经尿道钬激光前列腺剜除术治疗良性前列腺增生

目的 :评价经尿道钬激光前列腺剜除和前列腺组织粉碎术治疗良性前列腺增生 (BPH)的临床效果。　方法 :应用 10 0W钬激光器和组织粉碎器对 35例BPH病人实施经尿道钬激光剜除和前列腺组织粉碎术治疗。　结果 :本组 35例手术均获成功。手术时间 30～ 180min ,平均 (6 0 .0± 2 3.2 )min。获得前列腺组织 10～ 5 6g ,平均(31± 9) g ,术后留置导尿管时间 2 0h～ 4d ,平均1.5d。无术中术后输血病例。组织病理学诊断均为BPH。 32例获随访 ,术后 3个月随访国际前列腺症状评分 (IPSS)由 (2 4.0± 6 .2 )分降至 (5 .6± 3.6 )分 (P <0 .0 0 1)。最大尿流率 (Qmax)由 (8.5± 3.9)ml/s上升至 (2 2 .0± 7.2 )ml/s(P <0 .0 0 1) ,残余尿由 (138± 12 5 )ml减少到 (2 1± 15 )ml,未发生严重并发症。　结论 :钬激光前列腺剜除术是治疗BPH的有效微创方法 ,术中术后出血少 ,能够完整剜除增生的前列腺组织。留置导尿管时间短 ,临床症状改善明显。     

双极等离子体电切联合钬激光碎石同期治疗前列腺增生合并膀胱结石

目的探讨良性前列腺增生(benign prostatic hyperplasia,BPH)合并膀胱结石的安全有效的治疗方法。方法采用英国Gyrus等离子双极电切系统和美国科以人Lumenis100W钬激光系统,钬激光550μm光纤由等离子电切镜操作通道置入碎石,治疗参数为1.5~3.0J/15~25Hz,总功率30~60W,平均48W。冲出结石碎块,更换等离子电切环,从中叶到两侧叶切除前列腺腺体直至前列腺包膜,前列腺尖部切至精阜前缘,留置F20三腔尿管,术后生理盐水冲洗1~2d。结果 128例手术均获成功,手术时间42~135min,(64±22)min,其中前列腺切除时间(42±20)min,碎石时间(16±12)min。术后4~5d拔除尿管排尿通畅,无电切综合征、闭孔神经反射、膀胱穿孔等并发症,无结石残留。128例随访6~12个月,平均8个月,术后6个月国际前列腺症状评分由(26.5±4.2)分降至(6.8±1.2)分(t=16.782,P=0.000);生活质量评分由(4.6±0.6)分降至(1.8±0.6)分(t=11.561,P=0.000);最大尿流率由(5.3±3.2)ml/s升至(20.2±4.2)ml/s(t=12.684,P=0.000);残余尿量由(118±52)ml降至(16±9)ml(t=18.544,P=0.000)。结论双极等离子体电切联合钬激光碎石是治疗BPH并膀胱结石微创、安全而有效的方法 。     

Holmium laser enucleation of the prostate: results at 6 years

OBJECTIVES: The issue of durability is an important concern when evaluating new surgical modalities. To date, only 24-mo data have been published on holmium enucleation of the prostate (HoLEP) despite its widespread use worldwide although 4-yr data exist for the earlier technique of holmium resection. This study addresses the issue of durability of HoLEP. METHODS: All patients who had undergone HoLEP and been evaluated in three prospective trials conducted at this institution between 1997 and 2002 were evaluated. Patients available at follow-up had data assessed on the International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), quality of life (QOL), International Continence Society Male Short Form (ICS-SF), International Index of Erectile Function (IIEF), Benign Prostatic Hyperplasia Impact Index (BPHII), and continence questionnaire. RESULTS: The mean follow-up was 6.1 yr (range: 4.1-8.1 yr). The mean age of the patients at follow-up was 75.7 yr (range: 58-88 yr). Of 71 HoLEP patients originally studied on the protocol, 38 (54%) were available for analysis, 14 were deceased, and 19 were lost to follow-up. The mean IPSS for this group was 8.5 (range: 0-24) and Q(max) 19 ml/s (range: 6-28 ml/s). The QOL score was 1.8 (range: 0-5) and the BPHII 2.0 (range: 0-11). One patient (1.4%) had undergone reoperation, an additional HoLEP. Overall, 92% were either satisfied or extremely satisfied with their outcome. CONCLUSIONS: HoLEP is durable and most patients remain satisfied or extremely satisfied with the long-term outcome.     

