Transurethral Plasmakinetic Enucleation Of Prostate Research Articles

Progressive pre-disconnection of urethral mucosal flap during transurethral plasmakinetic enucleation of prostate improves postoperative urinary continence.

To investigate the effect of progressive pre-disconnection of urethral mucosal flap during transurethral plasmakinetic enucleation of prostate (TUPEP) on early recovery of urinary continence. Clinical data of patients with benign prostatic hyperplasia (BPH) admitted in Zhujiang Hospital of Southern Medical University during February and May 2022 were collected. All the patients underwent TUPEP, and the progressive pre-disconnection of urethral mucosal flap was performed in the procedure. The total operation time, enucleation time, postoperative bladder irrigation time and catheter indwelling time were recorded. Urinary continence was evaluated 24 h, 1 week, and 1, 3, 6 months after the removal of urinary catheter. All surgeries were successfully completed at one time with less intraoperative bleeding, and there were no complications such as rectal injury, bladder injury or perforation of prostate capsule. The total operation time was (62.2±6.5) min, the enucleation time was (42.8±5.2) min, the postoperative hemoglobin decrease by (9.5±4.5) g/L, the postoperative bladder irrigation time was (7.9±1.4) h, and the postoperative catheter indwelling time was 10.0 (9.2, 11.4) h. Only 2 patients (3.6%) had transient urinary incontinence within 24 h after catheter removal. No urinary incontinence occurred at 1 week, and 1, 3, 6 months after operation, and no safety pad was needed. The Qmax at 1 month after operation was 22.3 (20.6, 24.4) mL/s, international prostate symptom scores were 8.0 (7.0, 9.0), 5.0 (4.0, 6.0) and 4.0 (3.0, 4.0) at 1, 3 and 6 months after surgery, and quality of life scores at 1, 3 and 6 months after surgery were 3.0 (2.0, 3.0), 2.0 (1.0, 2.0) and 1.0 (1.0, 2.0), all of these indicators were better than those before surgery (all P<0.01). In the treatment of BPH, the application of progressive pre-disconnection of urethral mucosal flap in TUPEP can completely remove the hyperplastic glands and promote early recovery of postoperative urinary continence with less perioperative bleeding and decreased surgical complications.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

AB016. Transurethral PlasmaKinetic enucleation of prostate versus transurethral PlasmaKinetic resection of prostate for benign prostate hyperplasia

BackgroundTo compare the efficacy and safety of transurethral PlasmaKinetic enucleation of prostate (PKEP) versus transurethral PlasmaKinetic resection of prostate (PKRP) for benign prostate hyperplasia.MethodsThe Prospective and randomized controlled trials (RCTs) pertaining to PKEP and PKRP for benign prostate hyperplasia were retrieved from PubMed, Wanfang and so on. The level of trials was assessed by using Cochrane system.ResultsCompared with PKRP, the time of operation shorten 10.17 min, the time of catheterization and hospital stay shorten 22.30 h, 1.33 d respectively. The volume of intraoperative bleeding decreased 47.34 mL. The quantity of resectable prostate increase 10.76 g, difference is statistically significant (P<0.05). Compared with PKRP, the international prostate symptom score (IPSS) was lower after 3 months, the quality of life (QOL) and residual urine volume (RUV) was lower after 6 months, the maximum floe rate (Qmax) was higher after 3 and 6 months, difference is statistically significant (P<0.05). No significant differences were found in IPSS, QOL, Qmax, RUV, international index of erectile function 5 (IIEF-5) between PKRP and PKEP after 1 and 2 years. The incidence of transfusion and capsular perforation was lower than PKRP, but the incidence of postoperative Transient urinary incontinence was higher than PKRP.ConclusionsCompared with PKRP, PKEP cause less blood loss and requires a shorter operation time, a shorter catheterization time and a shorter hospital stay. It resects the proliferated prostate more cleanly with lower incidence of capsular perforation, but the incidence of postoperative transient urinary incontinence was higher. The short-term efficacy of PKEP was better than PKRP, but no significant differences were found in long-term efficacy and the postoperation influence of sex function between PKEP and PKRP.

膀胱冲洗液温度控制对改良前列腺剜切术后患者康复的影响

目的：探讨和比较不同温度冲洗液对膀胱冲洗的效果，从护理角度分析影响“低压灌注下经尿道四区分割法等离子体前列腺剜切术(four-area division transurethral plasmakinetic enucleation of prostate, FPKEP)”后发生膀胱痉挛和出血的相关因素。方法：对2011年6月~2013年6月间行剜切术的119例患者进行随机分组，实验组60例，对照组59例。实验组给予接近人体生理体温(35℃ ± 2℃)的冲洗液，对照组给予室温(22℃ ± 2℃)的冲洗液，分别进行膀胱冲洗，观察记录两组患者术后膀胱冲洗时间、冲洗液量、膀胱痉挛发生次数、出血情况、留置尿管时间、住院天数以及护理满意度。结果：实验组膀胱冲洗时间、冲洗液量、膀胱痉挛发生次数、出血情况、留置尿管时间以及住院天数均低于对照组，而患者满意度实验组高于对照组，P Objective: To evaluate the influence of rinse solution at different temperatures on bladder spasm and bleeding after the four-area division plasmakinetic enucleation of prostate under low-pres- sure perfusion. Methods: The 119 patients who underwent enucleation from June 2011 to 2013 were randomly assigned to receive irrigating solution at physiological temperature (35℃ ± 2℃) of 60 cases or to receive irrigating solution at room temperature (22℃ ± 2℃) of 59 cases. The indices, such as washing time, volume of the solution, convulsion, bleeding, indwelling catheter time, HOD, and nursing satisfaction were observed and recorded in both groups of patients. Results: The treatment parameters and adverse reactions of experimental group were lower than those of con-trol group, while patient satisfaction was much higher when compared with that of control group. The difference was statistically significant (p < 0.05). Conclusion: The temperature of irrigating fluid has a direct effect on postoperative bladder spasm and bleeding. Using irrigating solution at physiological temperature could obviously reduce complications and improve the clinical efficacy and patient satisfaction.

