高强度聚焦超声治疗前列腺增生症并糖尿病后尿动力学变化

[摘要] 目的 探讨高强度聚焦超声治疗前列腺增生症并糖尿病后尿动力学变化。方法 回顾性分析2011年6月至2012年2月高强度聚焦超声治疗前列腺增生症并糖尿病患者的临床资料,探讨其术后尿动力学的改变及其并发症的发生情况。结果 糖尿病组治疗后与治疗前比较,尿动力学明显改善,前列腺体积明显缩小,有统计学意义（P<0.05）。糖尿病组与非糖尿病组治疗后比较,后者尿动力学中FDV、PVR及Pmax改善更为明显,前列腺体积缩小更多,有统计学意义（P<0.05）。结论高强度聚焦超声治疗前列腺增生症并糖尿病安全有效,其尿动力学各项指标有明显的改善。     

高强度聚焦超声治疗高危前列腺增生症的临床疗效

目的 评价高强度聚焦超声（HIFU）治疗高危前列腺增生症的近期疗效及安全性。方法 选择高危前列腺增生症患者102例，超声定位实时监视下，从体外将高能量超声聚焦于增生的前列腺组织，应用FEP-BY02型高强度聚焦超声治疗机进行HIFU治疗，治疗后定期随访观察患者临床症状、体征及瘤体超声影像学变化。结果 102例患者治疗后近期总有效率为92.2%（显效＋有效＋部分有效），其中显效11例（10.8%），有效43例（42.2%），部分有效40例（39.2%），无效8例（7.8%）。结论 HIFU体外治疗可作为一种无手术创伤治疗高危前列腺增生症安全有效方法之一。     

经尿道等离子电切术治疗前列腺增生症(附36例报道)

目的探讨经尿道等离子电切术(PKRP)治疗前列腺增生症的临床效果。方法对36例接受PKRP的前列腺增生症患者进行分析,总结治疗效果和经验。结果 36例患者手术时间40～120min,未发生经尿道前列腺电切综合征(TURS)及包膜穿孔;术后留置尿管时间5～10天,30例患者获得随访,随访时间3个月,术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)较术前有明显改善(P<0.01)。结论经尿道前列腺等离子电切术是一种安全、有效的手术方法。     

经尿道前列腺汽化电切术围手术期的护理体会

目的总结前列腺增生症(BPH)经尿道前列腺汽化电切术(TUVP)围手术期的护理体会。方法对56例行TUVP患者实施术前心理疏导、术后严密观察病情变化,健康宣教等护理干预。结果本组56例患者手术均获成功,术后尿管拔出后无尿潴、排尿困、膀胱痉挛、出血、感染等发生。术后5~9 d均康复出院。结论规范实施TUVP围术期各项护理措施,可提高BPH的治疗效果,减少术后并发症,提高患者生活质量。     

经尿道等离子体双极电切术治疗前列腺增生症疗效观察

目的观察经尿道等离子体双极电切术治疗前列腺增生症的手术疗效。方法我院2008年1月～2010年1月应用经尿道等离子体双极电切术治疗前列腺增生症58例,比较术前、术后尿流动力学变化情况。结果 56例患者术中出血少,无TURS发生。术后随访6个月,RUV、Qmax、前列腺体积、IPSS均较术前明显改善（P〈0.05）。结论经尿道等离子体双极电切术治疗前列腺增生症取得了较好的治疗效果,术后并发症少,可明显改善患者的尿路功能,值得推广和应用。     

经尿道绿激光汽化术治疗复发性前列腺增生的临床观察

目的:总结80W绿激光汽化术治疗TURP术后复发性前列腺增生症的安全性及临床疗效。方法:应用经尿道绿激光汽化术治疗39例TURP术后复发前列腺增生患者,回顾性总结手术时间、治疗效果及并发症。结果:所有患者均一次成功完成手术。手术时间平均47min。所有患者未输血,未发生电解质紊乱。术后平均留置尿管时间(46.5±17.2)h。术后前列腺症状评分、生活质量评分、最大尿流率与术前比较明显改善。结论:经尿道绿激光汽化术治疗TURP术后复发前列腺增生症疗效确切、止血彻底,并发症少,可作为复发性前列腺增生症的理想的手术方法。     

