经尿道前列腺电切术后发生膀胱颈挛缩的多因素分析

目的 对经尿道电切术(TURP)后发生膀胱颈挛缩(BNC)的可能因素进行分析,探讨减少和预防该并发症的方法.方法 对1120例行TURP的患者中31例发生BNC的数据进行统计学分析,在前列腺体积、手术熟练程度、置尿管时间及有无术前尿潴留、前列腺炎、糖尿病等方面进行比较,了解其可能发生的因素.结果 BNC在小前列腺、单位电切时间长及合并前列腺炎的患者中发生率高(P＜0.05),而术前尿潴留、糖尿病对BNC发生无明显影响(P＞0.05).结论 前列腺体积小(＜30ml)、电流损伤及前列腺炎是发生BNC的重要因素.     

经尿道前列腺电切术后发生膀胱颈挛缩的条件logistic回归分析

目的对经尿道前列腺电切术(TURP)后发生膀胱颈挛缩(BNC)的各种因素进行多元回归分析,探寻主要影响因素。方法对2009年1月至2013年4月在我院泌尿外科接受TURP术治疗的前列腺增生患者812例进行随访,发现TURP术后的BNC患者,并选择同期内在我院泌尿外科行TURP术,术后1年内未出现BNC的患者进行配对,进行条件logistic回归分析。结果术前前列腺重量、单位时间切除重量、电凝切开深度这3个因素进入到多元回归方程,OR值分别为2.519、3.374、1.420。结论术前前列腺重量、单位时间切除重量、电凝切开深度是影响TURP术后BNC发生的主要因素,临床中应重视这些风险因素的参考价值,提高术者的手术操作技巧、术后对患者密切随访和及时处理是降低这种并发症的有效措施。     

TURP术后膀胱颈挛缩的原因分析及预防

目的对经尿道前列腺电切术（transurethral resection of prostate，TURP）后发生膀胱颈挛缩（bladder neck contracture，BNC）的原因进行分析，提出预防措施。方法将TURP术后发生BNC的28例与同期未发生BNC的60例患者进行比较。结果小前列腺、切除的前列腺重量轻、合并前列腺炎、单位时间内电切重量小者均易发生BNC（P〈0．05）。结论小前列腺、合并有前列腺炎及操作不熟练是BNC的可能原因，可采取严格手术适应证、提高操作技能、膀胱颈预切开等方法加以预防。     

经尿道前列腺电切术后膀胱颈挛缩的相关因素分析

目的探讨经尿道前列腺电切术(TURP)后膀胱颈挛缩(BNC)的相关因素。方法收集2012年1月至2020年12月于徐州医科大学附属医院泌尿外科行TURP治疗的良性前列腺增生(BPH)患者的临床资料。根据患者术后是否发生膀胱颈口挛缩分为BNC组和非BNC组。运用Logistic回归模型进行单因素和多因素分析, 筛选TURP后BNC发生的独立危险因素。结果本研究共纳入451例BPH患者, 中位随访时间25.3(14.1～104.0)个月, 其中BNC组30例, 非BNC组421例。单因素和多因素Logistic回归分析结果表明, 前列腺体积≤50 ml[比值比(OR)=2.890, 95%可信区间(CI):1.176～7.104, P<0.05], 纤维蛋白原水平≤2.5 g/L(OR=2.246, 95%CI:1.016～4.965, P<0.05)和术后留置尿管时间≥7 d(OR=2.850, 95%CI:1.173～6.926, P<0.05)是TURP后BNC发生的独立危险因素。结论为减少TURP后BNC的发生, 术前应测定纤维蛋白原水平;对于小体积前列腺, 应严...     

经尿道前列腺电切术后尿道狭窄发生的危险因素

目的 探讨经尿道前列腺电切术(TURP)后尿道狭窄发生的危险因素。方法 对200例诊断为良性前列腺增生症病人行经尿道前列腺电切术后随访12月～18月,对可能影响术后尿道狭窄的因素以Lo-gistic回归模型做单因素分析以及用逐步回归法行多因素分析。结果 本组共155例患者获完整随访,其中12例术后出现尿道狭窄,发生率为7.74%。术前尿路感染、术后留置尿管时间长短、手术切除前列腺重量三因素与术后尿道狭窄相关,相对危险度分别为9.305、2.973和5.587,有统计学意义(P<0.05)。结论 术前尿路感染、术后尿管留置时间的长短、手术切除前列腺的重量依次是TURP术后出现尿道狭窄的主要危险因素。     

