经尿道双极等离子前列腺腔内分段剜切术治疗前列腺增生症

目的探讨经尿道前列腺等离子双极分段剜切术的临床应用效果。方法对160例前列腺增生症患者采用经尿道前列腺腔内分段剜切术。对手术时间、术中出血量、术后留置尿管时间以及手术前后前列腺国际症状评分（IPSS）、生活质量评分（QOL）、最大尿流率进行比较。结果手术时间30～180min,平均（78．3±26．7）min;术中出血30～320mL,平均（152．7±65．3）mL;未发生经尿道前列腺电切综合症（TURS）及包膜穿孔;术后留置尿管时间5～7d。132例患者获得随访,随访时间6～24月,IPSS由（25．2±5．3）分下降至（8．6±4．7）分,QOL由（5．0±0．5）分下降至（2．0±1．0）分,最大尿流率由（7．2±2．6）mL／s上升至（26．8±2．7）mL／s。结论经尿道前列腺等离子双极分段剜切术是一种安全、值得临床推广应用的手术方式。     

红激光汽化术治疗良性前列腺增生症的临床应用研究

目的 探讨红激光汽化术在良性前列腺增生症患者中的应用效果.方法 2010年6月至2014年9月本院采用红激光汽化术治疗42例良性前列腺增生症患者,观察记录手术时间、出血量、手术并发症,记录并统计分析手术前和术后3个月国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)及残余尿量(PVR)等指标的差异有无统计学意义.结果 42例患者均安全顺利完成手术治疗,平均手术时间(61.52±18.48) min,术后平均尿管留置时间(4.57±1.42)d.3个月后复查,IPSS评分由术前(27.33±3.95)分降至(9.05±1.45)分,QOL评分由术前(5.17±0.79)分降至(0.95±0.56)分,Qmax由术前(6.07±1.97) mL/s升至(19.05±1.93) mL/s,PVR由术前(107.76±66.99)mL下降至(17.05±6.74) mL,血红蛋白术前术后稳定.结论 红激光汽化术治疗良性前列腺增生症安全性高,疗效可靠.     

高龄高危巨大前列腺增生症的腔内治疗

目的:探讨应用经尿道前列腺电切术治疗高龄高危巨大良性前列腺增生症的临床疗效及安全性。方法:在积极进行个体化围手术期处理的基础上,采用经尿道前列腺电切术治疗高龄高危巨大患者43例,观察平均手术时间、术中出血量、手术并发症,记录并计算手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、剩余尿量及尿流率改变等指标的差异。结果:43例均安全渡过围手术期,平均手术时间94.8min,术中出血量105.4mL,IPSS及QOL评分由术前平均31.8及5.1分别下降至10.4及1.7,最大尿流率由术前4.7mL/s增加至术后14.9mL/s,残余尿量由术前172.0mL下降至术后44.6mL,手术前后比较差异均有统计学意义(P0.05)。结论:应用经尿道前列腺电切术治疗高龄高危巨大良性前列腺增生症,疗效确切,手术安全。     

尿动力学检查术前对BPH患者TVP术后疗效的评价作用

目的：探讨尿动力学检查在术前对前列腺增生（BPH）患者行经尿道前列腺电汽化术（TVP）术后疗效的评价作用。方法：对800例拟行TVP的BPH患者术前行尿动力学检查、国际前列腺症状（IPSS）评分,并于术后随访1年,观察最大尿流率,IPSS评分。结果：800例BPH患者术前最大尿流率均〈15ml／s,IPSS评分平均〉29分。根据术前最大尿道压力、最大尿道压力与充盈时膀胱最大压力的关系、膀胱顺应性及是否存在尿道外括约肌与膀胱逼尿肌压力不协调等指标共分为四组。术后1年最大尿流率平均分别为18．3ml／s、17．9ml／s、9．2ml／s和8．2ml,s,IPSS评分平均分别为12分、11分、23分和26分。其中各组术后最大尿流率〉15ml／s,分别占89．8％、85．5％,29,2％和22．5％。Ⅰ组、Ⅱ组术后各项指标与Ⅲ组,Ⅳ组比较差异均有统计学意义（P〈0．05）。结论：尿动力学榆查对BPH患者行TVP术的疗效有良好的评价作用,可为BPH患者采用何种治疗方法提供重要依据。     

