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.

Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia： a meta-analysis of randomized controlled trials

To evaluate the efficacy and safety of plasmakinetic resection of the prostate （PKRP） versus transurethral resection of the prostate （TURP） for the treatment of patients with benign prostate hyperplasia （BPH）, a meta-analysis of randomized controlled trials was carried out. We searched PubMed, Embase, Web of Science and the Cochrane Library. The pooled estimates of maximum flow rate, International Prostate Symptom Score, operation time, catheterization time, irrigated volume, hospital stay, transurethral resection syndrome, transfusion, clot retention, urinary retention and urinary stricture were assessed. There was no notable difference in International Prostate Symptom Score between TURP and PKRP groups during the 1-month, 3 months, 6 months and 12 months follow-up period, while the pooled Qmax at 1-month favored PKRP group. PKRP group was related to a lower risk rate of transurethral resection syndrome, transfusion and clot retention, and the catheterization time and operation time were also shorter than that of TURP. The irrigated volume, length of hospital stay, urinary retention and urinary stricture rate were similar between groups. In conclusion, our study suggests that the PKRP is a reliable minimal invasive technique and may anticipatoriiy prove to be an alternative electrosurgical procedure for the treatment of BPH.

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.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia(2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

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.

Urinary and sexual function changes in benign prostatic hyperplasia patients before and after transurethral columnar balloon dilatation of the prostate

BACKGROUND Transurethral columnar balloon dilatation of the prostate(TUCBDP) is a new surgical treatment, but its efficacy remains controversial because of limited clinical application.AIM To investigate the clinical effect of TUCBDP for benign prostatic hyperplasia(BPH).METHODS Overall, 140 patients with BPH who underwent surgical treatment were included in the study. A random number table was used to divide the participants into study and control groups(n = 70 per group). The study group underwent TUCBDP. The prostate resection surgical time, intraoperative blood loss, bladder irrigation time, catheter indwelling time, length of hospital stay, International Prostate Symptom Score(IPSS), maximum urine flow rate(Qmax), residual urine volume(RUV), changes in the International Erectile Function Score(ⅡEF-5) score, serum prostate-specific antigen(PSA), quality of life(QOL) score, and surgical complications were compared in both groups.RESULTS The operation time, intraoperative blood loss volume, bladder flushing time, urinary catheter indwelling time, and length of hospital stay were significantly lower in the study group than in the control group(P < 0.05). There were no significant differences in the IPSS, Qmax, and RUV measurements between the study and control groups(P > 0.05). However, at 3 mo post-surgery, the IPSS and RUV measurements were both lower(P < 0.05) and Qmax values were higher(P < 0.05) compared to the pre-surgery results in both groups. The ⅡEF-5 scores before and 3 mo after surgery were not significantly different between the study and control groups(P > 0.05). At 1 mo after surgery, the ⅡEF-5 score was higher in the study group than in the control group(P < 0.05). The serum PSA levels and QOL scores before treatment and at 1 and 3 mo after treatment were not significantly different between the study and control groups(P > 0.05). However, lower serum PSA levels and QOL scores were observed after 1 and 3 mo of treatment compared to pre-treatment levels in the study group(P < 0.05). The surgical complication rate of the study group(4.29%) was lower than that of the control group(12.86%;P < 0.05).CONCLUSION TUCBDP for BPH and transurethral resection of the prostate can achieve better results, but the former method is associated with less surgical trauma.

Safety of Overnight Hospitalization after Transurethral Resection of Prostate

Background: Monopolar transurethral resection of prostate has long been a standard method of managements of benign prostatic hyperplasia. The safe and superior efficacy of transurethral resection of prostate (TURP) always argues strongly for maintaining it as the primary mode of therapy for patients with benign prostatic hyperplasia (BPH). There is a trend toward early catheter removal after transurethral resection of prostate (TURP) even to the extent of performing it as a day case. We explored the safety and feasibility of early catheter removal and discharging the patient without catheter after TURP. Materials and methods: Forty patients who underwent monopolar TURP were included in a prospective study. The decision to remove catheters on the first morning after surgery was based on the color of the catheter effluent, absence of clots, normal vital signs and adequate urine output. Patients who voided successfully were discharged on the same day as catheter removal. Results: Among the forty patients whose catheters were removed on first postoperative day, 38 patients (95%) voided successfully, and were discharged on the same day. However, two out of forty patients (5%) were recatheterized due to urethral discomfort during micturition. The catheter was removed on the next day. Mean overall duration of catheterization was 18.36 hours, and overall length of patient hospitalization was 21.68 hours. Conclusions: Overnight hospitalization and early catheter removal after transurethral prostatectomy are an appropriate, safe and effective way of patient care with minimal morbidity.

