Transurethral Plasmakinetic Enucleation 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.

Transurethral plasmakinetic resection versus enucleation for benign prostatic hyperplasia: comparison of intraoperative safety profiles based on endoscopic surgical monitoring system

ObjectiveTo compare the intraoperative safety profiles of transurethral plasmakinetic resection of the prostate (PK-TURP) with transurethral plasmakinetic endoscopic enucleation of the prostate (PK-EEP) in the treatment of benign prostatic hyperplasia (BPH) based on endoscopic surgical monitoring system (ESMS).MethodsA total of 128 patients who were diagnosed with BPH were stratified based on prostate volume (PV) and accepted PK-EEP or PK-TURP treatment at 1:1 ratio. The ESMS as a novel method was used to monitor blood loss and fluid absorption during the operation. Clinical parameters such as intraoperative blood loss volume, fluid absorption volume, operation time, tissue weight of resection, preoperative and postoperative red blood cell count (RBC), hemoglobin concentration (HB), hematocrit (HCT), electrolyte, postoperative bladder irrigation time, indwelling catheter time, hospital stay time and other associated complications were documented and compared between two groups.ResultsNo significant differences in majority of baseline characteristics were observed among patients with different prostate volumes between two surgical methods. For patients with prostate volume < 40 ml, the average operation time of patients who received PK-EEP treatment was much more than those who received PK-TURP (P = 0.003). On the other hand, for patients with prostate volume > 40 ml, the PK-TURP surgery was associated with a significant increase in intraoperative blood loss (P = 0.021, in PV 40–80 ml group; P = 0.014, in PV > 80 ml group), fluid absorption (P = 0.011, in PV 40–80 ml group; P = 0.006, in PV > 80 ml group) and postoperative bladder irrigation time as well as indwelling catheter time but decrease in resected tissue weight compared to the PK-EEP treatment.ConclusionThe ESMS plays an important role in comparison of intraoperative safety profiles between PK-TURP and PK-EEP. Our data suggest that PK-TURP treatment is associated with a decreased operation time in patients with prostate volume < 40 ml and the PK-EEP treatment is associated with decreased intraoperative blood loss, fluid absorption and increased tissue resection for patients with prostate volume > 40 ml. Our results indicate that the size of prostate should be considered when choosing the right operation method.

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.

Immediate Transurethral Plasma Kinetic Enucleation of the Prostate Gland for Treatment of Benign Prostatic Hyperplasia-Associated Massive Hemorrhage: A Single-Center Experience.

Purpose: Benign prostatic hyperplasia-associated massive hemorrhage is a urological emergency. We evaluated the outcome from immediate transurethral plasma kinetic enucleation of the prostate gland (i-TUPKEP) for BHM treatment.Methods: We retrospectively analyzed the records of 49 patients with acute BMH who underwent i-TUPKEP between January 2014 and November 2018 at our institution. The hemostatic effect, International Prostate Symptom Score (IPSS), and quality of life (QoL) score were evaluated preoperatively as well as 3, 6, and 12 months postoperatively. Postoperative follow-up also included measurement of the peak flow rate (Qmax) and post-void residual urine volume (PVR). Clinical characteristics, weight of resected tissue, duration of bladder irrigation, duration of hospital stay, complications, as well as the time required for enucleation and resection, were recorded.Results: BMH causes were attributed to transurethral surgery (17/49, 34.7%), violent catheterization (13/49, 26.5%), cystoscopy (10/49, 20.4%), and urethral dilatation (9/49, 18.4%). Bleeding was from different sites of prostate-gland tissues during i-TURKEP. i-TUPKEP-controlled BMH effectively induced immediate, notable, and lasting improvements in the IPSS and QoL score. Qmax was close to normal, and the PVR was within the physiological range, postoperatively. Long-term complications were not observed.Conclusion: Our preliminary data suggest that i-TUPKEP is a feasible method for controlling BHM and relieving BPH symptoms.

Research on Applications of Transurethral Plasmakinetic Enucleation of the Prostate in Elderly Patients Aged ≥80 Years.

