A Clinical Study Comparing Plasmakinetic Enucleation And Resection Of The Prostate Versus Plasmakinetic Resection Of The Prostate In The Treatment Of Benign Prostatic Hyperplasia

Objective:Transurethral resection of the prostate is a gold standard for the treatment of benign prostatic hyperplasia(BPH).In recent years,many hospitals at home and abroad have conducted plasmakinetic enucleation of the prostate(PKEP).PKEP is an anatomical removal of hyperplastic glands along the surgical capsule,with less bleeding and complete removal of the glands.It is expected to be the new“gold standard”for the future treatment of BPH.Because PKEP requires a certain learning curve and operating skills,the technology is not mature.Can easily cause damage to the external urethral sphincter,leading to urinary incontinence.Many surgeons spontaneously combine the advantages of PKEP with plasmakinetic enucleation of the prostate(PKRP)in clinical practice,ie plasmakinetic enucleation and resection of the prostate(PKERP).The anatomy of the surgical capsule eliminates the advantages of the hyperplastic glands and can prevent the external urethral sphincter injuries.This study compares the safety,efficacy,and feasibility of PKERP and PKRP and provides a reference for the clinical application of PKERP.Methods:The clinical data of 89 BPH patients received transurethral resection at our hospital department from 2015-10 to 2017-10 were analyzed and divided into two groups.PKERP group:Plasma kinetic enucleation of the prostate,40 cases in total;PKRP group:Plasma kinetic resection,49 cases in total.Record preoperative patients'age data,IPSS,QOL,PSA,PV,PVR,Qmax,Hb,and Na~+values of two groups respectively;Keep record intraoperative operation time,quality of resection prostate tissue,bleeding loss and complication.Measure postoperative Hb and Na~+values immediately,record postoperative bladder washing time,indwelling catheter time,hospital stay and complication;Record postoperative follow-up data after 6months,IPSS,QOL,PVR,Qmax and complication,then add up these indicators and make a contrast.Results:89 BPH patients surgery operation were all smoothly accomplished.1.Preoperative indexes comparison:Age,IPSS,QOL,PSA,PV,PVR,Qmax,Hb,Na~+,the difference of indexes were compared between two groups P>0.05,which has no statistical significance and no comparability.2.Intraoperative indexes comparison:Operation time,the quality of resection prostate tissue,bleeding loss,the difference of indexes were compared between two groups P<0.05,which has statistical significance.There is a suggestion that PKERP is superior to PKRP in operation time,the quality of resection prostate tissue and bleeding loss.No blood transfusion occurred in PKERP group,with 2 cases in PKRP group(4.08%);besides,no capsular perforation occurred in PKERP group,with 4cases in PKRP group(8.16%),the difference indexes were compared between two groups P<0.05,which has statistical significance.It is suggested that the incidence of capsular perforation in PKERP is lower than in PKRP group.And no other complication occurred in PKERP group.3.Postoperative indexes comparison:The difference of Hb and Na~+and Hb values,Hb value were compared between two groups P<0.05,which has statistical significance.It shows that PKERP has less impact than PKRP on circulatory system.The Na~+value difference between two groups P>0.05,no statistical significance and it indicates that PKERP exerted similar effect on Na~+value compared with PKRP.The difference index of bladder washing time,indwelling catheter time and hospital stay between two groups P<0.05,which has statistical significance and showed that PKERP has advantage over PKRP on postoperative recovery.4.Other major perioperative complication indexes comparison:No secondary hemorrhage occurred in PKREP group,with 3 cases in PKRP group,but 2 cases were markedly improved by prolonging cystic oppression washing time(4.08%),and 1 case was operated surgical hemostasis(2.04%).Urethral bladder irritation syndrome in 6 patients(15.0%)in PKERP group and 13 cases in PKRP group (26.53%).No uroschesis occurred after removed urethral catheter in PKREP group,with 3 cases in PKRP group(4.08%),3 cases appeared temporary urinary incontinence after 24 hours in PKREP group(7.5%),with 2 cases in PKRP group(4.08%),2 cases appeared temporary urinary incontinence within one week in PKREP group(5%),with 1 case in PKRP group(2.04%);1 cases occurred temporary urinary incontinence within two weeks in PKREP group,but recovered by training pelvic floor muscle and taking oral M3 receptor blockers within postoperative 2 months.In PKRP group all the patients recovered without true incontinence,TURS and urethral stricture.5.Follow up data comparison after postoperative 6 months:IPSS,QOL,Omax and PVR improved obviously compared with preoperative data and had significant difference in the same group(P<0.01),but had no significant difference between two groups(P>0.05).It showed that both of PKREP and PKRP can improve subjective and objective indicators.Conclusions:1.PKERP has shorter operation time and less bleeding than PKRP;2.PKERP is less complications,safe and effective;3.PKERP can accumulate erroneous surgical experience and skills,and it can be a transitional technique from PKERP to complete PKEP.It is worthy of clinical application.