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.

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.

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.

Patient-controlled intravenous fentanyl for cystospasm after transurethral resection of the prostate

Objective： To evaluate the clinical efficacy and safety of patient-controlled intravenous analgesia （PCIA） with fentanyl for cystospasm after transurethral resection of the prostate. Methods： Sixty benign prostatic hyperplasia （BPH） patients scheduled for transurethral resection of the prostate （TURP） under general anesthesia with laryngeal mask airway （LMA） were randomly divided into groups F and S. Group F （n=30） received PCIA device with fentanyl 10 ug/kg＋8 mg ondansetron, and Group S （n=30） received placebo （PCIA device with 8 mg ondansetron）. The visual analog scale （VAS） scores for pain were evaluated at 0, 2, 4, 8, 16, 24, and 48 h by the same staff. And recorded were incidence of cystospasm, side effects, application of hemostatic, duration of drawing Foley catheter and continuous bladder irrigation, time of exhaust after operation, time of post-operative stay and cost of hospitalization. Results： The incidence of cystospasm in Group F was significantly lower than that in Group S in the 48 h after operation （P〈0.05）, the VAS scores for pain in Group F was significantly lower than that in Group S within the 48 h after operation （P〈0.01）. The time of exhaust after operation in Group F was significantly later than in Group S （P〈0.05）. No significant difference was observed in applications of hemostatic, duration of drawing Foley catheter, duration of continuous bladder irrigation, time of post-operative stay and cost of hospitalization between the 2 groups. Conclusion： PCIA with fentanyl （10 ug/kg） relieves pain with little side effect and reduces cystospasm satisfactorily.

Alternative mechanisms for prostate-specific antigen elevation:A prospective analysis of 222 transurethral resections of prostate patients

AIM: To investigate the relationship between prostatespecific antigen(PSA) levels and(1) bladder outlet obstruction(BOO) and(2) the severity of prostate inflammation.METHODS: Two hundred and twenty-two consecutive patients undergoing transurethral resection of the prostate(TURP) were prospectively included. Patients with proven urinary tract infection and/or known prostate cancer were excluded. PSA levels, International Prostate Symptoms Score(IPSS), prostate weight, post residual volume and pressure flow parameters were determined. A histopathological assessment of the presence and severity of inflammation was also performed.RESULTS: Patients had a mean age of 69.1 ± 8.6 years(45-90 years), with mean preoperative PSA levels of 4.7 ± 5.4 ng/m L(0.2-32.5 ng/m L) and IPSS of 15.7 ± 6.9(0-32). Mean Pdet Q max was 96.3 ± 34.4 cm H2O(10-220 cm H2O). The mean resected prostate weight was 39.4 ± 27.3 g(3-189 g). Correlations were observed between PSA(logarithmic) and resected prostate weight(r = 0.54; P < 0.001), PSA(logarithmic) and Pdet Q max(r = 0.17; P = 0.032), and resected prostate weight and Pdet Q max(r = 0.39; P < 0.001). Furthermore, low correlations were observed between PSA(logarithmic) and active(r = 0.21; P < 0.0001) and chronic(r = 0.19; P = 0.005) inflammation. CONCLUSION: In this study we showed a correlation between BOO(Pdet Q max) and PSA(logarithmic). Furthermore, we demonstrated a weak correlation between PSA(logarithmic) and active as well as chronic prostatic inflammation.

Is verumontanum resection needed in transurethral resection of the prostate?

Transurethral resection of the prostate is the mainstay for treatment of bladder outflow obstruction. It is a procedure that involves various complications and has a high success rate. In view of a recent publication presenting the effect of verumontanum resection on functional outcome and possible complications after TURP, the present manuscript presents the available evidence on the subject as well as the possible criticism about the technique suggested by the authors. The results available do not confirm that by resecting the verumontanum there is a clinically significant improvement in the functional outcome, however confirm that continence is not affected. The criticism probably lies in the fact that resecting such a small amount of tissue like the verumontanum(its size probably remains the same with few changes during lifetime) probably does not affect outcome, yet the resection of hyperplastic apical tissue around it may play a role in functional improvement.

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.

Effect of hydromorphone hydrochloride combined with ropivacaine for PCEA after transurethral resection of prostate on pain mediators and stress response

Objective: To study the effect of hydromorphone hydrochloride combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after transurethral resection of prostate on pain mediators and stress response. Methods: A total of 138 patients who received transurethral resection of prostate in Ankang Central Hospital between May 2014 and October 2016 were selected and randomly divided into group A and group B, group A received postoperative hydromorphone hydrochloride combined with ropivacaine for PCEA, and group B received postoperative morphine hydrochloride combined with ropivacaine for PCEA. The serum contents of pain mediators, inflammatory response cytokines and stress hormones of the two groups were detected before surgery as well as 12 h, 24 h and 48 h after surgery. Results: 12 h, 24 h and 48 h after surgery, serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of both groups of patients were significantly higher than those before surgery, and serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of group A were significantly lower than those of group B. Conclusion: Hydromorphone hydrochloride combined with ropivacaine for PCEA can effectively reduce the pain and stress after transurethral resection of prostate.