A prospective study of transurethral resection of prostate and transurethral enucleation of prostate for benign prostatic hyperplasia according to different weights of prostate

Objective To compare the clinical effect of transurethral plasma kinetic enucleation of prostate (TPKEP) and transurethral resection of prostat (TURP) for benign prostatic hyperplasia (BPH) according to different weights of prostate.Methods 245 cases of BPH were divided into two groups randomly.122 cases underwent TURP and 123 cases underwent TPKEP.All cases were divided into three subgroups:67 cases in ＜40 g group,96 cases in 40-70 g group and 82 cases in ＞70 g group,according to different weights of prostate.Perioperative parameters and short-term outcomes between two groups were compared.Results In the ＜40 g subgroup there was no significant difference between two groups in perioperative factors and short-term outcomes (P＞0.05).In the 40-70 g subgroup,tissue resected by TPKEP was significantly more than that by TURP (30.2± 13.1 g versus 30.2± 13.1 g,P＜0.05).The intraoperative blood loss was less in TPKEP group than that in TURP group (70.1±10.4 ml versus 81.3±11.3 ml,P＜0.05).The decline of prostate specific antigen (PSA) was more dramatically in TPKEP group than that in TURP group after 3 months (2.6±0.3 μg/L versus 2.1±0.6 pg/L,P＜0.05).In the ＞70 g subgroup,the decline of PSA level was (3.4±0.3) μg/L after 3 months in TPKEP group,more than (2.3±0.7) μg/L in TURP group (P＜0.05).The increase of Qmax after 3 months in TPKEP group was (18.6±3.5) ml/s,more than (16.6±3.4) ml/s in TURP group (P＜0.05).There was no significant difference between the two groups in international prostate symptoms score and residual urine volume (P＞0.05).The transfusion rate for TPKEP (3 ca-ses) were lower than that for TURP (12 cases) (P＜0.05),but the incidence of false incontinence for TPKEP (17 cases) were higher than that for TURP (6 cases) (P＜0.05).Conclusions Compared with TURP,TPKEP resect the entire prostate with the advantages of less blood loss and more effective for a large prostate.TPKEP had no advantage for small prostate,and the medical results are equivalencies in prostate with medium size. Key words: Transurethral plasma kinetic enucleation of prostate; Transurethral resection of prostate; Prostatic hyperplasia; Prospective studies

Comparison of Fluid Absorption between Transurethral Enucleation and Transurethral Resection for Benign Prostate Hyperplasia

Introduction: Although transurethral resection of prostate (TURP) remains the reference standard for benign prostate hyperplasia (BPH), the concern about complications promotes researchers to develop alternative surgical methods with fewer complications. In this study, we compared the safety and efficacy between the transurethral plasma kinetic enucleation of prostate (TUPKEP) and transurethral plasma kinetic resection of prostate (TUPKRP), mainly including absorption of irrigation fluid, the operation time, the weight of prostate tissue removed and severe complications. Methods: Sixty BPH patients were randomly and evenly assigned to the TUPKEP or TUPKRP group. The irrigation fluid used in both groups was 1% ethanol-containing saline solution. The ethanol concentrations in the subjects' end expiration were measured during operation. The volume of irrigation fluid absorbed was calculated accordingly. Results: No significant difference was found in operation time between two groups, whereas the weight of prostate tissue resection was significantly higher in the TUPKEP than that in the TUPKRP group. Conclusion: The study provides evidence for the safety, feasibility and effectiveness of both bipolar transurethral techniques. Further, compared to the TUPKRP group, the TUPKEP group has more efficient for resection of prostatic hyperplasia tissue, even though in terms of fluid absorption, no difference has been found in both groups. Ethanol monitoring is simple, safe and effective, which is beneficial for enhancing safety procedures.

The efficacy of transurethral plasmakinetic enucleation of prostate plus suprapabic lithotomy for elder patients with benign prostatic hyperplasia and multiple bladder stones

Objective To explore the efficacy of transurethral plasmakinetic enucleation of prostate in combination with suprapabic lithotomy for elder patients with benign prostatic hyperplasia and multiple bladder stones. Methods Transurethral plasmakinetic enucleation of prostate in combination with suprapabic lithotomy was performed on 13 elder patients with benign prostatic hyperplasia and multiple bladder stones. Results All the patients received active postoperative treatment for complications. After their general health status became better, transurethral plasmakinetic enucleation of prostate was performed prior to suprapabic lithotomy. All the patients safely spent the perioperative period and had normal postoperative urination and no incision infection. Conclusions Transurethral plasmakinetic enucleation of prostate plus suprapabic lithotomy for benign prostatic hyperplasia and multiple bladder stones is simple and effective, has smaller incisions and shorter surgical duration, and is worth popularizing. Key words: Transurethral plasmakinetic enucleation of prostate ; Benign prostatic hyperplasia; Multiple bladder stones