Research Of Urodynamic After Transurethral Enucleation And Resection Of Prostate

BackgroundBenign prostatic hyperplasia (BPH) is one of the most common ailments affecting the elderly men. Although it is not a life-threatening disease, BPH can have detrimental impacts on quality of life. Without intervened in time, it may give rise to serious consequences, such as uremia. Currently there are two main treatments:drugs and surgery which includes open surgery and minimally invasive transurethral surgery. Surgical treatment modalities have undergone a revolutionary change with minimally invasive techniques.The transurethral surgery has its advantage such as patients’rapid recovery, shorter hospitalization time and fewer complications, as the classic representative of transurethral surgery, transurethral resection of prostate(TURP) had replaced the traditional open surgery, and became the gold standard of surgery treatment of benign prostatic hyperplasia.But as TURP extensively carried out in clinic, many scholars found that there were a lot of disadvantages of this method. On the basis of TURP, a domestic famous scholars improved and originally created a new surgical method named transurethral enucleation and resection of prostate (TUERP). Through continuous improvemen and promotion, he got great achievements. And the advantages of this method compared with TURP had been recognized in peers at home and abroad gradually. With the widely developed of TUERP, the gold standard of TURP would be replaced by TUERP in the future.Urine dynamics test was gradually carried out in recent decades, mainly included four parts:free uroflowmetry; cystometrograms(CMG); pressure-flow studies(P-Q test); resting urethral pressure profile(RUPP). Before the test, the doctors’judging about BPH mainly came from patients’ symptoms, digital rectal examination and imaging data such as ultrasonic test.As is known to all, BPH is mainly composed by three group of symptoms including bladder outlet obstruction(BOO), detrusor instability and detrusor contractility decline. Between them bladder outlet obstruction factors is the initial factors, and surgery can directly solve the problem.If only according to patients’ symptoms, IPSS scores, digital rectal examination and imaging data, it is difficult to judge the accurate degree of bladder outlet obstruction, and the operation effect would not be ideal, even many adverse consequences would happen.Urine dynamics test mainly studies such as urine flow rate, degree of bladder outlet obstruction, detrusor pressure and urethral pressure, the indicators can respectively reflect the bladder function, bladder outlet obstruction and urethral sphincter function, etc.It plays an important role in preoperative evaluation, forecast of surgical curative effect and judgement of postoperative effect of BPH. And the result is objective, little influenced by both doctors and patients. Compare with traditional indicators such as the international prostate symptom score (IPSS), quality of life score (QOL), etc, it can reflect the differences between pre-operation and post-operation more accurately.ObjectiveCurrently there were many articles about research of TUERP in the application of BPH, most of them compared it with TURP, or compared the differences between different instruments, indicators were mainly involved in the IPSS score, QOL score, postvoid residual volume (PVR), indicators of urine dynamics test measures were always maximum urinary flow rate(Qmax) only. Although the maximum urinary flow rate was a important indicator to assess the postoperative effect of prostate, but only one indicator was not convincing enough.At present, the articles about follow-up of postoperative urine dynamics test were less, and most of them were early follow-up research.The result showed that the early effect of TURP and TUERP was similar. Except controlling bleeding, another advantage of TUERP is more thoroughly removing prostate hyperplasia gland. TUERP remove the gland completely from surgical capsule, theoretically, the postoperative recurrence rate should be close to zero. To confirm and obtain more extensive evidence to this assumption, we compared all urine dynamics test indicators of BPH patients before and after surgery operation, while extending the follow-up time to five years.MethodsThe cases treated in zhujiang hospital, southern medical university in July2008to June2009were collected. All patients had undergone standard TUERP operated by two experienced professors personally. Before and after surgery operation, clinical datas such as IPSS score, QOL score, serum prostate specific antigen (PSA), prostate volume and urine dynamics test indicators were collected.And then we got in touch with them by phone, made sure that they could return to the hospital to participate the follow-up research. Collected all the patients’test indicators including urine dynamics test for free.With professional statistical software SPSS13.0, we analyzed all the patients’ statistics which eventually came into the follow-up research, using t test and chi-square test to compare the differences