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【Objective】 To establish a model for predicting the risk of urinary incontinence after holmium laser enucleation of the prostate (HoLEP). 【Methods】 The clinical data of 258 patients with benign prostatic hyperplasia (BPH) who underwent HoLEP in our hospital during Jan.2019 and Feb.2022 were retrospectively analyzed. According to the occurrence of urinary incontinence after surgery, they were divided into the urinary incontinence group (n=84) and non-urinary incontinence group (n=174). Lasso regression was used to screen the predictors of urinary incontinence after HoLEP. Logistic regression was used to establish a suitable model, and a nomogram of urinary incontinence after HoLEP was drawn. Bootstrap was used to verify and draw the calibration curve of the model, calculate the C index, and draw the clinical decision curve to further verify the accuracy and identification ability of the model. 【Results】 Predictors including International Prostate Symptom Score (IPSS), Quality of Life Score (QoL), body mass index (BMI), diabetes, prostate volume (PV), and prostate-specific antigen (PSA) were selected, based on which a prediction model was constructed. The area under the receiver operating characteristic (ROC) curve of the prediction model was 0.766 0, and the 95% confidence interval was 0.704-0.828. Bootstrap internal validation showed a C-index of 0.766 2, and the calibration model curve coincided well with the actual model curve. The clinical decision curve analysis showed that the model had high accuracy, and net benefit in the probability of urinary incontinence was within 10% to 82%. 【Conclusion】 IPSS, QoL, diabetes, prostate volume, and PSA are predictors that can affect the occurrence of urinary incontinence after HoLEP. The model has high accuracy, identification ability and net benefit.
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【Objective】 To compare the efficacy and safety of thulium laser enucleation of the prostate (ThULEP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH). 【Methods】 Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were searched in PubMed, Embase, Cochrane Library, CNKI and Wanfang Database from Jan.1,2010 to May 30,2022. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. All divergences were resolved by a third researcher. RevMan 5.4 software was used for Meta analysis. 【Results】 A total of 7 studies were included, involving 1 726 patients, 750 in the ThULEP group and 976 in the HoLEP group. Meta analysis showed that, compared with HoLEP group, the ThULEP group had shorter catheter indwelling time [MD=-0.10, 95%CI (-0.17--0.03), P=0.004] , shorter hospital stay [MD=-0.43, 95%CI (-0.60--0.25), P<0.000 01] , lower IPSS score 12 months after surgery [MD=-1.13, 95%CI (-1.95- -0.30), P=0.007] , lower QoL score 12 months after surgery [MD=-1.00, 95%CI (-1.19- -0.81), P<0.001] ,lower transfusion rate [OR=0.11, 95%CI (0.03-0.36), P=0.000 3] and lower incidence of urinary incontinence [OR=0.24, 95%CI (0.09-0.66), P=0.006] . 【Conclusion】 ThULEP may have similar efficacy and safety as HoLEP in the treatment of BPH, and has more advantages in some aspects.
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The essence of the clinical problem caused by benign prostatic hyperplasia(BPH) is lower urinary tract obstruction. Compared with drug treatment, surgery can fundamentally relieve the obstruction. Transurethral endoscopic surgery has become the most important surgical treatment for BPH. In recent years, everyone has been working on exploring the physical properties of various energy platforms, especially lasers, to maximize their advantages in clinical use, various surgical concepts and methods contend. This article summarized my 40 years of experience in transurethral laparoscopic surgery to discuss my experience and thoughts.
