高危良性前列腺增生29例的微创经尿道前列腺电切的治疗观察

目的　探讨微创经尿道前列腺电切术 (TURP)治疗高危良性前列腺增生 (BPH)患者的疗效。方法　采用微创TURP ,改变传统的前列腺电切部位 ,治疗高危BPH 2 9例。结果　术后平均随访 12个月 ,2 9例有效 (10 0 % ) ,国际前列腺症状评分 (IPSS)由术前 2 7.7± 2 .1减少至 8.8± 2 .3(P <0 .0 1) ,生活质量评分 (Qol)由术前平均 4 .7± 0 .7下降至 2 .3± 0 .8(P <0 .0 5 ) ,最大尿流率 (Qmax) (8.7± 1.9)ml/s增加至 (14 .9± 1.7)ml/s ,剩余尿 (RU)从术前 (12 9± 4 2 .8)ml减少至 (36± 11.8)ml。结论　微创TURP是治疗高危前列腺增生合并尿潴留患者的有效方法     

经尿道气化电切治疗重度前列腺增生症

目的探讨重度前列腺增生症(BPH)的治疗方法。 方法应用经尿道前列腺电气化术(TUVP)加经尿道前列腺电切术(TURP)联合治疗重度BPH患者60例。 结果 手术时间50-90 min,平均75 min,平均切除前列腺组织70 g。仅发生1例先兆电切综合症。术后平均6天拔管,自行排尿通畅。IPSS由术前平均25.5分下降至术后平均7.0分(P<0.001),最大尿流率(Qmax)由术前平均5.2 ml/s升至术后平均18.9 ml/s(P<0.001),剩余尿量由术前平均100 ml降至术后平均15 ml。术后继发性出血1例,一过性尿失禁1例。 结论TUVP加TURP联合治疗BPH兼有两者优点,是彻底治疗重度BPH安全、有效的方法。     

单侧叶电切治疗高危重度前列腺增生症39例疗效观察

目的　为寻求安全而有效的方法治疗高危重度前列腺增生症 (BPH) ,探讨经尿道单侧叶电切方法疗效。方法　应用经尿道单侧叶电切治疗BPH 39例。结果　切除前列腺重量平均 37g ,手术时间平均 43min ,术中失血量平均 5 0ml;无电切综合征及大量失血发生。 31例获随访 1～ 2 4个月 ,IPSS评分平均从术前的 34 3分降至 8 7分 ;最大尿流率从平均5 6ml/s增加至 17.4ml/s,生活质量明显改善。结论　经尿道单侧叶前列腺电切方法具有手术时间缩短 ,出血量少 ,疗效显著等优点 ,是一种较理想的姑息切除术式 ,适用于高危重度BPH的治疗。     

普通电切镜经尿道行前列腺剜除术治疗良性前列腺增生的疗效

目的 探讨以普通电切镜经尿道行前列腺剜除术(transurethral enucleative resection of prostate,TUERP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的效果.方法 回顾性分析86例采用TUERP治疗BPH患者的临床资料,分别比较术前、术后国际前列腺症状评分(IPSS)、生活质量指数(QOL)、最大尿流率(Qmax)、残余尿量(PVR)情况.结果 手术均顺利完成,平均手术时间(62.7±19.3)min,切除腺体平均重量(37.2 ±8.5)g.术后IPSS由术前(23.9±5.2)分降至(5.4±3.7)分,QOL由术前(4.6±1.1)分降至(1.2±0.9)分,Qmax由术前(6.3±2.0)ml/s上升至(21.0±3.6) ml/s,PVR由术前(149.0±35.8)ml降至(21.2±9.9) ml.术后3例出现暂时性尿失禁,1例出现尿道外口狭窄,经治疗后痊愈.结论 TUERP术具有手术时间短、并发症少、术后恢复快、症状解除明显等优点,是治疗BPH的安全、有效的治疗方法.     

