经尿道前列腺电汽化联合电切术治疗前列腺增生症(附56例报告)

自１９９８年７月～１９９９年３月,采用经尿道前列腺电汽化（ＴＶＰ）联合经尿道前列腺电切（ＴＵＲＰ）术治疗前列腺增生症（ＢＰＨ）５６例,效果良好。报告如下。一般资料　本组５６例,年龄６１～８５岁,平均７２岁。病程２～１５年,平均４．５年。其中合并尿潴留４４例,术前留置尿管。经腹Ｂ超前列腺估重２２～７３ｇ,平均４５ｇ;ＩＰＳＳ症状评分为（２７．４±３．５）分,生活质量评分（ＱＯＬ）（４－９±０－４）分,ＭＦＲ（６．８±３．１）ｍｌ／ｓ。剩余尿（Ｒ）７０～２００ｍｌ,平均１１０ｍｌ。采用美国ＣＩＲＣＯ…     

记忆合金网状支架治疗高危前列腺增生症尿潴留

目的 探讨记忆合金网状支架治疗前列腺增生症的疗效和适应征。方法 总结１９９４年２月～１９９９年２月应用新型支架、置入器,改进置入技术,汉字９９例高危前列腺增生症伴尿潴留患者的临床疗效。结果 ９７例（９７．９％）有效,ＩＰＳＳ由术前平均３０．６减少至７．８,最大尿流率从术前０增加至１３．８ｍｌ／ｓ,剩余尿从术前尿潴留减少至３０．５ｍｌ。结论 应用新型支架、置入器在经直肠超声监视下置入记忆合金网状支架     

经尿道前列腺电汽化切除术(附100例报告)

１９９６年１２月～１９９７年１２月，对１００例良性前列腺增生症（ＢＰＨ）行经尿道前列腺电汽化切除术（ＴＵＶＰ）。术后随访１～１２个月，患者在尿流率、国际前列腺症状（ＩＰＳＳ）、生活质量（ＱＯＬ）评分、剩余尿（ＲＵ）等方面均有显著改善。ＴＵＶＰ兼有经尿道前列腺电切及经尿道前列腺激光治疗的优点，具有操作简便、去除增生组织量大、出血少、并发症低、恢复快、疗效显著等特点，是值得推广的新方法     

经尿道汽化电切术治疗前列腺增生症（附42例报告）

我们自１９９７年１２月～１９９８年１１月采用经尿道前列腺汽化电切术（ＴＵＥＶＡＰ）共治疗良性前列腺增生症（ＢＰＨ）４２例,效果良好。报告如下。临床资料　本组４２例年龄５６～８４岁,平均７２－５岁。病程１～１１年,平均４－２年。均有严重的排尿困难,有尿潴留者２３例,术前行膀胱造瘘者１１例。ＩＰＳＳ（３１－２±１－２）分,ＱＯＬ（５－１±０－４）分;Ｂ超测定前列腺体积为（４４－７±９－５）ｍｌ;最大体积为９８－３ｍｌ,最大尿流率（ＭＦＲ）为（６－２±１６）ｍｌ／ｓ,剩余尿（Ｒ）为（１３１±４１－６…     

经尿道微波针组织间消融术治疗前列腺增生症

１９９４年１１月～１９９５年９月采用经尿道微波针组织间消融术（ＴＵＷＮＡ）治疗前列腺增生症（ＢＰＨ）患者２５例，其中２１例随访６个月。术后前列腺症状积分下降了１６．８±４．１分（８０．１％），最大尿流率增加了６．７±１．９ｍｌ／ｓ（７４．４％），剩余尿减少了６６．７±３７．２ｍｌ（７６．１％），前列腺体积减少了１．１±１．７ｍｌ（２．３％），其差异有显著性意义。病理检查见增生的前列腺组织发生凝固坏死，有的形成空腔，造成前列腺实质缺损，有效地解除了后尿道梗阻，是一种可望代替手术的ＢＰＨ治疗方法。     