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Objective:To investigate the efficacy and safety of thulium laser enucleation of the prostate-pre-transection urethral mucosa at the apex of prostate and traditional three lobe enucleation of the prostate for the treatment of benign prostatic hyperplasia patients.Methods:The data of 270 patients with benign prostatic hyperplasia who were underwent ThuLEP-PAM or ThuLEP in our hospital from May 2020 to September 2021 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: ThuLEP-PAM group (120 cases) and ThuLEP group (150 cases). There was no significant difference comparing the age [(69.8±7.7) years vs. (71.4±8.0) years], prostate volume [55.5(41.0, 71.0)ml vs. 58.5(45.0, 80.3)ml], the serum PSA [3.0(1.8, 4.6) ng/ml vs. 3.3(2.1, 5.5)ng/ml], international prostate symptom scores (IPSS) [22(17, 28) vs. 22(17, 27)], the quality of life score (QOL)[5(4, 6) vs. 5(4, 6)], the maximum urinary flow rate (Q max)[5.6(3.5, 7.3)ml/s vs. 5.5(4.0, 7.1)ml/s], the residual urine volume [ 31(0, 81)ml vs. 31(0, 102)ml] between the ThuLEP-PAM group and the ThuLEP group. No significant difference was found between the two groups( P>0.05). In the ThuLEP-PAM group, the external sphincter ring was located firstly, and urethral mucosa at the apex of prostate was circumferentially incised at 5 mm proximal of the sphincter ring by laser. Then the urethral mucosa was incised at the left sulcus beside the verumontanum and the prostate surgical capsule gap was exposed. After the middle lobe was removed, the left and right lobes were removed along the urethral mucosa pre-incision line at the prostatic apex. The ThuLEP group was enucleated by traditional three lobes enucleation. Perioperative indicators and postoperative complications during short-term follow-up were compared between the two groups. Results:All patients successfully completed the operation and the symptoms of the lower urinary tract were significantly improved. Comparison the perioperative factors between ThuLEP-PAM group and ThuLEP group included the following: operative time 90(70, 103)min vs. 83(61, 102)min; enucleated tissue weight 27.0(19.3, 36.5)g vs. 27.0(19.0, 39.0)g; decrease of the hemoglobin 9.9(7.4, 12.4)g/L vs. 9.5(7.1, 12.7)g/L; catheterization time 3.5(3.0, 4.0)d vs. 3.5(3.0, 5.0)d; hospital stay 6.0(5.0, 6.0)d vs. 5.0(4.0, 6.0)d. NO significant difference in these parameters was found between the two groups( P>0.05). There also was no significant difference in PSA[1.1(0.8, 1.5) ng/ml vs. 1.0(0.8, 1.6) ng/ml], IPSS score [5(4, 6) min vs. 5(4, 6)min], QOL score [2(1, 3) vs. 2(1, 3)], Q max [20.9(17.5, 22.5) ml/s vs. 20.4(17.8, 22.7) ml/s] and PVR [0 ml vs. 0(0, 6)ml] between the two groups ( P>0.05) after more than 3 months of follow-up. The incidence of incontinence for ThuLEP-PAM(2 cases)were lower than that for ThuLEP(11 cases)( P=0.031), but there was no significant between the two groups in other complications such as blood transfusion, haematuria, post-voidalurinary retention and urethral stricture. Conclusions:ThuLEP-PAM and ThuLEP have similar effect on the improvement of lower urinary tract symptoms in patients with benign prostatic hyperplasia, both of which have good efficacy and high safety. The biggest advantage of ThuLEP-PAM over ThuLEP is that it reduces the incidence of early postoperative stress urinary incontinence.
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Objective : To study the effect of modified holmium laser enucleation of the prostate (HoLEP) on sexual function in patients with benign prostatic hyperplasia (BPH). Methods ¡¤ The clinical data of 167 middle-aged and elderly patients with BPH treated by modified HoLEP from Feb. 2017 to Oct. 2018 were retrospectively analyzed. According to the status of sexual activity after operation, the patients were divided into study group who had sex (65 cases) and control group who had no sex (102 cases). The risk factors of sexual activity after operation in the two groups were analyzed. The changes of erectile function and ejaculatory function in the study group before and after operation were recorded and analyzed by international index of erectile function (IIEF-5) score, erection hardness score (EHS) model and ejaculatory function question-naire. Results ¡¤ There were no significant differences between the two groups in the stress urinary incontinence, postoperative hospitalization time, weight of enucleated prostate, crush time, total prostate specific antigen, preoperative urinary retention and enucleation time. The patients in the study group were younger than those in the control group (P=0.000). There were no significant differences in IIEF-5 score and EHS in the study group before and 1, 3, 6 months after operation. There were no significant differences in shorten ejaculation latency, ejaculation pain and ejaculation with or without semen in the study group before and after operation, but the patients of decreased semen volume increased from 41.82% (23/55) to 92.73% (51/55) (P=0.000). Conclusion ¡¤ Age is a risk factor in BPH patients, whether there is sexual activity after modified HoLEP or not. The modified HoLEP has no significant effect on erectile function, but the effect on ejaculatory function is the decrease of ejacu-lated semen volume.
