Etricacy And Safety Of Percutaneous Cystostomy Holmium Laser Lithotripsy Combined With PKRP In The Treatment Of BPH With Bladder Stone

Objective:To investigate the effect and clinical value of holmium laser lithotripsy combined with plasmakinetic resection of the prostate(PKRP)in the treatment of benign prostatic hyperplasia(BPH)with bladder stone.Materials and methods:A retrospective analysis of the clinical data of 98 BPH patients with bladder stone who underwent surgery from January 2015 to December 2018.Among them,62 patients(group A,average age 71.15 years)were treated by transurethral holmium laser lithotripsy combined with PKRP,36 patients(group B,average age 71.42 years)were treated by percutaneous cystostomy holmium laser lithotripsy combined with PKRP.The clinical data of the patients were collected,including operation time(total operation time,holmium laser lithotripsy time and PKRP time),bladder washing time,catheter removal time,hospital stay time,laboratory examination(hemoglobin,WBC count,serum sodium level),postoperative pain score and utilization rate of analgesics,treatment cost,intraoperative and postoperative complications,preoperative and postoperative international anterior The scores of IPSS,QOL and patients' satisfaction were also evaluated.All data were analyzed by SPSS 20.0.Results:The mean follow-up time of 98 BPH patients with bladder stone was 6.7 months,and all were followed up for 6-9 months.1.Compared with group A,there was no significant difference in age,history time,prostate volume,bladder stone surface area and stone CT value in group B(P>0.05).2.In total operation time,there was no significant difference between group B and group A,(122.31±5.78)min vs.(120.19 ± 7.23)min,P>0.05;holmium laser lithotripsy time of bladder stone in group B was significantly longer than that in group A,(38.64±4.35)min vs.(24.95±2.60)min,P<0.05,but PKRP operation time in group B was only(83.67 ± 7.84)min,significantly lower than that in group A(95.24± 6.98)min,P<0.05.3.Improvement of lower urinary tract symptoms after operation:IPSS and QOL in both groups were significantly improved after operation,P<0.05;IPSS and QOL in group B compared with group A,there was no significant difference,P>0.05.4.There was no significant difference between the two groups in terms of bladder continuous flushing time,catheter removal time,average hospitalization time and satisfaction survey index during hospitalization,hemoglobin,incidence of complications,P>0.05,but the total cost of treatment in group B was significantly higher than that in group A,(23100.19 ± 740.57)yuan vs.(21054.29 ± 1083.33),6 hours after operation,the pain score of group B was 4.91± 1.25,which was significantly higher than that of group A(3.06± 1.10),and the use rate of analgesics(61.11%)was also significantly higher than that of group A(32.26%),P<0.05.Conclusion:1.Holmium laser lithotripsy combined with PKRP in the treatment of BPH combined with bladder stone has the advantages of small trauma,low incidence of intraoperative and postoperative complications,the PKRP time in the group of holmium laser lithotripsy combined with PKRP was significantly shortened,which might be a better choice for BPH patients with obvious bleeding during PKRP.2.The cost of hospitalization in the group of holmium laser lithotripsy combined with PKRP was increased,the degree of postoperative pain and the use rate of analgesics were significantly increased,and the patients with BPH with poor pain tolerance should be carefully selected.3.Transurethral holmium laser lithotripsy can be used as a supplement to transurethral holmium laser lithotripsy,when combined with PKRP to treat BPH patients with bladder stone,it is reasonable to choose according to the experience of the operator,the volume of prostate,the condition of urethra and the operation history of lower abdomen.