Nd:YAG/KTP双波长激光治疗前列腺增生症(附61例报告)

目的探讨激光治疗前列腺增生（ＢＰＨ）的微创技术。方法采用Ｎｄ：ＹＡＧ／ＫＴＰ双波长激光经尿道非接触式前列腺切除术治疗ＢＰＨ６１例。随访１～２２个月。结果观察６个月,ＩＰＳＳ评分达（９０±２８）分,生活质量评分（２０±０６）分,最大尿流率（１４８±３４）ｍｌ／ｓ及剩余尿量（１５２±３１）ｍｌ／ｓ。结论本术式治疗ＢＰＨ具有损伤小,安全性高,并发症少等优点。术后最佳疗效在２～３个月以后。有效率达１００％。     

经尿道激光治疗前列腺增生症118例报告

报告采用Ｎｄ：ＹＡＧ非接触式激光治疗１１８例前列腺增生症（ＢＰＨ），随访６个月。结果术后前列腺症状评分降低，最大尿流率及平均尿流率增加，残余尿减少。手术时间短，术中术后出血少，操作简单，对患者全身影响小。术后无尿失禁，无膀胱、尿道穿孔等严重并发症。本法较适宜于前列腺Ⅰ°～Ⅱ°增生患者。对Ⅲ°以上，梗阻严重者效果欠佳，目前还不能代替开放性手术及经尿道前列腺电切除术（ＴＵＲＰ）。     

通尿灵治疗前列腺增生症临床疗效观察

目的：验证通尿灵治疗前列腺增生症（ＢＰＨ）的临床疗效。方法：选择经临床确诊的ＢＰＨ患者５９例,口服通尿灵５０ｍｇ,２次／ｄ,共８周。分别于用药前,治疗后４周及８周行国际前列腺症状评分,尿流率,残余尿量,血清前列腺特异性抗原（ＰＳＡ０及前列腺体积等指标测定,同时对出现的副作用进行记录。     

Nd：YAG非接触式激光治疗前列腺增生：附32例报告

Ｎｄ：ＹＡＧ非接触式激光治疗前列腺增生（附３２例报告）孙颖浩，钱松溪，许传亮，马永江自１９９４年１１月～１９９５年４月应用Ｎｄ：ＹＡＧ非接触式激光机经尿道治疗前列腺增生症（ＢＰＨ）３２例，对经治病人术后尿流动力学改善、激光作用前列腺组织的病理改变、激...     

接触与非接触式激光经尿道前列腺切除术

为探讨并发症少，死亡率低的疗前列腺增生症（ＢＰＨ）的更有效方法，采用接触与非接触式激光联合治疗ＢＰＨ５１例。术中先以接触式激光将５、７点间腺体切除，再以非接触式侧射探头高功率６０Ｗ照射侧叶腺体致组织塌陷，扩大排尿通道。１１例腺体较大，组织炭化重者加用经尿道有列腺切除术（ＴＵＲＰ）。结果５１例中，４８例成功，３例因腺体〈８０ｍｌ改行开放手术。术后随访１－１２个月，平均６．６个月，平均最大尿流率１７．     

前列舒乐治疗前列腺增生症临床观察

本文报告前列舒乐治疗良性前列腺增生症 58例。结果显示 :用药后 ,患者下尿路梗阻症状明显减轻 ,症状结分 (Ｉ—ＰＳＳ)、残余尿、最大尿流率及平均尿流率等 ,较用药前有很大改善。 1年临床使用表明 ,前列舒乐无毒副作用 ,是治疗前列腺增生症(ＢＰＨ)较理想的临床治疗药物。1　材料与方法1 1　材料　门诊选择 80例ＢＰＨ患者 ,均经病史询问、直肠指检、前列腺Ｂ超、结合尿流率检查 ,而确诊。随访 58例 ,年龄在 4 8～ 87岁 ,平均年龄 6 7 5岁。均有明显尿频 ,夜尿增多 ,排尿困难等症状 ,1/ 3病人有不同程度残余尿 15～ 12 0ｍｌ。1 2　方法　…     

