| BackgroundBenign prostatic hyperplasia(BPH)was one of the most common benign diseases among the middle-aged and elderly male population,which often caused dysuria.It was one of the most common diseases of urinary system.The main clinical symptoms of BPH included symptoms of urinary obstruction and overactive bladder.The Obstruction symptom mainly include urinary retention,urine thinning,voiding time longer,intermittent urination,urination fatigue,urge incontinence,filling urinary incontinence,urinary dribbling,endless sense.Overactive bladder symptoms included increased nocturia frequency,urgency urinary incontinence and urgency.The main clinical symptoms were lower urinary tract symptoms.Daily activities,social communication,and sleep of cases were seriously affected by these symptoms,which could cause depression and anxiety.It greatly damaged physical and mental health of cases,and the quality of life were also greatly reduced.At present,the methods used in the treatment of BPH included drug therapy,observation and treatment,and surgical treatment.BPH was a progressive disease with lower urinary tract symptoms.With the increase of the course of BPH,most patients with lower urinary tract symptoms and complications would be aggravated.The oral drug treatment was invalid at that time,and needed surgical treatment ultimately.The surgical treatment of BPH was mainly removaled excessive hyperplasia of glandular tissue.The classical surgical procedures included transurethral bipolar plasmakinetic resection of prostate(TURP),transurethral resection of the prostate(TURP),open prostatectomy.TURP was still the "gold standard'.surgical procedure for BPH.On the basis of TURP,TURP was the third generation technique and equipment for BPH.With the characteristics of precision cutting,normal saline lavage,shallow penetration and high thermal focal,TURP greatly improved the safety and efficacy.With the continuous improvement of endoscopic surgical equipment and surgical methods,the treatment of BPH was developped and improved.Liu Chunxiao,a scholar of our country,combined the advantages of open surgery and minimally invasive surgery,who was firstly developed the transurethral plasmakinetic enucleation of the prostate(TUERP).The application of TUERP in clinical practice was found to be effective,minimally invasive and safe.It combined the advantages of minimally invasive and open prostatectomy.Beside the advantages of open radical prostatectomy and no recurrence after operation,it was minimally invasive surgery to achieve less bleeding,high safety,postoperative recovery and small trauma.Now the TUERP was a major breakthrough in surgical treatment of BPH.In addition,the number of diabetes patients in China more than forty million,this disease had been a serious threat to human health.At the same time,with the increasing in the proportion of the elderly and the degree of aging in China.The incidence of diabetes mellitus and BPH increased with age.The number of elderly male patients with diabetes mellitus BPH also showed an increasing trend.Although the current treatment of diabetes was gradually improved,the clinical efficacy of BPH was also getting better and better.However,the surgical treatment of patients with diabetes mellitus with BPH technology needed to be further improved.At present,there was no correlated study between the quality of life of patients with diabetes mellitus and BPH.In this study,BPH patients with diabetes mellitus in our department were collected,who were treated by TUERP or TURP.The clinical efficacy,perioperative complications and the impact on the quality of life of the two kinds of surgery were compared analyzed.Objective to evaluate the efficacy of TUERP in minimally invasive treatment of BPH.The safety,efficacy and feasibility of TUERP were verified,so as to provide a scientific basis for further clinical application.ObjectiveTo determine the clinical efficacy,feasibility and safety of the TUERP and TURP for BPH patients with diabetes mellitus,and its effect on the quality of life of the patients.To provide theoretical basis for the selection of therapeutic methods and clinical application in BPH patients with diabetes mellitus.MethodsBPH patients with diabetes were admitted to study in our hospital from January 2015 to June 2016.According to the inclusion and exclusion criteria,cases were selected.All of cases were examined by transrectal ultrasonography and the volume of the prostate was measured.The maximum urinary flow rate(Qmax)and post void residual were measured by urodynamic study.The life quality score(QOL),the International Prostate Symptom Score(IPSS),self rating Anxiety Scale(SAS)and self rating Depression Scale(SDS)were investigated and assessed.All patients included in this study were benign prostatic hyperplasia,diagnosed of BPH with diabetes mellitus,who met the inclusion criteria.Cases were treated with either TURP or TUERP.The methods of randomized controlled,single blind trial design and randomized equalization were uses.40 patients in the observation group were treated with TUERP,and 40 patients in the control group were treated with TURP.Comparative analysis of two groups of perioperative and postoperative observation indicators.The patients were followed up for the first time in postoperative 3th month,who were followed by telephone follow-up or outpatient review.The collected data were analyzed by SPSS21.0 software,and the P<0.05 was defined as the difference between the two groups.