摘要:目的:探討良性前列腺增生經尿道前列腺電切術圍手術期的護理經驗。方法:回顧性分析96例良性前列腺增生患者臨床資料。結果:96例患者手術順利,圍手術期經周密的護理,療效滿意,無明顯并發癥。結論:周密的手術期護理對經尿道前列腺電切術治療老年良性前列腺增生十分重要。Abstract: Objective: To investigate the perioperative nursing care of transurethral prostatic resection (TURP). Methods: The data of 96 TURP cases were analyzed retrospectively. Results: All the operations were performed successfully, and there were no obvious complications among the patients with precise nursing care. Conclusion: It is very important for precise nursing care to the patients who underwent TURP.
【摘要】 目的 探討經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生的有效性和安全性。 方法 2008年4月－2009年4月，應用Gyrus超脈沖等離子體行經尿道前列腺腔內逆行剜除汽化切除術124例，前列腺重量為（62.3±21.7） g。術中首先用電切鏡鞘、電切環鈍銳性相結合將前列腺增生腺體沿外科包膜逆行剝離、剜除，同時斷血供，然后推至膀胱頸處后切除。統計手術時間、術中出血量及收集到的前列腺組織質量，術后留置尿管時間、住院時間、手術后前列腺特異性抗原（prostatic specific antigen，PSA）、殘余尿量（post voiding residual volume，PVR）、最大尿流率（Qmax）、國際前列腺癥狀評分（international prostatic symptom scores，IPSS）及生活質量評分（quality of life，QOL）等指標的變化。 結果 124例手術順利完成。手術時間（48.1±19.4） min，腺體組織質量（57.6±19.6） g，平均失血量（86.2±20.7） mL，僅1例需要輸血，出血量和手術時間隨前列腺體積和重量的增加而相應增加和延長。術后留置尿管時間（3.1±1.6） d，住院時間（5.8±1.4） d。隨訪6～18個月，所有患者術后1、6個月Qmax、PVR、IPSS、QOL均較術前得到改善，與術前比較差異均有統計學意義（Plt;0.05）。術后6個月血清PSA降至（0.90±0.26） ng/mL，與術前比較差異有統計學意義（Plt;0.05）。繼發尿道外口狹窄3例，經尿道擴張治療后恢復排尿通暢；繼發尿失禁2例，經保守治療分別于術后1～6個月恢復；無永久性尿失禁、再次手術止血患者，無手術死亡者，未發生經尿道前列腺電切綜合征。 結論 經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生安全有效，值得臨床推廣使用。【Abstract】 Objective To evaluate the safety and clinical efficacy of superpulse plasmakinetic body in transurethral intracavitary retrograde enucleation and vaporization resection of the prostate (TUEVRP) for the treatment of benign prostatic hyperplasia (BPH). Methods Between April 2008 and April 2009, Gyrus TUEVRP was performed on 124 patients with obstructive BPH whose mean prostatic weight was (62.3±21.7) g. The hyperplasia prostate glands were retrogradely dissected and enucleated along surgical capsule to the bladder neck by sharp and blunt dissection combination of the resectoscope tip or loop. Simultaneously, the blood supply of the gland was clamped. The changes of such indexes as operating time, perioperative blood loss, collected prostatic specimen weight, postoperative catheterization time, hospitalization time, prostatic specific antigen (PSA), post voiding residual volume (PVR), maximum urinary flow rate (Qmax), international prostatic symptom score (IPSS), and quality of life (QOL) were assessed. Results All surgeries were successfully carried out with an average operation time of (48.1±19.4) minutes ranged from 25 to 175 minutes. The mean collected prostatic specimen weight was (57.6±19.6) g ranged from 20.2 to 125.7 g. The blood loss was ranged from 45 to 350 ml, averaging at (86.2±20.7) mL during the operation. Blood transfusion was needed in only one case. Blood loss and operation time were increased and prolonged in accordance with the increase of prostatic volume and weight. The postoperative catheterization time was ranged from 2 to 5 days, averaging at 3.1±1.6. The mean hospitalization time was (5.8±1.4) days ranged from 5 to 8 days. All patients were followed up for 6 to 18 months. Qmax, PVR, IPSS and QOL-score six months after operation were significantly improved compared with those before operation (Plt;0.05). There were three cases of external urethral stricture, and they were treated with urethral dilatation successfully. Two cases of urinary incontinence recovered 1 and 6 months later, respectively, by traditional treatment. There were no cases of permanent urinary incontinence, reoperation for hemostasis, operative death, or transurethral resection syndrome. Conclusion TUEVRP is safe and clinically efficacious in the treatment of BPH, and is worthy of clinical promotion.
