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1.
PURPOSE: To compare the efficacy and safety of the PlasmaKinetic (PK) Superpulse system with that of conventional transurethral resection of the prostate (TURP) in terms of restoration of urinary flow and early postoperative course. PATIENTS AND METHODS: One hundred five men older than 45 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia (BPH) were randomized, 51 undergoing standard TURP with glycine as the irrigation fluid and 53 TURP with the PK Superpulse system with normal saline as irrigant. The operative time, intraoperative blood loss, catheter time, change in serum electrolytes (particularly sodium), and uroflowmetry and American Urological Association (AUA) Symptom Scores were compared. RESULTS: The blood loss as well as the catheter time observed in the PK Superpulse arm were significantly less than those in the conventional-TURP arm. The mortality rate was 0 in both the arms. The mean operative time was less in the PK Superpulse arm, although not significantly so. Hyponatremia was statistically insignificant. Significant changes were observed in the AUA Scores in both arms. CONCLUSION: The PK Superpulse system provides faster removal of tissue in a bloodless field with better views and a safer environment of saline irrigation with efficacy comparable to that of conventional TURP. However, further randomized trials with extended follow-up may be needed to better define the role of the PK Superpulse system in treating patients with symptomatic BPH.  相似文献   

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The aim of this study was to compare the clinical results of plasmakinetic resection of the prostate (PRP) with standard transurethral resection (TUR) of the prostate (TURP). A total of 240 patients (mean age 63.5; age range 52-90 years), with symptomatic benign prostatic hyperplasia were randomized into two groups and treated with two different techniques (TURP and PRP). We evaluated pre-operative, per-operative and post-operative (first and 12th months) findings of all patients. The mean catheterization time was 3 and 4.5 days in the PRP and standard TURP groups, respectively (P<0.001). We observed the improvements in maximum flow rates in PRP group were significantly higher than TURP group (P<0.001). TUR of the prostate using plasmakinetic energy seems to be a promising treatment alternative to conventional TURP. It has the advantages of low intraoperative and post-operative complications, short convalescence, excellent intraoperative hemostasis, absence of fluid absorption and TUR syndrome.  相似文献   

4.
OBJECTIVE: To report the results and long-term follow-up of transurethral resection of the prostate (TURP) with a new resection device, the Rotoresect (Karl Storz, Tuttlingen, Germany). PATIENTS AND METHODS: Most endoscopic resection techniques for benign prostatic tissue aim for high ablation rates and minimal bleeding. Available resection electrodes are effective, but cause high blood loss (loop electrode), or less bleeding but poorer ablation rates (electrovaporization). To resolve these conflicts the Rotoresect was developed in 1995; it consists of a specially designed rotating resection electrode, driven by a micromotor, and a high-frequency current to enable simultaneous coagulation, vaporization and mechanical tissue removal during resection. To date, 84 patients with benign prostatic hyperplasia have had their prostate resected with this device (mean prostate size 46.0, sd 18.4 mL) and have been assessed for up to 4 years. RESULTS: During resection there was very little bleeding, with no significant changes in haemoglobin or sodium levels. The mean (sd) duration of catheterization was 1.4 (1.1) days; the urinary peak flow rate was improved from 9.7 (3.2) to 24.2 (8.23) mL/s and the residual urine volume reduced from 187.3 (109.6) to 22.7 (19.5) mL. The International Prostate Symptom Score and quality-of-life index were both improved, from 24.0 (7.5) to 4.1 (2.7), and 4.2 (3.2) to 0.8 (0.9), respectively. Overall the results were stable during the 4 years of follow-up. CONCLUSION: The Rotoresect combines the advantages of standard resection (high ablation rate) by actively rotating the resection electrode, and the haemostatic effect of electrovaporization (minimal blood loss) by simultaneous tissue coagulation and vaporization.  相似文献   

