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

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

Transurethral prostate surgery in prostate cancer patients: A population-based comparative analysis of complication and mortality rates

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.

Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

Objective:To scrutinize the definitions of minimal invasive surgical therapy(MIST)and to investigate urologists’knowledge,attitudes,and practices for benign prostatic obstruction surgeries.Methods:A 36-item survey was developed with a Delphi method.Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included.Urologists were invited globally to complete the online survey.Consensus was achieved when more than or equal to 70%responses were“agree or strongly agree”and less than or equal to 15%responses were“disagree or strongly disagree”(consensus agree),or when more than or equal to 70%responses were“disagree or strongly disagree”and less than or equal to 15%responses were“agree or strongly agree”(consensus disagree).Results:The top three qualities for defining MIST were minimal blood loss(n=466,80.3%),fast post-operative recovery(n=431,74.3%),and short hospital stay(n=425,73.3%).The top three surgeries that were regarded as MIST were Urolift®(n=361,62.2%),Rezum®(n=351,60.5%),and endoscopic enucleation of the prostate(EEP)(n=332,57.2%).Consensus in the knowledge section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,day surgery feasibility,and post-operative continence.Consensus in the attitudes section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,and day surgery feasibility.Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement,lower retreatment rate,and better suitable for prostate more than 80 mL.Conclusion:Minimal blood loss,fast post-operative recovery,and short hospital stay were the most important qualities for defining MIST.Urolift®,Rezum®,and EEP were regarded as MIST by most urologists.

Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

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.

Metabolic surgery and intestinal gene expression:Digestive tract and diabetes evolution considerations

AIM: To investigate the effects of bariatric surgery on metabolic parameters, incretin hormone secretion, and duodenal and ileal mucosal gene expression.METHODS: Nine patients with type 2 diabetes mellitus(T2DM), chronic serum hyperglycemia for more than2 years, and a body mass index(BMI) of 30-35 kg/m2 underwent metabolic surgery sleeve gastrectomy with transit bipartition between May 2011 and December2011. Blood samples were collected pre and 3, 6 and12 mo postsurgery. Duodenal and ileal mucosa samples were collected pre- and 3 mo postsurgery. Pre- and postoperative blood samples were collected in the fasting state before ingestion of a standard meal(520kcal) and again 30, 60, 90, and 120 min after the mealto determine hemoglobin A1c(HbA1c) levels and the lipid profile, which consisted of triglyceride and total cholesterol levels. Intestinal gene expression of p53 and transforming growth factor(TGF)-β was analyzed using quantitative reverse-transcription PCR. Gastric inhibitory polypeptide(GIP) and glucagon-like peptide-1(GLP-1)were quantified using the enzyme-linked immunoassay method and analyzed pre- and postoperatively.Student's t test or repeated measurements analysis of variance with Bonferroni corrections were performed as appropriate.RESULTS: BMI values decreased by 15.7% within the initial 3 mo after surgery(31.29 ± 0.73 vs 26.398± 0.68, P < 0.05) and then stabilized at 22% at 6mo postoperative, resulting in similar values 12 mo postoperatively(20-25 kg/m2). All of the patients experienced improved T2 DM, with 7 patients(78%)achieving complete remission(HbA1c < 6.5%), and 2patients(22%) achieving improved diabetes(HbA1c< 7.0% with or without the use of oral hypoglycemic agents). At 3 mo postoperatively, fasting plasma glucose had also decreased(59%)(269.55 ±18.24 mg/dL vs 100.77 ± 3.13 mg/dL, P < 0.05)with no further significant changes at 6 or 12 mo postoperatively. In the first month postoperatively,there was a complete withdrawal of hypoglycemic medications in all patients, who were taking at least2 hypoglycemic drugs preoperatively. GLP-1 levels significantly increased after surgery(149.96 ± 31.25 vs220.23 ± 27.55)(P < 0.05), while GIP levels decreased but not significantly. p53 gene expression significantly increased in the duodenal mucosa(P < 0.05, 2.06 fold)whereas the tumor growth factor-β gene expression significantly increased(P < 0.05, 2.52 fold) in the ileal mucosa after surgery.CONCLUSION: Metabolic surgery ameliorated diabetes in all of the patients, accompanied by increased antiproliferative intestinal gene expression in non-excluded segments of the intestine.

