A Clinical Study Of Laparoscopicpreserving Urethral Enucleation Of The Prostate

Objective:To investigate the clinical effects and safety of laparoscopic Madigan prostatectomy in the treatment of benign prostatic hyperplasia（BPH）,and to provide the basis for the clinical selection of minimally invasive surgical treatment of BPH.Methods:The clinical data of 103 patients with BPH who underwent surgery in our hospital from September 2019 to January 2021 were analyzed retrospectively.According to the surgical methods,32 cases of laparoscopic Madigan prostatectomy were divided into group A and 71 cases of TURP were divided into group B.The clinicopathological data,the incidence of complications and the follow-up data from 1 to12 months after the operation of the two groups were collected.The data were compared and statistically analyzed to evaluate the efficacy and safety of the two surgical methods in the treatment of BPH.Results:There was no significant difference in operation time between group A（95.7±28.4 min vs.93.6±31.2 min）and group B（P>0.05）;Postoperative hemoglobin decline（13.8±8.4 g/L vs.17.6±7.9 g/L）,catheter indwelling time（1.5±1.8 d vs.4.9±1.6d）,bladder irrigation time（1.1±0.9 d vs.3.4±0.8 d）was significantly better than group B（P<0.05）.During the follow-up,IPSS,Qo L and Q_max of the two groups were significantly improved at 1,3,6,and 12 months after the operation（P<0.05）,and there was no significant difference between the two groups（P>0.05）.There was no significant difference in IIEF-5 between the two groups before operation and 3,6,and 12 months after operation（P>0.05）,but the incidence of retrograde ejaculation in group A（0%vs.25.4%）was significantly lower than that in group B group（P<0.05）.Postoperative complications in the two groups included:transfusion（Clavien-Dindo II）,urinary tract infection（Clavien-Dindo I）,intestinal obstruction（Clavien-Dindo II）,transient urinary incontinence（Clavien-Dindo I）,urethral stricture（Clavien-DindoⅢ-a）,bladder neck contracture（Clavien-DindoⅢ-a）,retrograde ejaculation（Clavien-DindoⅠ）,and no complication above Clavien-DindoⅣoccurred in the two groups.The total incidence of complications in group A（4/32 12.50%vs.37/71 52.11%）was significantly lower than that in group B（P<0.05）.Conclusion:Laparoscopic Madigan prostatectomy is a safe and feasible approach for BPH,and may have the advantages of greater gland removal,less blood loss,shorter bladder irrigation time,and preservation of ejaculation function,but it still needs to be further confirmed by large-scale prospective studies.