(1)Preoperative observation indexThe data of cases was collected,including the age,course of disease,BMI,maximum urinary flow rate(Qmax),with basic diseases or not,prostate specific antigen(PSA),prostate volume(PV),post void residual(PVR),International Prostate Symptom Score(IPSS),life the quality score(QOL),self rating Anxiety Scale(SAS),self rating Depression Scale(SDS)investigation.The QOL,IPSS,SAS and SDS were investigated in all patients after admission.(2)The observation indicators during operationThe intraoperative bleeding volume,operation time,intraoperative blood transfusion and transfusion,whether the removal of the gland weight,catheter time and postoperative complications of indwelling postoperative hospitalization time,postoperative bladder washing time after operation of cases between the both groups.Whether side effects or not,including bladder and urethral injury,transurethral resection syndrome(TURS),capsular perforation,and the operation was converted to open surgery.(3)Postoperative observation indexThe postoperative hospital stay,postoperative continuous bladder irrigation time,postoperative indwelling catheter time and postoperative complications of the two groups were recorded.(4)The follow-up observationAfter postoperative third month and sixth month,the clinical efficacy was evaluated.Cases were followed up for the first time after third months.The follow-up contents including:postoperative urination,symptoms,such as frequent urination,urgency,dysuria,dysuria,hematuria and so on.The recovery of the patients after operation,and the urodynamic examination,including the detection of PVR and Qmax,and the QOL score,IPSS score,SAS and SDS.To ask the patient the presence of urine thinning,urinary incontinence,urinary endless,urine after drop,dysuria and other symptoms,and whether drug therapy or not.The objective symptoms after operation included PVR,Qmax,and postoperative complications in postoperative third months.The postoperative QOL score,IPSS score,SAS and SDS survey in 3th month were used to evaluate the subjective indicators.ResultsA total of 80 patients with diabetes mellitus were enrolled in this study.All the patients were successfully treated with BPH.No patients were converted to open surgery.(1)The preoperative observation indicators included age,BMI,course of disease,hypertension,glycosylated hemoglobin,post void residual,maximum urinary flow rate,preoperative IPSS score,QOL score,prostate volume,tPSA and so on.There was no significant difference between the two groups(P>0.05),suggested that the two groups of patients were evenly distributed,and the groups were comparable.(2)Compared with TURP,the operation time,bladder irrigation time,indwelling catheter time and hospitalization time of patients treated with TUERP were significantly shorter,bleeding was significantly less,and more the prostate gland weight,it has a statistically significant difference between the groups(P<0.05).These results suggest that TUERP could shorten the operation time,reduce intraoperative bleeding and accelerate postoperative recovery.(3)The observation indicators of all patients included:Qmax,PVR,IPSS score,QOL score questionnaire score,SAS and SDS survey.The Qmax and PVR of cases were detected,and the IPSS score and QOL score were used to evaluate the improvement of clinical symptoms and quality of life.The SAS and SDS were conducted to investigate the mental state of the patients,including anxiety and depression.Compared with preoperative,the Qmax increased obviously,PVR,IPSS and QOL score and SDS survey questionnaire score,SAS score of cases were significantly decreased in the postoperative 3 th month,the difference was statistically significant(P<0.05).By comparing the observation group and the control group at different time periods(including preoperative and postoperative 3th month and 6th month)follow-up indicators,the results showed that a statistically significant difference between the groups(P<0.05),and the indicators of the postoperative 3th month and 6th month were not statistically significant,compared with TURP,TUERP can significantly improve the postoperative urine flow rate,under the urinary tract symptoms,significantly improve the quality of life of patients,relieve anxiety and depression in patients with mood state.(4)40 cases treated by TUERP with a total of four patients with complications,the incidence of complications was 10.0%.There were one case of intraoperative capsular perforation,and three cases of postoperative urinary incontinence.TURP treatment of 40 cases of patients with a total of 13 patients with complications,the complication rate was 32.5%,including 3 cases of secondary hemorrhage,6 cases of postoperative capsular perforation,2 cases of postoperative urinary incontinence and urethral stricture in 2 cases,the observation group of patients with complication rate was significantly lower,and the capsular perforation rate in the observation group was significantly lower,the difference was statistically significant(P<0.05).It was suggested that TUERP for BPH patients with diabetes mellitus have less complications and higher safety.ConclusionThe clinical effect of TUERP and TURP on the quality of life in BPH patients with diabetes mellitus was exact.Compared with TURP,the advantages of TUERP was less trauma,faster postoperative recovery,high safety,improve postoperative voiding symptoms and quality of life,worthy of further clinical application. |
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