Associations among benign prostate hypertrophy, atypical adenomatous hyperplasia and latent carcinoma of the prostate

Aim： To investigate the frequency of atypical adenomatous hyperplasia （AAH） and its associations with benign prostate hypertrophy （BPH） and latent histological carcinoma of the prostate （LPC） in autopsy material. Methods： Two hundred and twelve prostate specimens obtained from autopsy material were subjected to whole mount analysis in an attempt to investigate the associations among BPH, AAH and LPC. Results： Most histological carcinomas and AAH lesions were found in enlarged prostates with intense hypertrophy. No statistically significant relation was found between BPH and the main characteristics of LPC, such as tumor volume, histological differentiation and biological behavior. Our data regarding multi-focal tumors showed a tendency for multi-focal carcinomas to develop in larger prostates, and a tendency of AAH lesions to develop in larger prostates. No statistically significant relation was found between AAH and LPC. Conclusion： There seems not any causative aetiopathogenetical or topographical relation between AAH lesions and prostate adenocarcinoma. AAH lesion seems to be a well-defined mimicker of prostatic adenocarcinoma, and the reported association of AAH with prostatic carcinoma could probably be an epiphenomenon.

Efficacy of Bladder Neck Incision (BNI) Versus Transurethral Resection of Prostate (TURP) in Management of Benign Prostatic Hyperplasia (BPH) Causing Obstruction: A Randomised Controlled Study

Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.

Correlation between the International Prostate Symptom Score, Ultrasound Features and Maximum Flow Rate in Cameroonian Patients with Benign Prostatic Hypertrophy

Background: Benign prostatic hypertrophy is the non-malignant stromal and epithelial proliferation of the prostate gland, with or without associated anatomical enlargement of the gland and clinical symptoms. Symptomatic Benign prostatic hypertrophy may cause obstructive symptoms, irritative symptoms or both obstructive symptoms include a sensation of incomplete bladder emptying, straining to void, urinary hesitancy and weak stream while irritative symptoms include dysuria, nocturia, urinary frequency and urinary urgency. A quantitative measure of the severity of lower urinary tract symptoms due to benign prostatic hypertrophy can be obtained using the International Prostate Symptoms Score. Ultrasonography is useful for helping to determine bladder and prostate size in patients with urinary lower urinary tract symptoms. Uroflowmetry is a non-invasive test that assesses voiding function. It provides valuable data on the voided volume, time is taken to reach maximum flow rate and average flow rate. The goal of this study was to improve the follow up of patients with benign prostatic hypertrophy by providing simple, available, affordable and non-invasive that best predict bladder outlet obstruction and the quality of life in these patients. Method: This was a cross-sectional analytic study carried out over a period of five months from May 2020 to September 2020 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, which is a tertiary hospital in Cameroon. Were included in the study, adult males who presented with lower urinary tract symptoms and prostatic enlargement suggestive of benign prostatic hypertrophy taking into account clinical, uroflowmetry and ultrasound findings. Results: A study population of 103 participants was recruited. The mean age of patients was 63.17 ± 10.26 years. Concerning the International Prostate Symptoms Score, the mean total, voiding (obstructive) and storage (irritative) scores were 14.6 ± 6.2, 8.5 ± 4.1 and 6.05 ± 2.7 respectively. The mean maximum flow rate was 13.44 ± 3.88 mL/s. The mean prostate volume was 53.71 ± 16.46 ml. A majority of patients have an enlarged prostate 1.5 to 2 times (46 to 60 mL) the upper limit for normal value. The intravesical prostatic protrusion was present in eighty-three (80.58%) and absent in 20 (19.42%). Above a prostate volume of 60 mL, 91% to 100% of our patients had intravesical prostatic protrusion. There was strong evidence (p < 0.001) that a change from no intravesical prostatic protrusion to intravesical prostatic protrusion grade 1 increased the chances of having a low maximum flow rate with a crude odds ratio of 7.98. The adjusted odds ratio after multivariate analysis was 5.26 and this remained statistically significant (p = 0.03). Conclusion: the measure of intravesical prostatic protrusion is superior to the prostate volume in the assessment of maximum flow rate and thus the follow up of patients with benign prostatic hypertrophy. This measure which is non-invasive, easy to measure, easily accessible, and cost effective may be a useful tool in predicting voiding dysfunction and acute urinary retention.

