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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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As principais complicações pós-operatórias de Ressecção Transuretral da Próstata (RTU-P) são: retenção urinária por coágulos sanguíneos na sonda e a contaminação exógena do sistema urinário por manipulação do profissional de saúde ao realizar a técnica de lavagem vesical. O artigo descreve o desenvolvimento de um protótipo para a manutenção do sistema urinário fechado durante a lavagem vesical e permitir a medição das pressões no interior do cateter vesical de demora (CVD) de três vias com o protótipo durante a técnica da lavagem vesical. Trata-se de uma pesquisa tecnológica baseada no modelo de Processo de Desenvolvimento do Produto de Rozenfeld. Foram realizados testes de funcionalidade por meio de experimentos em ambiente controlado dentro de laboratório. O protótipo apresentou resultados satisfatórios quanto a manutenção do sistema urinário fechado durante a técnica de lavagem vesical. O uso do catéter permitiu a medição das pressões específicas do CVD de três vias em três momentos diferentes: cateter desobstruído, cateter parcialmente obstruído e cateter totalmente obstruído. Os resultados obtidos demonstram que o protótipo pode representar uma ferramenta inovadora na área de urologia. Atendeu as especificações do projeto e possibilitou a manutenção do sistema urinário fechado na lavagem vesical. Além de diminuir os riscos de contaminação do sistema urinário durante a manipulação da técnica. Portanto, o presente estudo demostrou que o protótipo é plenamente seguro quando comparado as pressões exercidas dentro do CVD. Existe a necessidade de realizar testes experimentais em humanos para comprovar a diminuição de contaminação do trato urinário como uso do protótipo.
The main postoperative complications of Transurethral Resection of the Prostate (TURP) are urinary retention by blood clots in the probe and exogenous contamination of the urinary system by manipulation of the healthcare professional when performing the bladder washing technique. The aim of this study was to develop a prototype for keeping the urinary system closed during bladder washes and to measure the internal pressures of the three-way Indwelling Urinary Catheter (IDC) during the bladder washing technique. This was a technological study based on the Rozenfeld's Product Development Process model. Functionality tests were carried out through experiments in a controlled environment in the laboratory. The prototype showed satisfactory results regarding the preservation of the urinary system closed during the bladder washing technique. It was possible to obtain specific pressures from the three-way IDC at three different moments: unobstructed catheter, partially obstructed catheter, and totally obstructed catheter. The results obtained demonstrate that the prototype can represent an innovative tool in the area of urology. It met the project's specifications and preserved the urinary system closed during the bladder washing. Moreover, it reduces the risk of urinary system contamination during the technique manipulation. Therefore, the present study showed that the prototype is fully safe regarding the pressures exerted inside the IDC. There is a need to carry out experimental tests in humans to prove the decrease of urinary tract contamination with the use of this prototype.
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Benign prostatic hyperplasia (BPH) is a common disease in elderly men, and transurethral laser prostatectomy (TULP) has been widely used in the clinic to remove bladder outlet obstruction caused by BPH. Previous animal models for wound repair after prostatectomy have many limitations, and there have been no previous reports of a mouse model of TULP. Therefore, this study aimed to establish a novel mouse model of TULP. Twelve healthy adult Kunming (KM) mice received transurethral laser vaporization prostatectomy with a 200-μm thulium laser. The mice were sacrificed, and wound specimens from the prostatic urethra and bladder neck were harvested at 1 day, 3 days, 5 days, and 7 days after surgery. Hematoxylin-eosin (HE) and immunohistochemistry were applied to confirm the establishment of the mouse TULP model. One day after the surgery, urothelium expressing uroplakin (UPK) was absent in the urethral wound site, and a large number of necrotic tissues were found in the wound site. There was no UPK-positive urothelium in the wound 3 days after surgery. At 5 days after surgery, monolayer urothelium expressing UPK was found in the wound site, indicating that the re-epithelization of the wound had been completed. On the 7th day after surgery, there were multiple layers of urothelium with UPK expression, indicating that the repair was completed. It is feasible to establish a mouse TULP model by using a microcystoscope system and a 200-μm thulium laser.
