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.

An update on transurethral surgery for benign prostatic obstruction

Clinical benign prostatic hyperplasia(BPH)is one of the most common cause of lower urinary tract symptoms and transurethral resection of prostate(TURP)has been the gold standard technique for surgical treatment of benign prostate obstruction(BPO)over the last 2 decades.Although monopolar TURP is considered a safe and effective option for surgical management of BPO,there are some disadvantages,namely bleeding,transurethral resection syndrome,incompleteness of treatment.This review aims to highlight these problems,and describe the advances in technology and techniques that have evolved to minimise such complications.With the advent of lasers and bipolar technology,as well as enucleative techniques to remove the prostatic adenoma/adenomata,the problems of bleeding,transurethral resection syndrome and incomplete treatment are significantly minimised.Monopolar TURPwill likely be replaced by such technology and techniques in the near future such that transurethral surgery of the prostate remain a safe and effective option in alleviating the harmful effects of BPO.

Cross-sectional and longitudinal studies on interaction between bladder compliance and outflow obstruction in men with benign prostatic hyperplasia

Aim： To explore the interaction between bladder compliance （BC） and bladder outflow obstruction （BOO） in men with benign prostatic hyperplasia （BPH） using cross-sectional and longitudinal studies. Methods： A total of 181 men with BPH were recruited, and 100 of them were followed for one year. Cystometry was performed in a standing or a sitting position with 30 mL/min infusion. BC was manually corrected and defined. Obstruction coefficient （OCO）, linear passive urethral resistance relation and international continence society （ICS） nomogram were used to diagnose BOO. The obstructed parameters were compared between the reduced BC group and the non-reduced group. BC was compared between the first investigation at the beginning of study and the second investigation at the end of study during the one-year follow-up period. Results： The group with reduced BC had increased OCO and linear passive urethral resistance relation. BC was significantly lower in the obstructed group （55.7 mL/cm water） than that in unobstructed and equivocal one （74.9 mL/cm water, P 〈 0.01）. BC gradually reduced with the increased obstructed grade. There was a significantly weak negative correlation between BC and OCO （r = - 0.132, P 〈 0.01）. Over the one-year follow-up period in the longitudinal study, BC for all men changed from 54.4 to 48.8 mL/cm water （P 〉 0.05）, and BC for the group with BOO fell from 58.4 ± 70.1 to 46.5 ± 38.7 mL/cm water （P 〉 0.05）. Conclusion： In men with BPH, a significant systematic decrease occurred in BC in the obstructed group and a significant systematic increase with urethral resistance occurred in the low BC group. A longitudinal study of the tendency of BC reduction in a group with BOO is necessary in the future.

Best surgical treatment for very large benign prostatic obstruction

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.

Thulium：YAG VapoEnucleation of the prostate in large glands： a prospective comparison using 70- and 120-W 2-μm lasers

This study compared the efficacy of 70- and 120-w 2-μm thulium：YAG VapoEnucleation of the prostate （ThuVEP） for patients with benign prostatic obstruction （BPO）. A prospective analysis of 84 patients with symptomatic BPO and prostatic enlargement （t〉 60 ml） who underwent either 70-w （n=44） or 120-w ThuVEP （n=40） non-randomly was carried out. Patient demographics and perioperative and 12-month follow-up data were analysed. The mean prostate volume was 79.90---27.49 ml in patients who had received 70-w ThuVEP, which was less than in those who had received 120-w ThuVEP （88.53＋-25.10; P=0.033）. The mean enucleation （resected weight/laser time, 2.16±1.21 g min-1 vs. 1.23±0.60 g min-1; P=-0.013）, operation efficiency （resected weight/total operation time, 0.76±0.35 g min-1 vs. 0.42＋-0.27 g min-1; P=-0.000） and percentage of resected tissue （66.93%±22.79% vs. 45.41%±23.33%; P=-0.000） were higher with 120-w treatment compared to 70-w ThuVEP. One patient （1.2% of total patients） （in the 120-w group） required a blood transfusion postoperatively. Sixty-one patients （73%） were available for review at the 12-month follow-up time point. The quality of life （QoL）, International Prostate Symptom Score （IPSS）, maximum urinary flow rate （Qmax）, postvoiding residual urine （PVR） and prostate volume improved significantly after treatment （P≤ 0.035） and were not significantly different between those treated with the different devices （70- and 120-w）. The median prostate volume reduction was 81.70% and 82.19% with 70- and 120-w ThuVEP, respectively. The incidence of complications was low and did not differ between groups treated with the different devices. Two patients （2.4%） （one per group） had a bladder neck contracture at the follow-up. ThuVEP is a safe and efficacious procedure for the treatment of symptomatic BPO. The incidence of complications was low with both devices. The 120-w thulium：YAG device enhances the effectiveness of Th,VEP with reeard to the oercentaee of resected tissue and the enucleation/ooeration efficiency.