Effect of Preoperative Dutasteride on Bleeding Related to Transurethral Resection of Prostate in Patients with Benign Prostatic Hyperplasia

Background: Transurethral resection of prostate (TURP) is the gold standard in the surgical treatment of symptomatic benign prostatic hyperplasia (BPH). Blood loss is one of the most common complications of TURP. Objective: To evaluate the effect of preoperative dutasteride on bleeding related to TURP in patients with BPH. Materials and Methods: This prospective interventional study was done in the department of urology, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period of July 2016 to June 2017. A total of 70 cases of BPH planned for TURP were included in this study according to the statistical calculation. Patients were randomly allocated to control group A (TURP without dutasteride) and dutasteride group B (TURP with dutasteride). Each group consisted of 35 patients. Group B patients were treated with dutasteride 0.5 mg/day for 4 weeks before TURP. The main outcome of blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before and 24 hours after surgery. Data were analyzed and compared by statistical tests. Results: Comparison of outcome between groups shows that there was a significant difference in term of pre-post operative change of hemoglobin and hematocrit levels in the control group A compared to the dutasteride group B (Hb = 2.96 ± 0.80 gm/dl vs. 1.81 ± 0.71 gm/dl, respectively, p = 0.001;Hct = 11.20% ± 2.12% vs. 6.07% ± 2.02%, respectively, p = 0.02). A significant lower mean blood loss was observed in the dutasteride group compared to the control group. Conclusion: Preoperative dutasteride therapy reduces blood loss related to TURP in patients with BPH. This therapy can be practiced to reduce surgical bleeding associated with TURP.

Evaluating the Influence of the Prostate Weight on the Morbidity and Mortality of Transvesical Open Prostatectomy: Prospective Analysis of 108 Cases in the Urology-Andrology Department of the Ignace Deen National Hospital in Conakry

Introduction: Open transvesical prostatectomy remains today one of the most effective approaches for the management of benign prostatic hyperplasia despite the fact that, this method is associated with multiple complications. The objective of this study was to evaluate the influence of prostate weight on the morbidity and mortality of transvesical prostatectomy for adenoma in the urology-andrology department of the Ignace Deen National Hospital. Materials and Methods: This was a prospective, longitudinal and analytical study lasting 6 months, from March 1, 2022 to August 31, 2022 including patients admitted and operated on by open transvesical prostatectomy by assessing the influence of prostate weight on the morbidity and mortality of transvesical adenomectomies. Results: 108 patients were included in our study, the average age of our patients was 70 ± 7.7 years, cultivators were the most represented profession with 38.89%, and hypertension was the most represented comorbidity with 75%. 33.06% of cases became complicated and surgical wound infection was the main complication with a frequency of 17.40%. Statistical analysis did not conclude that, the prostate weight does not have a statistically significant influence on the morbidity and mortality of transvesical open prostatectomy for benign prostatic hyperplasia. Conclusion: Prostate weight has no influence on the morbidity and mortality of transvesical prostate adenoma.

The Clinical Effect of Bipolar Transurethral Resection in Saline of Benign Prostate Hyperplasia with Long Term Follow-Up

Transurethral resection of the prostate (TURP) is considered as the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Long-term follow-up of the clinical effect of bipolar transurethral resection of the prostate (B-TURP) in saline for BPH is required. Objective: To compare, with long term follow-up, the efficacy and safety of B-TURP in the treatment of BPH with prostate gland volumes of 45 ml, and larger than 60 ml. Materials and Methods: From January 2006 to December 2016, 318 patients with a mean age of 69.45 ± 8.37 years and a median prostate volume of 42 cm3 (56.51 - 32.47) were treated with B-TURP by single urologist (SP) at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. We retrospectively analyzed the perioperative status of patients’ status follow-up for at least 6 months and up to 5 years. Post-void residual (PVR) and maximum flow rate (Qmax) were assessed preoperatively and postoperatively. Operative time, length of catheterization and hospitalization and complications were all reported. Results: The main indication for B-TURP was failure of medication (81.13%). Perioperative results showed no statistical significance among the groups in terms of catheterization days and the hospitalization length. During the follow-up, the improvement of postoperative parameters was compared with preoperative subscales, at different periods from baseline and after 24, 36, 48, and 60 months post treatment. PSA, Q max, PVR, and average flow rate were significantly different from pre-operation data (p Conclusion: With long-term follow-up, B-TURP is a safe and effective technique for BPH management with prostate gland 45 ml and larger than 60 ml.