Subject(s)
Aged , Animals , Humans , Male , Mice , Laser Therapy , Prostatectomy , Prostatic Hyperplasia/surgery , Thulium , Transurethral Resection of ProstateABSTRACT
Objective:To evaluate the relationship between declined preoperative left ventricular diastolic function and postoperative increased extravascular lung water (EVLW) in the patients undergoing transurethral resection of the prostate (TURP).Methods:A total of 116 patients, aged 55-90 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with body mass index of ≤30 kg/m 2, undergoing elective TURP under general anesthesia, without increased EVLW before surgery, were included in the study.Lung ultrasound examination was performed and lung ultrasound scores were assessed before leaving PACU.Increased EVLW was defined as lung ultrasound score ≥20.The occurrence of increased EVLW after operation was recorded, and patients were divided into increased EVLW group and non-increased EVLW group according to whether increased EVLW occurred.Multivariate logistic regression analysis was used to identify the risk factors for postoperative increased EVLW. Results:The results of multivariate logistic regression analysis showed that declined preoperative left ventricular diastolic function was an independent risk factor for postoperative increased EVLW ( P<0.05). Conclusions:Declined preoperative left ventricular diastolic function is an independent risk factor for postoperative increased EVLW in the patients undergoing TURP.
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Retrospectively analyze the clinicopathological data of a patient with metastatic hormone sensitive prostate cancer, and review relevant literature. The patient was male, 68 years old. Complaints of dysuria and urgency for half a year. Blood PSA>100 ng/ml, magnetic resonance showed that the prostate was occupying space, the boundary with the seminal vesicle gland was not clear, and the pelvic cavity had multiple bone lesions. Bone scan revealed multiple bone metastases. The prostate biopsy showed adenocarcinoma, Gleason score 5+ 5. The clinical stage was T 3N 0M 1b.A palliative transurethral resection of the prostate was performed due to urination obstruction, and endocrine therapy with medical castration combined with abiraterone and prednisone. PSA was continuously controlled at <0.006 ng/ml. After half a year of treatment, the prostate-specific membrane antigen single-photon emission computerized tomography and magnetic resonance examination revealed sternal and parasternal soft tissue lesions. Local radiotherapy and continuous endocrine therapy were given. The disease was under long-term control.There are various treatment options for metastatic hormone sensitive prostate cancer. Medical castration treatment combined with abiraterone and prednisone can effectively control the disease with mild adverse reactions. Palliative transurethral resection of the prostate can improve the symptoms of urinary obstruction and may also improve the prognosis of patients.
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Conclusion:Patients with OlimHSPC who are not sensitive to traditional CAB treatment, ADT combined with abiraterone acetate neoadjuvant therapy and postoperative adjuvant therapy can be attempted.
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Prostate cancer has become the most common malignant disease in male. Due to development of therapy methods, the overall survive rate of advanced prostate cancer has been improved significantly. The demands for higher quality of life are impending in advanced prostate cancer patient. With the progression of prostate cancer, about 1/3 to 2/3 of patients will suffer from moderate to severe lower urinary tract symptoms. Severe lower urinary tract symptoms can lead to negative effects on treatment and quality of life. However, there is no standard treatment for lower urinary tract symptoms in advanced prostate cancer patients. This article reviews the clinical application of palliative transurethral resection of prostate in patients with advanced prostate cancer.
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For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.
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OBJECTIVE@#To establish the incidence of postoperative bacteriuria (PBU) in patients after undergoing transurethral resection of the prostate (TURP) using sterile distilled water as irrigating fluid, and determine the possible risk factors for its development.@*METHODS@#A retrospective cohort study of patients who underwent TURP using distilled water as irrigating fluid from 2014-2018 at a tertiary government hospital was performed. Included were patients who had urine culture results upon admission, treated with antibiotics or received antibiotic prophylaxis within 24 hours prior to operation, as appropriate, and had a repeat culture prior to discharge. PBU was defined as the presence of significant (≥ 105 CFU/mL) bacteriuria upon catheter removal in patients with either no growth on preoperative urine culture or growth of a different organism from that of the preoperative culture. Chi-square and Student’s T-test were used to compare those with and without PBU and attributable risk (AR) values were determined for identified risk factors.@*RESULTS@#Eighty-four patients with a mean age of 65 (± 6.32) years were included. Sixteen (19%) patients developed PBU. Preoperative catheterization and resection time of more than 30 minutes were found to be associated with the development of PBU (p=0.020 and 0.047, respectively), with AR of 24.24% (95% CI [13.90,34.58]) and 22.86% (95% CI [13.02,32.69]). Age, resected prostate weight, and diabetes mellitus were not found to be associated with PBU.@*CONCLUSION@#Postoperative bacteriuria rate of 19% was noted with the use of distilled water as irrigant during TURP. Significant risk factors for its development included preoperative catheterization and prolonged resection times.
