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.

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.

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.

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.

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.

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.

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.

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.

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

Prostatic Adenomectomy by High Approach versus Millin: Our Results on a Series of 15 Cases

Background: In 2023, conventional surgery for benign prostatic hyperplasia (BPH) is still used despite the introduction of minimally invasive techniques in the therapeutic arsenal. Objective: To present our results of Millin prostatic adenomectomy in a preliminary series of 15 cases. Patients and Methods: Cross-sectional study conducted at the Urology Department of the Bouaké University Hospital from January 2022 to January 2023. It involved 15 patients with benign prostatic hyperplasia (BPH) who had undergone high adenomectomy using the Millin technique. Results: During the study period, 15 cases of benign prostatic hyperplasia were treated surgically by high adenomectomy using the Millin technique. The mean age of the patients was 63.6 years, ranging from 53 to 78 years. Nine (9) patients were consulted for progressive complications of benign prostatic hyperplasia (BPH), i.e. 60% (n = 9). The mean IPSS score was 28 (20 to 35), and seven (7) patients had a comorbidity (46.44%). The digital rectal examination (DRE) was in favour of benign prostatic hypertrophy in all patients, and the mean weight of the prostate at DRE was 75 g, ranging from 55 g to 100 g. From a paraclinical point of view, prostatic ultrasound revealed a mean BPH weight of 82.7 g with extremes of 55 to 100 g. Post-micturition residue was greater than 150 ml in 60% (n = 9). The mean prostate-specific antigen (PSA) level was 3.8 ng/ml, ranging from 1.4 to 15 ng/ml. There was one case of severe anaemia with a haemoglobin level of 6 g/dl on haemogram, treated by blood transfusion. The cytobacteriological examination of the urine (ECBU) revealed five cases of E. coli infection, i.e. 33.33% (n = 5). Millin prostatic adenomectomy was performed under antibiotic prophylaxis at induction. All patients underwent locoregional anaesthesia. The mean weight of the adenoma was 80 g with extremes of 55 to 155 g. Blood loss was minimal at less than 100 ml, i.e. 86.6% (n = 13). The average operating time was 56.9 minutes, ranging from 45 to 75 minutes. The Retzius space was drained in an average of 2.75 days, with extremes of 2 to 4 days. The average duration of postoperative bladder catheterisation was 8.7 days, with extremes of 7 to 10 days. The average duration of bladder irrigation-washing was 3.6 days. The average hospital stay was 8.55 days, with extremes of 8 to 10 days. Morbidity was represented by Orchi-epididymitis (66%, n = 1) and mortality was 6.66% (n = 1). 6 months later, the 14 patients had good micturition comfort with an RPM of less than 10 ml. Anatomo-pathological examination of the adenomectomy specimen was in favour of an adenomyofibroma of the prostate with no stigma of malignancy. Conclusion: Prostatic adenomectomy using the Millin technique is rarely performed, but a look at the results shows that it is still the least morbid and fatal technique.

剪切波弹性成像检测尿道周围前列腺组织弹性模量与良性前列腺增生患者血清前列腺特异抗原的相关性研究

目的:分析尿道周围前列腺组织弹性模量与良性前列腺增生(BPH)患者血清前列腺特异抗原(PSA)的相关性。方法:采用便利抽样法收集2019年10月至2022年10月在合肥市第二人民医院接受治疗的200例BPH患者,所有患者均进行超声剪切波弹性成像与血清PSA检查,剪切波弹性成像测量尿道周围前列腺组织弹性模量取平均值,依据国际前列腺症状评分(IPSS)结果将其分为轻度组(96例)、中度组(59例)及重度组(45例),同时纳入本院前列腺检查人群中非前列腺病变的30名相关资料为健康对照组,分析比较患者尿道周围前列腺组织弹性模量与血清PSA的相关性。结果:统计学分析显示,各组受检者前列腺弹性模量值比较差异均有统计学意义(F=190.914,P<0.05)。与健康对照组相比,轻度组、中度组及重度组患者前列腺弹性模量值显著升高,差异有统计学意义(t=6.572、14.172、18.441,P<0.05);与轻度组相比,中度组、重度组患者前列腺弹性模量值显著升高(t=7.853、18.274,P<0.05);与中度组相比,重度组患者前列腺弹性模量值显著升高(t=11.371,P<0.05);不同程度的BPH患者间血清PSA差异均有统计学意义(F=126.143,P<0.05)。与健康对照组相比,轻度组、中度组及重度组患者血清PSA显著升高(t=10.694,14.368、13.804,P<0.001);与轻度组相比,中度组、重度组患者血清PSA显著升高(t=6.401、13.047,P<0.05);与中度组相比,重度组患者血清PSA显著升高(t=7.293,P<0.001);健康对照组血清PSA与尿道周围组织弹性模量无显著相关性(P>0.05)。轻度组、中度组及重度组患者血清PSA与尿道周围组织弹性模量均呈显著正相关(r=0.314、0.296、0.354,P<0.05)。结论:BPH患者血清PSA水平与尿道周围前列腺组织弹性模量值显著升高,二者存在正相关的关系。