经尿道前列腺切开术选择性治疗前列腺增生症的疗效观察

目的　评价经尿道前列腺切开术（ＴＵＩＰ） 治疗年龄较轻或高龄高危的小体积前列腺增生症（ＢＰＨ）的疗效。　方法　采用ＴＵＩＰ治疗ＢＰＨ患者８３ 例。　结果　手术时间１０ ～２５ｍｉｎ ,平均随访３ ．２ 年,术后国际前列腺症状评分（ＩＰＳＳ）由（２６．９ ±４ ．８） 分降至（１１．３ ±３ ．４） 分（Ｐ＜ ０ ．０５） ,最大尿流率（ＭＦＲ） 由（６．７ ±２．４）ｍｌ／ｓ 上升至（１３．６ ±３ ．５）ｍｌ／ｓ（ Ｐ＜ ０ ．０５）,剩余尿（ＲＵ） 由（９８．５ ±４５．３）ｍｌ 降至（２６ ．６ ±１７．９）ｍｌ（ Ｐ＜ ０ ．０５） 。逆行射精发生率为７ ．７％ （４／５２） 。　结论　对于ＢＰＨ＜ ３５ｇ,ＴＵＩＰ可取得与经尿道前列腺汽化术（ＴＵＶＰ） 相似的疗效,且逆行射精、膀胱颈挛缩及阳萎的发生率低,适用于症状明显的年龄偏小或高龄高危的小体积ＢＰＨ 患者。     

前列腺部分电切术在高危前列腺增生症中的应用

为了提高高龄高危前列腺增生症（ＢＰＨ）患者的治疗效果，对７２例高危ＢＰＨ病人采用经尿道部分前列腺电切治疗，平均随访３．５年。结果显示：电切前列腺组织平均１４．４ｇ，占预测前列腺重量的２１．９％；术后ＩＰＳＳ由２６．５±３．７降至１０．２±２．７，最大尿流率由５．９±２．５ｍｌ／ｓ提高至１４．８±２．３ｍｌ／ｓ，而术后再手术率与其他并发症并未增加。切除前列腺组织１０～１５ｇ与１５～２５ｇ两组的术后ＩＰＳＳ、尿流率无明显差异。认为经尿道部分前列腺电切适用于高龄高危ＢＰＨ病人，手术不必刻意追求前列腺切除的重量及彻底性，其效果关键在于切除的部位与方法。     

经尿道前列腺电气化术治疗BPH疗效评价：附84例报告

目的 评价经尿道前列腺电气化术（ＴＵＶＰ）治疗前列腺增生症（ＢＰＨ）的临床效果。方法 采用电气化法加电切法施行经尿道前列腺电气化术治疗ＢＰＨ８４你。结果 ７６你获得０．５年随访。国际前列腺症状评分（ＩＰＳＳ）由术前（２７．４±３．１）分降压（１０．５±１．７）分,生活质量评分（ＱＯＬ）由（５．３±０．６）分降为（２．１±０．４）分,剩余尿量由（１３２．１±４４．５）ｍｌ降至（２８．６±１４．２）ｍ     

经尿道前列腺电汽化与经尿道前列腺电切对BPH的疗效比较

对２４０例有症状的前列腺增生症（ＢＰＨ）患者分别行经尿道前列腺电汽化术（ＴＶＰ）和经尿道前列腺电切术（ＴＵＲＰ）。结果显示：１２０例ＴＶＰ手术者，前列腺症状评分（ＩＰＳＳ）从术前的２０．９下降至术后３个月的５．１（Ｐ＜０．００１），最大尿流率由１０．６ｍｌ／ｓ上升至１９．２ｍｌ／ｓ（Ｐ＜０．０１）。ＴＵＲＰ组１２０例，ＩＰＳＳ从术前的２１．２下降至术后３个月的５．２（Ｐ＜０．００１），最大尿流率由１０．２ｍｌ／ｓ上升至１９．４ｍｌ／ｓ（Ｐ＜０．０１），两组比较无显著差异性（Ｐ＞０．０５）。平均留置导尿管时间：ＴＶＰ组２６．５小时，ＴＵＲＰ组５０．７小时，有显著性差异（Ｐ＜０．０１）。术后阳萎发生率：ＴＶＰ组２．４％，ＴＵＲＰ组１４．５％（Ｐ＜０．０５）。ＴＶＰ组术中无大出血及经尿道前列腺电切综合征（ＴＵＲＳ）发生，需输血者仅１例。ＴＵＲＰ组３例发生ＴＵＲＳ，输血１４例。比较结果：ＴＶＰ能达到与ＴＵＲＰ完全相同的治疗效果，且并发症少，价格相对较低，近期效果满意。     