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Objective@#To investigate the relationship between prostate volume and postoperative stress urinary incontinence (SUI) in the elderly benign prostatic hyperplasia (BPH) patients following holmium laser enucleation of the prostate (HoLEP).@*Methods@#A retrospective analysis was performed on clinical data of 110 elderly (age ≥ 60 years) BPH patients who underwent HoLEP in Grand Hospital of Jincheng in Shanxi between 2014 and 2018. In these patients, preoperative transrectal ultrasonography revealed that the prostate volume was 21-198(74.53 ± 31.26) ml. According to prostate volume, the patients were allocated to large prostate volume group (prostate volume ≥ 80 ml), intermediate prostate volume group (40 ml < prostate volume < 80 ml) and small prostate volume group (prostate volume ≤ 40 ml). All patients underwent the HoLEP, the incidence of postoperative SUI was compared among the three groups after withdrawal of stenting catheters.@*Results@#After HoLEP, 74 patients were uneventful, while 36 patients experienced the postoperative SUI. No perpetual SUI patient was found after follow-up for 1 week to 6 months. The incidence of postoperative SUI after HoLEP was positively correlated with prostate volume (r=0.331, P < 0.05). The 36 elderly BPH patients with postoperative SUI accounted for 51.35%(19/37), 33.33% (12/36) and 13.51% (5/37), respectively in large, intermediate and small prostate volume groups, with statistically significant difference among three groups after Kruskal-Walls test (χ2= 11.930, P < 0.05).@*Conclusions@#The incidence of postoperative stress urinary incontinence after HoLEP of the prostate is positively correlated with prostate volume in the elderly BPH patients.
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Objective@#To assess the clinical effects of transurethral holmium laser enucleation of the prostate (HoLEP) combined with Jisheng Shenqi Decoction (HoLEP + JSSD) on BPH.@*METHODS@#This study included 110 BPH patients treated in our hospital from August 2017 to April 2018, who were randomly assigned to receive HoLEP (n = 55) or HoLEP + JSSD (n = 55). We compared the pre- and post-operative IPSS, quality of life (QOL) score, prostate volume, postvoid residual urine volume (PVR), maximum urinary flow rate (Qmax), average urinary flow rate (Qavg) and levels of serum T, E2 and T/E2 as well as postoperative complications between the two groups of patients.@*RESULTS@#After treatment, both IPSS and QOL score were significantly lower in the HoLEP + JSSD than in the HoLEP group (P 0.05) or the total incidence rate of complications postoperatively (21.82% vs 29.09%, P > 0.05).@*CONCLUSIONS@#HoLEP + JSSD can significantly alleviate the lower urinary tract symptoms as well as improve the QOL and bladder and urinary tract functions of BPH patients.
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Objective@#To evaluate the efficiency and safety of transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of BPH in patients with a history of transrectal prostate biopsy (TRPB).@*METHODS@#We retrospectively analyzed the clinical data on 102 cases of BPH treated by HoLEP in our hospital between November 2015 and May 2017, of which 42 had received TRPB prior to HoLEP (the PB group) but not the other 60 (the non-TRPB ［NPB］ group). We compared the preoperative, perioperative and postoperative follow-up data between the two groups of patients.@*RESULTS@#There were no statistically significant differences in the mean age, prostate volume, and preoperative post-void residual urine volume (PVR), IPSS, quality of life (QOL) score and maximum urinary flow rate (Qmax) between the two groups of patients. The preoperative PSA level was significantly higher in the PB than in the NPB group (［10.30 ± 3.62］ vs ［2.62 ± 1.75］ μg/L, P < 0.01), and the operation time markedly longer in the former than in the latter (［78.00 ± 18.25］ vs ［67.93 ± 15.89］ min, P < 0.01), particularly in the patients with an interval of <2 weeks between HoLEP and TRPB than in those with an interval of ≥2 weeks (［91.17 ± 16.51］ vs ［68.13 ± 12.45］ min, P < 0.01). Statistically significant differences were not found in the postoperative hemoglobin level, continuous bladder irrigation duration, catheter-indwelling time and hospital stay, nor in the incidence rate of transient urinary incontinence between the PB and NPB groups (47.62% vs 45%, P = 0.794). There were no transurethral resection syndrome, bladder or rectal injury, or blood transfusion in either group, nor statistically significant differences in PVR, Qmax, IPSS and QOL score between the two groups of patients at 3, 6 or 12 months after operation.@*CONCLUSIONS@#HoLEP is a safe and effective surgical treatment of BPH for patients with a history of TRPB, which can reduce the time and increase the safety of operation when performed at ≥2 weeks after TRPB.