The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials

Objective Bleeding is one of the most common complications of transurethral resection of the prostate(TURP).Several previous studies reported that administering dutasteride before surgery could reduce perioperative bleeding.We aimed to evaluate the efficacy of preoperative dutasteride treatment in benign prostatic hyperplasia patients undergoing TURP by performing a meta-analysis of relevant randomized controlled trials(RCTs).Methods A comprehensive literature search was performed through the electronic databases including Medline,Cochrane Library,Google Scholar,and ClinicalTrial.gov in October 2020.RCTs evaluating the role of dutasteride for TURP were screened using the eligibility criteria and the quality of RCTs was assessed using the Cochrane Risk of Bias Tool.The heterogeneity was assessed using I2 statistic.The measured outcomes were hemoglobin(Hb)levels,perioperative blood loss,blood transfusion,microvessel density(MVD),and operation time.Data were pooled as mean difference(MD)and odds ratio(OR).Results A total of 11 RCTs consisting of 627 samples from the treatment group and 615 samples from the placebo group were analyzed.Patients that received dutasteride had less reduction in Hb levels(MD−1.10,95%confidence interval[CI]−1.39 to−0.81,p<0.00001).Dutasteride also significantly reduced the operation time(MD−1.79,95%CI−2.97 to−0.61,p=0.003)and transfusion rate after surgery(OR 0.34,95%CI 0.15 to 0.77,p=0.009)compared to the control group.However,the MVD(MD−3.60,95%CI−8.04 to 0.84,p=0.11)and perioperative blood loss in dutasteride administration for less than 4 weeks(MD 46.90,95%CI−144.60 to 238.41,p=0.63)and more than 4 weeks(MD−190.13,95%CI−378.05 to−2.21,p=0.05)differences were insignificant.Conclusion Preoperative administration of dutasteride is able to reduce bleeding during TURP,as indicated by less reduction in Hb level,lower transfusion rate,and less operation time.

Emphysematous sloughed floating ball after prostate water vaporization Rezum:A case report

BACKGROUND Rezūm™water vapor therapy is a new minimally invasive endoscopic technology for the management and treatment of benign prostatic hyperplasia.CASE SUMMARY A 63-year-old male presented to our department with severe dysuria,frequency,urgency,and interrupted stream 2 mo after receiving Rezūm™therapy.The symptoms were caused by a retained floating emphysematous necrotic sloughed tissue.We also discovered a persistent bacterial infection that was resistant to parenteral antimicrobial therapy.The treatment of the patient included surgical removal of the necrotic tissue.CONCLUSION Despite the good safety profile and minimal adverse events related to Rezūm™therapy,major complications can still occur.

Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms:results from a center with over 500 patients

Aim： To identify possible risk factors for erectile dysfunction （ED） after transurethral resection of prostate （TURP） for benign prostatic hyperplasia （BPH）. Methods： Between March 1999 and March 2004, 629 patients underwent TURP in our department for the treatment of symptomatic BPH. All patients underwent transrectal ultrasound examination. In addition, the flow rate, urine residue, International Prostate Symptom Score （IPSS） and quality of life （QOL） were recorded for those who presented without a catheter. Finally, the erectile function of the patient was evaluated according to the International Index of Erectile Function Instrument （IIEF-5） questionnaire. It was determined that ED existed where there was a total score of less than 21. The flow rate, IPSS and QOL assessment were performed at 3 and 6 months post-treatment. The IIEF-5 assessment was repeated at a 6-month follow-up. A logistic regression analysis was used to identify potential risk factors for ED. Results： At baseline, 522 （83 %） patients answered the IIEF-5 questionnaire. The mean patient age was （63.7 ± 9.7） years. The ED rate was 65%. After 6 months, 459 （88%） out of the 522 patients returned the IIEF questionnaire. The rest of the group was excluded from the statistical analysis. Six months after TURP, the rate of patients reporting ED increased to 77 %. Statistical analysis revealed that the only important factors associated with newly reported ED after TURP were diabetes mellitus （P = 0.003, r = 3.67） and observed intraoperative capsular perforation （P = 0.02, r = 1.12）. Conclusion： The incidence of postoperative, newly reported ED after TURP was 12%. Risk factors for its occurrence were diabetes mellitus and intraoperative capsular perforation. （Asian J Androl 2006 Jan; 8： 69-74）

