[Clinical observation of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia and overactive bladder].
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To evaluate clinical efficacy of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia (BPH) and overactive bladder (OAB).From May 2007 to May 2010, a total of 37 patients diagnosed BPH and OAB were treated by holmium laser enucleation of the prostate. After a mean follow-up of 4.9 months postoperatively, indices such as International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), residual urine volume and video urodynamics were monitored and statistically analyzed.The mean preoperative IPSS and QOL score were 29.6 ± 5.2 and 4.3 ± 0.9, and decreased to 4.6 ± 1.2 and 1.2 ± 1.0 postoperative. The mean Qmax was (6 ± 3) ml/s preoperative and increased to (21 ± 5) ml/s postoperative. Preoperative average residual urine volume was (167 ± 11) ml, decreased to (41 ± 18) ml after operation. During follow-up, 86.5% patients' symptoms and quality of life improved continuously, however 13.5% patients existed residual postoperative OAB symptoms.When BPH with OAB patients exist bladder outlet obstruction, bladder outlet obstruction should be relieved first then OAB symptoms can be relieved in majority of patients, but some patients have residual symptoms.Keywords:
Residual urine
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To investigate the clinical effect of transurethral resection of the prostate(TURP) combined with transurethral incision of the bladder neck( TUIBN) in the treatment of bladder outlet obstruction( BOO) caused by small-volume benign prostatic hyperplasia( BPH).We retrospectively analyzed the clinical data about 56 cases of small-volume BPH. The patients,aged 45- 71( mean 59. 6) years,all showed varied degrees of dysuria and 20 of them had a history of chronic prostatitis. Preoperative examinations included the obtainment of International Prostate Symptom Score( IPSS),evaluation of the quality of life(QOL),ultrasonography, urodynamic examination, and cystoscopy. All the patients received alpha-blockers for 3- 6 months without obvious response and therefore underwent TURP + TUIBN.Postoperative follow-up lasted 12- 24 months. Urinary tract stricture was found in 2 cases(3. 57%) at 1 month after surgery, which was improved after urethral dilation,and bladder neck contracture occurred in 1 case(1. 79%) at 3 months, which was relieved by repeated TUIBN. Compared with the baseline, the IPSS was dramatically decreased at 12 months postoperatively(25. 54 ± 2. 33 vs 12. 76 ± 2. 37,P < 0. 01),and so was the postvoid residual([68. 07 ± 17. 09]vs [31. 02 ± 9. 75] ml. P < 0. 01),while the maximum urinary flow rate(Qmax) was significantly increased([8. 47 ± 0. 96]vs [15. 83 ± 1. 47]ml/s, P < 0. 01).TURP + TUIBN is superior to either TURP or TUIBN alone in the treatment of BOO induced by small-volume BPH for its higher effectiveness and safety.
Dysuria
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Objectives: To evaluate the safety and efficacy of transurethral bipolar enucleation of the prostate due to benign prostatic hyperplasia. Methods: This is a prospective study and 37 patients undergoing Transurethral bipolar enucleation of the prostate (TUBE) for BPH will be taken for the study. Preoperative factors evaluated included International Prostate Symptom Score (IPSS), postvoid residual volume (PVR), estimated blood loss, operative time, pathologic weight, and complications. Postoperative evaluation was performed at 1month, 6 months and 12months. Results: Preoperative, 1 month, 6 months, and 12 months mean postvoid residual volumes were 235 mL, 33.6 mL, 20 mL and 20 mL; mean IPSS were 31.6, 2.97, 2.97 and 2.97; mean Q max was 5.8ml/sec, 20.23ml/sec,25.5ml/sec, and 25.5ml/sec; preoperative and post operative mean quality of life scores were 5.4 and 2.2; mean operative time was 87.5 minutes. Hemoglobin drop was 0.6g/dl, and pathologic weight was 45.45 g. 10 patients underwent partial enucleation. Early stress incontinence occurred in 9 patients (24.3%).Urinary tract infection occurred in 1 patient, and Superficial mucosal bladder injury in 1 patient. Conclusions: International Prostate Symptom Score, quality of life, Qmax, and postvoid residual volume (PVR) showed statistically significant improvements from baseline. TUBE is a safe, effective, and reproducible procedure for BPH.