经尿道前列腺汽化电切术66例护理体会

目的探讨经尿道汽化电切除术治疗前列腺增生症围术期的护理措施。方法对66例行经尿道汽化电切除术的前列腺增生症患者,术前加强心理护理、手术准备,术后严密观察,做好基础护理,加强管道护理、生活护理和健康指导。结果66例均手术成功,术后出血少、恢复快;术后随访6个月～3年,病人无尿道狭窄、尿失禁等并发症。结论经尿道前列腺部分电汽化切术是治疗前列腺增生症的有效措施,而提高护理效率是手术成功的保证。     

尿流动力学检查在经尿道前列腺电切术术前的应用

目的探讨尿流动力学检查在经尿道前列腺电切术（TURP）术前的应用,对提高术前诊断水平及对手术指征、手术方法、手术时机选择的价值。方法回顾分析186例前列腺增生症患者在TURP术前尿流动力学检查的临床资料。结果186例前列腺增生症患者经尿流动力学检查,140例有不同程度的膀胱出口梗阻,且与其他动力学异常同时存在;140例患者行TURP手术治疗,8例行膀胱造瘘术,38例行药物保守治疗。结论TURP术前尿流动力学检查可提供前列腺增生疗患者膀胱尿道功能状况,对治疗方案及手术时机的选择以及术后疗效评估提供量化参数。     

TURP治疗良性前列腺增生的临床分析(附912例报告)

目的总结经尿道前列腺电切术(TURP)治疗良性前列腺增生症的疗效、安全性及围手术期处理的经验。方法回顾性分析我院近11年来应用TURP治疗的912例良性前列腺增生症患者的临床资料。结果平均手术时间73min(30～115min);58例术后发生低钠血症,其中52例为初期手术病例,5例术后出血膀胱填塞行开放手术治疗,均为初期手术病例。术后输血19例,术后5～7d拔除尿管。无死亡病例,无真性尿失禁。结论TURP是治疗良性前列腺增生症的理想选择。     

经直肠高强度聚焦超声(HIFU)治疗良性前列腺增生的临床研究

目的探讨经直肠高强度聚焦超声（high-intensity focused ultrasound，HIFU）治疗良性前列腺增生（BPH）的有效性和安全性。方法对150例BPH患者采用Sonablate 500型“经直肠超声聚能刀”进行前列腺消融术。在术前、术后30min，1、2、6和12个月，经直肠超声观察前列腺和前列腺部尿道的影像学变化，通过尿液分析、国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）和残余尿量（PVR）进行疗效评估，同时观察术后并发症。23例术后12个月行排尿期膀胱尿道造影。结果对143例进行了12个月的观察随访，术后IPSS评分和QOL评分降低，PVR减少，Qmax明显提高（P〈0．01），前列腺体积缩小（P〈0．05）。前列腺消融时间25—90min。术后留置尿管时间为3—19d，7例术后反复排尿困难、药物治疗效果不佳者行TURP手术，3例患者出现附睾炎，1例术后15d发生尿道直肠瘘。术后经直肠超声观察和膀胱尿道造影，证实术后前列腺部尿道较术前明显增宽。结论“经直肠超声聚能刀”前列腺消融术，能对前列腺组织进行选择性破坏，具有微创（无血手术）、安全和并发症少等优点。对前列腺中叶增生明显者可联合TURP治疗。“经直肠超声聚能刀”治疗BPH近期疗效满意，远期疗效有待进一步观察。     

TREATMENT OF BENIGN PROSTATIC HYPERPLASIA WITH HIGH INTENSITY FOCUSED ULTRASOUND: AN INITIAL CLINICAL TRIAL IN JAPAN WITH MAGNETIC RESONANCE IMAGING OF THE TREATED AREA

Background
High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point and is expected to induce tissue thermal ablation. Transrectal HIFU was applied to symptomatic benign prostatic hyperplasia (BPH) for relief of intravesical obstruction without injury to surrounding tissue. The clinical effectiveness and safety of transrectal HlFU were investigated. Methods: Thirty-seven Japanese men with symptomatic BPH were treated with HIFU. The treatment was minimally invasive; operating time was less than 40 minutes, and a post treatment indwelling catheter was left in place for 3–4 days.
Results:
me maximum urinary flow rate (ml. per second) increased from 7.6 ± 0.6 to 9.3 ± 0.6 at three months in 37 patients ( P < c 0.05). During the same period the International Prostatic Symptom Soore and Quality of Life score (points) decreased from 23.6 ± 1.4 to 10.5 ± 0. 5.2 ± 0.3 to 2.6 ± 0.1 ( P < 0.001), respectively. Overall response estimated by these three individual parameters were as follows; excellent 18.9 %, good 48.6 %, fair 70.8% and poor 21.6% at three months. Magnetic resonance imaging using an endorectal coil showed coagulative necrosis defined in the therapy zone at one month after treatment. Side effects were transient urinary retention in six patients (16.2%), gross hematuria in four patients (10.8%) and hematospermia in four patients (10.8%). There was almost no intraoperative blood loss.
Conclusions:
Transrectal HIFU treatment of symptomatic BPH is safe, reduces symptoms significantly. and leads to a slight increase in uroflow.     