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Objective To compare the efficacy and safety of turning holmium laser enucleation of the prostate (THoLEP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH).Methods A retrospective analysis of 532 patients with BPH surgery from January 2016 to December 2017 was performed,including 289 cases of transurethral resection of holmium laser enucleation (THoLEP) and 43 cases of transurethral holmium laser enucleation (HoLEP).Cases with incomplete data were excluded.Finally,100 patients were enrolled and divided into THoLEP group and HoLEP.The mean ages of patients in the THoLEP group and the HoLEP group were (74.6 ± 8.2) years and (75.3 ± 7.7) years,respectively.The prostate weights were (52.3 ± 23.1) g and (52.6 ± 22.7) g,respectively.International prostate symptom scores (IPSS) were (22.8 ± 1.3) and (23.1 ± 1.6),and the quality of life score (QOL) scores were (4.4 ± 0.5) and (4.3 ± 0.8),respectively.The rate of mximum flow rate (Qmax) was (5.9 ± 2.7) ml/s and (6.3 ± 2.8) mL/s,respectively.The residual urine volume was (149.3 ± 8.7) ml and (145.3 ± 9.7) ml,respectively.There was no significant difference between the two groups (P ＞ 0.05).Results Compared with HoLEP group,THoLEP group showed shorter operation time [(44 ± 13) min vs.(61 ± 15) min,P ＜ 0.05] and less intraoperative bleeding [(101.6 ± 13.2) ml vs.(119.9 ± 18.0) ml,P ＜ 0.05].The weight of the resected tissue in the THoLEP group was slightly larger than that in the HoLEP group,however the difference was not statistically significant [(30.5 ± 9.5) g vs.(28.7 ± 8.5) g] (P ＞ 0.05).The incidence of transient urinary incontinence in THoLEP group was less than that in HoLEP group [2 and 4 cases,P ＜ 0.05].There were no cases of urinary incontinence in both groups after 3 months,and no permanent urinary incontinence in both groups.THoLEP was slightly better than HoLEP group,but the difference was not statistically significant (P ＞0.05).Conclusions Compared with HoLEP,THoLEP has similar short-term results,and has more advantages in shortening the operation time,reducing intraoperative bleeding and transient urinary incontinence.It is a safer and effective method for the treatment of benign prostatic hyperplasia.
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Objective To investigate the relationship between prostate volume and postoperative stress urinary incontinence (SUI) in the elderly benign prostatic hyperplasia (BPH) patients following holmium laser enucleation of the prostate (HoLEP). Methods A retrospective analysis was performed on clinical data of 110 elderly (age ≥60 years) BPH patients who underwent HoLEP in Grand Hospital of Jincheng in Shanxi between 2014 and 2018. In these patients, preoperative transrectal ultrasonography revealed that the prostate volume was 21-198(74.53 ± 31.26) ml. According to prostate volume, the patients were allocated to large prostate volume group (prostate volume≥80 ml) , intermediate prostate volume group (40 ml<prostate volume<80 ml) and small prostate volume group (prostate volume≤40 ml). All patients underwent the HoLEP, the incidence of postoperative SUI was compared among the three groups after withdrawal of stenting catheters. Results After HoLEP, 74 patients were uneventful, while 36 patients experienced the postoperative SUI. No perpetual SUI patient was found after follow-up for 1 week to 6 months. The incidence of postoperative SUI after HoLEP was positively correlated with prostate volume (ri0.331, P<0.05). The 36 elderly BPH patients with postoperative SUI accounted for 51.35% (19/37), 33.33% (12/36) and 13.51% (5/37), respectively in large, intermediate and small prostate volume groups, with statistically significant difference among three groups after Kruskal-Walls test (χ2 = 11.930, P < 0.05). Conclusions The incidence of postoperative stress urinary incontinence after HoLEP of the prostate is positively correlated with prostate volume in the elderly BPH patients.