经尿道前列腺电切术后发生尿道狭窄及尿失禁的危险因素分析

目的:探讨预测经尿道前列腺电切术(TURP)后发生尿道狭窄及尿失禁的危险因素。方法:回顾性研究2018年10月至2022年10月收治的261例因良性前列腺增生(BPH)而接受TURP并具有至少6个月的完整术后随访数据的患者资料,按照术后是否存在尿道狭窄和尿失禁将患者分为尿道狭窄组(n=18)和非尿道狭窄组(n=243)、尿失禁组(n=12)和非尿失禁组(n=249),对比两组患者的年龄、病程、高血压、糖尿病、国际前列腺症状评分(IPSS)、前列腺体积、最大尿流率、术前是否尿潴留、总前列腺特异性抗原水平、术前是否留置尿管状态、术前是否合并尿道感染、手术时间、术后留置尿管时间、术后尿管牵引时间等,采用单因素和多因素Logistic回归性分析来筛选独立的预测因素。结果:TURP术后尿道狭窄和尿失禁发生率分别是6.9%和4.6%;多因素logistic回归分析发现,合并糖尿病(OR=9.526,95%CI:2.824～32.127,P<0.01),术前合并尿道感染(OR=6.500,95%CI:1.513～27.925,P=0.012),术后留置尿管时间(OR=2.063,95%CI:1...     

经尿道前列腺电切术对勃起功能影响的研究

目的:分析经尿道前列腺电切术(TURP)对勃起功能的影响程度及引起术后勃起功能障碍的各种 因素。方法:随访257例行TURP术患者,按年龄、前列腺切除重量、术前性功能状况、术后是否有低钠血症和术 中前列腺包膜是否穿破五个因素分别比较其作用下的术前术后性功能改变情况。并采用电切术切除犬前列腺组 织,观察其电切术后前列腺损伤深度及标志勃起神经功能的指标(一氧化氮活性),评估电切术对勃起神经损伤程 度的影响。结果:术中前列腺切除重量大小与术后是否有低钠血症发生对TURP术后勃起功能障碍的发生无明 显关系(P>0.05)。>65岁者与≤65岁者、术前性功能不完全者与术前性功能完全者、术中穿破前列腺包膜与 包膜完整者的三因素中,前者术后勃起功能障碍发生率均比后者高(P<0.05)。实验研究显示电切术损伤仅局 限于前列腺本身,最深仅为1.6mm。阴茎海绵体一氧化氮活性测定,术前术后差别无统计学意义。结论:年龄、 术前性功能状况、术中是否穿破前列腺包膜三因素对TURP术后勃起功能障碍影响明显。实验研究显示电切术 损伤仅局限于前列腺本身。经尿道前列腺电切术只要操作规范,手术本身并不引起术后勃起功能障碍。     

慢性前列腺炎患者前列腺电切术后下尿路症状及膀胱颈挛缩发生的临床研究

目的探讨比较良性前列腺增生(BPH)患者与BPH合并慢性前列腺炎(CP)患者经尿道前列腺电切术(TURP)后,下尿路症状(LUTS)的变化及膀胱颈挛缩(BNC)的发生情况。方法回顾性分析2015年1月至2016年6月我院行TURP术后病理证实为BPH的患者198例,分为A组:单纯BPH组(78例)和B组:BPH合并CP组(120例),比较两组术前和术后3个月IPSS评分以及术后6个月BNC发生情况。结果手术治疗后各组IPSS评分均较术前明显降低(P值均0.001)。术前A组与B组IPSS评分分别为(20.3±5.1)分和(26.9±4.3)分,术后两组IPSS评分分别为(5.6±2.2)分和(12.1±3.5)分,差异均具统计学意义(P0.05)。BPH合并CP组膀胱颈挛缩发生率显著高于单纯BPH组(6.67%vs 3.85%,P0.05)。结论 BPH合并CP患者TURP术前、术后的LUTS均高于单纯BPH患者,BPH合并CP是TURP术后膀胱颈挛缩发生的危险因素。     

