ABSTRACT
Objective To discuss the risk of factors influencing persistent frequency after transurethral resection of the prostate (TURP).Methods The clinical data of 119 post-TURP patients treated from January 2014 to June 2015 was retrospectively analyzed.The age was (72.1 ±2.3)years old.There were 15 cases with hypertension,23 cases with diabetes and 6 cases with heart disease.The preoperative IPSS score of 119 cases was (22.1 ± 5.9) points,with (10.2 ± 1.8) points in urinary storage period and (11.8 ± 4.7) points in urination period.Urination frequency was (10.8 ± 2.6) times per day and there were (3.8 ± 0.8) times of nocturnal urination.B-ultrasound:residual urine volume was (38.1 ± 9.1) ml and prostate volume was (34.1 ± 4.2) ml.Preoperative maximum urine flow rate was (8.8 ± 3.9) ml/s.The detrusor pressure at maximum urinary flow rate was (43.9 ± 14.1) cm H2O (1 cmH2O =0.098 kPa),maximum detrusor pressure was (99.7 ± 12.2) cmH2O and effective bladder volume was (217.5 ± 14.8) ml.Contraction of bladder weakened in 40 cases (33.6％) and 36 cases (30.2％) had detrusor overactivity.According to whether continuous urinary frequency was developed,the patients were divided into frequency-positive group and frequency-negative group.The differences between the patients in two groups were compared and univariate analysis was performed.A multivariate logistic regression was performed on statistically significant indicators.Results Among the 119 patients,21 were frequency-positive and 98 were frequency-negative.Univariate analysis showed that age,IPSS score,preoperative urinary storage score,detrusor pressure at maximum urinary flow rate,maximum detrusor pressure,effective bladder volume,contraction decrease of bladder,preoperative detrusor activity were important indicators affecting the condition of postoperative urinary frequency (all P ＜ 0.05).Multivariate analysis showed that old age (OR =3.842,P =0.021),high total IPSS score (OR =5.109,P =0.011),low maximum detrusor pressure (OR =3.477,P =0.039),low effective volume of bladder (OR =4.051,P =0.017) and detrusor overactivity (OR =3.662,P =0.025) were independent risk factors for urinary frequency after TURP.Conclusions The age,the high IPSS score before operation,low maximal detrusor pressure,low effective bladder capacity and the bladder detrusor activity could be independent predictive factors of persistent frequency after TURP.
ABSTRACT
ObjectiveTo present the innovative transurethral resection of the distal ureter and bladder cuff by Holmium laser and to compare the perioperative and oncological outcomes following nephroureterectomy using three different methods of managing the distal ureter and bladder cuff.Methods From January 2000 to December 2010,162 patients underwent excision of the distal ureter and bladder cuff by transurethral Holmium laser (32 cases,Group A),transurethral electric resection (51 cases,Group B) or open procedure (79 cases,Group C) combined with open or retroperitoneal laparoscopic nephroureterectomy.5 French ureteral balloon catheter was inserted into the targeted ureter to prevent possible microscopic tumor seeding.The therapeutic effectiveness,perioperative complications,postoperative recovery and oncologic outcomes were compared among groups.The follow-up time was 3 -96 months.ResultsGroup A and B showed statistically significant better results on the operative time (203.6 ± 31.5 min and 207.2 ±24.3 min),blood loss ( 127.4 ± 63.2 ml and 135.0 ± 82.7 ml) and postoperative hospital stay (5.8 ± 1.3d and 5.6 ±1.2 d) than those of Group C (248.0 ±42.9 min,484.5 ±217.7 ml,8.7 ±3.5 d),respectively ( P ＜ 0.01 ).Six cases of obturator nervous reflex occurred in Group B,with 3 cases of bladder peroration and 2 conversions to open procedure.There were no difference in bladder tumor occurrence,retroperitoneal recurrence,tumor cell seeding and cancer-specific survival among the 3 groups.ConclusionsOur data have validated the superiority of transurethral approach over conventional open procedure including perioperative index,recovery and comparable oncologic outcomes with open group.Holmium laser demonstrated better results including fewer complication,cleaner surgical vision and operating accuracy than that of electric resection.Transurethral Holmium laser resection of the distal ureter and bladder cuff has been proved to be a technically innovative minimally invasive and oncological safe method.
ABSTRACT
Objective To compare the safety and efficacy of holmium laser enucleation of the prostate (HoLEP), one of the minimally invasive treatments available for men with benign prostatic hyperplasia (BPH),with transurethral resection of the prostate (TURP). Methods A total of 337 cases of BPH were divided into 2 groups;of them 185 cases underwent HoLEP and 152,TURP.The volume of irrigating fluid absorption and blood loss,and other therapeutic results were measured and compared between the 2 groups. Results Comparison between HoLEP group and TURP group included the following:irrigating fluid absorption was (604.8?97.6)ml vs (1095.0?209.8)ml;blood loss,(124.3?24.1)ml vs (330.3?36.9)ml;resected prostate weight,(17.4?2.2)g vs (25.2?3.4)g;operating time,(54.9?20.0) min vs (45.1?18.0) min;catheterization time,(2.2?0.2) d vs (3.4?0.3)d;and length of hospital stay after operation, (5.2?1.1) d vs (8.8?1.3) d. Significant differences were found between the 2 groups (P