前列腺组织间质细胞的表达及临床意义

目的：研究前列腺增生症（ＢＰＨ）组织间质细胞表达的相关临床意义。方法：应用免疫组织化学和细胞计数方法对前列腺组织各类间质细胞进行定量测定,并与ＢＰＨ患者各项临床参数进行相关分析。结果：ＢＰＨ组织中平滑肌细胞和成纤维细胞明显增多,其中平滑肌细胞数与ＩＰＳＳ呈正相关,与平均尿流率和最大尿流率呈明显负相关,成纤维细胞数与前列腺体积呈明显正相关。结论：平滑肌细胞和成纤维细胞增殖在ＢＰＨ发病过程和临床表现中     

前列腺部分电切术在高危前列腺增生症中的应用

为了提高高龄高危前列腺增生症（ＢＰＨ）患者的治疗效果，对７２例高危ＢＰＨ病人采用经尿道部分前列腺电切治疗，平均随访３．５年。结果显示：电切前列腺组织平均１４．４ｇ，占预测前列腺重量的２１．９％；术后ＩＰＳＳ由２６．５±３．７降至１０．２±２．７，最大尿流率由５．９±２．５ｍｌ／ｓ提高至１４．８±２．３ｍｌ／ｓ，而术后再手术率与其他并发症并未增加。切除前列腺组织１０～１５ｇ与１５～２５ｇ两组的术后ＩＰＳＳ、尿流率无明显差异。认为经尿道部分前列腺电切适用于高龄高危ＢＰＨ病人，手术不必刻意追求前列腺切除的重量及彻底性，其效果关键在于切除的部位与方法。     

经尿道前列腺组织内消融治疗良性前列腺增生症（附36例报告）

１９９５年２～６月，对３６例ＢＰＨ患者进行了经尿道前列腺组织内消融治疗。经随访，２９例患者在尿流率、前列腺症状（Ｉ－ＰＳＳ）及生活质量（ＱＯＬ）评分等方面均有明显改善。为ＢＰＨ患者提供了又一新的非手术治疗方法。     

经尿道针刺前列腺组织内消融术治疗前列腺增生症36例报告

采用经尿道针刺前列腺组织内消融术治疗前列腺增生症（ＢＰＨ）３６例，结果２９例拔管后能自行排尿，且较术前明显通畅，最大尿流率，前列腺症状评分及生活质量评分均较术明显改善（Ｐ〈０．０５及Ｐ〈０．００１）；５例保留尿管２周后能自行排尿，２例改行其他手术治疗，并介绍前列腺组织内消融术操作方法，就其治疗原理及临床效果进行了讨论，认为前列腺组织内消融术是目前治疗ＢＰＨ较为安全有效的方法。     

A randomized controlled trial comparing transurethral resection of the prostate,contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: urodynamic effects

PURPOSE: We compared urodynamic and uroflowmetry improvements in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) after transurethral prostate resection, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS: A prospective randomized controlled trial was performed in men with lower urinary tract symptoms suggestive of BPH who met the criteria of the International Scientific Committee on BPH, had a prostate volume of between 20 and 65 ml., and a Sch?fer obstruction grade of 2 or greater. Before and 6 months after treatment urodynamics and free uroflowmetry were performed. RESULTS: A total of 50, 45 and 46 men were randomized to transurethral prostate resection, laser treatment and electrovaporization, respectively. Baseline characteristics were similar in the 3 groups. Detrusor contractility did not change in any of the treatment groups. The average maximum free flow rate increased by a factor of 2.4 after transurethral prostate resection, 2.5 after laser prostatectomy and 2.4 after electrovaporization. The Sch?fer obstruction grade decreased by a factor of 0.3 in all groups. Obstruction (Sch?fer grade greater than 2) was not noted after transurethral prostate resection or electrovaporization but it was evident in 2 patients after laser prostatectomy. Effective capacity increased by a factor of 1.5 or more. The incidence of detrusor instability was decreased by half in all groups. The incidence of significant post-void residual urine volume decreased in all groups. CONCLUSIONS: There were no significant differences in the improvement in urodynamic and uroflowmetry parameters 6 months after treatment when comparing transurethral prostate resection, contact laser prostatectomy and electrovaporization in men with lower urinary tract symptoms suggestive of BPH.     

