Clinical Efficacy And Safety Of Transurethral Columnar Balloon Dilation Of The Prostate For Benign Prostatic Hyperplasia In Small Prostates(<30ml):A Retrospective Study

Objective:At present,there are deficiencies in the treatment of small volume(<30ml)benign prostatic hyperplasia(BPH).The "gold standard" transurethral resection of the prostate(TURP)has the following problems:(1)the possibility of serious complications;(2)Limited improvement of bladder outlet obstruction in patients with small volume BPH;(3)The incidence of bladder neck contracture is high in the long term;(4)It can not completely solve the causes of lower urinary tract symptoms of small volume BPH,such as prostate fibrosis and excessive contraction of smooth muscle;(5)It has a great impact on sexual function,etc.Transurethral incision of the prostate(TUIP)has the problem of high reoperation rate.Transurethral columnar balloon dilatation of the prostate(TUCBDP)is an improved minimally invasive new technology.Its efficacy and safety in the treatment of medium and large volume BPH have been confirmed,but whether it is applicable in small volume BPH population is not completely clear.This study will explore the clinical efficacy and safety of TUCBDP in the treatment of small volume(<30ml)BPH.Methods:To retrospectively analyze the clinical data of 92 patients with BPH who underwent TUCBDP in our hospital and outside hospitals from October 2016 to November 2019.The patients were divided into two-center small-volume BPH(<30ml)group,our hospital small-volume BPH(<30ml)group,external hospital small-volume BPH(<30ml)group,external hospital small-moderate volume BPH(<90ml)group,two-center moderate-volume BPH(30-90ml)group and two-center small-moderate volume(<90ml)BPH group.The preoperative and postoperative International Prostate Symptom Score(IPSS),Quality of Life Score(QOL),maximum urinary flow rate(Qmax),postvoid residual volume(PVR),times of nocturnal urination and times of daytime urination were compared and analyzed,and the incidence of postoperative complications was also observed.Results:The average age of 92 patients was(70.89 ± 8.14)years old,and the average prostate volume was(33.23± 19.71)ml,including 56 cases with prostate volume less than 30ml and 36 cases with prostate volume ranging from 30ml to 90ml.In two-center small-volume BPH(<30ml)group(n=56),at 1,3 and 6 months after operation,the mean IPSS score decreased from baseline to(12.25±3.24),(8.52±2.25),(7.81 ± 1.78),QOL score decreased from baseline to median 2.0(1.0,2.0),2.0(1.0,2.0),1.0(1.0,2.0),and Qmax increased from baseline to(9.93±3.00)ml/s,(12.56±4.09)ml/s,(12.94±2.84)ml/s,PVR decreased from baseline to median 10.0(00.0,20.0)ml,9.0(00.0,16.3)ml and 12.0(0.0,20.0)ml,respectively;One month after operation,the times of nocturia and diurnal urination decreased to an average of(1.68 ± 0.68)and(6.52 ± 1.13)respectively;More than 24 months after operation,the average IPSS and QOL of 17 patients decreased from baseline to(13.82±7.20)and(3.06±1.34),respectively.The differences of the above indexes were statistically significant(All P<0.01).Through comparative analysis in our hospital small-volume BPH(<30ml)group(n=21),external hospital small-volume BPH(<30ml)BPH group(n=35),external hospital small-moderate volume(<90ml)BPH group(n=71),two-center moderate-volume(30-90ml)BPH group(n=36)and two-center small-moderate volume(<90ml)BPH group(n=92),it was found that IPSS,QOL,Qmax,PVR,times of nocturia and times of diurnal urination were significantly improved in the follow-up of 1-6 months after operation,and all the differences were statistically significant(All P<0.01).The incidence of postoperative complications was as follows:incontinence in 28 patients(28.3%),hematuria in 10 patients(10.9%),bladder irritation signs in 5 patients(5.4%),acute urethritis in 4 patients(4.3%),dysuria in 3 patients(3.3%),electrolyte disturbance in 3 patients(3.3%),bladder spasm in 3 patients(3.3%),acute urinary retention in 2 patients(2.1%),bleeding in 1 patient(1.1%),and urethral stricture in 1 patient(1.1%).One month after operation,83.3%of the adverse reactions could be recovered through treatment(50/61).Six months after operation,98%of the adverse reactions were recovered.At this time,only one patient still had urinary incontinence.This patient recovered his urinary control ability 9 months after operation.Conclusions:The short-term clinical effect of TUCBDP in the treatment of small volume BPH patients is accurate and significant,with the advantages of short operation time,few complications,minimally invasive and all postoperative adverse reactions can be improved after symptomatic treatment,which is in general a safe and effective procedure.