Pressure-flow studies in patients with benign prostatic hyperplasia:a study comparing suprapubic and transurethral methods

Aim： To compare the use of the suprapubic puncture method versus the transurethral method in pressure-flow studies in patients with benign prostatic hyperplasia. Methods： Twenty-three men with benign prostatic hyperplasia underwent both suprapubic and transurethral pressure-flow studies during a single session. Standard pressure-flow variables were recorded in all patients with both methods, enabling calculation of obstruction using commonly used grading systems, such as the urethral resistance algorithm, the Abrams-Griffith （AG） number and the Schaefer linear nomogram. Results： There were statistically significant differences between the methods in the mean values of maximum flow rate （P 〈 0.05）, detrusor pressure at the maximum flow （P 〈 0.01）, urethral resistance algorithm （P 〈 0.01）, AG number （P 〈 0.01） and maximum cystic capacity （P 〈 0.01）. Of the men in the study, 10 （43.5%） remained in the same Schaefer class with both methods and 18 （78.3%） in the same AG number area. Using the transurethral method, 12 （52.2%） men increased their Schaefer class by one and 1 （4.3%） by two. There were also differences between the suprapubic and transurethral methods using the AG number： 4 （17.4%） men moved from a classification of equivocal to obstructed and 1 （4.3%） from unobstructed to equivocal. Conclusion： The differences between the techniques for measuring intravesical pressure alter the grading of obstruction determined by several of the commonly used classifications. An 8 F transurethral catheter significantly increases the likelihood of a diagnosis of bladder outlet obstruction when compared with the suprapubic method.

Botulinum toxin and benign prostatic hyperplasia

Benign prostatic hyperplasia(BPH)is a clinical condition where lower urinary tract symptoms are caused by both a physically obstructing prostate as well as tight smooth muscles around the bladder outlet.Treatment of this condition with botulinum toxin has been used since 2003,but this interest has somewhat died down after two large randomized controlled trials(RCTs)showing equivalence of results between their treatment and placebo arms.However,with review of animal studies and unexplained exaggerated effect of the placebo arms of the two RCTs,together with recent data of sustained benefits after 18 months of treatment,the place of botulinum toxin in the BPH field is probably still present.

Beyond prostate, beyond surgery and beyond urology: The “3Bs” of managing non-neurogenic male lower urinary tract symptoms

Lower urinary tract symptoms(LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving symptoms that may occur due to several causes.Instead of simply focusing on the enlarged prostate,more attention has to be paid to the entire urinary tract as well as multiple system comorbidities.Therefore,prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required.Based on current literature,this paper proposes the“3Bs”concept for managing non-neurogenic male LUTS,namely,“beyond prostate”,“beyond surgery”and“beyond urology”.The clinical application of the“3Bs”enables urologists to carry out integrated,individualized and precise medical care for each non-neurogenic male LUTS patient.