经尿道前列腺电汽化切除术(附100例报告)

1996年12月至1997年12月,对100例良性前列腺增生症(BPH)患者进行经尿道前列腺电汽化切除术(TUEVAP)。术后随访1～12月,患者在尿流率、国际前列腺症状评分(I-PSS)及生活质量(QOL)评分、残余尿(RU)减少等方面均有显著改善。TUEVAP结合了TURP及TULP的优点,具有操作简便、去除增生组织量大、出血少、并发症少、恢复快、疗效显著等特点,是一种值得推广应用的治疗BPH的新方法。     

前列腺增生症与输精管结扎的相关性分析

目的 :探讨前列腺增生症 (BPH)与输精管结扎的关系。　方法 :调查 6 0岁以上男性农民 5 70人的国际前列腺症状评分 (IPSS)、生活质量评分 (L)、最大尿流率 (MFR)、前列腺体积 (V)及残余尿 (R)等指标 ,其中作过输精管结扎者 140人。　结果 :输精管结扎者BPH发病率 (2 7.1% )明显低于未作结扎者 (4 7.9% ) ,两者有极显著差异 (P<0 .0 1)。　结论 :输精管结扎对BPH的发生有阻遏作用。     

萘哌地尔治疗良性前列腺增生的疗效观察

目的 :评价萘哌地尔 (Naftopidil)治疗良性前列腺增生 (BPH)的有效性和安全性。　方法 :80例诊断为BPH的病人 ,随机分为试验组 4 0例和对照组 4 0例。试验组给予萘哌地尔片 2 5mg ,每晚口服 ,共 4 2d ;对照组给予盐酸坦索罗辛胶囊 0 2mg ,每晚口服 ,共 4 2d。采用随机、双盲、双模拟、阳性药物平行对照法 ,以国际前列腺症状评分 (IPSS)、最大尿流率 (Qmax)作为主要疗效指标 ,以生活质量评分 (QOL)、残余尿量、前列腺体积作为次要疗效指标。　结果 :两组治疗前后IPSS、Qmax、QOL比较差异均有显著性 (P <0 .0 5 ) ,治疗后两组间比较差异无显著性 (P >0 .0 5 ) ;残余尿量两组治疗前后比较差异均无显著性 (P >0 .0 5 ) ,治疗 6周后两组间比较差异有显著性 (P <0 .0 5 ) ,前列腺体积治疗前后两组比较及两组间差异均无显著性 (P >0 .0 5 )。总的不良事件较少 (3 75 % ) ,两组间比较差异无显著性 (P >0 .0 5 )。　结论 :萘哌地尔是治疗BPH的有效和安全的药物     

输精管结扎术用于预防和治疗前列腺增生的实验研究

目的 :探讨输精管及输精管静脉结扎用于预防和治疗良性前列腺增生 (BPH)的可能性及有效率。　方法 :取 5～ 6岁龄雄性杂交犬 4 0只 ,随机分为A、B、C、D 4组 ,每组 10只 ,其中A、B两组喂混合饲料制成BPH模型 ,C、D两组喂普通饲料 ,2年后将A、C两组犬的双侧输精管连同输精管静脉结扎 ,B、D两组犬仅解剖显露输精管 ,但不结扎。继续原方法饲养 2年后将 4 0只犬处死解剖出前列腺称重 ,测量体积 ,然后分组取材制片 ,观察组织学改变。　结果 :A、C两组及B、D两组前列腺重量及体积相比较 ,差异有显著性 (P <0 .0 1)。A、C两组前列腺组织切片呈退行性变而B、D两组呈增生性改变。　结论 :在BPH前行输精管及输精管静脉结扎可减轻犬在老年期的BPH ;在增生后结扎可使犬前列腺组织发生不同程度的萎缩     

良性前列腺增生合并梗阻的相关因素

前列腺增生、膀胱出口梗阻和下尿路症状是一组既独立又相关的因素 ,良性前列腺梗阻 (BPO)则反映上述 3因素的交错和重合 ,也是临床治疗的直接目标 ,本文综述近年来有关前列腺增生合并BPO的相关因素的研究进展 ,着重讨论了尿流动力学、前列腺组织学、前列腺及其尿道形态学等改变与BPO关系     

