| Background and purpose:Benign prostatic hyperplasia(BPH) is a common disease of old men,which morbidity is increased with age.It is said by clinical doctor BPH with more than 80-year-old,at least combined with one or more vital organs,systems for serious disease or function damaged as called high-risk benign prostate hyperplasia.The effects of medical treatment is poor,the risk of open surgery is high and the microwave,radio frequency,the urethra mesh stent and balloon dilatation and other minimally invasive treatment are also poor.With the development of endoscopic technology,transurethral resection of prostate(TURP) is now considered as the gold standard of surgical therapy of BPH.How to improve tolerance to surgery,to reduce blood loss intraoperative and to prevent transurethral resection of prostate syndrome or other serious complications is a direction of exploration for surgeons of urology.To seek the proper methods or treat high-risk benign prostate hyperplasia,the clinical study from June 2004 to June 2008,there were 76 patients of high-risk benign prostate hyperplasia in our hospital,which was properly managed during perioperative period and by chance to TURP.37cases applying TURP by Nesbit's methods and 39cases by modified Nesbit's methods and to evaluate operative time,bleeding during operation,the weights of the prostate tissues resected,postoperative bladder irrigation time,postoperative complications,postoperative recovery and analysis the comparative effect of the report are as follows: Methods:1.Including and excluding standard:1.1 Including standardFrom June 2004 to June 2008,The old male patients who were suffered from the lower urinary tract symptoms such as thamuria,nocturia and progressive dysuria were diagnosed as BPH by prostate specific antigen,digital rectal examination,international prostate symptom score(I-PSS) quality of life score(QOLS) and urinary dynamics.The BPH with more than 80-year-old,at least combined with one or more vital organs, systems for serious disease or function damaged is called high-risk benign prostate hyperplasia.1.2 Excluding standardWe rule out those cases who were diagnosed as prostate cancer with high prostate specific antigen or the normal international prostate symptom score(I-PSS),quality of life score(QOLS) and urinary dynamics.1.3 The patients with inducation accepted TURP which were done by the surgeons qualified as associate chief physician of our hospital.The pathological diagnosis after operation of all the patients was BPH.2 Assemble the data:2.1 Between June 2004 and June 2008 data were respectively obtained on our 37 consecutive cases applying TURP by Nesbit's methods.we gathered the detailed clinical data of these patients,including present and past history,in particular,asked whether patients with hypertension,diabetes,respiratory dysfunction and the other combined internal medicine diseases,the weights of prostates estimated by B-mode ultrasound before operation,preoperative and postoperative maximum flow rate(Qmax), determination of residual urine volume(RUV) and the International prostate symptom score(I-PSS),quality of life score(QOL) assessment,total operation time,the weights of the prostate tissues resected,bleeding during operation,postoperative bladder irrigation time,time of postoperative hospital stay,postoperative complications.2.2 Between June 2004 and June 2008 data were respectively obtained on our 39 consecutive cases applying TURP by modified Nesbit's methods,we gathered the detailed clinical data of these patients,including present and past history,in particular, asked whether patients with hypertension,diabetes,respiratory dysfunction and the other combined internal medicine diseases,the weights of prostates estimated by B-mode ultrasound before operation,preoperative and postoperative maximum flow rate(Qmax),determination of residual urine volume(RUV) and the International prostate symptom score(I-PSS),quality of life score(QOL) assessment,total operation time,the weights of the prostate tissues resected,bleeding during operation, postoperative bladder irrigation time,time of postoperative hospital stay, postoperative complications.3 Data analyzing:3.1 The comparative analysis of the two group such as age,preoperative and postoperative maximum flow rate(Qmax),determination of residual urine volume (RUV) and the International prostate symptom score(I-PSS),quality of life score(QOL) assessment,total operation time,the weights of the prostate tissues resected,bleeding during operation,postoperative bladder irrigation time,time of postoperative hospital stay,postoperative complications.3.2 All the data were analyzed by SPSS13.0 for windows.We chose different statistical method depended on the different data information.Result:1 The procedure has been successful and no patient experienced TURsyndrome.By modified Nesbit's methods the mean weight of the resected prostate tissue was 37.8±4.8g,the mean operation time was 65.3±12.1minutes,the mean bleeding during operation was 201.3±83.5ml,the mean postoperative bladder irrigation time was 42.5±12.3hours,the mean time of postoperative hospital stay was 6.5±1.5days,postoperative complications was 3cases.The I-PSS was decreased from 27±7score to 7.5±3.4score with good results postoperation(P＜0.05),such as the maximum flow rate(Qmax),the residual urine volume(RUV) and the quality of life score(QOL).2 By Nesbit's methods the mean weight of the resected prostate tissue was 36.4±3.6g,the mean operation time was 85.7±14.5minutes,the mean bleeding during operation was 256.4±113.2ml,postoperative complications was 6cases.The I-PSS was decreased from 27±6 score to 8.5±2.3 score with good results postoperation (P＜0.05) such as the maximum flow rate(Qmax),the residual urine volume(RUV) and the quality of life score(QOL).3 Comparing the results of TURP by modified Nesbit's methods with Nesbit's methods,the age,the preoperative and postoperative maximum flow rate(Qmax),the residual urine volume(RUV),the International prostate symptom score(I-PSS),the quality of life score(QOL) and the weights of the prostate tissues resected were no significant differences(P＞0.05),but the total operation time,bleeding during operation, postoperative bladder irrigation time,time of postoperative hospital stay,postoperative complications were statistically significant differences(P＜0.05).The results of TURP by modified Nesbit's methods were less operative time,less bleeding during operation and less postoperative complications than Nesbit's methods,the differences were significantly(P＜0.05).Conclusion:Transurethral resection prostate by modified Nesbit's methods is a safe and effective method.It could promote the quality of operation for high-risk benign prostate hyperplasia,with less operative time,less bleeding during operation,less postoperative complications. |
PDF Full Text Request