Randomized trial of safety and efficacy of transurethral resection of the prostate using contact laser versus electrocautery

The aim of this study was to prospectively evaluate the safety and efficacy of contact laser ablation of the prostate (CLAP) vs. transurethral resection of the prostate (TURP) in symptomatic benign prostatic hypertrophy (BPH). During a 1-year period (1995-1996), 37 males 50 years of age or older were randomized to either CLAP using Nd:YAG laser treatment or TURP. Patients with Qmax <15 mL/s, American Urological Association (AUA) symptom score >12, and postvoid residual (PVR) >125 mL were enrolled. Patients were excluded if they had prior surgical treatment for BPH or known conditions that could affect bladder function. Comparisons of preoperative and postoperative symptom scores, Qmax, PVR, total catheter time, hospital stay, complications, and hematocrit changes were performed. A 2:1 randomization was used, which resulted in 26 CLAP and 12 TURP patients. One-year follow-up data were available for 21 CLAP and 7 TURP patients. The mean prostate volume, age, AUA symptom score, and Qmax were not significantly different between the two arms. Significant differences in favor of CLAP were shorter catheter time (27.2 vs. 40.4 hours; p < .05) and shorter hospital stays (28.5 vs. 60.0 hours; p < .05). The only other significant difference between the two arms was a lower AUA symptom score in favor of TURP at 1 year (4.7 vs. 8.4; p < .05). Qmax, PVR, and postoperative hematocrit were similar between the groups. The only complications included recatheterizations, which occurred more frequently in the TURP patients (25% vs. 14%). CLAP appears to be slightly less effective in AUA symptom score reduction; however, it is equally safe and is superior for shortening catheter time and hospital stay compared to TURP.     

经尿道等离子双极前列腺切除术与前列腺电切术的疗效比较

目的比较经尿道等离子体双极电切术(PKRP)与经尿道前列腺汽化电切术(TURP)治疗良性前列腺增生症(BPH)的临床疗效。方法将300例有症状的前列腺增生症(BPH)患者随机分成两组,各150例,分别行PKRP和TURP术,记录患者围手术期和术后3个月复查的有关指标(手术时间、术中出血量、冲洗时间、留管时间、住院时间,国际前列腺症状评分(IPSS),尿流率峰值(Qmax)和生活质量评分(QOL)),并发症(TURS、术中输血、继发出血、尿失禁、膀胱痉挛、尿道狭窄)发生率,对两组数据进行统计学分析。结果 PKRP组出血量、冲洗时间、留管时间和住院时间少于TURP组,两组相比差异有显著性(P0.05),术后3个月,两组患者症状评分、生活质量分析、最大尿流率均比术前明显改善(P0.05),PKRP组并发症发生率为3.3%,低于TURP组的13.3%,两组比较差异有统计学意义(P0.05),所有并发症对症处理恢复正常,两组均无死亡病例。结论 PKRP与TURP均是治疗BPH的有效术式,但PKRP较TURP并发症少,安全性高,是治疗BPH较理想的微创术式。     

高海拔地区前列腺增生患者行等离子前列腺汽化电切术与经尿道前列腺电切术的比较

目的 比较高海拔地区前列腺增生（BPH）合并高原性疾病患者行经尿道双极等离子前列腺电切术（PKRP）与经尿道前列腺电切术（TURP）治疗效果.方法 对甘孜藏族自治州人民医院2008年6月至2012年3月156例前列腺增生合并高原性疾病患者（PKRP组78例,TURP组78例）进行回顾性研究,比较两组年龄、前列腺体积、病程、前列腺特异抗原（PSA）、手术时间、术中出血量、尿管留置时间、术后膀胱冲洗时间、住院天数、术后血钠浓度、术后并发症、术前及术后国际前列腺症状评分（IPSS）、残余尿（RUV）、最大尿流率（Qmax）、生活质量评分（QOL）等.结果 两组患者年龄、前列腺体积、病程、PSA、术前及术后IPSS评分、残余尿、最大尿流率、生活质量评分、手术时间、住院天数均无统计学差异（P＞0.05）.PKRP组术中出血量、留置尿管时间、术后膀胱冲洗时间、术后并发症发生率均低于TURP组,术后血钠浓度高于TURP组（P＜0.05）.结论 对于高原BPH患者这一特殊群体,TURP、PKRP治疗疗效相当,但对于手术安全性,手术并发症的控制,PKRP术较TURP术有较多优势,对该类患者应优先选择PKRP术.     

