Minimal transurethral prostatectomy plus bladder neck incision versus standard transurethral prostatectomy in patients with benign prostatic hyperplasia: a randomised prospective study

OBJECTIVE: To evaluate the effectiveness and complications of the combination of minimal transurethral resection of the prostate and bladder neck incision in comparison with those of the standard transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Forty patients with prostates of 相似文献   

Transurethral incision of prostate compared with transurethral resection of prostate in 132 matching cases

In a prospective project during a 2-year period 132 patients with bladder outlet obstruction who were candidates for transurethral incision of the prostate were managed alternately by transurethral incision and transurethral resection of the prostate. Both operations were compared in matched patients. The results and complications favored transurethral incision, although there was no statistical significance except for the high incidence of bladder neck contracture after transurethral resection (p equals 0.028).     

Internal urethrotomy of the prostatic urethra or transurethral resection in benign prostatic hyperplasia.

Transurethral resection of the prostate is the most common technique for the treatment of benign prostatic enlargement. The inconveniences of prostatic resection are retrograde ejaculation and bladder neck stenosis in small prostates. A randomized prospective trial was done to compare the results of conventional transurethral resection of the prostate in 22 patients and urethrotomy of the prostatic urethra in 27 with respect to postoperative retrograde ejaculation, persistent urinary symptomatology and maximal flow rates. After a mean followup of 25 months we concluded that internal urethrotomy of the prostatic urethra is the operation of choice in patients with a prostate of up to 30 gm.     

Venous air embolism during transurethral resection of the prostate

Venous air embolism during transurethral surgery is a rare event. There have been case reports in the anesthesia and urology literature of fatal air embolism during transurethral prostate resection and transurethral incision of the bladder neck. We present a case of nonfatal venous air embolism during transurethral prostate resection in which incorrect assembly of the bladder irrigation-resectoscope-drain system led to a rapid entrainment of air into the open venous channels of the prostate bed.     

Fibrous contracture of bladder neck: cause, prevention, and treatment.

Through a retrospective study of bladder neck contracture it was found that bladder neck resection and incision were equally effective for treatment of postoperative bladder neck contractures. It was also found that incising the bladder neck at the end of transurethral resection of the prostate (TURP) did not cause vesicoureteral reflux and did not improve the incidence of postoperative bladder neck contracture.     

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。     

Transurethral incision of the bladder neck and prostate.

Between March 1983 and December 1988, 66 men 50 years old and older with symptomatic bladder outlet obstruction underwent transurethral incision of the bladder neck and prostate. Patients selected for incision had a small, clinically benign, prostate and peak urinary flow rate of less than 15 ml. per second. Preoperative and postoperative evaluation included symptom questionnaires and uroflowmetry. A single midline incision was made extending from the bladder neck to the verumontanum. Results were available in 64 of the 66 men who underwent the procedure with a mean followup of 2.24 years. Mean symptom scores decreased from 9.66 preoperatively to 4.59 postoperatively (p less than 0.001) and peak urinary flow rates increased from 7.4 to 14.7 ml. per second (p less than 0.0001). Antegrade ejaculation was preserved in 83.3% of the men who preoperatively had antegrade ejaculation. Subsequent transurethral resection of the prostate was required in 5 patients (7.6%). With a mean followup of greater than 2 years transurethral incision of the bladder neck and prostate was effective in treatment of bladder outlet obstruction caused by a small prostate while maintaining antegrade ejaculation in the majority of patients.     

Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique

Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.     

Prevention of post-prostatectomy vesical neck contracture by prophylactic vesical neck incision

Most vesical neck contractures occur after resection of adenomas weighing less than 20 gm. This complication is believed to be secondary to excessive resection or fulguration of an undilated bladder neck. Prophylactic bladder neck incision was performed in conjunction with transurethral resection of the prostate on 114 patients with prostatic adenomas weighing less than 20 gm. Vesical neck contracture occurred in 1 patient (0.87 per cent), compared to 12 contractures in 161 patients who underwent transurethral resection of the prostate alone (7.5 per cent). Increasing bladder neck diameter by incision appears to be protective against formation of vesical neck contractures in patients with small obstructing prostatic adenomas.     

Simultaneous transurethral resection of a bladder tumor and benign prostatic hyperplasia: Four case reports and literature review

To evaluate the recurrence of a bladder tumor on the prostate fossa and bladder neck in patients undergoing simultaneous transurethral resection of a bladder tumor (TUR-BT) and benign prostatic hyperplasia (BPH) in our hospital, we retrospectively studied four patients who underwent simultaneous TUR-BT and transurethral resection of the prostate (TUR-P) in 2001 to 2004. The pathology was confirmed histologically to be transitional cell carcinoma of the bladder tissue or atypia cells and BPH. Two patients had bladder tumor recurrence at 18 and 33 months during the postoperative follow-up period (10–36 months, with a mean of 18.5 months). One at the bladder neck recurred 33 months postoperatively, and the other in the trigone area, near the bladder neck, recurred after 18 months. After another TUR-BT, there were no more recurrences in these two patients. No tumor progressed to the invasive stage. Tumor recurrence on simultaneous TUR-BT and TUR-P patients is a key issue of concern. We present a brief history of the four patients and a literature review. We concluded that conducting the two procedures simultaneously is clinically feasible for selected patients.     

Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials

PURPOSE: Transurethral prostatic resection is the gold standard surgical treatment in men with lower urinary tract symptoms suggestive of bladder outlet obstruction but it has also been related to some risks, such as a relatively high rate of blood transfusion, sexual function problems and so forth. Transurethral prostatic incision is a simpler and less invasive procedure than transurethral prostatic resection. However, it is underused. We systematically reviewed all published randomized controlled trials comparing the effectiveness of transurethral prostatic incision with standard transurethral prostatic resection for bladder outlet obstruction and performed a meta-analysis of the available relevant data. MATERIALS AND METHODS: Nine randomized controlled trials comparing the treatment effectiveness of transurethral prostatic resection and transurethral prostatic incision were identified, evaluated and reviewed in a meta-analysis. The quality of these studies was also appraised. RESULTS: Each treatment achieved clear improvements in subjective and objective outcomes. The improvement in symptoms was equivalent 12 months postoperatively for transurethral prostatic incision and resection. For maximum flow rate transurethral prostatic resection resulted in greater improvement than transurethral prostatic incision. However, transurethral prostatic incision had several advantages over transurethral prostatic resection, such as lower incidence of complications, fewer blood transfusions, decreased risk of retrograde ejaculation, and shorter operative time and hospital stay. Also, the treatments had an equivalent incidence of postoperative catheterization duration and reoperation rate within the first 12 months. Furthermore, patients in each group had a similar subjective view of the treatments received. CONCLUSIONS: In the first 12 months after surgery transurethral prostatic incision has effectiveness that is equivalent to transurethral prostatic resection for treating patients with suspected benign prostatic obstruction who have a relatively small prostate. However, there is little evidence on the relative long-term effectiveness of the 2 treatments 2 to 5 or 10 years after surgery. There is no clear cutoff point for prostate size that leads to good results after transurethral prostatic incision. A large-scale, multicenter randomized controlled trial is now required to evaluate comprehensively the effectiveness, impact on quality of life and overall cost of transurethral prostatic incision compared with transurethral prostatic resection.     

An objective comparison of transurethral resection and bladder neck incision in the treatment of prostatic hypertrophy

Transurethral resection has become the operation of choice in almost all cases of benign prostatic enlargement. However, when the gland does not exceed 30 gm. bladder neck incision is easier to perform, results in a lower morbidity, and is less likely to be followed by incontinence and retrograde ejaculation. We studied 2 groups of men with proved obstruction. Complete urodynamic investigation was done on 51 patients before and on 44 patients after the operation. We compared our subjective and objective findings in the 2 groups. The conclusion suggest that bladder neck incision is as effective as transurethral resection in relieving the obstruction of prostatic enlargement in the presence of a small gland.     

Bladder neck stenosis after transurethral resection of prostate: does size matter?

AIM: To understand the risk factors associated with the incidence of bladder neck stenosis (BNS) after transurethral prostate surgery. PATIENTS AND METHODS: We retrospectively reviewed 900 patients who underwent transurethral prostate surgery over a 4-year period. The mean age of the men was 72.3 (47-94) years. The specific outcome data assessed related to BNS, including type of operation performed, resected tissue weight and history of previous surgery in the lower urinary tract. RESULTS: 29 (3.4%) patients developed BNS at a mean of 10.3 (3-33) months, with a mean resected prostatic tissue weight of 11+/-3.7 g. Four of the 29 patients with BNS were treated with bladder neck resection and re-stenosed. Fifty-four men underwent bladder neck incision for small prostates with a high bladder neck, measured by digital rectal examination and assessed cystoscopically, with no BNS. All the remaining patients from our series did not have a BNS, with a mean resected weight of 28+/-8.9 g, which is statistically greater than in the BNS group (p<0.05, unpaired t test). CONCLUSIONS: BNS after transurethral prostate surgery is a significant problem. It is clear from our study that resection in small prostates with no sign of a high bladder neck will increase the development of BNS. Thus, small prostates should be managed by an initial bladder neck incision, even if the bladder neck is not high.     

Unilateral bladder neck incision: endoscopic treatment of bladder neck obstruction. Results in 100 patients

Endoscopic diathermy unilateral incision of the bladder neck was carried out in 100 consecutive male patients. This procedure was performed for bladder neck obstruction and small benign prostate. The operative details of this technique are given. Follow-up after 2 months revealed excellent symptomatic and urodynamic results. Morbidity was low. Results remain stable after 13 +/- 9 months. One patient needed a transurethral resection of the prostate. Retrograde ejaculation occurred in 5% of the patients. Unilateral bladder neck incision is a simple procedure safe, and easy to learn, with a low risk of retrograde ejaculation. It is the operation of choice for small benign prostate, bladder neck obstruction and young patients.     

