经尿道前列腺电汽化与经尿道前列腺电切对BPH的疗效比较

对２４０例有症状的前列腺增生症（ＢＰＨ）患者分别行经尿道前列腺电汽化术（ＴＶＰ）和经尿道前列腺电切术（ＴＵＲＰ）。结果显示：１２０例ＴＶＰ手术者，前列腺症状评分（ＩＰＳＳ）从术前的２０．９下降至术后３个月的５．１（Ｐ＜０．００１），最大尿流率由１０．６ｍｌ／ｓ上升至１９．２ｍｌ／ｓ（Ｐ＜０．０１）。ＴＵＲＰ组１２０例，ＩＰＳＳ从术前的２１．２下降至术后３个月的５．２（Ｐ＜０．００１），最大尿流率由１０．２ｍｌ／ｓ上升至１９．４ｍｌ／ｓ（Ｐ＜０．０１），两组比较无显著差异性（Ｐ＞０．０５）。平均留置导尿管时间：ＴＶＰ组２６．５小时，ＴＵＲＰ组５０．７小时，有显著性差异（Ｐ＜０．０１）。术后阳萎发生率：ＴＶＰ组２．４％，ＴＵＲＰ组１４．５％（Ｐ＜０．０５）。ＴＶＰ组术中无大出血及经尿道前列腺电切综合征（ＴＵＲＳ）发生，需输血者仅１例。ＴＵＲＰ组３例发生ＴＵＲＳ，输血１４例。比较结果：ＴＶＰ能达到与ＴＵＲＰ完全相同的治疗效果，且并发症少，价格相对较低，近期效果满意。     

经尿道前列腺电切治疗前列腺癌(附47例报告)

为解除前列腺癌所致的膀胱出口梗阻，对４７例前列腺癌病人行睾丸切除术及采用经尿道前列腺电切（ＴＵＲＰ）治疗。平均随访２．８年。结果：电切前列腺组织１７．１±６．６ｇ，手术前后对比，国际前列腺症状评分（ＩＰＳＳ）由２３．６±５．５降至８．９±２．０，最大尿流率由６．２±３．０提高至１４．５±４．４ｍｌ／ｓ，前列腺体积由５４．６±１５．０降至２８．１±６．１ｍｌ。６例电切彻底者最后切除前列腺标本仍有前列腺癌组织。术后未发现有血行转移。认为ＴＵＲＰ是前列腺癌的姑息性治疗措施，不会引起血行转移，但电切不彻底，术后前列腺体积缩小是抗雄激素治疗结果     

经尿道前列腺电汽化术的合并症

报告５７例前列腺增生症患者在经尿道前列腺电汽化术（ＴＵＶＰ）治疗中发生６例次（１０．５％）合并症，其中ＴＵＲ综合征１例（１．８％），术后继发膀胱出血１例（１．８％），术后膀胱颈挛缩２例（３．５％）及尿道外口狭窄２例（３．５％）。分析了其发生原因并提出防治措施，所有患者预后良好     

前列腺术后肺动脉血栓栓塞

１９８０年１月到１９９３年３月采用耻骨上经膀胱前列腺摘除术（ＴＶＰ）、经尿道前列腺电切（ＴＵＲＰ）和膀胱造瘘加双侧睾丸切除术三种方式治疗１１２８例前列腺增生或前列腺癌患者，术后５～１３天（平均６．４天）发生肺栓塞５例，占０．４％，存活２例，死亡３例。对其发生率、危险因素、栓子起源、临床表现、诊断、治疗及预防进行讨论，并提出临床诊断标准及预防治疗措施。     

经尿道前列腺电切术的并发症及其防治

报道经尿道前列腺电切术（ＴＵＲＰ）８７５例的临床资料，年龄４７～８７岁，平均６９．２岁。主要临床表现为进行性排尿困难，夜尿次数增多和尿潴留。术中术后常见并发症的发生率分别为：ＴＵＲ综合征２．７％，包膜穿孔和尿外渗１．７％，切破静脉窦而中止手术０．６％，术中出血和术后继发性出血３．９％，暂时性尿失禁３８％，永久性尿失禁０１％，排尿不畅和尿道狭窄２．１％，阳萎１２０％，逆行射精４５０％。对上述并发症的防治进行了讨论。     