ObjectiveTo systematically review the association between 5α-reductase inhibitors (5ARIs) and risk of sexual dysfunction in subjects with benign prostatic hyperplasia (BPH).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies on the association between 5ARIs and risk of sexual dysfunction in subjects with BPH from inception to October 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata 12.0 software.ResultsA total of 15 studies involving 17 774 subjects were included. The results of the meta-analysis showed that compared with the placebo group, 5ARIs could significantly increase risk of erectile dysfunction (RR=1.52, 95%CI 1.36 to 1.69, P<0.000 1), while decrease libido (RR=1.79, 95%CI 1.37 to 2.32, P<0.000 1) and ejaculation disorder (RR=2.97, 95%CI 1.82 to 4.83, P<0.000 1) in subjects with BPH. Subgroup analysis of the type of 5ARIs, intervention period, publication year and sample size showed that the 5ARIs had a higher risk of sexual dysfunction than the placebo group.ConclusionsCurrent evidence shows that 5ARIs can increase risk of erectile dysfunction, decrease libido and ejaculation disorder in subjects with BPH. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
【摘要】 目的 探討經尿道等離子雙極電切術（PKRP）治療前列腺增生的安全性及臨床療效。 方法 2009年2-12月，采用PKRP治療前列腺增生患者76例，記錄手術時間、手術療效及術后并發癥。 結果 患者手術時間35～130 min，平均55 min。術中失血60～150 mL，均未輸血。手術切除前列腺質量18～72 g。無直腸和膀胱穿孔，無電切綜合征（TURS）及閉孔神經反射發生，無一例發生真性尿失禁，無死亡。術后隨訪2～6個月，IPSS評分平均為9分，最大尿流率平均為16.7 mL/s。 結論 PKRP是治療前列腺增生的理想方法之一。【Abstract】 Objective To evaluate the efficacy of transurethral plasmakinetic resection of the prostate (PKRP) on benign prostatic hyperplasia. Methods A total of 76 patients with benign prostatic hyperplasia from February to December 2009 were treated with PKRP. The operative duration, therapeutic effect and postoperative complications were observed and recorded. Results The operative duration ranged from 35 to 130 minutes (average 55 minutes).The intraoperative blood loss was 60-150 mL, and no one needed transfusion.The prostate gland excised weight was 18-72 g. There were no intestinal and bladder perforation, no transurethral resection syndrome (TURS) or obturator nerve reflex occurs, and no urinary incontinence or death.IPSS score was nine and the maximal average uroflow was 16.7 mL/s during the 2-6 month follow-up. Conclusion PKRP is one of the ideal methods treating benign prostatic hyperplasia, especially for high-risk patients with benign prostatic hyperplasia.
