经尿道前列腺电切术后的腹腔镜下前列腺癌根治术

目的 探讨TURP术后发现前列腺癌行腹腔镜下前列腺癌根治术的手术技巧及经验.方法 2007年4月至2010年7月收治既往行TURP术后发现前列腺癌的患者5例,平均年龄73岁,TURP术后平均(2.8±1.1)个月行腹腔镜下前列腺癌根治术.结果 5例手术顺利完成,其中经腹腔途径1例,经腹膜外途径4例.平均手术时间(227.6±38.4)min,术中平均出血(130.0±152.5)ml,术后平均随访(16.1±15.9)个月,最长40个月,5例均存活,控尿功能好,无明显尿失禁.结论 TURP术后行腹腔镜下前列腺癌根治术疗效满意,先前的TURP术增加了腹腔镜操作难度,但在腹腔镜技术熟练的条件下是可行的.

Abstract：

Objective To describe our experience in laparoscopic radical prostatectomy (LRP)for incidental prostate cancer after TURP. Methods From April 2007 to July 2010, 5 patients with incidental prostate cancer after TURP were treated with a mean age of 73 years. The patients underwent LRP (2.8± 1.1) months after TURP. Results The five cases of LRP were performed successfully, with 1 case of transperitoneal approach and 4 cases of extraperitoneal approach. Mean operation time was (227.6±38.4) min, mean blood loss was (130±152.5) ml, and the mean follow-up was (16.1 ± 15.9) months. All five patients survived, and their urinary function was good without any incontinence. Conclusions Previous TURP represents a technical challenge when performing LRP, but highly skilled surgeons trained to perform LRPs can handle it.     

腹腔镜前列腺癌根治术治疗经尿道前列腺电切术发现的前列腺癌14例临床分析

目的:总结腹腔镜前列腺癌根治术(LRP)治疗在经尿道前列腺电切术(TURP)中发现的前列腺癌的临床经验。方法:回顾我院自2011年至2016年应用LRP治疗在TURP手术发现的前列腺癌共计14例,对其临床资料及随访结果进行分析。结果:14例TURP后LRP均顺利完成。TURP与LRP时间间隔1~4个月。手术时间80~220(163±94)min。失血量100~500(188±152)ml。所有病例术中无直肠损伤;无中转开放手术;无输血;1例切缘阳性,肿瘤侵及脉管及神经。术后留置尿管时间7~16(11.7±3.7)d。淋巴瘘1例。术后随访中位时间28个月(4~68个月)。13例术后12个月时尿控满意,无尿失禁;1例随访不足12个月者未发生尿失禁。1例切缘阳性者给予术后放疗及内分泌治疗,目前肿瘤控制良好。其余13例随访中未发现生化复发及临床复发。结论:既往TURP手术会导致前列腺周围组织水肿、粘连、纤维化及膀胱颈部瘢痕愈合,增加后续的LRP手术的难度,但是在TURP术后实施LRP仍可获得了满意的功能及肿瘤学预后。术者应对上述困难应充分了解并重视,同时患者也应明确了解上述的手术的风险。并由经验丰富的医生来实施手术。TURP后1个月LRP似乎可以获得更好的解剖层面,降低手术难度。     

经尿道等离子前列腺汽化电切术与经尿道前列腺电切术的近期疗效比较

目的比较经尿道等离子前列腺汽化电切术（TUPKRP）与经尿道前列腺电切术（TURP）的近期疗效。方法将前列腺增生（benign prostatic hyperplasia，BPH）患者随机分为两组，分别行TUPKRP和TURP，比较两组术前和术后6个月检查的各项指标并进行统计学分析。结果术前两组一般情况比较无统计学意义（P〉0．05）；术后6个月两组国际前列腺症状评分、生活质量评分、最大尿流率比术前均得到明显改善（P〈0．01）；术中输血量、电切综合征发生率、术后平均膀胱冲洗时间、置管时间和住院时间，TUPKRP组明显小于TURP组（P〈0．01）。结论TUPKRP治疗BPH具有与TURP近期疗效相似；术中并发症发生率及患者术后恢复时间明显少于TURP，有良好的应用前景。     

