Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Mar 12, 2019; 8(1): 1-8
Published online Mar 12, 2019. doi: 10.5410/wjcu.v8.i1.1
Prostate resection speed: A key factor for training and broad outcomes?
Jack Donati-Bourne, Shahd Nour, Emiliya Angova, George Delves
Jack Donati-Bourne, Shahd Nour, Emiliya Angova, George Delves, Department of Urology, Queen’s Hospital Burton NHS Foundation Trust, Burton-on-Trent DE13 0RB, United Kingdom
Author contributions: Donati-Bourne J conceived the study, data collection, data analysis, drafted first and final manuscript; Nour S participated in data collection, data analysis and drafted first manuscript; Angova E participated in data collection, data analysis and drafted first manuscript; Delves G participated in data analysis, review of draft and final manuscript.
Institutional review board statement: Ethics approval from the Queen’s Hospital Burton NHS Foundation Trust was not required for this study, due to retrospective observational study design.
Informed consent statement: Retrospective observational study design with no identifiable patient data, therefore consent not required for conduct of study.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jack Donati-Bourne, MBChB, MSc, Surgeon, Department of Urology, Queen’s Hospital Burton NHS Foundation Trust, 81 Ravenhurst Road, Burton-on-Trent DE13 0RB, United Kingdom. dr.donatibourne@gmail.com
Telephone: +44-01283-566333
Received: September 24, 2018
Peer-review started: September 25, 2018
First decision: November 20, 2018
Revised: November 22, 2018
Accepted: January 21, 2019
Article in press: January 22, 2019
Published online: March 12, 2019
Processing time: 169 Days and 10.1 Hours
ARTICLE HIGHLIGHTS
Research background

Trans-urethral resection of prostate (TURP) is one of the most commonly performed operations in urology to treat bladder outflow obstruction (BOO) in men as well as a key endo-urological training tool in the British National Health Service (NHS) for training junior urologists. The working hypothesis is that prostate resection speed (PRS) in the context of bipolar TURP surgery, is not a key factor in major complication rates or broad patient outcomes at 3 mo after surgery, and therefore supervising consultants should not focus primarily on resection speed when teaching TURP.

Research motivation

The study was motivated to identify whether resection speed during TURP training should be a key factor.

Research objectives

The main objective was to identify whether TURP resection speed affected significant complication and broad outcomes at 3 mo. The study found that resection speed did not correlate with significant complication and broad outcomes at 3 mo. The authors propose that PRS should not be a key factor during TURP training.

Research methods

Participants included: all Bipolar TURPs undertaken between 13/04/2016 and 27/06/2017. Exclusions: patients undergoing concomitant operations or where intra-operative equipment problems occurred. Patients identified via operative logbooks and case notes retrieved electronically.

Research results

The study found that PRS did not correlate with significant complication and broad outcomes at 3 mo. The authors propose a similar study with increased power and qualitative assessment of symptomatic improvement in relation to PRS.

Research conclusions

PRS did not correlate with significant complication and broad outcomes at 3 mo. The authors conclude that PRS should not be a key factor during TURP training as increasing experience will lead to natural acquisition of speed. PRS is not a cardinal factor in bipolar TURP surgery for significant complication rates or broad outcomes 3 mo after surgery. In the era of monopolar TURP resection, PRS was highly relevant due to risks of TURP syndrome. In bipolar surgery the use of saline as irrigation fluid minimises this risk. Therefore the authors propose a paradigm shift in training whereby less focus is placed on PRS and greater emphasis on sound safe surgical technique.

Research perspectives

The authors propose a paradigm shift in training whereby less focus is placed on PRS and greater emphasis on sound safe surgical technique. The authors propose a similar study with increased power and qualitative assessment of post-operative symptomatic improvement in relation to PRS. Prospective high-powered study with IPSS evaluation pre- and post-TURP and correlation with PRS.