移行区指数预测良性前列腺增生的临床意义

1998年 4月至 2 0 0 1年 6月 ,我们对良性前列腺增生 (ＢＰＨ)患者前列腺体积(ＴＰＶ)及移行区体积 (ＴＺＶ)进行测量 ,并计算移行区指数 (ＴＺＩ) ,探讨其与ＢＰＨ致下尿路症状 (ＬＵＴＳ)的关系。报告如下。资料与方法　本组 2 86例。年龄51～ 84岁 ,平均 68岁。均以症状性ＢＰＨ就诊。前列腺癌、急性前列腺炎、尿道狭窄、神经源性膀胱及有前列腺手术或药物治疗史的患者均不纳入本研究。患者均行国际前列腺症状评分(ＩＰＳＳ) ,并测定最大尿流率 (Ｑｍａｘ)和剩余尿量 (ＰＶＲ) ,经直肠超声 (ＴＲＵＳ)测量前列腺三径及移行区三径 (前后、…     

前列腺增生症腔内B超的声像特征及定量指标间的相关回归分析

为探讨良性前列腺增生症（ＢＰＨ）腔内Ｂ超特征及超声所测定量指标与手术切除标本重量间的相互关系，对５６３例ＢＰＨ患者进行了经直肠Ｂ超检查，测定整个腺体及移行带体积并与４５例手术标本行相关回归分析。结果发现：ＢＰＨ有其特有声像特征，移行带体积与手术标本重量值呈显著相关性（ｒ＝０９８８，Ｐ＜０００１，误差为４％）；腺体体积与手术标本重量值间也成直线相关性，但误差达４７８％。使用多平面高频７５ＭＨｚ探头的经直肠Ｂ超可以准确估计前列腺及增生腺体的大小，前列腺区带的定量学研究对减少超声误差，指导ＢＰＨ诊断及治疗十分重要。     

前列腺增生体积、症状积分和梗阻程度的相关性研究

目的：探讨前列腺增生体积、症状积分和膀胱出口梗阻程度的相关性。方法：对４３例住院手术的前列腺增生症患者进行国际前列腺症状评分（ＩＰＳＳ），其中经腹壁Ｂ超测前列腺体积（Ｖ）者２７例；行排尿期尿道测压确定膀胱出口梗阻者２７例，并用压力下降梯度（ＭＵＰＰ Ｇｒａｄｉｅｎｔ）代表梗阻程度。结果：ＩＰＳＳ和Ｖ呈正相关（ｎ＝２７，ｒ＝０．３９３３，Ｐ＝０．０２１），ＩＰＳＳ和ＭＵＰＰ Ｇｒａｄｉｅｎｔ呈正相关     

良性前列腺增生组织NO合酶表达的免疫组化研究

为探讨一氧化氮合酶（ＮＯＳ）在良性前列腺增生（ＢＰＨ）组织中的表达及其意义，采用免疫组化法对２４例ＢＰＨ组织中ＮＯＳ表达进行检测。结果显示：ＮＯＳ在ＢＰＨ组织神经纤维和神经节均有表达，血管内皮细胞和腺体上皮细胞亦可见ＮＯＳ表达。２４例ＢＰＨ中，外周区强阳性１７例，弱阳性７例；移行区强阳性１０例，弱阳性１４例，两者比较有显著性差异（Ｐ＜０．０５）。提示ＢＰＨ组织中存在一氧化氮（ＮＯ）神经传导通路，ＮＯ可影响前列腺平滑肌张力。     

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。     

前列腺重量与膀胱出口梗阻相关性的研究

目的探讨ＢＰＨ患者尿动力学评估价值及膀胱出口梗阻与前列腺重量的关系。方法采用影像尿动力学检查评估临床常规方法诊断的ＢＰＨ患者。结果６３例ＢＰＨ患者中,１３例膀胱出口无梗阻;经影像尿动力学检查确诊为ＢＰＨ的患者中,以前列腺重量３０ｇ为界,大于３０ｇ组前列腺重量与ＡＧ图分级成正相关（ｒ＝０．４３,ｎ＝２２,Ｐ＝０．０４６）,而小于３０ｇ组则无此相关性。结论ＢＰＨ患者有必要行尿动力学检查以除外膀胱功能障碍性疾病。前列腺大于３０ｇ时宜采用减小前列腺体积的治疗方法,而大于３０ｇ则应采用缓解膀胱颈梗阻的治疗方法     

