter-free at follow-up. Results: In total, 337 men remained for final analysis. The proportion operated on due to UR was 46%. In men with LUTS, the response rate was 95%. One in four were classified as excellent responders, fulfilling all four outcome criteria. Men with UR had a successful removal of the catheter after TURP prior to discharge in 77% of the cases and an additional 6% within 3 months, yielding a total response rate of 83%. Conclusion: TURP is a successful procedure in men with bothersome LUTS and in men with UR. Considering the difference regarding voiding outcomes in men operated on due to LUTS or UR, these groups should be analysed separately in future studies comparing TURP against newer treatment modalities.
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| 3. |
- Sagen, Erik, 1979, et al.
(författare)
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Patient related factors affecting in-hospital costs of a TURP procedure
- 2021
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 55:4, s. 324-330
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Treatment costs of lower urinary tract symptoms secondary to benign prostatic enlargement (BPE) are a substantial economic burden that will continue to increase in the future as a result of the ageing male population and increasing health awareness. The true costs for surgical interventions against BPE have been difficult to quantify as treatment costs strongly depend on the performance setting and may also vary among different healthcare systems, regions and institutions. The purpose of this study was to disclose the in-hospital costs and main expense items associated with a transurethral resection of the prostate (TURP). Methods: A cohort of men subjected to TURP due to BPE was analysed during a 3-year period (2017-2019). All in-hospital expenses were registered using an electronic spreadsheet. Patient background and perioperative variables were registered using retrospective chart reviews. Results: A total of 122 men were available for final analysis. Of these, 70 men were operated on due to bothersome LUTS and 52 men due to urinary retention. The mean and median (inter quartile range) cost per patient was euro4025 and euro3702 (2961 - 4390), respectively. The main drivers of total cost were length of stay, the surgical procedure and anaesthesia related costs. Factors associated with increasing total cost per patient were increasing age, prostate volume, presence of urinary retention, occurrence of complications, increasing catheter time and length of stay. Conclusion: The main factor that influences total cost for an elective TURP procedure is the occurrence of postoperative complications. Our findings firmly underscore the indispensability to employ every possible means to avoid and prevent complications of any kind.
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| 4. |
- Sagen, Erik, 1979, et al.
(författare)
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The morbidity associated with a TURP procedure in routine clinical practice, as graded by the modified Clavien-Dindo system
- 2019
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 53:4, s. 240-245
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Tidskriftsartikel (refereegranskat)abstract
- Background: Transurethral resection of the prostate (TURP) is considered the reference surgical method of treating benign prostatic enlargement (BPE) causing obstruction. The procedure still carries a significant risk of perioperative morbidity according to previous reports. The aim of the present study was to disclose complications after TURP undertaken in routine clinical practice at a non-academic center. Methods: All patients with BPE submitted to TURP from January 2010 to December 2012 were evaluated for complications occurring during hospital stay, after discharge up to the end of the third post-operative month and finally for any late endourological re-interventions undertaken up to five years after TURP. All complications were graded according to the Clavien-Dindo system. Results: In total, 354 men underwent a TURP during the study period. In total, 47% had pre-operative urinary retention. Significant co-morbidity was seen in 17% of men (ASA III-IV). Spinal anaesthesia was applied to 312 men (88%). During hospital stay, major complications, graded as Clavien-Dindo >= III, was seen in only eight men (2.3%). Minor complications occurred in 91 men (26%). Between hospital discharge and follow-up visit major complications were noted in 12 men (3.4%). Minor complications occurred in 79 men (22%). The only factor that was associated with an increased risk of a major complication was general anaesthesia. Late complications, requiring an endourological re-intervention, occurred in 30 men (9.7%). Conclusion: TUR-P in routine clinical practice was associated with a low incidence of severe complications. TUR syndrome was very rare. Within five years a small proportion of men require the transurethral intervention to be redone.
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| 5. |
- Sagen, Erik, 1979, et al.
(författare)
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Transurethral resection of the prostate: fate of the non-responders.
