Al-Hammouri Firas, Abu-Qamar Adnan
Prince Hussein Bin Abdullah Urology Center, King Hussein Medical Center, Amman, Jordan.
J Pak Med Assoc. 2011 Jul;61(7):628-31.
To evaluate and review our experience in management of patients with big size prostate using monopolar transurethral resection of the prostate (TURP).
Between January 2005 and March 2010, TURP was performed on 198 patients with prostate size between 80 and 120 grams. The patients were subjected to standard urologic pre-operative evaluation and they were given 5 alpha reductase inhibitor for two weeks before surgery. TURP was performed using 27F continuous-flow resectoscope, Otis urethrotomy and suction cystostomy were done, and 500 ml normal saline with 20mg furosomide was given intraoperatively. Catheterization time, hospital stay, peri-operative and late complications were recorded. All patients were seen at 6 weeks and 6 months post surgery in the outpatient clinic. Symptoms and complications were evaluated and histopathological diagnoses were recorded.
The mean age was 67 +/- 3.7 years (range 57-80 years). Of these, 102 patients presented with retention and obstructive uropathy, 36 with recurrent haematuria, 12 with urinary bladder stones, 11 with recurrent urinary tract infection and 37 patients with moderate to severe international prostate symptom score (IPSS) and not responding to medical treatment. The mean prostate volume was 88 +/- 8.22 grams (range 80-120 grams) with an average residual urine of 160 ml (range 20-1500 ml). The mean Qmax was 6.8 +/- 1.7 ml/sec (range 2.1-11.7 ml/sec) and the mean IPSS score was 20.2 +/- 6.2 (range 15-30). The average operative time was 72 +/- 6.2 minutes (range 58-92 minutes). The mean drop in haemoglobin was 3.2 +/- 0.6 mg/dl (range 2.1-6.1 mg/dl) and immediate post-operative mean sodium drop was 3 +/- 1.36 mmol/l (range 0.9-13 mmol/l). Blood transfusion was needed in 17 patients (8.6%), two patients developed TURP syndrome (1%), and clot retention occurred in two patients (1%). The average time of hospital stay was 2.3 +/- 0.25 days, catheterization time was 48-72 hours, and re-catheterization was needed in three patients (1.5%). The mean IPSS score six weeks after surgery was 9.9 +/- 1.7 (range 6-21) and the mean Qmax was 18.1 +/- 2.1 ml/sec (range 6-22). Urethral stricture and bladder neck contracture occurred in 12 and 3 patients respectively (6 and 1.5%). Completion TURP was needed in four patients (2%).
Standard monopolar TURP with some modification in resection technique in addition to perioperative care will allow the urologist to treat benign prostate hyperplasia with prostate size between 80-120 grams successfully in centers where new laser technology is not available.
评估并回顾我们使用单极经尿道前列腺切除术（TURP）治疗大体积前列腺患者的经验。
2005年1月至2010年3月期间，对198例前列腺体积在80至120克之间的患者进行了TURP手术。患者接受了标准的泌尿外科术前评估，并在手术前两周给予5α还原酶抑制剂。使用27F连续冲洗式电切镜进行TURP手术，同时进行奥蒂斯尿道切开术和膀胱造瘘术，并在术中给予含20mg呋塞米的500ml生理盐水。记录导尿时间、住院时间、围手术期及远期并发症。所有患者在术后6周和6个月在门诊复诊。评估症状和并发症，并记录组织病理学诊断结果。
患者平均年龄为67±3.7岁（范围57 - 80岁）。其中，102例患者表现为尿潴留和梗阻性尿路病，36例为复发性血尿，12例为膀胱结石，11例为复发性尿路感染，37例患者国际前列腺症状评分（IPSS）为中度至重度且药物治疗无效。平均前列腺体积为88±8.22克（范围80 - 120克），平均残余尿量为160ml（范围20 - 1500ml）。平均最大尿流率（Qmax）为6.8±1.7ml/秒（范围2.1 - 11.7ml/秒），平均IPSS评分为20.2±6.2（范围15 - 30）。平均手术时间为72±6.2分钟（范围58 - 92分钟）。血红蛋白平均下降3.2±0.6mg/dl（范围2.1 - 6.1mg/dl），术后即刻血钠平均下降3±1.36mmol/l（范围0.9 - 13mmol/l）。17例患者（8.6%）需要输血，2例患者发生TURP综合征（1%），2例患者出现血块残留（1%）。平均住院时间为2.3±0.25天，导尿时间为48 - 72小时，3例患者（1.5%）需要再次导尿。术后6周平均IPSS评分为9.9±1.7（范围6 - 21），平均Qmax为18.1±2.1ml/秒（范围6 - 22）。分别有12例（6%）和3例（1.5%）患者发生尿道狭窄和膀胱颈挛缩。4例患者（2%）需要行二次TURP手术。
在没有新型激光技术的中心，除围手术期护理外，对切除技术进行一些改进的标准单极TURP可使泌尿外科医生成功治疗前列腺体积在80 - 120克之间的良性前列腺增生患者。
