A Comparative Study On The Efficacy And Safety Of Three Types Of Single Central Transurethral Resection Of Prostate

Background:Benign prostatic hyperplasia?BPH?is one of the most common diseases of middle-aged and elderly men.At present,Transurethral resection of the prostate?TURP?is still the"gold standard"for surgical treatment of BPH.However,TURP has more intraoperative and postoperative complications,such as transurethral resection syndrome?TURS?,urethral stricture,sexual dysfunction,and recurrence.With the development of intraluminal minimally invasive technology,more and more safe and effective intraluminal minimally invasive treatment BPH technology is gradually developed in the clinic,but each intraluminal minimally invasive technology has its own advantages and disadvantages.Therefore,look for safer and more effective,complication low intraluminal minimally invasive techniques are still a huge challenge for clinicians.Objective:To compare transurethral plasmakinetic resection of the prostate?PKRP?,transurethral plasmakinetic enucleation of the prostate?PKEP?,and transurethral thulium laser enucleation of the prostate,?ThuLEP?,the efficacy and safety of three surgical methods for the treatment of BPH.Methods:According to the inclusion and rejection criteria,retrospectively analyzed the BPH patients who were treated in the urology ward of the Sixth Hospital of Guangzhou Medical University from July 2017 to September 2019.A total of 186patients who met the criteria were included in this study,and were divided into three groups according to different surgical methods,including 64 cases in the ThuLEP group,62 cases in the PKEP group,and 60 cases in the PKRP group.Record the age,prostate volume,international prostate symptom scores?IPSS?,preoperative quality of life?QoL?,preoperative hemoglobin value,preoperative maximum urinary flow rate?Qmax?,detrusor pressure at maximum flow rate?Pdet-Qmax?of the three groups of patients and record intraoperative time,bleeding volume,weight of glandular tissue removed,intraoperative complications;record postoperative hemoglobin value,indwelling catheter time,continuous bladder irrigation time,postoperative hospital stay,recent postoperative complications,and 6 months postoperative Qmax,Pdet-Qmax,IPSS,QoL,complications.Compare the therapeutic effect and safety of the three surgical methods.Results:The ages of the three groups?ThuLEP group 69.63±8.41 v PKEP group69.73±8.50 vs PKRP group 70.60±7.77?,preoperative hemoglobin?ThuLEP group130.45±17.77g/L vs PKEP group 129.16±21.27g/L vs PKRP group 131.15±17.51g/L?,prostate volume?ThuLEP group 46.44±18.79ml vs PKEP group 50.32±21.43ml vs PKRP group 50.93±21.32ml?,preoperative IPSS?ThuLEP group 25.22±2.72 vs PKEP group 25.82±2.44 vs PKRP group 25.45±2.42?,preoperative QoL?ThuLEP group6?5-6?vs PKEP group 6?5-6?vs PKRP group 6?5-6??,preoperative Qmax?ThuLEP group 5.52±2.76ml/s vs PKEP group 5.19±3.24ml/s vs PKRP 6.23±3.81ml/s?,preoperative Pdet-Qmax?ThuLEP group 46.09±19.09 cmH₂O vs PKEP group43.83±17.55cmH₂O vs PKRP group 40.53±22.28cmH₂O?.There was no significant difference between the baseline indicators of the three groups?P>0.05?.The intraoperative observation indicators:operation time?ThuLEP group 79.61±28.25min vs PKEP group 90.68±27.63min vs PKRP group 94.93±29.56min?,intraoperative blood loss?ThuLEP group 29.92±10.33ml vs PKEP group 52.50±22.67ml vs PKRP group 84.83±33.97ml?and weight of glandular tissue removed?ThuLEP group40.0?30.0-60.0?g vs PKEP group 47.5?40.0-60.0?g vs PKEP group 30.0?20.0-50.0?g?.Among the above indexes,ThuLEP group was superior to PKEP group and PKRP group in terms of operation time and intraoperative blood loss?P?0.05?,and PKEP group was also superior to PKRP group?P?0.05?.ThuLEP group and PKEP group were larger than PKRP group in weight of resectioned gland tissue?P?0.05?,but there was no significant difference between ThuLEP group and PKEP group?P>0.05?.Postoperative observation indicators:postoperative hemoglobin?ThuLEP group123.28±17.51g/L vs PKEP group 115.19±21.25g/L vs PKRP group 114.37±17.52g/L?,the postoperative hemoglobin decrease value?ThuLEP group 7.25±3.49g/L vs PKEP group 13.97±7.70g/L vs PKRP group 16.78±6.32g/L?,indwelling catheter time?ThuLEP group 67.88±26.72h vs PKEP group 78.55±26.71h vs PKRP group87.00±31.53h?,postoperative continuous bladder flushing time?Thu LEP group0.00?0.00-15.75?h vs PKEP group 14.00?0.00-21.63?h vs PKRP group20.25?15.50-29.00?h?,postoperative hospital stay?ThuLEP group 3.00?2.00-4.00?d vs PKEP group 4.00?3.00-5.00?d vs PKRP group 4.00?3.00-5.75?d?.Among the above postoperative observation indicators,the postoperative hemoglobin in ThuLEP group was higher than that in PKEP group and PKRP group?P?0.05?.The ThuLEP group was significantly shorter than the PKEP and PKRP groups in the time of postoperative indwelling catheter,postoperative continuous bladder flushing time and postoperative hospital stay?P?0.05?,and the PKEP group in the postoperative continuous flushing time and postoperative hospital stay also significantly shorter in the PKRP group?P?0.05?.In the recent postoperative complications:there were two cases of dysuria,one case of urinary incontinence,and one case of postoperative fever in the ThuLEP group.There were three cases of dysuria,one case of urinary incontinence,and one case of blood transfusion in the PKEP group.Six patients in the PKRP group had difficulty urinating,three had incontinence,one had postoperative hypotension,and one had fever.But there was no significant difference in the recent postoperative complications among the three groups?P>0.05?;Six-month follow-up indicators:IPSS?ThuLEP group 6.68±1.79 vs PKEP group 6.52±1.58 vs PKRP group 6.59±1.79?,QoL?ThuLEP group 1?0-1?vs PKEP group 1?0-1?vs PKRP group 1?0-2??,Qmax?ThuLEP group 15.79±1.55ml/s vs PKEP group 15.48±1.56ml/s vs PKRP group15.92±1.80ml/s?,Pdet-Qmax?ThuLEP group 37.30±3.69cmH₂O vs PKEP group33.80±3.51cmH₂O vs PKRP group 33.97±6.67cmH₂O?.Pdet-Qmax has no significant difference before and after operation?P>0.05?.IPSS,QoL,Qmax are significantly improved compared with preoperative.Six months postoperative complications:one case of urinary incontinence and one case of erectile dysfunction in the ThuLEP group;two cases of urinary incontinence and one case of erectile dysfunction in the PKEP group;fives cases of urinary incontinence and one case of urethral stricture in the PKRP group,two patients had erectile dysfunction.But there is no obvious difference between the three groups?P>0.05?.Conclusion:1.ThuLEP,PKEP,and PKRP are effective in the treatment of BPH.They have the advantages of less trauma,less intraoperative bleeding,and faster postoperative recovery.2.Compared with PKEP and PKRP,ThuLEP is superior in operation time,intraoperative blood loss,indwelling catheter time,continuous bladder irrigation time and postoperative hospital stay.