==inizio objective==

the turp syndrome, characterized by a defcit diselettrolitico and consequently the cardiovascular and autonomic nervous system. The rational resides in ‘absorption by the body of high amount of volume of the endoscopic transmission fluid used (10 and 30 mlmin) for procedures, in this case, the turp to which must be added the toxicity, specific, the fluid used, which, subsequently, sometimes, makes it independent of the damage caused to the body by the absorbed volume .
The factors that influence such absorption are:
1) the transmission liquid 2) low pressure venosa3) prolonged endoscopic maneuver over 1 h 4) opening of numerous venous sinuses 5) perforation of the capsule thus facilitating the passage of the liquid in the cavity peritoneal and consequently its reabsorption

==fine objective==

==inizio methodsresults==

Patient data: Male of 65 years, luts 3v nocturia, in tp finasteride from 2 years , pa average of 130 / 85mm / hg (pa values generally normal no other therapy in progress), psa <4 ng / l, no familiar k prostate, dre negative in nodules', vol gland adenoma 60cc unweighted; hb12.5g / dl, creatinine 0.98 ==fine methodsresults== ==inizio results== endoscopic resection duration 2h, 30 min after the turp: hyperthermia (up to 39.5 ° C), blood pressure down, sodium 125, means of transmission used physiological, energy used jayrus, grams resected undetected. Hb 11.0g / dl, creatinine 1.2 ==fine results== ==inizio discussions== the symptoms can occur, even at 24 h from intervention, and is characterized by disparate epiphenomena, mostly triggered, after the reabsorption of the transmission medium, from hyponatremia: hypertension, hypotension, bradycardia, hypothermia, tachycardia, hyperthermia of reflection, scotoma and fotomi, hypoxia, nausea, severe vomiting, shortness of breath associated with pulmonary edema. The hypervolemia caused by excessive absorption of transmission fluid due to hypertension and bradycardia, between the other, fatigue of the left ventricle, which ease the transition in the fluid at the level of the third space, triggering pulmonary edema. The subsequent dilution of the osmolar concentration of sodium causes edema at the level of the central nervous system and subsequently hypovolemia with all that sequela of symptoms mentioned before. For another variation of osmolarity induces hemolysis allowing it to settle of hemoglobin in the kidneys causing renal failure. Although, the use of some sources of energy and therefore of certain liquid transmission can be made more rare the phenomenon of resorption syndrome, it is, however, present. The tur syndrome in addition to the common pathophysiology of increase in circulating volume, recognizes a related toxicity liquid irrigation. Some examples are: the distilled water provides the best optical vision, but causes, to a high extent, intravascular hemolysis due to the different serum osmolality. Therefore Next you have the precipitation of hemoglobin in the renal tubule causing acute renal failure. • Glycine solution has an osmolarity of 200 mOsml / L, it is metabolized by the liver into ammonium and can lead to visual disturbances. High levels of ammonium, as known, may lead to neurological disorders. • mannitol solution is the only irrigant isosmolar (275 mOsml / L). Not only it is metabolized and excreted by the kidneys, but for precisely the absorption of large amounts of mannitol move liquids in the vascular compartment and lead to rapid fluid overload, cardiac failure and pulmonary edema. The treatment, of course varies depending on the symptoms and severity. It may be necessary to administer from atropine to adrenaline to correct a slow heartbeat or low blood pressure; anticonvulsant drugs, if they are Significantly greater neurological symptoms; blood transfusions, designed to rebalance both the hematocrit that the electrolyte balance; furosemide 40 mg only in the case in which there is the appearance of pulmonary edema, because of for if the drug induces sodium depletion .In addition in cases of severe hyponatremia (120 mmol / l) administering a hypertonic solution at 3% in order, however, to obtain a slow electrolytic rebalancing ==fine discussions== ==inizio conclusion== Conclusion: the ts was treated with close monitoring of Pa and with infusion of hypertonic solution, facilitating the removal of the liquid from the third space but not facilitating sodium depletion (as is by administering furosemide) would take place. The patient gradually took in 6-h period normal values and returned asintomatic .The recognizing of this syndrome allows the implementation of the most appropriate measures to restore the patient's health ==fine conclusion== ==inizio reference== Bibliografia 1. Dietrich Gravenstein, MD Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida the International Anesthesia Research Society 1997 Transurethral Resection of the Prostate (TURP) Syndrome: A Review of the Pathophysiology and Management Continuing Education in Anaesthesia, Critical Care & Pain j Volume 9 Number 3 2009 2. Aidan M O’Donnell BSc MB ChB FRCA Irwin TH Foo MB BChir MD MRCP(UK) FRCA Anaesthesia for transurethral resection of the prostate. Bipolar Transurethral Resection Versus Monopolar Transurethral Resection for Benign Prostatic Hypertrophy: A Systematic Review and Meta-Analysis 3. Yin Tang, MD, Jinhong Li, MD, Chuanxiao Pu, MD, YunJin Bai, MD, HaiChao Yuan, MD, Qiang Wei, MD, and Ping Han, MD JOURNAL OF ENDOUROLOGY Volume 28, Number 9, September 2014 4. Balzarro M, Ficarra V, Bartoloni A et al. The pathophysiology, diagnosis and therapy of the transurethral resection of the prostate syndrome. Urol Int 2001; 66: 121–6 5. Kirollos MM, Campbell N. Factors influencing blood loss in transurethral resection of the prostate (TURP): auditing TURP. Br J Urol 1997; 80: 111–5 6. Gravenstein D. Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management. Anesth Anal 1997; 84: 438–46 7. Blanshard H, Bennett D. TURP syndrome. In: Allman KG, McIndoe AK, Wilson IH, eds. Emergencies in Anaesthesia. Oxford: Oxford University Press, 2006; 270–1 8. Imiak S, Weavind L, Dabney T, Wenker O: Interactive Case Report in Anesthesia and Critical Care. The Internet Journal of Anesthesiology 1999; Vol3N1; Published January 1, 1999; Last Updated January 1, 1999. 9. Omar MI1, Lam TB, Alexander CE, Graham J, Mamoulakis C, Imamura M, Maclennan S, Stewart F, N'dow J BJU Int. 2014 Jan;113(1):24-35. doi: 10.1111/bju.12281. Epub 2013 Oct 24.Systematic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP). ==fine reference==