经尿道等离子束切割前列腺治疗良性前列腺增生(附712例报告)

目的:探讨经尿道等离子束切割前列腺治疗良性前列腺增生的安全性与有效性。方法:应用经尿道等离子束治疗良性前列腺增生712例,平均年龄70.6岁,平均前列腺质量52 g;术前、术后行尿流率、残余尿量测定、国际前列腺症状评分(IPSS)及生活质量评分(QOL)并予以比较。结果:本组病例712例,平均年龄70.6岁,手术时间20～120 m in,平均51 m in。切割前列腺组织15～96 g,平均46 g。无电切综合征发生。术后随访1～52个月,平均27.6个月,最大尿流率(Qm ax)由术前的4.7上升至19.1 m l/s;IPSS由术前的26.6分下降至5.8分;QOL评分由术前的5.4分下降至1.7分,3项指标手术前后比较均有显著性差别(P均<0.01)。结论:经尿道等离子束切割前列腺治疗良性前列腺增生是一种安全、有效的手术方式。     

Expression of survivin and apoptotic biomarkers in benign prostatic hyperplasia

PURPOSE: We assessed the differential expression of survivin and other apoptotic markers in stromal and epithelial compartments of benign prostatic hyperplasia (BPH) and normal prostate tissue. MATERIALS AND METHODS: Immunohistochemical staining for survivin, and transforming growth factor-beta1 and its receptors was done in normal prostate and BPH areas from 114 consecutive patients who underwent radical prostatectomy. Moreover, staining for survivin, Bcl-2, Bax, caspase-3 and Ki-67 was performed in prostate specimens from 23 consecutive patients who underwent open prostatectomy and 4 young patients who underwent cystoprostatectomy and had a normal prostate. RESULTS: Survivin and Bcl-2 expression increased incrementally from normal prostate to epithelial BPH to stromal BPH. Caspase-3 expression was higher in BPH epithelium than in BPH stroma, which in turn was higher than that in normal prostate. Ki-67 was significantly over expressed in BPH stroma and epithelium. Survivin expression in BPH tissue correlated with International Prostate Symptom Score, quality of life, post-void residual urine volume, maximum urine flow rate and transforming growth factor-beta1 expression. CONCLUSIONS: Survivin is over expressed in BPH and it correlates with BPH parameters. Increases in proliferation and inhibition of apoptosis have a role in BPH.     

Transurethral holmium laser resection of the prostate

PURPOSE: We evaluated the efficacy of the holmium:YAG laser for transurethral endoscopic prostatectomy for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We treated 103 patients with BPH with holmium:YAG laser resection of the prostate. A high power holmium laser generating a maximum of 60 or 81 W. was used in a pulsed mode, applying energy directly to prostatic tissue via a forward firing 550 micron. fiber transurethrally under direct vision. Treatment outcome was evaluated by the International Prostate Symptom Score, quality of life score, maximum flow rate and post-void residual urine volume. We also compared holmium laser surgery and transurethral resection of the prostate for operative factors, such as surgical duration, bleeding volume and catheterization time. RESULTS: Average symptom score, quality of life score, peak flow rate and post-void residual significantly improved at 1 week, 1 month and 3 months postoperatively, with improvement maintained up to 36 months postoperatively in the holmium:YAG group. Intraoperative bleeding volume was significantly lower and catheterization time was significantly shorter for holmium:YAG than for transurethral prostatic resection. Use of the holmium laser caused no complications. CONCLUSIONS: Because of its effectiveness and safety holmium:YAG resection is a viable potential surgical alternative for symptomatic BPH. The holmium:YAG laser has been verified to be useful for many purposes in urology.     