Innovative endoscopic enucleations of the prostate--Xie’s Prostate Enucleations

In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vapor enucleation and resection of the prostate(TVERP),transurethral vapor enucleation of the prostate(TVEP),and ultrasound-navigated TVEP(US-TVEP)are new,innovative endoscopic enucleation procedures.These procedures are named Xie’s Prostate Enucleations(Xie’s Procedures for short).Current clinical data indicate that Xie’s Procedures are safe and effective treatment options for patients with BPH,especially for patients with larger prostates.Further prospective,randomized clinical trials compared with traditional transurethral resection of prostate(TURP)are still needed.

Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and metaanalysis

BACKGROUND Prostate artery embolization(PAE)is a promising minimally invasive therapy that improves lower urinary tract symptoms(LUTS)related to benign prostatic hyperplasia(BPH).Transurethral resection of the prostate(TURP)is the gold standard therapy for LUTS/BPH.AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH.Sources included PubMed,Embase,Cochrane library databases,and Chinese databases before June 2022.A systematic review and meta-analysis were conducted.Outcome measurements were combined by calculating the mean difference with a 95%confidence interval.Statistical analysis was carried out using Review Manager 5.3.RESULTS Eleven studies involving 1070 participants were included.Compared with the TURP group,the PAE group had a similar effect on the International Index of Erectile Function(IPSS)score,Peak urinary flow rate(Qmax),postvoid residual volume(PVR),Prostate volume(PV),prostatic specific antigen(PSA),The International Index of Erectile Function short form(IIEF-5)scores,and erectile dysfunction during 24 mo follow-up.Lower quality of life(QoL)score,lower rate of retrograde ejaculation and shorter hospital stay in the PAE group.There was no participant death in either group.A higher proportion of haematuria,urinary incontinence and urinary stricture was identified in the TURP group.CONCLUSION PAE may be an appropriate option for elderly patients,patients who are not candidates for surgery,and patients who do not want to risk the potential adverse effects of TURP.Studies with large cases and long follow-up time are needed to validate results.

Comparison of 80 W versus 120 W 532 nm Laser Prostatectomy for BPH

Purpose: Improvements to photoselective vaporization of the prostate (PVP) have been made over time, particularly with the introduction of higher power systems. Few studies however have compared the performance of these systems to their predecessors. The purpose of this study was to compare the clinical and perioperative outcomes of 80 W vs. 120 W PVP. Materials and Methods: A series of 267 and 209 consecutive patients underwent 80 W and 120 W PVP, respectively, from September 2001 to May 2009 at Weill Cornell Medical College (GreenLightTM laser system, American Medical Systems, Inc., Minnetonka, MN). Data were collected on patient demographics, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), and perioperative parameters. Maximum flow rate (Qmax), postvoid residual (PVR), and transrectal ultrasound prostate volume were recorded. Statistical analyses were carried out utilizing the Shapiro-Wilk, Mann-Whitney, Wilcoxon and unpaired t tests (SPSS 15.0, SPSS Inc., Chicago, IL, USA). Results: Baseline parameters were similar between the two groups except for greater median age (72.8 vs. 69.2 years, p = 0.01) and lower median PSA (2.0 vs. 3.3, p = 0.01) in the 80 W group. Median laser time was longer in the 80W group (85 vs. 51 minutes, p 0.001) with a higher median energy utilized (253 vs. 210 kJ, p = 0.001). Final IPSS, Qmax, PVR, and PSA were equivalent between the two groups. Conclusions: In our series, PVP was safe and effective. Durable and similar improvements in symptoms and objective parameters were achieved in patients with both 80 W and 120 W laser systems. PVP with the 120 W system, however, provided faster and more efficient vaporization compared to the 80 W system.

Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasiad-a single-center experience

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.

The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention

In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate （PK-TURP） for patients with benign prostatic hyperplasia （BPH） with acute urinary retention （AUR）. We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR （n = 348） and non-AUR groups （n = 778）. After the urethral catheters were removed, the urine white blood cell （WBC） count in the AUR group significantly increased compared with the non-AUR group （P〈 0.01）. However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group （P 〈 0.001）. A total of 87.1% （303/348） patients in the AUR group and 84.1% （654/778） patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group （P 〈 0.01）. The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3-12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.