Objective: To evaluate the safety and efficacy of transurethral plasmakinetic enucleation of the prostate (PKERP) vs. transurethral resection of the prostate (TURP) in elderly patients aged ≥80 years with benign prostate hyperplasia.Materials and Methods: We conducted a retrospective analysis of the PKERP (n = 123) and TURP (n = 143) in patients aged ≥80 years at urology department of The Third Xiangya Hospital of Central South University from January 2016 to October 2019. Then the preoperative, intraoperative, and postoperative data of different indicators were compared between the two groups. The follow-up was done at 3 months, 1 year after surgical treatment.Results: No significant differences were observed between the two groups for the baseline characteristics, including age, prostate volume, prostate-specific antigen (PSA) level, concurrent disease, maximum urinary flow rate (MFR), international prostate symptoms score (IPSS), and quality of life (QoL) score. The operative time, hemoglobin decrease, and postoperative flushing time were significantly lower in the PKERP group compared with the TURP group. However, no significant differences were observed between both groups for postoperative hospital stay, incidence of transurethral resection syndrome (TURS), prostatic capsular perforation, and genuine urinary incontinence. The follow-up results showed that the MFR of the PKERP group was significantly higher than the TURP group at 1 year after surgery.Conclusion: Compared with TURP, PKERP is a safe and efficacious method for treating patients aged ≥80 years with benign prostate hyperplasia, and it may improve long-term urination symptoms.

Evaluation of efficacy and safety of improved transurethral plasma kinetic enucleation of the prostate in high-risk patients with benign prostatic hyperplasia and coronary artery disease.

ObjectiveThis prospective study aimed to evaluate the safety of improved transurethral plasma kinetic enucleation of the prostate (iTUPKEP) in the perioperative period in high-risk patients with benign prostatic hyperplasia (BPH) and coronary artery disease.MethodsPatients with BPH underwent surgical treatment with transurethral vapour resection of the prostate (TUVP) or iTUPKEP. Serum endothelin-1, cardiac troponin-I, and high-sensitivity C-reactive protein concentrations were evaluated in the short term after surgery. The postvoid residual urine volume, maximum urinary flow rate, international prostate symptom score, and quality of life indicators were evaluated in the long term after surgery.ResultsEndothelin-1 concentrations were lower in the iTUPKEP group than in the TUVP group at 1 and 2 days postoperatively. The iTUPKEP group had lower cardiac troponin-I and high-sensitivity C-reactive protein concentrations at all time points postoperatively. The postvoid residual urine volume, international prostate symptom score, and quality of life values were lower, but the maximum urinary flow rate was higher, in the iTUPKEP group than in the TUVP group.ConclusionsThe iTUPKEP procedure has a smaller effect on vascular endothelial function compared with TUVP. Therefore, iTUPKEP may reduce the incidence of postoperative cardiovascular adverse events in high-risk patients with BPH and coronary artery disease.

Application of Two New Feature Fusion Networks to Improve Real-time Prostate Capsula Detection.

Excess prostate tissue is trimmed near the prostate capsula boundary during transurethral plasma kinetic enucleation of prostate (PKEP) and transurethral bipolar plasmakinetic resection of prostate (PKRP) surgeries. If a large portion of the tissue is removed, a prostate capsula perforation can potentially occur. As such, real-time accurate prostate capsula (PC) detection is critical for the prevention of these perforations. This study investigated the potential for using image denoising, image dimension reduction and feature fusion to improve real-time prostate capsula detection with two objectives. First, this paper mainly studied feature selection and input dimension reduction. Secondly, image denoising was evaluated, as it is of paramount importance to transient stability assessment based on neural networks. Two new feature fusion techniques, maxpooling bilinear interpolation single-shot multibox detector (PBSSD) and bilinear interpolation single shot multibox detector (BSSD) were proposed. Before original images were sent to the neural network, they were processed by principal component analysis (PCA) and adaptive median filter (AMF) for dimension reduction and image denoising. The results showed that the application of PCA and AMF with PBSSD increased the mean average precision (mAP) for prostate capsula images by 8.55% and reached 80.15%, compared with single shot multibox detector (SSD) alone. Application of PCA with BSSD increased the mAP for prostate capsula images by 4.6% compared with SSD alone. Compared with other methods, ours were proven to be more accurate for real-time prostate capsula detection. The improved mAP results suggest that the proposed approaches are powerful tools for improving SSD networks.

Bipolar transurethral enucleation of the prostate combined with open cystolithotomy in the treatment of large and giant prostate with bladder stones: Case series.