前列腺剜除联合小切口取前列腺术在前列腺支架术后晚期并发症中的应用

目的探讨前列腺剜除联合小切口取前列腺术在前列腺支架术后晚期并发症患者中的疗效。方法对2013年至2015年收治的12例前列腺支架术后有并发症的患者行前列腺剜除联合小切口取前列腺术。结果 12例患者手术均成功,手术时间58~84min,无大出血和尿外渗等并发症。术后随访,IPSS评分3~12分,QoL 0~3分,残余尿量0~82 mL,最大尿流率12~20mL/s。结论前列腺剜除联合小切口取前列腺术可有效治疗前列腺支架术后晚期并发症,具有创伤小、手术时间短等优点。     

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。     

尿道口前移-阴茎头成形术在尿道下裂再手术患者中的应用

目的观察尿道口前移-阴茎头成形术(MAGPI)在尿道下裂再手术中的应用效果。方法回顾性分析2010年9月至2020年7月于四川省人民医院小儿外科行尿道下裂再手术修复中应用MAGPI手术的31例患者资料,阴茎头区域修复采用MAGPI手术,术中再根据其合并的并发症情况选择相应的尿道下裂修复术式进行手术修复。术后随访并记录并发症发生情况、尿道下裂阴茎外观客观评分(HOSE)和自由尿流率。结果本组患者共31例,随访时间7个月～11.5年,中位随访时间6.2年。年龄在2岁6个月～24岁2个月,中位年龄5.3岁。HOSE评分(满分16分计)术前7～16分,平均(11.6±2.3)分;术后12～16分,平均(15.5±0.9)分。改良HOSE评分(满分20分计)术前11～19分,平均(15.4±2.2)分;术后16～20分,平均(19.4±0.9)分。HOSE及改良HOSE评分术前与术后差异均具有统计学意义(P=0.000)。19例获得术后3个月以上尿流率检查,最大尿流率(Qmax)8.7～29.5mL/s,平均(14.3±5.4)mL/s。结论 MAGPI术式应用于尿道下裂再手术阴茎头区的修复可获得较好的尿流率及阴茎外观的改善,术后相关并发症率不高,手术安全有效。     

单孔机器人辅助单纯前列腺切除术的初步体会

目的:探讨单孔机器人辅助单纯前列腺切除术（spRASP）治疗良性前列腺增生（BPH）的可行性及临床应用价值。方法:回顾性分析2020年11月—2021年6月上海中医药大学附属曙光医院泌尿中心7例采用spRASP治疗BPH患者的临床资料。平均年龄（67±9）岁。经估算的平均前列腺体积（78.3±12.9） mL;平均残余尿（PVR）(58.0±24.8) mL;平均国际前列腺症状评分（IPSS）(20.9±5.9)分,平均生活质量评分（QOL）(4.7±1.5)分,平均最大尿流率(Q_max)（7.9±3.6） mL/s。比较患者术前和术后3个月的IPSS评分、QOL评分、PVR、Q_max、IIEF等差异,分析评价手术疗效。结果:7例手术均顺利完成。平均手术时间（85.5±25.5） min,平均估计出血量（75.5±25.5） mL,平均留置引流管时间（3.4±0.8） d,平均留置尿管时间（7.5±1.2） d,术后平均住院时间（5.1±3.1） d。术后3个月患者平均IPSS评分（10.8±3.1）分、平均QOL评分（1.6±0.9）分、平...     