前列腺增生行电切术后其特异性抗原浓度变化的研究

目的：探讨良性前列腺增生（ＢＰＨ）病人行标准经尿道前列腺电切术（ＴＵＲＰ）后菜前列腺特异性抗原（ＰＳＡ）值的变化。方法；采用放射免疫法对６２例因ＢＰＨ而行标准ＴＵＲＰ的病人术前及术后３－４个月的ＰＳＡ进行测定。结果；ＰＳＡ值由术前的４．３μｇＬ降为１．８μｇ／Ｌ，平均减少５８％，前列腺体上术前的４６．５ｍｌ减少为２４．４ｍｌ，平均减少４８％，相当于每切除１ｇ前列腺组织，ＰＳＡ下降０．１１μ／Ｌ；术     

良性前列腺增生术后再入院原因分析

自１９８２年１月～１９９８年３月收治良性前列腺增生（ＢＰＨ）术后再次入院病人５５例,现对再入院原因进行分析。资料和方法　１９８２年１月～１９９８年３月,我院行ＢＰＨ手术治疗者７８４例,其中行经尿道前列腺电切术（ＴＵＲＰ）４３６例,行开放前列腺摘除手术３４８例。患者年龄５７～８４岁,平均６５－６岁。ＴＵＲＰ术后再入院病人４３例,发生率９－８％（４３／４３６）,分析其原因：（１）腺体残留或复发者３０例,其中２个月内再次手术者９例,２个月～３年内再次手术者９例,３～１０年者１２例。（２）尿道狭窄８例,…     

经尿道前列腺电气化术治疗BPH疗效评价：附84例报告

目的 评价经尿道前列腺电气化术（ＴＵＶＰ）治疗前列腺增生症（ＢＰＨ）的临床效果。方法 采用电气化法加电切法施行经尿道前列腺电气化术治疗ＢＰＨ８４你。结果 ７６你获得０．５年随访。国际前列腺症状评分（ＩＰＳＳ）由术前（２７．４±３．１）分降压（１０．５±１．７）分,生活质量评分（ＱＯＬ）由（５．３±０．６）分降为（２．１±０．４）分,剩余尿量由（１３２．１±４４．５）ｍｌ降至（２８．６±１４．２）ｍ     

前列腺切除术后性功能障碍245例分析

调查２４５例因良性前列腺增生症（ＢＰＨ）行耻骨上前列摘除术（ＳＰＰ）或经尿道前列腺切除术（ＴＵＲＰ）患者手术前后性功能的情况。结果发现术后勃起功能障碍发生率ＳＰＰ组为１０．４％；ＴＵＲＰ组为１４．３％，两组无明显差异；逆行射精发生率ＳＰＰ组为２６．３％，ＴＵＲＰ组为４８．７％，ＴＵＲＰ组明显高于ＳＰＰ组，并就ＢＰＨ术后性功能障碍性的原因及预防措施进行了讨论，认为除年龄、术前性功能状态、术者经验、心     

小体积良性前列腺增生治疗方式的选择

目的：寻找治疗小体积良性前列腺增生（ＢＰＨ）患者的最佳治疗方式。方法：对４２例小体积ＢＰＨ患者采用直肠Ｂ超及尿动力学检查相结合方法进行综合分析，如移行区指数（ＴＺＩ）〉０．４且存在膀胱颈梗阻者，采用ＴＵＲＰ治疗；如ＴＺＩ≤０．４且存在膀胱颈梗阻者，则行药物治疗，结果：ＴＺＩ〉０．４者ＴＵＲＰ治疗效果好（９３．３％），药物治疗效果较差（５０．０Ａ％０；ＴＺＩ≤０．４者药物治疗优于ＴＵＲＰ治疗：ＴＺＩ≤０．４而无膀胱颈梗阻者手术及药物治疗均无效。结论：治疗小体积ＢＰＨ患者的原则是尿动力学检查有膀胱颈梗阻存在，如ＴＺＩ〉）．４，宜行ＴＵＲＰ治疗；如ＴＺＩ〉０．４，则行药物治疗，如尿动力学检查无膀胱颈梗阻存在，则应继续寻找病因。     

