The Risk and Effectiveness of Transurethral Resection of Prostate
JARIYA LERTAKYAMANEE, M.D., F.R.C.A., M.P.H.*, EM-ORN RUKSAMANEE, B.N.*, ANUPAN TANTIWONG, M.D., F.R.C.S.T.**, KARUNA BOONSUK, M.D.*, INGPORN NILPRADAB, B.N.** PUTTIPANNEE VORAKUPOKATORN, M.D., F.R.C.A.T.*, SUCHAI SOONTRAPA, M.D., F.R.C.S.T.**
Affiliation : * Deparunent of Anesthesiology, ** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Objectives : The authors wanted to know: 1. Whether TURP can decrease the International prostate symptom score (IPSS) and improve the Quality of Life (QOL) scores concerning urination at 1.5 months post-operatively for at least 25 per cent of the pre-operative scores? ; 2. What are the common medical diseases in this type of patient? ; and 3. What are the mortality and immediate complications of TURP?
Method : This was a prospective, before-after design trial. All patients who came to have TURP at a tertiary care hospital were studied. IPSS and QOL scores were recorded before surgery and again when the patients came back to follow up at 1.5 months after discharge. Patients were evaluated for cardiopulmonary reserve and congestive heart failure. Anesthetic technique of choice was spinal anesthesia with 0.5 per cent bupivacaine. Anesthetic and surgical complications were recorded if the definitions were met.
Analysis : Pre-operative and 1.5 months post-operative scores were compared using paired t-test and 95 per cent confidence interval.
Results : During the 13 months there were 269 consecutive males who received TURP. The mean ± SD age was 70.4 ± 8.8 years (range 35-97). The mean difference between pre- and post-opera tive IPSS was 6.7 ± 9.1 (95% CI 5.2-7.8). Quality of Life also improved, the mean difference between pre- and post-operative QOL was 3.2 ± 1.6 (95% CI 2.9-3.5). Most patients had ASA class 2. Com mon pre-operative existing diseases were hypertension (31.6%), ischemic heart disease (18.2%), dia betes (15.6%), and COPD (7.1%). Anesthetic techniques were spinal block (77.3%), epidural block (5.9% ), continuous epidural ( 11.2% ), and general anesthesia (5.6% ). Intra-operative complications were reported and TUR syndrome occurred in I patient (0.37%). There was one surgical death 3 days post-operation, due to septic shock probably from bowel perforation.
Conclusion : The patients' symptoms and quality of life significantly improved, but there was 1 surgical death and 1 TUR syndrome among 269.
Keywords : TURP