ObjectivesThe present network meta-analysis was conducted to evaluate the potential efficacy and safety of various surgical approaches in the treatment of benign prostatic hyperplasia with enlarged prostate.MethodsPubMed, EMbase, The Cochrane Library, Clinicaltrials.gov and CNKI databases were electronically searched to identify eligible studies. Two reviewers independently screened literature, extracted data and evaluated risk of bias and the ADDIS 1.16.8 software was used to conduct meta-analysis.ResultsA total of 23 studies involving 2 849 patients with 5 approaches including open prostatectomy (OP), holmium laser enucleation of the prostate (HoLEP), plasmakinetic/bipolar plasmakinetic enucleation of the prostate (PK/BPEP), transurethral vaporization of the prostate (TUVP), and laparoscopic prostatectomy (LSP) were included. HoLEP, PK/BPEP and OP were superior to the other methods in improving the objective indicators and subjective feelings of patients during both short and medium-term follow-up. However, compared with OP, HoLEP and PK/BPEP were observed to result in a significantly lower hemoglobin level (MD=1.65, 95%CI 0.35 to 4.41; MD=2.62, 95%CI 0.64 to 2.90), longer postoperative irrigation time (MD=4.67, 95%CI 1.29 to 10.66; MD=2.67, 95%CI 1.32 to 6.63), as well as indwelling catheter after operation (MD=1.64, 95%CI 0.48 to 4.15; MD=2.52, 95%CI 0.60 to 3.78). In terms of short-term complications, PK/BPEP (RR=0.45, 95%CI 0.13 to 1.29) was found to be significantly lower than that of OP.ConclusionsHoLEP and PK/BPEP can be probably used as a superior treatment option for large volume benign prostatic hyperplasia because of its better curative effect, higher safety and quick postoperative recovery.
ObjectiveTo evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).MethodsRandomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.ResultsA total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=?25.95 mL, 95% confidence interval (CI) (?31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=?10.35 h, 95%CI (?18.25, ?2.45) h, P=0.042], average duration of bladder irrigation [WMD=?10.28 h, 95%CI (?17.52, ?3.04) h, P=0.038], and average length of hospital stay [WMD=?1.24 d, 95%CI (?1.85, ?0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=?0.89 m/s, 95%CI (?1.74, ?0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).ConclusionsIn the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.
Objective To evaluate the effect of pretreatment with epristeride on decreasing intraoperative bleeding during transurethral resection of prostate (TURP) and to study its mechanism. Methods A total of 60 patients with benign prostatic hyperplasia undergoing TURP were divided into two groups: 30 patients were pretreated with epristeride 5 mg×2 daily for 7 to 11 days before TURP, and 30 patients did not receive any pretreatment. The operations for the two groups of patients were conducted by the same doctors. The operation time, the weight of resected prostatic tissue, and the volume of irrigating fluid were recorded. Blood loss, bleeding index, and bleeding intensity were calculated. Microvessel density (MVD), vascular endothelial growth factors (VEGF), and nitric oxide synthase type III (eNOS) expression were measured by the immunohistochemistry SPmethod in prostatic tissue. Results In the epristeride and control groups, the mean blood loss was 179.51±78.29 ml and 237.95±124.38 ml (Plt;0.05); the mean bleeding index was 7.68±3.94 ml/g and 9.73±3.42 ml/g (Plt;0.05); the mean bleeding intensity was 2.43±1.03 ml/min and 3.30±1.50 ml/min (Plt;0.05); the mean value of MVD was 18.80±5.68 and 23.70±4.91 (Plt;0.05); the mean rank of VEGF was 23.48 and 31.77 (Plt;0.05); and the mean rank of eNOS was 22.36 and 31.14 (Plt;0.05), respectively. Conclusion Pretreatment with epristeride decreases intraoperative bleeding during TURP. The preliminary results suggest that angiogenesis in the prostatic tissue is suppressed.
Objective To determine whether antibiotic prophylaxis can reduce the risk of postoperative bacteriuria in men undergoing transurethral resection of prostate (TURP) who have sterile preoperative urine. Method MEDLINE, EMBASE and Cochrane Library were searched for RCTs comparing antibiotic prophylaxis and placebo/blank controls for men undergoing TURP with preoperative sterile urine. The search strategy was established according to the Cochrane Prostatic Diseases and Urologic Cancers Group search strategy. Data was extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Fifty three relevant trials were searched, of which 27 trials were included and 26 were excluded. Antibiotic prophylaxis significantly decreased the rate of post-TURP bacteriuria.The pooled relative risk (RR) and 95% confidence interval were 0.36 (0.28, 0.46). Conclusions Prophylactic antibiotics could significantly decrease the incidence of post-TURP bacteriuria. Further comparative RCTs and cost-effective should be performed analysis to establish the optimal antibiotic regimes for the benefit of patients undergoing TURP.
Objective To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Methods We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2. Result We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (Pgt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group. Conclusion The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.
