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.

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.

Bipolar Transurethral Prostate Resection: A Study of 112 Cases

Background: With the advancement of technology, prostate resection can be performed nowadays using endoscopic techniques, which include monopolar and bipolar transurethral prostate resection. This study aimed to evaluate the results of bipolar transurethral prostate resection in a single urology center in Cameroon. Materials and Methods: This was a retrospective study carried out over two years (2015-2017) involving 112 patients with symptomatic prostate diseases who underwent transurethral prostate resection with the help of a bipolar Olympus generator. Results: The ages of the participants ranged from 44 years to 85 years, with a mean age of 64.41 ± 9.5 years. Fifty-six (50%) patients presented with only obstructive symptoms, five (4.46%) had only irritative symptoms, twenty (17.86%) presented with both obstructive and irritative symptoms, eight (7.14%) presented with macroscopic hematuria, seven (6.25%) with urinary tract infections, and sixteen (14.29%) with acute urinary retention. Digital rectal examination was unremarkable in 74 (66.07%) findings and was positive in 38 (33.93%) patients. The median prostate diameter was 70 [59 - 86.5] mm. The mean preoperative IPSS was 24.46 ± 5.68. The mean surgery duration was 77.61 ± 23.87 minutes. The mean volume of irrigation fluid used during surgery was 24.84 ± 6.40 ml. The differences between the preoperative and postoperative mean IPPS score, maximum urine flow rate, and quality of life were statistically significant (all P Conclusion: Bipolar transurethral prostate resection is a viable alternative to open surgery or laparoscopic surgery for large prostate glands. This technique is also associated with a reduction in prostate-related morbidity.

Necrosis zone depth after bipolar plasma vaporization and resection in the human prostate

Objectives:To compare the depth of thermal necrosis after use of bipolar resection and vaporization technique comparing intra-individually bipolar loop and bipolar button electrodes.Methods:Transurethral resection and vaporization of the prostate was performed in 55 male patients(260 specimens in total).In a standardized procedure,a bipolar resection loop was used for resection,and a bipolar button electrode was used for vaporization.Both electrodes were applied in each patient,either in the left or in the right lateral lobe.The depth of necrotic zones in the resected or vaporized tissue of each patient was measured in a standardized way by light microscopy.Results:The mean depth with standard deviation of thermal injury caused by the loop electrode was 0.0495±0.0274 mm.The vaporization electrode caused a mean thermal depth with standard deviation of 0.0477±0.0276 mm.The mean difference of necrosis zone depths between the two types of electrodes(PlasmaButtoneresection loop)was 0.0018 mm(p=0.691).Conclusion:For the first time,we present directly measured values of the absolute necrosis zone depth after application of plasma in the transurethral treatment of benign prostatic hyperplasia.The measured values were lower than in all other transurethral procedures.Standardized procedures of measurement and evaluation allow a statistically significant statement that the low necrosis depth in bipolar procedures is independent of the applied electrodes.

Analysis of 3 cases of bladder explosion in transurethral plasma prostatectomy

Objective:To investigate the causes of bladder explosion during transurethral plasmakinetic resection of prostate and to explore effective measures to reduce the risk of bladder explosion.Methods:The treatment process of bladder rupture(2cases)and bladder muscle layer laceration(1case)during transurethral plasmakinetic resection of prostate were retrospectively analyzed.Results:Two cases with intra-peritoneal rupture were cured by open surgery,and 1case with bladder muscle layer laceration was cured by conservative treatment.The main cause of bladder explosion is that:the flammable gas produced during the resection of prostate tissue mixed with the gas from the outside into the bladder to a certain proportion,in the action of electric spark,causing gas explosion.Conclusions:Using dorsal elevated position,shortening operative time,and reducing gas entering the bladder are three key points to prevent bladder explosion.

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.

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.

经尿道前列腺等离子双极电切术治疗高危良性前列腺增生患者的多中心、前瞻性研究

目的探讨经尿道前列腺等离子双极电切术(transurethral plasmakinetic resection of prostate,TUPKP)治疗高危良性前列腺增生(BPH)患者的临床疗效。方法采用前瞻性多中心研究设计。在全国20家医院泌尿外科按照纳入排除标准,入组行TUPKP治疗的高危BPH患者,分析患者基线、围手术期及术后3个月随访的相关数据,评价疗效和安全性。结果2016年9月至2018年12月共入组229名高危BPH患者。与基线相比,术后3个月随访的国际前列腺症状评分改变量为-17.28[95%CI(-18.02,-16.54)]分、最大尿流率改变量为5.61[95%CI(0.68,10.54)]mL·s^(-1)、残余尿量改变量为-84.50[95%CI(-96.49,-72.51)]mL、生活质量评分改变量为-3.24[95%CI(-3.42,-3.06)]分,差异均具有统计学意义(P<0.05)。术中及术后并发症的发生率低,未发生与手术相关的不良事件。结论TUPKP可以用于治疗高危BPH患者,建议由技术熟练的术者实施手术。

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.