高危前列腺增生经尿道前列腺电切手术疗效观察

目的观察高危良性前列腺增生患者经尿道前列腺电切手术治疗效果。方法分别观察63例高危良性前列腺增生患者与同期72例前列腺增生患者手术前后的症状评分、最大尿流率及残余尿量。结果63例患者手术后均恢复自主排尿,IPSS评分、最大尿流率及残余尿量与术前比较,均有意义;IPSS、最大尿流率与同期TURP术72例患者手术疗效对比无显著意义,而残余尿量绝对数值对比有显著差异。结论高危患者能在纠正基础疾病后,积极行TURP术治疗,效果满意。     

经尿道选择性绿激光汽化术与电切术治疗前列腺增生的价值比较

目的探讨经尿道选择性绿激光前列腺汽化术(PVP)治疗前列腺增生的安全性和疗效以及与经尿道前列腺电切术(TURP)相比的优势。方法对我院2003年10月—2007年9月行经尿道选择性绿激光汽化术患者75例(PVP组)及同期行经尿道前列腺电切术(TURP组,对照组)患者53例的临床资料(年龄,病程、术前IPSS、术前最大尿流率,术前残余尿、前列腺质量)、手术情况(手术时间,术后输血,术后尿管留置时间,术后住院时间)、疗效(术后最大尿流率,术后IPSS)等指标进行比较分析。结果两组年龄、病程、术前IPSS评分、术前最大尿流率、术前残余尿量等项指标之间的差异均无统计学意义(P>0.05)。PVP组前列腺质量(60.715±30.253)g,小于TURP组的(71.580±28.914)g(P=0.012 9)。两组手术后的IPSS以及最大尿流率较术前明显改善(P<0.01);而两组内手术前后的IPSS及最大尿流率比较,差异无统计学意义(P>0.05)。平均手术时间、术后输血、术后尿管留置时间、术后住院时间两组比较差异有统计学意义(P<0.05或P<0.01)。结论经尿道选择性绿激光汽化技术安全、疗效可靠,与传统的电切手术相比具有明显的优势,临床应用前景广阔。     

经尿道前列腺电汽化术治疗前列腺增生症60列体会

目的:探讨电汽化切割治疗前列腺增生症(BPH)的效果。方法:采用经尿道前列腺电汽化术(TUVP)治疗良性前列腺增生60例。结果:平均手术时间60min;平均出血70ml;最大尿流率由术前5.32±2.35ml/s上升至术后的18.5±3.22ml/s;IPSS症状评分术前28.34±3.12,术后降至8.4±2.12(P〈0.05)。结论:经尿道前列腺电汽化切割出血少,手术安全,治疗效果明显,是治疗BPH最有效的治疗方法之一。有利于在基层广发的开展和普及。     

2μm激光前列腺汽化切除术治疗高危前列腺增生

正目的:探讨2μm激光汽化切除术治疗高危前列腺增生(BPH)的安全性和有效性。方法:高危前列腺增生症患者50例,采用行经尿道前列腺汽化切除术,应用德国RevoLix产激光手术系统,波长2μm,输出功率120 W,连续输出。观察平均手术时间、术中出血量、术后留置尿管时间、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)、最大尿流率(Qmax)及残余尿量(PVR)等指标的差异。     

钬激光经尿道行前列腺整叶剜除改良法治疗前列腺良性增生的效果

 目的 探讨经尿道前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)整叶改良法治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的效果。方法 选择2015-11至2018-02武警山西总队医院应用钬激光经尿道行前列腺整叶剜除改良法治疗的BPH患者,共117例,观察术中安全性、手术前后最大尿流率(Qmax)、国际前列腺症状评分(IPSS)。结果 117例手术时间30～150 min,平均(106.0±30.5)min。膀胱冲洗时间12～48 h,平均(36.0±9.8) h。术后留置尿管3～8 d,平均(4.0±1.7)d。住院时间5～14d,平均(8.0±2.8)d。术后3个月IPSS从术前(23.2±6.4)降至(5.1±2.5),Qmax从术前(4.4±2.3)ml/s增加至(19.5±7.5)ml/s。无严重并发症。结论 整叶法经尿道前列腺钬激光剜除术治疗BPH手术过程安全,无严重并发症,尤其适用于高龄、高危患者,效果满意。     

