Benign prostatic hyperplasia,which can be abbreviated as prostatic hyperplasia,is a urinary system disease that has a high incidence in middle-aged and elderly male populations in China.The incidence of benign prostat...Benign prostatic hyperplasia,which can be abbreviated as prostatic hyperplasia,is a urinary system disease that has a high incidence in middle-aged and elderly male populations in China.The incidence of benign prostatic hyperplasia is increasing year by year.Patients with benign prostatic hyperplasia are prone to have bladder outlet obstruction,which in turn leads to an increase in residual urine volume in the bladder and impurities in the urine,such as upper urinary calculi that enter the bladder,urine crystals,various exfoliated cells,etc.If these substances stay in the bladder for a long time,stones in the bladder will be generated.Benign prostatic hyperplasia with bladder stones can severely obstruct the urinary tract,causing clinical symptoms such as urinary tract infections,urinary urgency,frequent urination,and dysuria.These symptoms seriously affects the physical and mental health of patients,leading to low levels of normal work and quality of life.With the development of medical technology,surgical treatment is commonly used in clinical practice.Among them,transurethral prostatectomy is widely used in clinical treatment,and has achieved good results.展开更多
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 ben...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.展开更多
Biochemical recurrence(BCR)is important for measuring the oncological outcomes of patients who undergo radical prostatectomy(RP).Whether transurethral resection of the prostate(TURP)has negative postoperative effects ...Biochemical recurrence(BCR)is important for measuring the oncological outcomes of patients who undergo radical prostatectomy(RP).Whether transurethral resection of the prostate(TURP)has negative postoperative effects on oncological outcomes remains controversial.The primary aim of our retrospective study was to determine whether a history of TURP could affect the postoperative BCR rate.We retrospectively reviewed patients with prostate cancer(PCa)who had undergone RP between January 2009 and October 2017.Clinical data on age,prostate volume,serum prostate-specific antigen levels(PSA),biopsy Gleason score(GS),metastasis stage(TNM),D’Amico classification,and American Society of Anesthesiologists(ASA)classification were collected.Statistical analyses including Cox proportional hazard models and sensitivity analyses which included propensity score matching,were performed,and the inverse-probability-of-treatment-weighted estimator and standardized mortality ratio-weighted estimator were determined.We included 1083 patients,of which 118 had a history of TURP.Before matching,the non-TURP group differed from the TURP group with respect to GS(P=0.047),prostate volume(mean:45.19 vs 36.00 ml,P<0.001),and PSA level(mean:29.41 vs 15.11 ng ml?1,P=0.001).After adjusting for age,PSA level,T stage,N stage,M stage,and GS,the TURP group showed higher risk of BCR(hazard ratio[HR]:2.27,95%confidence interval[CI]:1.13–3.94,P=0.004).After matching(ratio 1:4),patients who underwent TURP were still more likely to develop BCR according to the adjusted propensity score(HR:2.00,95%CI:1.05–3.79,P=0.034).Among patients with PCa,those with a history of TURP were more likely to develop BCR after RP.展开更多
Transurethral resection of the prostate(TURP) is considered the gold standard surgical treatment of symptomatic benign prostatic hyperplasia. TURP has gained ground in urologic centers of excellence forits effective l...Transurethral resection of the prostate(TURP) is considered the gold standard surgical treatment of symptomatic benign prostatic hyperplasia. TURP has gained ground in urologic centers of excellence forits effective long term results with low incidence of complications. Far away from excellence, it associated with blood loss, and TUR syndrome particularly in patients with larger prostates. For this reasons, many minimally invasive new techniques have been implemented in recent years. Bipolar technique has recently been introduced, to minimize the complications of the standard TURP technique.展开更多
Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprap...Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.展开更多
Acute kidney injury(AKI) is associated with extended hospital stays,high risks of in-hospital and long-term mortality,and increased risk of incident and progressive chronic kidney disease.Patients with urological dise...Acute kidney injury(AKI) is associated with extended hospital stays,high risks of in-hospital and long-term mortality,and increased risk of incident and progressive chronic kidney disease.Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy,older age,and preexistent chronic kidney disease.Nonetheless,precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking.Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures.Whereas severe AKI after prostate surgery in general appears to be unusual,AKI associated with transurethral resection of the prostate(TURP) syndrome and with rhabdomyolysis(RM) after radical prostatectomy have been frequently described.The purpose of this review is to discuss the current knowledge regarding the epidemiology,risk factors,outcomes,prevention,and treatment of AKI associated with prostatic surgery.The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.展开更多
Background A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields. They can simulate a variety of surgical scenarios to improve the overall skills required for...Background A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields. They can simulate a variety of surgical scenarios to improve the overall skills required for endoscopic operations, and also record the operative process of trainees in real-time and allow for objective evaluation. At present, some simulators for transurethral resection of the prostate （TURP） are available. The utility of virtual reality simulators in training of transurethral prostatectomy was investigated. Methods Thirty-eight urologists were randomly selected to take part in a simulation based training of TURP using the TURPSimTM system. Pre and post-training global rate scale （GRS） scores and objective parameters recorded by the simulator were assessed. Then, questionnaires were filled out. Results Compared with baseline levels, the GRS scores of trainees increased （18.0±4.0 vs. 12.4±4.2, P 〈0.001）, while the rate of capsule resection （26.3%±0.6% vs. 21.2%±0.4%, P 〈0.001）, amount of blood loss （（125.8±86.3） ml vs. （83.7±41.6） ml, P 〈0.001）, external sphincter injury （3.6±2.9 vs. 2.0±2.0, P 〈0.001 ） decreased significantly after training. Most trainees were satisfied with the simulator based training and believed that the simulator accurately mimicked actual surgical procedures and could help improve their surgical skills. Conclusions As a new method of training on transurethral prostatectomy skills, training of TURP using a virtual simulator can help urologists improve their surgical skills and safety. Therefore, the application of the TURPSimTM system in education and training of urologic surgery is warranted.展开更多
文摘Benign prostatic hyperplasia,which can be abbreviated as prostatic hyperplasia,is a urinary system disease that has a high incidence in middle-aged and elderly male populations in China.The incidence of benign prostatic hyperplasia is increasing year by year.Patients with benign prostatic hyperplasia are prone to have bladder outlet obstruction,which in turn leads to an increase in residual urine volume in the bladder and impurities in the urine,such as upper urinary calculi that enter the bladder,urine crystals,various exfoliated cells,etc.If these substances stay in the bladder for a long time,stones in the bladder will be generated.Benign prostatic hyperplasia with bladder stones can severely obstruct the urinary tract,causing clinical symptoms such as urinary tract infections,urinary urgency,frequent urination,and dysuria.These symptoms seriously affects the physical and mental health of patients,leading to low levels of normal work and quality of life.With the development of medical technology,surgical treatment is commonly used in clinical practice.Among them,transurethral prostatectomy is widely used in clinical treatment,and has achieved good results.