经尿道前列腺等离子双极电切和经尿道前列腺电切治疗良性前列腺增生的临床结果比较

目的比较经尿道前列腺等离子双极电切术(PKRP)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PKRP组78例,TURP组78例,比较2组手术时间、术中出血量,术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)及并发症发生率。结果PKRP组手术时间、术中出血量、术后2个月内暂时性尿失禁发生率、术后4周内继发性出血及3个月内尿道狭窄发生率分别为(64±21)min,(247±84)ml,26．9％(21／78),1．3％(1／78)和2．6％(2／78),TURP组分别为(78±18)min,(432±132)ml,48．7％(38／78),10．3％(8／78)和12．8％(10／78),2组比较差异均有统计学意义(P<0．05)。2组均未发生电切综合征(TURS)。PKRP组术后IPSS为4．6±1．2,QOL为1．1±0．8,Qmax为(26．1±4．6)ml／s; TURP组分别为4．8 4±1．1、1．3±0．8、(25．3．4±4．2)ml／s;均较术前明显改善(P<0．01),但组间差异无统计学意义。结论PKRP与TURP比较,治疗BPH疗效相近,但安全性更好,是治疗BPH的理想方法。     

经尿道前列腺等离子电切术治疗良性前列腺增生疗效观察

目的探讨经尿道前列腺等离子电切术(TUPKRP)治疗良性前列腺增生的效果。方法随机将140例前列腺增生患者分成2组,各70例。对照组给予经尿道前列腺电切术(TURP),观察组给予TUPKRP治疗。比较分析2组治疗效果。结果 2组手术时间比较差异无统计学意义(P0.05),观察组的术中出血量、膀胱冲洗时间、留置尿管时间、住院时间、并发症发生率均小于对照组,差异有统计学意义(P0.05)。结论 TUPKRP治疗良性前列腺增生创伤小、并发症发生率低,恢复时间短。     

经尿道前列腺电切术与双极等离子电切术治疗良性前列腺增生的临床比较

目的比较经尿道前列腺电切术(TURP)与经尿道前列腺双极等离子电切术(PKRP)治疗良性前列腺增生(BPH)的近期临床疗效、安全性。方法将146例确诊为BPH患者随机分为2组,每组各73例,分别采用PKRP和TURP,2组病例术前前列腺症状评分(IPSS)、生活质量评分(QOL)、剩余尿量(RUV)、最大尿流率(Qmax)比较差异均无统计学意义(P0.05),比较术前术后临床的各项指标及两种手术方法的效果。结果 2组患者手术时间、手术前后血红蛋白变化程度、术前术后血钠浓度差异均有显著性意义(P0.01);术后3、6个月随访,2组IPSS、QOL、RUV均较术前明显下降,Qmax均较术前明显增加,组间比较差异均无统计学意义(P0.05)。术后膀胱冲洗时间、留置导尿时间差异无统计学意义(P0.05)。TURP组并发症发生率27.3%,PKRP组术后并发症发生率8.2%,并发症发生率差异有统计学意义。结论 PKRP与TURP比较,治疗BPH近期疗效相似,但PKRP安全性更高,并发症少。     

经尿道前列腺气化电切术治疗前列腺增生临床体会

目的 探讨经尿道前列腺气化切割及电切术,治疗前列腺增生(BPH)的疗效及临床体会.方法 采用经尿道前列腺气化切割电切术治疗BPH患者150例,对临床资料进行回顾性总结.结果 手术顺利、出血少、疗效满意,未出现严重并发症.结论 经尿道前列腺气化加电切术治疗BPH安全性高、并发症少、恢复快,具有出血少、手术时间短等优点.     

256例经尿道前列腺电切术后尿道狭窄的临床分析

目的探讨经尿道前列腺电切术后引起的尿道狭窄的原因及治疗方法。方法选取笔者所在医院2009年1月～2010年1月收治的经尿道前列腺电切术后尿道狭窄的患者256例。结果本组患者全部治愈。其中,采用单纯尿道扩张治疗的患者有167例,治愈时间为1～3个月;采用尿道内切开术治疗的患者有89例,一次性切开成功的有42例,占47.2%。治愈时间为3～6个月。术后随访6～24个月,治疗后的IPSS为：（12.3±2.3）分;QOL为（1.7±0.3）分;Qmax为（22.5±1.5）mL/s;AFR为（14.1±1.5）mL/s;RUV为（20.7±8.9）mL/s。结论尿道前列腺电切术后尿道狭窄,除了清楚其病因,并注意预防意外,早期选择合适的方法进行治疗是康复的关键。     

经尿道前列腺汽化电切术结合经尿道前列腺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(TUVP)结合经尿道前列腺电切术(TURP)治疗前列腺增生患者的价值。方法：结合三种电极的特点回顾性分析146例前列腺增生患者接受TUVP和TURP治疗后的疗效。结果：全部患者均安全度过围手术期,术后疗效满意,无严重并发症,提高了高龄高危患者的生活质量。结论：TUVP结合TURP是治疗前列腺增生的安全有效的方法。     