钛丝尿道支架用于治疗手术高危前列腺增生症

应用国产钛丝尿道支架放置于尿道前列腺部治疗手术高危良性前列腺增生症６９例。通过电切镜放置钛丝支架，６７例成功。术后患者排尿困难明显缓解。随诊１￣１５个月，均能自主排尿，无尿潴留发生。４１例最大尿流率于１２．５ｍｌ／ｓ，尿路感染得以控制；２６例最大尿流率大于８．５ｍｌ／ｓ，总有效率９７．１％。作者认为该方法治疗前列腺增生症简便、安全、疗效好、并发症少，对不能接受手术治疗的前列腺增生患者尤为适宜。文中     

网状支架治疗前列腺增生症121例的远期疗效

目的 评价应用记忆合金网状支架治疗前列腺增生症(BPH)合并膀胱出口梗阻(BOO)的远期临床疗效。方法 1995.3～1999.5月应用国产镍钛合金网状支架治疗前列腺增生症患者121例,术后1年分别进行随访;重新评定疗效。结果 术后1、2、4年有效率分别为91.5％、80.9％、64.3％,IPSS由术前25.4减少至8.5,MFR从术前2.5ml/s增加至13.4ml/s,RUV由术前119.3ml减少至52.8ml。结论 前列腺尿道测量的准确性及支架安放的准确性影响手术的远期疗效。网状支架仍然适用于前列腺增生症的高危患者。     

经尿道手术治疗小体积前列腺增生所致膀胱出口梗阻

目的探讨经尿道前列腺电切(transurethral resection of prostate,TURP)+经尿道膀胱颈切开术(transurethralincision of bladder neck,TUIBN)治疗小体积前列腺增生所致膀胱出口梗阻的疗效。方法 2002年3月～2007年1月,采用TURP+TUIBN治疗小体积前列腺增生所致膀胱出口梗阻31例,其中有完整随访资料的25例,年龄46～71岁,平均56岁,病程8～77个月,平均32个月,前列腺重量15～30 g,平均24 g。比较术前、术后国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿量(PVR)等指标,以评估疗效。结果手术时间25～47 min,平均38 min。经尿道切除前列腺组织重量6～17 g,平均9.8 g。术后病理报告25例均为良性前列腺增生(其中20例为纤维增生型),15例伴慢性前列腺炎。术后随访6～24个月,平均15个月。23例排尿通畅,1例尿道狭窄(行尿道扩张后排尿通畅),1例膀胱颈挛缩。术前、术后6个月IPSS评分分别为(26.60±3.07)分、(6.92±1.26)分,Qmax为(7.96±2.30)ml/s、(19.60±2.31)ml/s,PVR为(132.80±64.84)ml、(18.60±7.97)ml,差异均有显著性(P=0.000)。结论 TURP+TUIBN是治疗小体积前列腺增生所致膀胱出口梗阻的一种较为理想的术式。     

Can prostate stents be used to predict the outcome of transurethral resection of the prostate in the difficult cases?

