经尿道前列腺汽化电切术治疗前列腺增生症

1998年2月以来,我们采用汽化切割圈(Vapor-tome)行经尿道前列腺汽化电切术(TUEVAP)治疗前列腺增生症(BPH)126例,效果满意,报告如下.     

经尿道前列腺汽化电切术

国外学者将经尿道前列腺汽化电切术(TULP)与经尿道前列腺电切术(TURP)、激光凝固汽化前列腺(TULP)进行了比较，发现TUVP在去除组织、解除梗阻、改善尿流率等方面与TURP相似，优于TULP，术中、术后并发症亦少，且随访效果TUVP也优于激光组。     

汽化电切术治疗前列腺增生症疗效观察

我科 1998年 4月～ 2 0 0 1年 3月对2 78例前列腺增生症病人施行经尿道前列腺汽化电切术 (ＴＵＥＶＡＰ) ,取得满意疗效。现报道如下。1　临床资料1 1　一般资料　 2 78例前列腺增生病人全部经肛门指检、Ｂ超检查前列腺三径、残余尿测定、尿流率检查、前列腺特异性抗原 (ＰＳＡ)检查 ,并经术后病理证实诊断无误。年龄 6 0～ 88岁 ,平均 ( 70 90±6 43)岁。前列腺重量 ( 5 3 14± 2 8 9)ｇ。2 78例中有 42例伴慢性尿潴留病人术前已行耻骨上膀胱造瘘术 (ＳＰＣ) ( 15 11% )。肾盂积水 17例 ( 6 11% ) ,肾功能不全 2 3例 ( 8 7% ) ,高血压 …     

电汽化加电切术治疗前列腺增生症36例报告

2002年3月至2005年4月,我院采用经尿道前列腺电汽化术（TUP）加前列腺电切术（TURP）治疗前列腺增生症36例。现报告如下。     

经尿道前列腺汽化电切术治疗前列腺增生症58例

2002年3月～2005年1月,我们对58例前列腺增生症（BPH）者行经尿道前列腺汽化电切术（TUVP）,疗效满意。现报告如下。     

经尿道前列腺汽化电切术治疗前列腺增生症48例

2002—09／2006—01我们对48例前列腺增生症（BPH）病人行经尿道前列腺汽化电切术（TUVP），疗效满意，现总结报告如下。     

前列腺汽化电切术后规范化康复43例

经尿道前列腺汽化电切术(TURP)是手术治疗前列腺增生(BPH)的新技术,因其手术时间短、出血少、无切口、恢复快在临床得到广泛应用。老年患者多伴有心肺疾病、糖尿病等基础疾病,传统的术后康复治疗恢复效果不理想,易出现再度尿     

经尿道前列腺汽化电切术治疗前列腺增生症的体会

目的 探讨经尿道前列腺汽化电切术治疗前列腺增生症的临床效果. 方法 采用经尿道前列腺汽化电切术治疗前列腺增生症患者106例. 结果 平均手术时间80 min,手术顺利,出血量少,无经尿道电切综合征发生,疗效满意. 结论 经尿道前列腺汽化电切术是治疗前列腺增生症的理想方法 ,其安全性高,疗效显著,并发症少,值得推广.     

经尿道部分前列腺汽化电切术治疗高危前列腺增生症

目的 探讨治疗高危前列腺增生症(BPH)安全有效的手术方法.方法 对121例高危BPH患者采用联合经尿道汽化电切(TUVP)和经尿道电切(TURP)部分前列腺进行治疗.结果 切除前列腺重量15～70 g,平均47.5 g,手术时间30～105 min,平均55 min,失血量80-210 ml,无电切综合征(TRUS)发生,无手术死亡,术后国际前列腺症状评分(IPSS)明显下降、生活质量评分(QOL)明显提高.结论 联合经尿道部分前列腺汽化电切和电切术治疗高危前列腺增生症是安全有效的手术方法.     

经尿道前列腺汽化电切术与等离子电切术治疗高龄高危良性前列腺增生的疗效比较

我院于2008年11月至2010年11月,分别采用经尿道前列腺汽化电切术(TUVP)及等离子电切术(PKRP)治疗高危前列腺增生(BPH)患者148例,取得了较好的治疗效果。     

Bacteremia in connection with transurethral resection of the prostate

Summary A bacteriological survey of 50 consecutive patients undergoing transurethral resection of the prostate was performed. Preoperatively, 28% of the patients had asymptomatic bacteriuria. In the postoperative period, 46% of all the patients developed transient bacteremia. A significantly higher rate of bacteremia was found in patients with hypertrophy of the prostate than in those with cancer of the prostate and in patients undergoing long-lasting surgical intervention. Patients who developed bacteremia due to pathogenic bacteria were hospitalized for a significantly longer period of time.