经尿道前列腺双极等离子电切术治疗前列腺增生症（附128例报告）

目的评估治疗前列腺增生症（BPH）的有效、安全的手术方法。方法采用经尿道前列腺双极等离子电切术（PKRP）治疗BPH患者128例。结果128例患者术后3个月随访,最大尿流率从7.6 mL/s增加到18.8 mL/s,国际前列腺症状评分（IPSS）从25分减少到8.7分,未出现严重并发症,疗效满意。结论经尿道前列腺双极等离子电切术是一种安全性高、并发症少、疗效确切的手术方法。     

经尿道电汽化术联合电切术治疗大体积前列腺增生症

目的探讨经尿道前列腺电汽化术（TUVP）联合经尿道前列腺电切术（TURP）治疗大体积良性前列腺增生症（BPH）的安全性及疗效。方法回顾分析体积大于60mL的345例BPH患者行TUVP联合TURP术的资料。结果345例中术中转开放手术4例，术后因膀胱积血电切镜下止血1例，开放血块清除1例，手术时间55—125min，平均75min，出现前列腺电切综合症前兆症状2例。术后随访215例，时间为3月-5年，最大尿流率Qmax由术前7．4mL／s升至术后16．7mL／s，国际前列腺症状评分（IPSS）由术前26分降至术后9分，剩余尿（Ru）由81mL降至12mL，无永久性尿失禁。结论TUVP联合TURP治疗大体积BPH手术安全、疗效满意。     

Results of holmium laser resection of the prostate for benign prostatic hyperplasia

PURPOSE: To assess the results of holmium laser resection of the prostate (HoLRP) in the treatment of benign prostatic hyperplasia. PATIENTS AND METHODS: Since October 1996, 259 patients have undergone elective HoLRP. Peak urinary flow rates (Qax), IPSS scores, and duration of catheterization and hospital stay from admission to discharge catheter free were used as outcome measures. RESULTS: There were no perioperative deaths nor cases of transurethral resection syndrome. Two patients required blood transfusion. The mean duration of catheterization was 1.6 days and the mean hospital stay 2.9 days. The mean IPSS decreased from 21.0 preoperatively to 7.0 at 1 year, whilst the Qmax increased from 10.5 mL/sec to 20.5 mL/sec. CONCLUSION: The HoLRP technique is a safe and effective treatment for benign prostatic hyperplasia, allowing resection of the prostate at the level of the capsule with minimal bleeding or fluid absorption and with results equivalent to those of standard transurethral resection.     

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.     

盐酸坦洛新（坦索罗辛）缓释片治疗良性前列腺增生症的临床疗效观察

目的探讨盐酸坦洛新（坦索罗辛）缓释片对良性前列腺增生症的治疗效果。方法自2006年9月～2007年8月,选择良性前列腺增生症患者83例,给予高选择性a,受体阻断剂盐酸坦洛新（坦索罗辛）缓释片0．2mg,每晚1次,连服4周。记录治疗前后患者的国际前列腺症状评分（IPSS）、最大尿流率（MFR）、平均尿流率（AFR）、残余尿量（Ru）、前列腺体积、血压等变化,并进行比较。结果经过4周服药治疗,患者的IPSS评分及残余尿量明显下降（P〈0．01）,而MFR与AFR均明显增加,差异有统计学意义（P〈0．01）。前列腺体积及血压治疗前后比较差异无统计学意义（P〉0．05）。结论盐酸坦洛新（坦索罗辛）对良性前列腺增生症的症状改善、提高患者的生活质量等方面具有良好的临床实用价值,且副作用较小,值得临床广泛应用。     

Efficacy and safety of intraprostatic temperature-controlled microwave thermotherapy in patients with benign prostatic hyperplasia: results of a prospective,open-label,single-center study with 1-year follow-up

