Objective To determine whether antibiotic prophylaxis can reduce the risk of postoperative bacteriuria in men undergoing transurethral resection of prostate (TURP) who have sterile preoperative urine. Method MEDLINE, EMBASE and Cochrane Library were searched for RCTs comparing antibiotic prophylaxis and placebo/blank controls for men undergoing TURP with preoperative sterile urine. The search strategy was established according to the Cochrane Prostatic Diseases and Urologic Cancers Group search strategy. Data was extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Fifty three relevant trials were searched, of which 27 trials were included and 26 were excluded. Antibiotic prophylaxis significantly decreased the rate of post-TURP bacteriuria.The pooled relative risk (RR) and 95% confidence interval were 0.36 (0.28, 0.46). Conclusions Prophylactic antibiotics could significantly decrease the incidence of post-TURP bacteriuria. Further comparative RCTs and cost-effective should be performed analysis to establish the optimal antibiotic regimes for the benefit of patients undergoing TURP.
【摘要】 目的 探讨经尿道等离子双极电切术（PKRP）治疗前列腺增生的安全性及临床疗效。 方法 2009年2-12月，采用PKRP治疗前列腺增生患者76例，记录手术时间、手术疗效及术后并发症。 结果 患者手术时间35～130 min，平均55 min。术中失血60～150 mL，均未输血。手术切除前列腺质量18～72 g。无直肠和膀胱穿孔，无电切综合征（TURS）及闭孔神经反射发生，无一例发生真性尿失禁，无死亡。术后随访2～6个月，IPSS评分平均为9分，最大尿流率平均为16.7 mL/s。 结论 PKRP是治疗前列腺增生的理想方法之一。【Abstract】 Objective To evaluate the efficacy of transurethral plasmakinetic resection of the prostate (PKRP) on benign prostatic hyperplasia. Methods A total of 76 patients with benign prostatic hyperplasia from February to December 2009 were treated with PKRP. The operative duration, therapeutic effect and postoperative complications were observed and recorded. Results The operative duration ranged from 35 to 130 minutes (average 55 minutes).The intraoperative blood loss was 60-150 mL, and no one needed transfusion.The prostate gland excised weight was 18-72 g. There were no intestinal and bladder perforation, no transurethral resection syndrome (TURS) or obturator nerve reflex occurs, and no urinary incontinence or death.IPSS score was nine and the maximal average uroflow was 16.7 mL/s during the 2-6 month follow-up. Conclusion PKRP is one of the ideal methods treating benign prostatic hyperplasia, especially for high-risk patients with benign prostatic hyperplasia.
目的 比较经尿道前列腺剜除术（TUEP）与经尿道前列腺电切术（TURP）的疗效。 方法 2010年11月－2011年3月，收治前列腺增生（BPH）患者58例，分别采用TUEP（30例）、TURP（28例）治疗。患者年龄55～87岁，平均73岁；病程1～12年，平均5年。术前常规行直肠指检前列腺光滑无结节；经直肠前列腺彩色超声多普勒检查，测得前列腺体积为50～80 mL，平均62 mL；血清前列腺特异性抗原＜10 ng/mL。 结果 TUEP组术中出血量、术后冲洗时间均短于TURP，切除前列腺组织体积大于TURP组，差异均有统计学意义（P＜0.05）。术后拔除尿管后发生暂时性尿失禁TUEP组1例，TURP组发生2例，两组比较差异无统计学意义；两组均无永久性尿失禁发生。 结论 TUEP与TURP相比较，TUEP手术疗效好，出血少、恢复快，且并发症少。
ObjectiesTo investigate the impact of family nursing intervention on the quality of life in postoperative patients with benign prostatic hyperplasia (BPH). MethodsIn total, 60 consecutive patients who underwent BPH surgeries between December 2012 and January 2014 were enrolled and randomly assigned to receive either timely outpatient follow-ups and routine rechecks (control group) or nursing intervention of telephone call follow-ups and family visits by professional nurses (intervention group). Quality of life was assessed by international prostate symptom score (IPSS) and generic quality of life inventory-74 (GQOLI-74), and was compared before and after intervention between the two groups. ResultsThere were no statistically significant differences in GQOLI-74 scores of all dimensions at discharge between the intervention group and the control group (P>0.05). However, six months after discharge, GQOLI-74 scores of all dimensions were significantly different between the two groups (P<0.05), and were also significantly different from the scores at discharge in both groups (P<0.05). At discharge, IPSS scores were not significantly different between the two groups (P>0.05). Six months after discharge, IPSS scores of the intervention group (6.33±1.03) and the control group (7.83±0.94) were significantly different (P<0.05), and were also significantly different from the scores at discharge in the intervention group (7.93±1.31) and the control group (8.10±1.06) (P<0.05). Three patients in the control group (10.0%) were admitted into the hospital again due to bleeding, while there was no bleeding case in the intervention group. No such complications as urethrostenosis or urinary incontinence occurred in both groups. Conclusion Family nursing intervention improves effectively the quality of life in postoperative patients after surgeries for benign prostatic hyperplasia.