Evaluation of the tumor angiogenesis in benign prostate hyperplasia and prostatic cancer with MR perfusion-weighted imaging

Objective： To explore the application of MR perfusion-weighted imaging （PWI） in the benign and malignant prostate diseases, and evaluate the correlations of PWl features with vascular endothelial growth factor （VEGF） and microvessel density （MVD）. Methods： Seventy-four consecutive patients who were diagnosed clinically for the prostate diseases, including forty-four cases with benign prostate hyperplasia and thirty cases with prostatic cancer proved pathologically, were examined by PWI. MVD and VEGF were stained with immunohistochemical methods. Some parameters of PWl, including the steepest slope of signal intensity-time curve （SSmax） and the change in relaxation rate （ΔR2^＊ peak） at lesions, were analyzed. Correlation analysis was used to determine the relationship between the results of PWl and immunohistochemistry. Results： （1） In the benign prostate hyperplasia （BPH）, SSmax and ΔR2^＊ peak of perfusion curve were 34.2 ± 2.9 and 1.49 ± 0.11, respectively; however, in the prostatic cancer （Pca）, they were 58.6± 4.8 and 3.18 ±0.49 respectively; there were statistical differences （t = 2.16 and 2.31, P 〈 0.05）. （2） The VEGF and MVD expressions of thirty Pca patients were significantly higher than those of forty-four BPH patients （x2 = 28.64, P 〈 0.01; t = 21.2, P 〈 0.01）. MVD expressions of Pca and BPH groups showed positive associations with VEGF expressions （P 〈 0.01）. On MR perfusion-weighted imaging, SSmax and ΔR2^＊ peak showed associations with MVD and VEGF expressions （P 〈 0.01）. Conclusion： On MR perfusion-weighted imaging, SSmax and ΔR2^＊ peak can reflect MVD and VEGF expression levels in the benign and malignant prostate diseases and might be implied the tumor angiogenesis so as to distinguish benign from malignant and provide the important information for the surgeon to diagnose and treat the prostatic diseases.

Transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia ( BPH) . Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm la-

Significance of preoperative detrusor contractility to the postoperative assessment of prostatectomy for benign prostatic hyperplasia

Objective To study the value of preoperative detrusor contractility to the outcome assessment of prostatectomy for benign prostatic hyperplasia ( BPH) . Methods A total of 109 patients with BPH were analyzed. Their ages ranged from 62 to 83 years with a mean of

Efficacy and safety of Chinese herbal medicine for benign prostatic hyperplasia： systematic review of randomized controlled trials

Chinese herbal medicine is commonly used as a treatment for benign prostatic hyperplasia （BPH）, but its efficacy and safety remain to be examined. To compare the efficacy and adverse events of Chinese herbal medicine alone or used adjuvantly with Western medications for BPH. Two independent reviewers searched the major electronic databases for randomized controlled trials comparing Chinese herbal medicine, either in single or adjuvant use with Western medication, with placebo or Western medication. Relevant journals and grey literature were also hand-searched. The outcome measures included changes in urological symptoms, urodynamic measures, prostate volume and adverse events. The frequency of commonly used herbs was also identified. Out of 13 922 identified citations of publications, 31 studies were included. Eleven studies with a Jadad score i〉 3 were selected for meta-analysis. Chinese herbal medicine was superior to Western medication in improving quality of life and reducing prostate volume. The frequency of adverse events in Chinese herbal medicine was similar to that of placebo and less than that of Western medication. The evidence is too weak to support the efficacy of Chinese herbal medicine for BPH due to the poor methodological quality and small number of trials included. The commonly used herbs identified here should provide insights for future clinical practice and research. Larger randomized controlled trials of better quality are needed to truly evaluate the efficacy of Chinese herbal medicine.

Relationship between age and prostate size

In a community-based study, the relationship between age and human prostate size was investigated in a population of men between the ages of 40 and 70 years to determine the normal prostate increase curve equation. One thousand male volunteers were randomly recruited from the Shanghai community, and the length, width, height, volume of the transition zone （TZ） and the whole prostates were measured by transrectal ultrasound （TRUS）. Each volunteer was evaluated bythe International Prostate Symptom Score （IPSS）. Among those who completed the examination, the mean prostate parameters were all positively associated with increased age. There were statistically significant differences between each age group （P〈O.05）. The mean transition zone volume （TZV） had a higher increase rate with age than the mean total prostate volume （TPV）, indicating that the enlargement of the TZ contributed the most to the increase in TPV. While all prostate parameters were positively correlated with the IPSS, the strongest correlation was associated with the TZ length （TZL） and TZV. The growth curve equations for prostate width, height and length were also positively associated with increasing