前列腺增生行电切术后其特异性抗原浓度变化的研究

目的：探讨良性前列腺增生（BPH）病人行标准经尿道前列腺电切术（TURP）后其前列腺特异性抗原（PSA）值的变化。方法：采用放射免疫法对62例因BPH而行标准TURP的病人术前及术后3～4个月的PSA进行测定。结果：PSA值由术前的4．3μg／L降为1．8μg／L，平均减少58％．前列腺体积由术前的46．5ml减少为24．4ml，平均减少48％，相当于每切除1g前列腺组织，PSA下降0．11μg／L；术后有84％的病人PSA值＜4μg／L，97％的病人＜10μg／L。结论：BPH行标准TURP后，其PSA值应在正常参考范围内，即＜4μg／L。     

Perioperative management of transurethral surgery for benign prostatic hyperplasia: A nationwide survey in Japan

Objectives: Various types of minimally invasive surgical treatments, including transurethral resection of prostate (TURP), are being carried out in Japan for patients with benign prostatic hyperplasia (BPH). The aim of the present study was to elucidate the current status of perioperative care for these treatments by carrying out a nationwide survey. Methods: Assisted by the Japanese Endourology and ESWL Association, perioperative data from 157 institutions participating in this survey were collected and analyzed. Results: This survey included 3918 patients undergoing TURP, 242 TUR in saline (TURis), 638 holmium laser enucleation of the prostate (HoLEP), 90 holmium laser ablation (HoLAP) and 241 photoselective vaporization (PVP). Mean operative time was shorter in TURP (71 min) and longer in HoLEP (127). Although no transfusions were required in cases undergoing HoLAP or PVP, blood was frequently transfused in those undergoing TURis (25.6%), TURP (10.2%) and HoLEP (7.8%), and the difference was significant. During the hospital stay, the incidence of TUR‐syndrome, postoperative bleeding requiring bladder irrigation, acute urinary retention/difficulty on micturition and pad use at discharge was highest in TURP (2.3%), TURis (7.9%), HoLAP (16.7%) and HoLEP (15.1%), respectively. Two patients undergoing TURP died (0.05%). The shortest mean postoperative hospital stay was for PVP (1.6 days, even if the readmission rate within 90 days was the highest in this same group; 6.2%). Perioperative care during hospital stay varied among the five types of procedures. Conclusions: This survey provides useful documentation on the current status of minimally invasive treatments for BPH in Japan. Complication rates for TURP are not significantly higher as compared with other procedures. Thus, TURP can still be considered as the gold standard for BPH treatment.     

Peri-operative morbidity and changes in symptom scores after transurethral prostatectomy in Switzerland: results of an independent assessment of outcome

OBJECTIVES: To assess, in a prospective study, the contemporary outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) in Switzerland, by evaluating peri-operative morbidity and changes in lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Between January 2000 and January 2005, 11 hospitals in Switzerland participated in the study. The hospitals were required to inform Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss healthcare system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTS: Data on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively (P < 0.001). CONCLUSIONS: The results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.     

Transurethral microwave thermotherapy vs transurethral resection for treating benign prostatic hyperplasia: a systematic review

OBJECTIVE: To conduct a systematic review of randomized controlled trials evaluating the efficacy and safety of transurethral microwave thermotherapy (TUMT) compared with transurethral resection of the prostate (TURP) in treating men with symptomatic benign prostatic hyperplasia (BPH). METHODS: We searched Medline, the Cochrane Library and reference lists of retrieved studies to identify randomized trials of >/= 6 months duration with >/= 10 patients in each treatment arm. Data were extracted on study design, patient and treatment characteristics, urinary symptoms, urinary flow, adverse events and repeat treatment for BPH. RESULTS: Six studies were evaluated, involving 540 patients. The mean age (67.8 years), baseline symptom score (19.5), and peak urinary flow (PUF, 8.6 mL/s) did not differ by treatment group. The pooled mean urinary symptom score decreased by 65% with TUMT and 77% with TURP. The weighted mean (95% confidence interval) difference for the symptom score at the follow-up was -1.83 (-3.09 to -0.58) points, favouring TURP. The pooled mean PUF increased by 70% with TUMT and 119% with TURP. The weighted mean difference for the PUF at the follow-up was 5.37 (4.22-6.51) mL/s, favouring TURP. Retrograde ejaculation (57.6% vs 22.2%), transfusions (5.7% vs 0%) and re-treatment for strictures (relative hazard 9.76) were all significantly more common after TURP, but re-treatment for BPH was significantly more common after TUMT (relative hazard 10.0). CONCLUSIONS: TUMT techniques are effective and safe short-term alternatives to TURP for treating BPH. However, TURP provided greater symptom and urinary flow improvements and fewer subsequent BPH treatments than TUMT.     

