AIM To compare outcomes after open simple prostatectomy without bladder irrigation, in subjects drained by combined 2-way urethral catheter and suprapubic catheter(SPC) vs those drained by 2-way urethral catheter only...AIM To compare outcomes after open simple prostatectomy without bladder irrigation, in subjects drained by combined 2-way urethral catheter and suprapubic catheter(SPC) vs those drained by 2-way urethral catheter only.METHODS A total of 84 participants undergoing Freyer's simple prostatectomy over an 18-mo period were randomized into 2 groups(n=42). Subjects in group 1 were managed with 2-way urethral catheter and in situ 2-way SPC while subjects in group 2 had a 2-way urethral catheter drainage only. In group 1 subjects, the SPC was spigotted and only used for drainage if there was clot retention. The primary outcomes were number of clot retention episodes, and number of clot retention episodes requiring bladder syringe evacuation. Other secondary outcomes evaluated were blood loss, requirement of extra analgesics, duration of surgery, hospital stay and presence or absence of post-op complications. RESULTS The mean age in the groups was 65.7(± 7.6) in group 1 vs 64.8(±6.8) in group 2.The groups were similar with respect to age, prostate specific antigen, prostate volume, blood loss, duration of surgery, blood transfusion and overall complication rate. However statistically significant differences were observed in clot retention episodes between group 1 and 2:0.8(±1.5)vs3.5(±4.4), P<0.000, clot retention episodes requiring evacuation with bladder syringe 0.4(± 0.9) vs 2.6(± 3.8), P = 0.001, requirement of extra analgesics 0.4(±0.5)vs4.0(±1.5), P<0.000 and duration of admission 8.6d(± 1.2) vs 7.3 CONCLUSION Subjects drained with a combination of urethral and SPCs have fewer clot retention episodes and reduced requirement of extra analgesics but slightly longer hospital stay.展开更多
Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms inste...Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms instead of PCa.We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery,namely complication and mortality rates.Methods:Within the American College of Surgeons National Surgical Quality Improvement Program database(2011-2016),we identified patients who underwent transurethral resection of the prostate,photoselective vaporization,or laser enucleation.Patients were stratified according to postoperative diagnosis(PCa vs.BPH).Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality.A formal test of interaction between diagnosis and surgical technique used was performed.Results:Overall,34542 patients were included.Of all,2008(5.8%)had a diagnosis of PCa.The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients(odds ratio:0.9,95%confidence interval:0.7-1.1;p=0.252).Moreover,similar rates of perioperative mortality(p=0.255),major acute cardiovascular events(p=0.581),transfusions(p=0.933),and length of stay of more than or equal to 30 days(p=0.174)were found.Additionally,all tests failed to show an interaction between post-operative diagnosis and surgical technique used.Conclusion:Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts.Moreover,the diagnosis seems to not influence surgical technique outcomes.展开更多
Aim: To explore the feasibility and safety of greenlight photoselective vaporization of the prostate (PVP) on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplas...Aim: To explore the feasibility and safety of greenlight photoselective vaporization of the prostate (PVP) on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) and to evaluate their clinical and voiding outcome. Methods: A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score (IPSS), quality of life score (QoL), uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results: All patients got through the perioperative period safely. The chief advantages of PVP were: short operative time (25.6 ± 7.6 min), little bleeding loss (56.8 ± 14.3 mL) and short indwelling catheterization (1.6 ± 0.8 d). The IPSS and QoL decreased from (29.6 ± 5.4) and (5.4 ± 0.6) to (9.5 ± 2.6) and (1.3 ± 0.6), respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data (P 〈 0.05). No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion: PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.展开更多
BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral sten...BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral stent implantation,minor complications such as urinary tract infection,irritative symptoms,gross hematuria,and urethral pain have been observed;however,there are no reports of life-threatening events.Herein,we report a critical case of Fournier’s gangrene that occurred 7 years after prostatic stenting.CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia(volume,126 ccs;as measured by transrectal ultrasound)had undergone insertion of a thermoexpandable urethral stent(Memokath 028)as he was unfit for surgery under general anesthesia.However,the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent(Memokath 028).We had planned to remove the Memokath 028;however,the patient was lost to follow-up.The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area.In digital rectal examination,tenderness and heat of prostate was identified.Also,the black skin color change with foulsmelling from right scrotum to right inguinal area was identified.In computed tomography finding,subcutaneous emphysema was identified to same area.He was diagnosed with Fournier’s gangrene based on the physical examination and computed tomography findings.In emergency room,Fournier’s gangrene severity index value is seven points.Therefore,he underwent emergent extended surgical debridement and removal of the Memokath 028.Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed.However,the patient died 14 days after surgery due to multiorgan failure.CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients,its rapid removal may help prevent severe complications.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
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) ...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.展开更多
To evaluate the safety and efficacy of transrectal high-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH), serial studies were conducted in 150 BPH patients before and 30 m...To evaluate the safety and efficacy of transrectal high-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH), serial studies were conducted in 150 BPH patients before and 30 min, 1, 2, 6 and 12 month(s) after Sonablate-500TM HIFU treatment. A silicon-coated indwelling 16F latex catheter was placed during the determination of the therapy zone. Preoperative and postoperative evaluations were made by using the international prostate symptom score (IPSS), quality of life (QOL), uroflowmetric findings and transrectal ultrasound, and incidence of complications. The cystourethrography was done in 23 patients within 1 year postoperatively. The results showed that after HIFU treatment, IPSS and QOL scores were significantly decreased at 1, 2, 6 and 12 month(s) (P〈0.01). Maximum urine flow rate (6.0 to 17.2 mL/s, P〈0.01), PVR (75.0 to 30.3, P〈0.01) and prostatic volume (65.0 to 38.1 mL, P〈0.05) were significantly improved 12 months after the operation. Recurrent urinary retention (17=2) and urethrorectal fistula (n=1) occurred at the 15th postoperative day. The duration of the HIFU prostate ablation was 25-90 min. The mean time for an indwelling catheter was 3-19 days. These data demonstrate that treatment of BPH with Sonab- late-500TM HIFU is safe and effective.展开更多
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 enlarg...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.展开更多
Benign prostatic hyperplasia (BPH) is one of the common diseases in middle-aged and elderly men, and its clinical symptoms include storage symptoms, voiding symptoms and post-urination symptoms. Surgery is an importan...Benign prostatic hyperplasia (BPH) is one of the common diseases in middle-aged and elderly men, and its clinical symptoms include storage symptoms, voiding symptoms and post-urination symptoms. Surgery is an important treatment method for benign prostatic hyperplasia. It is suitable for BPH patients with moderate to severe LUTS (Lower Urinary Tract Symptoms) and has significantly affected the quality of life. The surgical methods include transurethral resection of the prostate and transurethral holmium laser enucleation of the prostate. While offering a high chance of cure, it also brings some complications, including postoperative urinary incontinence. This article mainly reviews the urinary incontinence after transurethral prostate surgery in recent years and analyzes its risk factors, and summarizes the experience for further prediction and reduction of the incidence of urinary incontinence.展开更多
A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra n...A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19.2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.展开更多
Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical int...Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical intervention.From July 2019 to June 2020,the ERAS program was applied to 248 patients,and the conventional program was applied to 238 patients.After 1 year of follow-up,the differences between the ERAS group and the conventional group were evaluated.The ERAS group had a shorter time of urinary catheterization compared with the conventional group(mean±standard deviation[s.d.]:1.0±0.4 days vs 2.7±0.8 days,P<0.01),and the pain(mean±s.d.)was significantly reduced through postoperative hospitalization days(PODs)0-2(POD 0:1.7±0.8 vs 2.4±1.0,P<0.01;POD 1:1.6±0.9 vs 3.5±1.3,P<0.01;POD 2:1.2±0.7 vs 3.0±1.3,P<0.01).No statistically significant difference was found in the rate of postoperative complications,such as postoperative bleeding(P=0.79),urinary retention(P=0.40),fever(P=0.55),and readmission(P=0.71).The hospitalization cost of the ERAS group was similar to that of the conventional group(mean±s.d.:16927.8±5808.1 Chinese Yuan[CNY]vs 17044.1±5830.7 CNY,P=0.85).The International Prostate Symptom Scores(IPSS)and quality of life(QoL)scores in the two groups were also similar when compared at 1 month,3 months,6 months,and 12 months after discharge.The ERAS program we conducted was safe,repeatable,and efficient.In conclusion,patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.展开更多