小体积良性前列腺增生治疗方式的选择

目的：寻找治疗小体积良性前列腺增生（ＢＰＨ）患者的最佳治疗方式。方法：对４２例小体积ＢＰＨ患者采用直肠Ｂ超及尿动力学检查相结合方法进行综合分析，如移行区指数（ＴＺＩ）〉０．４且存在膀胱颈梗阻者，采用ＴＵＲＰ治疗；如ＴＺＩ≤０．４且存在膀胱颈梗阻者，则行药物治疗，结果：ＴＺＩ〉０．４者ＴＵＲＰ治疗效果好（９３．３％），药物治疗效果较差（５０．０Ａ％０；ＴＺＩ≤０．４者药物治疗优于ＴＵＲＰ治疗：ＴＺＩ≤０．４而无膀胱颈梗阻者手术及药物治疗均无效。结论：治疗小体积ＢＰＨ患者的原则是尿动力学检查有膀胱颈梗阻存在，如ＴＺＩ〉）．４，宜行ＴＵＲＰ治疗；如ＴＺＩ〉０．４，则行药物治疗，如尿动力学检查无膀胱颈梗阻存在，则应继续寻找病因。     

B超测量与手术切除前列腺重量的比较

为弄清Ｂ超测量的前列腺重量与开放手术实际摘取以及经尿道电切的前列腺标本重量间的关系。本科 1997年～ 1999年对需行开放手术或经尿道前列腺电切 (ＴＵＲＰ)治疗的病人术前分别经Ｂ超测量前列腺重量和术后实际取得的前列腺标本重量进行了比较。现将结果报告如下。1　材料与方法　近 3年来本院行前列腺增生 (ＢＰＨ)手术治疗的10 0例病人 ,按腺体大小相近选取。分为耻骨上经膀胱前列腺摘除术和ＴＵＲＰ术两组 ,每组各 50例。病人年龄 59～ 82岁 ,平均 71岁。术前均经直肠三维Ｂ超测量前列腺上下、左右、前后三个径线 ,按前列腺体积公式Ｖ …     

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。     

前列腺切除术后性功能障碍245例分析

调查２４５例因良性前列腺增生症（ＢＰＨ）行耻骨上前列摘除术（ＳＰＰ）或经尿道前列腺切除术（ＴＵＲＰ）患者手术前后性功能的情况。结果发现术后勃起功能障碍发生率ＳＰＰ组为１０．４％；ＴＵＲＰ组为１４．３％，两组无明显差异；逆行射精发生率ＳＰＰ组为２６．３％，ＴＵＲＰ组为４８．７％，ＴＵＲＰ组明显高于ＳＰＰ组，并就ＢＰＨ术后性功能障碍性的原因及预防措施进行了讨论，认为除年龄、术前性功能状态、术者经验、心     

Transition Zone Ratio and Prostate-Specific Antigen Density: The Index of Response of Benign Prostatic Hypertrophy to an Alpha Blocker

Background: The aim of the present study was to determine whether the indices of transrectal ultrasonography (TRUS) are related to the clinical response to tamsulosin, a long-acting selectiveα₁-blocker.
Methods: Sixty patients with symptomatic benign prostatic hypertrophy (BPH) were treated with tamsulosin hydrochloride (0.2mg/day) for 2 months. The findings on TRUS and uroflowmetry and the AUA symptom score before treatment were compared with those obtained at the end of the 2 month treatment period. For the indices of TRUS, transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume, and prostate specific antigen density (PSAD) were calculated.
Results: There was a significant correlation between the pretreatment TZ ratio and the residual urine volume ( r = 0.421, P = 0.0005). Patients with a lower TZ ratio and/or PSAD responded well to the treatment. The correlation between the PSAD value and the percent change in peak urinary flow rate was statistically significant ( r = -0.432, P = 0.0009).
Conclusion: TRUS provides simple parameters of PSAD that can be used to predict the response of patients to tamsulosin hydrochloride.     