文摘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.
基金This manuscript was supported by the National Key Research and Development Program of China(Grant No.SQ2017YFSF090096)the Prostate Cancer Foundation Young Investigator Award 2013,the National Natural Science Foundation of China(Grant No.81300627,No.81370855,No.81702536,and No.81770756)+1 种基金Programs from Science and Technology Department of Sichuan Province(Grant No.2014JY0219 and No.2017HH0063)Young Investigator Award of Sichuan University 2017.
文摘Biochemical recurrence(BCR)is important for measuring the oncological outcomes of patients who undergo radical prostatectomy(RP).Whether transurethral resection of the prostate(TURP)has negative postoperative effects on oncological outcomes remains controversial.The primary aim of our retrospective study was to determine whether a history of TURP could affect the postoperative BCR rate.We retrospectively reviewed patients with prostate cancer(PCa)who had undergone RP between January 2009 and October 2017.Clinical data on age,prostate volume,serum prostate-specific antigen levels(PSA),biopsy Gleason score(GS),metastasis stage(TNM),D’Amico classification,and American Society of Anesthesiologists(ASA)classification were collected.Statistical analyses including Cox proportional hazard models and sensitivity analyses which included propensity score matching,were performed,and the inverse-probability-of-treatment-weighted estimator and standardized mortality ratio-weighted estimator were determined.We included 1083 patients,of which 118 had a history of TURP.Before matching,the non-TURP group differed from the TURP group with respect to GS(P=0.047),prostate volume(mean:45.19 vs 36.00 ml,P<0.001),and PSA level(mean:29.41 vs 15.11 ng ml?1,P=0.001).After adjusting for age,PSA level,T stage,N stage,M stage,and GS,the TURP group showed higher risk of BCR(hazard ratio[HR]:2.27,95%confidence interval[CI]:1.13–3.94,P=0.004).After matching(ratio 1:4),patients who underwent TURP were still more likely to develop BCR according to the adjusted propensity score(HR:2.00,95%CI:1.05–3.79,P=0.034).Among patients with PCa,those with a history of TURP were more likely to develop BCR after RP.
文摘Transurethral resection of the prostate(TURP) is considered the gold standard surgical treatment of symptomatic benign prostatic hyperplasia. TURP has gained ground in urologic centers of excellence forits effective long term results with low incidence of complications. Far away from excellence, it associated with blood loss, and TUR syndrome particularly in patients with larger prostates. For this reasons, many minimally invasive new techniques have been implemented in recent years. Bipolar technique has recently been introduced, to minimize the complications of the standard TURP technique.
文摘Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.
文摘Acute kidney injury(AKI) is associated with extended hospital stays,high risks of in-hospital and long-term mortality,and increased risk of incident and progressive chronic kidney disease.Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy,older age,and preexistent chronic kidney disease.Nonetheless,precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking.Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures.Whereas severe AKI after prostate surgery in general appears to be unusual,AKI associated with transurethral resection of the prostate(TURP) syndrome and with rhabdomyolysis(RM) after radical prostatectomy have been frequently described.The purpose of this review is to discuss the current knowledge regarding the epidemiology,risk factors,outcomes,prevention,and treatment of AKI associated with prostatic surgery.The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.
文摘Background A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields. They can simulate a variety of surgical scenarios to improve the overall skills required for endoscopic operations, and also record the operative process of trainees in real-time and allow for objective evaluation. At present, some simulators for transurethral resection of the prostate （TURP） are available. The utility of virtual reality simulators in training of transurethral prostatectomy was investigated. Methods Thirty-eight urologists were randomly selected to take part in a simulation based training of TURP using the TURPSimTM system. Pre and post-training global rate scale （GRS） scores and objective parameters recorded by the simulator were assessed. Then, questionnaires were filled out. Results Compared with baseline levels, the GRS scores of trainees increased （18.0±4.0 vs. 12.4±4.2, P 〈0.001）, while the rate of capsule resection （26.3%±0.6% vs. 21.2%±0.4%, P 〈0.001）, amount of blood loss （（125.8±86.3） ml vs. （83.7±41.6） ml, P 〈0.001）, external sphincter injury （3.6±2.9 vs. 2.0±2.0, P 〈0.001 ） decreased significantly after training. Most trainees were satisfied with the simulator based training and believed that the simulator accurately mimicked actual surgical procedures and could help improve their surgical skills. Conclusions As a new method of training on transurethral prostatectomy skills, training of TURP using a virtual simulator can help urologists improve their surgical skills and safety. Therefore, the application of the TURPSimTM system in education and training of urologic surgery is warranted.