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Benign prostatic hyperplasia (BPH) is a common disease in the elderly population and holmium laser enucleation of the prostate (HoLEP) is an important method for its management. However, postoperative complications of HoLEP affects the patients' quality of life as well as the outcome of surgery. Based on the ten-year clinical practice and multi-center data analysis, the author puts forward the concept of "postoperative urethral recovery" for BPH patients receiving HoLEP, which involves postoperative pain recovery, urination recovery, urine control recovery, sexual function recovery, and a postoperative recovery system aiming at the acceleration of recovery.
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Aged , Humans , Male , Holmium , Laser Therapy , Methods , Lasers, Solid-State , Pain, Postoperative , Postoperative Period , Prostatectomy , Methods , Prostatic Hyperplasia , General Surgery , Quality of Life , Recovery of Function , Sexual Behavior , Treatment Outcome , Urethra , Physiology , UrinationABSTRACT
Objective@#To compare the safety and effectiveness of shovel-shaped electrode transurethral plasmakinetic enucleation of the prostate (PKEP) with those of plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH).@*METHODS@#We retrospectively analyzed the clinical data about 78 BPH patients received in Shanghai Ninth People's Hospital from June 2016 to January 2017, 39 treated by shovel-shaped electrode PKEP and the other 39 by PKRP. We observed the patients for 6 months postoperatively and compared the effects and safety of the two surgical strategies.@*RESULTS@#No statistically significant difference was observed between the PKEP and PKRP groups in the operation time (［69.3 ± 8.8］ vs ［72.2 ± 7.9］ min, P = 0.126), but the former, as compared with the latter, showed a markedly less postoperative loss of hemoglobin (［3.9 ± 2.8］ vs ［13.9 ± 5.2］ g/L, P 0.05) and other postoperative complications.@*CONCLUSIONS@#Both PKEP and PKRP are effective methods for the treatment of BPH, but PKEP is worthier of clinical recommendation for a better safety profile, more thorough removal of the prostate tissue, less blood loss, shorter hospital stay, and better improved quality of life of the patient.
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Humans , Male , China , Electrodes , Equipment Design , Prostatic Hyperplasia , General Surgery , Quality of Life , Retrospective Studies , Transurethral Resection of Prostate , Methods , Treatment OutcomeABSTRACT
Objective@#To explore the strategies of preserving urinary continence in transurethral plasmakinetic enucleation of the prostate (PKEP) for benign prostate hyperplasia (BPH).@*METHODS@#We treated 65 BPH patients by PKEP with preservation of urinary continence (UC-PKEP), which involved protection of the external urethral sphincter in the beginning of surgery, proper preservation of the anterior lobe of the prostate to protect the internal urethral sphincter in the middle, and preservation of the integrity of the bladder neck towards the end. We compared the postoperative status of urinary continence of the patients with that of the 54 BPH cases treated by complete plasmakinetic enucleation of the prostate (Com-PKEP).@*RESULTS@#All the operations were performed successfully with the urinary catheters removed at 5 days after surgery. In comparison with Com-PKEP, UC-PKEP achieved evidently lower incidence rates of urinary incontinence at 24 hours (31.49% vs 13.85%, P 0.05), and 3 months (3.70% vs 0%, P >0.05) after catheter removal. Compared with the baseline, the maximum urinary flow rate (Qmax) was significantly improved postoperatively in both the Com-PKEP (［7.43 ± 3.26］ vs ［20.58 ± 3.22］ ml, P <0.05) and the UC-PKEP group (［8.04 ± 2.28］ vs ［20.66 ± 3.08］ ml, P <0.05).@*CONCLUSIONS@#Transurethral PKEP is a safe and effective method for the management of BPH, during which the strategies of avoiding blunt or sharp damage to the external urethral sphincter in the beginning, properly preserving the anterior lobe of the prostate in the middle and preserving the integrity of the bladder neck towards the end may help to achieve rapid recovery of urinary continence.