The importance of measuring the prostatic transition zone: an anatomical and radiological study.

OBJECTIVE: To assess the accuracy and reliability of measurements of the volume of the transition zone (TZ, representing the hypertrophied benign component) and whole prostate by TRUS in patients with BPH or cancer, by comparing the radiological with pathological findings after surgery. PATIENTS AND METHODS: The study comprised 36 patients with prostate cancer undergoing radical prostatectomy and 34 patients with symptomatic BPH treated using retropubic adenectomy. The weights of the radical prostatectomy specimens and of the enucleated adenomas were correlated with the corresponding volumes of the TZ and of the whole prostate, respectively, measured by TRUS using the prolate ellipsoid method. RESULTS: The mean (sd) TZ volume measured by TRUS was 36.9 (25.48) mL, whereas the weight of the enucleated specimen was 42.7 (33.58) g (correlation coefficient r=0.95, P<0.001). The TRUS estimate of the volume of the whole prostate was 29.2 (9.24) mL, while the radical prostatectomy specimens weighed 34.5 (10.76) g (r=0.78, P<0.001). The variability in the TZ volume estimate ranged from -17% to +18%, whereas the variability for whole prostate was -21% to +30% (P<0.05). CONCLUSIONS: Measurements of the TZ of the prostate by TRUS are more accurate than those for the whole prostate. An assessment of the TZ volume may be sufficiently reliable to be used in the clinical management of BPH and to detect prostate cancer using the prostate-specific antigen density of the TZ as a marker.     

Changes in serum prostate-specific antigen following prostatectomy in patients with benign prostate hyperplasia

PURPOSE: To investigate how prostatectomy for patients with benign prostate hyperplasia (BPH) affected the serum prostate-specific antigen (PSA) levels. METHODS: In 193 patients who underwent prostatectomy for BPH, serum PSA levels were measured before and three months after the operation. The total prostate weight measured by transrectal ultrasonography (TRUS) and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in PSA levels after the operation. RESULTS: The transition zone volume measured by TRUS could well estimate the weight of the surgical specimen in patients who underwent subcapsular prostatectomy and transurethral resection of the prostate. The concentration of preoperative serum PSA showed a significant correlation with the prostatic volume and with the transition zone volume. Removal of 1 g of BPH tissue reduced serum PSA levels by an average of 0.18 ng/mL. The change in serum PSA levels after the prostatectomy correlated with the total prostatic gland volume and with the transition zone volume. CONCLUSIONS: The elevated PSA levels in patients with BPH were caused by the enlargement of the transition zone. After the resection of the adenoma, PSA levels should be expected to decrease to the normal range.     

Relationship between age and prostate size

In a community-based study, the relationship between age and human prostate size was investigated in a population of men between the ages of 40 and 70 years to determine the normal prostate increase curve equation. One thousand male volunteers were randomly recruited from the Shanghai community, and the length, width, height, volume of the transition zone (TZ) and the whole prostates were measured by transrectal ultrasound (TRUS). Each volunteer was evaluated by the International Prostate Symptom Score (IPSS). Among those who completed the examination, the mean prostate parameters were all positively associated with increased age. There were statistically significant differences between each age group (P<0.05). The mean transition zone volume (TZV) had a higher increase rate with age than the mean total prostate volume (TPV), indicating that the enlargement of the TZ contributed the most to the increase in TPV. While all prostate parameters were positively correlated with the IPSS, the strongest correlation was associated with the TZ length (TZL) and TZV. The growth curve equations for prostate width, height and length were also positively associated with increasing age.     