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RESUMEN Introducción: la resección transuretral de próstata (RTUP), independiente de si es con equipo monopolar o bipolar (RTUP-B), es la cirugía estándar en el manejo quirúrgico de los síntomas del tracto urinario inferior (STUI) o de las complicaciones derivadas de la obstrucción por hiperplasia prostática benigna (HPB). Objetivo: revisar la literatura sobre frecuencia y factores de riesgo para complicaciones de la RTUP con bipolar. Resultados: se hizo una revisión de la literatura mediante la búsqueda en Medline desde 1996 hasta 2017. De 76 artículos revisados, 50 se incluyeron. Estos reportan que la RTUP-B ofrece buenos resultados a largo plazo. Las complicaciones en su mayoría son grado I según la clasificación de Clavien-Dindo y las más frecuentes son la eyaculación retrógrada, hematuria secundaria, retención o infección urinaria y estrechez uretral o contractura del cuello vesical. Los factores de riesgo fueron comorbilidades, gravedad de la enfermedad al momento de la intervención, técnica y habilidad del cirujano, entre otros. Discusión: aunque la mayoría de las complicaciones secundarias a la RTUP-B son leves, definir el momento óptimo para la realización de la cirugía e intervenir los factores de riesgo modificables, podría contribuir a mejorar los resultados de esta técnica quirúrgica.
SUMMARY Introduction: Regardless of the technique used, either bipolar or monopolar, transurethral resection of the prostate (TURP) is considered the cornerstone of surgical management for low urinary tract symptoms (LUTS), and benign prostatic obstruction (BPO). Objective: To review the available literature regarding the frequency of bipolar TURP (B-TURP) complications and the risk factor associated with them. Results: The search was conducted using Medline and studies addressing the research question published between 1996 and 2017 were retrieved. Seventy six article were screened and 50 were included. Those papers reported that B-TURP was associates with good long-term outcomes. According to Clavien-Dindo classification, a high proportion of complications were grade I, and the most frequent ones were: retrograde ejaculation, urine retention, urinary tract infection, bleeding and urethral stricture. Risk factors most commonly associated with these complications were: patient's medical status before surgery, the extent of disease at the time of the procedure, skills and technique of the surgeon, amongst other. Discussion: The majority of the surgical complications associated with B-TURP are mild, and identifying the best moment to conduct the procedure and intervening on modifiable risk factors before surgery, may contribute to improve outcomes of the B-TURP.
Subject(s)
Transurethral Resection of Prostate , Postoperative Complications , Intraoperative ComplicationsABSTRACT
Introduction: Clinical benign prostatic hyperplasia (BPH)is one of the most common cause of lower urinary tractsymptoms in ageing men. Gold standard for BPH now days,is transurethral resection of the prostate (TURP). Hence; thepresent study was planned to prospectively analyse 500 TURPcases.Material and methods: 500 patients who underwent TURPafter failed medical therapy for BPH or with absoluteindication for TURP were anlayzed. All patients underwentultrasonography for post void residual urine and prostatesize, Serum PSA, DRE and uroflowmetry. Urine routineand culture along with renal function test was done in allpatients. Urodynamic study was done in patients suspectedfor neurogenic bladder. Data in relation to intraoperativeparameters and postoperative follow-up were analysed.Results: In the present study, data of a total of 500 patientswas analysed. Fever, haematuria and clot retention was foundto be present in 20, 25 and 18 patients respectively. Deathoccurred in 1 patient due to cardiac complication. Bloodtransfusion was required in 50 patients. Stricture and bladderneck contracture was seen in 16 and 9 patients respectively asa manifestation of late complication. Incontinence was foundto be present in 1 patients.Conclusion: TURP is one of the best minimally invasivetreatment for BPH. Along with being cost-effective, it isalso associated with significantly shorter hospital stay andminimum morbidity
