| BackgroundBenign prostatic hyperplasia(BPH),which refers to the nonmalignant growth or hyperplasia of prostate tissue,is the most common chronic and clinically progressive disease that causes lower urinary tract symptoms in middle-aged and elderly men.Approximately 50%of men over the age of 50 develop moderate to severe lower urinary tract symptoms(LUTS),and 25%of LUTS patients eventually require surgery.Transurethral resection of prostate(TURP)is a classic minimally invasive resection for more than 80 years.It replaces the traditional open surgery and becomes the gold standard for surgical treatment of BPH due to its features of small trauma and quick recovery.However,the study found that TURP still has many disadvantages.Transurethral enucleation and resection of prostate(TUERP)has the advantages of small TURP trauma,quick recovery,complete resection and low recurrence rate by changing the resection method of prostate.The sheath of the electrosurgical lens was used to imitate the finger,and the action of the finger dissection of the prostate along the surgical capsule in the traditional surgical operation was simulated.The hyperplastic glands and the surgical capsule were completely dissected retrograde under direct vision.At present,TUKEP is still controversial,and its evidence-based medicine evidence is still less,which requires further study.The incidence of short-term urinary incontinence after TUKEP was higher than that of TUPR.Prostatic hyperplasia mainly occurred in the peripheral zone and the glandular region around the urethra,but no anterior lobe hyperplasia was found in the local anatomical results and the operation process.The external sphincter of the male urethra is actually a complex,which is close to the front of the prostate above the verumontum level,and is in the shape of a half moon.Injuring this structure is likely to cause dysfunction of urine control in patients.To facilitate surgical positioning,the prostate was divided into anterior,medial,lateral,and posterior lobes using Lowsley’s(1912)lobation method.Studies have shown that the incidence of urinary incontinence after TURP with anterior lobes preserved is lower than that of classical TURP.Considering the anatomical characteristics of the prostate,we proposed transurethral bipolar plasma enucleation of the prostate with anterior lobes preserved.ObjectiveA non-randomized controlled trial was conducted to explore whether preserving the anterior lobe of the prostate is beneficial to reduce the incidence of short-term urinary incontinence after TUKEP,and to provide certain reference for clinical work.Design,setting and participantsA single-center non-randomized controlled clinical trial was conducted,with the TUKEP group with preserved anterior lobe as the experimental group and the anatomic enucleation group as the control group.The observation time points 24 hours,1 week and 2 weeks after surgery were set.The preoperative general data,intraoperative and postoperative observation indexes of the two groups of subjects were compared and analyzed.ResultThe incidence of urinary incontinence at 24h,1 week and 2 weeks after removal was 11.54%,3.85%and 0%,respectively,which were lower than those in the anatomic enucleation group and the electric resection group.ConclusionThe results of this study tentatively suggest that TUKEP with anterior lobes retained has a lower incidence of short-term urinary incontinence than classical TUKEP,especially 24h after catheter removal.Preserving the anterior lobe of the prostate(10-2 points)may reduce the injury of urethral semicircular muscle and periurethral striated muscle during surgery to protect its urinary control function,which is worthy of further investigation and guidance for clinical practice. |
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