经尿道前列腺气化加电切术治疗良性前列腺增生

我们自 1998年开始将经尿道前列腺气化术(ＴＵＶＰ)和经尿道前列腺电切术 (ＴＵＲＰ)相结合治疗良性前列腺增生 (ＢＰＨ) 15 0例 (Ａ组 ) ,并与以往采用单纯ＴＵＲＰ者 80例 (Ｂ组 )作对照 ,效果较好 ,现报告如下。1　资料与方法1.1　 临床资料Ａ组 15 0例 ,年龄 5 7～ 90岁 ,平均 68.6岁。Ｂ组 80例 ,年龄 5 8～ 88岁 ,平均 67.6岁。均根据国际前列腺症状评分 (ＩＰＳＳ)、生活质量评分 (ＱＯＬ)、前列腺指检、经腹Ｂ超检查和尿流率测定诊断为ＢＰＨ(两组上述指标见表 1)。Ａ组有心、脑、血管、肺等疾病以及糖尿病、膀胱结石等并发症者 12 …     

腹腔镜下根治性前列腺切除术治疗TURP术后偶发前列腺癌的配对分析

目的探讨经尿道前列腺切除术(TURP)后偶发前列腺癌行腹腔镜根治性前列腺切除术(LRP)在外科手术、肿瘤学及尿控等方面的影响。方法回顾性分析自2012年1月至2017年12月北部战区总医院泌尿外科285例接受了LRP治疗的男性患者的临床资料。其中37例患者术前已接受过TURP治疗(TURP组),另外选取37例没有接受过TURP的患者与之配对(对照组)。运用相关统计学方法比较两组患者在围手术期并发症、外科手术、肿瘤及尿控等方面的差异。结果两组患者在年龄、体质指数、血清前列腺特异性抗原(PSA)水平以及术前和术后Gleason评分等方面无统计学差异。TURP组与对照组相比患者出血量较多[(555.4±238.4)vs.(237±111.3)mL,P<0.05]、手术时间较长[(256.7±65.3)vs.(215.2±62.3)min,P<0.05]、输血概率大(5.4%vs.0.0%,P<0.05)、并发症发生率较高(43.2%vs.13.5%,P<0.05)。TURP组的手术阳性切缘率与对照组相比(35.1%vs.24.3%)差异无统计学意义(P=0.353)。手术后12个月的尿控率两组相似,但在3个月时TURP组的尿控率较低(40.5%vs.70.2%)。在平均随访36.5个月后,TURP组和对照组分别有10.8%和8.1%的患者出现生化复发,差异无统计学意义。结论TURP后LRP需要更长的手术时间、失血更多、并发症发生率更高和更差的短期尿控,但两组患者远期肿瘤切除效果及远期尿控没有差异,所以TURP后行LRP的疗效是安全可靠的。     

Outcome of radical prostatectomy for incidental carcinoma of the prostate

OBJECTIVE

To evaluate a contemporary series of patients with incidental prostate cancer detected by transurethral resection of the prostate (TURP) and undergoing radical prostatectomy (RP).

PATIENTS AND METHODS

Between 1998 and 2004, 1931 patients had TURP for obstructive voiding symptoms and suspected BPH. Incidental prostate cancer was found in 104 (5.4%); 26 of these patients had a RP. The pathological staging and treatment of these patients were reviewed retrospectively and the follow‐up results obtained.

RESULTS

Of the 26 patients who had RP, 17 had T1a and nine had T1b carcinoma of the prostate. After RP, six (35%) in the T1a group had no residual tumour (pT0) and 11 (65%) had pT2 cancer; the respective incidence in those with T1b was two and seven, with no pT3 disease in either group. The preoperative Gleason grading did not correspond well with that after RP; 30% of the patients had upgraded Gleason scores and 42% showed either downgrading or no residual tumour, with 81% having Gleason scores of <7. After a median follow‐up of 47 months, one patient is receiving hormonal therapy because of biochemical relapse.

Conclusion

Subsequent to stringent PSA testing and prostate biopsy when indicated, the rate of incidental prostate cancer is low. Furthermore, substantially many patients will harbour either no residual cancer or tumours with favourable characteristics in their RP specimens. However, there is currently no possibility to reliably predict the absence of aggressive prostate cancer after TURP, and thus safely recommend observation instead of further therapy. Therefore, patients with incidental prostate cancer need to be counselled individually. The decision ‘treatment or no treatment’ should be determined by the patients’ age and life‐expectancy, tumour aggressiveness in the TURP specimen and the prostate‐specific antigen level after TURP.     

