良性前列腺增生症不同术式术后疗效不良原因的研究

目的：探讨良性前列腺增生症（BPH）不同术式术后疗效不良的原因及特点,进一步提高手术成功率。方法：应用尿动力学检测其他检查手段对84例BPH术后症状改善不良的患者按手术方式的不同分组进行检查分析。结果：尿道前列腺电切术组术后改善不良的主要原因依次为膀胱出口再梗阻（84.9％）、逼尿肌收缩无力（30.4％）和逼尿肌不稳定（DI）（18.2％）。开放组主要原因依次为逼尿肌收缩无力（52.9％）、逼尿肌不稳定（35.2％）和膀胱出口再梗阻（33.3％）。2组数据经X^2检验差异有显著性意义（P=0.000）。结论：不同手术方式,其术后疗效不良原因差异有显著性。TURP组再梗阻率远高于开放组,在一定程度上反映目前TURP手术技术有待进一步提高。术前存在逼尿肌收缩无力和DI,是导致术后疗效不良的重要因素。     

耻骨上前列腺切除术后并发症的防治

目的：探讨耻骨上前列腺切除术后常见出血,尿失禁、前列腺窝品狭窄和膀胱无抑制痉挛４种并发症的原因及防止方法,方法：采用窝品周圈深“８”字环扎血管及术皇导尿管牵拉压迫或术中经尿道电切镜电灼术;术中避免损伤胱外括约肌;缝合窝口时不缩紧,保证可容２指大小;术后由骶管内持续注入０．１２５％布比卡因,结果：采用以上措施经治１０９例患者,取得较好的临床效果,与经典的耻骨上前列腺切除术相比,术后并发症的发生率明显     

经尿道前列腺电切术与汽化切除术的并发症分析

目的 分析经尿道前列腺电切术（TURP）与经尿道前列腺汽化切除术（TVP）术中、术后常见并发症，进一步提高手术安全性和有效性。方法 回顾分析经尿道前列腺切除术4156例，其中TURP1056例，TVP3100例。比较2组患者术中、术后早期和远期并发症的发生率。结果 TURP与TVP平均手术时间分别为62min和54min，平均切除组织21．2g和36．7g。因术中出血而需输血者分别为14．1％和0．2％（P〈0．01），电切综合征（TURS）2．7％和0．9％（P〈0．01），包膜穿孔尿外渗3．7％和0．8％，术后出血2．2％和0．2％，尿路感染4．0％和5．7％，尿道狭窄2．5％和2．8％，膀胱颈部挛缩2．2％和2．1％，勃起功能障碍7．0％和2．3％（P〈0．01），逆行射精为45．0％和45．6％，永久性尿失禁各1例。结论 TURP与TVP均为良性前列腺增生安全而有效的外科治疗方法。但TURP术中出血、TURS、包膜穿孔尿外渗、术后出血、勃起障碍发生率明显高于TVP，而TVP尿道狭窄和膀胱刺激症状发生率略高于TURP组。     

良性前列腺增生症并发前列腺结核

目的：提高对良性前列腺增生症（BPH）并发前列腺结核的认识。方法：回顾性分析8例BPH并发前列腺结核患者临床资料。结果：8例BPH并发前腺结核均依靠病理检查确立诊断。1例接受抗结核治疗,1例接受TURP,6例接受开放手术。1例发生切口延迟愈合和尿瘘,另6例平均随访10.8个月,疗效满意。结论：BPH并发前列腺结核易与BPH或前列腺癌混淆,确诊依靠病理检查,一经确诊,应及时应用抗结核药物,防止并发症。     

前列腺增生症睾丸切除术后远期疗效观察

目的：探讨前列腺增生症（BPH）睾丸切除术后的远期疗效。方法：对16例在5年前进行睾丸切除术的BPH尿潴留患者进行随访，测量前列腺体积和观察排尿症状的变化。结果：睾丸切除术后5年增生前列腺体积缩小33．4％，其中12例患者排尿通畅（75．0％），剩余尿量平均28ml，1例改为膀胱造口；3例佐以α-受体阻滞剂治疗。结论：睾丸切除术后增生的前列腺发生永久性萎缩，该方法可使大部分BPH尿潴留患者缓解症状。     

