ABSTRACT
Objective:To explore the application of 16-words formula " resection surrounding the proximal part of seminal colliculus, lateral tunnel, plane extending and bladder neck preservation" in transurethral enucleation resection of prostate with plasma rod electrode (TUERP).Methods:The clinical data of 88 patients with benign prostatic hyperplasia (BPH) admitted to our department from May 2018 to July 2019 were retrospectively analyzed. The age of patients was (67.0±8.6)years, and the volume of prostate was (51.0±27.3)ml. All patients were treated with TUERP using transurethral plasma rod electrodes according to the above 16-words formula. The perioperative clinical data and follow-up results at the 3rd month postoperation were statistically analyzed.Results:All operations were successfully completed. The operation time was (49.7±17.7)min, including gland enucleation time (16.8±6.7)min, tissue resection time (33.0±12.3)min, enucleated tissue weight (45.5±24.4)g, intraoperative blood loss (10.2±2.9)ml, postoperative continuous bladder irrigation time (1.9±0.8)d, postoperative hospital stay (4.1±0.7)d. There were no significant changes in hemoglobin and sodium concentration at 2 hours after operation ( P>0.05). The International Prostate Symptom Score (IPSS), quality of life score (QOL), maximum urinary flow rate (MFR) and residual bladder urine were significantly improved at 3 months after operation ( P<0.05). The patients were followed up for 3 to 14 months (average 6.8 months). There were 6 cases of Clavien grade Ⅰ complications, 1 case of Clavien Ⅱ complications, 1 case of Clavien Ⅲ complications, and no Clavien Ⅳ-Ⅴ complications occurred. Conclusions:The TUERP with plasma rod electrode according to the 16-words formula is an ideal choice for BPH treatment, which has the advantages of simple operating, high efficiency of enucleation, less blood loss, fast recovery and satisfied improvement of urination symptom.
ABSTRACT
Objective To evaluate the functional and oncological outcomes of patients with locally advanced prostate cancer (PCa) treated by hormone therapy combined with extra-fascia1 laparoscopic radical prostatectomy (LRP) plus extended lymph node dissection (ePLND).Methods From January 2004 to June 2016,a total of 255 PCa cases (pT3-4NxM0) who received LRP plus ePLND were enrolled into our study.The mean age of the patients was 67 (range 44-88) years,and median PSA level was 21.2 (range 0.6-454.0) ng/ml.The patients were divided into earlier group (from January 2004 to December 2011,160 cases) and later group (from January 2012 to June 2016,95 cases) according to different treatment periods.The baseline demographics between the two groups were similar.All patients routinely received adjuvant hormone therapy (AHT) postoperatively.The patients in the later group underwent collapsin response mediator protein 4 (CRMP4) methylation study on the prostatic biopsy preoperatively.Those with a CRMP4 methylation level ＞ 15％ or rectum/bladder neck invasion,were treated by neoadjuvant hormone therapy (NHT) for 3-6 months.Positive surgical margin (PSM),progression-free survival (PFS),cancer-specific survival (CSS),overall survival (OS) and postoperative continence rates between the two groups were analyzed and compared.Results The mean operative time of the earlier and later group were (239 ±65) min and (203±51) min,mean blood loss were (109-±65) ml and (96-±44) ml,mean dissected nodes were (19 ± 5) and (21 ± 7),respectively (all P ＞ 0.05).The total PSM rate was 19.2％,and PSM rates of the two groups were 23.1％ and 12.6％ (P =0.04).All the 255 cases received AHT and 25 cases in the later group underwent NHT.The median follow-up time was 73 months (range 10-152 months).The total 5-year PFS,CSS and OS rates were 77.7％,94.3％ and 87.1％,respectively,and the rates between groups were 73.8％ vs.86.1％ (P=0.03),93.1％ vs.98.6％ (P=0.07),and 85.0％ vs.92.8％ (P =0.11),respectively.The 1-year postoperative continence rates were 91.9％ vs.97.9％ (P =0.09).Conclusions Hormone therapy combined with LRP plus ePLND represents an oncological and functional effective option in patients with locally advanced PCa,and improved PFS might be acquired by preoperative tumor staging.