A Comparative Study On The Clinical Results Between Transurethral Enucleative Resection Of The Prostate With Plasmakinetic System And Plasmakinetic Resection Of The Prostate For Benign Prostatic Hyperplasia

ObjectivePlasmakinetic resection of the prostate(PKRP) has been used in the endosurgical treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia(BPH) for its better clinical results than transurethral resection of the prostate(TURP).Transurethral enucleative resection of the prostate(TUERP) is a unique modification of TURP.We compare the safety and efficacy of TUERP with PKRP in the treatment of BPH to further the study of TUERP.Methods.A total of 116 patients who were diagnosed with BPH from January 2004 to June 2005 in ZhuJiang Hospital,of them 64cases underwent TUERP and 52 cases underwent PKRP.The device was Gyms bipolar plasmakinetic endoscopic system. The blood loss,operative time and other therapeutic results were measured and compared between the 2 groups.Results1.No significant differences were found in age,prostate volume,IPSS,QOL score,postvoid residual,Qmax,total serum PSA level before operation,between the 2 groups(P＞0.05).2.Intraoperative blood loss,(122.1±47.5) ml vs(160.0±70.5) ml;resected prostate volume,(40.1±12.9)ml vs(26.8±9.6)ml;operating time,(46.2±24.2)min vs (54.9±21.0)min.Significant differences were found between the 2 groups(P＜0.05).3.Bladder irrigation time was(1.6±0.6)d vs(2.8±1.1)d;catheterization time, (2.5±0.5)d vs(3.7±1.1)d;and hospitalization time after operation,(3.5±0.6)d vs (4.9±1.1)d.Significant differences were found between the 2 groups(P＜0.05).4.No TURS and hyponatremia developed in the 2 groups.No transfusion was needed in the 2 groups.No obturator nerve reflex occurred in the 2 groups.No capsular perforation occurred in the 2 groups.5.64 cases in TUERP group were followed up for 2 years,and 52 cases in PKRP group were followed up for 2 years.Qmax,QOL score,IPSS at 3,6,12,24 months after operation were improved significantly compared with that of preoperative(P＜0.05).PV,total serum PSA level at 24 months after operation decreased significantly compared with that of preoperative(P＜0.05).Significant difference were found in Qmax between two groups at 3,12,24 months after operation(P＜0.05),but there was no significant difference in Qmax between two groups at 6 months after operation(P＞0.05).There was no significant difference in PVR between two groups at 24 months after operation(P＞0.05).There was no significant differences in IPSS and QOL score at 3,6,12,24 months after operation between two groups(P＞0.05).Significant differences were found in prostate volume and its decrease,total serum PSA level and its decrease between the 2 groups at 24 months(P＜0.05).6.The incidence of short-term incontinence of urine in TUERP and PKRP group is 9.3%(6/64),7.6%(4/52) respectively.All the cases with short-term incontinence of urine recovered in 1 month after operation.There were 1 case of urethral stricture in TUERP group and 2 cases of urethral stricture in PKRP group.There were 1 case of bladder neck stricture in TUERP group and 2 cases of bladder neck stricture in PKRP group.No significant difference were found between the 2 groups(P＞0.05).7.The incidence of retrograde ejaculation in TUERP and PKRP group is 70.13% (45/64),69.23%(36/52) respectively at 6 months after operation,while 59.38% (38/64),63.46%(33/52) respectively at 24 months after operation.There is no significant difference between the 2 groups(P＞0.05).Conclusions:1.TUERP is similar to PKRP in safety and as efficacious as PKRP in 2 years after operation.2.The incidence of intraoperative and postoperative complications in TUERP group is low,and TUERP needs shorter operative time and postoperative recovery time than PKRP,therefore TUERP is as good as PKRP in the treatment of BPH.3.Both TUERP and PKRP can make the high incidence of retrograde ejaculation. There is no significant difference between TUERP and PKRP on this marker.But TUERP may be more helpful to reduce the incidence of retrograde ejaculation than PKRP.4.TUERP is helpful to improve the detection of incidental prostatic carcinoma for its more obtainment of surgical specimens and more completely resection of prostatic tissue than PKRP,therefore it is also helpful to decrease the recurrence of BPH after operation.5.Surgeons need better understanding of surgical capsule in TUERP.It is most important for surgeons to find surgical capsule plane in TUERP.Therefore TUERP has a longer learning curve than PKRP.