Multicenter experience with photoselective vaporization of the prostate on men taking novel oral anticoagulants

Objective:Photoselective vaporization of the prostate(PVP)is a widely performed surgical procedure for benign prostatic obstruction.This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants(NOACs).This study was to examine the perioperative outcomes in men on NOACs undergoing PVP,with particular reference to perioperative morbidity.Methods:A retrospective analysis of PVP datasets was undertaken from three centres in Sydney(Australia),Toulouse(France)and Boston(USA).Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified.Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo(CD)classification.Results:There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period.The mean age was 776.5 years.The mean prostate volume,energy utilization and vaporisation time was 9456 mL,301211 kJ,and 3521 min respectively.The mean postoperative duration of catheterization and duration of hospitalization was 2.22.4 days and 2.42.4 days respectively.There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions.Conclusions:This study supports the safety of men on NOACs undergoing PVP.Whilst this study represents the largest experience of PVP in these men,larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.

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.

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.

良性前列腺增生尿道参数研究

目的:探究良性前列腺增生(BPH)患者尿道几何参数与症状及梗阻相关性,评估超声诊疗价值。方法:回顾性分析220例BPH患者数据,包括年龄、IPSS评分、vIPSS评分、sIPSS评分、QoL问卷评分、前列腺长度、宽度、移行带高度、长度和宽度等。结果:超声参数与年龄正相关;尿道长度与IPSS评分有密切线性关系;近段尿道拱高(Puah)与IPSS评分和QoL量表评分的相关性显著;移行带体积(Vtz)是Pul变化的重要预测因子。结论:超声几何参数,如尿道长度、Puah,对评估症状严重度及梗阻情况有重要价值,有助于临床诊断与治疗决策。

不同术式对BPH所致梗阻性膀胱顺应性下降患者血清PGE 2、5-HT、尿动力学指标及并发症的影响

目的探讨应用不同术式治疗良性前列腺增生(BPH)所致梗阻性膀胱顺应性(BC)下降患者的临床效果。方法回顾性选取2022年2月至2024年2月华北理工大学附属医院接受诊治的130例BPH所致梗阻性BC下降患者作为研究对象。根据手术方案不同将患者分为对照组(n=68)和研究组(n=62)。对照组采取经尿道前列腺电切术(TURP)治疗,研究组采取经尿道双极等离子电切术(BPRP)治疗。比较两组围术期相关指标(手术时间、术中出血量以及住院时间)、术前及术后2 d的血清因子指标[前列腺素E 2(PGE 2)、5-羟色胺(5-HT)]、术前及术后3个月的尿动力学指标[最大尿流率(Qmax)、BC、残余尿量(PVR)]、并发症发生情况以及术前、术后3个月的生活质量[良性前列腺增生患者专用生活质量量表(BPHQLS)]评分。结果研究组的手术时间、住院时间分别为(45.16±7.37)min、(5.26±1.04)d,均短于对照组[(52.47±8.36)min、(7.43±1.47)d],术中出血量为(63.39±12.65)mL,少于对照组[(86.73±21.47)mL],差异均有统计学意义(P<0.05)。研究组术后2 d的PGE 2、5-HT水平分别为(17.48±4.52)ng/L、(539.68±48.48)ng/mL,均低于对照组[(25.73±5.27)ng/L、(625.87±52.62)ng/mL],差异均有统计学意义(P<0.05)。研究组术后3个月的BC、Qmax分别为(28.07±4.72)mL/cmH 2O、(18.53±3.86)mL/s,均高于对照组[(24.86±4.35)mL/cmH 2O、(13.79±2.41)mL/s],PVR为(38.38±6.96)mL,低于对照组[(49.27±8.64)mL],差异均有统计学意义(P<0.05)。研究组并发症发生率为4.84%,低于对照组(20.59%),差异有统计学意义(P<0.05)。术后3个月的疾病、心理、满意度BPHQLS评分分别为(117.64±12.54)、(43.21±4.22)、(34.36±5.77)分,均高于对照组[(94.61±13.64)、(37.46±6.43)、(28.64±5.74)分],差异均有统计学意义(P<0.05)。结论BPRP治疗BPH所致梗阻性BC下降患者,创伤更小,可降低PGE 2、5-HT水平,疼痛更轻,可有效改善尿动力学指标,还可降低术后并发症发生率,提升患者的生活质量。