Interstitial laser coagulation combined with minimal transurethral resection of the prostate for the treatment of benign prostatic hyperplasia

BACKGROUND: Transurethral resection of the prostate (TURP) represents the gold standard in the surgical treatment of benign prostatic hyperplasia (BPH). However, this method still has significant morbidity mainly associated with irrigation fluid absorption and blood loss. PATIENTS AND METHODS: A combination of interstitial laser coagulation (ILC) with limited TURP was established to reduce specific risks of transurethral resection and was applied in 41 patients with bladder outlet obstruction caused by BPH. In these patients, a subtotal resection of the prostate was not possible because of anesthesiologic risk factors. After insertion of a suprapubic catheter, ILC was performed under visual control using an Nd:YAG laser followed by resection of the bladder neck or the median lobe. Isotonic carbohydrate solution with 1% ethanol was used for irrigation, and irrigation fluid uptake was quantified by measurements of the ethanol concentration in the patients' exhaled breath. Additional measures such as blood loss, need for blood transfusions, and operative time were evaluated. RESULTS: The operations were performed without major complications with a mean operative time of 35 +/- 11 minutes for the entire procedure. An irrigation fluid uptake of 9 +/- 32 mL and no TUR syndrome were observed. The mean blood loss was minimal with a change in the hemoglobin of -1.3 +/- 1.1 g/dL and no need for blood transfusions. CONCLUSION: These results demonstrate that ILC with subsequent minimal TURP is an applicable method in the surgical treatment of BPH with reduction of blood loss and of the risk of TUR syndrome. This procedure may help to reduce the morbidity of TURP, especially in high-risk patients.     

经尿道前列腺电切术及等离子电切术治疗重度BPH患者的疗效比较

目的:比较经尿道前列腺电切术(TURP)及等离子电切术(PKRP)治疗重度BPH(前列腺体积70ml)的疗效及并发症。方法:回顾性分析80例(TURP 34例,PKRP 46例)重度BPH患者的临床资料。比较两组病例的手术时间、切除的腺体组织重量、术中失血量、术中转开放手术例数、持续膀胱冲洗时间、留置尿管时间、术后1、3、6个月的主观症状(IPSS、QOL)、客观评分(PVRU、Qmax、PSA)及并发症等。结果:TURP组和PKRP组手术时间、术中失血量、持续膀胱冲洗时间及留置尿管时间比较,差异具有统计学意义(P0.05)。两组术中所切除的前列腺腺体组织重量和术中转开放手术例数比较,差异无统计学意义(P0.05)。两组术后发生二次出血的例数比较,差异具有统计学意义(P0.05)。两组术后发生暂时性尿失禁、泌尿系感染、尿道狭窄、膀胱颈挛缩和尿失禁的例数比较,差异无统计学意义(P0.05)。术后1、3、6个月随访,两组IPSS、QOL、PVRU、Qmax和PSA均较术前明显改善(P0.05),但组间比较差异均无统计学意义(P0.05)。结论:对于前列腺体积70ml的重度BPH患者,TURP和PKRP均有明显的临床效果,特别是PKRP更具有术中出血少、安全性高、并发症少等优点。     

Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g

OBJECTIVES: To compare the safety and efficacy of two alternatives for surgically treating symptomatic benign prostatic hyperplasia (BPH), i.e. transurethral vapour resection of the prostate (TUVRP) and holmium laser enucleation of the prostate (HOLEP), with transurethral resection of the prostate (TURP), the standard surgical therapy, as treating large prostates is associated with greater morbidity, and to date there is no simultaneous comparison of these three methods. PATIENTS AND METHODS: We prospectively randomized 150 patients (50 in each group) with BPH and glands of >40 g to undergo either TURP, TUVRP or HOLEP. The evaluation before treatment included urine culture, serum prostate specific antigen (PSA) level estimation, the International Prostate Symptom Score (IPSS), peak urinary flow rate (Q(max)), and transabdominal ultrasonography to estimate prostate size and postvoid urine residue (PVR). The operative duration, blood loss, resected tissue weight, change in levels of haemoglobin and serum sodium, nursing contact time, duration of catheterization, and complications were noted. After surgery patients were reassessed for the IPSS, Q(max) and PVR at 6 months and 1 year. RESULTS: The patients in all three groups had comparable characteristics before surgery. The mean operating duration and intraoperative irrigant used for TUVRP was less than for HOLEP or TURP, and blood loss with HOLEP and TUVRP was less than with TURP (all P < 0.001). Postoperative irrigation, nursing contact time, and catheter duration were significantly less for HOLEP than TURP or TUVRP, and for TUVRP than TURP. At follow-up, patients in all groups had a significant improvement from baseline in IPSS, Q(max,) and PVR, but the differences between the groups were not significant at 6 months or 1 year. CONCLUSIONS: HOLEP and TUVRP are both acceptable alternatives to TURP for treating large prostate glands, with less perioperative morbidity and comparable efficacy at 6 months and 1 year.     

三种经尿道前列腺切除术治疗良性前列腺增生的疗效比较

目的比较良性前列腺增生（BPH）的三种经尿道手术治疗效果。方法分别采用经尿道前列腺电切术（TURP）、经尿道双极等离子前列腺切除术（PKRP）和经尿道铥激光前列腺切除术（TmLRP）治疗BPH共137例。结果三种术式患者手术前后前列腺症状评分（IPSS）、生活质量评分（QOLs）、残余尿（RUV）、最大尿流率（Qmax）比较均得到显著改善（P〈0．01），疗效满意。前列腺重量（PW）〈40g时，TmLRP组手术时间明显短于PKRP和TURP组（P〈0．01）。PW〉50g时，TmLRP组手术时间明显长于PKRP和TURP组（P〈0．01）。TmLRP和PKRP组术中出血少，术后膀胱冲洗时间、留管时间及住院时间均短于TURP组（P〈0．01）。站论三种经尿道手术方法均是治疗BPH的有效手段，TmLRP和PKRP比TURP更安全，术中及术后并发症更少。     

Advantages of transurethral rotoresection versus standard transurethral resection in the management of benign hyperplasia of the prostate

BACKGROUND AND PURPOSE: The endourologic community is in search of safer and efficient alternatives to conventional transurethral resection of the prostate (TURP). This research compared the efficacy of two transurethral resection techniques - conventional loop and rotoresection - in the surgical management of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: From January 2000 through December 2001, we randomized 128 BPH patients aged 55 to 74 years (average 61.4 +/- 2.7 years), all complaining of symptoms for prostatism for 1 to 14 years (average 4.5 +/- 1.5 years), to either transurethral rotoresection (TURotor; N = 58) or TURP (N = 70). The mean ages in the two groups were 67.53 +/- 7.21 years and 62.93 +/- 6.43 years, respectively. The diagnosis of BPH was made on the basis of patient history, International Prostate Symptom Score (IPSS), digital rectal examination, transrectal ultrasonography, uroflowmetry, and serum prostate specific antigen (PSA) concentration. Three months after surgery, we again measured the residual urine volume, uroflow, IPSS, and prostate size by ultrasonography. RESULTS: The TURotor took 30.1 +/- 10.2 minutes with an intraoperative blood loss of 130 +/- 25 mL. During the immediate postoperative period, an insignificant amount of blood was visible in the urine and irrigation fluid. We removed the catheter at 1.8 +/- 0.69 days. At 3 months' follow-up, the maximum uroflow rate (Q(max)) had increased to 19.87 +/- 6.77 mL/sec, and the residual urine volume had fallen to 38.75 +/- 18.84 mL. The average TURP lasted 42.1 +/- 13.2 minutes, or almost 30% longer than TURotor. The intraoperative blood loss averaged 21050 mL. The catheter was removed in 2.2 +/- 0.78 days. At 3 months, the Q(max) was 20.78 +/- 6.56 mL/sec, and the average amount of residual urine had fallen to 35.48 +/- 8.71 mL. CONCLUSION: Rotoresection is a promising alternative to conventional TURP because it affords almost bloodless, 30% faster removal of prostate tissue.     