Holmium: YAG Laser Resection of the Prostate Versus Visual Laser Ablation of the Prostate and Transurethral Ultrasound-Guided Laser Induced Prostatectomy: A Retrospective Comparative Study

Background:
Transurethral resection of the prostate (TUR-P) is the gold standard for treating symptomatic benign prostatic hyperplasia (BPH) despite some perioperative morbidity. As a minimally-invasive alternative to TUR-P, a neodymium:YAG laser, and more recently a holmium:YAG laser, have been used in transurethral surgery for BPH. In order to assess the safety and efficacy of various BPH treatments, the outcome in patients treated with transurethral ultrasound-guided laser induced prostatectomy (TULIP), visual laser ablation of the prostate (VLAP) and holmium:YAG laser resection of the prostate (HoLRP) were retrospectively compared.
Methods:
From May 1995 to August 1996, 60 patients with symptomatic BPH underwent TULIP (n=20), VLAP (n=20), and HoLRP (n=20). All patients were evaluated preoperatively and at 1 and 3 months postoperatively by the International Prostate Symptom Score (IPSS), the IPSS quality-of-life score (QOL), maximum flow rate (MFR), prostate volume, and residual urine volume.
Results:
The preoperative mean IPSS was 18.5, 19.3, and 19.6 and the mean MFR was 6.3, 6.9, and 6.1mL/sec in the TULIP, VLAP, and HoLRP groups, respectively. At 1 month after surgery, the mean IPSS was 10.2, 9.5, and 4.7 and the mean MFR was 9.6, 1 3.4, and 1 8.7mL/sec while at 3 months the mean IPSS was 6.2, 6.1, and 3.6 and the mean MFR was 14.1, 1 6.0, and 21.5 mL/sec in patients treated with TULIP, VLAP, and HoLRP, respectively. No serious complication occurred in any patient.
Conclusion: Although HoLRP requires expertise, it appears to be a promising treatment modality for BPH.     

Comparative study of transurethral laser prostatectomy versus transurethral electroresection for benign prostatic hyperplasia

BACKGROUND: Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). Recently, less invasive transurethral laser prostatectomy, such as visual laser ablation (VLAP) or interstitial laser coagulation (ILCP), have been developed. Herein, we investigated the efficacy of VLAP and ILCP compared to TURP. METHODS: A total of 80 patients with BPH were treated: 20 patients by VLAP, 30 patients by ILCP and 30 patients by TURP. All patients were followed up for 12 months after their operations. Treatment outcomes were evaluated by four different criteria: (i) the International Prostatic Symptom Score (I-PSS), (ii) the maximum flow rate (Qmax), (iii) postvoided residual urine volume before treatment and one, three, six and 12 months after treatment, and (iv) prostatic volume before operation and three and six months postoperatively. RESULTS: The I-PSS, Qmax and residual urine volume were significantly improved compared to baseline levels and the improvement continued for 12 months in the three groups: for I-PSS (P<0.001 in the VLAP group and P<0.0001 in the ILCP and TURP groups), Qmax (P<0.001 in the VLAP and ILCP groups, and P<0.0001 in the TURP group), residual urine volume (P<0.01 in the VLAP group and P<0.0001 in the ILCP and TURP groups). Significant reduction of the prostatic volume was recorded only in the ILCP and TURP groups (P<0.001). CONCLUSION: Visual laser ablation and ILCP can be good alternative treatments for BPH. Visual laser ablation provides good outcomes in patients with small-sized BPH and with risk factors such as heart disease or anticoagulation therapy.     

经尿道摩西钬激光前列腺剜除术治疗良性前列腺增生的临床研究

目的探讨经尿道摩西钬激光前列腺剜除术在良性前列腺增生(BPH)患者中的应用效果,旨在为BPH患者快速康复提供更好的手术治疗方案。方法应用前瞻性随机双盲对照研究法,选取2018年8月至2019年11月在本院住院的80例BPH患者作为研究对象,将其随机分为两组,对照组(40例)采用经尿道100 W钬激光前列腺剜除术,研究组(40例)采用经尿道摩西钬激光前列腺剜除术,手术均由同一医师完成,术式为改良钬激光前列腺剜除术(三叶十七步法);比较两组的前列腺剜除时间、术中出血量、术后3 h血清钠下降程度、术后拔除尿管时间、住院时间,统计两组患者术前、术后3个月的最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺症状评分(IPSS),观察学习曲线等指标。结果研究组的前列腺剜除时间、术中出血量、术后拔除尿管时间、住院时间比较差异有统计学意义(P<0.05),两组患者手术前后的血清钠变化差异无统计学意义(P>0.05);两组术后3个月的Qmax、PVR、IPSS均较治疗前显著改善(P<0.05),但术后组间比较差异无统计学意义(P>0.05);两组患者术中均无膀胱损伤及TUR综合征患者,无输血患者,无术后尿道外口狭窄患者,术后均无严重并发症;学习曲线方面,经尿道摩西钬激光前列腺剜除术的学习曲线较短。结论经尿道摩西钬激光前列腺剜除术安全性高、风险较小、疗效良好、术后康复快,且学习曲线较短,表现出较高的临床应用价值。     