The surgical management of large or giant prostate still has challenges to urologists, especially if combined with bladder stones, and the traditional techniques by open prostatectomy and cystolithotomy have significant morbidity rates. The endoscopic procedure might not be feasible to treat both conditions in a single procedure, despite advances in surgical techniques and instrumentation, we present a one-session procedure by a combined endoscopic and open approach for treating benign prostatic hyperplasia (BPH) larger than 100 g combined with bladder stones in the elderly patient with other comorbidities. Between May 2017 and January 2020, bipolar transurethral plasma kinetic enucleation of the prostate (TUEP) followed by open cystolithotomy was performed to six patients at our institution, three of them combined with a big bladder stone(s). All the patients have other chronic chest and heart diseases; we retrospectively collected the data. All the patients diagnosed as BPH of big size or giant prostate over 100 g, with bladder stone, and all the patients treated with the same procedure. We founded that the combination methods showed a significant effect in terms of surgery time, patient outcomes and recovery, hospital discharge. The mean age of patients was 78.16 ± 4.2 (73-84) years, and the mean prostate-specific antigen (PSA) value was 16.27 ± 10.01 (8.32-32.17) ng/mL. The mean size of the prostate measured by MRI/US was 266.16 ± 89.1 (169-405) mL. The mean total operation time was 70.5 ± 10.9 (60-90) min, while the mean enucleation time was 28.38 ± 6.61 (23-40) min. The mean intraoperative blood loss was 193.33 ± 19.66 (170-220) mL. The mean resected prostate weight was 217.166 ± 94.67 (117-365) g. The mean post-operative hospital stay was 2.6 ± 0.81 (2-4) days. One patient was readmitted 2 months later due to urinary tract infection, and one patient complains of urine incontinence who spontaneously subsided in 4 months after surgery, other that no severe postoperative complications observed, a significant reduction of serum PSA and IPSS recorded at 3 months, postoperatively. Although simple open prostatectomy remains the reference standard for the treatment. Of excessively large or giant prostatic hyperplasia, the combination procedure not only facilitates the management of selected cases of hyperplasia but further imparts significant benefits to patients and surgeons alike. This treatment plan is safe, time-consuming, and could revolutionize future treatment approaches to giant prostate.

Transurethral enucleation of the prostate combined with laparoscopic bladder diverticulectomy

Objective We present a one-session procedure for treating bladder diverticula combined with benign prostatic hyperplasia (BPH). Material and methods Between January 2015 and April 2019, transurethral plasmakinetic enucleation of the prostate (TUEP) followed by laparoscopic bladder diverticulectomy (LD) were performed in 12 patients at our institution, in four of them combined with bladder stone(s) and in one patient combined with diverticular tumor. Clinical data were retrospectively collected. Results The mean size of the prostate was 137.3 ± 96.3 (65.5–403.3) ml. The mean maximal diameter of the diverticulum was 8.0 ± 2.7 (3.2–12.0) cm. The mean total operation time was 214.2 ± 69.0 (120–300) min, and the mean enucleation time was 23.2 ± 6.4 (12–35) min. The mean intraoperative blood loss was 52.1 ± 14.9 (30–80) ml. The average pre- and post-operative maximum flow rate was 5.1 ± 1.4 (2.4–8.5) ml/s and 12.8 ± 2.3 (9.6–17.1) ml/s. Except for urinary infection in one patient, no other severe peri- or postoperative complications were observed. Conclusions TUEP accompanied by LD in one session provides an effective and minimally invasive surgical treatment for bladder diverticula combined with BPH, with or without bladder stones, and permits reasonable operation time and rapid discharge.

Predictors Of Postoperative Lower Urinary Tract Symptoms Improvements In Patient With Small-Volume Prostate And Bladder Outlet Obstruction.