BACKGROUND AND PURPOSE: Different devices for transurethral microwave thermotherapy (TUMT) are currently available for the treatment of benign prostatic hyperplasia (BPH). We evaluated the efficacy and safety of the Prostalund Feedback Treatment (PLFT), which continuously records the intraprostatic temperature, and its impact on sexual function of the patients. PATIENTS AND METHODS: A total of 41 patients with lower urinary tract symptoms attributed to BPH were entered in this prospective open-label, single-center study of PLFT. The initial evaluation was performed according to a standard protocol. At 3, 6, and 12 months, the International Prostate Symptom Score (IPSS), bother score, sexual function, and peak flow rate (Qmax) were recorded. In addition, determination of prostate volume by transrectal ultrasonography (TRUS) and measurement of residual urine volume were repeated at the 6- and 12-month visits. All adverse events were also recorded. Patients with IPSS of < or =7, > or =50% improvement in IPSS from baseline, a Qmax of > or =15 mL/sec, or > or =50% improvement in Qmax from baseline were judged responders to the treatment. RESULTS: Thirty-three of the patients completed the 12-month visit. The response rate was 88% (29 of 33 patients). There was a statistically significant decrease in IPSS at the 12-month visit, the mean IPSS being 7.1 v 21.9 at baseline (P<0.001). The mean IPSS was 10.3 and 7.6 at the 3- and 6-months' follow-up, respectively. The bother score presented a similar improvement, with a decrease from a mean of 4.2 at baseline to a mean of 1.4 after 12 months (P<0.001). The mean Qmax improved from 8.4 mL/sec at baseline to 15.9 mL/sec, 19.2 mL/sec, and 17.8 mL/sec at 3, 6, and 12 months, respectively (P<0.001). The mean change in prostate volume, as determined by TRUS, was 16 mL at 6 months and 19 mL at 12 months (P<0.001). The procedure was well tolerated. The mean post-treatment catheterization time was 17.90 days. Bladder spasms and urinary tract infection were the most common adverse events. Coitus ability remained practically unchanged after treatment (from 71% to 74.3%), but the number of patients with ejaculation decreased (from 78% to 51.4%). CONCLUSION: Our results indicate that PLFT is an effective and safe treatment for most patients with BPH.     

前列腺增生并膀胱结石的微创治疗（附34例报告）

目的：探讨前列腺增生症（BPH）并膀胱结石的微创治疗方法和疗效.方法：采用分期治疗办法,先在局麻下经尿道采用EMS系统作气压弹道碎石,3天后再行经尿道前列腺电切（TURP）.结果：34例经尿道气压弹道碎石手术时间20～60 min,平均45 min;无膀胱黏膜损伤、膀胱穿孔、泌尿系感染.患者感轻微疼痛但可忍受.其中4例患者术后排尿恢复通畅,予以出院,其余30例行TURP,手术时间20～75 min,平均50 min,术中、术后均未输血,无TUR综合征（TURS）发生.术后持续膀胱冲洗1～2天,术后5天拔除尿管,患者排尿通畅.30例患者随访3个月～2年,术后IPSS评分为（7.5±0.5）分,最大尿流率（MFR）平均〈15 ml/s.结论：TURP结合EMS系统气压弹道碎石术是BPH并膀胱结石的一种安全、有效的治疗方法.     

Feedback microwave thermotherapy with the ProstaLund Compact Device for obstructive benign prostatic hyperplasia: 12-month response rates and complications

PURPOSE: To evaluate the effectiveness of the ProstaLund Compact Device in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: A series of 38 consecutive patients with a mean age of 72.6+/-8.2 years, 19 with an indwelling catheter, underwent transurethral microwave thermotherapy (TUMT) with the ProstaLund Compact Device. Pretreatment evaluation included transrectal ultrasonography (TRUS), urodynamics, and cystoscopy for all patients and flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS), and quality-of-life (QoL) assessment for those without a catheter. The mean prostate volume was 63.5+/-30 cc. The Qmax, IPSS, and QoL studies were repeated at 3, 6, and 12 months, while urodynamics, cystoscopy, and TRUS were repeated at 6 and 12 months. RESULTS: The treatment lasted a mean of 43.1+/-17.1 minutes, achieved a maximal intraprostatic temperature of 58.7+/-7.2 degrees C, and destroyed 18.4+/-14.3 g of prostatic tissue. Twelve months post-treatment, for the patients without a catheter preoperatively, the IPSS was improved from 21.5+/-6.3 to 6.5+/-3.1 (P<0.001), Qmax from 7.2+/-3.1 mL/sec to 18.1+/-7.4 mL/sec (P<0.001), detrusor pressure at Qmax from 87.5+/-15 cm H2O to 48.4+/-16.4 cm H2O (P<0.001), and PVR from 113.2+/-78.2 mL to 34.6+/-36.7 mL (P<0.01). The good-response rates for IPSS (or=50% improvement), Qmax (>or=15 mL/sec or >or=50% improvement), PVR (<50 mL or >or=50% decrease), and QoL (相似文献   