Transurethral Visual Laser Ablation of the Prostate for Benign Prostatic Hyperplasia Using a KTP/YAG Laser

Background :
Transurethral visual laser ablation of the prostate (VLAP) has been established as an alternative method for the treatment of benign prostatic hyperplasia (BPH). However, most VLAP procedures utilize only a neodymium:yttrium-aluminum-gamet (Nd:YAC) laser. Since a potassiumtitenyl-phosphate (KTP) laser offers limited tissue penetration, KTP can be safely utilized to excise part of the obstructing prostatic tissue. This study assessed the interaction between KTP vaporization and YAG coagulative ablation to determine the safety and efficacy of VLAP utilizing a combined KTP/YAG treatment.
Methods :
Forty patients with bladder outlet obstruction secondary to BPH were treated with VLAP using a KTP/YAG laser. The laser light was delivered by an angle delivery device.
Results :
Most cases demonstrated a significant improvement in routine subjective and objective parameters (AUA symptom score, peak flow rate, average flow rate, and amount of residual urine). No significant complications relating to this procedure were reported, however, 4 patients experienced postoperative acute urinary retention.
Conclusion :
KTP/YAG laser ablation of the prostate is safe and effective for the treatment of BPH.     

三种经尿道前列腺切除手术的疗效比较

目的：比较前列腺增生症（BPH）的三种经尿道手术的治疗效果。方法：分别采用尿道前列腺电切术（TURP）、经尿道前列腺电气化术（TUVP）和经尿道接触式激光前列腺切除术（TULP）治疗BPH共357例。结果：TULP及TUVP的手术时间比TURP缩短,出血明显减少,膀胱冲洗时间、置管时间及住院时间均短于TURP。结论：三种经尿道手术方法都是治疗BPH的有效手段,其疗效TURP与TUVP相似,TULP稍逊,但TULP跟TUVP与TURP比较操作更易掌握,出血量及并发症更少,联合应用TUVP和TURP或TULP相TURP可缩短手术时间、增加前列腺切除量和提高疗效。     

Bladder Dysfunction in Patients with Benign Prostatic Hyperplasia: Relevance of Cystometry as Prognostic Indicator of the Outcome after Prostatectomy

Background: We correlated cystometric findings to the clinical features of benign prostatic hyperplasia (BPH) and compared them in terms of outcome after prostatectomy.
Methods: Cystometric findings obtained from 78 patients who underwent prostatectomy were correlated with clinical features in BPH patients. In 41 consecutive patients of this group, prospective periodical cystometry was also performed.
Results: Low bladder compliance correlated significantly with an increase in age and prostate volume, detrusor instability and impaired contractility. Low compliance also correlated with irritative symptoms, decreased maximum flow rate, increased post-void residual urine and an increase in the American Urological Association symptom score. Postoperative persistent incontinence was associated with low bladder compliance and detrusor instability. In a prospective study, bladder dysfunction was not completely restored in 53% of patients examined at a mean interval of 7.7 months after prostatectomy.
Conclusions: Among the cystometric parameters investigated, low compliance was the most relevant to the clinical features of BPH and had some predictive value for the outcome after prostatectomy. In about half of the BPH patients with bladder dysfunction preoperatively, this condition was irreversible for a significant period of time after prostatectomy, in spite of surgical relief of the infravesical obstruction.