==inizio objective==

The photoselective vaporization of the prostate with the surgical technology of straight beam lithium triborate laser (LBO) is considered one of the most promising alternatives for the treatment of benign prostatic hyperplasia (BPH). The aim of the present work is to share our initial experience of the 180-W straight beam LBO laser photoselective vaporesection of the prostate to evaluate the technical improvement. Our approach and technique for GreenLight XPS (180 W GreenLight Laser) drawing on personal experience with both anatomic and standard vaporization techniques were applied in 63 cases.

==fine objective==

==inizio methodsresults==

From April 2015 to December 2016 we performed 63 procedures. All patients were preoperatively assessed with the International Prostate Symptom Score (IPSS), post-avoid residual urine (PVR), prostate-specific-antigen level and prostate volume measurement. Perioperative parameters and complications were recorded.
Patients were assessed at 1 week and 1 month postoperatively. A transurethral cystoscopy was performed 3 months after the procedure

==fine methodsresults==

==inizio results==

This technique resulted in a significant improvement of IPSS and PVR. Mean operative time was 50 minutes. The mean prostate volume was 60 ml. Applied energy of 250 KJ and a laser working time of 30 minutes were applied. The percentage of urinary retention after the Green light procedure was 20%. This percentage was reduced increasing catheter indwelling and hospital stay time to 48 hours instead 24 hours.
We recorded one case of fistole prostate with right adductor muscle, two case of persistent urinary incontinence (over 6 months) and one case of blood transfusion during the recovery. Finally, one case of capsule perforation was noticed