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Humans , Male , Organ Sparing Treatments , Methods , Postoperative Period , Prostatic Hyperplasia , General Surgery , Quality of Life , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urethra , Urinary Bladder , Urinary Catheterization , Urinary IncontinenceABSTRACT
Objective To compare the clinical effect and safety between transurethral green laser enucleation of the prostate and transurethral resection of the prostate (TURP) in the treatment of high-risk benign prostatic hyperplasia (BPH).Methods A total of 101 patients with high-risk BPH were selected from March 2014 to January 2016 in the Central Hospital of Xinxiang City.Among the patients,52 patients were treated with transurethral green laser enucleation of the prostate (green laser group),another 49 patients underwent TURP (TURP group).The operation time,intraoperative blood loss,the mass of resected prostate,bladder irrigation time,postoperative indwelling catheter time,postoperative hospitalization time,transurethral resection syndrome (TURS) and postoperative complications were compared between the two groups.The international prostate symptom scale (IPSS) score,quality of life (QOL) score,maximum urinary flow rate (Qmax) and postvoid residual (PVR) were compared between the two groups before and three months after operation.Results The operation time,bladder irrigation time,indwelling catheter time,postoperative hospitalization time of patients in green laser group were significant shorter than those in TURP group(P ＜ 0.05),the intraoperative blood loss in green laser group was significantly less than that in TURP group (P ＜ 0.05),and the mass of resected prostate in green laser group was significantly more than that in TURP group (P ＜ 0.05).There were no significant difference in the incidence of perioperative blood transfusion,TURS,urethral stricture,temporary urinary incontinence,postoperative infection,bladder neck contracture and retrograde ejaculation between the two groups (P ＞ 0.05).There was no significant difference in IPSS score,QOL score,Qmax and PVR between the two groups before operation (P ＞ 0.05).The IPSS score,QOL score and PVR at three months after operation were significantly lower than those before operation (P ＜ 0.05).The Qmax at three months after operation was significantly higher than that before operation (P ＜0.05).There was no significant difference in IPSS score,QOL score,Qmax and PVR between the two groups at three months after operation (P ＞ 0.05).Conclusion Transurethral green laser enucleation of the prostate and TURP for treating high-risk BPH can obtain good therapeutic effect.Transurethral green laser enucleation of the prostate in the treatment of high-risk BPH has the advantages of shorter operation time,less intraoperative bleeding,faster postoperative recovery and good safety.
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Objective To investigate the efficacy and safety of transurethral plasmakinetic enucleation of the prostate (PKEP)combined with suprapubic cystostomy rotary resection in the treatment of large volume(>100 ml)benign prostatic hyperplasia(BPH). Methods From June 2015 to December 2015,28 patients with BPH[volume,(112.6 ±9.8)ml]were given transurethral PKEP.The resected gland was pushed into the bladder and the vesical stoma was extended.Whereafter a 10 mm trocar was introduced via suprapubic cystostomy, and then rotary resection of glands was performed and removed under transurethral observation. Results All the operations were successfully completed.The operating time was(85.8 ±26.5)min,the enucleation time was(38.0 ±11.3)min, and the rotary resection time was(47.5 ±20.2)min.Two patients had much flushing fluid extravasated into retropubic space and were given no special treatment.Two patients suffered the complication of transient stress urine incontinence after removal of catheter,and they were recovered within 4 weeks.Follow-up for 3-6 months found no urethral stricture. The IPSS scores at 3 months after operation were(13.5 ±3.6)points. Conclusion Transurethral PKEP combined with suprapubic cystostomy rotary resection in the treatment of large BPH is safe.