前列腺钬激光整块剜除术与经尿道前列腺电切术治疗前列腺增生的比较

目的对比前列腺钬激光整块剜除术（HoLEP）与经尿道前列腺电切术（TURP）在治疗前列腺增生（BPH）中的疗效。 方法行前瞻性研究,将医院2018年6月至2021年6月收治的76例BPH患者纳为研究对象,随机数字表法将其均分为HoLEP组及TURP组,比较两组围术期相关指标及术后恢复指标,探究两种术式在治疗BPH中的疗效。 结果HoLEP组手术时间较TURP组延长,血红蛋白下降值较TURP组低,前列腺切除重量较TURP组增加,差异均具有统计学意义（P<0.05）。HoLEP组手术前后电解质Na⁺及K⁺水平比较,差异均无统计学意义（P>0.05）,TURP组术后Na⁺及K⁺水平较其术前均下降,且其术后Na⁺及K⁺水平均低于HoLEP组术后水平,差异均具有统计学意义（P<0.05）。HoLEP组术后膀胱冲洗时间、留置导尿管时间及术后住院时间均短于TURP组,差异具有统计学意义（P<0.05）。HoLEP组术后并发症发生率低于TURP组,差异具有统计学意义（P<0.05）。术后6个月,两组国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Q_max）、残余尿以及最大尿流率时逼尿肌压力（Pdet/Q_max）水平比较,差异均无统计学意义（P>0.05）。 结论HoLEP及TURP均能有效切除增生前列腺组织,改善BPH患者下尿路症状,实现治疗目的,但与TURP相比,HoLEP术后并发症更少,患者术后恢复更快。     

经尿道等离子前列腺逆行剥离切除术治疗良性前列腺增生症

目的探讨经尿道等离子前列腺逆行剥离切除术治疗良性前列腺增生症（benign prostatic hyperplasia,BPH）的效果。方法2005年12月～2007年12月,经尿道等离子前列腺逆行剥离切除术治疗BPH68例。术前B超测量前列腺体积30～120ml,平均75ml;残余尿量（RU）60～250ml,平均89ml;最大尿流率（Qmax）3.5～6.9ml/s,平均5.1ml/s;IPSS评分19.8～23.5分,平均21.6分。结果68例均手术成功,切除的前列腺组织30～120g,其中〉60g15例。手术时间35～85min,平均45min。术中失血50～100ml,平均60ml,无输血。无前列腺外科包膜破裂、静脉窦破裂、膀胱前列腺连续部穿孔。68例术后随访4～6个月,Qmax增至16.4～23.2ml/s（平均19.8ml/s）,RU降至0～15ml（平均5ml）,IPSS评分0～6.8分（平均4.2分）,均恢复正常。无尿失禁。结论经尿道等离子前列腺逆行剥离切除术治疗BPH具有手术彻底、出血少、尿失禁发生率低等优点,手术相对简单,易于掌握。     

爱普列特治疗良性前列腺增生的疗效观察

目的 :评价爱普列特 (Epristeride)治疗良性前列腺增生 (BPH)的安全性、有效性。 　方法 :14 1例诊断为BPH的病人 ,年龄 5 0～ 83岁 ,平均 (6 6 .18± 6 .4 1)岁。给予爱普列特片 5mg ,2次 /d口服 ,共 12 0d。以国际前列腺症状评分 (IPSS)、最大尿流率 (Qmax)、前列腺体积 (V)及剩余尿 (Ru)的变化率评分综合判断疗效。疗效分类 :显效、有效、改善和无效 ,以显效和有效计算有效率。　结果 :139例参加有效率统计 ,其中 :显效 37例 (2 6 .6 2 % )、有效 76例 (5 4 .6 8% )、改善 2 0例 (14 .39% )、无效 6例 (4.32 % ) ,有效率为 81.2 9%。不良反应共 7例 (5 .0 4 % ) :皮疹1例 (0 .72 % )、胃肠道反应 1例 (0 .72 % )、失眠 1例 (0 .72 % )、耳鸣 1例 (0 .72 % )、勃起功能障碍 3例 (2 .16 % ) ,2例因不良反应而停药 (1.4 4 % ) ,不参加统计有效率。未出现有临床意义的实验室指标异常。　结论 :爱普列特片是治疗BPH安全、有效的药物。     

雌激素及其受体在良性前列腺增生中的作用

雌激素是前列腺间质细胞强有力的生长调节剂 ,它与其特异性受体结合后发挥作用。大量研究表明 ,雌激素及其受体参与了老年男性良性前列腺增生的发生、发展全过程。本文主要综述了雌激素及其受体在良性前列腺增生发病过程中作用的研究进展     

