The Clinicopathological Analysis Of The Recurrent Hyperplasia After Transurethral Resection Of Prostate

Objective To calculate the proportion of severe hematuria in patients with recurrent prostate hyperplasia.To compare the differences in the gross morphology and pathological structure between the primary and the recurrent prostatic hyperplasia and to investigate the underlying clinical and pathological basis of recurrent hematuria in patients with recurrent prostatic hyperplasia.Methods The clinical data of 801 inpatients of benign prostatic hyperplasia and 57 recurrent cases with benign prostatic hyperplasia in Zhongshan Hospital Xiamen University from January 2008 to January 2017 were reviewed retrospectively.The proportion of the admission due to severe hematuria was calculated and the morphological and pathological differences between the primary and the recurrent hyperplastic prostates were analysed under endoscope.The clinical data of 19 patients of recurrent cases with benign prostatic hyperplasia in our hospital were reviewed retrospectively.19 patients treated with TURP twice for benign prostatic hyperplasia were enrolled into this study.Intraoperative images was collected-and the expression of PSA?CD34 and SMA was detected in two groups of prostate tissues using immunohistochemistry.And the proportion of the prostatic epithelium,glandular lumen,smooth muscle was calculated and microvessel density was analysised.Results In 801 patients,18 patients with benign prostatic hyperplasia were admitted to hospital due to severe hematuria,accounting for about 2.2%.In 57 patients with recurrent prostate hyperplasia,26 patients presented with severe hematuria accounting for about 45.6%and severe hematuria was ranked first for the cause of hospitalization;The differences between the proportion of complaints were statistically significant(P<0.05).Under the resectsocope,the primary hyperplastic prostate tissue show even hyperplasia and smooth surface;while the recurrent hyperplastic prostate tissue showed irregular nodular hyperplasia,uneven surface and sometimes mucosal bleeding point visible.Immunohistochemical staining combined with computer aided imaging analysis was used to measure the proportion of each component of the prostate tissue of the primary hyperplasia and the recurrent hyperplasia.In the first surgical specimens,the average proportions of the prostatic epithelium,glandular lumen and smooth muscle were 18.4±13.2%,9.3±3.5%,35.7±15.2%regularly;while in the second surgical specimens,the average proportions of the prostatic epithelium,glandular lumen and smooth muscle were 16.4±8.5%,8.6±3.3%and 29.7±12.2%regularly.The mean MVD values of the first and second surgical specimens were 22.9±9.1?27.5±9.3.The MVD value of the recurrent hyperplasia group were higher than that of the primary hyperplasia group,the difference between the two groups was statistically significant(P<0.05).The proportion of the smooth muscle was lower than that of the primary hyperplasia group,the difference between.the two groups was statistically significant(P<0.05).There was no significant difference between the two groups in the proportion of epithelial and glandular lumen(P>0.05).Conclusions Severe hematuria is the main reason of hospitalization for patients with recurrent prostate hyperplasia,accounting for about 45.6%.The general appearance of the recurrent hyperplastic prostate was irregular nodular hyperplasia and the surface was easy to bleed.The presence of severe hyperplasia in recurrent hyperplastic prostate maybe associated with higher microvessel density and thinner blood vessel wall and reduced smooth muscle with impaired structures.