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Bakteriämie in Verbindung mit transurethraler Prostataresektion

Zusammenfassung Bei 50 nacheinander zur transurethralen Prostataresektion eingewiesenen Patienten wurden bakteriologische Untersuchungen durchgeführt. Präoperativ hatten 28% der Patienten eine asymptomatische Bakteriurie. In der postoperativen Phase wurde bei 46% der Patienten eine vorübergehende Bakteriämie nachgewiesen. Patienten, die wegen Prostatahypertrophie operiert wurden, wiesen signifikant häufiger eine Bakteriämie auf als Patienten mit Prostatakarzinom und Patienten, bei denen ein langdauernder chirurgischer Eingriff erforderlich war. Patienten, bei denen pathogene Bakterien im Blut nachgewiesen wurden, mußten signifikant länger stationär behandelt werden.

     

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.     

Post transurethral resection of prostate incontinence in previously radiated prostate cancer patients

OBJECTIVES: This is a retrospective review evaluating the incidence of incontinence post transurethral resection of prostate (TURP) in patients who have had previous external beam radiation (XRT) for prostate cancer (PCA). MATERIALS AND METHODS: 1,230 patients underwent XRT for PCA between January 1985 and April 1996. From this group, 16 patients mean age of 67.8 years (range 48-84) at the time of XRT had a subsequent TURP for obstructive symptoms a median of 3.25 years later (range 3 months to 10.2 years). Patients have been followed post TURP for a median of 5.0 months (range 1 to 81 months). RESULTS: Nineteen percent (3) patients developed incontinence post TURP. An additional patient remained in retention and continued to suffer overflow incontinence. Incontinence was associated with a shorter time interval between XRT and TURP (13 months versus 55.3 months) and with a greater amount of prostatic resection (19 grams versus 11.4 grams) when compared to the continent group, but did not meet statistical significance. CONCLUSION: A high risk of incontinence post TURP in previously radiated patients was demonstrated. The association with a shorter time interval between procedures and the larger resection suggests that a conservative approach is warranted. Studies with the use of preop and post TURP urodynamics would be useful in further defining risk factors in this population.     

非那雄胺在经尿道前列腺双极等离子剜除术围手术期的临床应用

目的 探讨非那雄胺对经尿道前列腺双极等离子剜除术患者围手术期出血的影响.方法 将前列腺增生患者150例随机分为3组,对照组:50例,未服用非那雄胺;治疗1组:50例,非那雄胺5 mg,1次/d,术前、术后均应用7 d;治疗2组:50例,非那雄胺5 mg,2次/d,术前、术后均应用7d;3组患者均采用经尿道前列腺双极等离子剜除术,比较各组患者术中出血量、手术时间、术中冲洗液量、每克切除前列腺组织出血量、每分钟出血量、术后冲洗时间、术后冲洗液量及3个月内再出血就诊率.结果 150例患者均顺利完成经尿道前列腺双极等离子剜除术.与对照组比较,治疗1组和治疗2组的术中出血量、手术时间、术中冲洗液量、每克切除前列腺组织出血量、术后冲洗时间及术后冲洗液量均显著减少(P＜0.05);每分钟出血量3组分别为(1.77±0.89) ml/min、(1.71±0.82)ml/min和(1.70±0.81) ml/min,差异无统计学意义(P＞0.05).治疗1组和治疗2组的术中出血量、手术时间、术中冲洗液量、每克切除前列腺组织出血量、每分钟出血量、术后冲洗时间、术后冲洗液量比较,差异无统计学意义(均P＞0.05).术后3个月内再出血就诊率治疗1组(8/35)和治疗2组(3/26)与对照组(17/39)比较,明显减少(x2=3.544、7.523,P=0.016、0.025),治疗2组明显少于治疗1组(x2 =1.293,P=0.044).结论 经尿道前列腺双极等离子剜除术围手术期服用非那雄胺能够减少出血.     

Correlation of benign prostatic obstruction-related complications with clinical outcomes in patients after transurethral resection of the prostate

We aim to investigate the correlation of benign prostatic obstruction (BPO)-related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO-related complications and 1078 (46.3%) had BPO-related complications. Compared with patients without BPO-related complications, those with BPO-related complications were older (p = 0.001) and usually had other urologic comorbidities (p = 0.003). Additionally, they tended to have more tissue resected (p < 0.001), a higher American Society of Anesthesiologists grade (p = 0.002), and larger prostates (p < 0.001). Nonetheless, there was no obvious difference in surgical complications between both groups (p > 0.05). Among patients with BPO-related complications, compared with the bladder stone group, only the bladder stone+ group tended to have a greater urinary infection risk after transurethral resection of the prostate. Compared with patients with one or two BPO-related complications, those with three BPO-related complications tended to have a higher risk of pulmonary embolism and acute coronary syndrome (p < 0.05). Despite the widespread use of medication, patients with BPO-related complications were older and had larger prostates; however, transurethral resection of the prostate is still considered a safe and recommended surgical treatment. Nevertheless, those with three or more complications were at a higher risk of severe complication after surgery, and active surgical intervention is needed once BPO-related complications develop.     

