Comparative Study On The Three Minimally Invasive Methods Of Benign Prostatic Hyperplasia

BackgroundBenign prostatic hyperplasia(benign prostatic,hyperplasia,BPH)is a common disease in older men over the age of 50,the incidence rate is over 50%.over the age of 80,the incidence rate up to 90%.BPH is a common cause of bladder outlet obstruction,dysuria and urine road obstruction symptoms(lower urinary tract symptoms,LUTS),resulting in the damage of kidney and bladder,become one of the important diseases affecting middle-aged men,s health.The treatment of BPH includes drug treatment,surgical treatment,minimally invasive treatment,but there is certain limitation.As for open prostatectomy for trauma has high risk of complications and other shortcomings,the traditional surgical treatment have been gradually abandoned.In current,many safe and effective minimally invasive surgical methods are more and more get widely used such as transurethral plasma cutting operation TUPKRP ? the urethral selectivity green laser vaporization PVP?prostatic artery embolization PAE etc.in clinical practice.The recent clinical effect and operation situation this paper summarizes the study 70 patients with TUPKRP,PVP and PAE are three ways to treat BPH,parallel comparative analysis.ObjectiveAnalysis of Third Affiliated Hospital of Xinxiang Medical College from September 2013 to September 2015 in the Affiliated Hospital of Xinxiang Medical University,70 cases of surgical treatment of BPH patients(30 cases of PVP,30 cases of TUPKRP,10 cases of PAE data).Summary and recorded before and after operation of International Prostate Symptom Score(IPSS)before and after score of quality of life(QOL),the average operative time,intraoperative blood loss,postoperative average bladder flushing time,postoperative residual urine volume,maximum urine rate,complications,postoperative length of hospital stay.The statistical analysis of the above data,the safety and clinical efficacy of the three methods,choose a suitable for their own best way to provide the basis for surgical treatment of patients.MethodsIn this study,the clinical data comes from September 2013 to September 2015 in the 70 Affiliated Hospital of Xinxiang Medical University underwent surgical treatment of BPH patients(30 cases of PVP,30 cases TUPKRP,10 cases of PAE data).The operation was proficient in PVP,TURP and PAE of the professor and try to reduce the difference caused by the factors.Preoperative were transrectal refers to the examination(DRE),ultrasound examination,urine flow rate determination(except for acute urinary retention),International Prostate Symptom Score(IPSS),quality of life(QOL),residual urine(PVR)and serum prostate specific antigen(prostate-specific antigen(PSA)examination in the diagnosis of BPH.Observe and record the index operation.The average operation time,intraoperative bleeding,postoperative average bladder washing time,postoperative indwelling catheter time,residual urine volume,maximum diuresis rate,complications,preoperative and postoperative International Prostate Symptom Score(IPSS)before and after score of quality of life(QOL),postoperative length of hospital stay.The statistical analysis of the above data,the safety and efficacy of three methods are compared.Results1.Comparison of the general situation and the weight of the prostate was no significant difference between three groups(P > 0.05).2.Operation time: the average time of PVP group was 66.7±11.7min,and the TUPKRP group was longer than the PAE group.The difference between the three groups was statistically significant(P<0.05);the amount of bleeding during operation: PVP group(42.2±8.4)ml less than TUPKRP group(112.6±22.7)ml,while the PAE group had minimal bleeding.There was significant difference between the three groups(P<0.05).3.The postoperative bladder irrigation time: PVP group(24.7±2.3)h less than TUPKRP group(41.6±3.4)h,the difference between the two groups compared with statistical significance(P < 0.05)and PAE group without postoperative bladder irrigation;indwelling catheter time: PVP group(4.2±0.8)d less than TUPKRP group(5±0.9 d),the difference is statistically significant(P < 0.05);postoperative hospitalization time: PVP group(7.2±0.7)d less than TUPKRP group(8.4±1.0 d),the difference between the two groups compared with statistical significance(P < 0.05).4.Patients were followed up for 3 months.TUPKRP IPSS,QOL,Qmax and PVR were(6.1±1.6),(2.2±1.4),(18.5±3.1)ml / s,(22.6±8.1)ml,PVP group respectively(5.4±2.0),(1.7±1.5),(19.7±3.3)ml / s,(23.8±7.9 ml).PAE group were(13.4±1.2)?(2.6±0.4)?(18.6±1.9)ml/s?(48.8±10.6)ml.The three groups of patients with IPSS,QOL,Qmax and PVR were significantly improved compared with preoperative P<0.05),but there was no significant difference between the three groups(P>0.05).5.TUPKRP group of 2 patients with bleeding greater postoperative patients after treated by blood transfusion,postoperative follow-up inquiry found that there were 1 cases of secondary hemorrhage.Dysuria,postoperative temporary urinary incontinence and urethral stricture were 1 cases,2 cases,2 cases.The postoperative complications were more than the other two groups.PVP group of postoperative dysuria,temporary urinary incontinence and urethral stricture cases were l cases,1 cases,0 cases.The PAE group had 2 patients with postoperative lower abdominal and perineal pain mild discomfort(tolerance),1 patients had temporary hematuria(recovery day after operation).Dysuria,postoperative temporary urinary incontinence and urethral stricture were 2 cases,0 cases,0 cases.Conclusions1.Three kinds of operation mode can significantly improve patients with symptoms of lower urinary tract obstruction is effective in treating BPH minimally invasive surgery.2.Although after transurethral resection of the prostate of green laser selective vaporization surgery for a long time,but more TUPKRP is has the advantages of simple operation,less bleeding,high safety,postoperative indwelling catheter time and hospitalization time is short,quick recovery and other advantages,is a treatment of BPH is safe and minimally invasive surgery.3.Interventional treatment of shorter operative time,shorter hospitalization time,suitable for near surgery patients,is a supplement of endoscopic surgery.