==fine results==

==inizio discussions==

Currently TURP is still the gold standard in the surgical treatment of BPH. Our results demonstrate that the LBO laser photoselective vaporesection of the prostate has equally efficacy and greater safety compared with TURP especially for the elderly and high-risk patients with oral anticoagulation and bleeding tendency. By means of the GreenLight XP 180 watt laser anatomic photoselective vaporization of the prostate instead of standard vaporization, we observed an improvement of surgical outcomes and obstructive symptoms with smaller catheter indwelling time. The anatomic vaporization is a partial enucleation of prostatic adenoma from prostate capsule and tissue vaporization from capsule to lumen. Moreover, this technique decreased postoperative irritative symptoms

==fine discussions==

==inizio conclusion==

The XPS GreenLight Laser is a system that allows the urologist to perform an effective treatment option for BPH. The main positive features are the following: length of hospital stay and operative catheter time reduction, less surgical bleeding.
The XPS GreenLight Laser is a system that afford the urologist an effective treatment option for BPH however with shorter length of stay in hospital, less operative catheter time and surgical bleeding. The cost of one fiber is 1200 € that is more expansive that a TURP procedure but we have to consider that a patient can be dismissed 24 hours after the procedure without catheter. We have been able to treat larger gland (until 80 ml) with significantly quicker operative time without compromise surgical outcomes and significant complications. Moreover, the XPS GreenLight Laser can be a chance to patients which can’t be undergone traditional surgery

==fine conclusion==

==inizio reference==

1) Can J Urol. 2011 Oct;18(5):5918-26.
GreenLight 180W XPS photovaporization of the prostate: how I do it.
Zorn KC1, Liberman D.
2) Minerva Urol Nefrol. 2016 Dec 1. [Epub ahead of print]
Green light vaporization of the prostate (PVP): is it an adult technique?
Brassetti A1, De Nunzio C, Barry Delongchamps N, Fiori C, Porpiglia F, Tubaro A
3) Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate.
Benejam-Gual JM, Sanz-Granda A, Budía A, Extramiana J, Capitán C.
Actas Urol Esp. 2014 Jul-Aug;38(6):373-7. doi: 10.1016/j.acuro.2013.10.011. English, Spanish
4) Direct Comparison of GreenLight Laser XPS Photoselective Prostate Vaporization and GreenLight Laser En Bloc Enucleation of the Prostate in Enlarged Glands Greater than 80 ml: a Study of 120 Patients.
Misrai V, Kerever S, Phe V, Zorn KC, Peyronnet B, Rouprêt M.
J Urol. 2016 Apr;195(4 Pt 1):1027-32. doi: 10.1016/j.juro.2015.10.080

==fine reference==

==inizio objective==

The aim of our study was to evaluate the effect of silodosin in patients with lower urinary tract symptoms associated with benign prostatic enlargement (BPE/LUTS) non-responders to medical terapy with tamsulosin.

==fine objective==

==inizio methodsresults==

Patients who were taking tamsulosin 0,4 mg once daily for BPE/LUTS at last 12 months who visited the our centers from May 2015 to July 2016 were enrolled. The inclusion criteria were as follows: International Prostate Symptoms Score (IPSS) ≥ 8 points; Bother score (BS) ≥ 3 points; prostate volume measured by ultrasonographic method ≤ 40 mL; maximal urinary flow rate (Qmax) < 15 mL/s and post-voiding residual (PVR) ≤ 150 ml. Patients enrolled stopped tamsulosin and began terapy with silodosin 8 mg once daily. The symptom scores and uroflowmetry with PVR evaluation were measured 8 weeks after silodosin administration. Furthermore we investigated adverse drug reactions throughout the study period. The primary end-point of evaluation for efficacy was the change in IPSS and BS from the beginning of silodosin terapy; secondary end-points were changes in objective parameters (Qmax, PVR). Changes from baseline after the initiation of administration were evaluated by t-test. Values are the mean ± standard deviation, and findings of P < 0.05 were considered significant. Statistical analyses were performed with SAS 9.1.3 for Microsoft Windows (SAS Institute Inc, NC, USA). ==fine methodsresults== ==inizio results== One hundred-nine patients were enrolled in the study. Change in IPSS total score after administration of silodosin was -2.8 ± 3.7 (18.6 ± 5.1 versus 15,3 ± 1.9) (p < 0,05). Similar changes were observed in subscores of IPSS, that is, voiding symptoms, storage symptoms and post-micturition symptoms. The results about BS were similar to those for IPSS (4.2 ± 1.2 versus 3.7 ± 1.3) (p < 0,05). Qmax (10.9 ± 2.0 versus 11.9 ± 1.8) and PVR (103.4 ± 34.3 versus 99.6 ± 23.6) were not significantly improved (p > 0,05). Adverse drug reactions were observed in 19 of 109 patients (17.4%) after administration of silodosin. The most frequently observed adverse drug reaction to silodosin was ejaculatory disorder in 7 patients (7.2%).