良性前列腺增生症的治疗进展

前列腺是一个很小的性附属器官，由于它是尿液和精液输出的“关卡”，容易发生多种疾病，故是近年来研究的热点。良性前列腺增生症（BPH）是老年人的常见疾病，其治疗方法不断更新。10多年前的治疗方法较少，仅有TURP或开放手术，许多只有轻度或中度症状的BPH做了手术。现在的治疗方法较多，增加了许多易为患者接受的新方法，如药物治疗或微创技术治疗。为此，现将BPH治疗的最新进展综述如下。1药物治疗前列腺内的主要成分是基质，基质与腺上皮的比率为66：1[1]。基质内平滑肌与结缔组织各占38％，腺上皮与腺管胜各占12％。因此，BPH…     

前列腺增生症射频治疗疗效分析

采用经尿道射频治疗良性前列腺增生症（ＢＰＨ）患者６００例，并进行２年的随访观察。结果：４个月的主观症状缓解为７５．６％，１年为３４．７％，２年为４１．０％．高温治疗症状缓解优于低温治疗者，１年改善率分别为４１．０％及３２．６％；低龄者与高龄者疗效差别无统计学差异。９例复发者０．５年后给予第２次射频治疗，疗效优于首次治疗。认为射频治疗对ＢＰＨ的近期疗效是肯定的，主要缓解时间在３－６个月内，但其疗效与     

前列腺增生症术后再手术原因分析

目的为了探讨减少前列腺增生症术后再手术率。方法分析１９８０年１月至１９９６年６月收治的前列腺增生症术后再手术患者１８例。结果再手术主要原因为腺窝出血、腺体残留、膀胱颈挛缩和膀胱及前列腺段尿道铸型结石形成等。结论术中适当缩小膀胱颈口、常规楔形切除后唇、术后应用抗生素、避免早期剧烈活动以及彻底切除增生的腺体是防止和减少术后再手术率的关键。     

经尿道前列腺汽化电切术并发症的防治体会

目的探讨经尿道前列腺汽化电切术（TUVP）常见并发症及其处理，总结防治经验，提高TUVP的治疗效果。方法回顾有症状的行TUVP术的前列腺增生症（BPH）患者152例，对并发症的发生及处理方法随访3个月。结果本组无死亡病例，电切综合征（TURS）2例，继发性出血2例，暂时性尿失禁3例，膀胱颈挛缩1例，术后排尿困难1例，尿道狭窄9例，阳痿14例，逆行射精68例。结论TUVP与经尿道前列腺电切（TURP）有相似的并发症发生。精细地操作、有效地控制尿路感染可以减少TUVP术后并发症的发生。     

腹腔镜下耻骨后腹膜外保留尿道的前列腺切除术

目的探讨腹腔镜下经耻骨后腹膜外保留尿道的前列腺切除术治疗大腺体前列腺增生症的可行性。方法自2006年1月至2007年1月对9例前列腺增生症的病人采用腹腔镜行耻骨后腹膜外前列腺切除术,病人年龄为(77.8±6.8)岁,范围为(62～83)岁。经直肠前列腺B超显示前列腺大小为(101.3±36.2)g,范围为(62～172)g,均无明显中叶增生。腹腔镜手术包括耻骨后腹膜外腔的建立、排列成倒U字形5个穿刺套管的放置、前列腺被膜的切开、增生腺瘤的切除、前列腺部尿道的保护及前列腺被膜的缝合等主要步骤。结果9例病人手术顺利,术中出血(190±160.6)ml,范围为(60～600)ml,手术时间为(174±59.8)min,范围为(90～240)min。术后恢复顺利,尿管拔除时间为(8.4±3.8)d。术后3月复查病人尿流率、国际前列腺症状评分(IPSS)评分、生活质量评分(QOL)等较术前明显好转。术前有性功能的4例病人术后性功能无损。结论对腺体大的前列腺增生症行腹腔镜下经耻骨后腹膜外行前列腺切除术是可行的,病人创伤小、恢复快、效果满意。     