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Holmium laser enucleation of the prostate (HoLEP) is a standard surgical procedure for treatment of benign prostatic hyperplasia (BPH). A low incidence of postoperative urinary incontinence in association with anteroposterior dissection HoLEP was recently reported. We evaluated 66 patients with BPH who underwent anteroposterior dissection HoLEP from March 2013 to November 2014. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, maximum flow rate (Qmax), and post-void residual urine volume (PVR) were assessed preoperatively and at 1 and 3 months after treatment. The incidence of postoperative urinary incontinence, which was defined as the requirement of more than one pad per day, was compared between the first and second half of the patient population. Postoperative urination parameters (IPSS, QOL index, Qmax, and PVR) were significantly improved. The incidence of urinary incontinence at 3 months was significantly lower in the second half (4%) than first half (28%) of the patient population (p＝0.020). In conclusion, anteroposterior dissection HoLEP is an effective procedure for the treatment of BPH and can reduce the rate of postoperative urinary incontinence, even in low-volume institutes.
Urination
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Nephrology
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In order to investigate how holmium laser enucleation of the prostate (HoLEP) improves urinary storage symptoms, we assessed blood flow in the urinary bladder mucosa of patients with benign prostatic hyperplasia (BPH) before and after laser surgery. Seventy-four consecutive patients with BPH (median age 69 years, range; 53-88) underwent HoLEP at our institution and are included in this study. We prospectively assessed the International Prostate Symptom Score (IPSS), IPSS-QOL Score, the Overactive Bladder Symptom Score (OABSS), uroflowmetry, and blood flow in the urinary bladder, before and after surgery. Blood flow in the bladder mucosa was measured using the OMEGA FLOW (OMEGAWAVE, Tokyo, Japan) laser Doppler flowmeter. The median volume of the enucleated adenomas was 45.0 g (range: 25.0 to 83.2). The median IPSS improved significantly from 20 (range: 6-35) to 3 (0-22) (p < 0.001; Wilcoxon signed-rank test), as did the storage symptoms score, which decreased from 13 (2-20) to 3 (1-8) (p < 0.001). Median bladder blood flow increased at the trigone from 9.57 ± 0.83 ml/sec to 17.60 ± 1.08 ml/sec. Multiple regression analysis for the improved storage symptom score eliminated all explanatory variables except increased bladder perfusion. The data suggest that HoLEP improves blood flow in the bladder mucosa, which independently leads to the improvement of storage symptoms.
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[Objective]To study the safety and the short-term effect of transurethral resection of the prostate 2 μm laser treatment of benign prostatic hyperplasia (BPH) with large volume.[Methods]25 cases of BPH (ranged from 80 to 100 g) were treated with 2 μm continuous wave laser vaporesection. Laser power was 70 W. Surgery in all patients before and after 3 months respectively international prostate symptom score (IPSS), maximum urinary flow rate (Qmax) and residual urine volume (RUV). Operative time, bleeding volume and electrolyte changes were recorded for patients in each group. The time after removal of catheter, bladder washing time and Length of Stay was observated.[Results]All patients were successfully completed surgery, postoperative obstruction of lower urinary tract symptoms was in varying degrees of ease. Preoperative and postoperative 3 months IPSS, Qmax and RUV had statistical difference (P 0.01). Operative time was (110±33) min, decreased hemoglobin levels was (10±7) g/L, and all without blood transfusion, meanwhile none of the patients with electrolyte disturbance, which resulted in the surgery was safe during peroperative period. The time after removal of catheter (3±0.9) d, bladder washing time (6 h) and Length of Stay (4±1.4) d was short after operation. There was no further surgery, urinary incontinence, and complications such as urethral stricture postsurgery. [Conclusion]2 μm continuous wave laser vaporesection is the treatment of BPH with large volume in an effective manner, and it can be significantly improved of symptoms of BPH patients with lower urinary tract obstruction.