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Objective To evaluate the efficacy and safety of transurethral laser shovel type vaporresection-enucleation of the prostate (LS-VREP) based on the inter-layer of surgical capsule for the treatment of benign prostatic hyperplasia (BPH),which was less 80 g weight.Methods From September 2013 to August 2016,a retrospective study was performed including 1 369 cases of BPH patients,who were treated by 120-160 W transurethral laser (straight green-light) shovel type vapor-resection-enucleation of the prostate (LS-VREP group,n =1 008) and transurethral resection of the prostate (TURP group,n =361).The preoperative data,including average age,prostate weight,IPSS,QOL,Qmax and PVR was reviewed.There was no significant difference of the above data between the two groups (P ＞ 0.05).Operative time,changes of hemoglobin and serum sodium concentration,postoperative bladder irrigation time,catheter indwelling duration,hospital stay,pre-and 3 months post-operative IPSS,QOL,Q PVR were recorded.In addition,complications were monitored.Results Mean operation time of LS-VREP group was (46.1 ± 18.6) min,while TURP group was (48.2 ± 15.2) min,and there was no difference between the two groups (P ＞ 0.05).Post-operative mean hemoglobin concentration and serum sodium concentration of LS-VREP group decreased (1.6 ± 1.2) g/L and (1.2 ± 0.6) mmol/L respectively,while those of TURP group decreased (5.7 ± 3.6) g/L and (3.2 ± 1.2) mmol/L,and the differences were statistically significant (P ＜ 0.05).Mean post-operative catheter indwelling time,and post-operative hospital stay of LS-VREP group was (42.9 ± 12.7) h and (3.2 ± 0.6) d,while TURP group was (65.7 ± 15.4) h and (5.4 ± 1.2) d,and the differences were statistically significant (P ＜ 0.05).Comparatively IPSS,QOL,Qmax and PVR were all improved significantly in both groups at 3 months after operation (P ＜ 0.05),but no significant difference was found between the two groups (P ＞ 0.05).After three months' follow-up of post-operation,as for the complication rate,including TURS,bleeding requiring reoperation,incontinence,dysuria and erectile dysfunction,LS-VREP group (15/1 008) was less than that of TURP group (30/361,P ＜ 0.05).Conclusions The LS-VREP based on the inter-layer of surgical capsule is safe and effective for the treatment of BPH patients whose prostate weight was less than 80 g.LS-VREP showed less intraoperative bleeding,faster postoperative recovery,and high safety,which is considered a safe,effective and optimized minimally invasive surgery.
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Objective@#To investigate the clinical effect of "3+1" bladder function restoration combined with holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with acontractile detrusor (ACD).@*METHODS@#We treated 35 BPH patients with ACD by HoLEP followed by "3+1" bladder function restoration, that is, a 3-phase bladder function training plus simultaneous 1-drug medication after surgery. We recorded and analyzed the detrusor pressure, post-void residual urine volume (PVR), maximum urinary flow rate (Qmax), International Prognostic Scoring System (IPSS) scores, quality of life (QoL), voluntary micturition, satisfaction with the bladder function, hydronephrosis, ureterectasia, renal function, and urinary tract infection of the patients before and after treatment.@*RESULTS@#Compared with the base line, at 6 months treatment, the patients showed significantly increased detrusor pressure (［35.1±2.7］vs ［50.2±2.3］ cmH2O, P<0.05) and Qmax (［4.2±2.7］vs ［21.1±4.1］ ml/s, P<0.05) but decreases in PVR (［173.0±31.6］ vs ［30.5±12.9］ml, IPSS score (27.3±3.2 vs 5.1±1.4, P<0.05) and QoL (4.1±0.8 vs 0.8±0.1, P<0.05), elevated rates of voluntary urination (0% ［0/35］ vs 100% ［35/35］, P<0.05), regularurination (0% ［0/35］ vs 85.71% ［30/35］, P<0.05), grade Ⅰ satisfaction with bladder function (0% ［0/35］ vs 85.71% ［30/35］, P<0.05), reduced rate of overflowing urinary incontinence (28.57% ［10/35］ vs 5.71% ［2/35］, P<0.05), and increased percentages of normal renal function (34.29% ［12/35］ vs 85.71% ［30/35］, P<0.05) and non-infection of the urinary system (17.14% ［6/35］ vs 94.29% ［33/35］, P<0.05). After treatment, urination was markedly improved in 94.29% (33/35) of the patients.@*CONCLUSIONS@#"3+1" bladder function restoration combined with HoLEP produced a desirable effect on BPH with ACD, though its long-term effect remains to be further investigated.