经直肠高能聚焦超声与经尿道前列腺切除术治疗前列腺增生症近期疗效比较

目的研究经尿道前列腺切除术(TURP)与经直肠高强度聚焦超声系统(HIFU)治疗前列腺增生症(BPH)的临床疗效。方法对80例BPH手术患者随机分为2组,每组40例,分别行TURP、HIFU前列腺消融术治疗,回顾分析并比较各组术后一般情况及并发症等。复查IPSS、QOLS、PV、Qmas、RUV等疗效指标,对所测指标进行统计学分析。结果两组病人术前一般情况比较差别无显著性(P>0.05)。HIFU组在术后相关指标及并发症发生率与TURP组有显著差异(P<0.05),HIFU组的并发症发生率明显低于TURP组。各组术后主、客观症状均较术前明显改善,比较有显著性差异(P<0.05)。HIFU组在术后3个月主、客观指标比较中与TURP组有显著差异(P<0.05),但在术后1年时HIFU组、TURP组各主、客观指标比较差别无显著性(P>0.05)。结论HIFU前列腺消融术与TURP近期疗效相当,但它在治疗BPH患者中,较TURP更安全,更具微创,术中无出血,手术时间、住院时间短,并发症少等优点。     

Long-term outcome of transrectal high- intensity focused ultrasound therapy for benign prostatic hyperplasia

OBJECTIVE: The aim of this study was to determine the long-term outcome after transrectal high-intensity focused ultrasound (HIFU) therapy for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS: Between June 1992 and March 1995, 98 men (mean age: 66 years) with LUTS due to BPH underwent transrectal HIFU therapy at our institution, and the data of 80 patients were included in this long-term analysis. Principal inclusion criteria were a peak flow rate (Qmax) < or =15 ml/s, AUA/IPSS score > or =18 and a prostate volume < or =75 ml. Postoperatively, patients were seen at 6-month intervals with assessment of symptom score, uroflowmetry and post-void residual volume. In the present analysis, follow-up was terminated at 4 years. The mean follow-up of the study population (excluding the patients who underwent transurethral resection of the prostate, TURP, due to insufficient therapeutic response) was 41.3 months (range: 13-48 months). RESULTS: In treatment responders (HIFU only; n = 45), the symptom score decreased from preoperatively 19.6 to 8.5 (-53%) after 12 months and subsequently showed only marginal fluctuations within the 4-year study period. The Qmax increased from preoperatively 9.1 to 11.8 ml/s (+30%) after 12 months and gradually declined to 10.2 ml/s (+12%) after 4 years. 35 men (43.8%) underwent TURP due to insufficient therapeutic response during the 4-year study period. The mean time interval between HIFU therapy and TURP was 26.5+/-2.7 months (range: 1-48 months). The retreatment-free period was significantly longer for patients with a pretreatment average flow rate >5 ml/s (p = 0.05) and lower grades of urodynamically documented bladder outflow obstruction (p = 0.03). A similar trend, which did not reach statistical significance, was noted for individuals with higher Qmax and lower post-void residuals. CONCLUSIONS: These long-time data indicate that transrectal HIFU therapy for BPH, at least in its present form, did not stand the test of time, as 43.8% of patients had to undergo TURP within 4 years after initial therapy. These data underline the need for long-term studies with follow-ups over several years to reliably assess the role of less invasive treatment options for BPH.     

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.     