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Objective To investigate the effect of the endoscopic surveillance system in irrigating fluid absorption and bleeding during transurethral resection of the prostate.Methods In vitro trials,we simulated the fluid absorption and bleeding in the operation by using self-developed endoscopic surveillance system from January 2013 to June 2013.Continuous irrigation of 5 ％ mannitol solution,we extracted 5 times irrigating fluid (each time 100 ml and a total of 500 ml) in the process of irrigation and recorded absorption measurements of every time extraction rinses.At the same time,we dripped human whole blood 5 times(each time 5 ml and a total of 25 ml) in the process of irrigation and recorded the bleeding measurements.The above process was repeated three times to detect the accuracy and consistency of the endoscopic surveillance system.In clinical trials,50 cases of BPH were monitored in surgery and the biochemical index,hemodynamics,irrigating fluid absorption and bleeding were compared from October 2016 to April 2017.The included criteria contained as follow:the age of patients should be more than 50 years.The transabdominal ultrasound showed that the volume of prostate should be more than 60 ml.The maximal uroflowmetry should be less than 15ml/s.The IPSS scores should be more than 8.Based on the operative time,two groups (＜60 min and ≥ 60 min) were classified.Results We developed the endoscopic surveillance system which is original in the world.In vitro trials,the average irrigating fluid were (100.60 ± 2.07) ml,(201.00±3.39) ml,(302.00±4.67) ml,(403.60±4.39) ml and (502.40 ±7.57) ml;and the average bleeding were (5.06 ± 0.11) ml,(10.10 ± 0.16) ml,(15.04 ± 0.15) ml,(20.06 ± 0.11) ml and (25.10 ± 0.16) ml.No significant difference was observed in all groups (P ＞ 0.05).In clinical trials,we compared some preoperative and postoperative indexes.The average blood oxygen saturation were (94.46 ± 2.49) ％ and (92.39 ± 2.77) ％ (P ＜ 0.01),the average Serum sodium ion concentration were (141.05 ± 2.52) mmol/L and (138.06 ± 4.27) mmol/L(P ＜ 0.01),the average HGB were (143.50 ± 13.43) g/L and (137.04 ± 14.25) g/L(P ＜ 0.01).The average HCT were (42.05 ± 4.09) ％ and (137.04 ± 14.25) ％ (P ＜ 0.01).The average HR were (77.9 ± 7.6) beats per minute and (77.93 ± 6.93) beats per minute (P＞0.05).The MAP were (90.32 ± 9.75) mmHg and (91.07±8.96)mmHg(P＞0.05).The average serum potassium ion concentration were (4.13 ± 0.53) mmol/L and (4.09 ± 0.37) mmol/L (P ＞ 0.05).The average irrigating fluid absorption of the group less than 60 minutes and the group equal or more than 60 minutes were (401.83 ± 279.23) ml and (885.25 ± 367.68) ml (P ＜ 0.01).The average blood loss were (64.10 ±47.47) ml and (158.40 ± 65.22) ml(P ＜0.01).The preoperative and postoperative hemodynamic,blood biochemical and hematology showed difference in our trials.Irrigating fluid absorption and blood loss were positively associated with operation time.Conclusions The endoscopic surveillance system was safety and accuracy.It can offer real-time monitoring data and alarm mechanism for the surgeons that possibly improve operation safety.