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.     

Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate

OBJECTIVE: Plasmakinetic vaporesection of the prostate (PKVP) using normal saline irrigation has the theoretical advantage of avoiding transurethral resection syndrome and minimizing blood loss. It may also shorten the operative time since tissue is resected instead of just vaporized. The aim of this study was to evaluate the efficiency, safety and advantages of PKVP compared with standard transurethral resection of the prostate (TURP) at a regional acute hospital. METHODS: A total of 60 consecutive men admitted from a waiting list for surgery for benign prostatic hyperplasia (BPH) were prospectively randomized to either PKVP or TURP. Peri- and postoperative outcome data at 3 months were obtained. RESULTS: The PKVP loop achieved a fast and sharp cutting action similar to that with the traditional TURP loop. Data analysis was based on 51 patients. There were no significant differences between the methods in resection time, postoperative catheterization time and hospital stay. The mean reductions in serum sodium 2 hours after PKVP and on postoperative day 1 were 0.52 mmol/L and 3.35 mmol/L, respectively, while mean reductions in haemoglobin were 0.36 g/dL and 0.24 g/dL, respectively. There was no significant difference in haemoglobin reductions between PKVP and TURP (p = 0.326 at 2 hours; p = 0.192 on day 1) and serum sodium (p = 0.757 at 2 hours; p = 0.888 on day 1). Both groups achieved comparable improvement in International Prostate Symptom Score (p = 0.862), quality-of-life score (p = 0.169) and peak flow rate (p = 0.96) at 3-month follow-up. CONCLUSION: PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting.     

经尿道等离子双极电切术与传统电切术治疗重度前列腺增生症的比较

目的比较经尿道等离子双极电切术(PKRP)与传统经尿道前列腺电切术(TURP TUVP)对重度前列腺增生症的治疗效果。方法采用PKRP术与TURP TUVP术治疗重度前列腺增生症各32例进行比较。结果两种方法的手术时间、术后IPSS减分率及尿流率改善差异无显著性(P>0.05);但与TURP TUVP术相比,PKRP术术中出血量更少,术中术后无低钠血症及水中毒发生,被膜损伤少而轻。结论PKRP术具有止血好、安全度大、对机体生理功能影响小、并发症少、易掌握等优点,在治疗重度前列腺增生症时更为突出。     

经尿道前列腺电切与双极等离子电切对前列腺电切术后尿道狭窄的影响

目的研究经尿道前列腺电切术（TURP）和双极等离子电切术（PKRP）治疗前列腺增生（BPH）与术后尿道狭窄的关系。方法对59例接受TURP患者,36例接受PKRP患者的临床资料进行回顾性研究,分析手术时间、术后冲洗时间、留置尿管时间、术后住院时间、术后6个月尿常规白细胞数等指标与相应的尿道狭窄发生率的关系。结果术前两组一般情况比较无统计学差异（P〉0.05）;手术时间、术后冲洗时间、留置尿管时间、术后住院时间、术后6个月尿常规白细胞数,PKRP组明显优于TURP组（P〈0.05）。术后6个月中,TURP组有10例发生尿道狭窄（16.9%）,而PKRP组则仅为1例（2.8%）（P〈0.05）。Logistic回归分析,TURP组术后留置尿管时间是影响尿道狭窄的主要危险因素,PKRP组各指标对尿道狭窄的发生无明显差异。结论 TURP术后留置尿管时间是导致尿道狭窄的主要因素。PKRP术后尿道狭窄发生率明显低于TURP,有良好的应用前景。     