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PURPOSE: To present our 2-year data comparing photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP) for patients suffering from lower urinary tract symptoms (LUTS) secondary to large-volume benign prostatic hyperplasia. MATERIALS AND METHODS: In this prospective, nonrandomized study, 81 patients with a prostate volume of between 70 and 150 mL underwent either PVP (40) or TURP (41). All patients were preoperatively assessed by International Prostate Symptom Score (IPSS), transrectal ultrasonography (TRUS), uroflowmetry, and postvoid residual urine (PVR) measurement. We compared parameters, complications, and functional follow-up between the groups. RESULTS: The baseline characteristics of the two groups were similar. Mean operative time was 126.2 +/- 17.4 minutes for PVP and 77.9 +/- 8.3 minutes for TURP (P < 0.001). Bleeding requiring blood transfusion in one patient and transurethral resection (TUR) syndrome in one patient were observed in the TURP group. Catheter indwelling times and hospitalization times of patients in the PVP group were all shorter than those of patients in the TURP group (P < 0.001). In both the groups, an immediate and highly significant improvement of maximum urinary flow rate (Q(max)), PVR, and IPSS was evident. Capsule perforation was observed in one patient undergoing TURP. Reoperation was required in three patients in the group of PVP and one patient in the TURP group. We observed urethral stricture in two patients after TURP. CONCLUSION: The postoperative micturition improvement was significant and lasting, and was equivalent in both groups. The rate of late complications is equally low with both procedures. Catheterization time and hospital stay were significantly shorter with PVP.  相似文献   

8.
OBJECTIVE: To assess the long-term efficacy and the safety of plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK) against standard transurethral resection of the prostate (TURP) for symptomatic prostatic obstruction. PATIENTS AND METHODS: Of 75 patients admitted to our clinic with symptomatic prostatic obstruction between 2001 and 2003, 40 who were randomized to undergo either TURP or PKVP, and who had returned for the follow-up, were included in this study. All treated patients completed the 36-months of follow-up; 25 had had PKVP and 15 a standard TURP. After surgery the treatment outcome was evaluated using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q(max)) and long-term complications of surgery. RESULTS: The two groups had similar baseline characteristics. The improvement in both groups was statistically significant for the IPSS and Q(max) at 24 and 36 months vs the baseline values (P < 0.05). The mean (sd) IPSS decreased from 21 (3.4) to 7.1 (1.5) and 7.6 (1.4) after PKVP and from 22 (3.8) to 5.2 (1.1) and 5.7 (1.2) after TURP, at 24 and 36 months, respectively. The mean Q(max) for the both groups increased significantly from baseline values at 2 and 3 years, respectively, at 20.8 (2.4) and 21.8 (3.1) mL/s after TURP, which was statistically significantly better than after PKVP, at 12.5 (2.1) and 14.4 (2.6) mL/s, respectively (P < 0.05). Although three patients (12%) in the PKVP group had TURP at 14, 20 and 36 months, respectively, for residual adenoma tissue, one patient had an additional operation after TURP. Bulbar urethral strictures occurred in one patient in each group, requiring internal optical urethrotomy. Erectile dysfunction was reported by three patients after PKVP (12%) and by two of 15 after TURP who were potent before surgery (P > 0.05). The retrograde ejaculation rates in patients with erectile function were similar in both groups (56% and nine of 15, respectively; P > 0.05). In the PKVP and TURP groups, 12 (48%) and nine of 15 patients were satisfied overall. CONCLUSIONS: Although early results showed that PKVP was a good alternative technique among the minimally invasive methods for surgically managing prostatic obstruction, the clinical outcome of PKVP in the long term was not comparable to the results after TURP.  相似文献   

