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 evalu...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.展开更多
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. Transurethra...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.展开更多
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 ac...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.展开更多
We aim to reassess the safety of the monopolar transurethral resection of the prostate （M-TURP） without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patien...We aim to reassess the safety of the monopolar transurethral resection of the prostate （M-TURP） without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit （10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively） were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier （4.6 days vs 5.2 days）, required shorter postoperative stays in the hospital （5.1 days vs 6.0 days）, and were at lower risk of operative complications （5.7% vs 9.2%）, especially bleeding requiring blood transfusion （2.9% vs 6.1%）. Similar findings were observed in cohorts of prostates of 30-80 ml and prostates 〉80 ml. Furthermore, among patients with a resection weight 〉42.5 g or surgical time 〉90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.展开更多
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) al...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.展开更多
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 bl...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.展开更多
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 T...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.展开更多
Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of...Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP （cTURP） within six months post-implant for patients with refractory urinary retention. Methods： One hundred and ninety patients with localized prostate cancer of clinical stages Tlc to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. Results： The median interval between prostate brachytherapy and cTURP was three months （range 1.5 to 5.0 months） There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months （range 6 to 26 months） after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen （PSA） of the patients who underwent cTURP was 0.42 ng/ml （range 0.08 to 0.83 ng/ml） at the end of their follow-up. Conclusions： Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.展开更多
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 prostati...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.展开更多
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....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.展开更多
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 thirtee...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展开更多
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 pat...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）展开更多
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 ...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.展开更多
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...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.展开更多
Benign prostatic hyperplasia(BPH)is a common disease in elderly men,and transurethral laser prostatectomy(TULP)has been widely used in the clinic to remove bladder outlet obstruction caused by BPH.Previous animal mode...Benign prostatic hyperplasia(BPH)is a common disease in elderly men,and transurethral laser prostatectomy(TULP)has been widely used in the clinic to remove bladder outlet obstruction caused by BPH.Previous animal models for wound repair after prostatectomy have many limitations,and there have been no previous reports of a mouse model of TULP.Therefore,this study aimed to establish a novel mouse model of TULP.Twelve healthy adult Kunming(KM)mice received transurethral laser vaporization prostatectomy with a 200-μm thulium laser.The mice were sacrificed,and wound specimens from the prostatic urethra and bladder neck were harvested at 1 day,3 days,5 days,and 7 days after surgery.Hematoxylin-eosin(HE)and immunohistochemistry were applied to confirm the establishment of the mouse TULP model.One day after the surgery,urothelium expressing uroplakin(UPK)was absent in the urethral wound site,and a large number of necrotic tissues were found in the wound site.There was no UPK-positive urothelium in the wound 3 days after surgery.At 5 days after surgery,monolayer urothelium expressing UPK was found in the wound site,indicating that the re-epithelization of the wound had been completed.On the 7th day after surgery,there were multiple layers of urothelium with UPK expression,indicating that the repair was completed.It is feasible to establish a mouse TULP model by using a microcystoscope system and a 200-μm thulium laser.展开更多
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 Hira...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.展开更多
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...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.展开更多
To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselectiv...To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselective vaporization of the prostate （PVP）. From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time （38.14 ± 23.64 h vs 72.54 ± 28.38 h, P 〈 0.001） and hospitalization （2.32 ± 1.25 days vs 4.07±1.23 days, P 〈 0.001） were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score （IPSS） （4.07 ±2.07 vs 5.00 ±2.10; P〈 0.001）, quality of life （QoL） （1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007）, maximal urinary flow rate （Qmax） （24.75±5.87 ml s^-1 vs 22.03 ±5.04 ml s^-1; P 〈 0.001）, postvoid residual urine volume （PVR） （14,29 ± 6,97 ml vs 17.00±6.11 ml; P = 0,001）, and prostate-specific antigen （PSA） value （0.78 ±0.57 ng ml^-1 vs 1.27 ±1.07 ng ml^-1; P 〈 0.001）. Both PKEP and PVP relieve low urinary tract symptoms （LUTS） due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKER Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.展开更多
Background:The prevalence of benign prostatic hyperplasia(BPH)in older men increases with age,beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years.Surgical procedures such as holmium laser enuc...Background:The prevalence of benign prostatic hyperplasia(BPH)in older men increases with age,beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years.Surgical procedures such as holmium laser enucleation of the prostate(HoLEP)and transurethral resection of the prostate(TURP)are the preferred treatments for BPH.Nevertheless,there is disagreement regarding the most efficient and safe treatment for BPH.The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.Materials and methods:This meta-analysis was performed in accordance with the PRISMA guidelines.In February 2023,a literature review was conducted using PubMed,ScienceDirect,and the Cochrane Library,and the meta-analysis was performed using RevMan V.5.4.Results:A total of 656 patients underwent HoLEP,and 653 patients underwent TURP.There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3,6,18,24,and 36 months;the HoLEP group showed a significant difference at 12 months.The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings,but the TURP group showed significant results at 24months.Meanwhile,the HoLEP group showed significant postvoid residual results.There was no significant difference in the quality of life between the groups.Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop.The operating time was shorter in the TURP group.The difference in specimen weight between the 2 groups was not statistically significant.The overall complications were similar in both groups,but the HoLEP group received significantly fewer blood transfusions.Conclusions:Holmiumlaser enucleation of the prostate demonstrated excellent efficacy and safety,with fewer hematological changes and complications;however,TURP had a shorter operating time.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
文摘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.