Volume determinations of the whole prostate and of the adenoma by transrectal ultrasound: correlation with surgical specimen

ObjectiveWe evaluated whether preoperative transrecta ultrasound (TRUS) mesaurements of the transition zone (TZ) and total prostate volumen predict real prostatic weight.Material y MethodsWe compare estimated TRUS volumes with surgical specimen weight, in surgically treated patients with localized prostate cancer (group A, n=33) or benign prostatic hyperplasia (group B, n=37). The volume was calculated by the ellipsoid formula. Both measurements were compared with surgical specimen weight, assuming 1 as specific prostate weight.ResultsGroup A: mean prostate measured volume was 38,6 cc. (SD 22,7), mean RP specimen weight was 54,2 g (SD 27,2)(p=0,001). Total estimated prostate volume underestimated prostatectomy specimen weight by 29%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated prostate weight=0,95 x prostatic measured volume + 17,657 (p=0,005).Group B: mean TZ measured volume was 62,8 cc. (SD 23,3), mean adenomectomy specimen weight was 79,9 g (SD 45,9) (p=0,001). TZ estimated volume underestimated adenomectomy specimen weight by 21%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated TZ weight=1,67 x TZ measured volume - 24,768 (p=0,04).ConclusionsWe found significative differences between TRUS measured volumes and real weight of surgical specimen. These differences could be corrected by simple formulas that allow to minimize the observed underestimations.     

Transrectal Ultrasonography to Predict the Clinical Outcome of Transurethral Microwave Thermotherapy in Patients with Benign Prostatic Hyperplasia

Background: This study evaluated the long-term efficacy of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia (BPH), and determined whether the indices obtained with transrectal ultrasonography (TRUS) can predict the clinical response to TUMT.
Method: Between November 1991 and June 1992, 43 patients with symptomatic BPH were treated with TUMT using the Prostcare device. The therapy consisted of a 1 -hour treatment under topical anesthesia. The findings of uroflowmetry and AUA symptom score before treatment were compared with those obtained dt each visit after the therapy. As the indices, the transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume, and presumed circle area ratio (PCAR) were calculated.
Results: There was a significant correlation between pretreatment TZ ratio and residual urine volume ( r = 0.472, P = 0.0022). The efficacy rates calculated by response criteria on the 3 point scale at 2 months, 12 months, and 30 months were 44.2%, 30.2%, and 25%, respectively. The significant prognostic factors that predicted the clinical effect 1 year after treatment were the TZ ratio and intraprostatic temperature. After controlling for the treatment temperature, the multivariate logistic regression model demonstrated that the TZ ratio was the significant predictor ( p = 0.049) of 1 year efficacy of treatment.
Conclusion: The present study showed that the efficacy rate of TUMT at 30 months was 25%, and that TKUS provides a simple parameter, the TZ ratio, which predicts the efficacy of TUMT.     

A new parameter in decision making for transurethral electroresection of benign prostate hyperplasia

OBJECTIVE: In this study, the clinical usefulness of transition zone (TZ) volume (TZV) measured by transrectal ultrasonography (TRUS) was investigated as a new parameter for the preoperative prediction of the treatment efficacy of transurethral resection of the prostate (TURP). METHODS: Fifty-six men with symptomatic benign prostatic hyperplasia (BPH; age 68.6 +/- 9.7 years) underwent TURP and were evaluated based on ordinary BPH parameters such as the international prostatic symptom score (I-PSS), quality of life (QOL) score, peak urine flow and entire prostate volume (PV), as well as the new TZV parameters and calculation of the TZ index. Relative risks were adjusted simultaneously for potentially confounding variables by multiple logistic regression analysis after adjustment for age, QOL, I-PSS, Qmax and residual urine. RESULTS: The adjusted relative risk for TURP at a TZ index of 0.1 increased to 4.5 (95% confidence interval 2.3-8.78). In general, poor responses were observed in patients with less symptomatic scores or lower values prior to operation, but there was a weak correlation between treatment outcome and preoperative scores or values of ordinary parameters. The volume parameters of BPH and PV did not predict treatment efficacy preoperatively, but TZV and the TZ index correlated with the treatment efficacy of TURP. CONCLUSION: TZV and the TZ index seem to be useful new parameters in preoperative decision-making with regard to TURP.     