经尿道等离子体双极前列腺电切术与经尿道前列腺电切术的疗效比较研究

目的:对比研究经尿道等离子体双极电切术(transurethral plasmakinetic resection of prostate,PKRP)及经尿道前列腺电切术(transurethral resection of prostate,TURP)的安全性与临床疗效。方法:纳入2010年3月至2012年9月78例有下尿路症状(lower urinary tract symptoms,LUTS)的良性前列腺增生(benign prostatic hyperplasia,BPH)患者,按1:1的比例随机分为两组,一组行PKRP(PKRP组),另一组行TURP(TURP组)。对比两组患者术前、术后(1个月、12个月)国际前列腺症状评分(international prostate symptom scores,IPSS)、最大尿流率(maximum flow-rate,Qmax)、生活质量(quality of life,QOL)、残余尿量(postvoid residual volume,PVR),围手术期基本情况,如手术时间、留置导尿管时间、膀胱冲洗量、住院时间;并发症发生率,如经尿道电切综合征(transurethral resection syndrome,TURS)、输血、尿潴留、尿道狭窄等。结果:两组患者手术时间、术中与术后冲洗液量、术后膀胱冲洗时间、包膜穿孔、尿道损伤、输血、尿潴留、二次手术、尿道狭窄发生率差异无统计学意义(P>0.05),PKRP组留置导尿管时间、住院时间明显少于TURP组。PKRP组无一例发生TURS,TURP组中6例患者发生TURS(P<0.05)。术后1个月、12个月两组患者IPSS、Qmax、QOL、PVR差异均无统计学意义,但两组患者IPSS评分均较术前显著下降,Qmax显著增高,PVR显著减少(P<0.05)。结论:PKRP与TURP具有相同的治疗效果,相较TURP,PKRP具有更短的留置导尿管时间、住院时间,发生TURS的风险更低;因此,PKRP是可供选择的前景良好的治疗BPH的微创术式。     

汽化电切镜下经尿道前列腺剜除术30例体会

目的:探讨电切镜下经尿道前列腺剜除术的手术方法和临床疗效。方法:回顾分析经尿道前列腺电切术中用腔内剜除法治疗30例良性前列腺增生症(benign prostatic hyperplasia,BPH)患者的临床资料。结果:30例均获痊愈,与前列腺汽化电切术相比手术时间、出血量、膀胱冲洗时间、留置尿管时间、并发症、术后最大尿流率差异均有统计学意义(P0.05)。结论:腔内剜除法是经尿道前列腺汽化电切术中切实可行的方法,尤适于重度增生患者,值得临床推广应用。     

Transurethral electrovaporization vs transurethral resection for symptomatic prostatic obstruction: a meta-analysis

OBJECTIVE: To compare the effectiveness and safety of transurethral electrovaporization (TUEVP) and transurethral resection of the prostate (TURP) for symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). METHODS: Publications comparing TUEVP and TURP were identified systematically using Medline, the Cochrane Controlled Trial Register and other database search engines. From a total of 25 randomized controlled trials, 20 studies met the predefined inclusion criteria and were subjected to a formal meta-analysis. Primary endpoints were symptom scores and peak urinary flow rates. Secondary endpoints included transfusion requirements, operative time, duration of catheterization, incidence of adverse events, hospital stay, re-operation rates and sexual dysfunction. RESULTS: After 1 year of follow-up there was no significant difference between TUEVP and TURP in urinary symptom scores and peak urinary flow rates. There was heterogeneity at baseline for both primary outcome measures. TUEVP was associated with significantly lower transfusion requirements, a shorter catheterization time, and a shorter length of stay. TURP was associated with a lower risk of urinary retention afterward and re-operation than was TUEVP. CONCLUSION: This formal meta-analysis suggests that both TUEVP and TURP in patients with symptomatic bladder outlet obstruction provide comparable improvements in maximum urinary flow rates and symptom scores. While comparative analysis is limited by the methodological shortcomings of the underlying studies and the short follow-up, both TURP and TUEVP may offer distinct advantages in terms of secondary outcomes. A future, well-designed, multicentre randomized clinical trial with extended follow-up may be needed to better define the role of vaporization techniques in treating patients with symptomatic BPH.     

