The Clinical Research Of The Treatment Of Large Benign Prostatic Hyperplasia(>100g) By Transurethral Anatomical Enucleation Of Prostate

Chaper 1 BackgroundBenign prostatic hyperplasia(BPH)is a common disease in elderly men.Transurethral resection of prostate(TURP)and open prostatectomy(OP)are the"gold standard" for surgical treatment.With the development of related technologies,a variety of new surgical methods have emerged in clinic and applied to the treatment of large volume BPH.Transurethral enucleation of the prostate(TUAEP)has a great application prospect.At present,many studies on the large prostate choose the prostate volume above 60ml,and there is still little systematic research on the endovascular treatment of 80ml or even more than 100g.In view of the reported clinical randomized controlled trials on the comparison of various surgical methods for the treatment of large volume BPH(>60ml),this study first comprehensively analyzed and compared them by network meta-analysis,in order to fully understand the advantages and disadvantages of various surgical methods in the treatment of large volume BPH(>60ml).And this study also retrospectively analyzed the use of TUAEP in the treatment of large BPH(>100g)cases,hoping to provide the necessary clinical basis for the clinical effect of TUAEP in the treatment of large BPH(>100g).Chaper 2 Management of large benign prostatic hyperplasia:A network meta-analysisObjective:Network meta-analysis is applied to comapre the safety and effectiveness of nine different types of surgery for the treatment of large benign prostatic hyperplasia(>60ml)including open prostatectomy(OP),transurethral resection of prostate(TURP),plasmakinetic enucleation of the prostate(PKEP),Holmium laser enucleation of the prostate(HoLEP),photoselective vaporization of the prostate(PVP),diode laser enucleation of the prostate(DiLEP),thulium laser resection of the prostate(TmLRP),transurethral vaporization of the prostate(TUVP)and laparoscopic simple prostatectomy(LSP).Methods:Medline,Embase and Cochrane Library databases were searched to collect all clinical randomized controlled trials for the treament of large volume benign prostatic hyperplasia(>60ml).IPSS of 1 year,Qmax of 1 year,operation time,catheterization time,derease in hemoglobin,incontinence rate and bladder neck contracture/urethral stricture rate were taken as outcome indicators.ADDIS software was used for statistical analysis.The odds ratio(OR)and 95%CI were used as the effect indexes in the binary variables,and the standardized mean difference(SMD)and 95%CI were used as the effect indexes in the continuous variables.Results:14 RCTs were included,involving 9 types of surgery.Results of network meta-analysis showed that there was no significant difference in IPSS of 1 year and Qmax of 1 year.The operation time of OP was shorter than that of PVP,TUVP and HoLEP,the operation time of PKEP was shorter than that of HoLEP,PVP,and TUVP,the operation time of TURP was shorter than that of PVP.The catheterization time of OP was longer than that of PKEP,PVP,TURP,TUVP,DiLEP and HoLEP,and the decrease in hemoglobin of OP was larger than that of PKEP and TUVP,the difference was statistically significant.There was no significant difference in the incontinence rate and bladder neck contracture/urethral stricture rate after operation,Conclusion:In the treatment of large volume BPH,the catheterization time of OP is longer,the intraoperative bleeding is more,but with shorter operation time.The operation time of PKEP is shorter than that of HoLEP,PVP and TUVP,and the operation time of TURP is shorter than that of PVP.There was no significant difference in the effectiveness indexes and postoperative complications of each surgical method included in the analysis.Chaper 3 A single-center retrospective study of Transurethral Anatomical Enucleation of Prostate for the treatment of large benign prostatic hyperplasia(>100g)Objective:To study the application and the clinical efficacy of transurethral anatomical enucleation of prostate(TUAEP)in the treatment of patients with large prostatic hyperplasia(>100g)and to compare the therapeutic effect of TUAEP on patients with different prostate volume.Methods:Clinical data of patients with large benign prostatic hyperplasia(>100g)treated with TUAEP in our hospital from January 2011 to December 2018 were analyzed retrospectively.The clinical information of patients was collected,including preoperative factors(age,prostate size,preoperative urinary retention,tPSA,fPSA,hemoglobin,Na+)and perioperative indicators(operation time,postoperative hospital stay,bladder irrigation time,catheterization time,drecrease in hemoglobin,recatheterization,blood transfusion).Meanwhile,according to prostate volume,the above patients were divided into three groups:100-150g,150-200g,more than 200g.The measurement data of the above three groups were analyzed by nonparametric test,and the counting data were tested by chi-square test.The Spearman's correlation analysis was performed between perioperative outcomes and prostate size.P<0.05 is considered to be statistically significant.Results:335 cases of postoperative TUAEP were included.The indicators are as follows:preoperative prostate size(136.95 ±43.52)g,total operation time(121.27±56.14)min,postoperative hospital stay was(5.24 ±1.86)d,catheterization time was(3.11± 1.39)d,decrease in hemoglobin(11.36 ± 12.67)g/L,serum Na+level changed(1.26±3.63)mmol/L,intraoperative blood transfusion in 15 cases(4.48%),postoperative blood transfusion in 28 cases(8.36%).The incidence of urinary incontinence and urethral stricture was 2.99%and 1.79%respectively.No TURS occurred.According to the size of prostate,the patients were divided into three groups.There were significant differences in the total operation time,postoperative hospital stay,the incidence of intraoperative blood transfusion and the incidence of postoperative blood transfusion among the three groups.In the comparison between the two groups,the incidence of intraoperative blood transfusion in 150-200g group and more than 200g group was higher than that in 100-150g group,the incidence of postoperative blood transfusion in more than 200g goup was higer than that in 150-200g group,the total operation time in 200g group was longer than that in 100-150g group and 150-200g group,and the postoperative hospital stay in 200g group was higher than that in 150-200g group.The correlation between operation time and prostate size was weak(Sperman r=0.2707).Meanwhile,there was no significant correlation between the perioperative outcomes(including postoperative irrigation time,catheterization time,postoperative hospital day,decrease in hemoglobin and decrease in serum sodium)and prostate size(Spearman r=0.0556,0.0546,0.1029,0.1654,0.0871,respectively).Conclusion:TUAEP is safe and effective in the treatment of benign prostatic hyperplasia(BPH)with volume larger than 100g.TUAEP has solved the problems of bleeding and TURS,the limitation of operation time and prostate volume has been broken,at the same time,it has achieved as minimally invasive as TURP and as thorough as open prostatectomy.