Objective To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Methods We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2. Result We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (Pgt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group. Conclusion The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.
摘要:目的:探讨良性前列腺增生经尿道前列腺电切术围手术期的护理经验。方法:回顾性分析96例良性前列腺增生患者临床资料。结果:96例患者手术顺利,围手术期经周密的护理,疗效满意,无明显并发症。结论:周密的手术期护理对经尿道前列腺电切术治疗老年良性前列腺增生十分重要。Abstract: Objective: To investigate the perioperative nursing care of transurethral prostatic resection (TURP). Methods: The data of 96 TURP cases were analyzed retrospectively. Results: All the operations were performed successfully, and there were no obvious complications among the patients with precise nursing care. Conclusion: It is very important for precise nursing care to the patients who underwent TURP.
目的:评价爱普列特（Epristeride）联合高特灵（Hytrin）治疗良性前列腺增生（BPH）的安全性、有效性。方法:48例诊断为BPH的患者，年龄50～80岁，平均（65±9.20）岁。给予高特灵5 mg，1次/每晚，共3月；爱普列特片5 mg，2次/天口服，共6月。观察治疗前后国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、前列腺体积（V）及膀胱残余尿量（Ru）的变化。结果:45例完成观察，服药3月后，除前列腺体积外，其他指标均有明显改善；6月后，各项指标均明显改善。治疗过程中未发现明显不良反应。结论:爱普列特片与高特灵联用治疗BPH安全、有效。
Objective To objectively evaluate the efficacy and safety of plasmakinetic enucleation for prostate (PKEP) vs plasmakinetic resection for prostate (PKRP) in treating benign prostate hyperplasia (BPH). Methods Such databases as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from their establishment to March 2011 for collecting the randomized controlled trials (RCTs) about PKEP vs PKRP for the treatment of BPH, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction conducted by two reviewers independently, meta-analyses were performed by using the RevMan 5.1 software. The level of evidence was assessed by using the GRADE system. Results Eight studies involving 991 patients were included. The results of meta-analyses showed that: a) safety indicator: compared with the PKRP, PKEP had shorter operation time (SMD=1.07, 95%CI 0.19 to 1.94, P=0.02), less intraoperative bleeding (SMD=2.06, 95%CI 1.42 to 2.69, Plt;0.01), much quantity of resectable prostate (SMD= –0.91, 95%CI –1.33 to –0.48, Plt;0.000 1), less intraoperative perforation (RR=4.48, 95%CI 1.43 to 14.02, P=0.01), shorter catheterization time (SMD=1.98, 95%CI 0.39 to 3.57, P=0.01), shorter bladder irrigation time (SMD=3.49, 95%CI 0.51 to 6.47, P=0.02) and shorter hospital stay (SMD=0.89, 95%CI 0.64 to 1.13, Plt;0.01), but there was no significant difference in total postoperative complications (RR=0.82, 95%CI 0.54 to 1.24, P=0.35); and b) efficacy indicator: compared with the PKRP, the International Prostate Symptom Score (IPSS) was lower after 3 months, the Quality Of Life (QOL) was higher after 3 months, and the improvement of residual urine volume (RUV) was better after 6 months; but other efficacy indicators had no significant difference between the two groups (Pgt;0.05). Based on GRADE system, all the evidence was at level C and weak recommendation (2C). Conclusion The current evidence indicates that PKEP is similar to PKRP in the treating effect, but it resects the proliferated prostate more cleanly with shorter operation time, lesser bleeding and more safety than PKRP; for the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are need.
