TRANSURETHRAL RESECTION FOR BENIGN PROSTATIC HYPERTROPHY

Abstract

One hundred and twenty-seven transurethral resections were performed on 114 patients with benign prostatic hypertrophy during the period between November 1959 and August 1963, at the Jikei University Hospital.
We have been using the modified Iglesias resectoscope, the sheath of which has a water control valve attached between the connecting tube and the spring catch lock so that one can control the valve very easily with the tip of the index finger.
The ages of the patients varied between 29 and 82 years; the average age at operation was 61.7 years.
Low spinal anesthesia or epidural anesthesia was employed in majority of the cases, though general anesthesia, venous anesthesia or generalized hypothermia was employed in some exceptional cases.
Urigal (cytal) was used in 65 cases as irrigating fluid, sterile distilled water in 44 cases, combination of sterile distilled water and 4% glucose in 14 cases, and combination of sterile distilled Water and urigal in 4 cases.
The biggest prostatic tissue resected weighed 68 grams, but the average weight was 10.5 grams.
The length of the time needed for the resecting procedure varied between 5 and 80 minuts; the average time was 40 minuts.
The average blood loss during the resecting procedure was about 133cc and average postoperative blood loss was about 22cc.
The venous blood specimens were taken before and immediately after the resecting procedure to examine the changes of the serum Na, K, Cl and BUN levels. The serum Na decreased 3.6mEq/L, K decreased 0.1mEq/L, Cl decreased 3mEq/L and only BUN remained unchanged.
The average term of postoperative indwelling catheter was 3.8 days and average length of hospitalization was 14 days.
The operative and postoperative complications consisted of 7 perforations of prostatic capsule, 5 meatal strictures, 4 epididymitis, 2 acute renal failures, 2 temporary urinary incontinences, an acute pneumonitis, a postoperative bladder neck contracture and many urinary infections.
One hundred and eight patients or 96.4% of the whole patients recovered well and showed improvement in urination.
There were two operative death or 1.75% of operative mortality in this series.
Though my experience is still limited and follow up period is not long enough, I feel that transurethral resection is the treatment of choice for the majority of patients with benign prostatic hypertrophy.