The Link Between Benign Prostatic Hyperplasia and Inflammation

ContextBenign prostatic hyperplasia (BPH) is one of the most common diseases associated with the aging process in men, particularly men aged >50 yr, yet only a few predictive factors have been identified. In recent years, attention has focused on the role of prostatic inflammation in the pathogenesis and progression of BPH.ObjectiveThis article reviews recent findings related to the potential link between local and systemic inflammation and BPH.Evidence acquisitionIn March 2013, at the annual meeting of the European Association of Urology in Milan, Italy, a satellite symposium entitled “Benign Prostatic Hypertrophy (BPH) and Inflammation, from Lab to Clinic,” was held with the goal of reviewing the latest data relating to the link between inflammation and BPH. This paper is based on one of the presentations at this symposium. A structured PubMed literature search was performed, and emphasis was placed on results from the past 10 yr.Evidence synthesisBPH is characterized by progressive hyperplasia of stromal and glandular cells, and clinically it is defined by lower urinary tract symptoms. In recent years, there has been accumulating evidence linking prostatic inflammation with BPH. The inflammatory infiltrates observed in patients with BPH are composed primarily of chronically activated T-lymphocytes. Cytokines and growth factors released from inflammatory cells create a proinflammatory environment that may support the fibromuscular growth seen in BPH and may also be responsible for inducing a state of relative hypoxia as a result of the increased oxygen demand of the proliferating cells. A number of clinical studies have confirmed the presence of inflammatory infiltrate in men with BPH, and this infiltrate has been shown to be involved in the pathogenesis, clinical appearance, and progression of this disorder. There is evidence emerging that systemic inflammation may also play a role in BPH, since in men with metabolic syndrome there was a significant correlation between prostate diameter/volume and the number of metabolic syndrome components.ConclusionsIt is clear that a number of different mechanisms are involved in the development and progression of BPH. Prostatic inflammation is an important feature, since it appears to be involved in the pathogenesis, symptomatology, and progression of the disease.     

经尿道前列腺电切和汽化术治疗前列腺增生412例报告

采用经尿道前列腺电切和汽化术治疗BPH412例，取得满意疗效。术后3个月随访，前列腺症状IPSS评分平均8．6分，最大尿流率平均14．4ml／s，残余尿量平均28ml，未出现严重并发症。认为汽化和电切结合经尿道前列腺切除术是一种安全性高、并发症少、疗效确切的新手术方法。     

单纯碎石取石联合药物治疗良性前列腺增生合并膀胱结石

目的探讨良性前列腺增生(benign prostatic hyperplasia,BPH)合并膀胱结石仅行碎石取石辅助药物治疗,未行前列腺手术治疗的临床效果。方法 2006年6月~2013年6月对62例良性前列腺增生合并膀胱结石采用耻骨上膀胱切开取石术、经尿道碎石取石术或体外冲击波碎石治疗膀胱结石,术后给予坦索罗辛和(或)非那雄胺缓解前列腺增生引起的下尿路症状,比较术前与术后1个月IPSS评分、QOL评分、残余尿量及最大尿流率的变化。结果术后1个月IPSS评分(12.9±4.8)分,明显低于术前(22.6±3.6)分(t=12.918,P=0.000);QOL评分(3.2±1.1)分,明显低于术前(4.7±1.0)分(t=8.279,P=0.000);残余尿量中位数13 ml(0~60 ml),明显少于术前中位数29 ml(0~102 ml)(Z=-3.614,P=0.000)。术前与术后1个月最大尿流率分别为(11.1±2.3)、(11.8±2.4)ml/s,无统计学差异(t=-0.755,P=0.441)。术后膀胱结石复发2例(3.2%),经体外冲击波碎石治疗后结石完全排除,随访未见结石复发。62例平均随访28个月(6~62个月),急性尿潴留2例,继发上尿路积水1例,反复肉眼血尿合并泌尿系感染2例,下尿路梗阻症状严重影响生活质量1例,此6例(9.7%)均行经尿道前列腺电切术。logistic回归分析显示Qmax是前列腺手术的独立危险因素(OR=0.213,P=0.026,95%CI:0.054~0.835)。结论单纯处理膀胱结石结合药物治疗对改善良性前列腺增生患者的下尿路症状有一定疗效。     

Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up

OBJECTIVE: Prospectively evaluate perioperative outcomes and 2-yr follow-up after holmium laser enucleation (HoLEP) and standard open prostatectomy (OP) for treating benign prostatic hyperplasia-related obstructed voiding symptoms, with prostates >70 g. METHODS: From March 2003 to December 2004, 80 consecutive patients were randomised for surgical treatment with HoLEP (n=41) or standard OP (n=39). All patients were preoperatively assessed with International Prostate Symptom Score and International Index of Erectile Function questionnaires and complete urodynamic evaluation. Intraoperative and perioperative parameters such as blood loss, catheter removal, and hospital stays were assessed. Early and late complications were recorded. Patients were evaluated at 1-, 3-, 12-, and 24-mo follow-ups with the same tests. RESULTS: Operating room time was significantly shorter for the OP group (72.09+/-21.22 min vs. 58.31+/-11.95 min, p<0.0001); catheter removal (1.5+/-1.07 d and 4.1+/-0.5 d, p<0.001) and hospital stay (2.7+/-1.1 d vs. 5.4+/-1.05 d, p<0.001) were shorter in the HoLEP group. Blood loss was less and blood transfusions fewer in the HoLEP group (p<0.001). In both groups urodynamic and uroflowmetry findings improved from baseline, were still evident at the 24-mo follow-up, and were comparable between the two groups. Late complications were also comparable. CONCLUSIONS: HoLEP is a feasible technique for treating large prostates. Functional results are similar to OP at the 2-yr follow-up. Reduced catheterisation, hospital stay, and blood loss make HoLEP an attractive option for the treatment of large prostates.     

老年犬自发性前列腺增生的实验研究

目的 :以老年犬自发性良性前列腺增生 (BPH)为实验动物模型 ,观察前列腺病理解剖、组织学和生物化学特征。　方法 :选择 6～ 13岁老年杂种家犬 ,经肛门指检、直肠探头B超和手术直视下测量前列腺体积 ,10只前列腺显著增生 (BPH组 )和 6只未增生 (对照组 )的老年犬为观察对象 ,测量血清睾酮 (T)、雌二醇 (E2 )、酸性磷酸酶(ACP)和前列腺特异抗原 (PSA)水平 ,并作组织学检查。　结果 :B超和实测表明 ,BPH组前列腺体积显著大于对照组 [BPH组分别为 (14 .7± 2 .3)和 (13.8± 1.9)cm3 ,对照组分别为 (8.4± 1.0 )和 (8.4± 1.9)cm3 ,P <0 .0 1];BPH组和对照组血清激素水平差异没有显著性 [T分别为 (14 .3± 2 .9)和 (16 .4± 4 .0 )nmol/L ,E2分别为 (137.6±70 .8)和 (16 4 .4± 82 .0 ) pmol/L ,P >0 .0 5 ];ACP分别为 (6 .6 3± 2 .76 )及 (4.92± 2 .19)U/L ,BPH组高于对照组 ,但无统计学差异 (P >0 .0 5 ) ;而PSA水平分别为 (5 .6± 0 .78)及 (3.10± 0 .5 4 ) μg/L ,P <0 .0 1。组织学检查发现 ,BPH组前列腺腺体增生 ,上皮细胞高度增加 ,间质相对较少 ,腺腔内上皮细胞增生形成大量长而分支多的乳头。　结论 :自发性BPH的老年杂种家犬是人类BPH病因学和药理学研究有用的实验动物。     

Role of Prostatic Inflammation in the Clinical Presentation of Benign Prostatic Hyperplasia

ContextAlthough it was hypothesised >20 yr ago that prostatic inflammation could influence clinical presentation and possibly surgical outcome in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), only more recently has compelling substantiating evidence become available.ObjectiveTo review the evidence for the role of inflammation in the clinical presentation and treatment of BPH/LUTS.Evidence acquisitionThis article is based primarily on material presented at a satellite symposium entitled, “Inflammation and Prostatic Diseases: From Bench to Bedside,” held during the 2015 annual meeting of the European Association of Urology in Madrid, Spain. Current data regarding the link between inflammation and BPH were reviewed.Evidence synthesisStudies such as the large-scale Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial and others have clearly demonstrated the association between the presence and/or degree of histologic inflammation and its impact on parameters such as prostate volume, voiding LUTS, and type of surgery required to treat BPH. Prostatic inflammation has been shown to increase by threefold the risk for acute urinary retention, an end point in the natural progression of BPH. Inflammation has been proposed as the common thread between the metabolic syndrome and BPH/LUTS, which frequently co-exist, and offers new therapeutic targets for medical treatment. Motivated patients can undertake lifestyle modifications (eg, weight, diet, exercise) to potentially prevent the need for surgery. Selective cyclooxygenase-2 inhibition appears promising as a therapeutic approach for inflammation, but its suitability for long-term use in the BPH population is limited by safety concerns.ConclusionsGreater understanding of the relationship between inflammation and the clinical presentation of BPH/LUTS provides an opportunity to effect clinical changes to improve treatment outcomes.Patient summaryAn increased understanding of the role of prostatic inflammation in the pathogenesis, symptomatology, and progression of benign prostatic hyperplasia (BPH) is likely to change the treatment paradigm for BPH.