title: Perioperative management of transurethral surgery for benign prostatic hyperplasia: a nationwide survey in Japan.
abstract: OBJECTIVE
  Various types of minimally invasive surgical treatments, including transurethral resection of prostate (TURP), are being carried out in Japan for patients with benign prostatic hyperplasia (BPH). The aim of the present study was to elucidate the current status of perioperative care for these treatments by carrying out a nationwide survey.
  
  
  METHODS
  Assisted by the Japanese Endourology and ESWL Association, perioperative data from 157 institutions participating in this survey were collected and analyzed.
  
  
  RESULTS
  This survey included 3918 patients undergoing TURP, 242 TUR in saline (TURis), 638 holmium laser enucleation of the prostate (HoLEP), 90 holmium laser ablation (HoLAP) and 241 photoselective vaporization (PVP). Mean operative time was shorter in TURP (71 min) and longer in HoLEP (127). Although no transfusions were required in cases undergoing HoLAP or PVP, blood was frequently transfused in those undergoing TURis (25.6%), TURP (10.2%) and HoLEP (7.8%), and the difference was significant. During the hospital stay, the incidence of TUR-syndrome, postoperative bleeding requiring bladder irrigation, acute urinary retention/difficulty on micturition and pad use at discharge was highest in TURP (2.3%), TURis (7.9%), HoLAP (16.7%) and HoLEP (15.1%), respectively. Two patients undergoing TURP died (0.05%). The shortest mean postoperative hospital stay was for PVP (1.6 days, even if the readmission rate within 90 days was the highest in this same group; 6.2%). Perioperative care during hospital stay varied among the five types of procedures.
  
  
  CONCLUSIONS
  This survey provides useful documentation on the current status of minimally invasive treatments for BPH in Japan. Complication rates for TURP are not significantly higher as compared with other procedures. Thus, TURP can still be considered as the gold standard for BPH treatment.
authors.affiliation: Division of Urology, Department of Surgery and Intensive Care, National Center for Geriatrics and Gerontology, Obu, AichiDepartment of Urology, Graduate School of Medical Sciences, Kyushu University, FukuokaDepartment of Urology, Graduate School of Medicine, Tohoku University, Sendai, MiyagiDepartment of Urology and Andrology, Kansai Medical University, Hirakata, OsakaDepartment of Urology, Nagoya University Graduate School of Medicine, Nagoya, AichiDepartment of Public Health, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Kikuo
authors.initials: K
authors.lastname: Okamura
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nojiri
authors.forename: Narihito
authors.initials: N
authors.lastname: Seki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D006306:Health Surveys; D006801:Humans; D007564:Japan; D008297:Male; D019990:Perioperative Care; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate