Open radical retropubic prostatectomy gives favourable surgical and functional outcomes after transurethral resection of the prostate

OBJECTIVES

To assess the peri‐ and postoperative outcome of patients treated with open radical retropubic prostatectomy (RRP) for prostate cancer and who had previously undergone transurethral resection of the prostate (TURP).

PATIENTS AND METHODS

Prospectively collected data from a consecutive series of 1760 patients who had RRP between July 2003 and June 2007 at our institution were used to retrospectively match 62 cases (with previous TURP) with the same number of controls (without previous TURP). Matching variables were patient age, body mass index, prostate volume, preoperative total prostate‐specific antigen (PSA) level, Gleason score, pathological stage, and intraoperative nerve‐sparing procedure. Complete 1‐year follow‐up data were available for all patients. All collected data on surgery and perioperative complications were analysed. Functional outcome data at the 1‐year follow‐up were evaluated by applying an institutional questionnaire. Sexual function was assessed using the abbreviated International Index of Erectile Function‐5 questionnaire, and urinary control was evaluated by defining complete urinary control as no pad usage.

RESULTS

The rate of complete urinary control rate in cases and controls was similar (81% vs 82%). When nerves were spared, 60% (15/25) of patients in either group were capable of sexual intercourse. The overall positive surgical margin rate was insignificantly higher in cases (19% vs 13, P > 0.05). After 1 year of follow‐up the biochemical recurrence rate (PSA >0.04 ng/mL) did not differ significantly in patients who had RRP after TURP vs RRP alone (six of 62, 10%, vs five of 62, 8%; P = 0.77).

CONCLUSIONS

RRP for prostate cancer in patients who have had previous TURP does not result in a higher perioperative complication rate, or a worse functional outcome.     

经尿道电切与气化切割前列腺增生症的疗效分析

目的比较经尿道电切前列腺术（TURP）、经尿道前列腺气化切除术（TUVP）的治疗效果并进行分析。方法在258例前列腺增生症患者中，按两种术式各随机抽取23例术前条件具有可比性的患者，进行疗效比较。结果两种术式患者手术前后前列腺症状均得到显著改善（P〈0．01），两组之间相比差异无显著性意义（P〉0．05）。结论两种术式治疗效果相同；TUVP操作简单、安全，对初学者来说尤其适宜；TURP仍为治疗BPH的金标准术式。     

前列腺增生术后尿道狭窄的腔内治疗体会

目的：为了提高腔内治疗前列腺术后尿道狭窄的疗效。方法：采用经尿道腔内治疗前列腺术后尿道狭窄34例，并进行临床总结。结果：本组34例患者采用经尿道腔内治疗，31例治愈，3例治疗失败，治愈率91．17％。治疗失败的原因可能与尿道长段狭窄及疤痕切除不彻底有关。结论：经尿道腔内治疗前列腺术后尿道狭窄是一种安全、有效的方法，成功的关键取决术中找到正确的尿道通路以及充分切除尿道疤痕组织。     

术后病人尿潴留的原因及预防护理

介绍了发生术后尿潴留的原因以及针对其原因应采取的预防措施,并提出心理支持、诱导排尿、穴位疗法、物理疗法等护理对策.     

经尿道前列腺电汽化术联合经尿道前列腺电切术治疗前列腺增生(附75例报告)

目的探讨前列腺增生(BPH)治疗的有效方法。方法联合应用经尿道前列腺电汽化术（TUVP）与经尿道前列腺电切术(TUVP)治疗BPH患者75例。结果住院时间4～13d，平均6d。术后随访3～28个月，与术前相比，IPSS、Qmax、QOL均有明显改善。本组无死亡病例，无经尿道前列腺电切综合征（TURS)发生。结论TUVP联合TURP应用于BPH，易掌握、安全、创伤小、疗效好。     