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.

Validity of virtual reality simulator in training of transurethral resection of prostate

Objective To assess the face and construct validity of a full procedural transurethral prostate resection simulator ( TURPSimTM ) in training of transurethral resection of prostate. Methods Ten experienced and thirteen inexperienced urologists ( TURP experience ≥ 30 and

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）

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.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

Objective:To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate(TURP)and correlate its incidence with intra-operative urethral mucosal injury during TURP.Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study.Methods:One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant.The prostate size,operative time,intra-operative mucosal rupture,catheter time,catheter traction duration,uroflowmetry,and post-operative stricture rate were compared.Results:A total of 150 patients underwent TURP,including 74 patients undergoing monopolar TURP(one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate)and 75 patients undergoing bipolar-TURP,all of which were performed using a 26 Fr sheath resectoscope.The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups.Out of 149 patients,nine patients(6.0%)developed urethral stricture.The severity of the injury(urethral mucosal injury)correlated with the likelihood of developing a subsequent complication(stricture urethra).Patients with stricture had significantly larger prostate volume than patients without stricture(65.0 mL vs.50.0 mL;p=0.030).Patients with stricture had longer operative time than patients without stricture(55.0 min vs.40.0 min;p=0.002).In both procedures,formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury.Conclusion:Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Role of Hiraoka's transurethral detachment of the prostate combined with biopsy of the peripheral zone during the same session in patients with repeated negative biopsies in the diagnosis of prostate cancer

BACKGROUND Persistent suspicion of prostate cancer(PCa)due to a rising prostate-specific antigen(PSA)level after repeated negative biopsies is a serious challenge in clinical practice.AIM To determine the role of Hiraoka’s transurethral detachment of the prostate(TUDP)combined with biopsy of the peripheral zone during the same session in patients with repeated negative biopsies in the diagnosis of PCa.METHODS We retrospectively evaluated the records of 10 patients who were eligible for inclusion in our hospital between December 2012 and August 2017.Patient demographics,a family history of PCa,the number of biopsies,prostate volume,pathological examination,and perioperative PSA level were obtained.RESULTS Two of 10 patients were pathologically diagnosed with PCa after surgery;the Gleason scores were 4+4 and 4+3,respectively.Both patients subsequently underwent laparoscopic radical prostatectomy.The median PSA levels preoperatively,and 3 mo and 1 year postoperatively in the other eight patients who were diagnosed with benign prostate hyperplasia after surgery were 19.10 ng/mL,1.10 ng/mL,and 1.15 ng/mL,respectively.The adjusted P values of the 3-mo and 1-year post-operative PSA level vs pre-operative PSA level were 0.003 and 0.026,respectively.None of the patients had increased PSA levels or PCa detected after a median 35 mo of follow-up.CONCLUSION TUDP combined with peripheral zone biopsy may improve the detection rate of PCa in patients with repeated negative biopsies.The PSA level declined rapidly in patients who had negative pathological examinations after TUDP,which remained stable 1 year after surgery.

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.

TURP和选择性绿激光汽化术治疗良性前列腺增生对性激素及勃起功能的影响

目的:探讨经尿道前列腺电切术(TURP)和选择性绿激光汽化术(PVP)治疗良性前列腺增生(BPH)对患者性激素水平及勃起功能的影响。方法:选取203例BPH患者为研究对象,根据手术方式不同分为TURP组(n=98)和PVP组(n=105)。比较两组患者手术一般情况(手术时间、术中失血量、留置尿管时间和住院时间)、手术前后性激素[雌二醇(E_(2))、睾酮(T)水平和雌雄激素比例(E_(2)/T)]、勃起功能[国际勃起功能指数(IIEF-5)评分和勃起硬度分级(EHS)评分]、生活质量[(QOL)评分]及并发症发生情况。结果:与TURP组相比,PVP组尿管留置时间及住院时间较短,术中失血量较少(P<0.05);术后1周,两组患者E_(2)、T水平、E_(2)/T及QOL评分均降低,且PVP组低于TURP组(P<0.05);IIEF-5评分及EHS评分均升高,且PVP高于TURP组(P<0.05)。PVP组术后并发症总发生率低于TURP组(6.67%vs.15.31%,P<0.05)。结论:相比于TURP,PVP治疗BPH更能能有效改善患者性激素水平、勃起功能及生活质量,且具有创伤小、术后并发症少等优势,值得临床推广。

An update on transurethral surgery for benign prostatic obstruction

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