前列腺钬激光剜除术与经尿道前列腺电切术的近期疗效比较

目的 :比较前列腺钬激光剜除术 (HoLEP)和经尿道前列腺电切术 (TURP)近期疗效。方法 :将前列腺增生 (BPH)患者随机分为两组 ,分别行HoLEP和TURP ,监测、记录两组患者围手术期和术后 6个月复查指标 ,将所测指标进行统计学分析。结果 :术前两组一般情况比较差异无统计学意义 (P >0 .0 5 ) ;术后 6个月 ,两组国际前列腺症状评分、生活质量评分、最大尿流率均比术前得到明显改善 (P <0 .0 1) ;术中输血量、电切综合征发生率、术后平均膀胱冲洗时间、置管时间和住院时间 ,HoLEP组明显小于TURP组 (P <0 .0 1)。结论 :HoLEP治疗BPH具有与TURP相似的近期疗效 ;术中并发症发生率及患者术后恢复时间明显少于TURP ,是目前BPH激光疗法中最有望替代TURP的一种新方法。     

高频能量发生器前列腺电切术治疗良性前列腺增生

目的:探讨高频能量发生器(HFG)前列腺电切术治疗良性前列腺增生(BPH)的临床应用。方法:72例BPH患者根据术式分为2组,36例行HFG前列腺电切术,冲洗液为0.9%生理盐水;36例行经尿道前列腺电切术(TURP),冲洗液为5%葡萄糖溶液。统计每例患者术前术后血红蛋白(Hb),中心静脉压(CVP)的变化及手术时间。术后随访2周、6个月,观察国际前列腺症状评分(IPSS)、最大尿流率(Qmax)和前列腺体积的变化。结果:两组之间CVP、手术时间、术后2周IPSS和Qmax的差异有统计学意义(P0.05)。不同治疗组治疗前后Hb变化、IPSS变化和Qmax变化的差异有统计学意义(P0.05)。结论:HFG前列腺电切术操作简便,其更高的切割效率,使术中基本无出血,采用等渗生理盐水为灌洗液,杜绝了电切综合症(TURS)的发生。HFG前列腺电切术是TURP的改良升级,对于快速解除膀胱出口梗阻、治疗BPH患者安全有效。     

经尿道前列腺电切术后膀胱颈挛缩17例诊治分析

目的探讨经尿道前列腺电切术(TURP)后膀胱颈挛缩的手术方法和预防措施。方法对17例膀胱颈挛缩患者临床资料进行回顾性分析。结果经尿道行残留前列腺组织电切术或先用冷刀切开颈部后换用电切刀切除瘢痕组织,术后3个月随访,17例患者症状均改善或消失。结论经尿道腔内治疗TURP术后膀胱颈挛缩是一种安全有效的方法。     

180-W GreenLight laser photoselective vaporization with multiple triamcinolone acetonide injections for the treatment of bladder neck contractures

Lasers in Medical Science - Bladder neck contracture (BNC), one of the most challenging complications after transurethral resection of the prostate (TURP) and photoselective vaporization of the...     

经尿道前列腺电切术后膀胱颈挛缩的防治

目的探讨腔内治疗经尿道前列腺电切术（TuRP）后膀胱颈挛缩（BNC）的疗效。方法回顾性分析TURP32例BNC患者,经尿道置入电切镜切除膀胱颈后唇组织,再用冷刀切开膀胱颈．然后再换用电切刀彻底切除疤痕组织。结果32例患者术后症状明显改善,最大尿流率16．2±4．0ml／s和平均尿流率6．8±2．0ml／s均高于术前（P〈0．05）。术后平均随访28个月,一次性手术治愈28例,复发4例,经再次或三次手术治愈。结论经尿道腔内手术治疗TURP术后BNC是一种安全,疗效确切的微创手术方法。     

Plasmakinetic prostate resection in the treatment of benign prostate hyperplasia: Results of 1-year follow up

