目的:探讨经尿道前列腺电切术(TURP)治疗高危良性前列腺增生症(BPH)的术中、术后常见并发症的原因、预防及治疗,提高手术安全性和有效性。方法: 回顾性分析62例高龄合并心肺疾患的前列腺增生症患者行经尿道前列腺电切术(TURP)的临床资料。结果: 62例排尿困难症状均改善,其中1例出现暂时性尿失禁,2月后好转,尿路感染7例,消炎治疗后好转,5例出现肉眼血尿,做对症处理后血尿消失,无输血病例,无经尿道电切综合征(TURS)发生。结论:采用TURP是良性前列腺增生症安全有效的外科治疗方法,疗效满意,并发症少,安全性高,住院时间短,费用低。
Objective To compare the effectiveness and safety of transurethral plasma kinetic enucleation of the prostate (TPKEP) and transurethral resection of the plasma (TURP) in patients with benign prostate hyperplasia (BPH) on the basis of bipolar plasma kinetic technology. Methods Eighty BPH patients who met the included criteria were assigned to two groups according to block balanced randomization, of which, 40 received TPKEP and the others received PKRP. We conducted statistical analysis after recording the clinical outcomes including international prostate symptom score (IPSS), quality of life (QOL), maximum flow (Qmax), post void residual urine volume (PVR), rates of prostate coated perforation, blood loss in the operation, duration of operation, time of bladder irrigation, duration of indwelling catheter, post-operative adverse effects, etc. Results The two groups were consistent at baseline before operation. The results of the analysis of clinical outcomes showed that, the TPKEP group was superior to the TURP group in prostate coated perforation (2 cases vs. 8 cases), hemoglobin in flushing fluid (index of blood loss, 10.95±5.02 g vs. 15.8±5.86 g), duration of operation (45.13±11.22 min vs. 53.33±8.69 min), time of bladder irrigation (12.58±2.77 h vs. 22.1±2.33 h), duration of indwelling catheter (65.13±10.67 h vs. 84.5±5.67 h), post-operative irritation sign of the bladder and urethra (5 cases vs. 12 cases), and the event of indwelling catheter after removal (0 cases vs. 4 cases), with significant differences; however, the TPKEP group was higher than the TURP group in the incidence of transient uracratia (10 cases vs. 3 cases), with a significant difference. The results of a 6-month follow-up showed that, no significant difference was found between the two groups in IPSS (2.78±1.03 vs. 2.40±1.13), QOL (1.28±0.45 vs. 1.45±0.51), Qmax (21.10±2.68 vs. 20.58±2.57), and PVR (2.82±2.90 vs. 2.18±2.27), respectively (Pgt;0.05). Long-term uracratia, urethrostenosis and secondary bleeding were not observed after operation in both groups. Conclusions TPKEP and TURP were alike in the short-term effectiveness of operation. TPKEP is safer than the TURP, which is regarded as a fairly ideal method for treating symptomatic BPH. However, the long-term effectiveness of TPKEP is yet to be further proved by large-scale randomized controlled trials with long-term follow-up.
Objective To evaluate the effect of pretreatment with epristeride on decreasing intraoperative bleeding during transurethral resection of prostate (TURP) and to study its mechanism. Methods A total of 60 patients with benign prostatic hyperplasia undergoing TURP were divided into two groups: 30 patients were pretreated with epristeride 5 mg×2 daily for 7 to 11 days before TURP, and 30 patients did not receive any pretreatment. The operations for the two groups of patients were conducted by the same doctors. The operation time, the weight of resected prostatic tissue, and the volume of irrigating fluid were recorded. Blood loss, bleeding index, and bleeding intensity were calculated. Microvessel density (MVD), vascular endothelial growth factors (VEGF), and nitric oxide synthase type III (eNOS) expression were measured by the immunohistochemistry SPmethod in prostatic tissue. Results In the epristeride and control groups, the mean blood loss was 179.51±78.29 ml and 237.95±124.38 ml (Plt;0.05); the mean bleeding index was 7.68±3.94 ml/g and 9.73±3.42 ml/g (Plt;0.05); the mean bleeding intensity was 2.43±1.03 ml/min and 3.30±1.50 ml/min (Plt;0.05); the mean value of MVD was 18.80±5.68 and 23.70±4.91 (Plt;0.05); the mean rank of VEGF was 23.48 and 31.77 (Plt;0.05); and the mean rank of eNOS was 22.36 and 31.14 (Plt;0.05), respectively. Conclusion Pretreatment with epristeride decreases intraoperative bleeding during TURP. The preliminary results suggest that angiogenesis in the prostatic tissue is suppressed.
【摘要】 目的 探讨采用不同方法经尿道前列腺等离子双极电切术（plasmakinetic resection of prostate，PKRP）的方法及疗效。 方法 2008年7月-2009年12月，应用不同方法行PKRP治疗156例前列腺增生。患者年龄59~87岁，平均74岁。病程20 d~18年。前列腺重量22~100 g，平均38 g。采用单纯顺行电切法治疗38例，部分剜除分割切除法治疗76例，完全剜除法治疗42例。 结果 156例手术均获成功，手术时间平均90 min。获得前列腺组织12~87 g，平均35 g。术后留置导尿管平均5.5 d，住院时间平均6.5 d。术后组织病理学诊断为良性前列腺增生152例，前列腺癌4例。拔除尿管后均能自主排尿，部分患者术后有尿道刺激症状；术后1个月内出现尿道外口狭窄3例，经尿道扩张治愈。随访时间1~12个月，平均6个月。短期尿失禁3例，时间分别为1周、1个月及3个月；无长期尿失禁。术后3个月国际前列腺症状评分（IPSS）症状评分平均减少24分，生活质量评分平均减少3分。 结论 PKRP安全、有效、并发症少，可针对患者情况采用不同切割方法，效果更佳。【Abstract】 Objective To explore the effects and methods of transurethral plasmakinetic resection of prostate(PKRP). Methods A total of 156 patients with prostatic hyperplasia were treated with various methods of transurethral PKRP from July 2008 to December 2009. Patient’s age ranged from 59 to 87 years,74 years on average. The disease duration was 20 days to 18 years.Method one:anterograde resection in 38 patients; method two:partition retrograde enucleation in 76 patients; method three:completely retrograde enucleation in 42 patients. Results All of the swgeries were successful. The mean duration of the operation was 90 minutes.The collected prostatic specimens were 12-87 g,35 g on average. The mean catheter remaining dwation was 5.5 days.The mean postoperative hospital stay was 6.5 days. Conclusions PKRP is safe and effective. It is effective with various methods of transurethral plasmakinetic resection of prostate.