膀胱冲洗液温度与TURP病人体温降低幅度的关系

目的:研究膀胱冲洗液温度与经尿道前列腺电切术(TUHP)病人手术前后体温变化的关系,从而为防止TURP病人术后体温下降采取措施提供依据。方法:将60例PUKP病人随机分成实验组和对照组,分别在术中对膀胱冲洗液采用加温和不加温处理,观察病人术前术后体温降低的差异。结果:对照组术后体温较术前降低1.5℃,实验组术后体温较术前降低0.41℃,差异有显著性(p<0.01);实验组病人的寒战发生率较对照组降低了15％。结论:采用加温膀咣冲洗液能缩小PURP病人的体温降低幅度,从而减少术后病人的不良反应     

三种经尿道手术方法治疗前列腺增生效果的评价

目的：比较三种经尿道手术方法治疗前列腺增生的效果。方法：分别采用经尿道前列腺电切术（TURP）、经尿道前列腺电气化术和经尿道KTP／YAG激光前列腺切除术共223例。结果：从手术时间看，TUVP、KTP／YAG的手术时间短，术中的出血量明显减少。术后留置尿管时间及住院时间也明显少于TURP组。最大尿流率及IPSS也均有明显的改善，其中KTP／YAG组改善的效果较TURPTUVP差。术后并发症中TURP组术后近期的再出血倒数高于其他两组。KTP／YAG的尿道狭窄发生率最低。三组患者均没有出现电切综合症、尿外渗和死亡。结论：三种方法均有明显的临床效果，各有其优缺点，临床上应根据其适应症选择合适的方法，联合应用可获得更好的效果。     

青年肾移植受者术后生活质量的调查

目的了解青年肾移植受者术后生活质量现况并分析其相关影响因素。方法便利抽样法选择2014年7月至2015年11月福州市某三级甲等综合医院收治的92例青年肾移植受者为研究对象,采用一般资料调查表、非精神科住院患者心理评定量表(mental status scale in non-psychiatric settings,MSSNS)和普适性简明生命质量量表SF-36(the MOS 36-item short form health survey)的简化版SF-12量表对其进行调查。结果青年肾移植受者MSSNS量表焦虑、抑郁、愤怒、孤独维度的得分分别为(19.03±4.84)、(14.16±4.23)、(9.96±3.12)、(11.83±3.27)分;SF-12量表生理健康(physical component summary,PCS)和心理健康(mental component summary,MCS)的得分分别为(49.08±14.54)、(57.85±14.43)分。不同性别、平均月收入、医疗费用支付方式、健康状况自评及是否发生移植肾功能延迟恢复(delayed graft function,DGF)受者的PCS的得分差异有统计意义(P0.05或P0.01);不同健康状况自评及是否发生DGF受者的MCS的得分差异有统计意义(均P0.01)。健康状况自评、焦虑、医疗费用支付方式、MSSNS得分、是否发生DGF是青年肾移植受者术后生活质量的影响因素。结论青年肾移植受者的生活质量不高,需关注青年肾移植受者中发生DGF和健康状况自评低的患者,及时有效识别其是否存在负性情绪,提高其社会支持水平。     

Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Enlargement

Context

There is a continuous decline in the number of transurethral resections of the prostate (TURP) and an increase use of minimally invasive surgical therapy (MIST) for lower urinary tract symptoms resulting from benign prostatic enlargement. Current results from randomised controlled trials (RCT) and methodologically sound prospective studies suggest that some of the proposed procedures have the potential to replace TURP.

Objective

To determine the contemporary status of TURP and of the currently most commonly applied transurethral MISTs: (1) bipolar TURP, (2) bipolar transurethral vaporisation of the prostate (bipolar TUVP), (3) holmium laser enucleation of the prostate (HoLEP), and (4) potassium-titanyl-phosphate (KTP) laser vaporisation of the prostate.

Evidence acquisition

This meta-analysis was based on a systematic Medline search assessing the period 1997–2009. All RCTs comparing TURP and the most commonly discussed ablative treatments were included. The end points of our analyses were functional outcomes and treatment-related adverse events.