半导体激光治疗高龄、高危前列腺增生症：—附70例报告

目的　探讨半导体激光间织内凝固治疗良性前列腺增生症（BPH）的临床应用优势及价值。 方法　应用强生830e组织间插入式半导体激光治疗仪进行激光间织内凝固（ILC）治疗高龄、高危BPH患者70例,大多数患者伴有1～2种慢性疾病,例如冠心病、慢性支气管炎、肺气肿、慢性肾功能不全、糖尿病、脑出血、脑梗死后遗症等。随访6～12个月,分别于术前、术后1、2、3与6个月进行国际前列腺症状评分（IPSS）和生活质量评分（QOL）,并测定最大尿流率（Qmax）和残余尿量以评价其疗效。 结果　治疗后6个月,IPSS达6.2±2.2,QOL为2.0±0.2,Qmax和残余尿量分别为17.2ml/s±2.1ml/s和10.2ml±2.4ml,与术前比较上述各项指示有明显改善,疗效显著(P＜0.001)。 结论　半导体激光治疗BPH具有损伤小、安全性高和并发症少等优点,术后2～3个月以后有效率可达100%,是目前治疗BPH中较有前途的方法之一。     

前列腺等离子电切术后再次排尿困难的原因分析

目的探讨前列腺电切术后再次排尿困难的原因。方法回顾分析自2006年2月以来收治的80例前列腺电切术后再次排尿困难14例患者的临床资料。结果尿道狭窄6例，继发出血3例，腺体残留1例，尿路感染1例，再发前列腺癌1例，膀胱逼尿肌功能障碍2例。结论尿道狭窄、继发出血、腺体残留是发生术后排尿困难的主要原因。术前行尿流动力学检查、控制感染及精细的手术操作，可以减少术后排尿困难的发生。     

良性前列腺增生症合并慢性前列腺炎的临床研究

目的探讨前列腺增生症(BPH)与慢性前列腺炎(CP)的关系及临床特点。方法对2009年1月—2011年12月我院泌尿外科收治的96例良性BPH患者的年龄、病程、国际前列腺症状评分(IPSS)、前列腺体积、PSA水平等项目进行回顾性分析研究。结果 96名研究对象总体的慢性前列腺炎的发生率为68.75%。合并慢性前列腺炎患者的年龄、病程、IPSS评分、前列腺体积及PSA水平显著高于单纯前列腺增生组。结论前列腺炎症在BPH的进展中起着重要作用,同时炎症可能会加重BPH患者的下尿路症状,应给予积极治疗。     

Accumulation of [<Superscript>11</Superscript>C]acetate in normal prostate and benign prostatic hyperplasia: comparison with prostate cancer

