Okamura Kikuo, Nojiri Yoshikatsu, Seki Narihito, Arai Yoichi, Matsuda Tadashi, Hattori Ryohei, Hasegawa Tomonori, Naito Seiji
Division of Urology, Department of Surgery and Intensive Care, National Center for Geriatrics and Gerontology, Obu, AichiDepartment of Urology, Graduate School of Medical Sciences, Kyushu University, FukuokaDepartment of Urology, Graduate School of Medicine, Tohoku University, Sendai, MiyagiDepartment of Urology and Andrology, Kansai Medical University, Hirakata, OsakaDepartment of Urology, Nagoya University Graduate School of Medicine, Nagoya, AichiDepartment of Public Health, Toho University School of Medicine, Tokyo, Japan.
Int J Urol. 2011 Apr;18(4):304-10. doi: 10.1111/j.1442-2042.2010.02712.x. Epub 2011 Jan 30.
Various types of minimally invasive surgical treatments, including transurethral resection of prostate (TURP), are being carried out in Japan for patients with benign prostatic hyperplasia (BPH). The aim of the present study was to elucidate the current status of perioperative care for these treatments by carrying out a nationwide survey.
Assisted by the Japanese Endourology and ESWL Association, perioperative data from 157 institutions participating in this survey were collected and analyzed.
This survey included 3918 patients undergoing TURP, 242 TUR in saline (TURis), 638 holmium laser enucleation of the prostate (HoLEP), 90 holmium laser ablation (HoLAP) and 241 photoselective vaporization (PVP). Mean operative time was shorter in TURP (71 min) and longer in HoLEP (127). Although no transfusions were required in cases undergoing HoLAP or PVP, blood was frequently transfused in those undergoing TURis (25.6%), TURP (10.2%) and HoLEP (7.8%), and the difference was significant. During the hospital stay, the incidence of TUR-syndrome, postoperative bleeding requiring bladder irrigation, acute urinary retention/difficulty on micturition and pad use at discharge was highest in TURP (2.3%), TURis (7.9%), HoLAP (16.7%) and HoLEP (15.1%), respectively. Two patients undergoing TURP died (0.05%). The shortest mean postoperative hospital stay was for PVP (1.6 days, even if the readmission rate within 90 days was the highest in this same group; 6.2%). Perioperative care during hospital stay varied among the five types of procedures.
This survey provides useful documentation on the current status of minimally invasive treatments for BPH in Japan. Complication rates for TURP are not significantly higher as compared with other procedures. Thus, TURP can still be considered as the gold standard for BPH treatment.
在日本，针对良性前列腺增生（BPH）患者开展了包括经尿道前列腺电切术（TURP）在内的各种类型的微创手术治疗。本研究的目的是通过全国性调查阐明这些治疗围手术期护理的现状。
在日本腔内泌尿外科和体外冲击波碎石术协会的协助下，收集并分析了参与本次调查的157家机构的围手术期数据。
本次调查包括3918例行TURP的患者、242例行生理盐水冲洗下经尿道前列腺切除术（TURis）的患者、638例行钬激光前列腺剜除术（HoLEP）的患者、90例行钬激光消融术（HoLAP）的患者以及241例行光选择性汽化术（PVP）的患者。TURP的平均手术时间较短（71分钟），而HoLEP的平均手术时间较长（127分钟）。虽然接受HoLAP或PVP的患者无需输血，但接受TURis（25.6%）、TURP（10.2%）和HoLEP（7.8%）的患者经常需要输血，差异具有统计学意义。住院期间，TUR综合征、术后需要膀胱冲洗的出血、急性尿潴留/排尿困难以及出院时使用尿垫的发生率在TURP（2.3%）、TURis（7.9%）、HoLAP（16.7%）和HoLEP（15.1%）中分别最高。2例行TURP的患者死亡（0.05%）。平均术后住院时间最短的是PVP（1.6天，即使该组90天内的再入院率最高，为6.2%）。住院期间的围手术期护理在这五种手术类型中各不相同。
本次调查提供了关于日本BPH微创治疗现状的有用资料。与其他手术相比，TURP的并发症发生率并没有显著更高。因此，TURP仍可被视为BPH治疗的金标准。
