Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia(2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for "Non-infection"

Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively,in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015,5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study.These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory results,while they had no infection in their blood and urine preoperatively.Without delay,5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours.The body temperature was recovered to normal in 2 or 3 days,and the blood and urine test results were not abnormal in 7 days.At last,5patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy.Especially for patients who had not presented infection preoperatively,careful preparation preoperatively,corrective manipulation,low pressure irrigation,drainage and controlling time during operation,and early diagnosis,appropriate treatment postoperatively are the key to cure and prevent urosepsis.

Prostatic anatomical parameters correlate with clinical characteristics suggestive of benign prostatic hyperplasia

We conducted the present study to assess the correlation of the prostatic anatomical parameters,especially the ratio of peripheral zone thickness and transitional zone thickness,with clinical and uroflowmetry characteristics suggestive of benign prostate hyperplasia(BPH).A total of 468 consecutive patients with a detailed medical history were identified.All patients were evaluated by scoring subjective symptoms with the International Prostate Symptom Score(IPSS)and quality of life(QoL).The prostatic anatomical parameters were measured using transrectal ultrasonography,and postvoid residual urine and maximum flow rate(Q_(max))values were also determined.Pearsonfs correlation analysis revealed that both total prostate volume(TPV;r=0.160,P<0.001)and transitional zone volume(TZV;r=0.104,P=0.016)increased with patients7 age;however,no correlations were observed of TPV,TZV,transitional zone index(TZI),and transitional zone thickness(TZT)with IPSS or QoL(all P>0.05).Peripheral to transitional zone index(PTI)was found negatively correlated with total IPSS(r=-0.113,P=0.024),storage IPSS(r=-0.103,P=0.041),and voiding IPSS(r=-0.123,P-0.014).As regards the uroflowmetry characteristics,PTI(r=0.157,P=0.007)was indicated to be positively correlated with Q_(max)and negatively correlated with TZI(r=-0.119,P=0.042)and TZT(r=-0.118,P=0.045),but not correlated with TPV,TZV,or peripheral zone thickness(PZT)(all P>0.05).Postvoid residual urine(PVR)had not correlated with all the prostatic anatomical variables(all P>0.05).This is the first study that formally proposed the concept of PTI,which is an easy-to-measure prostate anatomical parameter which significantly correlates with total IPSS,storage IPSS,voiding IPSS,and Q_(max),suggesting that PTI would be useful in evaluating and managing men with lower urinary tract symptoms(LUTS)/BPH.However,well-designed studies are mandatory to verify the clinical utility of PTI.

Genetic polymorphisms of CYP2D6*10 and the effectiveness of combined tamoxifen citrate and testosterone undecanoate treatment in infertile men with idiopathic oligozoospermia

Tamoxifen citrate, as the first line of treatment for infertile men with idiopathic oligozoospermia, was proposed by the World Health Organization （WHO）, and testosterone undecanoate has shown benefits in semen values. Our objective was to assess the effectiveness of treatment with tamoxifen citrate and testosterone un- decanoate in infertile men with idiopathic oligozoospermia, and whether the results would be affected by polymor- phisms of CYP2D6＊10. A total of 230 infertile men and 147 controls were included in the study. Patients were treated with tamoxifen citrate and testosterone undecanoate. Sex hormone, sperm parameters, and incidence of spontaneous pregnancy were detected. There were no significant differences between the control and patient groups with respect to CYP2D6＊10 genotype frequencies （P〉0.05）. The follicle-stimulation hormone （FSH）, luteinizing hormone （LH）, and testosterone （T） levels were raised, and sperm concentration and motility were increased at 3 months and became significant at 6 months, and they were higher in the wild-type allele （C/C） than in the heterozygous variant allele （C/T） or homozygous variant allele （T/T） subgroups （P〈0.05）. In addition, the percentage of normal morphology was raised at 6 months, and represented the highest percentage in the C/C subgroup （P〈0.05）. The incidence of spontaneous pregnancy in the C/C subgroup was higher than that in the C/T or T/T subgroups （P〈0.01）. This study showed that the CYP2D6＊10variant genotype demonstrated worse clinical effects in infertile men with idiopathic oligozoospermia.

Metabolic enzyme gene polymorphisms predict the effects of antioxidant treatment on idiopathic male infertility

To explore the relationship between genetic polymorphisms of metabolic enzymes such as CYP1A1,CYP2D6,GSTM1,GSTT1,and GSTP1 and idiopathic male infertility.By observing the efficacy of antioxidants in the treatment of idiopathic male infertility,the effect of metabolic enzyme gene polymorphisms on antioxidant therapy in patients with idiopathic male infertility was prospectively studied.This case-control study included 310 men with idiopathic infertility and 170 healthy controls.The cytochrome P4501A1(CYP1A1),cytochrome P4502D6(CYP2D6),glutathione S-transferase M1(GSTM1),glutathione S-transferase T1(GSTT1),and glutathione S-transferase P1(GSTP1)genotypes in peripheral blood samples were analyzed by polymerase chain reaction(PCR)and PCR-restriction fragment length polymorphism(PCR-RFLP).The idiopathic male infertility group was treated with vitamin C,vitamin E,and coenzyme Q10 for 3 months and followed up for 6 months.GSTM1(-),GSTT1(-),and GSTM1/T1(-/-)in the idiopathic male infertility groups were more common than those in the control group.The sperm concentration,motility,viability,mitochondrial membrane potential(MMP),and seminal plasma total antioxidant capacity(T-AOC)level in patients with GSTM1(-),GSTT1(-),and GSTM1/T1(-/-)were lower than those in wild-type carriers,and the sperm DNA fragmentation index(DFI),8-hydroxy-2'-deoxyguanosine(8-OH-dG),and malondialdehyde(MDA)and nitric oxide(NO)levels were higher.Therefore,oxidative damage may play an important role in the occurrence and development of idiopathic male infertility,but antioxidant therapy is not effective in male infertility patients with GSTM1 and GSTT1 gene deletions.