前列腺突入膀胱程度及尿TIMP-2水平与前列腺增生患者膀胱出口梗阻严重程度的相关性分析

目的研究前列腺突入膀胱程度(Intravesical prostatic protrusion,IPP)及尿金属蛋白酶组织抑制剂-2(Tissue inhibitor of metalloproteinase-2,TIMP-2)与前列腺增生患者膀胱出口梗阻(Bladder outlet obstruction,BOO)严重程度的相关性。方法收集99例良性前列腺增生(Benign prostatic hyperplasia,BPH)患者纳入本研究,收集患者临床资料,检测患者IPP及尿TIMP-2,对患者进行尿动力学检测。根据国际前列腺症状评分(International prostate symptom score,IPSS)将患者分为3组,0~7评分为轻度组,共42例,8~19分为中度组,共25例,20~35分为重度组,共32例。采用Logistic回归分析3组患者的临床资料、IPP、尿TIMP-2、膀胱出口梗阻指数(Bladder outlet obstruction,BOOI)的相关性。采用受试者工作特征曲线(Receiver operating characteristic,ROC)分析IPP、TIMP-2检测预测BOO的敏感性。结果使用单因素方差分析法分析3组患者的临床指标,随着患病程度加重,年龄、TPV、IPSS、IPP、尿TIMP-2水平均有增加趋势,尿动力学指标中Qmax下降,Pdet.Qmax、BOOI、PVR均升高,且差异具有统计学意义(P均<0.05)。相关性分析结果显示,3组患者BOOI与年龄、BMI、TPV、PVR无显著相关性(P均>0.05)。轻度组、中度组和重度组患者BOOI与IPP、尿TIMP-2以及IPSS均呈正相关(P均<0.05)。ROC曲线分析显示IPP与尿TIMP-2单独预测BOO均具有较强敏感性,IPP联合尿TIMP-2检测敏感性更高(P均<0.05)。结论IPP、尿TIMP-2与前列腺增生患者BOO严重程度具有相关性,且IPP联合尿TIMP-2预测BOO具有较高敏感性。

后尿道超声形态改变与良性前列腺增生致下尿路症状发生的相关性

目的探讨与分析后尿道超声形态改变与良性前列腺增生致下尿路症状发生的相关性。方法选择2020年月—2023年5月在商洛市商州区人民医院诊治的92例良性前列腺增生男性患者作为病例组,92名体检健康男性为对照组。检测病例组与对照组的后尿道超声形态的改变情况,同时对下尿路症状进行记录,并采用Spearman分析分析尿道超声形态改变与良性前列腺增生致下尿路症状的相关性。结果病例组的后尿道超声形态异常率为53.26%,对照组为5.43%,病例组的后尿道超声形态异常率显著高于对照组,差异有统计学意义(P<0.05)。病例组的膀胱出口梗阻指数、残余尿量都显著高于对照组,差异有统计学意义(P<0.05)。病例组最大尿流率明显低于对照组,差异有统计学意义(P<0.05)。在病例组中,Spearman分析显示后尿道超声形态异常与膀胱出口梗阻指数、残余尿量、最大尿流率等都存在相关性(P<0.05)。多因素logistic回归分析显示,良性前列腺增生患者后尿道超声形态异常为影响膀胱出口梗阻指数、残余尿量、最大尿流率的重要因素(P<0.05)。结论良性前列腺增生患者多表现为后尿道超声形态异常,伴随有膀胱出口梗阻指数、残余尿量、最大尿流率异常,后尿道超声形态改变与良性前列腺增生致下尿路症状的发生存在相关性。