Efficacy and safety of bipolar plasma vaporization of the prostate with ＂button-type＂ electrode compared with transurethral resection of prostate for benign prostatic hyperplasia

Background Transurethral resection of prostate （TURP） has been considered as the standard treatment for benign prostatic hyperplasia （BPH）. However, issues that have not yet been overcome for TURP include bleeding and absorption of irrigation fluid. Thus, novel improvement of the surgery is necessary. This study aimed to evaluate the efficacy and safety of bipolar plasma vaporization of the prostate （BPVP） with ＂button-type＂ electrode against standard TURP for BPH.

非那雄胺联合经尿道前列腺等离子体双极电切术对良性前列腺增生患者术后疼痛程度、尿动力学的影响

目的探讨非那雄胺联合经尿道前列腺等离子体双极电切术对良性前列腺增生患者术后疼痛程度、尿动力学的影响。方法选取2021年1月至2022年12月浙江中医药大学附属湖州市中医院及浙江中医药大学附属第二医院收治的100例良性前列腺增生患者作为研究对象。随机分为对照组(采用经尿道前列腺等离子体双极电切术)和观察组(采用经尿道前列腺等离子体双极电切术联合非那雄胺),各50例。比较两组的一般手术指标、术后疼痛程度、尿动力学指标、术后并发症发生率。结果观察组手术时间、尿管拔除时间、住院时间比对照组短,术中出血量比对照组少,差异具有统计学意义(P<0.05);术后,观察组疼痛程度优于对照组,差异具有统计学意义(P<0.05);观察组并发症发生率低于对照组,但差异无统计学意义(P>0.05);术后6个月,两组残余尿量(PVR)水平下降,且观察组低于对照组,两组最大尿流率(Qmax)、膀胱顺应性(BC)水平升高,且观察组高于对照组,差异具有统计学意义(P<0.05)。结论非那雄胺联合经尿道前列腺等离子体双极电切术治疗良性前列腺增生的临床效果好,可缩短手术时间、尿管拔除时间、住院时间,减少术中出血量,且可有效减轻患者术后疼痛,减少PVR,增加Qmax及BC。

前列腺增生患者TUPKRP术后发生全身炎症反应综合征的危险因素分析

目的探讨经尿道前列腺等离子电切术(TUPKRP)患者术后发生全身炎症反应综合征(SIRS)的危险因素,以期为临床决策的制定提供参考。方法收集2019年5月—2022年5月于新疆某医院行TUPKRP手术的170例BPH患者的临床资料,将发生术后SIRS的患者纳入SIRS组,未发生术后SIRS的患者纳入非SIRS组。收集2组患者一般资料、实验室检查结果及围术期指标,采用单因素分析及多因素logsitic回归模型分析TUPKRP术后发生SIRS的危险因素。结果170例接受TUPKRP术治疗的BPH患者中,32例(18.82%)发生术后SIRS。SIRS组和非SIRS组患者在年龄、合并2型糖尿病(T2DM)与否、术前前列腺体积、术前尿路感染与否、术前血白蛋白(Alb)水平、术前血红蛋白(Hb)水平及手术时间方面的差异均有统计学意义(P<0.05);而2组患者在身体质量指数、高血压史、术前国际前列腺症状评分(IPSS)、术前白细胞(WBC)计数、术中出血量及术后尿管留置时间方面的差异均无统计学意义(P>0.05)。logistic回归模型分析结果提示高龄(OR=1.194,95%CI:1.078~1.322),合并T2DM(OR=3.142,95%CI:1.412~6.991),术前前列腺体积大(OR=1.087,95%CI:1.029~1.148)是TUPKRP术后发生SIRS的独立危险因素(P<0.05),术前高Hb水平(OR=0.903,95%CI:0.838~0.973)是TUPKRP术后发生SIRS的独立保护因素(P<0.05)。结论TUPKRP术后SIRS发生率较高,高龄、合并T2DM、术前前列腺体积大是TUPKRP术后发生SIRS的独立危险因素,而术前高Hb水平是TUPKRP术后发生SIRS的独立保护因素。可针对以上相关因素进行相应干预,以减少术后SIRS发生。