Carbon-11 acetate positron emission tomography (PET) has been reported to be of clinical value for the diagnosis of prostate cancer. However, no detailed analysis has yet been carried out on the physiological accumulation of [(11)C]acetate in the prostate. The purpose of this study was to elucidate the physiological accumulation of [(11)C]acetate in the prostate using dynamic PET. The study included 30 subjects without prostate cancer [21 with normal prostate and nine with benign prostatic hyperplasia (BPH)] and six patients with prostate cancer. A dynamic PET study was performed for 20 min after intravenous administration of 555 MBq of [(11)C]acetate. The standardised uptake value (SUV) at 16-20 min post tracer administration and the early-to-late-activity ratio of the SUV (E/L ratio), which was determined by dividing the SUV(6-10 min) by the SUV(16-20min), were calculated to evaluate the accumulation of [(11)C]acetate. The prostate was clearly visualised and distinguished from adjacent organs in PET images in most of the cases. The SUV of the prostate (2.6+/-0.8) was significantly higher than that of the rectum (1.7+/-0.4) or bone marrow (1.3+/-0.3) ( P<0.0001 in each case). The SUV of the normal prostate of subjects aged <50 years (3.4+/-0.7) was significantly higher than both the SUV for the normal prostate of subjects aged > or =50 years (2.3+/-0.7) and that of subjects with BPH (2.1+/-0.6) ( P<0.01 in each case). The primary prostate cancer in six cases was visualised by [(11)C]acetate PET. However, the difference in the SUV between subjects aged > or =50 with normal prostate or with BPH and the patients with prostate cancer (1.9+/-0.6) was not statistically significant. There was also no significant difference in the E/L ratio between subjects aged > or =50 with normal prostate (0.98+/-0.04) or BPH (0.96+/-0.08) and patients with prostate cancer (1.02+/-0.12). In conclusion, a normal prostate exhibits age-related physiological accumulation of [(11)C]acetate. Careful interpretation of [(11)C]acetate PET images of prostate cancer is necessary because the SUV and the E/L ratio for the normal prostate and for BPH overlap significantly with those for prostate cancer.     

非那雄胺改善良性前列腺增生电切除术后出血的临床研究

目的观察术前短期服用非那雄胺对改善良性前列腺增生（BPH）电切除术后出血的疗效。方法 2010年2月～2011年3月在我院住院接受经尿道前列腺等离子双极电切除手术的BPH患者195例,其中65例术前1 w服用非那雄胺5 mg/次,2次/d,为非那雄胺10 mg组;65例术前1 w服用非那雄胺5 mg/次,1次/d,为非那雄胺5 mg组;其余65例术前1 w未服用非那雄胺,为空白对照组。对所有患者术后生理盐水持续膀胱点滴冲洗、导尿管留置时间及生理盐水冲洗量进行统计。结果非那雄胺10 mg、5 mg组以及空白对照组持续膀胱点滴冲洗时间分别为（33.85±3.45）h、（41.53±3.62）h和（50.25±3.92）h,3组间比较差异有统计学意义（P〈0.05）;3组留置导尿管时间分别为（125.44±18.27）h、（132.36±15.52）h和（144.48±14.89）h,3组之间比较差异有统计学意义（P〈0.05）;3组生理盐水冲洗量分别为（8.23±1.35）L、（9.76±1.32）L和（10.38±2.24）L,3组之间比较差异同样有统计学意义（P〈0.05）。结论术前1 w服用非那雄胺对改善BPH电切除术后出血的效果安全可靠,非那雄胺10 mg组降低术后出血疗效优于非那雄胺5 mg组。     

经直肠针刺组织内消融治疗良性前列腺增生症临床报告

目的探讨一种安全、简便、疗效确切的良性前列腺增生症（Ｂｅｎｉｇｎｐｒｏｓｔａｔｅｈｙｐｅｒｐｌａｓｉａ,ＢＰＨ）非手术治疗方法。方法采用ＷＥ７５６６型前列腺组织内消融治疗仪及自行制作的消融针引导器,对２３例ＢＰＨ患者经直肠前列腺组织内针刺消融治疗（Ｔｒａｎｓｒｅｃｔａｌｉｎｔｅｒｓｔｉｔｉａｌａｂｌａｔｉｏｎ,ＴＲＩＡ）。据前列腺增生体积确定进针数,本组平均进９针,进针深度１５～２０ｃｍ,每针消融时间７ｍｉｎ,消融最高温度为９５℃。对２１例患者治疗后３个月、６个月分别进行了随访。结果残余尿、国际前列腺症状评分（Ｉ－ＰＳＳ）、生活质量评分（ＱＯＬ）分别与治疗前比较差异有极显著意义（Ｐ＜００１）,最大尿流率（ＭＦＲ）及前列腺体积治疗后６个月改善显著（Ｐ＜００１）。结论为治疗良性前列腺增生症提供了一种新的方法     