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Objective To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP.Methods We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan'an hospital affiliated to Kunming medical university retrospectively.The patients' age ranged from 58 to 75 years,with an average of 64.3 years.The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month,with an average of 3.5 months.5 cases were urethral stricture at penis segment,11 cases were urethral stricture at the junction of penis and scrotum,and the length of the narrow urethra was 2-5 cm,with an average of 3.4cm.The average maximum uroflowmetry in preoperative was (5.3 ± 2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months,5 cases were treated with intraurethral incision combined with urethral dilatation (1 or 2 times).16 cases were not effective after receiving the above treatment,so that all cases were treated with dorsal mosaic surgery with penis free flap.Subarachnoid anesthesia combined with epidural anesthesia,the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator.Incision from the ventral side of the urethra.The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body.The length of the incision was extended 0.5 cm to the normal urethral mucosa.The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea,and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse,the full thickness of the penis flap was taken,and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra),the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side,Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra,the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine,and the fascia and skin were sutured layer by layer.The 5-0 absorbable thread sutures the wound after the foreskin was taken.Results The operations were successfully completed.The operation time was 90-120 min,with an average of 102.3 min.The intraoperative blood loss was 10-30 ml.The symptoms of dysuria were relieved in all patients after removal of the catheter at 3 weeks postoperative.4 weeks after surgery,no signs of urethral stricture were observed in urethrography.And the maximum flow rate was ＞ 15 ml/s in 13 cases,while 3 cases was 10-15 ml/s.The mean maximum flow rate in postoperative was [(20.4 ± 7.3) ml/s],which was significantly higher than that in preoperative (t =7.7602,P ＜ 0.05).B-ultrasound showed 13 cases without residual urine and 3 cases of residual urine volume ＜ 30 ml.All patients had no serious complications such as urinary fistula,urethral diverticulum and extravasation of urine.After 1 year of follow-up,1 patient was lost to follow up,and none of the remaining15 cases had urethral obstruction due to re-stricture.Conclusion Dorsal mosaic surgery with penis free flap could be an effective method and had no obvious complications for the treatment of anterior urethral stricture after TURP.
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OBJECTIVE@#To compare the effectiveness of abdominal placement of indwelling Foley catheter (IFC)versus thigh traction in the prevention of bleeding and pain after transurethral resection of the prostate(TURP).@*PATIENTS AND METHODS@#This randomized, controlled trial involves 91 patients who underwent TURP atJRRMMC. After TURP, 46 patients were inserted with a urethral catheter which was then anchoredto the thigh and placed on traction, while the catheter was anchored to the abdomen without applicationof any traction in the remaining 45. A simple dipstick test was used to check for the presence of bloodin urine on the 12th and 24th hour after the surgery. Intensity of pain from the catheter was assessedprior to discharge using a visual analogue score (VAS).@*RESULTS@#There were no significant differences between the two groups in terms of the amount of bloodin the urine at the 12th hour (p=1.00) and 24th hour (p=0.427) after TURP. The mean VAS score wassignificantly higher for the thigh traction group (5.17 vs 1.51, p=0.0001). Additionally, there weremore patients in the IFC thigh traction group who complained of moderate (65% vs 4.4%, p= 0.0001)and severe (20% vs 4.4%, p= 0.0001) pain.@*CONCLUSION@#Abdominal placement of IFC post TURP is an effective, safe and comfortable way incontrolling post-operative bleeding post-TURP. This method can provide better pain control.
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Objective@#To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP.@*Methods@#We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan′an hospital affiliated to Kunming medical university retrospectively. The patients' age ranged from 58 to 75 years, with an average of 64.3 years. The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month, with an average of 3.5 months. 5 cases were urethral stricture at penis segment, 11 cases were urethral stricture at the junction of penis and scrotum, and the length of the narrow urethra was 2-5 cm, with an average of 3.4cm. The average maximum uroflowmetry in preoperative was (5.3±2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months, 5 cases were treated with intraurethral incision combined with urethral dilatation(1 or 2 times). 16 cases were not effective after receiving the above treatment, so that all cases were treated with dorsal mosaic surgery with penis free flap. Subarachnoid anesthesia combined with epidural anesthesia, the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator. Incision from the ventral side of the urethra. The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body. The length of the incision was extended 0.5 cm to the normal urethral mucosa. The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea, and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse, the full thickness of the penis flap was taken, and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra), the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side, Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra, the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine, and the fascia and skin were sutured layer by layer. The 5-0 absorbable thread sutures the wound after the foreskin was taken.@*Results@#The operations were successfully completed. The operation time was 90-120 min, with an average of 102.3 min. The intraoperative blood loss was 10-30 ml. The symptoms of dysuria were relieved in all patients after removal of the catheter at 3 weeks postoperative. 4 weeks after surgery, no signs of urethral stricture were observed in urethrography. And the maximum flow rate was >15 ml/s in 13 cases, while 3 cases was 10-15 ml/s. The mean maximum flow rate in postoperative was [(20.4±7.3) ml/s], which was significantly higher than that in preoperative (t=7.7602, P<0.05). B-ultrasound showed 13 cases without residual urine and 3 cases of residual urine volume <30 ml. All patients had no serious complications such as urinary fistula, urethral diverticulum and extravasation of urine. After 1 year of follow-up, 1 patient was lost to follow up, and none of the remaining15 cases had urethral obstruction due to re-stricture.@*Conclusion@#Dorsal mosaic surgery with penis free flap could be an effective method and had no obvious complications for the treatment of anterior urethral stricture after TURP.