Evaluation for Madigan's prostatectomy in patients with benign prostatic hyperplasia

Aim: To comparatively evaluate the efficacy and post-operative complications of the Madigan's prostatectomy(MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasiawere divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symp-tom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The InternationalContinence Society (ICS) nomogram, Abrams-Griffiths (AG) number and linear passive urethral resistance relationanalysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamicparameters before and after operation, as well as the advantages and post-operative complications were recorded andcompared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urody-namic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantagesof the absence o     

经尿道前列腺选择性绿激光手术与经尿道前列腺电切术的疗效比较

目的评价经尿道前列腺选择性绿激光手术（greenlight photoselective vaporization of prostate,PVP）与经尿道前列腺电切术（transurethral prostatectomy,TURP）的临床疗效。方法将178例良性前列腺增生（benign prostatic hyperplasia,BPH）患者随机分为两组,95例行PVP术（PVP组）,83例行TURP术（TURP组）,比较两种术式的平均手术时间、术中出血量、输血量、近期疗效及并发症等情况。结果 PVP组和TURP组平均手术时间分别为（47.4±5.1）min和（61.7±6.2）min,前者显著低于后者,PVP组术中出血量、输血量、术后膀胱冲洗时间、留置尿管时间及住院时间均显著少于TURP组,PVP组近期并发症发生率明显小于TURP组,两组术后前列腺国际症状评分（IPSS）、生活质量评分（QOL）、最大尿流率、剩余尿量较术前均有显著改善。结论 PVP是一种安全有效的治疗BPH的理想微创术式,具有手术时间短、创伤小、出血少、恢复快、并发症发生率低等特点。     

Madigan前列腺增生切除术

为了提高前列腺增生症的手术治疗效果，采用Ｍａｄｉｇａｎ手术治疗前列腺增生症患者２５例。１５例尿道完整，１０例损伤尿道缝合修复；术后出血少、恢复快；随访４～２５个月，无尿道狭窄、尿失禁等并发症。对手术优点、术中注意事项及适应证的选择进行了讨论。     

改良 Madigan 前列腺切除术在临床的应用(附53例报告)

为了提高前列腺切除术的治疗效果，１９９３年９月～１９９６年５月对５３例前列腺增生症患者采用改良Ｍａｄｉｇａｎ前列腺切除手术。术前留置尿管后作ＣＴ检查，按ＣＴ测量前列腺体积计算重量并分度，了解尿道走向。手术特点为锐性分离前列腺与尿道、膀胱颈之间的组织及前列腺包膜，切除增生的腺体组织，保留完整尿道与膀胱颈。术后恢复快，并发症少，随访１～３２个月，疗效满意。对手术操作要点及适应证进行了讨论。     

A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia

PURPOSE: We undertook a systematic review to assess the safety and efficacy of holmium laser prostatectomy compared to transurethral resection of the prostate. MATERIALS AND METHODS: We searched literature databases through August 2002. Holmium laser studies, including holmium laser resection of the prostate (HoLRP) and holmium laser enucleation of the prostate (HoLEP), of any design, and the transurethral prostatectomy (TURP) arms of randomized controlled trials (RCTs) with sample sizes greater than 50 patients, date restricted to 1995 onward, were included for comparison. RESULTS: Three RCTs comparing HoLRP and TURP, and 2 RCTs comparing HoLEP and TURP were identified. For each of the holmium procedures there was also 1 nonrandomized comparative study and a number of case series (HoLRP 13, HoLEP 10). With the exception of 1 randomized trial the quality of the available evidence was poor, with the other RCTs lacking information regarding methods of randomization, allocation concealment and blinding. The majority of studies were characterized by relatively short followup periods and significant losses to followup. In terms of safety the data suggest that the holmium laser procedures are superior to TURP with regard to a number of key indicators of blood loss (transfusion rates, postoperative bladder irrigation, duration of catheterization and length of hospital stay), although amount of blood loss was rarely reported. In terms of efficacy the holmium laser procedures appear to be similarly effective to TURP in relieving the symptoms of benign prostatic hyperplasia. CONCLUSIONS: Holmium laser prostatectomy is at least as effective as TURP for managing the symptoms of benign prostatic hyperplasia. However, at the present time the long-term durability of the holmium procedures with respect to TURP cannot be determined due to a lack of published studies with sufficient followup.     