Objective To evaluate the correlation between benign prostatic hyperplasia (BPH) and metabolic syndrome (MS). Methods Total 666 elderly male patients admitted to West China Hospital for routine physical examination in May, 2010 were included in this study. The related laboratory tests of BPH and MS were taken. The correlation among BPH, lower urinary tract Symptoms (LUTS), prostate volume (PV), MS and its component diseases were analyzed. Results Hypertension was an important risk factor for BPH (OR=1.309, 95%CI 1.033 to 1.661), low HDL-C hyperlipidemia was a risk factor for IPSS scored over 7 points (OR=1.573, 95%CI 0.330 to 0.997), and the score of PV was positively correlated to obesity, hypertension, low HDL-C hyperlipidemia and MS (all Plt;0.05). Conclusion For the patient with BPH, MS and its component diseases mainly exert their effects on PV changes rather than LUTS.
ObjectivesTo systematically evaluate the efficacy and safety of 1 470 nm laser vaporization vs. transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) about the efficacy and safety of 1 470 nm laser vaporization vs. TURP for BPH from inception to October 22nd, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 6 RCTs and 4 non-RCTs were included. The results of meta-analysis showed that: 1 470 nm laser vaporization was superior to TURP in reducing intraoperative bleeding (MD=−103.87, 95%CI −148.08 to −59.65, P<0.000 01), hospital stay (MD=−3.82, 95%CI −4.35 to −3.28, P<0.000 01), postoperative indwelling catheter time (MD=−2.24, 95%CI −3.45 to −1.02, P=0.000 3), postoperative hemoglobin (MD=−1.63, 95%CI −3.14 to −0.12, P=0.03) and rate of secondary hemorrhage (OR=0.13, 95%CI 0.03 to 0.48, P=0.002). There were no significant differences in operative time, bladder irrigation time, transient urinary incontinence and urethral stricture, IPSS Score and Qmax at 3 months after operation between the two groups (P>0.05).ConclusionCurrent evidence shows that 1 470 nm laser vaporization is superior to TURP in reducing intraoperative bleeding and secondary hemorrhage. It may be more suitable for prostate surgery in anticoagulant or coagulative dysfunction patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To objectively evaluate the efficacy and safety of plasmakinetic enucleation for prostate (PKEP) vs plasmakinetic resection for prostate (PKRP) in treating benign prostate hyperplasia (BPH). Methods Such databases as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from their establishment to March 2011 for collecting the randomized controlled trials (RCTs) about PKEP vs PKRP for the treatment of BPH, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction conducted by two reviewers independently, meta-analyses were performed by using the RevMan 5.1 software. The level of evidence was assessed by using the GRADE system. Results Eight studies involving 991 patients were included. The results of meta-analyses showed that: a) safety indicator: compared with the PKRP, PKEP had shorter operation time (SMD=1.07, 95%CI 0.19 to 1.94, P=0.02), less intraoperative bleeding (SMD=2.06, 95%CI 1.42 to 2.69, Plt;0.01), much quantity of resectable prostate (SMD= –0.91, 95%CI –1.33 to –0.48, Plt;0.000 1), less intraoperative perforation (RR=4.48, 95%CI 1.43 to 14.02, P=0.01), shorter catheterization time (SMD=1.98, 95%CI 0.39 to 3.57, P=0.01), shorter bladder irrigation time (SMD=3.49, 95%CI 0.51 to 6.47, P=0.02) and shorter hospital stay (SMD=0.89, 95%CI 0.64 to 1.13, Plt;0.01), but there was no significant difference in total postoperative complications (RR=0.82, 95%CI 0.54 to 1.24, P=0.35); and b) efficacy indicator: compared with the PKRP, the International Prostate Symptom Score (IPSS) was lower after 3 months, the Quality Of Life (QOL) was higher after 3 months, and the improvement of residual urine volume (RUV) was better after 6 months; but other efficacy indicators had no significant difference between the two groups (Pgt;0.05). Based on GRADE system, all the evidence was at level C and weak recommendation (2C). Conclusion The current evidence indicates that PKEP is similar to PKRP in the treating effect, but it resects the proliferated prostate more cleanly with shorter operation time, lesser bleeding and more safety than PKRP; for the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are need.
ObjectiveTo evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).MethodsRandomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.ResultsA total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=−25.95 mL, 95% confidence interval (CI) (−31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=−10.35 h, 95%CI (−18.25, −2.45) h, P=0.042], average duration of bladder irrigation [WMD=−10.28 h, 95%CI (−17.52, −3.04) h, P=0.038], and average length of hospital stay [WMD=−1.24 d, 95%CI (−1.85, −0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=−0.89 m/s, 95%CI (−1.74, −0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).ConclusionsIn the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.