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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.
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>
Subject(s)
Humans , Male , Lasers, Solid-State , Therapeutic Uses , Length of Stay , Prostate , General Surgery , Prostatic Hyperplasia , General Surgery , Quality of Life , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urinary Bladder Neck Obstruction , General Surgery , Urinary Bladder, Overactive , General Surgery , Urinary Catheterization , Urination , PhysiologyABSTRACT
<p><b>Objective</b>To evaluate the safety and effect of transurethral holmium laser enucleation of the prostate (HoLEP) in comparison with bipolar transurethral plasmakinetic prostatectomy (TUPKP) in the treatment of benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>We searched the databases of PubMed, SCI, Ovid, The Cochrane Library, CNKI, CBM, VIP, and Wangfang Data for controlled clinical trials about HoLEP versus TUPKP in the treatment of BPH published up to April 2016. The studies were screened according to the inclusion and exclusion criteria, the data extracted, and their quality evaluated by 2 reviewers independently, followed by a meta-analysis using the RevMan 5.3 software.</p><p><b>RESULTS</b>A total of 7 studies were included, involving 2031 cases. In comparison with TUPKP, HoLEP showed significantly longer operation time (WMD = 24.61, 95% CI 11.88, 37.34, P lt; 0.001), shorter hospital stay (WMD =－1.91, 95% CI －3.74, －0.07, P = 0.04), shorter bladder irrigation time (WMD = －21.50, 95% CI －34.95, －8.06, P = 0.002), shorter catheter-indwelling time (WMD = －27.60, 95% CI －48.17, －7.03, P = 0.009), less hemoglobin loss (WMD = － 0.42, 95% CI －0.78, －0.07, P = 0.02); lower postvoid residual urine (PVR) at 3 months (WMD = －3.35, 95% CI －4.46, －2.23, P<0.001) and 6 months after surgery (WMD =－1.11, 95% CI －2.18, －0.05, P = 0.04); higher maximum urinary flow rate (Qmax) (WMD = 0.42, 95% CI 0.04, 0.80, P = 0.03) and fewer urinary tract irritation symptoms (OR =0.58, 95% CI 0.41, 0.81, P = 0.002) at 12 months after surgery. No statistically significant differences were found between the two groups in the volume of resected tissue, serum sodium reduction, urethral stricture, erectile dysfunction, retrograde ejaculation, or transient urinary incontinence (P>0.05), or in the improvement of the quality of life (QoL) at 1, 3 and 12 months, International Prostate Symptom Score (IPSS) at 1, 3, 6 and 12 months, Qmax at 1, 3 and 6 months, or International Index of Erectile Function-5 (IIEF-5) at 6 months after surgery (P>0.05).</p><p><b>CONCLUSIONS</b>HoLEP is preferred to TUPKP in clinical application for its advantages of higher Qmax at 12 months after surgery, lower PVR at 3 and 6 months, higher peri-operative safety, faster recovery, and fewer urinary tract irritation symptoms. However, for the quantity and quality limitations of the included publications, our findings are to be further supported by large-sample, multi-center, and high-quality prospective controlled clinical studies.</p>