Is the short‐term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction,status of detrusor contractility or detrusor overactivity?

AIM: The aim of this study was to investigate whether the preoperative degree of bladder outlet obstruction (BOO), detrusor underactivity (DUA) or detrusor overactivity (DO) affected the short-term outcome of transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). METHODS: Ninety-two patients with LUTS/BPH aged 50 years or older who were considered to be appropriate candidates for TURP were included in this study. Pressure-flow study and filling cystometry were performed to determine BOO, DUA and DO before TURP. The efficacy of TURP was determined at 3 months after surgery using the efficacy criteria for treatment of BPH assessed by the International Prostate Symptom Score, QOL index, maximum flow rate and postvoid residual urine volume. RESULTS: On preoperative urodynamics, 60%, 40% and 48% of patients showed BOO, DUA and DO, respectively. After TURP, 76% showed 'excellent' or 'good' overall efficacy, whereas only 13% fell into the 'poor/worse' category. The efficacy was higher as the preoperative degree of BOO worsened. In contrast, neither DO nor DUA influenced the outcome of TURP. However, the surgery likely provided unfavorable efficacy for patients having DO but not BOO. Only 20% of the patients who had both DO and DUA but did not have BOO achieved efficacy. CONCLUSIONS: Transurethral resection of the prostate is an effective surgical procedure for treatment of LUTS/BPH, especially for patients with BOO. DUA may not be a contraindication for TURP. The surgical indication should be circumspect for patients who do not have BOO but have DO.     

前列腺增生症再手术原因分析

目的：探讨前列腺增生症（ＢＰＨ）再手术的原因。方法：回顾分析２６例ＢＰＨ术后再入院手术患者的临床资料,再手术原因为膀胱颈挛缩１３例、腺体残留复发１０例、前列腺癌３例。结果：对膀胱颈挛缩及腺体残留复发者均施行开放手术或经尿道电切治疗,术后尿路梗阻症状解除。３例前列腺癌就诊已属晚期,施行去势术加氟他胺治疗,术后分别于１０～２８个月因全身广泛转移导致衰竭而死亡。结论：ＢＰＨ开放手术后膀胱颈挛缩,ＴＵＲＰ     

Visual Laser Ablation of the Prostate and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

For the past 50 years, transurethral resection of the prostate (TURP) has been the most common treatment for benign prostatic hyperplasia (BPH). The authors have conducted visual laser ablation of the prostate (VLAP) for BPH as a minimum invasive surgery. The results were compared with those of VLAP, VLAP+transurethral incision of the prostate (TUIP), and TURP as other treatments for BPH. In the VLAP group, 50 of 52 (96.2%), 36 of 40 (90.0%) and 31 of 36 (86.1%) were categorized as having more than a Fair Response (FR) at 3, 6 and 12 months, postoperatively. In the VLAP+TUIP group, 24 of 29 (82.8%), 19 of 22 (86.4%) and 9 of 11 (81.8%) were classed as having more than a FR at 3, 6 and 1 2 months, postoperatively. Forty–one of 42 (97.6%), 1 7 of 1 7 (100.0%) and 6 of 6 (100.0%) patients reaction to TURP was more than FR in overall response at 3, 6 and 12 months, postoperatively. The need for a blood transfusion, perforation of the prostate capsule and transit incontinence persisting for more than 1 month occurred in 1 of 45 (2.2%), 1 (2.2%) and 4 (8.9%) patients in the TURP group. Bladder neck contracture was seen in 4 of 52 (7.7%) in the VLAP group. Average postoperative catheter duration was shorter in the VLAP+TUIP (5.7 ± 8.4 days) than in the VLAP group (10.3 ± 10.4 days). Although TURP remains the standard treatment for BPH, VLAP results in less morbidity compared to TURP. VLAP with TUIP appears to lessen the risk of postoperative urinary retention and provide better results in longer follow–up studies.     