Significance of the extent of transurethral prostatic resection for postoperative complications

The significance of the extent of transurethral prostatic resection for benign prostatic hypertrophy was evaluated as regards early and late postoperative complications in a prospective, randomized study. The two treatment groups were preoperatively comparable in age, incidence of urinary retention and estimated prostatic weight. In 83 cases the median weight of resected tissue was 18 (range 4-118) g, while in 84 cases the resection was less extensive--median weight 7 (1-40) g. No significant intergroup difference was found in incidence of bladder tamponade, bladder perforation, urinary tract infection or pneumonia. The blood transfusion need was greatest among the patients with complete transurethral adenomectomy of the prostate. Concerning late postoperative complications, the groups did not differ in incidence of urethral stricture, bladder neck contracture or reoperation for benign prostatic hypertrophy. Patients with preoperative urethral instrumentation had heightened risk of developing postoperative urethral stricture.     

膀胱颈切开防止小体积前列腺汽化电切术后膀胱颈挛缩的回顾研究

目的比较经尿道前列腺汽化电切术（TUVP）和TUVP＋膀胱颈内切开术（TCBNI）治疗小体积前列腺增生的疗效和术后膀胱颈挛缩的发生率。方法小体积前列腺增生患者51例,均行经直肠前列腺彩超以及尿流动力学检查明确诊断,19例采用TUVP治疗,32例采用TUVP＋TCBNI治疗,比较两组之间术前术后的Qmax以及膀胱颈挛缩的发生率和预后。结果两组之间术后尿流率均较前有改善,TUVP＋TCBNI组优于TUVP组（P〈0.05）,TUVP组术后发生膀胱颈挛缩6例,尿道扩张改善3例,3例再次手术治疗,TUVP＋TCBNI组术后发生膀胱颈挛缩2例,均行尿道扩张后好转。结论对于小体积前列腺增生,TUVP以及TUVP＋TCBNI均能改善排尿梗阻症状,但是TUVP＋TCBNI组优于TUVP组,且能更有效防止并减轻术后膀胱颈挛缩的发生以及严重程度,应作为治疗小体积前列腺增生的首选术式。     

Comparative study of the Iglesias technique and the suprapubic drainage technique for transurethral resection

Previously we presented a method of suprapubic vesical drainage in which the irrigation fluid was continuously drained from the bladder during transurethral resection of the prostate gland. This method has now been compared to the Iglesias procedure of continuous irrigation. Twenty patients were used for the study, which measured blood loss, intravesical pressure, fluid resorption, operation time and flow of irrigation fluid through the bladder. Bladder pressure was also measured when using different anaesthetics. The results showed that the operation time was much shorter when the suprapubic technique was used. Bladder pressure during the suprapubic procedure was similar to intravenous pressure but was higheer with the Iglesias procedure.     

经尿道前列腺切除术后膀胱颈及前列腺窝结石的诊断和治疗（附7例报告）

目的：探讨经尿道前列腺切除术后继发膀胱颈及前列腺窝结石的诊断和治疗。方法：2005年5月～2012年7月共收治7例经尿道前列腺切除术或等离子切除术后长期膀胱刺激征和血尿的患者,经超声和CT检查诊断为膀胱颈及前列腺窝结石,采用经尿道手术对结石进行处理。结果：内镜下见7例患者的前列腺窝和膀胱颈部均有片状或斑点状黄色结石,一次手术取净结石。术后患者膀胱刺激征和血尿明显减轻。4例患者结石成分分析结果为草酸钙结石。随访16～24周,所有患者症状消失,CT检查膀胱颈及前列腺窝无结石复发。结论：经尿道前列腺切除手术后,如果患者出现长期膀胱刺激征和血尿,要考虑到膀胱颈及前列腺窝结石的可能性;超声或CT检查可帮助明确诊断;经尿道手术可彻底去除结石。     

Persistent detrusor overactivity after transurethral resection of the prostate

Detrusor overactivity is associated with aging and benign prostatic obstruction and often causes the troublesome symptoms of urgency and urgency incontinence (overactive bladder), persistent detrusor overactivity after transurethral resection of the prostate being the cause of more than a third of poor symptomatic outcomes following surgery. Most of the evidence currently suggests that neurons of the urothelium at the bladder neck play a significant role in the genesis of detrusor overactivity. Treatment options including botulinum toxin injections and intravesical vanilloids have been studied in the treatment of persistent detrusor overactivity, but further studies are needed specifically in patients with persistent detrusor overactivity after transurethral resection of the prostate. As urodynamic studies are able to predict a proportion of postoperative failures, more widespread use is advocated by many in the routine assessment of lower urinary tract symptoms thought to be due to benign prostatic obstruction.     

Identification and dissection of bladder neck during laparoscopic radical prostatectomy

Bladder neck identification and dissection is a difficult step in performing laparoscopic radical prostatectomy. We describe a transurethral technique that facilitates laparoscopic identification and incision of the bladder neck. All cases were successful, with clear and sharp bladder neck margins. All bladder neck surgical margins were tumor free.