The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladd...The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors.One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement(BPE)who had not received medical treatment before were included in the study.In the first step,only the bladder calculi of patients were removed and medical treatment was given for BPE.The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2.Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model.In the follow-up of 117 patients with bladder stones removed and medical treatment initiated,49(41.9%)patients had prostate surgery indications.The indication for 33(67.3%)of 49 patients was medical treatment failure.The presence of intravesical prostatic protrusion(IPP;hazard ratio:2.071,95%confidence interval[Cl]:1.05-4.05,P=0.034),and high postvoiding residual urine volume(hazard ratio:1.013,95%Cl:1.007-1.019,P<0.001)were found to be preoperative risk factors for needing future prostate surgery.In patients who have not received medical treatment for BPE before,bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.展开更多
Two-micron (thulium) laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar t...Two-micron (thulium) laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um (thulium) laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia (BPH). This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate (TURP) during the 1-year follow-up.展开更多
Objective:According to the EAU Guidelines,transurethral resection of the prostate(TURP)has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostat...Objective:According to the EAU Guidelines,transurethral resection of the prostate(TURP)has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia(BPH).However,its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique.We reported the patient outcomes with our technique.Methods:We retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate(B-TUERP)between March 2015 and September 2015.Pre-and perioperative parameters were obtained from medical charts.Postoperative follow-ups were administrated at 1,3,6,12 and 24 month(s)after surgery,respectively.Results:All the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%.Qmax was significantly improved immediately after surgery,followed by a continuous improvement throughout the follow-ups.Following a steep decrease in mean prostate specific antigen(PSA)and post void residual(PVR)observed within the first half year after surgery,the serum PSA was then maintained at a constant level of 0.61 ng/mL.Temporary urinary retention was found in four cases(7.7%).Stress urinary incontinence occurred in five patients(9.6%),with the condition resolved in 1e2 weeks without extra treatment.Urethral strictures and bladder neck contractures,as the most commonly observed long-term complications,developed in four patients(7.7%).No recurrence was found during 2 years of follow-ups.An improvement in International Index of Erectile Function(IIEF-5)scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery,and sustained throughout the 24-month period.Conclusions:Enucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice.Currently,bipolar resection is a commonly employed procedure in clinical settings,and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists.Based on these findings,we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.展开更多
Aim: To determine the epidemiological, clinical, paraclinical characteristics and assess the result of surgical treatment of benign prostatic hyperplasia (BPH) in the urological department. Patients and Method: It is ...Aim: To determine the epidemiological, clinical, paraclinical characteristics and assess the result of surgical treatment of benign prostatic hyperplasia (BPH) in the urological department. Patients and Method: It is a retrospective descriptive study of 757 patient samples whose BPH diagnosis was pronounced and have benefited of the open surgery in urology department from January 2006 to December 2010. The variables studied were sociodemographical, clinical, paraclinical, therapeutical and the follow up. Those variables were: arterial tension, sonography, consultation reasons and hospitalization, the data provided rectal touch, the comorbidity, the prostatic specific antigen (PSA), other blood tests, urinary tests, medical management surgical treatment, the causes of death and the complications. Results: during the study period, 2406 patients were hospitalized, from them 1472 (61.18%) for