Nnabugwu I I, Ugwumba F O, Udeh E I, Ozoemena O F
Department of Surgery, College of Medicine, University of Enugu Campus, Enugu State, Nigeria.
Niger J Clin Pract. 2017 Dec;20(12):1590-1595. doi: 10.4103/njcp.njcp_70_17.
Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource-poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource-poor settings where the traditional master-apprentice (Halstedian) approach has remained the prevalent training technique.
We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software.
Twenty patients' files for TURP and twenty-eight patients' files for ORP met the inclusion criteria. Patients in the 2 treatment arms were similar in age (P = 0.22), body mass index (P = 0.45), proportion of prostate tissue extirpated (P = 0.38), and International Prostate Symptom Score 12-month postprocedure (P = 0.06). However, larger prostates were treated with ORP (P < 0.0005). The correlation of the weight of resected specimen to preoperative prostate volume (PV) (r = 0.78; P < 0.001) was similar to that of enucleated specimen to preoperative PV (r = 0.89; P < 0.001). Similarly, the proportion of extirpated specimen correlated positively with the preoperative PVs for both TURP (r = 0.23; P = 0.33) and ORP (r = 0.292; P = 0.13), with no evidence of any difference between the 2 correlation values (P = 0.84).
With appropriate patient selection, especially as a newly trained Surgeon, resections in TURP are as complete as enucleations in ORP.
由于缺乏必要的设备和技能，在资源匮乏地区，良性前列腺增生（BPE）手术管理中的微创手术应用有限。据观察，在资源匮乏地区，包括经尿道前列腺切除术（TURP）在内的泌尿外科内镜教学可能具有挑战性，在这些地区，传统的师徒（霍尔斯特德式）方法仍然是主要的培训技术。
在这项回顾性研究中，我们旨在通过比较经尿道前列腺切除术（TURP）切除的前列腺组织比例与耻骨后开放性前列腺切除术（ORP）摘除的比例，评估TURP切除的完整性。我们纳入了在接受TURP的霍尔斯特德式培训后的前18个月内接受尿道导管治疗的所有BPE患者。使用SPSS® 20和VassarStats®在线软件进行分析。
20例TURP患者档案和28例ORP患者档案符合纳入标准。两个治疗组的患者在年龄（P = 0.22）、体重指数（P = 0.45）、切除的前列腺组织比例（P = 0.38）和术后12个月的国际前列腺症状评分（P = 0.06）方面相似。然而，较大的前列腺采用ORP治疗（P < 0.0005）。切除标本重量与术前前列腺体积（PV）的相关性（r = 0.78；P < 0.001）与摘除标本与术前PV的相关性（r = 0.89；P < 0.001）相似。同样，切除标本的比例与TURP（r = 0.23；P = 0.33）和ORP（r = 0.292；P = 0.13）的术前PV均呈正相关，且两个相关值之间无差异证据（P = 0.84）。
通过适当的患者选择，尤其是对于新培训的外科医生，TURP的切除与ORP的摘除一样完整。