Newly Developed Equipment and Methods in the Treatment of BPH: Analysis of Present Status

Benign prostatic hyperplasia (BPH) is the most common disease among the aged male population. A variety of symptoms are mainly caused by obstructive changes at the prostatic urethra. Transurethral resection (TURP) has been the gold standard of treatment, but new equipment and methods such as TUMT, HIFU, TUNA, and laser prostatectomy have been developed and are being tested for clinical application. Our experience with new equipment and methods show that their effectiveness has yet to be conclusively evaluated by objective parameters, while subjective improvements have been seen with less invasive treatments such as TUMT, HIFU and TUNA. Laser prostatectomy confirmed its advantages in hemostasis but comparison of each treatment is difficult because of different pathological changes created by different energy sources shown by MRI. Further studies are required to examine the new equipment and methods and for identification of the treatment of choice for BPH.     

Indications, techniques and outcomes of high-intensity focused ultrasound (HIFU) for the treatment of localized prostate cancer

High-intensity focused ultrasound (HIFU) is a minimally invasive alternative for patients with localized prostate cancer, not suitable for radical prostatectomy because of a life expectancy less than 10 years or because of major co-morbidities precluding surgery. HIFU can be performed in patients with LUTS (associated TURP) or with a previous history of BPH surgery. HIFU is repeatable after the initial procedure if a recurrent cancer is diagnosed on control biopsies. Furthermore, this therapy is a viable option for patients with a local relapse after external beam radiation therapy: oncologic efficacy is conversely related to the initial prostate cancer stage before radiation therapy.     

良性前列腺增生合并糖尿病的围手术期护理体会

目的 :探讨良性前列腺增生 (BPH)合并糖尿病病人的围手术期护理方法 ,减少手术并发症 ,提高手术安全性。　方法 :回顾我院 1 2 6例BPH合并糖尿病病人围手术期的护理及治疗。　结果 :1 2 2例病人获得满意的护理疗效 ,其残余尿量及尿流率得到明显改善 ,无护理并发症。　结论 :BPH合并糖尿病病人围手术期的护理是手术成功的基础、术后疗效满意的后盾     

HIGH INTENSITY FOCUSED ULTRASOUND FOR BENIGN PROSTATIC HYPERPLASIA

Background:
Transurethral resection of the prostate (TURP) has been the gold standard of treatment for patients with symptomatic benign prostatic hyperplasia (BPH). The present paper discusses the safety and effectiveness of transrectal high intensity focused ultrasound (HIFU) for treating patients with symptomatic BPH.
Methods:
HlFU was conducted on 28 patients with BPH. At one, three and six months after treatment, all patients were examined for parameters including International Prostate Symptom Scores (I-PSS), Quality of Life (QOL) inquiry, uroflowmetry, and transrectal ultrasound for determining prostate volume.
Results:
I-PSS and QOL showed statistically significant improvement at one, three, and six months postoperatively (P< 0.0001 -0. Wilcoxon signed-rank test). Ten of 28 (35.7 Oh), 13 of 28 (46.4%), and 6 of 15 (40.0%) cases were categorized as effective cases with HlFU treatment at one, three, and six months follow-up.
Conclusions:
Focused ultrasound is an exciting new technology by which tissue can be destroyed at a site distant from the source of energy without damage to surrounding tissue. Clinical experience with alternative power settings, more accurate spacing of treatment lesions, and further development of HlFU machines may improve the results. Longer follow-up of patients with further clinipl evaluation of HlFU is necessary to define the efficacy of this technique.     

舒适护理在良性前列腺增生治疗中的应用价值

目的 探讨舒适护理配合经尿道前列腺等离子双极电切术治疗良性前列腺增生(benign protastic hyperplasia,BPH)的临床疗效.方法 回顾性分析2015年3月至2016年3月收入本院治疗的BPH患者64例,按护理方法分为观察组和对照组,观察组34例,对照组30例.两组均采用经尿道前列腺等离子双极电切术(transurethral plasmakinetic prostatetomy,TUPKP)进行手术治疗,对照组住院期间采用传统的常规护理,观察组同时采用常规护理和舒适护理.对比两组IPSS评分、QOL评分、SAS评分、护理满意度以及术后并发症情况.结果 两组患者治疗后症状均明显好转,术后IPSS评分和QOL评分较术前明显降低,出院SAS评分较入院SAS评分明显降低(P<0.0001).观察组出院SAS评分(47.7±4.8)明显优于对照组(57.4±4.5,P<0.05).观察组护理满意度(94.12%)明显优于对照组(66.67%,P<0.05).观察组并发症总发生率(8.82%)低于对照组(26.67%,P>0.05).结论 舒适护理模式配合TUPKP治疗BPH具有良好的临床效果,值得推广和应用.