AIM: In our randomized prospective study, we aimed to evaluate the efficiency of plasmakinetic resection of prostate (PKRP) by comparing the preoperative and postoperative results of the transurethral resection of prostate (TURP) and PKRP techniques which we administered in patients with benign prostate hyperplasia (BPH) in our clinic. METHODS: Of 57 patients for whom we thought an operative intervention was necessary, 30 cases in the first group had a TURP and 24 cases in the second group had a PKRP. International prostate symptom scores (I-PSS), uroflowmetry, measurement of residual urine amount and ultrasonography were performed for each patient both preoperatively and postoperatively (first month and first year). Operation times, urethral catheterization times, preoperative and postoperative Hb, Htc and serum Na values of the patients were compared and the complications of the groups were also compared. RESULTS: On first month and first year follow up between the groups, there was no significant statistical difference in I-PSS, maximum flow rate, average flow, residual urine and size of the prostate. The decrease in serum Na level was found to be significantly higher in the TURP group (P < 0.05). The operation times were not significantly different between the groups. While the postoperative catheterization time was 75.7 h in TURP group, it was found to be 42 h in PKRP group and it was clear that catheterization time was significantly shorter (P < 0001). CONCLUSION: It is obvious that PKRP is as efficient as TURP and it has a similar morbidity. In our opinion, PKRP makes a promising treatment for BPH with its advantages, such as early removal of postoperative urethral catheter, a shorter hospital stay and the absence of TUR syndrome risk.     

经尿道等离子前列腺电切术与普通电切治疗前列腺增生的疗效比较

目的：比较经尿道前列腺等离子电切术（TUPKRP）与经尿道前列腺电切术（TURP）治疗良性前列腺增生（BPH）的疗效指标,探讨两种术式的临床疗效。方法回顾性分析2011年1月～2013年6月在本院TUPKRP和TURP治疗的良性前列腺增生的病例资料96例,TUPKP组46例,TURP组50例。通过对两组手术所需时间长短、手术期间出血量大小、切除质量、术后膀胱清洗时间、手术并发症和手术前后3个月的前列腺症状评分、最大尿流率和生活质量进行评分。结果 TUPKRP组手术时间、术中出血量、术后冲洗时间和并发症的发生率明显低于TURP组,前列腺切除质量高于TURP组,差异具有统计学意义（P＜O.05）;术后3项指标I-PSS、Qmax、QOL都较手术前有明显改善,两者差别无统计学意义（P＞0.05）。结论TUPKRP与TURP治疗BPH的疗效相近,但TUPKRP平均手术时间短、术中出血量少、并发症发生率低,具有良好的应用前景。     

Trends in repeat prostatectomy after surgery for benign prostate disease: application of record linkage to healthcare outcomes

OBJECTIVE: To compare the risk of repeat prostatectomy for benign prostatic hyperplasia (BPH) in a population-based cohort of 19 598 men in Western Australia treated by transurethral resection of the prostate (TURP) or open prostatectomy over a 16-year period. PATIENTS AND METHODS: The Western Australian Health Services Research Linked Database was used to extract all hospital morbidity data, death records and prostate cancer registrations for men who had prostate surgery for BPH in 1980-95. The cumulative incidence of first repeat prostatectomy calculated using the actuarial life-table and incidence-rate ratios of the first repeat prostatectomy, comparing TURP and open prostatectomy, were obtained using Cox regression. RESULTS: The cases comprised 18 464 TURPs and 1134 open prostatectomies, from which there were 1095 subsequent repeat prostatectomies. After adjustment for calendar time, age and admission type, the incidence rate of the first repeat prostatectomy was up to 2.30 times higher (95% confidence interval, 1.62-3.27) after initial TURP than for initial open prostatectomy. The absolute risks at 8 years for TURP was 6.6%, and was 3.3% for open prostatectomy. CONCLUSION: The absolute risk of a repeat prostatectomy for TURP and open prostatectomy were consistent with the best reported international experience. There was evidence that the risk in 1990-95 had declined compared with earlier periods, despite a shift towards more closed procedures. The differential risks of repeat prostatectomy should be explained to patients and considered in the development of clinical guidelines, notwithstanding the advantages of TURP over open prostatectomy in terms of surgical morbidity and cost.     

Efficacy and morbidity of "channel" TURP.

Transurethral resection of the prostate (TURP) is necessary in a significant proportion of men with a diagnosis of carcinoma of the prostate. Often, "channel" TURP (resection of visually obstructing tissue without extension to the prostatic capsule in a patient with metastatic or locally advanced disease to improve voiding symptoms) is required. Although several theoretical concerns regarding the efficacy and morbidity of this procedure have been voiced, data to support these contentions are lacking. In a review of 41 patients undergoing channel TURP, all were able to void following the procedure. Two patients in whom the resection was carried through the external urinary sphincter, which had been invaded by tumor, were incontinent postoperatively. Two patients had mild stress incontinence. There were no perioperative deaths. These data suggest that incontinence is higher than expected with TURP for benign disease but that results may be acceptable to the patient with significant outlet obstructive symptoms.