Objective To evaluate the effect of pretreatment with epristeride on decreasing intraoperative bleeding during transurethral resection of prostate (TURP) and to study its mechanism. Methods A total of 60 patients with benign prostatic hyperplasia undergoing TURP were divided into two groups: 30 patients were pretreated with epristeride 5 mg×2 daily for 7 to 11 days before TURP, and 30 patients did not receive any pretreatment. The operations for the two groups of patients were conducted by the same doctors. The operation time, the weight of resected prostatic tissue, and the volume of irrigating fluid were recorded. Blood loss, bleeding index, and bleeding intensity were calculated. Microvessel density (MVD), vascular endothelial growth factors (VEGF), and nitric oxide synthase type III (eNOS) expression were measured by the immunohistochemistry SPmethod in prostatic tissue. Results In the epristeride and control groups, the mean blood loss was 179.51±78.29 ml and 237.95±124.38 ml (Plt;0.05); the mean bleeding index was 7.68±3.94 ml/g and 9.73±3.42 ml/g (Plt;0.05); the mean bleeding intensity was 2.43±1.03 ml/min and 3.30±1.50 ml/min (Plt;0.05); the mean value of MVD was 18.80±5.68 and 23.70±4.91 (Plt;0.05); the mean rank of VEGF was 23.48 and 31.77 (Plt;0.05); and the mean rank of eNOS was 22.36 and 31.14 (Plt;0.05), respectively. Conclusion Pretreatment with epristeride decreases intraoperative bleeding during TURP. The preliminary results suggest that angiogenesis in the prostatic tissue is suppressed.
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.
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.
目的:探讨经尿道前列腺电切术(TURP)治疗高危良性前列腺增生症(BPH)的术中、术后常见并发症的原因、预防及治疗,提高手术安全性和有效性。方法: 回顾性分析62例高龄合并心肺疾患的前列腺增生症患者行经尿道前列腺电切术(TURP)的临床资料。结果: 62例排尿困难症状均改善,其中1例出现暂时性尿失禁,2月后好转,尿路感染7例,消炎治疗后好转,5例出现肉眼血尿,做对症处理后血尿消失,无输血病例,无经尿道电切综合征(TURS)发生。结论:采用TURP是良性前列腺增生症安全有效的外科治疗方法,疗效满意,并发症少,安全性高,住院时间短,费用低。
【摘要】 目的 探讨良性前列腺增生症（benign prostatic hyperplasia，BPH）应用经尿道前列腺普通电切镜剜除术（transurethral electro enucleation of the prostate，TUEP）的方法及疗效。 方法 2007年12月－2010年7月，应用TUEP治疗BPH患者201例，并根据前列腺腺体的大小及形状的不同采用不同的剜除方法以提高手术的成功率。 结果 全部患者均顺利完成手术，切除前列腺重量平均38 g，平均手术时间100 min，术后平均留置导尿管时间5~7 d，术后平均住院时间5.5 d。 结论 TUEP是治疗良性前列腺增生症的一种有效方法。【Abstract】 Objective To evaluate the therapeutic effect of transurethral enucleation of prostate on benign prostatic hyperplasisa. Methods From December 2007 to July 2010, 201 patients with benign prostatic hyperplasia underwent transurethral enucleation. According to the size and shape of the gland, different enucleation ways were used to improve the surgical success rate. Results All of the enucleations were successful. The average weight of the resected prostate was 38 grams, the mean operation duration was 100 minutes, the average days of indwelling catheter was 5-7 days, and the average hospital staying was 5.5 days. Conclusion Transurethral enucleation of prostate for benign prostatic hyperplasia is effective.
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 探讨前列腺体积＞60 mL的前列腺增生症患者的手术安全性，提高部分合并尿道狭窄前列腺增生症患者的手术实施率。 方法 2009年3月－2010年3月，行耻骨上膀胱穿刺引流下经尿道前列腺电切术（TURP）治疗前列腺增生58例。年龄54～93岁，平均72岁，病程8个月～12年，平均7.2年；前列腺体积35～128 mL，平均78 mL；国际前列腺症状评分24～35分，平均30.2分 ；最大尿流率1.2～4.8 mL/s，平均1.8 mL/s；残余尿量84～210 mL，平均160 mL。术前无尿潴留28例。 结果 58例顺利完成手术，其中2例伴包膜穿孔，9例前尿道狭窄者通过去外鞘电切镜完成手术。所有患者切除前列腺组织体积18～86 mL，平均58 mL；术中冲洗液为5%葡萄糖液，用量18 600～42 500 mL，平均23 500 mL；手术时间45～185 min，平均70 min。术后病理检查均示良性前列腺增生，术后住院时间3～8 d，平均5 d。术后患者最大尿流率为18～46 mL/s，平均32 mL/s。 结论 耻骨上膀胱穿刺引流能降低膀胱内压，减少水、糖分吸收，增加手术安全性，提高了部分合并前尿道狭窄的前列腺增生患者的手术几率。