Influence Of Prostate Size On The Outcome Of Plasmakinetic Enucleation Of The Prostate

?Objective? To explore the influence of prostate size on the outcome of Plasmakinetic enucleation of the prostate(PKEP)for the treatment of benign prostatic hyperplasia(BPH)?Methods? From January 2004 to January 2014,the data of patients with symptomatic BPH who underwent Pk EP in our medical center were retrospectively reviewed.Patients were divided into 4 groups based on the preoperative prostate size measured by transrectal ultrasound(TRUS): smaller than 40 ml(Group 1),between 40 and 79 ml(Group 2),between 80 and 120 ml(Group 3),and larger than 120ml(Group 4).Patients in each group were followed up for 36 months,and the incidence of postoperative complications and urination related indicators such as preoperative and postoperative IPSS,QOL,serum PSA assay and post void residual(PVR)were recorded and compared.?Results?(1)Baseline characteristics of the patients in the 4 groups:Significant difference was observed in the age(57.5±6.4year vs 61.9±6.5 year vs 65.4±8.0 year vs 70.8±7.0 year),PSA(2.9±0.8 ng/ml vs 3.8±1.7 ng/ml vs 6.1±2.5ng/ml vs 9.9±4.3ng/ml),Qmax(12.0±5.3ml/s vs 9.1±6.7ml/s vs 7.8±5.8ml/s vs 6.9±7.1ml/s)and PVR(92.1±52.3ml vs 111.6±68.5ml vs 174.1±85.9ml vs 190.8±133.6 ml)among groups(P<0.05 for all).However,there was no significant difference in IPSS(25.4±7.4score vs 25.6±6.8score vs 25.2±8.3score vs 25.1±8.8score)and QOL(4.6±0.9score vs 4.5±1.0score vs 4.4±1.2score vs 4.4±1.2score)(p>0.05 for all).(2)Indication for surgery in the 4 groups:51.3%,47.4% and 42.1% of the Group1,Group 2 and Group 3 received surgical treatment mainly due to failure of drug treatment.In the fourth group,48.3% were operated due to recurrent urinary retention.(3)Perioperative variables in the 4 groups:operation time(65.7±12.1min vs 81.2±15.4min vs 93.8±13.2min vs 128.4±14.3min),resected prostate weight(18.0±7.1g vs 32.6±9.1g vs 58.5±13.9g vs 85.0±25.5g),operation efficiency(0.27±0.07g/min vs 0.40±0.06 g/min vs 0.62±0.07 g/min vs 0.67±0.23g/min)and decreased in hemoglobin(0.67±0.13g/dl vs 0.80±0.16g/dl vs 1.01±0.20g/dl vs 1.10±0.25g/dl)were compared among the 4 groups and showed significant difference(P<0.05 for all).However,duration of catheterization(36.4±16.1h vs 37.1±14.5h vs 38.0±12.5h vs 37.4±15.0h)was equivalent in the 4 groups without significant difference(P > 0.05).(4)Postoperative complications and Postoperative outcome during the 36-month follow-up: prostate perforation was a common complication,and no bladder perforation and transurethral resection syndrome(TURS)were found in patients.In the larger prostate group,the hemoglobin decreased more significantly than in the other groups,and the transfusion rates increased(0 vs 0.7% VS 1.0% vs 2.3%),but no significant difference was observed.During the 3-year follow-up,the efficacy of PKEP was equivalent for different prostate sizes,as the postoperative improvement of IPSS,QOL,Qmax and PVR(p>0.05 for all).?Conclusion? PKEP is a safe and effective surgical procedure.For patients with different sizes,postoperative IPSS,QOL,Qmax and PVR showed equivalent improvement.PKEP can treat all prostates regardless of size.