目的比较经尿道保留尿道前壁前列腺剜除术（transurethral ventral preserving enucleation of the prostate,TUVPEP）与经尿道前列腺电切术（transurethral resection of the prostate,TURP）治疗良性前列腺增生患者的安全性、效果和...目的比较经尿道保留尿道前壁前列腺剜除术（transurethral ventral preserving enucleation of the prostate,TUVPEP）与经尿道前列腺电切术（transurethral resection of the prostate,TURP）治疗良性前列腺增生患者的安全性、效果和严重并发症。方法200例良性前列腺增生（benign prostatic hyperplasia,BPH）患者,按照前列腺体积大小分为两层,M层为中大前列腺（45-80 g）,L层为巨大前列腺（〉80 g）,每层按随机数字表分为2组。M1组和L1组为试验组,M2组和L2组为对照组。试验组采用作者专利器械＂张氏多功能前列腺手术镜＂进行TUVPEP,简称张氏前列腺剜除术（Zhang’s enucleation of the prostate,ZSEP）,对照组进行TURP,统计手术持续时间、术中出血量、术后住院时间。出院后6个月随访,比较两组国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Q_（max））及严重并发症。采用SPSS 18.0统计软件进行分析,其中连续变量采用x±s表示,两组间比较采用t检验。结果 179例得到随访,试验组出血量显著少于对照组[M1组（27.63±20.35）m L与M2组（31.82±17.35）m L,P〈0.05;L1组（58.35±49.79）m L与L2组（73.39±43.78）m L,P〈0.05]。试验组住院时间显著缩短[M1组（3.80±1.03）d与M2组（6.61±1.91）d,P〈0.01;L1组（4.06±1.29）d与L2组（5.94±1.84）d,P〈0.01]。试验组术后Q_（max）显著高于对照组[M1组（21.10±7.56）m L/s与M2组（16.10±5.94）m L/s,P〈0.01;L1组（25.70±9.18）m L/s与L2组（16.20±5.01）m L/s,P〈0.01];试验组与对照组严重并发症分别为10%与21%,再次手术率分别为0%与6%,差异有统计学意义（P〈0.05）。结论与TURP比较,ZSEP显著减少出血量和手术时间,提高尿流率和减少严重并发症的发生,再次手术率极低,可缩短留置导尿时间和住院时间。展开更多
目的比较经尿道等离子双极前列腺剜除术(plasmakinetic enucleation of the prostate,PKEP)联合单纯等离子电切术(plasmakinetic resection of the prostate,PKRP)与单纯PKRP治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的临...目的比较经尿道等离子双极前列腺剜除术(plasmakinetic enucleation of the prostate,PKEP)联合单纯等离子电切术(plasmakinetic resection of the prostate,PKRP)与单纯PKRP治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的临床效果及安全性。方法前瞻性纳入作者医院诊断为BPH并伴有下尿路症状的患者共234例,根据治疗方式不同分为联合组(PKEP+PKRP治疗)87例和对照组(单纯PKRP治疗)147例,对两组术前、术中及术后随访3个月的资料进行比较分析。结果两组术前基本资料差异无统计学意义(P>0.05)。与对照组相比,联合组手术时间较长、切除腺体更多,减少了术中出血量、术后膀胱冲洗时间、术后尿管留置天数和住院时间,组间比较差异具有统计学意义(P<0.05)。术后3个月随访,两组前列腺症状评分、生活质量评分、最大尿流率、残余尿量等指标较术前均有显著改善,但两组间比较差异无统计学意义(P>0.05)。结论 PKEP联合PKRP治疗BPH安全、有效,且对患者的损伤较小,患者恢复快。展开更多
In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vap...In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vapor enucleation and resection of the prostate(TVERP),transurethral vapor enucleation of the prostate(TVEP),and ultrasound-navigated TVEP(US-TVEP)are new,innovative endoscopic enucleation procedures.These procedures are named Xie’s Prostate Enucleations(Xie’s Procedures for short).Current clinical data indicate that Xie’s Procedures are safe and effective treatment options for patients with BPH,especially for patients with larger prostates.Further prospective,randomized clinical trials compared with traditional transurethral resection of prostate(TURP)are still needed.展开更多
Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retro...Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.展开更多
文摘目的比较经尿道保留尿道前壁前列腺剜除术（transurethral ventral preserving enucleation of the prostate,TUVPEP）与经尿道前列腺电切术（transurethral resection of the prostate,TURP）治疗良性前列腺增生患者的安全性、效果和严重并发症。方法200例良性前列腺增生（benign prostatic hyperplasia,BPH）患者,按照前列腺体积大小分为两层,M层为中大前列腺（45-80 g）,L层为巨大前列腺（〉80 g）,每层按随机数字表分为2组。M1组和L1组为试验组,M2组和L2组为对照组。试验组采用作者专利器械＂张氏多功能前列腺手术镜＂进行TUVPEP,简称张氏前列腺剜除术（Zhang’s enucleation of the prostate,ZSEP）,对照组进行TURP,统计手术持续时间、术中出血量、术后住院时间。出院后6个月随访,比较两组国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Q_（max））及严重并发症。采用SPSS 18.0统计软件进行分析,其中连续变量采用x±s表示,两组间比较采用t检验。结果 179例得到随访,试验组出血量显著少于对照组[M1组（27.63±20.35）m L与M2组（31.82±17.35）m L,P〈0.05;L1组（58.35±49.79）m L与L2组（73.39±43.78）m L,P〈0.05]。试验组住院时间显著缩短[M1组（3.80±1.03）d与M2组（6.61±1.91）d,P〈0.01;L1组（4.06±1.29）d与L2组（5.94±1.84）d,P〈0.01]。试验组术后Q_（max）显著高于对照组[M1组（21.10±7.56）m L/s与M2组（16.10±5.94）m L/s,P〈0.01;L1组（25.70±9.18）m L/s与L2组（16.20±5.01）m L/s,P〈0.01];试验组与对照组严重并发症分别为10%与21%,再次手术率分别为0%与6%,差异有统计学意义（P〈0.05）。结论与TURP比较,ZSEP显著减少出血量和手术时间,提高尿流率和减少严重并发症的发生,再次手术率极低,可缩短留置导尿时间和住院时间。
文摘目的比较经尿道等离子双极前列腺剜除术(plasmakinetic enucleation of the prostate,PKEP)联合单纯等离子电切术(plasmakinetic resection of the prostate,PKRP)与单纯PKRP治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的临床效果及安全性。方法前瞻性纳入作者医院诊断为BPH并伴有下尿路症状的患者共234例,根据治疗方式不同分为联合组(PKEP+PKRP治疗)87例和对照组(单纯PKRP治疗)147例,对两组术前、术中及术后随访3个月的资料进行比较分析。结果两组术前基本资料差异无统计学意义(P>0.05)。与对照组相比,联合组手术时间较长、切除腺体更多,减少了术中出血量、术后膀胱冲洗时间、术后尿管留置天数和住院时间,组间比较差异具有统计学意义(P<0.05)。术后3个月随访,两组前列腺症状评分、生活质量评分、最大尿流率、残余尿量等指标较术前均有显著改善,但两组间比较差异无统计学意义(P>0.05)。结论 PKEP联合PKRP治疗BPH安全、有效,且对患者的损伤较小,患者恢复快。
文摘In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vapor enucleation and resection of the prostate(TVERP),transurethral vapor enucleation of the prostate(TVEP),and ultrasound-navigated TVEP(US-TVEP)are new,innovative endoscopic enucleation procedures.These procedures are named Xie’s Prostate Enucleations(Xie’s Procedures for short).Current clinical data indicate that Xie’s Procedures are safe and effective treatment options for patients with BPH,especially for patients with larger prostates.Further prospective,randomized clinical trials compared with traditional transurethral resection of prostate(TURP)are still needed.
文摘Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.