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RESUMEN La hiperplasia prostática benigna (HPB) es la neoplasia más común en hombres y puede requerir tratamiento quirúrgico cuando hay retención urinaria, uropatía obstructiva, hematuria a repetición, cistolitiasis o falta de mejoría de los síntomas con las terapias farmacológicas. Las opciones quirúrgicas más frecuentes son la prostatectomía abierta y la resección transuretral de próstata, entre cuyas complicaciones están las infecciones del tracto urinario (ITU) hasta en 12,9 % de los pacientes. Sin embargo, este porcentaje es variable porque no siempre se especifica la diferencia entre ITU y bacteriuria. Los siguientes son factores de riesgo: bacteriuria preoperatoria, tiempo quirúrgico mayor de 60 minutos y manipulación posoperatoria de la sonda vesical. Es importante que los profesionales de la salud que participan en la atención de pacientes con HPB conozcan e intervengan estas complicaciones infecciosas y sus factores de riesgo.
SUMMARY Benign prostatic hyperplasia (BPH) is the most common tumor in men and may require surgical treatment when there is urinary retention, obstructive uropathy, recurrent hematuria, cystolithiasis or lack of improvement of symptoms with drug therapies. The most common surgical options are open prostatectomy and transurethral resection of the prostate. Urinary tract infections (UTI) are among the complications of these procedures, and may occur in up to 12.9 % of patients. However, this percentage is variable because the difference between UTI and bacteriuria is not always specified. Risk factors are: preoperative bacteriuria, operating time longer than 60 minutes and handling of postoperative bladder catheter. It is important that health professionals involved in the care of patients with BPH know these infectious complications and their risk factors.
Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Prostatectomy , Prostatic Hyperplasia , InfectionsABSTRACT
Introducción: La hiperplasia prostática benigna (HPB) es una enfermedad caracterizada por síntomas del tracto urinario inferior (1). Estos síntomas suelen causar un impacto negativo en la calidad de vida del paciente llevándolo a padecer trastornos depresivos (7). Se han encontrado síntomas depresivos hasta en el 22.5% de los pacientes con HPB sin embargo, hay poca evidencia de que estos síntomas disminuyan luego de tratar la HPB (5). Una herramienta útil para medir los síntomas depresivos es la Escala de Medición de Depresión de Hamilton (3). Objetivos: Este estudio pretende evaluar la presencia de síntomas depresivos en pacientes con HPB y comprobar si estos síntomas disminuyen posteriormente al tratamiento quirúrgico para HPB. Métodos. Se utilizó un muestra de 30 pacientes, edad (promedio 67 ± 8 años), sometidos a tratamiento quirúrgico para HPB y quienes presentaran por lo menos un síntoma depresivo según la escala de medición de depresión de Hamilton. Resultados. Todos tuvieron resección transuretral de próstata (RTUP). Previo a la cirugía se encontraron síntomas depresivos en el 76%. Un mes posterior a la cirugía se encontraron síntomas depresivos en 28, sin embargo, se encontró depresión leve en el 23.3% (vs pre op 30%), depresión moderada en el 16.6% (vs pre op 30%) y depresión severa en el 13.3% (vs pre-op 16.6%). La Escala de Medición de Depresión de Hamilton tuvo una puntuación media preoperatoria de 13.93 puntos. Un mes posterior a la cirugía la puntuación media fue de 9.36 puntos. La diferencia fue de 4.56 puntos, lo cual es estadísticamente significativo (P=0.05). Hubo complicaciones quirúrgicas en 3 pacientes quienes tuvieron un aumento en el puntaje postoperatorio y hubo aumento del nivel de depresión. En el estudio 15 refirieron disfunción eréctil previo a la cirugía y únicamente 8 persistieron con disfunción luego de la cirugía. Conclusiones. Los pacientes con HBP constituyen una población en riesgo de padecer síntomas depresivos. Los síntomas depresivos están relacionados con padecer STUI y disfunción eréctil; ambas condiciones afectan la calidad de vida. El tratamiento quirúrgico para tratar la HPB es efectivo en disminuir los síntomas depresivos mejorando la calidad de vida causando mínimos efectos negativos.