Clinical value of prostate segmentation and volume determination on MRI in benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a nonmalignant pathological enlargement of the prostate, which occurs primarily in the transitional zone. BPH is highly prevalent and is a major cause of lower urinary tract symptoms in aging males, although there is no direct relationship between prostate volume and symptom severity. The progression of BPH can be quantified by measuring the volumes of the whole prostate and its zones, based on image segmentation on magnetic resonance imaging. Prostate volume determination via segmentation is a useful measure for patients undergoing therapy for BPH. However, prostate segmentation is not widely used due to the excessive time required for even experts to manually map the margins of the prostate. Here, we review and compare new methods of prostate volume segmentation using both manual and automated methods, including the ellipsoid formula, manual planimetry, and semiautomated and fully automated segmentation approaches. We highlight the utility of prostate segmentation in the clinical context of assessing BPH.Benign prostatic hyperplasia (BPH) can result in lower urinary tract symptoms, and is one of the most common diseases affecting aging men. BPH can compromise quality of life and is a major healthcare cost. Despite the high prevalence of BPH, few methods of accurately assessing prostate volume are actually used in clinical practice. While patient assessment of urinary symptoms dictates the need for treatment, it is highly subjective, whereas prostate volume change is a more objective measure of treatment response. The most common clinical model for approximating the prostate gland size is the ellipsoid model from transrectal ultrasonography (TRUS) imaging, which has been shown to underestimate prostate volume for prostates larger than 50 mL and to overestimate prostate volume for glands smaller than 30 mL (1). Despite its limitations, the TRUS method of prostate volume assessment is preferred in current clinical practice due to its availability and cost and time efficiency (2). More accurate prostate volume measurement with magnetic resonance (MR) planimetry is time-intensive and, thus, rarely performed.Prostate segmentation is an accurate technique for prostate volume determination that can be used in coregistration with various imaging modalities, such as magnetic resonance imaging (MRI) with positron emission tomography and MRI with ultrasonography. Segmentation can be used for both diagnostic and interventional procedures, including guided biopsies and focal ablation. Newly developed methods of automated prostate segmentation allow for efficient prostate volume determination, thereby enhancing decision support systems and computer-aided diagnosis tools.This article reviews the major methods of prostate volume determination currently in use, including the ellipsoid formula, manual planimetry, and semiautomated and fully automated segmentation. A clinical overview of BPH is also provided to highlight the utility of prostate segmentation in the clinical management of this disease.     

经尿道前列腺电气化切除术治疗高危前列腺增生症

目的　探讨经尿道电气化切除术治疗高危前列腺增生症的疗效。方法　对 5 8例高危前列腺增生症患者经尿道前列腺电气化切除术的临床资料进行回顾分析。结果　平均手术时间 86min,平均失血量 98ml,平均切割前列腺组织重量 6 8.6 g,术后留置导尿管 3～ 5d ,无电切综合征发生。术后尿流率、剩余尿按国际前列腺症状评分、生活质量评分均明显改善。结论　前列腺增生症合并心、肺、肾疾病或高血压、糖尿病时 ,开放性手术危险性大 ,经尿道电气化切除术为最理想的选择     

Correlation of serum prostate specific antigen, the volume and the intravesical prostatic protrusion for diagnosing bladder outlet obstruction in patients with benign prostate hyperplasia