PURPOSE OF REVIEW: Endoprosthesis has been used to maintain luminal patency in several different diseases and is well established in cardiovascular and gastrointestinal pathologies. The usefulness and application in prostatic pathology and benign prostatic hyperplasia are not as clear. This report reviews the development of overactive bladder in patients with bladder outlet obstruction due to benign prostatic hyperplasia. It also describes a new application of prostatic stents in patients with combined overactive bladder and bladder outlet obstruction. RECENT FINDINGS: Over the last few decades, interest has been focused on the pathology of overactive bladder due to bladder outlet obstruction. Persistent outlet obstruction can certainly induce overactivity in some cases. However, the significance of preoperative identification of the latter problem is still an open issue, and it is obviously of vital importance to find instruments to identify parameters of prognostic significance. Different prostatic stents have been used for a variety of purposes. Recent studies have demonstrated that prostatic stents are effective in relieving obstruction and urinary retention. However, the role of prostatic stents in bladder outlet obstruction is still not clear when compared with other minimally invasive options. By using a prostatic stent to simulate transurethral resection of the prostate, the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder has been possible to assess before the operation. However, larger controlled clinical studies are needed to corroborate the value of the test. SUMMARY: Prostatic obstruction can induce severe overactive bladder in some cases. A prostatic stent to relieve outflow obstruction and to simulate transurethral resection of the prostate decreases the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder because very high risk patients can be excluded from surgery. The stent test indicates that patients who do not leak and experience reduced symptoms when they are relieved of their outlet obstruction can be advised to have a transurethral resection of the prostate.     

Outcome analysis of the urethral stent (Memotherm®)

A number of patients with benign prostatic hyperplasia can not undergo surgical therapy because of advanced age, concomitant diseases, and other reasons. Since 1980, various types of urethral stents have been used for high-risk patients with benign prostatic hyperplasia. We report our experience with the use of urethral stents (Memotherm?). Between July 2002 and December 2010, we implanted urethral stents in 36 patients. The average follow-up period was 24.0 months. After stent implantation, 34 of the 36 patients were able to micturate. The average residual urine volume was 24.7 ml (0-250 ml), and the maximal urinary flow rate was 10.7 ml/s (3-24 ml/s). One stent had to be removed due to bladder tamponade, and one had to be exchanged due to dislocation. In 2 patients, a stone formed at the bladder end of the stent, and one of these patients underwent transurethral lithotripsy. Our results suggest that therapy with the Memotherm? urethral stent is a good option for patients suffering from urinary retention due to benign prostatic hyperplasia.     

Endoscopic balloon dilation of the prostate: early experience.

Coaxial balloon dilation catheters recently have been introduced for transurethral dilation of the prostate. We applied endoscopically a specially designed high pressure, large diameter balloon catheter to patients with benign prostatic hyperplasia or primary bladder neck hyperplasia who presented with symptomatic, cystoscopic and urodynamic evidence of obstruction. We report our preliminary experience with 42 patients: 28 with benign prostatic hyperplasia and 14 with bladder neck hyperplasia. Six months after dilation 46% of the patients demonstrated at least a 25% improvement in subjective (symptom score) and objective (corrected peak flow rate) parameters, while 6 (21%) experienced excellent (greater than 50%) symptomatic improvement despite unchanged corrected peak flow rates and 3 (11%) showed significant (greater than 50%) improvement in corrected flow rate alone. At 1, 3, 6 and 12 months the symptom scores decreased by 70, 67, 61 and 59% (median) from pre-treatment levels. Men with benign prostatic hyperplasia fared better than those with primary bladder neck hyperplasia (74 versus 58% decrease at 6 months). Objective evaluation by corrected peak flow rates demonstrated 25, 24, 28 and 2% median improvement at 1, 3, 6 and 12 months, respectively. Patients with primary bladder neck hyperplasia had substantially greater increases than those with benign prostatic hyperplasia (47 versus 27% at 6 months). Immediately after dilation the serum prostate specific antigen level increased by at least 1.5 ng. per ml. in 16 of 22 patients, indicating significant tissue trauma. Complications included mild bleeding and pain for the initial 24 hours and transient urinary retention in 2 patients. Our experience demonstrates the safety of an endoscopic approach to balloon dilation of the prostate that allows the urologist to maintain a central role in the assessment of a new approach to the treatment of obstructed voiding dysfunction.     

Urinary flow rate in benign prostatic hypertrophy.