Introduction: Benign Prostatic Hyperplasia (BPH) is a condition that leads to inferior urinary tract symptoms (1). These symptoms often cause a negative impact on the quality of life leading to depressive symptoms (7). Depressive symptoms are present in up to 22.5% of patients with BPH, however, there is limited evidence that these symptoms decrease with HPB treatment (5). A useful tool to measure depressive symptoms is the Hamilton Depression Rating Scale (HDRS) (3). Objective: Main purpose of the study is to assess the prevalence of depressive symptoms in patients with BPH and determine whether these symptoms decreased after a corrective surgery. Methods: A sample of 30 male patients, average age 67 ± 8 years old, with surgical treatment indication for BPH, with at least one depressive symptom according to the HDRS was obtained. Results: All patients in the study underwent transurethral resection of the prostate (TURP). Prior to surgery, depressive symptoms found in 76.6%. A month post-surgery depressive symptoms found in 28, however mild depression was present in 23.3% (vs pre-op 30%) moderate depression in 16.6% (vs pre-op 30.0%) and severe depression in 13.3% (vs pre-op 16.6%). Measurement with HDRS had a mean preoperative score 13.93 points; a post-surgery month the average score was 9.36. The difference was 4.56 points; which is statistically significant (P = 0.05). Three patients had surgical complications and they had an increase in postoperative score and also increased in the level of depression. In the study 15 patients reported erectile dysfunction prior to surgery; out of these patients only 8 persisted with dysfunction after surgery. Conclusions: BPH patients is a population at risk for developing depressive symptoms. Depressive symptoms are related to developing lower urinary tract symptoms and erectile dysfunction; both conditions affecting the quality of life. Surgery to treat BPH is effective in reducing depressive symptoms by improving the quality of life and with minimal adverse effects.
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<p><b>Objective</b>To evaluate the effectiveness and safety of low-concentration hydrogen peroxide solution (HPS) for continuous bladder irrigation after transurethral resection of the prostate (TURP).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 148 cases of benign prostatic hyperplasia (BPH) treated by TURP from January 2013 to January 2016. Seventy-six of the patients received postoperative continuous bladder irrigation with 0.15% HPS (group A) and the other 72 with normal saline (group B). We compared the two groups of patients in their postoperative hemoglobin (Hb) levels, duration of bladder irrigation, frequency of catheter blockage, time of catheterization, and length of hospital stay.</p><p><b>RESULTS</b>There were no statistically significant differences between the two groups of patients preoperatively in the prostate volume, International Prostate Symptoms Score, maximum urinary flow rate, postvoid residual urine, or levels of serum PSA and Hb (P > 0.05). At 48 hours after operation, a significantly less reduction was observed in the Hb level in group A than in group B (［3.38 ± 2.56］ vs ［7.29 ± 6.58］ g/L, P < 0.01). The patients of group A, in comparison with those of group B, also showed remarkably shorter duration of postoperative bladder irrigation (［32.57 ± 5.99］ vs ［46.10 ± 8.79］ h, P < 0.01), lower rate of catheter blockage (3.3% vs 11.8%, P < 0.01), shorter time of catheterization (［3.74 ± 0.79］ vs ［4.79 ± 0.93］ d, P < 0.01), and fewer days of postoperative hospital stay (［4.22 ± 0.81］ vs ［4.67 ± 0.88］ d, P < 0.01).</p><p><b>CONCLUSIONS</b>Low-concentration HPS for continuous bladder irrigation after TURP can reduce blood loss, catheter blockage, bladder irrigation duration, catheterization time, and hospital stay, and therefore deserves a wide clinical application.</p>
Subject(s)
Humans , Male , Anti-Infective Agents, Local , Catheter Obstruction , Hydrogen Peroxide , Length of Stay , Postoperative Hemorrhage , Postoperative Period , Prostatic Hyperplasia , Blood , General Surgery , Quality of Life , Retrospective Studies , Therapeutic Irrigation , Methods , Transurethral Resection of Prostate , Treatment Outcome , Urinary Bladder , Urinary Bladder Neck Obstruction , Urinary RetentionABSTRACT
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 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.