Reducing the Morbidity of Transurethral Resection of the Prostate Based on Patient Selection, Fluid Absorption, and Blood Loss

.............................................................................................................................. 4 PAPERS INCLUDED............................................................................................................... 5 ABBREVIATIONS.................................................................................................................... 8 INTRODUCTION ................................................................................................................... 10 General background................................................................................................................ 10 Benign prostatic hyperplasia................................................................................................... 11 Etiology................................................................................................................................ 11 Symptoms............................................................................................................................ 12 Complications ..................................................................................................................... 12 Economics of management ................................................................................................ 12 Evaluation ........................................................................................................................... 14 Adrenergic alpha-antagonists ........................................................................................... 16 5-alpha-reductase inhibitors.............................................................................................. 16 Transurethral incision of the prostate.............................................................................. 17 Transurethral resection of the prostate ........................................................................... 17 Open surgery ...................................................................................................................... 18 Other methods of treatment .............................................................................................. 18 Irrigating fluids in endoscopic surgery .................................................................................. 19 General ................................................................................................................................ 19 Distilled water..................................................................................................................... 20 Glycine................................................................................................................................. 20 Mannitol .............................................................................................................................. 21 Other fluids ......................................................................................................................... 21 Absorption................................................................................................................................ 21 Intravascular absorption ................................................................................................... 21 Extravascular absorption .................................................................................................. 22 Absorbed volume and risk of symptoms.......................................................................... 22 Traditional monitoring of irrigating fluid absorption.................................................... 23 Blood loss................................................................................................................................. 23 Long-term mortality after TURP ............................................................................................ 24 AIMS OF THE THESIS......................................................................................................... 29 ETHICAL CONSIDERATIONS ............................................................................................ 30 METHODS .............................................................................................................................. 31 Reducing the Morbidity of Transurethral Resection of the Prostate 7 Paper I...................................................................................................................................... 31 Paper II .................................................................................................................................... 32 Paper III .................................................................................................................................. 32 Paper IV................................................................................................................................... 33 Paper V .................................................................................................................................... 34 Monitoring of fluid absorption.......................................................................................... 35 Irrigating fluids in the studies ........................................................................................... 36 Fluid distribution................................................................................................................ 37 Evaluation of symptoms associated with absorption ...................................................... 38 Monitoring of blood loss .................................................................................................... 38 Urological investigations.................................................................................................... 39 Personality and mental testing .......................................................................................... 40 Cardiovascular investigations ........................................................................................... 41 Blood and urine chemistry ................................................................................................ 43 Radiographic investigations .............................................................................................. 44 Histopathology.................................................................................................................... 45 Initial treatment for lower urinary tract symptoms ....................................................... 46 Anesthesia ........................................................................................................................... 46 Treatment follow-up .......................................................................................................... 47 Statistics............................................................................................................................... 47 RESULTS ................................................................................................................................ 48 Paper I...................................................................................................................................... 48 Paper II .................................................................................................................................... 51 Paper III .................................................................................................................................. 53 Paper IV................................................................................................................................... 54 Paper V .................................................................................................................................... 56 DISCUSSION.......................................................................................................................... 61 BPH and cardiovascular risk factors ..................................................................................... 61 Fluid absorption ...................................................................................................................... 63 Blood loss................................................................................................................................. 69 CONCLUSIONS...................................................................................................................... 72 ACKNOWLEDGMENTS........................................................................................................ 73 REFERENCES ....................................................................................................................... 75 PAPERS I−V ........................................................................................................................... 85