Advances in Minimally Invasive Treatment of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a chronic condition that is more common in older men. BPH most commonly causes symptoms associated with LUTS and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) in men with BPH are a major cause of reduced quality of life in older men. If bladder outlet obstruction persists for a longer period of time, the contractility and voiding capacity of the detrusor muscle will gradually be affected by the obstructive factors, eventually leading to a loss of compensatory phase, characterised by a reduced electrical stimulation response, replacement of bladder muscle tissue by connective tissue, and a possible increase in voiding pressure, but a decrease in contractility of the detrusor muscle. As BOO progresses, it eventually leads to permanent contractile dysfunction of the detrusor muscle. Therefore, early initiation of surgical treatment in patients who are not well controlled by medication can reduce the complications associated with prostate enlargement. With the rise of minimally invasive treatment and the complications of open surgery, minimally invasive treatment of BPH has attracted increasing attention. Various emerging minimally invasive surgical modalities are being developed in clinical practice, and more and more minimally invasive techniques and concepts are focusing on safety, improving quality of life and reducing long-term complications to meet the different needs of different patients. Transurethral resection of the prostate (TURP) is currently the “gold standard” of minimally invasive surgical treatment, but with concerns about post-operative complications, the search for safer and more effective minimally invasive surgical options has become even more important. In recent years, with the increasing clinical application of new minimally invasive techniques such as various lasers, interventional treatments and implantable devices, there are more options for minimally invasive treatment of BPH. This article provides a brief review of research advances in the minimally invasive treatment of benign prostatic hyperplasia, with a view to informing clinical decisions.

A Review on Urinary Incontinence after Surgery for Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is characterized by the abnormal proliferation of cells, leading to structural changes. It is one of the most common diseases in ageing men. Its clinical presentations are dominated by lower urinary tract symptoms (LUTS). The therapeutic methods can be grouped into two options: the medical option and the surgical option in which prostate enucleation is found. In recent years many studies have reported the onset of urinary incontinence (UI) after prostate enucleation. The management of UI occurring after prostate enucleation is embarrassing for both the practitioner and the patient, and generates additional costs. Purpose: Cite the causes of UI after prostate enucleation for BPH, as well as ways to prevent the onset of UI after this surgery, specifically by the study of the vesicosphincteric system aimed at improving the technique of enucleation;our review will also deal with the therapeutic means of UI. Method: We retrieved studies from Science Direct, Wiley and Pubmed. Results: There are multiple etiologies of UI after prostate enucleation including urethral sphincter insufficiency (USI) and bladder dysfunction (BD). The management of UI after surgery could be conservative, surgical, or use new technologies. Urodynamic assessment before prostate enucleation for BPH is relevant. Conclusion: UI is a common post-operative complication of prostate enucleation. The study of the vesicosphincteric system leads us to believe that prostate enucleation for BPH, partially sparing the mucosa and the external urethral sphincter could decrease the incidence of UI after surgery.

Trace Element Levels in Prostate Gland as Carcinoma’s Markers

Objectives: The aim of this study was to evaluate the changes in the prostatic levels of trace elements in the malignant human prostate. Methods: Contents of 43 trace elements in normal (N, n = 37), benign hypertrophic (BPH, n = 32) and cancerous (PCa, n = 60) prostate were investigated. Measurements were performed using instrumental neutron activation analysis and inductively coupled plasma mass spectrometry. Results: The mass fractions of all trace elements with the exception of La, Nb, and Yb show significant variations in cancerous prostate when compared with normal and BPH prostate. The contents of Co, Hg, Rb, Sc, Se, and Zn were significantly lower and those of Ag, Al, Au, B, Be, Bi, Br, Ce, Cr, Cs, Dy, Er, Gd, Ho, Li, Mn, Mo, Nd, Ni, Pb, Pr, Sb, Sm, Sn, Tb, Th, Ti, Tl, Tm, U, Y, Yb, and Zr were significantly higher in PCa than in BPH tissues. When trace elements of cancerous prostate were compared with those in normal prostatic parenchyma, contents of Cd, Rb, Sc, Se, and Zn were significantly lower and Ag, Al, Au, B, Be, Bi, Br, Ce, Cr, Dy, Er, Fe, Gd, Hg, Ho, Li, Mn, Nd, Ni, Pr, Sb, Sm, Sn, Tb, Th, Tl, Y, and Zr were significantly higher. Conclusion: The Ag, Al, B, Br, Li, Mn, Ni, and Zn mass fraction in a needle-biopsy core can be used as the informative indicators for distinguishing malignant from benign prostate. Sensitivity, specificity, and accuracy of these tests were in range 72% - 100%, 66% - 100%, and 74% - 98%, respectively.

