Benign prostatic hyperplasia (BPH) surgery has developed for more than 100 years. After several major revolutions, it is still constantly innovating, which in turn has profoundly affected people’s concept and strategy for treating BPH. This paper reviews the background and process of the evolution of BPH surgery, discusses the innovative methods and rules, and looks forward to the future developmental trend, in order to provide reference for the further development of BPH surgery.

In recent years, minimally invasive surgery has been rapidly developed and has become the first choice for the treatment of moderate to severe benign prostatic hyperplasia (BPH). Although it can significantly improve the lower urinary tract symptoms, reduce complications, and enhance security, postoperative sexual dysfunction(SD) is still common, which affects the patients’ quality of life. In this paper, we discuss the incidence rate of SD after BPH surgery, the protection strategy of sexual function, and how to choose reasonable treatment from the perspective of sexual function protection.

The outcomes of surgical treatment of benign prostatic hyperplasia (BPH) has been verified as it causes few complications. However, if complications develop, they will have significant impacts on patients’ quality of life. Therefore, in order to provide individualized treatments, patients’ general condition, expectations of treatment, clinical symptoms, prostate volume, advantages and disadvantages of different operative methods and operators’ mastery of operative methods should be considered to reduce the incidence of postoperative complications such as stress incontinence, urethral stricture and bladder neck contracture. This article discusses the choices of surgical interventions of BPH from the perspective of surgical safety and reduction of complications so as to improve the satisfaction of patients.

The essence of the clinical problem caused by benign prostatic hyperplasia(BPH) is lower urinary tract obstruction. Compared with drug treatment, surgery can fundamentally relieve the obstruction. Transurethral endoscopic surgery has become the most important surgical treatment for BPH. In recent years, everyone has been working on exploring the physical properties of various energy platforms, especially lasers, to maximize their advantages in clinical use, various surgical concepts and methods contend. This article summarized my 40 years of experience in transurethral laparoscopic surgery to discuss my experience and thoughts.

【Objective】 To investigate the clinical efficacy and safety of transurethral blue laser vaporescetion of the prostate in the treatment of benign prostatic hyperplasia (BPH). 【Methods】 The clinical data of 100 BPH patients undergoing the surgery in our hospital during May and Sep.2022 were retrospectively analyzed. The observations included operation time, bladder irrigation duration, postoperative catheter indwelling time, hospital stay, complications, as well as changes in hemoglobin, International Prostate Symptom Score (IPSS), Quality of Life Scale (QoL) score, maximum urinary flow rate (Qmax), bladder residual urine volume (PVR), and other related indicators before and 3 months after surgery. 【Results】 All 100 procedures were successfully completed without turning to transurethral resection of the prostate and/or open surgery. No blood transfusion was needed. The operation time was (37.8±19.6) min, bladder irrigation time (1.3±0.5) d, catheter indwelling time (12.7±0.4) d, hospital stay (3.4±0.7) d, hemoglobin drop (4.1±7.1) g/L. The postoperative IPSS and QoL score were significantly lower than those before surgery (P<0.05); postoperative Qmax was higher than that before surgery (P<0.05); postoperative PVR was smaller than that before surgery (P<0.05). Urinary retention occurred in 4 cases (4%) after removal of the catheter; carnal hematuria and bladder clot formation occurred in 3 cases (3%); mixed urinary incontinence occurred in 2 cases (2%); stenosis of the external urethra occurred in 2 cases (2%). All complications were cured after symptomatic treatment. There were no serious perioperative complications, no intraoperative complications such as ureteral orifice injury or bladder perforation, and no serious postoperative complications such as transurethral resection syndrome (TURS), permanent urinary incontinence or bladder neck contracture. 【Conclusion】 The blue laser surgical system had satisfactory effects of vaporization and hemostasia. Transurethral blue laser vaporesection of the prostate is safe and effective in the treatment of BPH.

【Objective】 To evaluate the clinical efficacy of 200 W blue laser vaporization of prostate and the possibility of developing such surgery into day surgery. 【Methods】 The clinical data of 30 patients treated during Aug. and Sep.2022 were retrospectively reviewed. The residual urine volume, urine flow rate, International Prostate Symptom Score (IPSS) and Quality of Life Scale(QoL) score before and after surgery were compared. The operation time and postoperative routine urinary red blood cell count were recorded. 【Results】 All surgeries were successful and the catheter was moved 1 day after surgery. The operation time was (12.2±5.1) min, postoperative bladder irrigation time (20.0±4.2) h, and urinary red blood cell count (806.2±16.3)/μL. Recatheter was needed in 1 patient. The urinary flow rate before surgery, immediately and 1-month after surgery were (10.6±3.5) mL/s, (24.2±5.6) mL/s, and (27.2±3.1) mL/s, respectively. The residual urine was (57.3±3.2) mL before surgery and (5.6±3.1) mL 1-month after surgery. The average preoperative IPSS and QoL scores were (25.1±1.6) and (5.4±0.7), and were (9.5±1.4) and (2.9±0.6), respectively, 3-months after surgery. 【Conclusion】 Transurethral 200 W blue laser vaporization of the prostate is a practical and feasible surgical technique for the treatment of benign prostatic hyperplasia. It is effective, rapid and safe, and can greatly shorten the length of hospital stay and improve perioperative safety. With the improvement of clinical application technology, it can be a choice of prostatic day surgery.

【Objective】 To analyze the results, characteristics and clinical value of video urodynamic study (VUD) of lower urinary tract symptoms (LUTS) in young male. 【Methods】 A total of 106 young male LUTS patients (18-45 years old) who received VUD in our hospital during Jan.2016 and Sep.2021 were collected to analyze the clinical and imaging urodynamic characteristics. 【Results】 Of the 106 patients, 55 (52.44%) had neurogenic lower urinary tract dysfunction (NLUTD)with clear neurological etiology, and 51 (48%) had non-neurogenic lower urinary tract dysfunction (NNLUTD). In NLUTD patients, dysuria was the most common symptom (76.74%); lumbosacral lesions were the main cause (76.36%); imaging urodynamics indicated weakening of detrusor muscle in different degrees. In NNLUTD patients,the main symptoms were frequent urination (48.72%) and dysuria (48.72%); about 58.97% of patients had two or more LUTS, and the main diagnosis was detrusor underactivity (DU)(35.90%). 【Conclusion】 NLUTD in young male is characterized by varying degrees of detrusor muscle weakness, detrusor sphincter dyscoordination, and decreased bladder compliance. NNLUTD is mostly caused by detrusor overactivity (DO) and DU.

【Objective】 To investigate the relationship between preoperative albumin-to-alkaline phosphatase ratio (AAPR) and postoperative recurrence of localized penile cancer (T1-3N0M0). 【Methods】 Clinical data of patients with limited penile cancer admitted to our hospital during Jan.2012 and Jan.2017 were collected to compare the differences in age, body mass index (BMI), AAPR, hypertension, diabetes mellitus, tumor diameter, postoperative pathological grading and staging between the postoperative recurrence group and the non-recurrence group. 【Results】 The differences in AAPR(P=0.001), WHO/ISUP pathological grading(P=0.018), and pathological stage(P=0.012)between the recurrence and non-recurrence groups were statistically significant. Cox regression results showed that AAPR was an independent risk factor for recurrence (P=0.041). Survival curve results showed that patients in the high and low AAPR groups had an inverse relationship with recurrence-free survival (P=0.028). 【Conclusion】 Preoperative AAPR is an independent risk factor for recurrence after surgery for limited penile cancer and is associated with recurrence-free survival. As AAPR increases, the incidence of recurrence decreases and progression-free survival increases.

【Objective】 To determine the risk factors of urinary sepsis secondary to minimally invasive percutaneous nephrolithotomy (mPCNL) in patients with negative preoperative urine culture (UC). 【Methods】 A total of 274 patients with negative preoperative UC treated with mPCNL during Jan.2016 and Jun. 2021 were retrospectively analyzed. The incidence of urinary sepsis was observed, and the general data of patients with or without urinary sepsis after mPCNL were compared. logistic regression model was used to analyze the risk factors of urinary sepsis after mPCNL. 【Results】 Urinary sepsis occurred in 11 cases (4.01%). Univariate analysis showed that urinary sepsis was associated with gender, body mass index, stone load, diabetes, urine WBC ≥2+, urinary nitrite, procalcitonin, and operation time. Multivariate logistic regression analysis showed that the independent risk factors of urinary sepsis after mPCNL included diabetes (OR=2.34, 95%CI=1.051-5.43, P=0.037), stone load (OR=7.51, 95%CI=3.17-7.38, P=0.045), urine WBC≥2+ (OR=4.57, 95%CI=6.75-11.38, P=0.032), urinary nitrite positive (OR=6.45, 95%CI=0.93-26.87, P=0.028) and operation time≥120 min (OR=3.53, 95%CI=1.41-8.85, P=0.042). 【Conclusion】 Diabetes, stone load, urinary WBC ≥2+, positive urinary nitrite and operation time ≥120 minutes are the risk factors of urinary sepsis after mPCNL in patients with negative urine culture.

【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.