BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rar...BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.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
AIM:To investigate the best surgical treatment for very large benign prostatic obstruction(BPO).METHODS:A revision of literature was conducted in Pub Med database with 167 search results.Key words for the search were ...AIM:To investigate the best surgical treatment for very large benign prostatic obstruction(BPO).METHODS:A revision of literature was conducted in Pub Med database with 167 search results.Key words for the search were benign prostatic hyperplasia,surgical treatment,large,and volume.Inclusion criteria for this study were surgical treatment of benign prostatic obstruction for prostates equal to or larger than 80 cc.Among article search results,9 completed inclusion criterion and were revised.Each surgical technique included in those articles was compared to each other.The results were observed,and conclusions derived from this are presented.There is no statistical analysis.RESULTS:Of the 5 techniques presented in the revised articles[open transvesical enucleation,holmiumlaser enucleation of the prostate(HoL EP),photoselective vaporization of the prostate using potassium titanyl phospate laser,transurethral resection with bipolar energy,and transurethral enucleation with bipolar energy],open transvesical enucleation best permits the resolution of obstructive symptoms.It presents excellent maximum flow rates,high resected tissue volume and maintenance of results over time.These characteristics explain why it has been the gold standard treatment for prostates greater than 80 cc.However,it is at the expense of greater blood loss,urethral catheter and hospital stay times.Since its initial application in1996,the transurethral enucleation of the prostate by means of a holmium laser has become a procedure that has similar surgical outcomes with fewer complications when compared to open surgery making it an interesting alternative for very large BPO.Nonetheless,no procedure has removed open surgery as the gold standard for very large BPO.CONCLUSION:Open surgery has proved to be the gold standard for very large BPO.HoL EP appears as a minimally invasive alternative with same benefits but less morbidity.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
良性前列腺增生(benign prostate hyperplasia,BPH)是导致中老年男性下尿路症状(lower urinary tract symptoms,LUTS)的主要原因。手术是治疗BPH的有效方法,其中经尿道前列腺切除术(transurethral resection of the prostate,TURP)作为...良性前列腺增生(benign prostate hyperplasia,BPH)是导致中老年男性下尿路症状(lower urinary tract symptoms,LUTS)的主要原因。手术是治疗BPH的有效方法,其中经尿道前列腺切除术(transurethral resection of the prostate,TURP)作为BPH手术的“金标准”可以显著改善患者的LUTS和排尿状况,但其存在术后复发率和并发症发生率较高等缺点。随着激光技术的发展,钬激光前列腺剜除术(holmium laser enucleation of the prostate,HoLEP)因组织剜除彻底、术中术后出血少、术后恢复快、术后复发率低等优势得到迅速推广,并且有望替代TURP成为治疗BPH的标准术式。目前国内尚无关于HoLEP治疗BPH的共识指南。有鉴于此,国内多名专家结合国外相关文献及指南以及国内各医疗中心临床经验,针对HoLEP的手术适应症、禁忌症、手术步骤和手术护理等方面制定了本专家共识,旨在规范HoLEP的临床应用,更好地服务于BPH患者。展开更多
基金Supported by the Kunshan Research and Development Project,No.KSZ2203the Kunshan Research and Development Project,No.KZYY2205.
文摘BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.
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AIM:To investigate the best surgical treatment for very large benign prostatic obstruction(BPO).METHODS:A revision of literature was conducted in Pub Med database with 167 search results.Key words for the search were benign prostatic hyperplasia,surgical treatment,large,and volume.Inclusion criteria for this study were surgical treatment of benign prostatic obstruction for prostates equal to or larger than 80 cc.Among article search results,9 completed inclusion criterion and were revised.Each surgical technique included in those articles was compared to each other.The results were observed,and conclusions derived from this are presented.There is no statistical analysis.RESULTS:Of the 5 techniques presented in the revised articles[open transvesical enucleation,holmiumlaser enucleation of the prostate(HoL EP),photoselective vaporization of the prostate using potassium titanyl phospate laser,transurethral resection with bipolar energy,and transurethral enucleation with bipolar energy],open transvesical enucleation best permits the resolution of obstructive symptoms.It presents excellent maximum flow rates,high resected tissue volume and maintenance of results over time.These characteristics explain why it has been the gold standard treatment for prostates greater than 80 cc.However,it is at the expense of greater blood loss,urethral catheter and hospital stay times.Since its initial application in1996,the transurethral enucleation of the prostate by means of a holmium laser has become a procedure that has similar surgical outcomes with fewer complications when compared to open surgery making it an interesting alternative for very large BPO.Nonetheless,no procedure has removed open surgery as the gold standard for very large BPO.CONCLUSION:Open surgery has proved to be the gold standard for very large BPO.HoL EP appears as a minimally invasive alternative with same benefits but less morbidity.
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.
文摘良性前列腺增生(benign prostate hyperplasia,BPH)是导致中老年男性下尿路症状(lower urinary tract symptoms,LUTS)的主要原因。手术是治疗BPH的有效方法,其中经尿道前列腺切除术(transurethral resection of the prostate,TURP)作为BPH手术的“金标准”可以显著改善患者的LUTS和排尿状况,但其存在术后复发率和并发症发生率较高等缺点。随着激光技术的发展,钬激光前列腺剜除术(holmium laser enucleation of the prostate,HoLEP)因组织剜除彻底、术中术后出血少、术后恢复快、术后复发率低等优势得到迅速推广,并且有望替代TURP成为治疗BPH的标准术式。目前国内尚无关于HoLEP治疗BPH的共识指南。有鉴于此,国内多名专家结合国外相关文献及指南以及国内各医疗中心临床经验,针对HoLEP的手术适应症、禁忌症、手术步骤和手术护理等方面制定了本专家共识,旨在规范HoLEP的临床应用,更好地服务于BPH患者。