高龄前列腺增生患者手术的临床效果评估

【摘要】目的 探讨高龄前列腺增生患者行前列腺等离子电切术治疗的临床效果。方法 选取2012年7月至2014年8月在本院治疗的高龄前列腺增生患者78例,采用经尿道前列腺增生等离子电切术治疗,观察患者治疗前后国际前列腺症状评分（IPSS）、膀胱过度活动症状评分（OABSS）、生活质量评分（QOL）、最大尿流速率（Qmax）、残余尿量（PVR）等指标。结果 78例患者均顺利完成手术,术中无包膜穿孔、尿道括约肌以及输尿管口损伤,所有患者术后随访6个月,无尿失禁以及前列腺增长复发等情况;患者术后6个月IPSS、OABSS和QOL评分分别为（10.27±3.41）分、（3.86±1.44）分和（2.18±0.94）分,明显低于手术前的（22.18±5.18）分、（5.97±1.36）分和（5.11±0.12）分,差异比较有统计学意义（P＜0.05）;患者术后6个月Qmax为（15.24±2.84）mL/s,明显高于术前的（8.87±1.59）mL/s,差异比较有统计学意义（P＜0.05）;患者术后6个月PVR为（21.05±2.56）mL,低于术前的（105.56±32.19）mL,差异有统计学意义（P＜0.05）。结论 高龄前列腺增生患者行前列腺等离子电切术治疗有较好的临床效果,且安全可靠,值得在临床推广。     

经尿道前列腺汽化电切术治疗前列腺增生症

目的探讨经尿道前列腺汽化电切术治疗良性前列腺增生（BPH）的疗效。方法采用经尿道前列腺汽化切割并电切术（TUVP）治疗前列腺增生患者215例,年龄58～93岁,平均69-4岁,病程1个月～8年,术前IPSS评分平均为30．2分。结果所有手术均取得成功,无一例转为开放手术,平均手术时间50min,术中无输血,未出现严重的并发症。术后随访1年以上67例,其中短暂尿失禁8例,经保守治疗后均于1个月内恢复。术后IPSS评分平均8．6分;平均最大尿流率（Qmax）18．8mVs,与术前比较差异均有统计学意义。结论将电切与汽化切割相结合行经尿道前列腺切除是一种微创、安全性高且疗效确切的BPH治疗方法。     

Holmium laser enucleation for large (greater than 100 mL) prostate glands

BACKGROUND: To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands > 100 mL. METHODS: Eighteen patients with preoperative prostate volumes > 100 mL underwent the HoLEP procedure. The criteria for surgery were determined by a preoperative International Prostate Symptom Score (IPSS), a prior failure of medical therapy, and urinary retention. RESULTS: The mean preoperative IPSS and prostate gland size were 13.8 and 142.3 mL, respectively. The total energy used by the laser was 288.4 kJ. The mean catheter time was 23.8 h and, perioperatively, no patients had electrolyte abnormalities or required blood transfusions. The 3-week postoperative IPSS was 2.8, with minimum long-term complications. CONCLUSIONS: Holmium laser enucleation of the prostate with TUSTM is a safe and effective alternative to open prostatic surgery for glands > 100 mL.