low urinary tract diseases where 757 for BPH. The mean age was 64.18 years. The acute urine retention was the main cause of hospitalizations and consultations (51.51%). The rectal touch Helped in diagnosing 96.43% of cases. PSA in 74.10%, the sonography evaluated the volume of the prostate and the complications on the upper urinary tract, kidney dilatation and stones. An urgent evacuation of acute retention of urine in the bladder was done in 74.10%, a medical treatment was done in 33.47%. The open surgery was done in 66.47%. The evolution was good for 703 (92.86%), 54 died (7.14%) and the causes were various (anemia, hyperglycemia, HIV…). Conclusion: The BHP was the first reason of consultation and hospitalization in urology department in N’Djamena. Its diagnosis was done after the analysis of a beam clinical and paraclinical arguments. In the absence of an endoscopic resection column, open surgery was the only surgical treatment.展开更多
Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experi...Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.展开更多
文摘AIM To compare outcomes after open simple prostatectomy without bladder irrigation, in subjects drained by combined 2-way urethral catheter and suprapubic catheter(SPC) vs those drained by 2-way urethral catheter only.METHODS A total of 84 participants undergoing Freyer's simple prostatectomy over an 18-mo period were randomized into 2 groups(n=42). Subjects in group 1 were managed with 2-way urethral catheter and in situ 2-way SPC while subjects in group 2 had a 2-way urethral catheter drainage only. In group 1 subjects, the SPC was spigotted and only used for drainage if there was clot retention. The primary outcomes were number of clot retention episodes, and number of clot retention episodes requiring bladder syringe evacuation. Other secondary outcomes evaluated were blood loss, requirement of extra analgesics, duration of surgery, hospital stay and presence or absence of post-op complications. RESULTS The mean age in the groups was 65.7(± 7.6) in group 1 vs 64.8(±6.8) in group 2.The groups were similar with respect to age, prostate specific antigen, prostate volume, blood loss, duration of surgery, blood transfusion and overall complication rate. However statistically significant differences were observed in clot retention episodes between group 1 and 2:0.8(±1.5)vs3.5(±4.4), P<0.000, clot retention episodes requiring evacuation with bladder syringe 0.4(± 0.9) vs 2.6(± 3.8), P = 0.001, requirement of extra analgesics 0.4(±0.5)vs4.0(±1.5), P<0.000 and duration of admission 8.6d(± 1.2) vs 7.3 CONCLUSION Subjects drained with a combination of urethral and SPCs have fewer clot retention episodes and reduced requirement of extra analgesics but slightly longer hospital stay.
文摘Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms instead of PCa.We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery,namely complication and mortality rates.Methods:Within the American College of Surgeons National Surgical Quality Improvement Program database(2011-2016),we identified patients who underwent transurethral resection of the prostate,photoselective vaporization,or laser enucleation.Patients were stratified according to postoperative diagnosis(PCa vs.BPH).Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality.A formal test of interaction between diagnosis and surgical technique used was performed.Results:Overall,34542 patients were included.Of all,2008(5.8%)had a diagnosis of PCa.The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients(odds ratio:0.9,95%confidence interval:0.7-1.1;p=0.252).Moreover,similar rates of perioperative mortality(p=0.255),major acute cardiovascular events(p=0.581),transfusions(p=0.933),and length of stay of more than or equal to 30 days(p=0.174)were found.Additionally,all tests failed to show an interaction between post-operative diagnosis and surgical technique used.Conclusion:Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts.Moreover,the diagnosis seems to not influence surgical technique outcomes.
文摘Aim: To explore the feasibility and safety of greenlight photoselective vaporization of the prostate (PVP) on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) and to evaluate their clinical and voiding outcome. Methods: A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score (IPSS), quality of life score (QoL), uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results: All patients got through the perioperative period safely. The chief advantages of PVP were: short operative time (25.6 ± 7.6 min), little bleeding loss (56.8 ± 14.3 mL) and short indwelling catheterization (1.6 ± 0.8 d). The IPSS and QoL decreased from (29.6 ± 5.4) and (5.4 ± 0.6) to (9.5 ± 2.6) and (1.3 ± 0.6), respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data (P 〈 0.05). No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion: PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.
基金Supported by the 2021 Yeungnam University Research Grant.