累及移行带前列腺癌的诊断分析

目的分析累及移行带前列腺癌的临床特征,提高移行带前列腺癌的诊断率。方法回顾我院收治的77例前列腺癌患者,一组44例仅限于外周带;另一组33例已累及移行带。分析两组的临床表现、直肠指检、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原、经直肠前列腺超声以及前列腺穿刺活检。结果两组患者的年龄、排尿期和储尿期症状、直肠指检阳性率、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原以及病理分级没有显著性差异。移行带肿瘤存在泌尿系转移的风险。经直肠超声为移行带可疑病灶的定位提供了重要的参考,而对可疑病灶穿刺活检则能提高累及移行带前列腺癌的诊断率。结论经直肠超声行移行带可疑病灶的穿刺活检是诊断累及移行带前列腺癌的有效手段。     

Determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic hyperplasia: agreement with enucleated prostate adenoma weight

PURPOSE: Accurately estimating transition zone volume is important for the medical or surgical management of symptomatic benign prostatic hyperplasia and determination of prostate specific antigen density of the transition zone. We evaluated whether preoperative transrectal ultrasound measurements of the transition zone predict enucleated adenoma weight. MATERIALS AND METHODS: We measured transition zone volume preoperatively using transrectal ultrasound and the prolate ellipsoid method in 50 patients with presumed benign prostatic hyperplasia who underwent suprapubic prostatectomy. Transition zone volume corresponds to the adenoma. Enucleated adenoma weight was then correlated with preoperatively determined transition zone volume. RESULTS: As measured by transrectal ultrasound, mean transition zone volume plus or minus standard deviation was 80.88 +/- 37.42 cc (range 31 to 200). Mean enucleated adenoma weight was 68.70 +/- 36.26 gm. (range 18 to 180). There was a statistically significant correlation of estimated transrectal ultrasound volume of the transition zone with enucleated prostate adenoma weight (r = 0.95, p <0.001). However, when prostate adenoma weight was determined using the formula, prostate adenoma weight = -6.00 + 0.92 x transition zone volume, we noted a significant difference in mean prostate adenoma weight and mean transition zone volume (p <0.001). Since the regression coefficient of transition zone volume was significantly different from 1, we identified no agreement of prostate adenoma weight with estimated transrectal ultrasound volume of the transition zone. CONCLUSIONS: These data reveal a significant difference in mean prostatic adenoma weight and mean transition zone volume. Although transition zone volume measurements are well described, clear agreements on such measurements should be obtained to determine transition zone volume more precisely.     

Three-dimensional ultrasonography in evaluation of benign prostatic hyperplasia

BACKGROUND: The clinical application of volume estimation by 3-D ultrasound has recently gained much attention. However, there have been no reports evaluating the prostate volume by 3-D transrectal ultrasound (TRUS) before transurethral resection of the prostate (TURP). The purpose of the present study was to evaluate the value of 3-D TRUS for prediction of prostate morphology and resected weight before TURP and to investigate whether 3-D TRUS is a more useful examination than 2D TRUS in patients with benign prostatic hyperplasia (BPH). METHODS: Transurethral resection of the prostate was performed in 23 patients with BPH. We evaluated the prostate morphology and measured both the volumes of the whole prostate and the transition zone using 2-D and 3-D TRUS, respectively. The actual resected weight was recorded and compared with the volume of the whole prostate and that of the transition zone measured by 2D and 3-D TRUS. RESULTS: The volume of the transition zone measured by 3-D TRUS correlated most strongly with the resected weight (r = 0.84). A large median lobe was seen in three patients in whom the transition zone volume measured by 2-D TRUS was considerably larger than the resected weight. However, overestimation in the three patients decreased by the use of 3-D TRUS. CONCLUSIONS: It was concluded that 3-D TRUS was equal or superior to 2-D TRUS in prediction of the resected weight and 3-D TRUS offers better information as a diagnostic tool before TURP.