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Nocturia
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Objective To investigate changes in symptoms and quality of life (QOL) score before and after transurethral resection of the prostate ( TURP), and their related factors. Methods Forty-seven elderly male patients of benign prostate hyperplasia (BPH) with lower urinary tract symptoms were enrolled in the study, with an average age of 72 years. They all were undergone with TURP and evaluated with international prostate symptoms score (IPSS), QOL score, maximal urine flow rate (Qmax), residual urine volume, pressure-urine flow rate and prostate size before and after the procedure. Changes in these parameters and their related factors were analyzed. Results No complication was observed during TURP in the 47 patients. After TURP, two patients suffered from distal urethra stricture, one from retrograde ejaculation and six from aggravated urgent incontinence, and symptoms relieved with symptomatic treatment in all of them. Significant difference in overall IPSS, irritant score and obstructive score pre- and post-operation was observed P ＜ 0.01, i. e. , 22.7 ±4.9 and 10.5 ± 5.8, 10.5 ± 5.8 and 6.3 ± 3.5, and 12.1± 3.9 and 4.2 ± 3.3, respectively. QOL score was 4.6 ± 0.9 and 2.3 ± 1.3, Qmax (5.8 ± 2.9 ) ml/s and (12.4 ±5.2) ml/s and residual urine volume (99 ± 16) ml and (34 ± 19) ml pre- and post-operation,respectively ( all P ＜ 0.01 ). Follow-up time after the procedure, prostate volume and bladder volume at urgent urination desire all correlated with post-operation IPSS ( r = 0.751, P ＜ 0.05 ), and follow-up time after the procedure and age also significant correlated with post-operation QOL score (r = 0.470, P ＜ 0.05 ).Conclusions Overall IPSS, irritant score, obstructive score and QOL score improved significantly after TURP in symptomatic BPH patients, probably by varied related factors.
Key words:
Lower urinary tract symptoms; Transurethral resection of prostate; Quality of life
Retrograde ejaculation
Urination
Urine flow rate
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Background: To assess the functional outcomes and morbidity in patients undergoing holmium laser enucleation of the prostate (HoLEP) with and without previous transurethral prostate surgery. Methods: Patients were stratified into two groups, 558 patients who underwent primary HoLEP (group I) and 50 patients who underwent ‘secondary-HoLEP’ with prior transurethral prostate surgery (group II). Results: There were no significant differences in the preoperative parameters (median age, International Prostate Symptom Score [IPSS], prostate-specific antigen [PSA], prostate volume, maximum urinary flow rate [Qmax], and postvoid residual urine volume [PVR]). No significant intraoperative differences were noted in the use of total energy, resected volume, enucleation time, resection efficiency, and mean catheterization time. There were significant improvements in Qmax, PVR, and IPSS in both groups. Complications in groups I and II included 19 (3.1%) and 1 (2.0%) bladder injuries, 25 (4.4%) and 2 (4.0%) recatheterization for transient voiding difficulty, 20 (3.5%) and 2 (4%) cases of severe hematuria requiring additional treatment, and 5 (0.8%) and 0 cases for remorcellation due to remaining adenoma. Transient incontinence was the most common complication for both groups I and II, 30 cases (5.4%) and 3 cases (6.0%) respectively. Urinary tract infection showed improvement subsequent to antibiotic treatment. During the 6 month follow-up period, urethral stricture occurred in 7 cases (1.3%) for group I and in 1 case (2.0%) for group II. Conclusion: There were no significant differences in functional outcomes and morbidity between the two groups. ‘Secondary-HoLEP’ seems to be effective and safe for patients with prior BPH surgery.
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A total of 156 elderly patients (aged ≥ 70 years) with symptomatic bladder outlet obstruction as a result of benign prostatic hyperplasia (BPH) underwent trmsurethral photoselective vaporization (PVP). Pre- or post-operative urine flow rate, residual urine volume level, International Prostate Symptom Score (IPSS), and quality of life (QOL) score were recorded. Our data showed that maximum urine flow rate and residual urine volume were improved at 1, 12, 24, and 36 months following the treatment. There was statistically significant difference in IPSS and QOL when the intervention was considered (P < 0. 05). PVP might be a treatment of choice for high-risk elderly patients with obstructive BPH.
Key words:
Prostatic hyperplasia; laser surgery
Residual urine
Urine flow rate
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