Benign prostate hyperplasia (BPH) is common in elderly men. Nevertheless, the pathophysiology of low urinary tract symptoms (LUTS) may not be due only to BPH. Many men with LUTS are submitted to unnecessary medications or surgical interventions because their symptoms have not been correctly evaluated. Can diagnostic test such as serum prostate antigen (PSA), performed by nuclear medicine techniques and the trans-abdominal ultrasound determine with high sensitivity whether LUTS is due exclusively to BPH? The aim of the study was to correlate serum PSA, prostate volume (PV), intravesical prostatic protrusion (IPP), uroflowmetry measuring maximal urine flow/sec (Qmax), and the international prostate symptom score (IPSS) questionnaire, to estimate urine bladder outlet obstruction (BOO), in patients with BPH. A hundred and twelve patients with mean of age 72 +/- 8 years and LUTS were studied. All patients were examined according to the IPSS questionnaire, had their serum PSA tested and also Qmax of prostate volume and IPP by trans-abdominal ultrasound were examined. The patients were separated in groups according to serum PSA values (or= 4.1 ng/ml), prostate volume (PV< 20.20-40 and > 20 ml) and the intravesical prostatic protrusion (IPP < 5.5-10.10 mm). There was a statistical correlation between the BOO and: a) PSA (P = 0.004), b) prostate volume with P of < 0.001) and c) IPP = 0.005. On the contrary, there was no statistical correlation between BOO and IPSS, Qmax with P values 0.228 and 0.745 respectively. Receiving operating curve (ROC) showed that patients with a serum PSA value of 1.5-4 ng/ml, IPP of type II and PV 20-40 ml, had a sensitivity of 48% for PSA, of 50% for PV and of 47% for IPP and a specificity of 75%, 47% and 60% respectively. In conclusion, according to the results of this study, a more objective evaluation of BOO, which is exclusively due to BPH, should include, not only PV but also serum PSA values and IPP.     

HoLEP联合钬激光碎石同期治疗良性前列腺增生合并膀胱结石近期疗效观察

目的探讨经尿道前列腺钬激光剜除术(HoLEP)联合钬激光碎石同期治疗良性前列腺增生(BPH)合并膀胱结石的近期临床疗效。方法回顾性分析沈阳军区总医院泌尿外科自2013年3月至2014年12月收治的58例BPH患者的临床资料。BPH合并膀胱结石患者纳入A组(n=29),采用HoLEP同期钬激光碎石治疗;单纯BPH患者纳入B组(n=29),采用HoLEP治疗。监测和记录两组患者前列腺剜除时间、留置尿管时间、住院时间和术后1、3个月复查指标,最大尿流率(Qmax)、一次排尿容积(VOL)、国际前列腺症状评分(IPSS)、生活质量评分(QOLS)等,比较两组的近期疗效。结果 A组患者钬激光治疗膀胱结石时间(23.6±18.78)min,手术时间相应延长。两组患者手术中前列腺剜除时间、术后尿管留置时间和住院时间比较,差异无统计学意义(P>0.05)。术后1、3个月,两组患者的主观症状(IPSS、QOLS)和客观检查结果(Qmax、VOL)均较术前显著改善,差异均有统计学意义(P<0.01);但术后两组间比较,差异无统计学意义(P>0.05)。两组患者在术中、术后随访期间均未发生严重的并发症。结论 HoLEP联合钬激光碎石同期治疗BPH合并膀胱结石具有与未合并膀胱结石相同的近期疗效,是治疗BPH合并膀胱结石的有效方法。     

Differentiation of prostate cancer from benign prostate hypertrophy using dual-echo dynamic contrast MR imaging

OBJECTIVE: To investigate the usefulness of dynamic contrast magnetic resonance (MR) imaging in the differentiation of prostate cancer (PC) from benign prostate hypertrophy (BPH). MATERIALS AND METHODS: Eleven PC patients and 13 BPH patients were entered into the analysis. The mean gradient (MG) was calculated from the T2* term-eliminated time-signal intensity curve obtained from dynamic contrast MR data, and the MG of PC and that of BPH were compared. RESULTS: The MG of PC was significantly higher than that of BPH. When the threshold value was set to 1.88% per s for discriminating PC from BPH, the sensitivity, specificity, and accuracy were 100, 85, and 92%, respectively. CONCLUSION: The MG, which is derived from the T2* term-eliminated time-signal intensity curve, may be a useful index for differentiating PC from BPH.