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 t...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.展开更多
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 hyper...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.展开更多
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 t...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.展开更多
<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the ...<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. <strong>Materials and Methods:</strong> During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. <strong>Results:</strong> TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. <strong>Conclusion:</strong> TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.展开更多
文摘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.
文摘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.
文摘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.
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.