ObjectiveTo assess the methodological and reporting quality of systematic reviews/Meta-analyses (SRs/MAs) of transurethral procedure for benign prostatic hyperplasia (BPH). MethodWe electronically searched databases including PubMed, The Cochrane Library (Issue 12, 2014), Sciverse, CNKI, VIP and WanFang Data from inception to December 2014 to collect SRs/MAs of transurethral procedure about BPH. Two reviewers independently screened literature and assessed the methodological and reporting quality of included SRs/MAs by AMSTAR and PRISMA checklists. ResultsA total of 33 SRs/MAs were included. The results of qualitative analysis showed that:the main methodological weakness of included SRs/MAs included the lack of protocol, disappropriate conclusion formulation, the lack of publication bias assessment, and the lack of stating the conflict of interest. The average score of AMSTAR scale was 6.27±2.14. There were 11 items in PRISMA checklist with coincidence rate over 80%, 8 items between 50% to 80%, and 8 items less than 50%. ConclusionThe methodological and reporting quality of SR/MA of transurethral procedure for BHP is low, and that may decrease the reliability and value of results from SRs/MAs in the field. Future SRs/MAs should strictly follow the related reporting guidelines in order to improve the methodological and reporting quality, so as to provide more reliable evidence for clinical decision.
【摘要】 目的 探讨采用不同方法经尿道前列腺等离子双极电切术（plasmakinetic resection of prostate，PKRP）的方法及疗效。 方法 2008年7月-2009年12月，应用不同方法行PKRP治疗156例前列腺增生。患者年龄59~87岁，平均74岁。病程20 d~18年。前列腺重量22~100 g，平均38 g。采用单纯顺行电切法治疗38例，部分剜除分割切除法治疗76例，完全剜除法治疗42例。 结果 156例手术均获成功，手术时间平均90 min。获得前列腺组织12~87 g，平均35 g。术后留置导尿管平均5.5 d，住院时间平均6.5 d。术后组织病理学诊断为良性前列腺增生152例，前列腺癌4例。拔除尿管后均能自主排尿，部分患者术后有尿道刺激症状；术后1个月内出现尿道外口狭窄3例，经尿道扩张治愈。随访时间1~12个月，平均6个月。短期尿失禁3例，时间分别为1周、1个月及3个月；无长期尿失禁。术后3个月国际前列腺症状评分（IPSS）症状评分平均减少24分，生活质量评分平均减少3分。 结论 PKRP安全、有效、并发症少，可针对患者情况采用不同切割方法，效果更佳。【Abstract】 Objective To explore the effects and methods of transurethral plasmakinetic resection of prostate(PKRP). Methods A total of 156 patients with prostatic hyperplasia were treated with various methods of transurethral PKRP from July 2008 to December 2009. Patient’s age ranged from 59 to 87 years,74 years on average. The disease duration was 20 days to 18 years.Method one:anterograde resection in 38 patients; method two:partition retrograde enucleation in 76 patients; method three:completely retrograde enucleation in 42 patients. Results All of the swgeries were successful. The mean duration of the operation was 90 minutes.The collected prostatic specimens were 12-87 g,35 g on average. The mean catheter remaining dwation was 5.5 days.The mean postoperative hospital stay was 6.5 days. Conclusions PKRP is safe and effective. It is effective with various methods of transurethral plasmakinetic resection of prostate.