| Objective:By comparing the different operation timing for the treatment of medium size of hospitalized patients with BPH index(operation time, bleeding volume, resection of the prostate weight, bladder irrigation time, indwelling catheter time, hospital stay) and postoperative indexes(IPSS, QOL, Qmax, prostate volume). Three months after operation respectively in two groups of patients with compensated group(divided into two groups of directing operation and drug therapy before the operation) and the two groups of patients with decompensated group(divided into two groups of directing operation and drug therapy before the operation) were followed up, compare the index of IPSS, QOL, Qmax and prostate volume. Discuss the best treatment for moderate volume and timing of surgery in patients with BPH.Methods:Using a prospective controlled study, from December 2012 to October 2014 during the medium size of BPH patients in the Department of Urology of Affiliated Hospital of Yan’an University for treatment of 140 cases, the age ranged from 52 to 81(65.3±15.9), the course of disease was 1 to 13(5.2±2.9) years, ultrasound clew of bladder wall changes(abnormal morphology, rough, thickening and small room trabecular formation) and residual urine volume forming. According to the operation before whether to accept more than three months of drug therapy were divided into two groups(A, B), 70 cases in each group, compared two groups of patients hospitalized index(operation time, bleeding volume, resection of the prostate weight, bladder irrigation time, indwelling catheter time, hospital stay) and postoperative indexes(IPSS, QOL, Qmax, prostate volume). Bladder compensatory basis will be divided into two groups(A, B): direct compensation during the operation and drug therapy before operation group; decompensated immediate operation and drug therapy before operation group. After three months, the two groups of patients were followed up respectively for the compensation period and the period of the decompensation, compared IPSS, QOL, Qmax, prostate volume index, evaluate its clinical efficacy. Drug treatment given oral Finasteride(10mg/d) and Tamsulosin(0.2mg/d), treatment for three months or more. All patients were undergoing operation of the Transurethral resection of the prostate(TURP).Results:Operation in two groups(A, B) compared to the situation: operation time(48.4±10.5) min, amount of bleeding during operation(71.1±19.8)ml, bladder irrigation time(2.2±0.5)d, indwelling catheter time(3.1±1.2)d, postoperative hospital stay(5.0±1.3)d of the patients in the group B(Drug treatment for 3 months after the operation group) were compared with the operation time(65.7±11.8) min, amount of bleeding during operation(106.7±18.3)ml, bladder irrigation time(3.9±0.3)d, indwelling catheter time(5.2±1.8)d, postoperative hospital stay(7.9±1.0)d of the patients in the group A(Non drug therapy of direct operation group) respectively(P<0.01, respectively). And the two groups of patients with resection of the prostate weight was(22.6±9.8)g and(20.1±7.6)g, there were no significant difference(P>0.05).Two groups(A, B) of patients in the postoperative three months observation index comparison, the IPSS respectively(15.2±4.3) and(9.8±3.7)points, QOL respectively( 2.7±1.2) and(1.7 ±1.3)points, Qmax respectively(11.8±2.9) ml/s and(15.1±3.1)ml/s, prostate volume respectively(27.2±8.2)cm3 and(16.3±3.4)cm3, the difference has statistical significance(P < 0.05).Three months after operation, moderate volume BPH patients were in the compensatory phase, non drug therapy of direct operation group and drug treatment before the operation group of IPSS, QOL, Qmax, prostate volume were(12.7±4.1) and(7.8±3.3) points,(2.8±1.4) and(1.5±1.5) points,(12.0±2.8) and(15.2±3.4) ml/s,(18.9±7.8) and(12.7±6.3) cm3, each index of two groups were compared and the difference had statistical significance(P<0.05); And in decompensated period: non drug treatment directly operation group and drug treatment before the operation group of the IPSS, QOL, Qmax, prostate volume were(15.9±4.4) and(16.1±3.8) points,(2.6±1.1) and(2.4±1.3) points,(11.2±3.7) and(11.8±4.0) ml/s,(21.3±9.4) and(20.6±8.5) cm3, each index of two groups were compared and the differences were not statistically significant(P>0.05).Conclusion:1. When the front wall of the bladder does not change shape or less residual urine volume, it is recommended to drug treatment, drug treatment ineffective reoperation;When the bladder wall morphology has changed, and residual urine volume is higher, surgery may be considered directly.2. Morphological changes of the bladder wall may also be used as the timing of surgery in patients with moderate volume BPH indications.3. TURP front line combination therapy three months or more, can significantly improve BPH patients with moderate volume surgery cases, reduce postoperative bleeding, early catheter removal, shorter hospital stay, thus contributing to the rehabilitation of patients. |
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