蓝激光前列腺汽化切除术对良性前列腺增生患者术后性功能及下尿路症状的影响

目的分析蓝激光前列腺汽化切除术治疗良性前列腺增生(BPH)的临床效果及对患者术后性功能及下尿路症状(LUTS)的影响。方法回顾性分析2023年3—8月在泰安市中心医院迎胜院区泌尿肾病激光治疗中心接受手术治疗的91例BPH患者的临床资料,根据不同手术方式分为两组,蓝激光组(n=46)采用经尿道蓝激光前列腺汽化切除术,PKRP组(n=45)采用经尿道前列腺等离子电切术(PKRP)。比较两组患者的手术时间、膀胱冲洗时间、留置尿管时间、住院时间,术前、术后6个月的残余尿量(PVR)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(QoL)、国际勃起功能指数-5(IIEF-5)问卷、射精功能评分量表(CIPE)评分以及逆行射精发生率。结果两组手术时间[(24.66±5.38)min vs.(62.50±3.85)min]、膀胱冲洗时间[(20.40±2.78)h vs.(51.93±5.02)h]、留置尿管时间[(1.65±0.89)d vs.(6.73±2.98)d]及住院时间[(4.26±1.57)d vs.(8.45±2.28)d]比较,蓝激光组均明显短于PKRP组(P<0.05)。两组患者术前及术后6个月Qmax、PVR、QoL及IPSS比较差异无统计学意义(P>0.05)。术后6个月蓝激光组较PKRP组的IIEF-5问卷[(20.02±2.63)分vs.(17.64±1.75)分]及CIPE评分更高[(30.88±3.45)分vs.(26.25±3.51)分],差异具有统计学意义(P<0.05)。蓝激光组术后6个月的逆行射精发生率低于PKRP组(4.35%vs.35.60%,P<0.05)。结论蓝激光前列腺汽化切除术能够改善BPH患者LUTS,并且更好的保护了患者的性功能。

经尿道前列腺等离子双极电切术与经尿道前列腺电切术治疗良性前列腺增生患者的效果比较

目的:比较经尿道前列腺等离子双极电切术(TUPKP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)患者的效果。方法:选取2020年1月至2023年2月该院收治的74例BPH患者进行前瞻性研究,按随机数字表法将其分为对照组与观察组各37例。观察组采用TUPKP治疗,对照组采用TURP治疗,比较两组手术相关指标水平、手术前后疾病相关指标[前列腺特异性抗原(PSA)、前列腺素E_(2)(PGE_(2))]水平、尿流动力学指标[膀胱顺应性(BC)、最大尿流率(Qmax)、残余尿量(PVR)]水平、前列腺症状[国际前列腺症状评分(IPSS)]和术后并发症发生率。结果:观察组手术时间、导管留置时间、膀胱冲洗时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后7 d,两组PSA、PGE_(2)水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);术后3个月,两组BC、Qmax水平均高于术前,且观察组高于对照组,两组PVR水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);两组IPSS评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:TUPKP治疗BPH患者可降低手术相关指标、疾病相关指标水平和前列腺症状评分,改善尿流动力学指标水平,其效果优于TURP治疗。

经尿道前列腺等离子双极电切术治疗良性前列腺增生患者的效果

目的:观察经尿道前列腺等离子双极电切术(TUPKP)治疗良性前列腺增生(BPH)患者的效果。方法:选取2021年2月至2023年2月该院收治的86例BPH患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各43例。对照组行经尿道前列腺电切术(TURP)治疗,观察组行TUPKP治疗。比较两组围术期指标(术中出血量、手术时间、住院时间)水平,手术前后尿动力学指标[最大尿流率(Qmax)、残余尿量(PVR)、膀胱顺应性(BC)]水平、性功能[国际勃起功能指数-5(IIEF-5)]评分,以及并发症发生率。结果:观察组术中出血量少于对照组,手术时间、住院时间短于对照组,差异均有统计学意义(P<0.05);术后3个月,观察组Qmax、BC水平高于对照组,PVR水平低于对照组,差异均有统计学意义(P<0.05);术后3个月,观察组IIEF-5评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为4.65%(2/43),低于对照组的20.93%(9/43),差异有统计学意义(P<0.05)。结论:TUPKP治疗BPH患者可改善围术期指标、尿动力学指标水平,提高性功能评分,降低并发症发生率,效果优于TURP治疗。

