The Preliminary Study Of Transurethral Plasmakinetic Lobes-enucleation Of Prostate For Treating Benign Prostatic Hyperplasia And The Analyze Of Risk Factors Of Detrusor Underactivity In Benign Prostatic Hyperplasia Patients

Benign prostatic hyperplasia(BPH)is one of the most common diseases affecting quality of life(QoL)in aging men.The most of patients need operation to cure the disease.Transurethral resection of the prostate(TURP)remains to be considered the gold standard for treatment of symptomatic BPH when medical therapy fails.Other minimally invasive techniques,such as holmium laser enucleation of the prostate(HoLEP),photoselective vaporisation of the prostate and transurethral bipolar resection of prostate.However,they are not always accessible to all urologists due to some reasons.In the present study,we described the technique named transurethral plasmakinetic lobes-enucleation of prostate which was based on transurethral enucleation and resection of prostate and assessed the safety and efficacy.Benign prostatic hyperplasia results in different degrees of bladder outlet obstruction(BOO)and causes a series of lower urinary tract symptoms(LUTS).The aging process and long-term BOO in these patients could lead to detrusor underactivity(DU).It is controversial whether the operation for BPH should be performed in DU patients.Without treatment available to directly address the detrusor,therapy has focused on maximally reducing outlet resistance to permit efficient voiding.The pressure-flow study(PFS)is a only method to evaluate the degree of BOO and the strength of detrusor contractility.However,the invasive nature of PFS limit its application.The aim of our study was to analyze the relevant factors of detrusor contractility and improving the diagnostic accuracy in BPH patients.And provide some information for doctors and patients to make the decision before therapy.Therefore,our study was divided into two parts.The main purpose and content are as follow.Part Ⅰ:The preliminary study of transurethral plasmakinetic lobes-enucleation of prostate for treating benign prostatic hyperplasia.Objectives:To discuss the safety and efficacy of transurethral plasmakinetic lobes-enucleation of prostate for treating benign prostatic hyperplasia.Methods:50 patients who underwent transurethral plasmakinetic lobes-enucleation of prostate by a single surgeon at our institution from September 2017 to September 2018 were included in this study.Patients were assessed at one month postoperatively to evaluate the safety and efficacy of this operation.Results:All of the operations were succeed.The mean age of patients was(65.4±7.8)years and mean preoperative prostate volume was(65.6±46.5)mL,mean operation time was(67.6±34.7)min and mean resected tissue weight was(48.5±45.8)g.The postoperative haemoglobin drop was(1.1±1.1)g/dL.Mean catheter time and hospitalisation time were(3.1±1.2)days and(7.5±2.8)days,respectively.Patients were assessed at one month postoperatively.Compared with preoperative,the prostate specific antigen(PSA)level and TRUS volume reduced significantly[(2.4±2.9)ng/mL vs(5.2±5.6)ng/mL,(19.4±4.9)mL vs(65.6±46.5)mL,P<0.05].There was a significant improvement in maximum urinary flow rate(Qmax)[(16.5±5.3)mL/s vs(4.9±3.2)mL/s,P<0.05).Both international prostate symptom score(IPSS)and quality of life(QoL)scores improved significantly(21.4±2.8vs7.1±2.7,4.5±0.8vs1.4±0.5,P<0.05).No patient experienced incontinence,clot retention,urethral stricture and bladder neck contracture.Two patients(4%)had urinary tract infection.One patient(2%)experienced urinary retention after discharged.Conclusion:Transurethral plasmakinetic lobes-enucleation of prostate is a safe and effective method for treating benign prostatic hyperplasia.Part Ⅱ:The analyze of risk factors of detrusor underactivity in benigh prostatic hyperplasia patients.Objective:To analyze the risk factors of detrusor underactivity in benign prostatic hyperplasia patients by retrospectively analyzing the clinical characteristics.Methods:A total of 356 benign prostatic hyperplasia patients at our institute were enrolled in the study from January 2010 to June 2018.All cases were stratified by detrusor contractility into the detrusor underactivity group and the control group.Clinical parameters were analyzed in both groups.Results:Among the patients,154 and 202 cases were classified into the detrusor underactivity group and control group,respectively.There were significant differences between the detrusor underactivity group and the control group.The detrusor underactivity group had higher values of PSA,PV,and IPP(P<0.05).On univariate analysis,a significant association was observed between the detrusor contractility and prostate specific antigen(OR 0.959,95%CI 0.932-0.987,P=0.004),prostate volume(OR 0.990,95%CI 0.985-0.995,P=0.000),and intravesical prostatic protrusion(OR 0.810,95%CI 0.656-1.000,P=0.049).On multivariate analysis,PV(OR 0.991,95%CI 0.985-0.997,P=0.005)was an independent predictor of detrusor underactivity.Other variables were not statistically significant predictors.Conclusion:Our study showed that PSA,PV and IPP was relevant factors of detrusor underactivity.And PV was an independent risk factors of detrusor underactivity.These people with high value of PSA,PV,IPP should be performed urodynamic to exclude detrusor underactivity and therapeutic schedule should be selected more carefully.