Multiple urinary flow measurements were recorded on 12 men without bladder outlet obstruction, ten men with a clinically doubtful diagnosis of bladder outlet obstruction due to benign prostatic hypertrophy, 29 men with a proven clinical diagnosis of bladder outlet obstruction due to benign prostatic hypertrophy and eight men before and after prostatic surgery. All were over 50 years of age. Mean peak flow rates for non-obstructed men varied from 11.8 to 35.0 ml per second and the minimum threshold for mean peak flow rate in these subjects was 15.0 ml per second for voided volumes of 200 ml and above. The vast majority of subjects with obstruction had mean peak flow rates below 15 ml per second. Mean peak flow rates reverted to normal after prostatic surgery. Our findings justify the use of multiple determinations of peak flow rate as a routine screening examination in subjects who may have bladder outlet obstruction due to benign prostatic hypertrophy.     

经尿道电气化前列腺切除治疗症状性良性前列腺增生症

目的 研究经尿道电气化前列腺切除术（ＴＶＰ）治疗症状性良性前列腺增生症的有效性,安全性和远期效果。方法 １９９５年９月－１９９８年８月,对１５０例症状性良性前列腺增生患者采用了经尿道电气化前列腺切除术的两种气化电极进行了治疗。本组平均年龄７４．８岁。术前本组均经国际症状评分,生活质量评分,肛门指诊,经直肠Ｂ超,尿动力学测定,剩余尿检查。     

Laser prostatectomy. Long-term follow-up of 303 patients

OBJECTIVE: This retrospective study was undertaken to evaluate results and complications in 303 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH) who underwent laser prostatectomy focusing on the long-term follow-up, 57 patients had a follow-up of more than 3 years. MATERIALS AND METHODS: A total of 303 patients were treated with the neodymium:YAG laser system for 1993 to 1997, of whom 57 patients were followed up for at least 3 years. All of the patients have been evaluated after 3 months, 6 months and 2 years. 57 patients were evaluated after 3 years. Pre- and postoperative American Urological Association (AUA) symptom score, uroflowmetry (UF), and immediate and long-term complications were assessed. RESULTS: The mean AUA symptom scores of 303 patients decreased over the 24 months follow-up from 16.9 to 7.6. In 57 patients after 36 months the mean AUA symptom score was 7.1. The mean maximal UF increased over the 24 months from 9 to 14.1 cm3/s in 303 patients. In 57 patients at 3 years the mean UF was 13. 9 cm3/s. The overall complications of 303 patients included two perforations of the bladder wall and two perforations of the prostatic capsule. Six (1.9%) patients had postoperative febrile UTI and 28 (9.2%) patients had acute urinary retention after catheter removal. Early bleeding occurred in 3 (0.9%) patients, late bleeding in 8 (2.4%), 4 (1.2%) had urethral stricture, and 1 had stricture of the bladder neck. The overall reoperation rate for symptomatic residual tissue was 1.9% (6 patients). CONCLUSION: Neodymium:YAG laser ablation of prostate represents an efficacious surgical intervention for symptomatic bladder outlet obstruction due to BPH with minimal associated morbidity.     

Pharmaco-profilometry using alpha-1a adrenergic blockers in the diagnosis of dynamic infravesical obstruction in the vesicourethral zone segment

Alpha-blockers decrease sympathetic influence and thus lower pressure in bladder neck region. Pharmacoprofilometry with tamsulosin was used in diagnostic dynamic outlet obstruction in 43 patients with benign prostatic hyperplasia (BPH) and in 17 patients with urethral stricture. 12 BPH patients with positive results of the test received tamsulosin in a single daily dose 0.4 mg. After 3 months the subjective symptom score significantly improved in all the patients. Stenosis of the urethra and bladder neck was found in 17 patients who had micturation disturbance in different periods after prostatectomy. In 9 patients urethral pressure in the region of the bladder neck decreased after 3 days of tamsulosin treatment given a single daily dose 0.4 mg. Urethrotomy without bladder neck resection was performed in these patients. Three months later average Q max increased from 6 ml/s to 18 ml/s and residual urine decreased from 112 ml to 30 ml. Selective alpha-blocker profilometry allows to distinguish between organic and functional neck stenosis and choose the necessary treatment.