ABSTRACT
Objective:To investigate the feasibility and safety of suprapubic bladder puncture and gland fixation in transurethral enucleation of the prostate.Methods:The clinical data of 15 patients with benign prostatic hyperplasia admitted to the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2020 were retrospectively analyzed. The age was (70.27±5.35) years old, preoperative serum prostate-specific antigen (PSA) level was (3.03±1.37) ng/ml, preoperative total prostate weight was 80.3(70.49, 96.78)g, preoperative postvoid residual urine volume(PVR)was 80 (55, 108)ml, and the maximum urine flow rate (Q max) was (6.13±2.25) ml/s. The international prostate symptom score(IPSS) was 25(22, 27), quality of life (QOL)score was 5(5, 6), international erectile function index-5 (IIEF-5) score was (15.38±5.10). All 15 patients underwent conventional transurethral plasma enucleation of prostate by using the three-lobe method, and the enucleated gland was pushed into the bladder completely. Then a laparoscopic pneumoperitoneum needle was used to perform suprappubic cystipuncture, and ureteral grasping forceps were inserted through the outer sheath. The forceps were used to fix the enencied gland. A rapid harvesting electric resection was performed in the broad space of the bladder, and the Ellick was rinsed to remove the tissue fragments. Surgical indicators and complications were recorded. The improvement of subjective score (IPSS, QOL, IIEF-5) and objective index (Q max, PVR) was compared between preoperative and postoperative. Results:All the 15 operations were completed successfully and there were no complications such as blood transfusion, capsule perforation, transurethral resection syndrome, bladder injury, bladder puncture site laceration and bleeding. The weight of resected prostate tissue was 44(40, 60)g, with blood loss (79.20±18.93)ml.The time of enucleation operation was (54.13±10.88)min, with harvest cutting time (14.67±2.50)min, evisceration efficiency (0.89±0.08)g/min, harvesting efficiency (3.26±0.36)g/min, bladder irrigation time (2.47±0.52) d. The time of indwelling catheter was (3.73±0.80)d.The postoperative hospital stay was (4.40±0.91) d. Temporary urinary incontinence occurred in 1 case after operation. All patients were followed up for 6 months after operation. The IPSS score was 3(2, 3), QOL score was 0(0, 1), IIEF-5 score was (20.12±2.30), Q maxwas (21.80±2.14) ml/s and PVR was 10(5, 15)ml, which were all significantly different compared with those before surgery ( P<0.05). The symptoms of the patients were significantly improved. Conclusions:Transurethral plasma enucleation of prostate combined with suprapubic bladder puncture and fixed gland is effective in the treatment of benign prostatic hyperplasia. The subjective symptoms and objective examination of patients have been significantly improved, and no adverse operation-related complications have occurred. It is a suitable method for enucleation of prostate in units which are not equipped with transurethral tissue planer.
ABSTRACT
Objective:To explore the effects of meditation on patients underwent urodynamic examination.Methods:Totally 90 patients with benign prostatic hyperplasia who underwent urodynamic examination in the Department of Urology at the hospital from September 2018 to December 2019 were enrolled in the present study. They were assigned to experimental group and control group, with 45 cases in each group. The control group received routine nursing, basis on this, the experimental group carried out meditation training. The examination time, examination success rate as well as the incidence of complications were recorded between two groups. The systolic blood pressure, diastolic blood pressure and heart rate was compared at 10 min before the start of examination, 10 min after the start of examination, 10 min after the end of examination, respectively. In addition, the psychological stress was assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) at 1 day before the start of examination, 1 hour before the start of examination and 10 min after the end of examination.Results:The examination time were (33.56±4.95) min and the incidence of hematuria were 4.4% (2/45) in the experimental group, significantly lower than (36.42±6.32) min and 17.8% (8/45) in the control group, the difference was statistically significant (t value was 2.460, χ 2 value was 4.050, P<0.05). At 10 min before the start of examination, 10 min after the start of examination, the systolic blood pressure and diastolic blood pressure were (129.18±10.99) mmHg (1 mmHg=0.133 kPa), (130.73±11.81) mmHg and (89.42±14.50) mmHg, (98.36±15.51) mmHg in the experimental group, significantly lower than (135.93±10.17) mmHg, (139.49±10.64) mmHg and (96.29±13.85) mmHg, (105.80±12.02) mmHg in the control group ( t values were 2.297-3.695, P<0.01 or 0.05); at 10 min before the start of examination, 10 min after the start of examination, 10 min after the end of examination, the heart rate were (85.53±11.82) times/min, (90.51±8.82) times/min, (74.09±8.20) times/min in the experimental group, significantly lower than (92.80±11.95) times/min, (95.84±10.02) times/min, (77.60±8.51) times/min in the control group, the difference was statistically significant ( t values were 2.900, 2.680, 1.992, P<0.01 or 0.05). At 1 hour before the start of examination, the SAS and SDS scores were (54.42±3.85) pionts and (54.11±4.65) points in the experimental group, significantly lower than (58.44±7.37) pionts and (56.11±4.48) pionts in the control group, the difference was statistically significant ( t values were 3.247, 2.079, P<0.01 or 0.05). Conclusion:The meditation can help to relieve the physiological and psychological stress of patients who underwent urodynamic examination, shorten the examination time as well as reduce complications.