Subject(s)
Aged , Humans , Male , Holmium , Laser Therapy , Methods , Lasers, Solid-State , Personal Satisfaction , Prostatic Hyperplasia , General Surgery , Quality of Life , Recovery of Function , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urinary Bladder , Physiology , Urination , PhysiologyABSTRACT
Objective@#To compare the clinical effect of diode laser enucleation of the prostate (DIOD) with that of transurethral resection of the prostate (TURP) on benign prostate hyperplasia (BPH) with different prostate volumes.@*METHODS@#This retrospective study included 256 BPH patients treated by DIOD (n = 141) or TURP (n = 115) from March 2012 to August 2015. According to the prostate volume, we divided the patients into three groups: 80 ml (48 for DIOD and 39 for TURP). We obtained the relevant data from the patients before, during and at 6 months after surgery, and compared the two surgical strategies in operation time, perioperative levels of hemoglobin and sodium ion, post-operative urethral catheterization time and bladder irrigation time, pre- and post-operative serum PSA levels, International Prostate Symptoms Score (IPSS), post-void residual urine (PVR) volume and maximum urinary flow rate (Qmax), and incidence of post-operative complications among different groups.@*RESULTS@#In the 80 ml group (［3.35 ± 1.39］ ng/ml vs ［1.76 ± 0.91］ ng/ml, P <0.05). No blood transfusion was necessitated and nor postoperative transurethral resection syndrome or urethral stricture observed in DIOD. However, the incidence rate of postoperative pseudo-urinary incontinence was significantly higher in the DIOD (22.7%, 32/141) than in the TURP group (7.83%, 9/115) (P <0.05).@*CONCLUSIONS@#DIOD, with its obvious advantages of less blood loss, higher safety, faster recovery, and more definite short-term effectiveness, is better than TURP in the treatment of BPH with medium or large prostate volume and similar to the latter with small prostate volume.
Subject(s)
Humans , Male , Lasers, Semiconductor , Therapeutic Uses , Operative Time , Organ Size , Postoperative Complications , Prostate , Pathology , Prostatic Hyperplasia , Pathology , General Surgery , Quality of Life , Retrospective Studies , Therapeutic Irrigation , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urethral Stricture , Urinary Catheterization , Urinary IncontinenceABSTRACT
Objective:To evaluate the safety and clinical effect of holmium laser enucleation of the prostate (HoLEP) for pati-ents with benign prostatic hyperplasia (BPH) .Methods:A total of 40 patients with BPH from Jan 2015 to Jul 2015 were underwent HoLEP.Pre-and postoperative complication were recorded and the differences of the clinical parameters were also compared, including peak urinary flow rate (Qmax), residual urine volume (PVR), International Prostate Symptom Score (IPSS), quality-of-life (QOL) .Results:A total of 34 patients were included after operation and 6 patients lost to follow-up. Qmax, PVR, IPSS, QOL after three months postoperatively were improved significantly compared with that of preoperative (P<0.01) .Complications included intraoperative bladder injury (1 case), postoperative stress incontinence (2 cases), urethral stricture (1 case) .No patients experienced the sign of TUR syndrome and blood transfusion for severe bleeding.Conclusion:HoLEP has the advantage of good therapeutic effects,wide scope of application,better safety performance,smaller risk and it’s worth popularizing in primary hospitals.
ABSTRACT
<p><b>Objective</b>To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity.</p><p><b>METHODS</b>his study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively.</p><p><b>RESULTS</b>There were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group (［315±59］ vs ［287±76］ ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time (［2.7±0.8］ vs ［5.1±1.2］ d, P<0.05), postoperative bladder contracture time (［4.1±1.9］ vs ［5.8±2.4］ d, P<0.05), postoperative hospital stay (［4.4±1.8］ vs ［5.9±2.5］ d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05).</p><p><b>CONCLUSIONS</b>Both TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.</p>