Comparation of the predictive value between ultrasonography and urodynamics for the efficacy of transurethral resection of prostate in benign prostatic hyperplasia patients

Background Transurethral resection of prostate （TURP） has been widely used as a golden standard therapy of benign prostatic hyperplasia for over 40 years. However, not all patients achieved favorable outcome postoperatively. Since the level of bladder outlet obstruction and the dysfunction of detrusor （overactive and underactive） were both found to affect surgical efficacy, urodynamics was recommended as routine preoperative examination in selecting proper surgical candidates by International Continence Society in spite of its invasiveness and high cost. The aim of this research was to compare the predictive value between ultrasonography and urodynamics for TURP efficacy and determine if preoperative urodynamic test could be replaced by ultrasonography.Methods Two hundred and seventy-one patients took part in the retrospective analysis. All the subjects had preoperative evaluation of symptoms, life quality, and combined examination of ultrasonography and urodynamics. Surgical efficacy was measured according to the recovery of international prostate symptom score, quality of life score, and maximal flow rate 6 months after TURP. Fisher’s linear discriminant analysis was applied to establish the predictive models of surgical efficacy by choosing parameters from ultrasonography or urodynamics as independent factors. Receiver’s operating characteristic curve was then plotted to compare the values between the models.Results Sensitivity, specificity, positive and negative predictive value of models consisting of parameters from both ultrasonography and urodynamics were favorable. Corresponding models of ultrasonography and urodynamics were found to have non-significant difference in area under curve （P〉0.05）.Conclusions Preoperative ultrasonography has as strong value as urodynamics does in predicting surgical outcome of patients undergone TURP and might take the place of urodynamics in selecting surgical candidates. Further prospective analysis with larger popularity and longer period of follow up should be launched to verify the result of this research.

Transurethral resection of the prostate stricture management

For more than nine decades,transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction.The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty.Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate,the exact etiology of urethral stricture after TURP is still controversial.Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection,mechanical trauma,prolonged indwelling catheter time,use of local anesthesia,and electrical injury by a stray current.One single treatment option is not appropriate for all stricture types.The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods,including urethral dilation and direct visual incision,or open surgical procedures with varying urethroplasty techniques.Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse,we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate： a propensity score-matched analysis

We aim to reassess the safety of the monopolar transurethral resection of the prostate （M-TURP） without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit （10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively） were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier （4.6 days vs 5.2 days）, required shorter postoperative stays in the hospital （5.1 days vs 6.0 days）, and were at lower risk of operative complications （5.7% vs 9.2%）, especially bleeding requiring blood transfusion （2.9% vs 6.1%）. Similar findings were observed in cohorts of prostates of 30-80 ml and prostates 〉80 ml. Furthermore, among patients with a resection weight 〉42.5 g or surgical time 〉90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

经尿道选择性绿激光前列腺汽化术与经尿道等离子前列腺电切术治疗不同体积前列腺增生的结局指标比较

目的比较经尿道选择性绿激光前列腺汽化术(PVP)与经尿道等离子前列腺电切术(TUPKP)治疗不同体积前列腺增生患者的临床疗效。方法选择2019年1月—2022年1月于蚌埠医学院第一附属医院泌尿外科确诊的良性前列腺增生患者233例,根据术式不同分为PVP组(127例)和TUPKP组(106例)。根据前列腺彩超或MRI资料估算各组患者的前列腺体积,将患者再分为A组(<30 mL)、B组(30~80 mL)、C组(>80 mL)进行对比研究。结果A组和B组PVP术后血红蛋白下降值小于TUPKP术后,差异有统计学意义(P<0.01);而C组PVP术后血红蛋白下降值与TUPKP术后比较,差异无统计学意义(P>0.05)。A组和B组患者PVP手术时间均明显短于TUPKP手术时间(P<0.01),但C组患者PVP手术时间与TUPKP手术时间比较,差异无统计学意义(P>0.05)。A、B、C组患者PVP术后膀胱冲洗时间、留置导尿时间、平均住院时间明显短于TUPKP术后相应指标,差异有统计学意义(P<0.01)。并发症方面,PVP组电切综合征发生率低于TUPKP组(P<0.05);2组闭孔神经反射、尿失禁、尿道狭窄、膀胱颈挛缩的发生率比较,差异无统计学意义(P>0.05)。结论PVP作为一种新兴的治疗前列腺增生的手术方式,相较于传统的TUPKP,在手术时间、出血量、并发症方面均具有显著优势,特别是对于小体积前列腺增生患者。