ObjectiveTo explore the factors associated with improvement of lower urinary tract symptoms (LUTS) after transurethral plasmakinetic enucleation of the prostate (PKEP) and transurethral resection of the prostate (TURP) in patients with a small-volume prostate and bladder outlet obstruction (BOO).MethodsThe clinicopathologic data of 257 patients with BOO and a small-volume prostate from January 2013 to January 2018 were retrospectively collected preoperatively, 3 months postoperatively, and 12 months postoperatively. Patients were divided into postoperative success and failure groups based on the IPSS, IPSS-v, and IPSS-s. The relationship between each parameter and the improvement of postoperative LUTS was analyzed. Subgroup analysis was performed to compare the differences between the TURP and PKEP groups.ResultsAmong patients followed up for 3 months postoperatively, multivariate analysis demonstrated that IPP, PUA, and post-PCB were significant predictors of postoperative IPSS improvement; TZI, IPP, and PUA were significant predictors of postoperative IPSS-v improvement; post-PCB and the surgical procedure were significant predictors of IPSS-s improvement; and IPP and PUA were significant predictors of postoperative Qmax improvement. Among patients followed up for 12 months postoperatively, multivariate analysis revealed that IPP, PUA, and post-PCB were significant predictors of postoperative IPSS improvement; PUA was a significant predictor of postoperative IPSS-v improvement; post-PCB was a significant predictor of IPSS-s improvement; and IPP and PUA were significant predictors of postoperative Qmax improvement. The post-PCB was significantly lower in the PKEP than the TURP group and the prostatic calculi removal rate was significantly higher in the PKEP than the TURP group.ConclusionPatients with a greater preoperative IPP and PUA and smaller post-PCB showed greater improvement of postoperative LUTS. PKEP might help to remove calculi from between the transitional and peripheral zones of prostate. Compared with conventional TURP, PKEP may improve the early postoperative storage symptoms of LUTS in patients with a small-volume prostate and BOO.

Influence of prostate size on the perioperative and postoperative outcome of transurethral plasmakinetic enucleation of the prostate: Results of 892 patients with 3 years of follow-up

To explore the influence of prostate size on the outcome of Plasmakinetic enucleation of the prostate (PkEP) for the treatment of benign prostate hyperplasia (BPH), The data of 892 patients with symptomatic BPH who underwent PkEP were retrospectively reviewed. Among them, 199 (22.31%) had the prostate size smaller than 40 g (Group 1), 409 (45.85%) between 40 and 79 g (Group 2), 197 (22.09%) between 80 and 120 g (Group 3), and 87 (9.75%) larger than 120 g (Group 4). Perioperative variables, perioperative and postoperative complications were recorded. Patients were followed up for 36 months postoperatively. The efficiency of the surgery increased as the prostate size increased. Greater decreases in hemoglobin were noted in groups with larger prostates, while the duration of catheterization after the operation was similar across all groups. During the 3-year follow-up, the postoperative improvement in International Prostate Symptom Score (IPSS), Quality of Life (QOL), maximal flow rate (Qmax) and post-void residual urine volume (PVR), as well as longterm complications including urethral stricture and bladder-neck contracture were comparable across the 4 groups. These findings revealed that PkEP is more efficient for large prostate and can treat all prostates regardless of the size with equivalent symptom relief and micturition improvement.

Transurethral plasmakinetic enucleation of prostate and suprapubic small cut in the treatment of patients with moderate and severe benign prostatic hyperplasia and multiple bladder stones

Objective To discuss the safety and efficiency of transurethral plasmakinetic enucleation of prostate and suprapubic small cut in the treatment of patients with moderate and severe benign prostatic hyperplasia and multiple bladder stones. Methods A total of 18 patients with moderate and severe benign prostatic hyperplasia and multiple bladder stones underwent plasmakinetic enucleation. Enucleation of the prostate was pushed into the bladder. We made a small suprapubic incision (3~4 cm) to remove prostate tissue and bladder stones completely. Results All operations of the 18 patients were successful. The weight of prostate tissue was 65~256 g, with an average of 87.6 g. Bladder stones were 3~21, with an average of 6.3. The mean operative time of prostate enucleation was 20~40 min. The time of removing the gland and bladder stones was 15~30 min. The volume of blood loss during operation was 50~100 mL. The postoperative time of wash the bladder continuously was 24~28 hours. The urethral catheters were removed after 4~5 days. Temporary incontinence occurred in one patient, but it disappeared after mention anal training 5 days later. All the 18 cases were followed up from 2 to 34 months, with an average of 19.8 months. There was no blood and all had good urination. International Prostate Symptom Scores (IPSS) one month after operation decreased from 25.6 to 7.4. The mean volume of Qmax increased from 6.3 mL/s before operation to postoperative 17.6 mL/s. Conclusions Transurethral plasmakinetic enucleation of prostate and suprapubic small cut in the treatment of patients with moderate and severe benign prostatic hyperplasia and multi-ple bladder stones is safe and effective. With simple operation and fewer complications, it should be applied more widely for patients. Key words: Prostatic Hyperplasia; Urinary Bladder Calculi; Prostatectomy

Evaluation of the Learning Curve for Transurethral Plasmakinetic Enucleation and Resection of Prostate Using a Mentor-based Approach.