基金the National Key Research and Development Plan of China(Technology helps Economy 20202016YFC0106300)+1 种基金the National Natural Science Foundation of China(82174230)Major Program Fund of Technical Innovation Project of Department of Science and Technology of Hubei Province(2016ACAl52).
文摘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.
文摘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.
文摘We aim to reassess the safety of the monopolar transurethral resection of the prostate （M-TURP） without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit （10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively） were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier （4.6 days vs 5.2 days）, required shorter postoperative stays in the hospital （5.1 days vs 6.0 days）, and were at lower risk of operative complications （5.7% vs 9.2%）, especially bleeding requiring blood transfusion （2.9% vs 6.1%）. Similar findings were observed in cohorts of prostates of 30-80 ml and prostates 〉80 ml. Furthermore, among patients with a resection weight 〉42.5 g or surgical time 〉90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.
文摘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.
文摘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.
文摘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.
文摘Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP （cTURP） within six months post-implant for patients with refractory urinary retention. Methods： One hundred and ninety patients with localized prostate cancer of clinical stages Tlc to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. Results： The median interval between prostate brachytherapy and cTURP was three months （range 1.5 to 5.0 months） There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months （range 6 to 26 months） after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen （PSA） of the patients who underwent cTURP was 0.42 ng/ml （range 0.08 to 0.83 ng/ml） at the end of their follow-up. Conclusions： Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.
文摘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.
文摘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.
文摘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
文摘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）
文摘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.
文摘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.
基金The present study is supported financially by grants from the National Natural Science Foundation of China(No.81860141)the Foundation of Health and Family Planning Commission of Guizhou Province(Gzwjkj-2017-1-032)Guizhou Science-Technology Support Plan Projects([2019]2797).
文摘Benign prostatic hyperplasia(BPH)is a common disease in elderly men,and transurethral laser prostatectomy(TULP)has been widely used in the clinic to remove bladder outlet obstruction caused by BPH.Previous animal models for wound repair after prostatectomy have many limitations,and there have been no previous reports of a mouse model of TULP.Therefore,this study aimed to establish a novel mouse model of TULP.Twelve healthy adult Kunming(KM)mice received transurethral laser vaporization prostatectomy with a 200-μm thulium laser.The mice were sacrificed,and wound specimens from the prostatic urethra and bladder neck were harvested at 1 day,3 days,5 days,and 7 days after surgery.Hematoxylin-eosin(HE)and immunohistochemistry were applied to confirm the establishment of the mouse TULP model.One day after the surgery,urothelium expressing uroplakin(UPK)was absent in the urethral wound site,and a large number of necrotic tissues were found in the wound site.There was no UPK-positive urothelium in the wound 3 days after surgery.At 5 days after surgery,monolayer urothelium expressing UPK was found in the wound site,indicating that the re-epithelization of the wound had been completed.On the 7th day after surgery,there were multiple layers of urothelium with UPK expression,indicating that the repair was completed.It is feasible to establish a mouse TULP model by using a microcystoscope system and a 200-μm thulium laser.
基金Supported by Shengjing Hospital Science and Technology Program,No.MC05.
文摘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.
基金Shanghai medical specialty construction plan(No.ZK2019C07)。
文摘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.
文摘To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselective vaporization of the prostate （PVP）. From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time （38.14 ± 23.64 h vs 72.54 ± 28.38 h, P 〈 0.001） and hospitalization （2.32 ± 1.25 days vs 4.07±1.23 days, P 〈 0.001） were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score （IPSS） （4.07 ±2.07 vs 5.00 ±2.10; P〈 0.001）, quality of life （QoL） （1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007）, maximal urinary flow rate （Qmax） （24.75±5.87 ml s^-1 vs 22.03 ±5.04 ml s^-1; P 〈 0.001）, postvoid residual urine volume （PVR） （14,29 ± 6,97 ml vs 17.00±6.11 ml; P = 0,001）, and prostate-specific antigen （PSA） value （0.78 ±0.57 ng ml^-1 vs 1.27 ±1.07 ng ml^-1; P 〈 0.001）. Both PKEP and PVP relieve low urinary tract symptoms （LUTS） due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKER Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.
文摘Background:The prevalence of benign prostatic hyperplasia(BPH)in older men increases with age,beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years.Surgical procedures such as holmium laser enucleation of the prostate(HoLEP)and transurethral resection of the prostate(TURP)are the preferred treatments for BPH.Nevertheless,there is disagreement regarding the most efficient and safe treatment for BPH.The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.Materials and methods:This meta-analysis was performed in accordance with the PRISMA guidelines.In February 2023,a literature review was conducted using PubMed,ScienceDirect,and the Cochrane Library,and the meta-analysis was performed using RevMan V.5.4.Results:A total of 656 patients underwent HoLEP,and 653 patients underwent TURP.There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3,6,18,24,and 36 months;the HoLEP group showed a significant difference at 12 months.The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings,but the TURP group showed significant results at 24months.Meanwhile,the HoLEP group showed significant postvoid residual results.There was no significant difference in the quality of life between the groups.Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop.The operating time was shorter in the TURP group.The difference in specimen weight between the 2 groups was not statistically significant.The overall complications were similar in both groups,but the HoLEP group received significantly fewer blood transfusions.Conclusions:Holmiumlaser enucleation of the prostate demonstrated excellent efficacy and safety,with fewer hematological changes and complications;however,TURP had a shorter operating time.
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.