9.
Talic RF  El Tiraifi A  El Faqih SR  Hassan SH  Attassi RA  Abdel-Halim RE 《Urology》2000,55(6):1503-90; discussion 890-1
Objectives. Transurethral vaporization resection of the prostate (TUVRP) is a recent modification of the standard transurethral prostatectomy (TURP). The procedure uses one of the novel, thick resection loops coupled to augmented electrocutting energy. We evaluated the safety and efficacy of TUVRP in comparison with TURP.Methods. Sixty-eight patients with prostatic outflow obstruction were prospectively randomized between equal TUVRP and TURP treatment groups. Safety parameters evaluated included changes in serum hemoglobin, hematocrit, and sodium 1 and 24 hours after resection. Operative time, catheterization time, and incidence of complications were noted. Efficacy parameters included evaluation by the International Prostate Symptom Score and maximum flow rate.Results. Patients of both groups were balanced for the different baseline variables. One hour after TURP, patients had significantly lower levels of hemoglobin, hematocrit, and sodium (P = 0.03, 0.03, and 0.01, respectively). The prostate resection weight was similar in both groups; however, the difference in the mean operative time was significant (TUVRP group 42.4 minutes and TURP group 35.9 minutes, P = 0.02). The postoperative catheterization time was significantly shorter for the TUVRP group (23.1 ± 10.3 versus 36 ± 17.3 hours, P <0.0001). All patients were followed up for an average of 9 months. The International Prostate Symptom Score was 4 ± 3.4 and 5.6 ± 3.1 and the maximum flow rate was 19 ± 6.5 and 15.2 ± 10 mL/s for the TUVRP and TURP groups, respectively; these differences were statistically significant (P = 0.03 and 0.01, respectively). Complications included urethral strictures (6 patients) and delayed hemorrhage with clot retention (2 patients); no differences in the incidence of complications were noted between the two groups.Conclusions. The results of the present study have demonstrated that TUVRP is as safe and efficacious as TURP in the treatment of men with prostatic outflow obstruction. The shorter catheterization time observed after TUVRP may be clinically significant, considering the demand for lower morbidity profiles by patients. The longer operative time in TUVRP was related to the slower motion of the Wing electrode needed to add the advantages of electrovaporization.  相似文献   

10.
OBJECTIVE: To compare the haemostatic properties of standard transurethral resection of the prostate (TURP) and transurethral vaporization resection of the prostate (TUVRP), as perioperative bleeding is still regarded as the major complication of prostate resection. MATERIALS AND METHODS: Isolated blood-perfused porcine kidneys were used to determine the haemostatic efficacy of TURP and TUVRP (using two different electrodes). Bleeding was quantified precisely in relation to tissue ablation for the two techniques, and specimens were evaluated histologically. RESULTS: Both TUVRP groups had significantly less bleeding (P = 0.005) than the TURP group for a standardized ablation volume of perfused kidney tissue (18.9, 19.5 and 24.1 mL/min, respectively). The different TUVRP electrodes had no significant haemostatic differences. The histology showed significantly (P = 0.03) larger coagulation zones for the TUVRP groups than for standard TURP. CONCLUSIONS: TUVRP ex-vivo was associated with significantly better haemostasis than TURP. The haemostatic properties of different active electrodes for TUVRP seem to be equivalent.  相似文献   

11.
目的:探讨经尿道前列腺汽化电切术(transurethral vaporization resection of prostate,TUVRP)常见并发症的原因及防治措施,以减少并发症的发生,提高疗效。方法:回顾分析为317例良性前列腺增生患者行TUVRP的临床资料。结果:2例(0.6%)发生电切综合征,3例(0.9%)前列腺包膜穿孔,8例(2.5%)术后出血,6例(1.9%)不完全尿失禁,1例(0.3%)永久性尿失禁,7例(2.2%)发生尿道狭窄,3例(0.9%)腺体残留再次手术。结论:TUVRP治疗良性前列腺增生症效果良好,但仍有一定的并发症发生率,充分的术前准备、术中精细操作可减少并发症的发生,提高手术疗效。  相似文献   

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目的:通过比较经尿道选择性绿激光汽化和电切术治疗输尿管口周围腺性膀胱炎的术后临床指标,探讨经尿道选择性绿激光汽化术治疗输尿管口周围腺性膀胱炎的安全性和疗效.方法:对46例经病理活检证实侵及输尿管口的弥漫型腺性膀胱炎患者,采用单盲随机的方试,分别运用经尿道选择性绿激光汽化和电切术两种治疗方法,并对治愈率、有效率指标进行比较分析.结果:经尿道选择性绿激光汽化组较电切组治愈率、有效率明显提高.两组指标差异有统计学意义(P<0.01).结论:经尿道绿激光汽化术是目前治疗侵及输尿管口的弥漫型腺性膀胱炎较为理想的方法.  相似文献   