文摘BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral stent implantation,minor complications such as urinary tract infection,irritative symptoms,gross hematuria,and urethral pain have been observed;however,there are no reports of life-threatening events.Herein,we report a critical case of Fournier’s gangrene that occurred 7 years after prostatic stenting.CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia(volume,126 ccs;as measured by transrectal ultrasound)had undergone insertion of a thermoexpandable urethral stent(Memokath 028)as he was unfit for surgery under general anesthesia.However,the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent(Memokath 028).We had planned to remove the Memokath 028;however,the patient was lost to follow-up.The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area.In digital rectal examination,tenderness and heat of prostate was identified.Also,the black skin color change with foulsmelling from right scrotum to right inguinal area was identified.In computed tomography finding,subcutaneous emphysema was identified to same area.He was diagnosed with Fournier’s gangrene based on the physical examination and computed tomography findings.In emergency room,Fournier’s gangrene severity index value is seven points.Therefore,he underwent emergent extended surgical debridement and removal of the Memokath 028.Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed.However,the patient died 14 days after surgery due to multiorgan failure.CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients,its rapid removal may help prevent severe complications.
文摘<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. <strong>Materials and Methods:</strong> During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. <strong>Results:</strong> TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. <strong>Conclusion:</strong> TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.
文摘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.
基金the foundation of Medical Research of Guangdong Province (No. A2004478) the Program of Science and Technology of Guangdong Province (No. 2004B30301013).
文摘To evaluate the safety and efficacy of transrectal high-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH), serial studies were conducted in 150 BPH patients before and 30 min, 1, 2, 6 and 12 month(s) after Sonablate-500TM HIFU treatment. A silicon-coated indwelling 16F latex catheter was placed during the determination of the therapy zone. Preoperative and postoperative evaluations were made by using the international prostate symptom score (IPSS), quality of life (QOL), uroflowmetric findings and transrectal ultrasound, and incidence of complications. The cystourethrography was done in 23 patients within 1 year postoperatively. The results showed that after HIFU treatment, IPSS and QOL scores were significantly decreased at 1, 2, 6 and 12 month(s) (P〈0.01). Maximum urine flow rate (6.0 to 17.2 mL/s, P〈0.01), PVR (75.0 to 30.3, P〈0.01) and prostatic volume (65.0 to 38.1 mL, P〈0.05) were significantly improved 12 months after the operation. Recurrent urinary retention (17=2) and urethrorectal fistula (n=1) occurred at the 15th postoperative day. The duration of the HIFU prostate ablation was 25-90 min. The mean time for an indwelling catheter was 3-19 days. These data demonstrate that treatment of BPH with Sonab- late-500TM HIFU is safe and effective.
文摘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.
文摘Benign prostatic hyperplasia (BPH) is one of the common diseases in middle-aged and elderly men, and its clinical symptoms include storage symptoms, voiding symptoms and post-urination symptoms. Surgery is an important treatment method for benign prostatic hyperplasia. It is suitable for BPH patients with moderate to severe LUTS (Lower Urinary Tract Symptoms) and has significantly affected the quality of life. The surgical methods include transurethral resection of the prostate and transurethral holmium laser enucleation of the prostate. While offering a high chance of cure, it also brings some complications, including postoperative urinary incontinence. This article mainly reviews the urinary incontinence after transurethral prostate surgery in recent years and analyzes its risk factors, and summarizes the experience for further prediction and reduction of the incidence of urinary incontinence.
文摘A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19.2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.
基金The study is funded by the National Key Research and Development Program of China(grant No.2021YFC2009304)the Project of Science and Technology Department of Chengdu(grant No.2021-YF05-00717-SN)the Project of Science and Technology Department of Sichuan Province(2021YFS0117).
文摘Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical intervention.From July 2019 to June 2020,the ERAS program was applied to 248 patients,and the conventional program was applied to 238 patients.After 1 year of follow-up,the differences between the ERAS group and the conventional group were evaluated.The ERAS group had a shorter time of urinary catheterization compared with the conventional group(mean±standard deviation[s.d.]:1.0±0.4 days vs 2.7±0.8 days,P<0.01),and the pain(mean±s.d.)was significantly reduced through postoperative hospitalization days(PODs)0-2(POD 0:1.7±0.8 vs 2.4±1.0,P<0.01;POD 1:1.6±0.9 vs 3.5±1.3,P<0.01;POD 2:1.2±0.7 vs 3.0±1.3,P<0.01).No statistically significant difference was found in the rate of postoperative complications,such as postoperative bleeding(P=0.79),urinary retention(P=0.40),fever(P=0.55),and readmission(P=0.71).The hospitalization cost of the ERAS group was similar to that of the conventional group(mean±s.d.:16927.8±5808.1 Chinese Yuan[CNY]vs 17044.1±5830.7 CNY,P=0.85).The International Prostate Symptom Scores(IPSS)and quality of life(QoL)scores in the two groups were also similar when compared at 1 month,3 months,6 months,and 12 months after discharge.The ERAS program we conducted was safe,repeatable,and efficient.In conclusion,patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.