Robotic resection of liver focal nodal hyperplasia guided by indocyanine green fluorescence imaging: A preliminary analysis of 23 cases

BACKGROUND Focal nodal hyperplasia(FNH)is a common benign tumor of the liver.It occurs mostly in people aged 40-50 years and 90%of the patients are female.FNH can be cured by local resection.How to locate and judge the tumor boundary in real time is often a challenge for surgeons.AIM To summarize the technique and feasibility of robotic resection of FNH guided by indocyanine green(ICG)fluorescence imaging.METHODS The demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection of liver FNH guided by ICG fluorescence imaging between May 1,2018 and September 30,2019 were retrospectively analyzed.ICG was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg 48 h before the operation.During the operation,the position of FNH in the liver was located in the fluorescence mode of the Da Vinci Si robot operating system and the tumor boundary was determined during the resection.RESULTS Among the 23 patients,there were 11 males and 12 females,with a mean age of 30.5±9.3 years.Twenty-two cases completed robotic resection,while one(4.3%)case converted to open surgery.In the robotic surgery group,the operation time was 35-340 min with a median of 120 min,the intraoperative bleeding was 10-800 m L with a median of 50 m L,and the postoperative hospital stay was 1-7 d with a median of 4 d.Biliary fistula occurred in two(8.7%)patients after robotic operation and they both recovered after conservative treatment.One(4.3%)patient received blood transfusion and there was no death in this study.The postoperative hospital stay in the small tumor group was significantly shorter than that in the large tumor group(P<0.05).CONCLUSION ICG fluorescence imaging can guide the surgeon to perform robotic resection of liver FNH by locating the tumor and displaying the tumor boundary in real time.It is a safe and feasible method to ensure the complete resection of the tumor.

Sonablate-500^(TM) Transrectal High-intensity Focused Ultrasound (HIFU) for Benign Prostatic Hyperplasia Patients

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.

Vaginal Hyperplasia and Progressive Vaginal Fold Prolapse in a Bullmastiff Bitch

Canine reproductive problems constitute some of the most challenging cases encountered in small animal veterinary practice. This is usually complicated in breeding dogs by the unwillingness of clients to give consent for surgical interventions, due to the fear of loss of reproductive function. In this case, a two-year-old Bullmastiff bitch was presented to the Veterinary Teaching Hospital with a mass protrusion from the vulva. Clinical examination revealed an eversion of a tongue-shaped vaginal tissue from the floor of the vaginal wall which subsequently progressed to an eversion of the complete vaginal circumference forming a doughnut-shaped mass. Investigations carried out included ultrasonography, hematology, hormonal assay, vaginal cytology, vaginal swab microbial culture and antimicrobial sensitivity test. A diagnosis of vaginal fold prolapse (type III) which progressed from a type II prolapse was made. Due to the client’s initial disinclination to a surgical intervention, the approach to the case evolved from a conservative management to an eventual surgical correction. There was a request to preserve the reproductive function of the bitch, therefore ovariohysterectomy was declined and the case was managed by surgical excision of the prolapsed vaginal mass under general anesthesia. A peri-vulvar purse string suture was placed temporarily to restrict any further prolapse. Histopathological evaluation of the excised vaginal tissue confirmed marked hyperplasia of the stratified squamous epithelium with intracellular edema and spongiosis. There was focal ulceration of vaginal mucosa with neutrophilic infiltration. The lamina propria showed reduced cellular density with loose and edematous connective tissue. Post-surgical care included daily care of surgical wound and the administration of analgesic, antibiotic and vitamin supplements. Subsequently, there was no recurrence of the condition in the bitch which came into estrus 27 weeks post-surgery, and was bred with successful conception.

Beyond prostate, beyond surgery and beyond urology: The “3Bs” of managing non-neurogenic male lower urinary tract symptoms

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.

Co-existence of hepatocellular adenoma and focal nodular hyperplasia in a young female

Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are both benign hepatocellular lesions, presenting mainly in women of childbearing age in non-cirrhotic, non-fibrotic livers. Simultaneous occurrence of these two lesions is extremely rare. We herein report a case of a young female without any predisposing risk factors who presented to our emergency department complaining of acute abdominal pain. Imaging studies revealed a 6 cm lesion in the right hepatic lobe and a 2.5 cm lesion in the left hepatic lobe, respectively. In view of the patient’s symptoms and lack of a confirmed diagnosis based on imaging, we performed a bisegmentectomy V-VI and a wedge resection of the lesion in segment III by laparotomy. Postoperative course was uneventful and the patient was discharged on the fourth postoperative day. The pathology report demonstrated an HA in segments V-VI and FNH in segment III, respectively. Six months later, the patient remains asymptomatic with normal liver function tests, ultrasound and magnetic resonance imaging follow-up. To our best knowledge, this is the first case to describe simultaneous occurrence of HA and FNH without the presence of any known risk factors for these entities. The uncertainty in diagnosis and acuteness of presenting symptoms were established criteria for prompt surgical intervention.

A Review of Risk Factors for Predicting Urinary Incontinence after Benign Prostatic Hyperplasia

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.

