| Background and Objectives:The surgical management of patients with large prostate(≥80 m L) that cause bladder outflow obstruction(BOO) secondary to benign prostatic hyperplasia(BPH) is a challenging area.Transurethral resection of the prostate(TURP) is still regarded as the gold standard for the treatment of lower urinary tract symptoms(LUTS) secondary to benign prostate obstruction in prostates between 30 and 80 ml. With the continuous development resectoscope instruments and surgical techniques, the postoperative complications of TURP have decreased, more and more urologists try to use TURP for large-volume BPH(≥80 m L), and have achieved good results, but there is still the lack of a systematic, prospective comparative clinical study.The purpose of this study was to study the safety and effectiveness of TURP used for large-volume BPH, in comparison with TURP used for small/medium-volume BPH.Methods:Enrol all the BPH patients with the first surgery treatment in our center from January 2013 to March 2014(195 patients in total), and divide them into 2 groups by the volume of prostate: 79 cases in Group A(large-volume prostate group,≥80ml),116 cases in Group B(small/medium-volume prostate group,<80ml).Analyze the clinical data includint age, American society of anesthesiology(ASA) score, prostate-specific antigen(PSA), postvoid residual urine volume(PVR), international prostate symptom score(IPSS), quality of life(Qo L),maximum urinary flow rate(Qmax) and complications etc., record the operation time,the weight of resected prostate tissue in surgery, the hemoglobin(Hb) decrease after the surgery, the serum sodium concentration reduction after the surgery, catheterization time, length of stay(LOS), and use the modified Clavien classification system(CCS) to record and rate the perioperative complications in detail. Follow up the patients 3 months, 6 months and 12 months after the surgery, indicator index including IPSS, QOL, Qmax and PVR, and record adverse events including urinary tract infection, urethral stricture, bladder neck contracture, urinary incontinence and retrograde ejaculation.Result:According to the preoperative clinical data of both groups, Qmax was significantly lower in Group A than that of Group B(P<0.01), PSA was much higher in Group A than that of group B(P<0.01); no other significant statistical difference found in preoperative clinical data. All the patients in both groups were successfully operated; patients of Group A had longer operative time, more intraoperative removal of tissue, more postoperative Hb reduction(P<0.01). There is no statistical significance in the comparison of the serum sodium concentration reduction after the surgery, the CCS score of perioperative complications, catheterization time and LOS(P>0.05). 75 cases of Group A and 112 cases of Group B finished the follow-up after 12 months; the Qmax of both groups increased evidently(Group A: from 6.0±3.3ml/s to 17.8±5.0ml/s, Group B: from 7.5±3.2ml/s to 15.6±5.3ml/s, P<0. 01), IPSS scores in both groups reduced significantly(Group A: from 24.0±7.0 to 4.7±3.1,P<0.01), Group B: from 23.0±6.0 to 5.6±3.7,P<0.01). In the following-up after 12 months, the IPSS, QOL, PRV and complication occurrence rate of both groups showed no statistical significance(P>0.05)while the Qmax of Group A was significantly higher than that of Group B(P<0.01).Conclusion:After 12 months of follow-up, we can conclude that TURP for large-volume BPH patients compared with that for small/medium-volume BPH patients is also safe and effective, with small surgical trauma and rapid postoperative recovery, and is worthwhile to promote in hospitals with clinical application experiences of TURP. |
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