Laparoscopic radical prostatectomy: Transfer validity

Objectives: The impact of a formal fellowship training program on the independent practice of the trainees (i.e. transfer validity) has not been evaluated. We analyzed the transfer validity of a structured curriculum in an in‐door as well as an out‐door setting. Methods: After completing their training, two fourth generation laparoscopic surgeons who started at the same time compared operative parameters and oncological outcomes in their independent practice, prospectively analyzing the next 100 patients in each. One surgeon continued laparoscopic radical prostatectomy (LRP) in the same center of excellence (Group‐In), whereas the other implemented the procedure in a separate academic center (Group‐Out). Results: The demographics for both groups (Group‐In vs Group‐Out) were similar regarding age, prostate volume and preoperative prostate‐specific antigen levels. Mean operation times (214.8 vs 224.2 min; P = 0.494) and estimated blood loss (472.4 vs 402.6 mL; P = 0.109) did not differ significantly in both groups as well as complication rate (20 vs 24%), median catheter time (8 vs 8.5 days) and continence rates at 12 months (95 vs 95.5%). According to the pathological stages, the rates of positive surgical margins were similar for pT2 (3.2 vs 4.3%) and pT3 (42.8 vs 45.2%), respectively. Conclusions: With a well designed, long‐term preclinical and clinical fellowship training program, LRP techniques can be efficiently transferred from the center of excellence to other centers with no significant impact on surgical, functional and oncological outcomes.     

Laparoscopic radical prostatectomy: introduction of training during our first 50 cases

Background: The study aims to assess the initial experience of laparoscopic radical prostatectomy (LRP) in a regional centre in Australia which includes Fellowship training during our first 50 cases. Methods: Data were collected prospectively from our first 50 consecutive patients who underwent LRP for localized prostate cancer between September 2009 and October 2010. All cases were performed or supervised by the primary surgeon. Patient details, operative details, complications, early oncological and functional outcomes were analysed. Results: The median age was 65 (45–76) years and median preoperative prostate‐specific antigen was 7.5 (2.5–23) ng/mL, with palpable disease present in 48%. Using D'Amico's risk stratification, 14%, 74% and 12% were in low, intermediate and high‐risk categories, respectively. Forty percent of cases were training cases with a median of 5 (2–8) of 10 operative steps performed by the Fellow. There was one open conversion and no rectal injuries. Mean operative time was 288 (175–440) min and with blood transfusion rate of 6%. Mean length of stay was 2.5 (1–6) days. Positive surgical margin rates for pT2 and pT3 disease were 14% and 52%, respectively, although for the last 25 cases they were 7% and 30%, respectively. Continence rate was 86% at 6 months, and 45% and 33% of preoperatively potent patients were potent after bilateral and unilateral nerve preservation at 6 months. Conclusion: LRP has been safely introduced in a regional centre with establishment of a Fellowship training programme, with early results comparable with other open, laparoscopic and robotic series.     

Salvage radical prostatectomy for recurrent prostate cancer after radiation therapy

Salvage radical prostatectomy is considered for patients with locally recurrent prostate cancer after external beam radiotherapy. Between 2001 and 2004, 32 men treated with curative intent with radiotherapy for prostate cancer were subsequently treated with salvage surgery for clinically localized prostate cancer. We assessed the morbidity associated with this procedure and the outcome of the patients. Thirty-two patients underwent salvage radical prostatectomy. Initial pre-radiation median prostate-specific antigen was 13 ng/ml. Pre-radiation disease was clinical stage T1b in five cases, T2a in 10, T2b in 10 and T3a in seven. Mean operative time was 122 minutes, intraoperative blood loss was 550 ml and hospital stay and catheterization time were 5 and 12 days, respectively. There was biochemical failure in eight patients after salvage radical prostatectomy and 24 patients are biochemical non evidence of disease (bNED). In recurrent prostate local disease with prostate-specific antigen <10 ng/ml and life expectancy greater than 10 years, salvage radical prostatectomy is a reasonable treatment option.     

Delayed recovery of urinary continence after laparoscopic radical prostatectomy

AIM: To study the rate at which patients regained urinary continence during our institution's early experience with laparoscopic radical prostatectomy. METHODS: The urinary continence of 34 patients was recorded at various intervals following laparoscopic radical prostatectomy. These data were compared with those from 49 patients who had undergone radical retropubic prostatectomy. RESULTS: For laparoscopic prostatectomy patients, 2.9% had regained urinary continence at 1 month, 29.4% at 3 months, 46.9% at 6 months, 56.0% at 9 months and 60.0% at 12 months. For retropubic prostatectomy patients, the corresponding rates were 22.4% at 1 month, 63.3% at 3 months, 84.1% at 6 months, 92.9% at 9 months and 92.9% at 12 months. Backward stepwise logistic regression analysis indicated that laparoscopic surgery itself significantly predicted urinary incontinence at every interval from 1 to 9 months following surgery (P < 0.05). CONCLUSION: Patients' postoperative recovery of urinary continence was not satisfactory in our early experience with laparoscopic radical prostatectomy. Further efforts to elucidate the reason for this poor functional outcome are mandatory before the procedure is accepted as part of standard practice.