13.
目的:对比经尿道选择性绿激光前列腺汽化术(photoselective vaporization of prostate,PVP)与经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗良性前列腺增生症(benign prostate hyperplasia,BPH)的安全性及有效性。方法:按Cochrane系统评价方法,计算机检索Cochrane library、Medline、Embase、CNKI、CBM、万方、维普等文献资料库;手工检索中文泌尿外科期刊的相关文献。收集对比PVP及TURP治疗BPH的随机对照试验,质量评价后采用RevMan 5.0软件进行Meta分析。结果:共纳入5个符合要求的RCT研究,共528例患者。Meta分析结果显示:(1)有效性方面:PVP及TURP治疗BPH,术后6个月国际前列腺症状评分、生活质量、最大尿流率和残余尿量指标差异均无统计学意义(P>0.05)。(2)安全性方面:与TURP相比,PVP手术时间较长[MD=28.97,95%CI(9.72,48.21)],术后留置导尿时间短[MD=-2.86,95%CI(-4.58,-1.13)],住院时间较短[MD=-2.32,95%CI(-2.79,-1.85)],术中输血较少[OR=0.08,95%CI(0.02,0.34)],术后尿道狭窄率无显著差异[OR=0.74,95%CI(0.27,2.07)]。结论:PVP与TURP均能显著改善轻、中度前列腺增生患者的症状,具有相似的临床疗效。与TURP相比,PVP操作更安全,术后留置导尿时间及住院时间更短;术后尿道狭窄发生率方面两种术式无显著差异。  相似文献   

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BACKGROUND AND PURPOSE: With the improvement of medical therapy and minimally invasive surgical treatments for benign prostatic hyperplasia, the number of transurethral resections of the prostate (TURPs) done in training is decreasing. With fewer TURPs being performed, proficiency in this basic urologic technique has decreased, causing longer resection times. This often leads to a higher risk of fluid absorption, water toxicity, and hyponatremia (TUR syndrome). We examined the safety of bipolar electrocautery TURP (saline TURP) with the Gyrus PlasmaKinetic system using normal saline as irrigant. PATIENTS AND METHODS: Twenty-one men aged 54 to 85 years (median 70.0 years) underwent saline Plasma- Kinetic TURP from June 2002 to August 2003. Serum sodium, chloride, hemoglobin, and hematocrit were measured 1 hour prior to and 1 hour after TURP. Resection time, tissue weights, hospital stay, and catheter time were recorded and analyzed. RESULTS: The median preresection and postresection sodium concentrations were 139.0 mEq/mL and 140.0 mEq/L, respectively (ranges 130-142 mEq/L and 134-143 mEq/L). The corresponding chloride values were 106.5 mEq/L and 109.0 mEq/L (ranges 102-114 mEq/L and 106-116 mEq/L), and the hemoglobin and hematocrit values were 13.4 g/dL and 40.1 g/dL (8.7-15.2 g/dL and 33.7-46.7 g/dL) and 12.0 g/dL and 36.6 g/dL (8.2-14.4 g/dL and 27.5-43.7 g/dL), respectively. The median resection time was 65 minutes (range 45-140 minutes), and the median resected tissue weight was 20 g (range 5-61 g). There was no statistically significant difference between the preresection and postresection sodium concentrations, and no patient exhibited any clinical sign of TUR syndrome. CONCLUSION: Gyrus PlasmaKinetic TURP using normal saline as the irrigant is a safe alternative to and is technically no different from traditional monopolar TURP. The system also provides the longer time needed to train urology residents without compromising patient safety.  相似文献   

