Joshi H N, De Jong I J, Karmacharya R M, Shrestha B, Shrestha R
Department of Surgery Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre.
Department of Urology, University Medical Center Groningen, Groningen, The Netherlands.
Kathmandu Univ Med J (KUMJ). 2014 Jul-Sep;12(47):163-7. doi: 10.3126/kumj.v12i3.13708.
Benign prostatic hyperplasia is a condition occurring in elderly men in which the prostate gland is enlarged, hence the condition also known as benign enlargement of prostate. Benign hyperplasia can lead to both obstructive and irritative symptoms. Transurethral resection of prostate (TURP) still remains the gold standard modality of surgical treatment of obstructive lower urinary tract symptoms due to Benign hyperplasia.
The objective of this study was to evaluate the outcomes of TURP in large prostate (>80 grams) in comparison to small prostate (<80 grams) in terms of efficacy, safety and complications.
A total of 65 cases included in this prospective study, which were operated by a single surgeon with conventional monopolar TURP using standard technique. Intra -operative and post-operative complications, pre and post- operative quality of life (QoL) and international prostate symptom score (IPSS), operative time, time to removal of catheter and hospital stay were evaluated between small and large prostate gland volumes.
Out of 65 cases, 30 were with large prostate size i.e. 80 grams or more (group 1), and 35 cases were with small prostate size than 80 grams size (group 2). Mean age was 71.8 SD ± 6.9 years in group 1 and 68.2 SD ± 12.7 years in group 2. The mean preoperative volume of prostate was 88.8 grams (range 80-115 grams) in group 1 and 40.3 (range 20-65 grams) in group 2. The mean preoperative post void residual volume of urine (PVRU) was 244 ml SD ± 190.8 ml in group 1 and 117 ml ± 70.3 ml in group 2. Mean resection time in group 1 was 110 (range 90-130) minutes and in group 2 it was 90 minutes (range 55-115) minutes. There were quite satisfactory improvements in IPSS and QoL. No significant complications were observed except TUR syndrome in 2 cases from group 2, which were managed well in postoperative period.
With meticulous resection and intra-operative haemostasis using continuous out flow resectoscope, conventional monopolar TURP is equally safe and effective in large size prostate as compare in small size.
良性前列腺增生是老年男性中出现的一种病症，其中前列腺会增大，因此该病症也被称为前列腺良性肿大。良性增生可导致梗阻性和刺激性症状。经尿道前列腺切除术（TURP）仍然是治疗因良性增生引起的梗阻性下尿路症状的手术治疗的金标准术式。
本研究的目的是比较经尿道前列腺切除术（TURP）在大前列腺（>80克）与小前列腺（<80克）患者中的疗效、安全性和并发症情况。
本前瞻性研究共纳入65例患者，均由同一外科医生采用标准技术进行传统单极TURP手术。评估了小前列腺体积组和大前列腺体积组之间的术中及术后并发症、术前和术后生活质量（QoL）及国际前列腺症状评分（IPSS）、手术时间、拔除导尿管时间和住院时间。
65例患者中，30例为大前列腺体积，即80克或更大（第1组），35例为小于80克的小前列腺体积（第2组）。第1组的平均年龄为71.8±6.9岁，第2组为68.2±12.7岁。第1组前列腺术前平均体积为88.8克（范围80 - 115克），第2组为40.3克（范围20 - 65克）。第1组术前平均排尿后残余尿量（PVRU）为244毫升±190.8毫升，第2组为117毫升±70.3毫升。第1组平均切除时间为110分钟（范围90 - 130分钟），第2组为90分钟（范围55 - 115分钟）。IPSS和QoL有相当令人满意的改善。除第2组有2例出现TUR综合征外，未观察到明显并发症，这2例在术后得到了妥善处理。
使用连续冲洗式电切镜进行细致切除和术中止血，传统单极TURP在大体积前列腺手术中与小体积前列腺手术同样安全有效。
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