Evidence synthesis

Twenty-seven publications involving 23 different RCTs with a total of 2245 patients provided the highest level of evidence available (level 1b) and were fully assessed. Meta-analysis was conducted with SAS v.9.1.3 (SAS Institute, Cary, NC, USA). Forest plots were produced using the R software. Pooled odds ratios and 95% confidence intervals were calculated between various operative techniques versus TURP. Functional results between the specific transurethral procedures versus TURP were summarised as differences in means.

Conclusions

This meta-analysis demonstrates statistically comparable efficacy and overall morbidity for MISTs versus contemporary TURP. Type, category (minor vs major), and the number of complications (safety profile) vary specifically for each of the different transurethral techniques. We feel that the individual patient's clinical profile should be carefully assessed to identify the most appropriate transurethral technique.     

A Prospective,Randomised Trial Comparing Plasmakinetic Enucleation to Standard Transurethral Resection of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Three-year Follow-up Results

Background

Plasmakinetic enucleation of the prostate (PKEP) has recently been proved a safe and technically feasible procedure for benign prostatic hyperplasia (BPH). However, its long-term safety, efficacy, and durability in comparison with the gold-standard transurethral resection of the prostate (TURP) have not yet been reported.

Objective

To report the 3-yr follow-up results of a prospective, randomised clinical trial comparing PKEP with standard TURP for symptomatic BPH.

Design, setting, and participants

A total of 204 patients with bladder outflow obstruction (BOO) secondary to BPH were prospectively randomised 1:1 into either the PKEP group or the TURP group.

Intervention

The patients in each group underwent the procedure accordingly.

Measurements

All patients were assessed perioperatively and followed at 1, 3, 6, 12, 18, 24, and 36 mo postoperatively. The preoperative and postoperative parameters included International Prostate Symptom Score (IPSS), quality of life (QoL) scores, the International Index of Erectile Function (IIEF) questionnaire, maximum urinary flow rates (Q_max), transrectal ultrasound (TRUS)–assessed prostate volume, postvoid residual urine (PVRU) volume, and serum prostate-specific antigen (PSA) level. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared. All complications were recorded.

Results and limitations

PKEP was significantly superior to TURP in terms of the drop in haemoglobin (0.74 ± 0.33 g/dl vs 1.88 ± 1.06 g/dl; p < 0.001), intraoperative irrigation volume (11.7 ± 4.5 l vs 15.4 ± 6.2 l; p < 0.001), postoperative irrigation volume and time (18.5 ± 7.6 l vs. 30.0 ± 11.4 l and 16.6 ± 5.2 h vs 25.3 ± 8.5 h; all p < 0.001), recovery room stay (67.3 ± 11.1 min vs 82.0 ± 16.4 min; p < 0.001), catheterisation time (51.7 ± 26.3 h vs 80.5 ± 31.6 h; p < 0.001), hospital stay (98.4 ± 20.4 h vs 134.2 ± 31.5 h; p < 0.001), and resected tissue (56.4 ± 12.8 g vs 43.8 ± 15.5 g; p < 0.001). There were no statistical differences in operation time and sexual function between the two groups. At 36 mo postoperatively, the PKEP group had a maintained and statistically significant improvement in IPSS (2.4 ± 2.2 vs 4.3 ± 2.9; p < 0.001), QoL (0.6 ± 0.5 vs 1.6 ± 1.4; p < 0.001), Q_max (28.8 ± 10.1 ml/s vs 25.1 ± 8.0 ml/s; p = 0.017), and TRUS volume (21.0 ± 7.3 ml vs 26.4 ± 6.8 ml; p < 0.001), with urodynamically proven deobstruction (Schäfer grade 0.2 ± 0.02 vs 0.8 ± 0.1; p < 0.001). More extensive clinical trials are required to validate these results.

Conclusions

PKEP is a safe and highly effective technique for relieving BOO. At 3-yr follow-up, the clinical efficacy of PKEP is durable and compares favourably with TURP.