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目的:探讨经尿道前列腺电切术(TURP)和经尿道前列腺汽化切除术(TUVP)单独或联合治疗BPH的安全性和疗效。方法:2009年6月~2012年6月采用TURP和/或TUVP治疗BPH患者376例,其中TURP组116例,TUVP组125例,TURP与TUVP联合组(联合组)135例。经直肠B超检查计算三组前列腺重量分别为(81.3±22.8)、(78.5±21.5)和(82.2±20.6)g。比较三组之间手术时间、术中出血量、切除组织量、术后并发症等指标,以对比手术安全性;比较术前及术后3个月的Qmax、剩余尿量(RUV)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标,以对比其临床疗效。结果:TURP组、TUVP组和联合组的手术成功率分别为98.3%(114/116)、98.4%(123/125)和99.3%(134/135)(P0.05);平均手术时间分别为(43.2±12.4)min、(55.3±14.5)min和(47.4±13.1)min(P0.05);平均出血量分别为(220.4±50.5)ml、(85.5±24.6)ml和(100.4±30.2)ml(P0.05);平均切除组织质量分别为(49.2±11.3)g、(52.7±13.3)g和(50.4±12.6)g(P0.05);经尿道前列腺电切综合征(TURS)发生率分别为2.6%(3/116)、0.8%(1/125)和0.7%(1/135)(P0.05);术后暂时性尿失禁发生率分别为1.7%(2/116)、4.8%(6/125)和1.5%(2/135)(P0.05);术后3个月尿道狭窄发生率分别为1.7%(2/116)、4.0%(5/125)和1.5%(2/135)(P0.05)。三组患者术后3个月的Q max均较术前明显增加(P0.05),术后IPSS、QOL、RUV均较术前明显下降(P0.05),三组之间各指标比较差异均无统计学意义(P0.05)。结论:TURP、TUVP单独或联合均为治疗BPH的有效方法,TURP联合TUVP治疗兼有两者的优点,切割速度快,止血彻底,安全高效,并发症少,是治疗BPH的更好选择。  相似文献   

16.
Ruszat R  Wyler SF  Seitz M  Lehmann K  Abe C  Bonkat G  Reich O  Gasser TC  Bachmann A 《BJU international》2008,102(10):1432-8; discussion 1438-9

OBJECTIVES

To evaluate the intermediate‐term clinical efficacy and the rate of complications in 80 W photoselective vaporization of the prostate (PVP) with the potassium‐titanyl‐phosphate laser (GreenlightTM, (AMS, Minnetonka, MN, USA) compared with transurethral resection of the prostate (TURP) in a prospective non‐randomised two‐centre study.

PATIENTS AND METHODS

From December 2003 to August 2006, 396 patients (PVP 269, TURP 127) with lower urinary tract symptoms secondary to benign prostatic hyperplasia were included in the study. There was a significant difference in mean age (72 years for PVP vs 68 for TURP, P = 0.001). Patients were therefore stratified in age categories (<70, 70–80, >80 years) and compared for perioperative variables, functional outcome and complications, with a follow‐up of up to 24 months.

RESULTS

The mean prostate size was greater (overall, 62 vs 48 mL, P < 0.001) and mean operative duration longer (overall 72 vs 53 min; P = 0.001) for PVP in all age categories. The rate of intraoperative bleeding (3% vs 11%), blood transfusions (0% vs 5.5%) and capsule perforations (0.4% vs 6.3%), and early postoperative clot retention (0.4% vs 3.9%) was significantly lower for PVP. Hospitalization time was significantly shorter in the PVP group for patients aged <70 years (3.0 vs 4.7 days) and 70–80 years (4.0 vs 5.0 days; P = 0.001). The improvement of peak urinary flow rate was higher after TURP for any age category. The International Prostate Symptom Score and postvoid residual volume during the follow‐up showed no significant difference. After 12 months the overall prostate size reduction was 63% (?30 mL) after TURP and 44% (?27 mL) after PVP. The rate of repeat TURP/PVP was higher in the PVP group (6.7% vs 3.9%, not significant) within the follow‐up of up to 2 years. The incidence of urethral and bladder neck strictures was comparable.

CONCLUSIONS

PVP was more favourable in terms of perioperative safety. Although patients assigned for PVP were older and had larger prostates, PVP resulted in a similar functional outcome. Further follow‐up is needed to draw final conclusions about the long‐term efficacy of PVP.  相似文献   

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经尿道电汽化前列腺切除术电切综合征27例   总被引:2,自引:1,他引:1  
目的探讨经尿道电汽化前列腺切除术(transurethral vaporization of the prostate,TUVP)发生经尿道电切综合征(transurethral resection syndrome,TURS)的原因及诊治经验. 方法回顾性分析我院2002年9月~2005年3月322例TUVP发生27例TURS的临床资料. 结果 27例平均手术时间95 min(52~170 min) ,平均出血量251 ml(100~700 ml),切除前列腺组织16~82 g,平均36.1 g.21例前列腺被膜切破(77.8%).27例术后均有打呵欠,血压下降,同时伴有心率过缓,27例TURS时血清Na (122.3±9.6)mmol/L,较术前下降(16.3±4.5)mmol/L,差异有显著性(t=14.211,P<0.001).经及时10%氯化钠溶液、血管活性药、利尿等治疗后,26例迅速恢复正常;1例前列腺创面渗血合并膀胱血块填塞,开放手术治愈.27例随访1~3个月,Qmax(20.2±5.2)ml/s,无尿失禁. 结论前列腺被膜穿孔、静脉窦(丛)被切破、高压冲洗下电切、手术时间过长(超过90 min),促使TURS的发生;认识TURS的早期症状,及时采取治疗措施,可使病人转危为安.  相似文献   