The Effect of Switching Patients with Symptomatic Benign Prostatic Hyperplasia from Tamsulosin 0.2 mg to 0.4 mg

Objectives: In 2010, tamsulosin 0.2 mg (OD) was withdrawn from Thailand and replaced with tamsulosin 0.4 mg (OD). Therefore, we assessed the impact of this change on the patients, at a men’s health clinic, with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Material and Methods: Subjects were 100 men with BPH who had been taking tamsulosin 0.2 mg as needed for at least 3 months. The outcome measures were IPSS, AMS and IEFF5 scores and uroflowmetry. Tolerability was evaluated on by adverse events. Changes from baseline were assessed using the paired t-test. SPSS version 12.0 was used for statistical analysis, with p 0.05 considered significant. Results: The mean follow up of tamsulosin 0.2 and 0.4 mg were 20.23 and 10.56 months respectively. On switching from tamsulosin 0.2 to 0.4 mg, mean IPSS score improved from 15.54 ± SD 1.25 to 14.13 ± SD 1.09 (p = 0.034), Q max 15.91 cm3/sec ± SD 1.36 to 16.69 cm3/sec ± SD 1.52 (p = 0.128), and nocturia 3.15 ± SD 0.32 to 2.68 ± SD 0.39 (p = 0.015), respectively. However IEFF-5 score and AMS score increased from14.78 ± SD 1.38 to 15.79 ± SD 1.03 (p = 0.0055) and 34.76 ± SD 2.76 to 33.21 ± SD 2.62 (p = 0.0853), respectively. Treatment-related adverse events of Tamsulosin 0.2 mg included dizziness (4%), postural hypotension (3%) and retrograde ejaculation (3%). Interestingly, no withdrawals resulted from adverse events during Tamsulosin 0.4 mg assessment. Conclusions: Switching to tamsulosin 0.4 mg improves LUTS. The change was well tolerated by the majority of patients. Increased symptoms scores of erectile dysfunction and aging male during the study may be due to increased age.

The Outcome of Transvesical Prostatectomy—A Multicenter Retrospective Study

Background: Benign Prostatic Hyperplasia (BPH) is one of the commonest causes of lower obstructive uropathy and usually presents with lower urinary tract symptoms. However, in developing nations, the presentation is late often large prostate and associated complications of bladder outlet obstruction (diverticulae, stones, impaired renal function etc.) warranting open prostatectomy. Objective: The objective of this study is to share our experience of perioperative outcomes of open transvesical prostatectomy over a year involving two referral centers in Monrovia Liberia. Methodology: This was a retrospective study performed at The John F. Kennedy Medical Center and the Saint Joseph Catholic Hospital involving a total of 31 patients. Results: The mean age was 64.6 years (SD = 9.03) with a range 52 - 85 years. The study showed that 54.8% (17/31) of patients had preoperative catheter. The maximum duration of Catheter was greater than 4 weeks with a mean duration of 3.17 weeks. The mean hemoglobin was 11.30 g/dl. The commonest presenting complication was urinary retention at 25.8% (8/31) followed by hematuria 16.1% (5/31). Hypertension 41.9% (13/31) and diabetes 6.5% (/31) were the commonest comorbidity. The rate of postoperative complication was 38.7% with the commonest being surgical site infection 16.1% (5/31) and clot retentions 9.7% (3/31). There was a high rate of transfusion was 77.4% (24/31) patients. Up to about 13% (4/32) patients had coexisting stricture with 6.5% (2/31) patients treated with urethroplasty and 6.5% (2/31) patients treated by dilatation. The mortality rate was 6.5% (2/31) from renal impairment and severe sepsis. Conclusion: BPH is a common cause of lower obstructive uropathy. Most patients present with complications of the disease such as refractory symptoms, bladder stones or diverticulae necessitating surgery. However, due to the absence of endourological equipments in most parts of Africa and the large prostate at presentation, most settings consider open transvesical prostatectomy as a viable option. The perioperative morbidity is relatively higher, but the outcome remains acceptable.