文摘The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors.One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement(BPE)who had not received medical treatment before were included in the study.In the first step,only the bladder calculi of patients were removed and medical treatment was given for BPE.The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2.Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model.In the follow-up of 117 patients with bladder stones removed and medical treatment initiated,49(41.9%)patients had prostate surgery indications.The indication for 33(67.3%)of 49 patients was medical treatment failure.The presence of intravesical prostatic protrusion(IPP;hazard ratio:2.071,95%confidence interval[Cl]:1.05-4.05,P=0.034),and high postvoiding residual urine volume(hazard ratio:1.013,95%Cl:1.007-1.019,P<0.001)were found to be preoperative risk factors for needing future prostate surgery.In patients who have not received medical treatment for BPE before,bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.
文摘Two-micron (thulium) laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um (thulium) laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia (BPH). This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate (TURP) during the 1-year follow-up.
文摘Objective:According to the EAU Guidelines,transurethral resection of the prostate(TURP)has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia(BPH).However,its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique.We reported the patient outcomes with our technique.Methods:We retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate(B-TUERP)between March 2015 and September 2015.Pre-and perioperative parameters were obtained from medical charts.Postoperative follow-ups were administrated at 1,3,6,12 and 24 month(s)after surgery,respectively.Results:All the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%.Qmax was significantly improved immediately after surgery,followed by a continuous improvement throughout the follow-ups.Following a steep decrease in mean prostate specific antigen(PSA)and post void residual(PVR)observed within the first half year after surgery,the serum PSA was then maintained at a constant level of 0.61 ng/mL.Temporary urinary retention was found in four cases(7.7%).Stress urinary incontinence occurred in five patients(9.6%),with the condition resolved in 1e2 weeks without extra treatment.Urethral strictures and bladder neck contractures,as the most commonly observed long-term complications,developed in four patients(7.7%).No recurrence was found during 2 years of follow-ups.An improvement in International Index of Erectile Function(IIEF-5)scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery,and sustained throughout the 24-month period.Conclusions:Enucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice.Currently,bipolar resection is a commonly employed procedure in clinical settings,and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists.Based on these findings,we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.
文摘Aim: To determine the epidemiological, clinical, paraclinical characteristics and assess the result of surgical treatment of benign prostatic hyperplasia (BPH) in the urological department. Patients and Method: It is a retrospective descriptive study of 757 patient samples whose BPH diagnosis was pronounced and have benefited of the open surgery in urology department from January 2006 to December 2010. The variables studied were sociodemographical, clinical, paraclinical, therapeutical and the follow up. Those variables were: arterial tension, sonography, consultation reasons and hospitalization, the data provided rectal touch, the comorbidity, the prostatic specific antigen (PSA), other blood tests, urinary tests, medical management surgical treatment, the causes of death and the complications. Results: during the study period, 2406 patients were hospitalized, from them 1472 (61.18%) for low urinary tract diseases where 757 for BPH. The mean age was 64.18 years. The acute urine retention was the main cause of hospitalizations and consultations (51.51%). The rectal touch Helped in diagnosing 96.43% of cases. PSA in 74.10%, the sonography evaluated the volume of the prostate and the complications on the upper urinary tract, kidney dilatation and stones. An urgent evacuation of acute retention of urine in the bladder was done in 74.10%, a medical treatment was done in 33.47%. The open surgery was done in 66.47%. The evolution was good for 703 (92.86%), 54 died (7.14%) and the causes were various (anemia, hyperglycemia, HIV…). Conclusion: The BHP was the first reason of consultation and hospitalization in urology department in N’Djamena. Its diagnosis was done after the analysis of a beam clinical and paraclinical arguments. In the absence of an endoscopic resection column, open surgery was the only surgical treatment.
文摘Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.