TRANSURETHRAL RESECTION OF THE PROSTATE: STILL THE GOLD STANDARD

Background : In recent times there has been a number of newer methods advocated as treatment for bladder outlet obstruction. Prior to embracing these newer technologies, the authors' experiences with conventional transurethral resection of the prostate should be evaluated and compared with those experienced in the newer modalities. The objective was to determine whether a standard transurethral resection of the prostate (TURP) still compared favourably with the newer modalities in terms of duration of stay, duration of catheterization, re-admission rate, re-catheterization rate, cost and long-term results. The results are compared with those of workers whose level of expertise was the best that could be achieved with transurethral needle ablation (TUNA) and laser prostatectomy. Methods : During the 3-year period from September 1992 to September 1995, 575 TURP were carried out in a regional hospital. The total duration of stay, the postoperative duration of stay, the re-catheterization and re-admission rates were assessed and the costs estimated. Results : Transurethral resection of the prostate was shown to compare favourably in terms of the duration of hospital admission and the duration of catheterization, and to have a significantly lower re-catheterization rate and a significantly lower re-admission rate than the newer modalities. Conclusion : Transurethral resection of the prostate is still the method of choice for surgical management of bladder outlet obstruction, and it remains as the gold standard. Having reviewed the results of the newer modalities as carried out by the experts in those fields, it was found that TURP compares favourably with those procedures. From the point of view of duration of stay, duration of catherization, re-admission rate and re-catheterization rate, as well as cost and long-term results, TURP remains as the gold standard and the newer modalities are not believed to be advantageous at this stage.     

经尿道前列腺电切术后并发症分析及护理对策

目的：总结前列腺增生术后常见并发症的原因及护理对策.方法：前列腺增生电切术后常见并发症有术后出血、膀胱痉挛、TURP综合症、尿失禁、尿液外渗、下肢静脉血栓、尿道狭窄、尿路感染等,加强了术后并发症的观察并采取正确的护理措施.结果：为1 487例患者行前列腺电切术,术后163例出现并发症,经过治疗护理出院时并发症治愈或好转.结论：加强观察,采取正确恰当的护理措施是预防术后并发症的关键.     

浅谈曲骨穴埋线法用于TURP术后镇痛的机理

经尿道前列腺电切除术（TURP）术后膀胱痉挛性疼痛是常见的临床症状之一,严文兵等人将曲骨穴埋线法应用于TURP术后镇痛,发现效果良好。笔者从中西医结合角度分析曲骨穴埋线法用于TURP术后镇痛的治疗机理,包括腧穴的治疗作用、速效和续效作用、神经反射作用、内分泌调节作用4方面。     

Newly Developed Equipment and Methods in the Treatment of BPH: Analysis of Present Status

Benign prostatic hyperplasia (BPH) is the most common disease among the aged male population. A variety of symptoms are mainly caused by obstructive changes at the prostatic urethra. Transurethral resection (TURP) has been the gold standard of treatment, but new equipment and methods such as TUMT, HIFU, TUNA, and laser prostatectomy have been developed and are being tested for clinical application. Our experience with new equipment and methods show that their effectiveness has yet to be conclusively evaluated by objective parameters, while subjective improvements have been seen with less invasive treatments such as TUMT, HIFU and TUNA. Laser prostatectomy confirmed its advantages in hemostasis but comparison of each treatment is difficult because of different pathological changes created by different energy sources shown by MRI. Further studies are required to examine the new equipment and methods and for identification of the treatment of choice for BPH.     

Peri-operative morbidity and changes in symptom scores after transurethral prostatectomy in Switzerland: results of an independent assessment of outcome

OBJECTIVES: To assess, in a prospective study, the contemporary outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) in Switzerland, by evaluating peri-operative morbidity and changes in lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Between January 2000 and January 2005, 11 hospitals in Switzerland participated in the study. The hospitals were required to inform Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss healthcare system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTS: Data on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively (P < 0.001). CONCLUSIONS: The results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.     

经尿道前列腺切除术-室颤-复苏-围术期心肌梗死

报道71岁老年男性因前列腺增生实施经尿道前列腺切除术（transurethral prostatectomy,TURP）发生围术期心肌梗死（perioperative myocardial infarction,PMI）的诊疗过程。术中患者由于出现低血压、贫血、低体温、容量超负荷和低氧等引起长时间心肌缺血,最终诱发室颤...     

膀胱穿刺造瘘回流在前列腺电切术中的作用评价

目的：评价膀胱穿刺造瘘回流在前列腺电切术中的作用。方法：回顾性分析200例前列腺增生症患者,其中每100例分别在有或无膀胱造瘘回流的条件下进行手术;以前列腺重量50g为参照,将患者分为两组（重量〉50g和重量〈50g）。结果：前列腺重量大于50g,两术式的手术时间,手术前后血红蛋白、血钠的变化相比,差异有统计学意义。无膀胱造瘘术后发生尿管堵塞和尿路感染率高于有膀胱造瘘术式。结论：前列腺重量大于50g者,在膀胱造瘘回流条件下手术,能减少手术时间、降低手术风险。     

右美托咪定对糖尿病患者经尿道前列腺等离子电切术的影响

目的观察右美托咪定对糖尿病患者行前列腺等离子电切术(TURP)术中血糖的影响。方法选择2018年5月—2019年5月该院收治的60例椎管内麻醉TURP术患者,年龄65~75岁,ASAⅠ~Ⅱ级,随机分为对照组与观察组,各30例。观察组给予负荷剂量0.3μg/kg右美托咪定静脉泵注(15 min),后给予维持剂0.2μg/(kg·h)至手术结束。对照组同样方式给予等容量生理盐水。记录麻醉前(T0)、手术开始(T1)、手术后30 min(T2)、手术结束(T3)时患者静脉血糖的变化。结果观察组患者用药后与对照组相比,观察组患者血糖波动性较小;与观察组相比,对照组血糖值在T2、T3时间点与T0时间点相比持续上升,差异有统计学意义(P<0.05)。结论右美托咪定在糖尿病患者行TURP术中血糖水平更平稳,减少由于血糖变化带来的手术不便。