Bipolar Transurethral Resection of the Prostate: Short-Term Outcome Evaluation in Regional Hospital in Senegal

Introduction: Transurethral resection of the prostate is still the most popular procedure that use for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction in developed countries. Bipolar transurethral resection of the prostate (B-TURP) is a recent technique in our urological practice. The aim of this study was to evaluate our preliminary results on the use of a B-TURP in Kolda (Senegal) in a benign prostatic hyperplasia (BPH). Materials and Methods: This was a 15-month, retrospective and descriptive study from June 2021 to August 31, 2022. It examined the records of patients who had BPH requiring surgical treatment and who received Bipolar transurethral resection of the prostate (B-TURP) during the study period at the Kolda Regional Hospital in Senegal. We used a Karl STORZ bipolar endoscopy column with a 26 sheath and 30˚ optics. The parameters studied were the civil status of the patients, the clinical and para-clinical data as well as the operative indications. The data were entered and analyzed using Epi-info 3.5.1.1. Results: A total of 31 patients underwent bipolar transurethral resection of the prostate during the study period. The mean age of patients was 68.5 ± 12.6 years (range, 56 - 77 years). The mean total PSA was 4 ± 2.3 ng/ml (range, 0.5 - 11 ng/ml). The mean prostate size assessed by ultrasound was 54 ± 12.3 ml (range, 30 - 90 ml). The operative indication was dominated by BPH with impact on the upper urinary tract. The mean of bladder irrigation time was 21.4 ± 3.9 hours (range, 12 - 26 hours). In the immediate post-operative period, blood transfusions were performed in 2 patients (6.5%). In the medium-term follow-up, we noted one 1 (3.2%) case of urine retention requiring bladder catheterization. Conclusion: Bipolar Transurethral resection of the prostate B-TURP in saline system is efficacious and safe. The results of this preliminary study of B-TURP are satisfactory with a low complication rate. B-TURP decreases the duration of the hospitalization and the port of the probe. Our perspectives are oriented towards endoscopy of the upper urinary tract.

Predictive Factors for a Successful Day Case Benign Prostatic Hyperplasia Surgery: A Review

Introduction: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

经尿道前列腺等离子双极电切术对BPH患者术后性功能及血清PSA、PGI2水平变化的影响

目的:探讨经尿道前列腺等离子双极电切术对良性前列腺增生(BPH)患者术后性功能及血清前列腺特异性抗原(PSA)、前列环素(PGI2)水平变化的影响。方法:选取内江市第一人民医院89例BPH患者,依据手术术式不同分组,对照组44例给予气化电切术治疗,观察组45例给予经尿道前列腺等离子双极电切术治疗,观察比较两组手术情况[尿管留置时间、术中出血量、术后视觉模拟评分(VAS)]及手术前后国际前列腺症状(IPSS)评分、性功能各指标[国际勃起功能指数(IIEF-5)评分、早泄患者性功能-5(CIPE-5)评分]及血清PSA、PGI2水平变化情况,并统计两组并发症发生情况。结果:与对照组相比,观察组尿管留置时间短、术中出血量少、术后VAS评分及术后IPSS评分均较对照组低,差异具有统计学意义(P <0. 05);观察组术后IIEF-5及CIPE-5评分均高于对照组,差异具有统计学意义(P <0. 05);观察组术后血清PSA水平低于对照组,血清PGI2水平高于对照组,差异具有统计学意义(P <0. 05);观察组并发症发生率为4. 44%(2/45),低于对照组20. 45%(9/44),差异具有统计学意义(P <0. 05)。结论:采用经尿道前列腺等离子双极电切术治疗可改善BPH患者术后性功能及血清PSA、PGI2水平,效果显著,并发症发生率低。

检测尿NAG活性对判断BPH患者早期肾功能损害的意义

目的探讨测定尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)活性在判断良性前列腺增生症(BPH)患者早期肾功能损害方面的应用价值。方法检测65例BPH患者的尿NAG活性及血β2微球蛋白(β2-MG)、尿素氮(BUN)、肌肝(Cr)及最大尿流率(Qmax),并与80例年龄匹配的正常人群进行比较分析。同时对BPH患者手术前与术后1个月和3个月的NAG活性进行比较。结果BPH患者尿NAG活性明显高于正常对照组(P<0.01),尿NAG活性与BPH患者最大尿流率呈显著正相关(P<0.01)。术后3个月尿NAG活性下降明显,与术前相比有显著性差异(P<0.01)。结论BPH患者最大尿流率较低时肾功能可能已有部分损伤,尿NAG活性水平可作为判断BPH患者早期肾功能损伤的监测指标以及手术指征之一。