The Effects Of Dynamic Angle Lithotomy Position In Transurethral Plasma Resection Of Severe Prostatic Hyperplasia

ObjectiveTo evaluate the feasibility and safety of dynamic angle lithotomy position in transurethral plasma resection of severe prostatic hyperplasia.MethodsFrom July 2017 to June 2019,the patients with severe prostatic hyperplasia in the urology department of Lianyungang Hospital of traditional Chinese medicine were enrolled and randomly divided into the control group and the experimental group.The patients in the control group were placed in lithotomy position during the operation,while in the experimental group,the position of the operating table was adjusted dynamically according to the needs of the operation.Patient was placed in the Trendelenburg's lithotomy position(20° with the horizontal)when doctors operating the prostate tissue at 5-7 o'clock scale and the prostate tissue around the tip of the caruncle.Patient was placed in dorsal elevated lithotomy position(20° with the horizontal)when doctors operating the prostate tissue from the 10-2 o'clock scale of the bladder neck to the near end of the sphincter.Baseline data,the volume of tissue resected,the rate of tissue resected,the time of operation,the amount of bleeding during operation,the change of vital signs,the comfort degree during the operation,the time of bladder washing after operation,the time of indwelling catheter,the days of hospitalization after operation,as well as the international prostate symptoms score,the maximum flow rate of urine,postvoid residual urine volume,postoperative bleeding and complications were compared.Results64 patients with severe prostatic hyperplasia were enrolled,32 patients in each group.Among them,1 patient in the experimental group withdrew from the hospital due to other diseases,1 patient in the control group lost follow-up after operation,reoperation of 1 patient with postoperative massive hemorrhage.A total of 61 patients completed the study,31 in the experimental group and 30 in the control group.There was no significant difference in baseline data between two groups(P>0.05).The volume of tissue resected,the rate of tissue resected,the time of operation,the amount of bleeding during operation were significantly between two groups(P<0.01).There was no difference in SBP,DBP,HR,SpO2,R and the comfort degree during the operation between two groups(P>0.05).There was no prostatic capsule perforation,water poisoning and massive bleeding occurred in two groups.The time of bladder washing and indwelling catheter in the experimental group was significantly shorter than that the control group(P>0.05).There was no difference in the days of hospitalization between two groups(P>0.05).In the control group,5 patients had massive hemorrhage within 24 hours.Bleeding stopped in 4 patients after conservative treatment,and PKRP was implemented in 1 patient due to the large amount of bleeding and the presence of blood clots in the bladder.There was no dysuria,no urinary retention or incontinence occurred in two groups.All patients were followed up for one month after operation.The IPSS score,PVR and Qmax were all significantly different between the two groups before and after operation(P<0.01),but there was no difference between two groups(P>0.05).During the follow-up,intermittent hemorrhage with blood clot during the urination occurred in 3 patients in the control group.No complications such as urinary incontinence,urinary retention and urethral stricture were found in two groups.ConclusionWhen using dynamic angle lithotomy position,transurethral plasma prostatectomy for the treatment of severe prostatic hyperplasia is conducive to shorten the operation time,increase the volume of tissue resected and the rate of tissue resected,and reduce the risk of bleeding during the operation,the patient's vital signs are stable.