Management of BPH then 2000 and now 2016-From BPH to BPO

The diagnosis and treatment of benign prostatic obstruction(BPO)is based on a number of well-known lower urinary tract symptoms(LUTS)feared by all ageing males with functional testes.The ascent of modern urology turned this disease from lethal into an annoying but treatable health problem in the previous century.We are able to relieve the great majority of patients from their bothersome symptoms to a respectable quality of life by medication or removal of the obstructive part of the enlarged prostate.We can be proud of some progress made in the new millennium to reach a correct diagnosis and subsequent choice of treatment aiming for quality of life and cost-efficiency for public health.Still it remains symptomatic treatment and we expect the new generation of urologists to close some gaps in our knowledge on the regulation of prostatic growth to focus on prevention and elimination of the disease in the foreseeable future.

从“脑-心-肾-精室”轴的用药观探讨菟苓方治疗良性前列腺增生症

良性前列腺增生症的发生是阳气亏虚、湿浊内生进而阻滞精室的过程,可表现为肾虚湿阻证。结合“脑-心-肾-精室”轴的用药观,应用菟苓方治疗本病,以其禀“整体与局部同治”之意,补肾阳而助一身之阳,利水湿而祛一身水湿,同时重视祛除精室局部痰浊、瘀血,并兼具以平为期、补而不滞等特点。因此,通过探讨肾虚湿阻型良性前列腺增生症的中医病因病机,引出“脑-心-肾-精室”轴用药思路的重要意义,并据此探讨菟苓方的具体方义及相关临证经验,以期为临床应用提供参考。

前列腺增生手术要关注膀胱功能评估

良性前列腺增生(BPH)会导致良性前列腺梗阻(BPO),继而影响膀胱功能。基于793例BPO患者的尿动力学检查结果,将BPO患者的膀胱功能分为3个阶段、6种类型。其中逼尿肌过度活动伴收缩力受损(DHIC)是膀胱功能由代偿向失代偿的过渡期。不同指南针对BPO的手术建议未考虑患者的膀胱功能,本文强调BPH的手术治疗需要考虑患者的膀胱功能状态,进而选择有针对性的个体化手术方式。

合并COPD的BPH患者尿流动力学特征研究

目的探讨BPH合并COPD患者的尿流动力学特点。方法选择78例BPH患者,分为合并COPD的BPH组(43例)和无合并COPD的BPH组(35例),分别检测2组患者的前列腺体积和尿流动力学参数。结果与无合并COPD的BPH组患者相比,合并COPD的BPH组患者的最大尿流率降低、最大尿流率时的逼尿肌压下降、膀胱收缩指数减少(P均<0.05)。2组BPH患者的年龄、前列腺体积、残余尿量、尿道阻力因子、梗阻指数压力和膀胱出口梗阻指数比较差异均无统计学意义(P均>0.05)。结论合并COPD的BPH患者具有膀胱逼尿肌收缩乏力的尿流动力学特征。

良性前列腺梗阻微创治疗新进展

我国良性前列腺梗阻(BPO)患者数量不断增加,且越来越趋于年轻化。曾经的“金标准”方案经尿道前列腺电切术(TURP)更加适用于前列腺体积在40~80 mL范围内的患者,对于前列腺体积过小的患者易导致过度切除,而对于前列腺体积过大的患者切除效率低。随着微创技术的持续进步,一些新的技术被成功引入,如:前列腺动脉栓塞术、激光手术(剜除切割和汽化切割等)、微创单纯前列腺切除术、经尿道前列腺球囊扩张术、前列腺尿道悬吊术和机器人辅助前列腺水切割等。这些微创方法被视为TURP的替代方案,并被越来越多地应用于BPO的临床治疗。本文就BPO的多种微创治疗方法的最新进展进行综述。