==fine results==

==inizio discussions==

α1-Blockers (ABs) are frequently prescribed as first-line therapy for the treatment of moderate to severe LUTS/BPE. To date, six ABs have been approved for the treatment of LUTS/BPE: terazosin, doxazosin, tamsulosin, naftopidil (not available in western), alfuzosin (not available in japan) and silodosin. All of them have been reported to significantly improve voiding and storage LUTS(1). Efficacy of ABs was similar. However, their efficacy differs among individuals. Therefore, in daily clinical practice, we switch agents when one is not effective(2). Compared with non-selective ABs, drugs with a high selectivity for α1A-adrenoreceptors (α1A-ARs) may be more prostate-specific and maintain a therapeutic response in the treatment of symptomatic BPE with less systemic adverse effects. Silodosin was demonstrated to have a higher selectivity for the α1A-AR subtype than other ABs(3). A recent meta-analysis demonstrated, for the first time, that ABs can generate significant urodynamic outcomes in patients treated for LUTS/BPE. Interestingly, the meta-analysis showed a statistically significant benefit in favor of AB drugs in terms of bladder outfflow obstruction index (BOOI) and detrusor pressure at maximum flow (PdetQmax). Although no direct comparisons have ever been performed among different ABs, the highest levels of BOOI improvement were reported in the studies on silodosin, which differs from other ABs in its high pharmacologic selectivity for the α1A receptor subtype. However, if and how urodynamic efficacy depends on pharmacologic selectivity is still to be verified(1). Miyakita et al compared the efficacy and safety of silodosin and tamsulosin in LUTS patients with BPE by a randomized crossover method. In this study, silodosin significantly improved storage and post-micturition symptoms in addition to voiding symptoms in both the first and crossover treatment periods. Furthermore, it significantly improved nocturia, which among LUTS markedly affects quality of life, regardless of the period of administration(4). Similar effects we observed in our study in patients with BPE/LUTS non-responders to medical treatment (tamsulosin). IPSS and BS improved while we did not observe changes of Qmax and PVR. Statistical power of our study was weakened. Therefore, further prospective studies should be conducted with greater number of patients. However we think that these preliminary data which is contributed to the literature will be helpful as guiding tools for future investigations.

==fine discussions==

==inizio conclusion==

In our study we showed, for the first time, that silodosin improve symtomps score and quality of life test (IPSS and BS) in patients with LUTS/BPE non-responders to terapy with tamsulosin.

==fine conclusion==

==inizio reference==

(1) Fusco F, Palmieri A, Ficarra V, Giannarini G, Novara G, Longo N, Verze P, Creta M, Mirone V. α1-Blockers Improve Benign Prostatic Obstruction in Men with Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Urodynamic Studies. Eur Urol 2016;69(6):1091-101

(2) Araki T, Monden K, Araki M. Comparison of 7 α1-adrenoceptor Antagonists in Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: A Short-term Crossover Study. Acta medica Okayama 2013;67(4):245-51

(3) Ding H, Du W, Hou ZZ, Wang HZ, Wang ZP. Silodosin is effective for treatment of LUTS in men with BPH: a systematic review. Asian J Androl 2013;15(1):121-8

(4) Miyakita H, Yokoyama E, Onodera Y, Utsunomiya T, Tokunaga M, Tojo T, Fujii N, Yanada S. Short-term effects of crossover treatment with silodosin and tamsulosin hydrochloride for Lower Urinary Tract Symptoms associated with Benign Prostatic Hyperplasia. Int J Urol 2010;17(10):869-75

==fine reference==