经腹途径机器人辅助前列腺增生切除术初步经验

目的探讨经腹途径机器人辅助前列腺增生切除术(robotic-assisted simple prostatectomy,RASP)治疗大体积良性前列腺增生的手术经验、临床安全性及可行性。 方法回顾性分析2017年1月至2021年1月期间,首都医科大学附属北京安贞医院行RASP治疗的21例前列腺增生患者临床资料,对手术程序、术中和术后所存在的问题进行总结。 结果21例患者均顺利完成手术,无中转开放手术;平均手术时间(135.7±23.2)min,平均术中出血量(168.4±21.5)ml,无输血,术后24 h内停止膀胱冲洗,拔除造口管时间为术后2 d,拔除引流管时间为术后3 d,平均拔除尿管时间(12.5±2.4)d。术后3个月复查残余尿量、最大尿流率和国际前列腺症状评分均有改善,差异有统计学意义(P<0.01)。 结论RASP治疗大体积良性前列腺增生是一种安全、有效的微创方法,可能成为大体积良性前列腺增生的可选治疗手段。     

The costs of prostatectomy for benign prostatic hyperplasia

Using claims data for a 5% random sample of Medicare beneficiaries, we estimated the costs of surgical treatment for benign prostatic hyperplasia (BPH), including those related to the initial prostatectomy, the treatment of postsurgical complications, and reoperation within one year. We identified 14,480 men who underwent prostatectomy for BPH during 1986–1987, including 13,730 transurethral and 750 open procedures. Mean total inpatient costs (including all hospital charges and professional service fees) for these procedures were estimated to be $6,501 and $10,223, respectively. Among patients who underwent transurethral and open prostatectomy, we identified 938 (6.8%) and 39 (5.2%) individuals who had at least one readmission for postsurgical complications or reoperation. Total expected costs of transurethral and open prostatectomy, inclusive of readmissions for complications and reoperations within one year, were estimated to be $6,823 and $10,477, respectively. Our study indicates the economic burden represented by surgical treatment of BPH. © 1993 Wiley-Liss, Inc.     

The 12-year outcome analysis of an endourethral wallstent for treating benign prostatic hyperplasia

OBJECTIVE

To evaluate the long‐term results of using the Urolume^TM endourethral prosthesis (American Medical Systems, Minnetonka, MN, USA) for managing benign prostatic hyperplasia (BPH), an alternative minimally invasive option.

PATIENTS AND METHODS

Sixty‐two patients with moderate/severe lower urinary tract symptoms secondary to BPH were treated with the Urolume stent by one surgeon (J.H.P.). They were followed up at 12 weeks, 6 months and then yearly. Data recorded before and after treatment included symptom scoring, peak urinary flow rate (PFR) and postvoid residual volume (PVR). A one‐way anova was used to compare baseline and the 5‐ and 12‐year follow‐up data.

RESULT

Twenty‐two and 11 patients completed the 5‐ and 12‐year follow‐up, respectively. Twenty‐one (34%) patients died with the stent in situ from causes unrelated to BPH and Urolume insertion. Twenty‐nine (47%) stents were removed; 18 in the first 2 years, seven at 3–5 years and four at 9–10 years. Early stent explantation was primarily a result of poor case selection, or stent malposition/migration. Four stents were removed because the patient was dissatisfied. Late stent explantation was for symptom progression. At 5 years, the symptom score and PFR were 6.82 an 11.7 mL/s, respectively, compared with 20.4 and 9 mL/s at basleine (P < 0.05); at 12 years, the symptom score, PFR and PVR were 10.82, 11.5 mL/s and 80 mL, respectively. The mean quality of life score was 2 and no patient opted for any further treatment.

CONCLUSION

The Urolume wallstent is a safe treatment for BPH, in selected patients. Careful case selection and experience is mandatory. This stent can provide the urologist with an alternative along with other minimally invasive treatments for men with BPH at high risk of requiring transurethral resection.