ABSTRACTObjective To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP) prospectively.Materials and Methods Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA). Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist.Results The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002). The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (p<0.01). The senior urologist had a mean operative efficiency and enucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month’s parameter compared with preoperative values (p<0.001).Conclusions PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results.

Bipolar Plasmakinetic Enucleoresection of the Prostate: Our Experience with 245 Patients for 3 Years of Follow-Up.

The aim of this study was to evaluate the safety, feasibility, and effectiveness of bipolar transurethral plasmakinetic enucleation of the prostate (PKEP). Between January 2010 and October 2013, 245 patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent transurethral enucleation of prostate using bipolar plasma vaporization energy. Patients were evaluated preoperatively by full detailed history, routine preoperative investigation digital rectal examination, serum prostate-specific antigen, abdominal and transrectal ultrasonography, and maximum flow rates (Qmax). Patients' ages ranged from 50 to 81 (65.5 ± 6) years with transrectal ultrasound-measured prostate volume of 97.1 ± 36.7 mL resulting in an operating time of 76.9 ± 27.9 minutes, and postoperative irrigation and catheterization times were 3.5 ± 3.2 and 12.7 ± 6.1 hours, respectively. No significant complication occurred intra- or postoperatively. Qmax increased from 7.1 ± 3.2 mL/second preoperative to 18.4 ± 4.2 mL/second (p < 0.001). The International Prostate Symptom Score decreased from 25 ± 6 to 7.9 ± 2.4 (p < 0.01). This study confirmed that PKEP is a safe, easy to learn, and durable technique suitable for any prostate sizes.

Technical aspects of transurethral plasmakinetic enucleation and resection of the prostate for benign prostatic hyperplasia

TUERP, which is based on TURP, technically has been proven to be safe and effective with reduced complication rates. Due to the lack of systematic pre-clinical training, the surgery is learnt only inside the operative theatre in the majority of the Chinese medical centers. It is also known to have a steep learning curve, and very few articles have addressed the technical aspects of TUERP.Material and methods: The videos of 91 cases of bipolar transurethral enucleation and resection of the prostate, which were performed by one urological surgeon in our department from August 2013 to January 2016, were retrospectively analyzed. With an extensive review of the literature and based on the summary of our experience, detailed techniques and tips for TUERP are described.Results: The procedure is initiated from the enucleation of mid-lobe and progressed in a retrograde mode with the guide of the capsular plane. Along with the experience accumulated, the capability of landmark identifying and the surgical skills were improved.Conclusion: A steep operative learning curve may be the main obstacle to the widespread use of TUERP. Accurate identification and orientation of the landmark with good understanding of the three-dimensional structure of the prostatic fossa and the detailed technical issues of enucleating along the right capsule plane will be helpful for beginners to overcome the learning curve and gain confidence with this procedure and for experienced surgeons to further improve their surgical technique.

Curative effect of plasmakinetic enucleation of prostate in the treatment of large volume prostate

Objectives To evaluate the clinical effect of transurethral plasmakinetic enucleation of the prostate (PKEP) in treatment of large volume benign prostatic hyperplasia(BPH) (>80mL). Methods The clinical date of 80 patients with large volume BPH in the hospital from May 2012 to January 2015 were analyzed retrospectively. All patients were divided into PKEP group(n=37) and transurethral bipolar plasma kinetic prostatectomy (TUPKP group) (n=43) according to surgical ways. Perioperative indices, postoperative follow-up results of two groups were compared and ana- lysed. Results Bladder washing time (20.5 ± 6.7 )min, blood loss (120.5± 44.9 )mL, indwelling catheter time (4.4 ± 1.9)d, postoperative hospitalization (5.2 ±1.8)d in PKEP group were significantly lower than in TUPKP group and resection of the prostate weight (63.2± 21.5) g was significantly higher than TUPKP group (P 0.05). Qmax (22.4±4.7) mL/s in PKEP group was significantly higher than that in TUPKP group (19.5±4.0) mL/s (P 0.05), and the PSA values of the two groups were significantly decreased (P<0.05). The postoperative complication rate (62.16%) in the PKRP group was significantly lower than that in the TUPKP group (86.05%) and the difference was statistically significant (P<0.05). Conclusions PKEP has good clinical effect in the treatment of large volume BPH and TUPKP, it has the advantages of less bleeding, quick recovery and low complications. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate

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.