Multilocular Thymic Cysts with Follicular Hyperplasia: Report of a Case

We herein describe a rare case of multilocular thymic cysts (MTCs) with follicular hyperplasia. The patient was a 50-year-old man, who was symptom-free. A mediastinal mass was found on chest computed tomography (CT) followed after pancreatitis. Chest CT revealed a 30 × 10 mm anterior mediastinal mass with multiple cystic lesions. Magnetic resonance imaging showed an anterior mediastinal cystic mass with low-signal intensity on T1-weighted image and on high-signal intensity T2-weighted image. Thus we made a preoperative diagnosis of MTCs with thymoma within the cyst wall. The lesion was resected by thymectomy. Intraoperatively, multiple cysts and swelling of mediastinal lymph nodes were noted throughout the entire thymus. Histopathological findings revealed lymphoid follicular hyperplasia of thymic tissues but no neoplastic lesions. Based on these findings, a diagnosis of MTCs associated with thymic hyperplasia was made. This is a rare case that preoperatively was difficult to diagnose.

Fournier’s gangrene after insertion of thermo-expandable prostatic stent for benign prostatic hyperplasia:A case report

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.

Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

Aim:To explore the feasibility and safely 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 evalu- ate their clinical and voiding outcome.Methods:A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80W 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±7.6min),little bleeding loss(56.8±14.3mL)and short indwelling catheterization(1.6±0.8d).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 roLls and postvoid residual urine volume decreased to 55.6mL.These results are signifi- cantly 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.

普适泰片对良性前列腺增生术后尿动力学的影响

目的探讨普适泰片对良性前列腺增生术后尿动力学的影响。方法选取2022年5月—2023年5月南京医科大学附属苏州医院良性前列腺增生患者80例,随机数字表法分为2组,各40例。观察组采用普适泰片联合手术治疗,对照组单用经尿道纽扣式等离子前列腺剜除术治疗。比较2组的尿动力学参数、生活质量评分、疾病疗效、术后并发症。结果观察组残余尿量较对照组更低,但最大尿流率、膀胱顺应性尿动力学指标较高(P<0.05)。观察组生活质量高于对照组,总有效率(95.00%)高于对照组(70.00%)(P<0.05)。观察组并发症发生率低于对照组(P<0.05)。结论针对良性前列腺增生患者,通过采用普适泰片联合手术治疗,可改善患者尿动力学参数,提升生活质量,降低术后并发症,提升对良性前列腺增生的治愈率。

人工真皮联合自体瘢痕表皮移植修复大面积烧伤后期关节部位瘢痕畸形

背景:如何既为大面积深度烧伤患者瘢痕整形修复提供足够的皮源,又能避免术区创面瘢痕的再次增生,一直是烧伤与创面修复研究的重要课题。目的:观察人工真皮联合自体瘢痕表皮复合移植在大面积烧伤后瘢痕整复中的临床应用效果。方法:回顾性分析2021年1月至2023年1月在蚌埠医学院附属蚌埠第三人民医院接受手术治疗的大面积烧伤后瘢痕增生、挛缩畸形患者的病历资料,共纳入73例,按照治疗方法分为3组:A组(n=21)接受人工真皮联合自体瘢痕表皮移植治疗;B组(n=27)接受功能部位瘢痕松解后移植自体瘢痕表皮治疗;C组(n=25)接受功能部位瘢痕松解后移植自体中厚皮治疗。记录3组患者受皮区皮片存活及感染情况,受皮区及供皮区创面愈合时间;通过温哥华瘢痕量表(VSS)、日常生活活动能力(ADL)评定3组患者受皮区、供皮区瘢痕情况及受皮区功能恢复情况。结果与结论:①B组患者皮片感染率低于A、C组(P<0.05),皮片存活优级率高于A、C组(P<0.05);②A组患者受皮区创面完全愈合时间长于B、C组(P<0.05),C组患者受皮区创面完全愈合时间长于B组(P<0.05);C组患者供皮区完全愈合时间长于A、B组(P<0.05);③B组患者术后12个月受皮区温哥华瘢痕量表评分高于A、C组(P<0.05),C组患者术后6,12个月供皮区温哥华瘢痕量表评分高于A、B组(P<0.05);A、C组患者术后12个月日常生活活动能力量表评估优级高于B组(P<0.05);④结果显示,应用人工真皮与自体瘢痕表皮复合移植治疗大面积烧伤后瘢痕挛缩,既能达到与中厚皮移植同样的效果,又能避免供皮区术后瘢痕的再次增生,可缩短供皮区创面愈合时间,相较于单纯移植瘢痕表皮治疗有明显优势。