18.
PURPOSE: To determine the incidence of erectile dysfunction (ED) after PlasmaKinetic vaporization of the prostate (PKVP) using objective and subjective parameters and risk factors. PATIENTS AND METHODS: A total of 153 men completed a questionnaire detailing perceived sexual dysfunction and underwent nocturnal penile-tumescence testing using the RigiScan for three consecutive nights 3 or 4 days preoperatively and 3 months postoperatively. The International Index of Erectile Function (IIEF)-5 scores were obtained preoperatively and postoperatively. Full details of each operation were recorded, including grams of tissue resected, operative time, any short-term complications, especially emphasizing capsular perforation, and concomitant diseases such as diabetes and hypertension. The association of risk factors with the development of ED after PKVP was assessed. Complete data were available for 103 men (67.3%). Their mean age was 62.1 years (range 48-83 years). RESULTS: Postoperatively, 11 patients (10.6%) were found to have ED. Patients who developed ED postoperatively had a lower IIEF-5 score and penile-tumescence parameters preoperatively (for all parameters, P < 0.0001). As risk factors, diabetes, capsular perforation, and an IIEF-5 score <21 were found to be significant. CONCLUSIONS: The incidence of ED after PKVP measured objectively was 10.6%. In the absence of the risk factors, PKVP is a safe therapeutic strategy with regard to sexual function.  相似文献   

19.
Objective: To determine the chemical composition of surgical smoke produced during transurethral resection of the prostate (TURP) and vaporization. Methods: A total of 12 smoke samples were collected from a continuous irrigation suction drainage system to a Tenax absorber at a 0.05 L/min flow rate during TURP and vaporization. The gases were quantitatively and qualitatively analyzed by gas chromatography‐mass spectrometry (GC‐MS) equipped with a purge and trap sample injector. Results: The main chemical constituents of surgical smoke produced during TURP and vaporization include propylene, allene, isobutylene, 1,3‐butadiene, vinyl acetylene, mecaptomethane, ethyl acetylene, diacetylene, 1‐pentene, EtOH, piperylene, propenylacetylene, 1,4‐pentadiene, cyclopentadiene, acrylnitrile and butyrolactone. Three of the constituents are very toxic and carcinogenic (1,3‐butadiene, vinyl acetylene and acrylonitrile). The amount (mean ± standard deviation) of chemical components in the 45 L of gas and room air mixture produced during TURP and vaporization were as follows: propylene, 0.80 ± 0.52 mg; isobutylene, 212.85 ± 75.65 mg; 1,3‐butadiene, 0.93 ± 0.34 mg; ethyl acetylene, 0.09 ± 0.05 mg; 1‐pentene, 6.75 ± 1.62 mg; 1,4‐pentadiene, 0.06 ± 0.02 mg; and acrylonitrile, 1.62 ± 1.19 mg. Conclusions: Three of the toxic gases generated during TURP and vaporization are carcinogens (1,3‐butadiene, vinyl acetylene and acrylonitrile). Therefore, higher quality filter masks, smoke evacuation devices and/or smoke filters should be developed for the safety of the operating room personnel and patients during TURP and vaporization.  相似文献   

20.
经尿道前列腺电汽化术的合并症   总被引:89,自引:1,他引:89  
报告57例前列腺增生症患者在经尿道前列腺电汽化术(TUVP)治疗中发生6例次(10.5%)合并症,其中TUR综合征1例(1.8%),术后继发膀胱出血1例(1.8%),术后膀胱颈挛缩2例(3.5%)及尿道外口狭窄2例(3.5%)。分析了其发生原因并提出防治措施,所有患者预后良好  相似文献   

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