经尿道前列腺电切、气化术治疗前列腺增生症398例临床分析

目的:探讨经尿道前列腺电切(TURP)及经尿道前列腺气化(TUVP)治疗前列腺增生症的临床疗效。方法:回顾分析1987～1997年182例TURP及1998年～2002年216例TUVP临床资料。结果:疗效满意。TURP组182例,平均手术时间55min±5.7min,并发症发生率4.4％(8/182)。TUVP组216例,平均手术时间43min±4.9min,并发症发生率3.2％(7/216)。结论:TURP和TUVP近年来已成为治疗良性前列腺增生的金标准,具有手术时间短、出血少、创伤小、恢复快等优点,可作为治疗前列腺增生症的首选方法。     

Long-term results of contact laser versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia with small or moderately enlarged prostates

OBJECTIVE: To evaluate the long-term results of contact laser vaporization (CLV) of the prostate and transurethral resection of the prostate (TURP) in patients with symptomatic bladder outflow obstruction (BOO) caused by benign prostatic hyperplasia (BPH) with prostates smaller than 40 ml. MATERIAL AND METHODS: A total of 52 patients with lower urinary tract symptoms (LUTS) and urodynamically confirmed BOO caused by BPH with glands smaller than 40 ml were treated by means of CLV or TURP in a randomized trial. Changes in symptom score, urodynamics and prostate volume were evaluated during a 4-year follow-up period. RESULTS: A total of 42 (81%) of the patients were available for review at 4 years. The re-operation rate was 1/26 for each treatment. A sustained improvement in median Danish Prostate Symptom Score was seen in the laser group from 18 (range 5-54) to 5 (0-34) and in the TURP group from 18 (4-46) to 4 (0-18) (p<0.001 for both). A sustained improvement in maximum urinary flow rate was also seen in the laser group from 8.3 (4.8-19.6) ml/s to 14.3 (10.1-33.6) ml/s (p<0.001) and in the TURP group from 8.6 (5.0-15.9) ml/s to 16.1 (7.7-39.6) ml/s (p<0.01), without differences between the study groups. Median detrusor pressure at maximum urinary flow rate decreased significantly after both treatments, in the CLV group from 64 (32-112) cmH2O to 38 (18-65) cmH2O and in the TURP group from 57 (40-137) cmH2O to 28 (9-44) cmH2O (p<0.001 for both), and at 48 months was significantly higher in the laser group (p<0.01). At 4 years, 7/22 (32%) of the laser patients and 2/20 (10%) of the TURP patients were urodynamically obstructed. Post-void residual at 48 months was significantly lower in the TURP group than in the CLV group. Median prostate volume was smaller after TURP at 6 and 48 months (p<0.05). CONCLUSIONS: Long-term data of CLV and TURP treatments for BPH with small or moderately enlarged prostates indicate no significant difference in the relief of symptoms or in the rate of re-operations. However, the number of patients in this study was small and consequently the power to detect differences between the study groups was low. Regarding most objective outcome parameters, long-term follow-up revealed a slight advantage of TURP over CLV.     

Clinical relevance of transurethral resection of the prostate in "asymptomatic" patients with an elevated prostate-specific antigen level

OBJECTIVES: To determine the clinical relevance of transurethral resection of the prostate (TURP) in patients with minor lower urinary tract symptoms (LUTS) but elevated prostate-specific antigen (PSA) levels. METHODS: We retrospectively included 82 patients, aged 50.2-78.2 yr, with minor LUTS, elevated PSA (> or =4 ng/ml), and no signs of prostate cancer (PCa) after (multiple) negative multisite biopsies who underwent TURP after they were diagnosed by urodynamics with bladder outlet obstruction (BOO). We evaluated the clinical benefit of TURP by assessing its effect on International Prostate Symptom Score (IPSS) and PSA and the diagnostic value of histologic examination of the resected tissue for the presence of PCa. RESULTS: After TURP, histologic analysis of the resected specimen revealed that eight patients (9.8%) had PCa; seven of these patients had a tumour that needed further treatment. The remaining 74 patients (90.2%) were diagnosed with BOO due to benign prostatic hyperplasia/benign prostatic enlargement (BPH/BPE). In this group, the mean PSA level decreased from 8.8 ng/ml before TURP to 1.1 ng/ml in the first year and 1.3 ng/ml in the second year after TURP; the mean IPSS decreased from 8.8 to 1.5 in the first year after TURP. CONCLUSIONS: The current data suggest that patients with minor LUTS and elevated PSA without evidence of PCa are very likely to have BOO due to BPH/BPE and may benefit from TURP if obstruction is proved. However, a prospective trial is warranted to assess the impact of these results on clinical practice.