Clinical Curative Effect Analysis Of Transurethral Front-firing Greenlight Vaporization And Plasmakinetic Resection For The Treatment Of Leukoplakia Of Bladder

BackgroundLeukoplakia of the Bladder,also known as Vesical Leukoplakia,is a localized white flaky lesion that occurs on the surface of the bladder mucosa.It is particularly prevalent in the middle-aged women between the age of 50 to 70.Compared with chronic cystitis,there is no significant difference on the clinical symptoms and signs.In the past,it was thought that the morbidity of the disease was low.However,in the last ten years,with the development of minimally invasive techniques of urology,the wide application of the cystoscopy biopsies and imaging systems and the improvement of patients,health consciousness and living quality,the morbidity of Vesical leukoplakia is on the rise.At home and abroad,most scholars believe that Vesical leukoplakia belongs to leukoplakia.Although it is a benign lesion under the long-term stimulation of the bladder,patients have obvious clinical symptoms,and studies have shown that it may be a precancerous lesion developed for squamous cell carcinoma,so Vesical leukoplakia is encouraged to early discover and treat.Clinically,the method of treating Vesical leukoplakia has been advocated from the earlier radical cystectomy to the present endourethral surgery,including electric resection,electric coagulation,vaporization and laser.Transurethral resection with ion-scalpel is a classical surgical plan for the treatment of Vesical leukoplakia,whose recent and long-term efficacy has been confirmed by most studies.Photoselective vaporescetion of the prostate(PVRP)with the characteristics of high efficiency,short cutting time and hemostatic rate has broad application prospect in urology,the curative effect of which is similar to that of transurethral resection with ion-scalpel in the treatment of Vesical leukoplakia,or even better than transurethral resection.ObjectiveIn this study,we treated the patients with bladder leukoplakia by using front-firing greenlight vaporization or plasmakinetic resection,to compare the clinical efficacy of the two treatments,and to explore the best method of treatment of bladder leukoplakia.MethodsAll cases were from Department of Urology of Guangdong Second Provincial General Hospital.We retrospectively reviewed the clinical data of 40 patients with bladder mucosal leukoplakia from September 2013 to September 2016.The patients were randomly divided into two groups:20 cases treat with transurethral front-firing greenlight vaporization(observation group)and 20 cases treat with transurethral plasmakinetic resection(control group),with no statistical difference between the two groups(P>0.05).The operation time,hemorrhage volume during surgery,curative effect,relapse rate and urodynamic parameters were compared between the two groups.Logistic multiple regression analysis was used to analyze the factors influencing the curative effect.ResultsTwo groups of patients were successfully operated.The hemorrhage volume during surgery(3.0±1.8ml VS 5.6±4.2ml)had statistically significant difference between observation group and control group(P<0.05).The operation time(15.3±5.9min VS 16.0±6.0min)and hospital stay time(4.2±1.9d VS 4.1±1.8d)were no statistical difference between two groups(P>0.05).Two groups of postoperative patients were both followed up at least a full year.The cure rate(60%VS 40%),one-time cure rate(60%VS 25%),efficacy rate(100%VS 85%)and relapse rate were(0%VS 15%)had statistically significant difference between observation group and control group(P<0.05).The urodynamic parameters of two groups were significantly improved after operation.The parameters of observation group were superior to the control group,but the difference was not statistically significant(P>0.05).Logistic multiple regression analysis showed that maximumflow rate(Qmax)<13ml/s(OR=3.291,P=0.001),pdet-qmax(PQmax)>35cmH20(OR=6.661,P=0.001),functional urethral length(FUL)<2.3cm(OR=2.773,P=0.004)were the main factors affecting the therapeutic effect.ConclusionTransurethral front-firing greenlight vaporization and transurethral plasmakinetic resection are both the effective therapy for leukoplakia of bladder.By contrast,the former is more secure with a better long-term effect.The effect of surgical treatment may be greatly affected when patients with Qmax<13ml/s,PQmax>35cmH20,FUL<2.3cm case.