Clinical Study Of Dehydrated Ethanol Injection In Treatment Of Benign Prostatic Hyperplasia Guided By Transrectal Ultrasound

Background:Benign prostatic hyperplasia (BPH) is a kind of disease which frequently happened in senile male and increased with the growth of age. In the treatment of BPH,the curative efficacy of medication is limited, more injuries and bleeding happened in surgery process. At present mini-invasive therapy is suggested , and Transurethral resection of prostate(TURP), Transurethral eletrovaporization of the prostate(TUVP) are commonly used. But those methods have many complications such as converse ejaculation, urine irretention and so on. presently expansioned Transsuretharal microwave thermotherapy(TUMT) , TransUrethral Needle Ablation (TUNA) , Transsuretharal laser therapeutics and radio frequency ablation from some point could indeed ease urethral obstruction symptom resulted from prostatic hyperplasia,but these methods need general anesthesia, the aged with serious complication can not suffer anesthesia must depend on long-term or intermission urethral catheterization to drain urine. however in this way potential infection may exist,and eventually cause bad influence to the patient.Absolute alcohal ablation in treatment of prostatic hyperplasia was inspired from the therapy of hepatoma, parathyroid tumor ,renal carcinoma,detrusor muscle dysfuction . Plante has compared the curative effect between dehydrated ethanol ablation y and radio frequency,consider there was no significant difference between security ,but the latter has less efficiency in evidence, recurrence offen occurred and need repeat therapy. Absolute alcohal is researched the most and become one of the comprehensive method used in clinical medication.BPH treated by injection of dehydrated alcohal guided by transrectal ultrasonography has much question to be investigated. Objective:1.To estimate the value of transrectal ultrasonography in the diagnosis of benign prostate hyperplasia(BPH).2.To evaluate the efficacy and feasibility of a new approach for treatment of benign prostatic hyperplasia (BPH) involving injection of dehydrated ethanol into the prostate guided by TRUS.3.Summarize the evaluation index system of the curative effect on by transrectal ultrasound therapy for BPH.Method:1.To diagnose BPH by transrectal ultrasonography Examination through rectum , the patient was positioned at genuflex and flex hipmake left-lateral position. From the longitudinal section of prostate , the echo of inner gland (the tissu surround transition zones and urethra) and transition zones was observed, suprainferior was measured .then the max cross section was demonstrated to measure the width and thickness of the glandular organ and transition zone. The prostate体积volume =π/6×thickness(cm)×width(cm)×anteroposterior diameter (cm) . the quality of prostate, transition zone volum(TZV) , The thickness proportion between internal,external gland (Iw/Ew) and transition zone index (TZI) were calculated.2. BPH was ttreated with transrectal ultrasound-guided intraprostatic injection of absolute ethanal. Cleaning enema was used before the operation the left-lateral position was taken,disinfecting the region of crissum,to scan prostate through rectum utilizing the rectal probe which equipped puncturation rack (covering a sterile emulsion sleeve outside) ,needling path was observed ,the detector was changed direction to get oblique coronal section image of prostate ,urethra could be shown and length it was measured .a 20G transfixion pin was put which is 20cm length in rectum along the puncturation bracket ,to proceed slowly until the needle is seen in therapeutic site under ultrasonography , absolute alcohol was injected slowly under the monitor of ultrasound ,to the diffusion speed and range of alcohol determine needing spot and dose of alcohal for the second time ; the transductor was rotated at 180 degree ,using the same way to treat the other side of inner gland.The degree of the ablation with transrectal ultrasound in the third day after the procedure,repeat the whole therapy if it is necessary . 3.Efficacy evalution of Transrectal ultrasound-guided intraprostatic injection of dehydrated ethanol in the treatment of prostatic hyperplasia. 28 BPH patients was followed up after treatment of intraprostatic injection dehydrated alcohal. BPH was observed by transrectal ultrasound before treatment and 1 month ,3 month and 6 month after treatment.Some indexes were measured such as PV,TZV,TZI, Iw/Ew.Result:1.TRUS can display normal tissue and the focus of infection of prostate clearly ,provide evidence for the diagnosis of BPH. At the same time the index ofTPV,TZV,TZI and Iw/Ew help to make the diagnosis of BPH and evaluate the degree of hyperplasia.2. Twenty-eight symptomatic patients underwent BPH treated with transrectal ultrasound-guided intraprostatic injection absolute ethanal have been followed and evaluated for one,three,and six month post-treatment; Interventional Prostatic Symptom Score (IPSS),Quality of live Score (QOL) are decreased significantly 1 and 3 months after treatment (P<0.01). There were no significant differences in the parameters at 6 months. (P>0.05).Twenty five patients (89%) could micturate after removed urethral catheter or bladder syrinx 3 to 7 days after the treatment The residual urine volume after the procedure was 20 to 150 ml (P<0.01) ; There were few intraoperative and postoperative complications,3.After one month,three and six months treatment,The prostatic volume ,innergland/extragland thickness ratio, TZI and TZV were significantly decreased , There were no significant differences at 6 months when the same parameters were assessed(P>0.05) .Post and after treatment the index correlated well with each other,That indicates the prostatic volume innergland/extra gland thick ness ratio and TZI and the inner gland hemodynamics is corresponded with clinical symptoms.Conclusions:1.TRUS can clear display cellular construction, TZV,TZI,Iw/Ew,D/W is the best index in morphologic for estimate non-surgical treatment.2.It is a safe ,simple and effective method in treatment of BPH. especially for patients who is intolerance operation and old or at high risk anesthesiologically.3. Good correlation was shown between the objective indexes(TPV,TZV,TZI,D/W, Iw/Ew) and subjective indexes (IPSS,QOL).combination of objective and subjective indicator could consummate the therapeutic efficacy evaluation system of BPH non-surgery treatment, it can consummate the evaluation index system of the curative effect on therapy for BPH guided by transrectal ultrasound.