经尿道前列腺汽化切割术与电切术的比较

目的 比较经尿道前列腺汽化切割术(TUVP)和经尿道前列腺电切术(TURP)对良性前列腺增生(BPH)的治疗效果。方法 有症状的BPH患者100例,分成TUVP组50例,TURP组50例。结果 TUVP组与TURP组术前与术后前列腺症状评分(IPSS)、最大尿流率(MFR)、剩余尿(PVR)比较有显著差异(P<0.01),两组间比较无显著性差异(P>0.05)。术后血红蛋白、血细胞比积和血钠两组比较有显著性差异(P<0.05)。手术时间和前列腺切除体质量两组比较无显著性差异(P>0.05)。TUVP组继发出血1例(2.0％),尿道外口狭窄1例(2.0％),阳痿4例(8.0％),尿路刺激症状7例(14.0％),无尿失禁及TRUS发生。TURP组继发出血2例(4.0％),尿道外口狭窄1例(2.0％),阳痿5例(10.0％),TRUS出现1例(2.0％)尿路刺激症状6例(12.0%),无尿失禁发生。结论 TUVP治疗效果确切,达到与TURP完全相同的效果,术中出血明显少于TURP,无TURS发生,是最具潜力的新技术。     

A randomized prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia

Objectives. To compare the safety and efficacy of laser ablation of the prostate, one of the minimally invasive treatments available for men with benign prostatic hyperplasia, to transurethral resection of the prostate (TURP).Methods. A prospective randomized study of 100 men with benign prostatic hyperplasia, with 50 patients in each treatment arm, was conducted. All patients met the entry criteria: age older than 45 years, no history of carcinoma of the prostate, a peak flow rate less than 15 mL/s, medical therapy failure, and the ability to undergo regional or general anesthesia. All patients underwent a preoperative evaluation consisting of the American Urological Association (AUA) symptom score, uroflowmetry, pressure-flow study, transrectal ultrasound for prostate volume, and serum prostate-specific antigen determination. Patients underwent either TURP or laser ablation of the prostate using the potassium titanyl phosphate (KTP)/neodymium:yttrium-aluminum-garnet laser. Patients were seen for follow-up at 1, 3, 6, and 12 months.Results. The mean age was 68.2 years (range 45 to 90) for the laser group and 67.4 years (range 54 to 82) for the TURP group. The mean AUA symptom score was 22 for the laser group and 21 for the TURP group. The mean peak uroflow rate was 7.6 ± 3.4 mL/s for the laser group and 6.5 ± 4.0 mL/s for the TURP group. At 12 months of follow-up, the mean AUA symptom score had decreased to 7 (−69.5%) for the laser group and to 3 (−80.9%) for the TURP group. The mean peak uroflow rate increased to 15.4 mL/s (+107.8%) for the laser group and to 16.7 mL/s (+150.7%) for the TURP cohort. Seventy-five percent of the laser group had a 50% or greater decrease in their individual AUA symptom score compared with 93% of the TURP group. Sixty-five percent of the laser cohort had a 50% or greater increase in their peak uroflow rate compared with 75% of the TURP cohort.Conclusions. Laser prostatectomy produced improvements in the peak flow rate and symptom score similar to those produced by TURP. The patients who underwent laser treatment required a longer period to reach maximum improvement, which probably reflects the lack of tissue debulking at the time of surgery. Further improvement in laser technology will be required to produce more immediate results.     

半导体激光选择性增生腺体块状切除术与电切术治疗前列腺增生的比较

目的比较1 470 nm激光选择性前列腺增生腺体块状切除术（LRP-SM）与经尿道前列腺电切术（TURP）治疗前列腺增生（BPH）的疗效和安全性。 方法回顾性分析2018年2月至2019年2月我科收治的98例BPH患者,52例行LRP-SM,46例行TURP。记录两组患者的手术时间、血红蛋白下降值、膀胱持续冲洗时间、留置导尿管时间、住院时间及术后并发症等。评估术前及术后3个月国际前列腺症状评分（IPSS）、生活质量评分（QOL）、残余尿量（PVR）、最大尿流率（Qmax）等。 结果LRP-SM组与TURP组的手术时间[（42.2±16.3）min vs（58.4±18.2）min]、术后血红蛋白下降值[（2.4±0.8）g/L vs （4.5±1.6）g/L]、膀胱持续冲洗时间[（1.5±0.2）d vs （2.4±0.3）d]、留置导尿管时间[（2.4±0.3）d vs （4.6±2.4）d]、住院时间[（5.3±1.1）dvs （7.6±1.4）d]比较差异均有统计学意义（P<0.05）;两组术后3个月IPSS、QOL、PVR及Qmax显著优于术前（P<0.05）,但两组间比较差异无统计学意义（P>0.05）。TURP组2例因术后出血予以输血治疗,LRP-SM组无输血病例。TURP组3例和LRP-SM组1例有不同程度短暂性尿失禁,随访术后1～3月恢复正常。TURP组术后有1例尿道狭窄或膀胱颈挛缩需要再次行手术治疗,LRP-SM组无尿道狭窄或膀胱颈挛缩病例。TURP组16例和LRP-SM组4例有逆行射精。LRP-SM组并发症较少,差异有统计学意义（P<0.05）。 结论LRP-SM和TURP治疗BPH效果相当,但与TURP比较,LRP-SM具有出血风险少、恢复快、并发症发生率较低等优势,特别适合高龄、高危以及对性功能有需求的患者。     

