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.

Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation

我们证实了一个新奇方法为精索静脉曲张把 transumbilical 称为二港口的 laparoscopic 精索静脉曲张结扎(TTLVL ) ，它仍然被需要评估。在这研究，有等级 II-III 的左自发的征兆的精索静脉曲张的 90 个病人随机根据分级系统的 Dubin 被分到 TTLVL (n = 45 ) 并且常规 laparoscopic 精索静脉曲张结扎(CLVL )(n = 45 ) 。人口统计， intraoperative，手术后，并且后续数据在二个组之间被记录并且比较。在二个组的所有过程没有 intraoperative 复杂并发症和没有变换成功地被完成打开外科。没有重要差别在起作用的时间被发现，恢复在二个组之间的阴囊的疼痛的移动，肠恢复，手术后的医院停留，和手术后的分辨率(P &#x0003e；0.05 ) 。然而，为 TTLVL 组的手术后的吝啬的视觉模拟疼痛规模分数都与 CLVL 相比手术后地是在 24 h， 48 h， 72 h，和 7 天的更少(P = 0.001， 0.010， 0.006，和 0.027，分别地) 。在手术后的月内的吝啬的耐心的疤评价问询表分数 3 为 CLVL 组与 32.1 相比为 TTLVL 组是 29.7 (P &#x0003c；0.001 ) 。没有阴囊的萎缩，在后续时期期间在两个组观察。学习证明 TTLVL 是为精索静脉曲张的治疗的 CLVL 的一种安全、可行、有效的最低限度地侵略的外科的选择。与 CLVL 相比， TTLVL 可以减少手术后伤害并且改善化妆结果。