从“流气化湿”探讨良性前列腺增生的辨治

“流气化湿”理念的核心在于流转一身之气,畅气机以运水液。基于“流气化湿”理念探讨良性前列腺增生的辨治,认为人身之气流转顺通是小便通利的基础,而湿浊常导致气机阻滞不通,故须以流动周身气机为原则,复小便通利。临床中拟定宣气利湿、行气祛湿、芳香化湿、益气运湿治法,展布气机而湿浊邪气自除。同时注意顾护脾胃、津液,有助于改善下尿路症状。

老年前列腺增生症病人共病状态、衰弱、认知、生活质量间的关系

目的:探讨老年前列腺增生症(BPH)病人共病状态、衰弱、认知和生活质量间的关系。方法:选择2022年3月—2023年9月在我院泌尿外科住院的72例BPH病人为研究对象,采用中文版老年累积疾病评估量表(CIRS-G)、Fried衰弱量表、简易精神状态检查量表(MMSE)和健康调查量表(SF-36)对病人进行评估,并收集病人基本信息、血液化验指标。结果:病人中文版CIRS-G的疾病累积评分总分为(7.81±1.91)分,严重指数为(1.68±0.19),共病指数为(2.70±0.73),SF-36得分为(64.68±13.48)分,Fried衰弱量表得分为[1(0,2)]分,MMSE得分为(26.22±2.92)分。认知衰弱不同的病人SF-36得分不同(P<0.001)。病人疾病累积评分总分与共病指数、严重指数、Fried衰弱量表评分呈正相关,与MMSE评分呈负相关(P<0.05)。Fried衰弱量表评分与血红蛋白、血清白蛋白呈负相关(P<0.05),与C反应蛋白、血肌酐、空腹血糖呈正相关;MMSE评分与血清白蛋白呈正相关,与C反应蛋白、血肌酐、尿酸呈负相关(P<0.05)。结论:老年BPH病人共病状态明显,病人的衰弱状态与生活质量相关,病人的共病状态与认知、衰弱相关。

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。

PKRP与TUVP治疗良性前列腺增生症(BPH)的对比研究

目的对比分析经尿道等离子电切术(PKRP)与传统电切术(TUVP)治疗良性前列腺增生症(BPH)的疗效。方法 80例行手术治疗的BPH患者中PKRP治疗的40例患者设立为观察组,另外选择同期行TUVP治疗的40例患者设立为对照组,比较两组患者手术时间及术中出血量、住院时间,两组患者术前术后IPSS、最大尿流率(Qmax)的变化以及两组患者术后并发症发生率。结果观察组的手术时间、住院时间分别与对照组比较,差异无统计学意义(P>0.05),观察组的术中出血量明显少于对照组(P<0.01)。术后观察组Qmax与对照组比较明显升高,观察组的IPSS术后较对照组明显降低,组间比较差异有统计学意义(P<0.05),观察组术后无一例发生电切综合症,其并发症发生率达5%(2/40),对照组术后并发症发生率达25%(10/40),两组并发症发生率比较,差异有统计学意义(P<0.05)。结论经尿道等离子电切术(PKRP)较传统电切术(TUVP)治疗良性前列腺增生症出血少、并发症少、术后能明显改善患者的临床症状,值得推广和应用。

HoLEP、TUPKEP及TURP术治疗原发性高血压合并BPH的疗效分析及对炎性因子和血清PSA水平的影响

目的:研究钬激光前列腺剜除术(HoLEP)、经尿道等离子前列腺剜除术(TUPKEP)及经尿道前列腺电切术(TURP)治疗原发性高血压合并良性前列腺增生(BPH)的疗效分析及对炎性因子和血清PSA水平的影响。方法:选取医院收治的240例前列腺增生老年患者,将HoLEP治疗患者纳入HoLEP组(87例),TURP手术患者纳入TURP组(102例),TUPKEP手术患者纳入TUPKEP组(51例),分析三组患者的手术指标、排尿情况、生存质量、炎性因子、血清PSA和并发症之间的差异。结果:三组患者手术期间出血量、麻醉时间、输液量以及并发症等相关指标之间的差异无统计学意义;术后3个月,三组患者的IPSS评分、Qmax、RUV以及QOL比较,差异有统计学意义(F=11.225,F=62.043,F=3.360,F=62.043;P<0.05)。治疗后三组患者的炎性因子肿瘤坏死因子α(TNF-α)、IL-6、IL-8及血清PSA比较,差异有统计学意义(F=17.253,F=21.323,F=16.326,F=41.172;P<0.05)。结论:通过采取HoLEP治疗,排尿功能显著改善,患者的炎性反应以及血清PSA水平显著降低,安全性较好,患者的生命质量显著提升。