A Clinical Results Study Comparing Transurethral Plasmakinetic Enucleation And Resection Of The Prostate With Transurethral Plasmakinetic Resection Of The Prostate For Benign Prostatic Hyperplasia

Benign prostatic hyperplasia(BPH)is one of the most common cause for urination disorder affecting the elderly men.Transurethral resection of the prostate(TURP)had became the "gold standard" in the surgical treatment of benign prostatic hyperplasia.There were a lot of advantages of this method when the plasmakinetic was used in the surgery.Although transurethral plasmakinetic enucleation and resection of the prostate(TUERP)had been carried out over ten years,there were no reports on its long term clinical results.Can it challenge the "gold standard" of TURP?We sought to evaluate the clinical results of TUERP through comparing transurethral plasmakinetic resection of the prostate(TURP)by a long term follow-up study and a randomized trial,thus providing clinical evidence for further application.Chapter 1 A ten years follow-up study comparing transurethral plasmakinetic enucleation and resection of the prostate with transurethral plasmakinetic resection of the prostate for benign prostatic hyperplasiaObjectiveTo evaluate objectively the ten years clinical results of TUERP,including therapy effect,recurrence and complications.MethodsThe control group was TURP,and the experimental group was TUERP.The indicators were collected preoperatively from our historical records,including prostate volume(PV),postvoid residual volume(PVR),prostate specific antigen(PSA),maximum urinary flow rate(Qmax),international prostate symptom scores(IPSS)and quality of life(QOL).In this study,the data were measured and collected 10 years after operation as follows:PV,PVR,PSA,Qmax,IPSS,QOL and postoperative complications.We analyzed these data to compare the differences between the two groups before the operation and in the first and tenth postoperative years respectively.ResultsThe postoperative tenth years follow-up was showed that there were significant improvements of the PV,PSA,IPSS,QOL and Qmax in the experimental group than in the control group respectively.There was no significant difference of the preoperative PVR between the two groups,so it was no meaning of the different PVR between them postoperatively.ConclusionTo be compared with TURP,TUERP is more thoroughly removing prostate hyperplasia gland.The long term efficacy of TUERP is superior to TURP for surgical treatment of symptomatic BPH.The complication of TUERP is less than TURP,but the rate of retrograde ejaculation in TUERP is higher than that in TURP.There was no patient had to retreat because of postoperative recurrence.TUERP may instead of the TURP's status of "gold standard" in the future,but it has to have more evidence of the multicenter,large samples and long term randomized trial to further confirm.Chapter 2 A randomized trial comparing transurethral plasmakineticenucleation and resection of the prostate with transurethral plasmakinetic resection of the prostate for benign prostatic hyperplasiaObjectiveTo evaluate the short period feasibility,efficacy and safety of the TUERP for benign prostatic hyperplasia objectively.MethodsThe experimental group was TUERP,and the control group was TURP.The indicators were measured preoperatively,including PV,PVR,PSA,Qmax,IPSS,QOL.Before and after operation,Na+ and Hb were measured respectively.Intraoperative recorded indicators were as follows:duration of operation,the amount of bleeding,duration of indwelling catheter,hospitalization time,and complications during operation.In this study,the data in three and six months after operation were as follows:PVR,PSA,Qmax,IPSS,QOL and postoperative complications.We analyzed these data to compare the differences between the two groups before the operation and in the third and sixth postoperative months respectively.ResultsTo be compared to TURP,there were shorter time of the operation,less bleeding and sodium-loss in operation,more effective surgery and more quick recovery post-operation in TUERP.The short term postoperative follow-up was showed that there were significant improvements of the PSA,IPSS,QOL and Qmax in the experimental group than in the control group respectively.There were no significant difference of the prostate coated perforation and infusion in operation between the two groups.There were also no significant difference of PVR and postoperative complications(including secondary bleeding,acute urinary retention after operation,urethrostenosis,urinary incontinence,bladder neck contracture)between them postoperatively,but the rate of retrograde ejaculation in TUERP is higher than that in TURP.ConclusionTUERP is more thoroughly removing prostate hyperplasia gland.The short term efficacy and safety of TUERP is superior to TURP for surgical treatment of symptomatic BPH.The complication of TUERP is less than TURP,but the rate of retrograde ejaculation in TUERP is higher than that in TURP.TUERP may be the"gold standard" in the surgical treatment of benign prostatic hyperplasia in the future.