青少年局限性海绵状牙龈增生1例

青少年局限性海绵状牙龈增生(LJSGH)是一种具有独特病理表现的牙龈过度增生性疾病,其临床表现不典型,病因和发病机制尚不明确,在国内尚未有病例报道。该病的诊断主要依靠病理检测,治疗后存在复发可能性,最佳治疗方法仍缺乏一定的循证医学证据。本文报道1例LJSGH,并结合文献复习,对其临床特点、病理学特征和治疗进行总结,为该病的诊治提供参考。

康多内镜手术机器人系统行保留后尿道黏膜前列腺切除术治疗前列腺增生的效果

目的探讨国产康多机器人在保留后尿道黏膜前列腺切除术中的可行性。方法选取2023年4-5月暨南大学附属第六医院收治的3例前列腺增生患者作为研究对象。平均年龄70.3岁,术前平均总前列腺特异性抗原4.984 ng/ml,平均前列腺大小52.03 cm^(3)。手术均经腹膜外途径,所有患者采用基于国产康多机器人辅助的保留后尿道黏膜前列腺摘除术治疗,术后复查彩色多普勒超声,并对患者术后疗效进行随访。结果3例患者均顺利完成手术,手术时间分别为205、260和211 min;术中失血量分别为50、50和300 ml;患者尿道黏膜破裂1例;术后均未进行膀胱冲洗,所有患者保留尿管2周,去除导尿管后可自行排尿,仅有轻度尿路刺激症状;术后无前列腺感染、继发性出血、尿失禁及附睾炎等并发症,平均随访5.67个月。结论国产康多机器人在保留后尿道黏膜前列腺切除术在治疗中等以上腺体具有安全可行、学习曲线短、患者失血量少、导尿时间短、住院时间短等优势,患者术后排尿通畅,无明显并发症。

前列腺剜除电切术后排尿训练中的心理干预策略研究

目的了解在前列腺剜除电切术后排尿训练中介入心理干预的临床疗效。方法本次病例研究相关资料全部来自本院2022年5月至2022年12月期间由我科诊治的良性前列腺增生的患者100例,根据是否给予患者心理干预将这100例患者分为试验组和对照组,对照组予以常规护理+排尿训练,试验组予以心理干预+排尿训练,每组50例。对比两组患者排尿训练依从性、排尿障碍发生率以及生活质量改善情况。结果试验组患者排尿训练依从性高于对照组(P<0.05);生活质量改善情况优于对照组(P<0.05);满意度评价高于对照组(P<0.05)。结论在前列腺剜除电切术后患者排尿训练中介入心理干预,可提高患者排尿训练治疗的依从性,提高患者生活质量,进而提高了前列腺剜除电切术后的预后效果,可在临床上推广应用。

经尿道前列腺柱状水囊扩开术在不同程度心肺功能异常的高龄BPH患者中的临床应用研究

目的探讨经尿道前列腺柱状水囊扩开术在不同程度心肺功能异常的高龄前列腺增生(BPH)患者中的临床应用效果。方法选择75例BPH患者作为研究对象,分为轻微心肺功能异常组、中度心肺功能异常组和重度心肺功能异常组,所有患者均行经尿道前列腺柱状水囊扩开术治疗,比较三组患者的下尿路症状(LUTS)、国际前列腺症状评分(IPSS)、超声残余尿量、最大尿流率、生活质量、及术后并发症发生率。结果轻微心肺功能异常组憋尿困难、夜尿、尿不尽感、尿线变细、间断性排尿评分低于中度心肺功能异常组(t分别=5.19、6.14、6.03、5.33、6.02,P均<0.05);中度心肺功能异常组憋尿困难、夜尿、尿不尽感、尿线变细、间断性排尿评分低于重度心肺功能异常组(t分别=6.03、5.34、4.09、6.32、5.22,P均<0.05)。轻微心肺功能异常组手术后IPSS评分、残余尿量低于中度心肺功能异常组,生活质量评分及最大尿流率高于中度心肺功能异常组(t分别=4.59、5.11、-5.22、-5.03,P均<0.05),中度心肺功能异常组手术后IPSS评分、残余尿量低于重度心肺功能异常组,生活质量评分及最大尿流率高于重度心肺功能异常组(t分别=5.59、5.12、-6.03、-5.77,P均<0.05)。三组随访期间尿失禁、尿潴留、尿路感染及术后出血总发生率比较,差异无统计学意义(χ^(2)=1.04,P>0.05)。结论经尿道前列腺柱状水囊扩开术用于轻微心肺功能异常高龄BPH患者中效果最佳,有助于改善患者下尿路症状,改善患者尿动力学水平,提高患者生活质量,降低术后并发症发生率。