目的研究经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)与经尿道双极等离子前列腺剜除术(transurethral bipolar plasma kinetic enucleation and resection of the prostate,PKERP)治疗前列腺增生的疗...目的研究经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)与经尿道双极等离子前列腺剜除术(transurethral bipolar plasma kinetic enucleation and resection of the prostate,PKERP)治疗前列腺增生的疗效差异。方法选取2020年8月至2022年8月聊城市第二人民医院泌尿外科收治的前列腺增生患者90例,随机分为HoLEP组(45例,HoLEP治疗)、PKERP组(45例,PKERP治疗),比较两组围术期指标,测量术前、术后血清炎性因子、疼痛介质水平及最大尿流率,评估患者术后疼痛情况,统计术后并发症。结果HoLEP组术中出血量、膀胱冲洗天数、住院天数、导尿管留置天数均显著少于PKERP组;术后1周HoLEP组最大尿流率高于PKERP组;术后1天HoLEP组血清白介素-2(interleukin-2,IL-2)、白介素-6(interleukin-6,IL-6)均显著低于PKERP组(P<0.05);术后1天HoLEP组血清前列腺素E2(prostaglandin E2,PGE2)、5-羟色胺(5-hydroxy tryptamine,5-HT)水平显著低于PKERP组(P<0.05);术后1天、2天、3天HoLEP组疼痛视觉模拟评分法(visual analogue scale,VAS)均显著低于PKERP组,差异均有统计学意义(P<0.05);HoLEP组并发症发生率显著低于PKERP组(P<0.05)。结论HoLEP治疗前列腺增生,可显著下调患者术后炎性因子及疼痛介质水平,减轻患者术后疼痛感,且具有创伤性小、并发症少的优点。展开更多
Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retro...Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.展开更多
<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the ...<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. <strong>Materials and Methods:</strong> During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. <strong>Results:</strong> TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. <strong>Conclusion:</strong> TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.展开更多
文摘目的研究经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)与经尿道双极等离子前列腺剜除术(transurethral bipolar plasma kinetic enucleation and resection of the prostate,PKERP)治疗前列腺增生的疗效差异。方法选取2020年8月至2022年8月聊城市第二人民医院泌尿外科收治的前列腺增生患者90例,随机分为HoLEP组(45例,HoLEP治疗)、PKERP组(45例,PKERP治疗),比较两组围术期指标,测量术前、术后血清炎性因子、疼痛介质水平及最大尿流率,评估患者术后疼痛情况,统计术后并发症。结果HoLEP组术中出血量、膀胱冲洗天数、住院天数、导尿管留置天数均显著少于PKERP组;术后1周HoLEP组最大尿流率高于PKERP组;术后1天HoLEP组血清白介素-2(interleukin-2,IL-2)、白介素-6(interleukin-6,IL-6)均显著低于PKERP组(P<0.05);术后1天HoLEP组血清前列腺素E2(prostaglandin E2,PGE2)、5-羟色胺(5-hydroxy tryptamine,5-HT)水平显著低于PKERP组(P<0.05);术后1天、2天、3天HoLEP组疼痛视觉模拟评分法(visual analogue scale,VAS)均显著低于PKERP组,差异均有统计学意义(P<0.05);HoLEP组并发症发生率显著低于PKERP组(P<0.05)。结论HoLEP治疗前列腺增生,可显著下调患者术后炎性因子及疼痛介质水平,减轻患者术后疼痛感,且具有创伤性小、并发症少的优点。
文摘Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.
文摘<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. <strong>Materials and Methods:</strong> During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. <strong>Results:</strong> TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. <strong>Conclusion:</strong> TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.