经尿道两种不同手术方式治疗高危良性BPH的效果比较

目的:探讨经尿道两种不同手术方式治疗高危良性前列腺增生(BPH)效果比较。方法:回顾分析2021年6月至2023年6月我院收治108例高危BPH患者临床资料,依据手术方式不同分成电切组(n=42)与剜除组(n=66)。分析两组治疗效果。结果:剜除组手术、导管滞留及住院时间均短于电切组,术中出血量及剩余腺体质量少于电切组(P<0.05);剜除组国际前列腺症状评分、残余尿量、前列腺特异性抗原、前列腺素E2及睾酮水平低于电切组,最大尿流率水平、国际勃起功能问卷评分、早泄患者性功能-5评分法评分均高于电切组(P<0.05)。结论:对高危良性BPH患者采用经尿道前列腺等离子剜除术治疗效果更好。

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

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

经尿道前列腺等离子切除术治疗良性前列腺增生伴高血压的效果研究

目的比较经尿道前列腺等离子切除术(TUPKRP)与药物治疗对伴高血压的良性前列腺增生人群血压及血压节律变化的影响。方法回顾性纳入2021年6月—2023年6月本院103例良性前列腺增生患者为研究对象,依据治疗方案的不同将其分为药物治疗组47例(采用替米沙坦联合非那雄胺治疗)和手术治疗组56例(采用替米沙坦联合TUPKRP治疗)。比较2组治疗前以及治疗3、6个月时血压水平(24 h平均舒张压、24 h平均收缩压、日间平均舒张压、日间平均收缩压、夜间平均舒张压和夜间平均收缩压)、血压节律变化(杓型血压)、前列腺症状、前列腺体积、残余尿量和性功能。结果手术治疗组治疗3、6个月时不同时段平均血压低于药物治疗组,差异有统计学意义(P<0.05);手术治疗组治疗3、6个月时杓型血压转变率(67.86%、87.50%)高于药物治疗组(40.42%、68.09%),差异有统计学意义(P<0.05);手术治疗组治疗3、6个月时国际前列腺症状评分(IPSS)、残余尿量、前列腺体积低于、小于药物治疗组,差异有统计学意义(P<0.05);2组治疗前以及治疗3、6个月时性功能比较,差异无统计学意义(P>0.05)。结论替米沙坦联合TUPKRP可降低伴高血压的良性前列腺增生患者血压水平,调节血压节律变化,改善前列腺症状,缩小前列腺体积,减少残余尿量,且对患者性功能影响较小。

经尿道钬激光前列腺剜除术与经尿道前列腺等离子双极电切术治疗中等体积良性前列腺增生的效果及安全性比较

目的比较经尿道钬激光前列腺剜除术(HoLEP)与经尿道前列腺等离子双极电切术(BPRP)治疗中等体积良性前列腺增生(BPH)的效果及安全性。方法将85例中等体积BPH患者(前列腺体积30~80 mL)按手术方式不同分为经尿道钬激光前列腺剜除术治疗组(HoLEP组,n=46)和经尿道前列腺等离子双极电切术治疗组(BPRP组,n=39),比较2组手术相关指标(包括手术时间、术中出血量、术后住院时间、尿管留置时间及膀胱冲洗时间等)、术后并发症及术前术后国际前列腺症状评分(IPSS评分)、生活质量评分(QOL评分)、最大尿流率(Q_(max))、残余尿(PVR)等。结果HoLEP组术后住院时间、术中出血量、尿管留置时间较BPRP组显著减少(P<0.05)。2组术后IPSS评分、QOL评分、PVR值均较术前显著减少(P<0.01),Q_(max)值均较术前显著增加(P<0.01),且HoLEP组术后IPSS评分、QOL评分、Q_(max)值较BPRP组改善更为显著(P<0.05)。2组均无电切综合征和输血不良事件发生,2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论HoLEP与BPRP治疗中等体积前列腺增生均安全有效;但与BPRP治疗相比,HoLEP治疗可显著缩短术后住院时间、尿管留置时间,减少术中出血量,同时在改善患者症状、提高患者生活质量方面效果更为显著。