经尿道前列腺电切术术前停服阿司匹林的时间研究

目的探讨服用阿司匹林的前列腺增生患者在进行经尿道前列腺电除术（TURP）前停用阿司匹林的时间选择。 方法回顾性分析首都医科大学附属北京安贞医院2010至2015年间接受TURP的前列腺增生患者,根据术前是否服用阿司匹林及阿司匹林停药时间分为停药7 d组（40例）,停药>7 d组（42例）及对照组（术前未服用阿司匹林）。比较三组患者前列腺体积、住院时间、术后住院时间、手术时间、术中出血量、术中及术后输血例数、术后第1天血红蛋白下降、术后膀胱冲洗时间、尿管拔除时间、围手术期心脑血管并发症等相关指标。 结果停药7 d组、停药>7 d组与对照组三组前列腺增生患者,手术时间、术中出血、术后第1天血红蛋白下降、术后膀胱冲洗时间、尿管拔除时间、术后住院时间差异无统计学意义（P>0.05）,围手术期所有患者均未发生严重心脑血管事件,无死亡病例。 结论对于长期服用阿司匹林的前列腺增生患者,建议停药7 d后行TURP手术,延长停药时间并不能进一步减少出血量。     

High-energy transurethral thermotherapy with CoreTherm approaches transurethral prostate resection in outcome efficacy: a meta-analysis

BACKGROUND AND PURPOSE: Minimally invasive office-based treatments for benign prostatic hyperplasia (BPH) are challenging the traditional surgical and medical management options for symptomatic BPH. We conducted a meta-analysis of published randomized controlled trials that compared high-energy transurethral microwave thermotherapy (HE-TUMT) with transurethral resection of the prostate (TURP) to compare subjective and objective outcomes. MATERIALS AND METHODS: A literature search using Pub-Med was conducted to obtain all published data on HE-TUMT and all randomized controlled trials that compared HE-TUMT with TURP. Data were analyzed focusing on the pretreatment and posttreatment end points of the International Prostate Symptom Score(IPSS), maximum flow rate (Q(max)), and postvoid residual (PVR). A meta-analysis was conducted, and data were stratified with respect to the type of HE-TUMT machinery used. RESULTS: A total of 458 patients were studied. Differences in IPSS, Q(max), and PVR from current trials that compared TURP with HE-TUMT are best evaluated at 1-year follow-up. At this time point, changes in Q(max) (P < 0.001), IPSS (P = 0.01), and PVR (P = 0.02) are more significant if TURP is the management mode. HE-TUMT with the CoreTherm() device demonstrates the most significant improvements in subjective and objective criteria that approximate outcomes with TURP (Figs. 1-3). CONCLUSIONS: A meta-analysis of current randomized controlled trials that compared TURP with HE-TUMT demonstrates more significant changes in Q(max), IPSS, and PVR when TURP is used to manage symptomatic BPH. Despite these statistical differences, stratified data demonstrate that current HE-TUMT machinery is more effective than previously used lower-energy machinery, especially at objective end points. This is most evident when the CoreTherm device is used. These findings, coupled with the decreased costs and morbidity associated with HE-TUMT, support this treatment as a reasonable alternative to TURP.