右美托咪啶在老年患者经尿道前列腺电切术中的应用

目的 观察右美托咪啶(DEX)应用于老年患者经尿道前列腺电切术(TURP)的安全性及是否降低围术期不良反应发生率. 方法 选择美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,择期行TURP老年患者40例,随机分成2组,每组20例,行蛛网膜下腔阻滞麻醉.试验组(A组)于腰麻成功后10 min初始泵入0.5μg/kg DEX10 min),后以0.2μg/( kg·h)维持,手术结束时停止泵入;对照组(B组)给予同等剂量生理盐水.观察入室时(T0)、腰麻后10 min(T1)、DEX或生理盐水泵入后10 min(T2),手术开始时(I3),手术开始后30 min(T4)、手术结束时(T5)的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏血氧饱和度(SPO2)、警觉/镇静(OAA/S)评分及术中、术后不良反应发生率.评价患者的舒适度. 结果 与T0时间点比较,A组T3～T5时间点MAP降低,T2～T5时间点HR降低,T2～T4时间点RR降低,T2～T5时间点OAA/S评分降低;B组在T4～T5时间点RR降低(P＜0.05).与B组比较,A组在T3～T5时间点MAP降低,T2～T5时间点HR降低,T3时间点RR降低,T2 ～T5时间点OAA/S评分降低;寒战反应发生率降低;舒适度评分明显提高(P＜0.05). 结论 DEX应用于TURP术安全有效,可减少不良反应发生率,提高患者舒适度.     

经尿道前列腺等离子剜除术与电切术治疗前列腺增生的疗效比较

目的 比较经尿道前列腺等离子双极电切剜除术(TUPKEP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的临床疗效及安全性.方法 将142例BPH患者分为两组,TUPKEP组72例,年龄52～90岁,平均(70.5±7.6)岁,前列腺质量27～126 g,平均(75.6±10.3)g;TURP组70例,年龄51～87岁,平均(70.2±6.8)岁,前列腺质量25～118 g,平均(73.8±9.9)g.两组患者术前年龄、前列腺质量、前列腺症状评分(IPSS)、剩余尿量、最大尿流率、生活质量评分(QOL)比较,差异均无统计学意义(t值分别为0.2873、1.0612、1.0832、0.9522、0.0000、1.0774;P值分别为0.7743、0.2904、0.2806、0.3426、1.0000、0.2832).比较两组手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率及疗效.结果 TUPKEP组72例均获成功(100.0%),TURP组成功69例(98.6%).TUPKEP、TURP组平均手术时间分别为(46.2±6.4)min、(58.4±9.6)min,组间比较差异有统计学意义(t=8.9404,P-0.0000);两组术中出血量分别为(105.9±12.2)ml、(148.6±14.3)ml,组间比较差异有统计学意义(t=19.1608,P=0.0000);两组术后平均留置尿管时间分别为(3.5±1.0)d、(5.0±1.0)d(t=8.9364,P=0.0000);两组术后平均住院时间分别为(5.1±1.9)d、(7.0±0.6)d(t=4.9819,P=0.0000).TUPKEP组术后发生暂时性尿失禁1例,继发前列腺出血2例,尿道外口狭窄1例,并发症发生率5.56%,TURP组发生经尿道前列腺电切综合征2例,尿外渗1例,术后暂时性尿失禁2例,继发前列腺出血3例,尿道外口狭窄2例,并发症发生率14.29%.术后随访3个月,两组最大尿流率较术前明显增加,IPSS、剩余尿量、QOL均较术前明显下降,组间比较差异均无统计学意义(t值分别为1.1131、0.2543、1.2959、0.7252;P值分别为0.2676,0.7996、0.1971、0.4696).结论 TUPKEP与TURP治疗BPH的疗效相近,但TUPKEP平均手术时间短、术中出血量少、围手术期及术后并发症发生率低,手术安全性更高.     

Current indications for transurethral resection of the prostate and associated complications

Transurethral resection of the prostate (TURP) is the most common surgical procedure for relieving symptoms of benign prostatic hyperplasia. Here, we report our experience of current indications for TURP and their associated outcomes at Kaohsiung Medical University Hospital (KMUH). A total of 111 patients who underwent TURP at KMUH between May 2000 and December 2001 were included in this retrospective review. For each patient, the surgical indication was categorized into acute urinary retention, chronic complications (including renal impairment, recurrent urinary infection, bladder stone/diverticulum, post-void residue, and recurrent hematuria), and symptomatic prostatism. Thirty-five patients (31%) had acute urinary retention, 28 (27%) had chronic complications, and 48 (42%) had symptomatic prostatism. Most patients chose TURP only when medical treatment had failed to relieve symptoms, no matter what category they belonged to. Patients with acute urinary retention and chronic complications had larger prostates (p = 0.002) and more tissue resected (p = 0.05) than those with symptomatic prostatism. Patients with acute urinary retention seemed to be at greater risk of postoperative complications such as recurrent urinary retention and urinary tract infection. We suggest that urodynamic study may be necessary to rule out concomitant bladder dysfunction before surgery and that adequate prophylactic antibiotic treatment be used to decrease the risk of urinary tract infection during or after TURP, especially when pyuria is noted preoperatively in patients with acute urinary retention.