Experiences in the treatment of high-risk prostatic hyperplasia by laser intracavitary extirpation with hierarchical method

doi:10.3877/cma.j.issn.1674-3253.2020.03.002

Abstract

Abstract:

Objective

To investigate and evaluate the clinical effect and safety of intracavitary laser surgery with the hierarchical technique for high-risk prostate hyperplasia patients.

Methods

The modified surgery was performed on 89 cases of high risk prostate hyperplasia patients in the Third Affiliated Hospital of Sun Yet-Sen University. All the clinical data were analyzed retrospectively, The average age of the patient was (68±3) years, the average prostate volume was (57.4 ±2.6) ml. All patients underwent laser intracavitary prostate enucleation with the hierarchical approach, which is "Look for layers, easy first, difficult later, resect and enucleate", and their intraoperative and postoperative conditions were compared.

Results

All 89 procedures were performed successfully. The maximum urine flow rate (Qmax) were improved from (6.9±2.1) ml/s to (19.8±3.6) ml/s, and the international prostate symptom score (IPSS) were significantly decreased from (24.6±1.7) to (8.0±1.2), 3 months after surgery. No patient required transfusion. Transurethral resection syndrome, rectum and bladder perforation, and ureteral injury, massive bleeding, cardiovascular and cerebrovascular accidents and other serious complications were not occurred during the operation.

Conclusion

The laser exorsion surgery with hierarchical method has unique advantages in finding the capsule level and reducing postoperative complications of high-risk prostatic hyperplasia. It is easy to grasp and may provide a new method for colleagues.

Key words: Benign prostatic hyperplasia, Lay, Anatomy, 1 470 nm Laser

Baohua Luo, Mingzhao Li, Hua Wang, Huacong Feng, Yaodong Xie, Xiaopeng Liu. Experiences in the treatment of high-risk prostatic hyperplasia by laser intracavitary extirpation with hierarchical method[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(03): 166-170.

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References 20

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伴随症状/基础疾病	例数	比例（%）
泌尿系感染	21	23.6
腹股沟疝	13	14.6
膀胱结石	19	21.3
膀胱憩室	12	13.5
肾功能不全	6	6.7
血精	2	2.2
尿道狭窄	5	5.6
高血压	23	25.8
糖尿病	17	19.1
冠心病、心功能不全	6	6.7
心律失常	4	4.5
阻塞性肺疾病	3	3.4
脑梗塞	5	5.6
长期服用抗凝药物	7	7.9
置入心脏起搏器	1	1.1

伴随症状/基础疾病	例数	比例（%）
泌尿系感染	21	23.6
腹股沟疝	13	14.6
膀胱结石	19	21.3
膀胱憩室	12	13.5
肾功能不全	6	6.7
血精	2	2.2
尿道狭窄	5	5.6
高血压	23	25.8
糖尿病	17	19.1
冠心病、心功能不全	6	6.7
心律失常	4	4.5
阻塞性肺疾病	3	3.4
脑梗塞	5	5.6
长期服用抗凝药物	7	7.9
置入心脏起搏器	1	1.1

监测项目	均值（±s）	范围
年龄（y）	68±40	56～83
前列腺体积（ml）	57±13	042～167
手术时间（min）	39.1±15.5	14～92
术后2 h Hb下降量（g/L）	5.2±1.9	03～21
膀胱冲洗时间（h）	16.8±3.20	06～36
留置尿管时间（d）	5.9±0.2	5～9
住院天数（d）	5.1±0.8	04～10

监测项目	均值（±s）	范围
年龄（y）	68±40	56～83
前列腺体积（ml）	57±13	042～167
手术时间（min）	39.1±15.5	14～92
术后2 h Hb下降量（g/L）	5.2±1.9	03～21
膀胱冲洗时间（h）	16.8±3.20	06～36
留置尿管时间（d）	5.9±0.2	5～9
住院天数（d）	5.1±0.8	04～10

指标	IPSS（分）	QOL（分）	Qmax（ml/s）	PVR（ml）
术前	24.6±1.7	4.6±0.5	06.9±2.1	113.5±12.4
术后	08.0±1.2	2.4±0.3	19.8±3.6	17.2±2.5
P值	0.003	0.013	0.002	<0.001

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