between pre-operation and post-operation test results. Focusing on urine dynamics test indicators, including the maximum urinary flow rate, postvoid residual volume, maximum cycstometric capacity, bladder compliance, detrusor overactivity, maximum detrusor pressure, bladder outlet obstruction index, bladder outlet obstruction level, prostatic urethra pressure, prostatic urethra length, maximum urethral closure pressure is closely related to the prostate surgery. Meanwhile, we compared the IPSS score, QOL score, serum PSA, prostate volume to analyze the curative effect5years after TUERP. ResultsAccording to statistics,324BPH patients had accepted TUERP in July2008to June2009in zhujiang hospital, southern medical university. All cases were confirmed by pathologists. Among them,68cases had combined with chronic inflammation,36cases had combined with prostatic intraepithelial neoplasia(PIN), grade1. After strict screening,100cases finally came into the follow-up research group. The mean follow-up time was5years±6months.Before operation, the patients’total IPSS score was23.58±2.73, urination period score was10.07±1.83, storage period score was13.51±1.64; The QOL score was4.45±0.66; Prostate volume was68.17±23.60ml; Serum PSA is5.62±2.97ng/ml; Qmax was7.85±2.58ml/s; PVR was78.60±36.27ml; The maximum cycstometric capacity was258.42±67.48ml; Bladder compliance was12.14±5.57ml/H2O;The maximum detrusor pressure was96.06±9.72cmH2O;Bladder outlet obstruction index was65.15±12.19; Bladder outlet obstruction level was3.81±0.66; Prostatic urethra pressure was25.93±6.84cmH2O; Prostatic urethra length was4.84±0.51cm; The maximum urethral closure pressure was85.62±9.56ml;38.0%patients combined bladder detrusor instability.5years after TUERP, the patients’ total IPSS score was5.14±1.10, urination period score was2.02±0.67, storage period score was3.12±0.831; The QOL score was2.01±0.60; Prostate volume was28.02±7.54ml; Serum PSA is1.64±0.81ng/ml; Qmax was20.40±3.69ml/s; PVR was19.60±14.90ml; The maximum cycstometric capacity was352.47±67.68ml; Bladder compliance was24.96±6.67ml/H2O;The maximum detrusor pressure was62.88±4.74cmH2O; Bladder outlet obstruction index was22.22±6.22; Bladder outlet obstruction level was1.60±0.49; Prostatic urethra pressure was13.75±2.83CmH2O; Prostatic urethra length was2.80±0.41cm; The maximum urethral closure pressure was70.73±5.53ml;13.0%patients combined bladder detrusor instability.All corresponding indicators comparison results showed significant difference, P values≤0.01.Conclusion1.5years after TUERP, the patients’ subjective symptoms include IPSS score, QOL score were significantly improved, not just urination period improved, but also storage period. It was considered with increasing of bladder compliance and reducing of the bladder detrusor instability.2.5years after TUERP, the patients’serum PSA still remained low.Serum PSA was produced by prostate gland, it can objectively reflect the degree of prostate gland hyperplasia.Low level of PSA predicted residual gland recurrence was rarely after TUERP. Prostate volume shrinked considerably after operation, although ultrasonic test could not incarnate the advantages of TUERP, but combined with serum PSA, wo could believe that the recurrence rate was very few after TUERP.3. In the test of free uroflowmetry,5years after TUERP, the patients’maximum urinary flow rate(Qmax) obviously improved compared with preoperation results. Almost all of their test results became normal, and the postvoid residual volume(PVR) also reduced. These indicated that bladder outlet obstruction and detrusor high pressure had well relieved.4. In the test of cystometrograms (CMG),5years after TUERP, the patients’ bladder compliance(BC) and the maximum cycstometric capacity (MCC) increased significantly, as the same time, the rate of bladder detrusor instability reduced. These indicated that bladder’s feeling was good, detrusor was more stable and bladder could store more urine.We could speculate that frequency for urination significantly was reduced.5. In the pressure-flow studies(P-Q test),5years after TUERP, the patients’ maximum detrusor pressure (Pdet.max) reduced to normal levels. Bladder outlet obstruction index and level decreased significantly, These resuts showed that the operation remove bladder outlet obstruction thoroughly, and the occurrence rate of bladder neck contracture and urethral stricture was low.6. In the test of resting urethral pressure profile(RUPP),5years after TUERP, the patients’prostatic urethra pressure and length were in the normal range. The datas declined obviously after operation, it showed that the operation removed prostate hyperplasia gland very thoroughly, and the maximum urethral closure pressure (Pura.clos.max) was normal. It showed that the urethral sphincter function was normal, also suggests the rate of permanent incontinence was very low. 7.5years after TUERP, all aspects of index were still ideal, it showed that this operation method had a satisfactory effect in long-term, and the recurrence rate is low, it would be worthed generalizing in the clinical practice in the future.