- 2020
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Ingår i: Scandinavian journal of urology. - : Medical Journals Sweden AB. - 2168-1813 .- 2168-1805. ; 54:5, s. 443-448
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Tidskriftsartikel (refereegranskat)abstract
- Transurethral resection of the prostate (TURP) has been the standard method of surgical management of benign prostatic enlargement for decades. Some patients experience significant voiding dysfunction and discomfort postoperatively, without any apparent clinical complications from the procedure. Furthermore, a significant proportion of men still require postoperative catheterisation. This study analysed patients defined as non-responders after TURP with the principal aim to reveal their fate.A prospectively recruited cohort of 355 men, who underwent TURP during 2010-2012, was investigated. Non-responders were identified as still requiring catheterisation postoperatively and/or exhibiting all of the following voiding outcomes based on the de Wildt criteria: IPSS > 7, bother score > 2, Qmax < 15mL/s and PVR > 100mL. The non-responders were followed for a maximum period of three years using retrospective chart reviews.Thirty-five men were defined as non-responders. Of these, 26 men were operated on due to urinary retention and nine men due to bothersome symptoms. The non-responders were followed for a mean time of 72months. Seven men underwent a redo-TURP and two men a bladder neck incision. Eleven of the 35 men were finally judged as having satisfactory voiding parameters. Sixteen men used CISC. Eleven men reduced the frequency of CISC to a minimum. Seven men had to use an indwelling catheter indefinitely.Men with preoperative urinary retention constituted the vast majority of non-responders. The use of postoperative urodynamic studies was remarkably low. Almost one in three non-responders finally had a satisfactory outcome with or without re-intervention.
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| 6. |
- Sagen, Erik, 1979
(författare)
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Transurethral resection of the prostate: studies on efficacy, morbidity and costs
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lower urinary tract symptoms (LUTS), based on benign prostatic enlargement (BPE), are increasingly common, in ageing men. A considerable amount of men will ultimately progress with deteriorating symptoms or with the occurrence of complications secondary to obstruction of the bladder outlet, for example, urinary retention (UR). These subjects need surgery. Transurethral resection of the prostate (TURP) is the gold standard surgical intervention for symptoms associated with BPE. Over time, the TURP procedure has evolved due to manifold technical improvements and these progresses, coupled with improved surgical skill, are thought to have led to additional improvements regarding voiding outcomes, coupled with a decreased morbidity and mortality. The aims of this thesis were to explore and elucidate the effects of TURP, in a non-academic setting, including functional outcomes, complications and healthcare costs. All consecutive men subjected to a TURP procedure due to BPE at Skaraborgs Hospital during the periods 2010-2012 and 2017-2019 were identified and data retrieved from the hospital records. All men were followed-up for 3 months postoperatively and more if deemed necessary. Responders were defined according to criteria set up by de Wildt. Complications were graded in accordance with the Clavien-Dindo system. In Paper I, men with bothersome LUTS and men in UR reported response rates of 95% and 83% respectively indicating that TURP is a successful procedure in both these patient categories. In Paper II, the incidence of major complications was low, during hospital stay (2.3%) and between hospital discharge and follow-up (3.4%). Late complications, requiring endourological re-intervention occurred in 9.7%. In Paper III, we followed the fate of the 35 non-responders and found that 11 men were finally judged to have satisfactory voiding parameters, 16 men utilized clean intermittent self-catheterisation to varying degrees, 7 men had to use an indwelling catheter indefinitely, and only one man still suffered from bothersome LUTS. In Paper IV, we analysed all in-hospital expenses of 122 men subjected to TURP and found that the median cost for this procedure was 37343 SEK (IQR 29852-44260). The main drivers of total cost were length of hospital stay, the surgical procedure and anaesthesia related costs. The main factor that increased total cost per patient was the occurrence of complications. In summary, transurethral resection of the prostate is a rewarding operation in men with UR or with bothersome LUTS. Men with preoperative UR constituted most of non-responders. There was a low use of invasive urodynamic investigations after surgery. In the end, nearly one in three non-responders had a fair outcome with or without redo-surgery. TURP in routine clinical care was linked with a low incidence of serious complications. TUR syndrome was very rare. A small amount of patients needed the endourological treatment to be repeated. The main factor affecting total cost for a TURP procedure was the occurrence of postoperative complications.
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