OBJECTIVE: To investigate the effect of transurethral resection of bladder neck on primary female bladder neck obstruction and to analyze the expression of three kinds of sex hormone receptor (SR) in female bladder neck tissues diagnosed as primary bladder neck obstruction by the immunochemistry and statistics. METHODS: The clinical data of 40 female patients, admitted into Peking University People's Hospital for difficulty of voiding during Oct.2008 and Dec.2013 and eventually diagnosed as bladder outlet obstruction (BOO) by urodynamics, were retrospectively reviewed. BOO was defined as a maximum flow rate (Q_max) less than 12 mL/s together with a detrusor pressure at maximum flow rate (Pdet Q_max) more than 25 cmH₂O in urodynamic study in the absence of neurological disorders. Diagnosis was confirmed by the cystoscopy. Preoperative and postoperative AUASS scores were recorded and analyzed for observation of curative effects and complications. The immunochemical expression of SR of primary female bladder neck obstruction (PBNO) tissues and normal control was examined and applied to statistical analysis. RESULTS: There were significant changes postoperatively in voiding scores, storage scores and total scores (P<0.001). Postoperatively, 1 patient newly presented with overactive bladder (OAB), 4 patients newly presented with hematuria, and 1 patient underwent cystostomy. The symptoms of urinary retention with overflow incontinence in 2 patients disappeared after the surgery, and 3 patients complicated with OAB complained without urgency. In addition, pre-hydronephrosis improved postoperatively in six patients. The subjective satisfactory rate to the surgery of TURBN was 77.5% (31/40). Sex hormone receptor, including androgen receptor (AR), estrogen receptor (ER), progesterone receptor (PR), expressed in both bladder neck tissues of normal control and PBNO patients. In PBNO group, the expression of PR was significantly lower than that of control group (P<0.05), while the other 2 SRs expressed with no significantly statistical difference. PBNO patients were divided into 2 groups, according to their symptoms scores, and the expression of SRs showed no significant differences among the mild, moderate and severe groups (P>0.05). CONCLUSION The transurethral bladder neck resection is valid in treating with female PBNO patients, with rarely occurrence of complications. PR expressed less in the female bladder neck tissues, and is possibly correlated with the occurrence of female PBNO.
Female ; Humans ; Retrospective Studies ; Urinary Bladder Neck Obstruction/surgery* ; Urodynamics

OBJECTIVETo analyze different transurethral surgical methods for the treatment of small-size benign prostate hyperplasia (BPH) in order to improve the curative effect.

METHODSThe clinical data of 52 cases of small-size BPH treated by transurethral surgery were reviewed and analyzed. Of the total number, 12 underwent transurethral prostate resection (TURP), 18 TURP plus transurethral incision of the bladder neck (TUIBN) and 22 TURP plus transurethral resection of the bladder neck (TURBN). The curative effect of the three different surgical methods was evaluated by international prostate symptom score (IPSS), maximum flow rate (Qmax) and post-voiding residual urine volume (PVR).

RESULTSIn the TURP group, 3 cases were complicated with contracture of the bladder neck, and the IPSS, Qmax and PVR were (12.2 +/- 3.2), (11.7 +/- 2.6) ml/s and (27.6 +/- 13.0) ml, respectively. In the TURP + TUIBN group, there was only 1 case of the complication and the three indices were respectively (8.6 +/- 3.2), (16.7 +/- 3.0) ml/s and (20.0 +/- 8.0) ml. No complication was observed in the TURP + TURBN group and the three indices were (6.2 +/- 3.0), (22.7 +/- 3.1) ml/s and (8.0 +/- 4.0) ml, respectively. No statistical difference (P > 0.05) was found in IPSS, Qmax and PVR among the three groups before the operation, but significant difference (P < 0.01) was observed after it. The curative effect was better in the TURP + TUIBN group than in the TURP, but was the best in the TURP + TURBN.

CONCLUSIONSTURP + TURBN, being more effective than TURP + TUIBN, should be used as the first option for the surgical treatment of small-size BPH. The key to the operation is to thoroughly remove not only the hyperplastic gland but also the pathological changes of the bladder neck.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; methods ; Urinary Bladder Neck Obstruction ; surgery

ObjectiveTo compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity.

METHODShis study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively.

RESULTSThere were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group (［315±59］ vs ［287±76］ ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time (［2.7±0.8］ vs ［5.1±1.2］ d, P<0.05), postoperative bladder contracture time (［4.1±1.9］ vs ［5.8±2.4］ d, P<0.05), postoperative hospital stay (［4.4±1.8］ vs ［5.9±2.5］ d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05).

CONCLUSIONSBoth TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.

Humans ; Lasers, Solid-State ; therapeutic use ; Length of Stay ; Male ; Prostate ; surgery ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Transurethral Resection of Prostate ; methods ; Treatment Outcome ; Urinary Bladder Neck Obstruction ; surgery ; Urinary Bladder, Overactive ; surgery ; Urinary Catheterization ; statistics & numerical data ; Urination ; physiology

OBJECTIVETo investigate the effect of transurethral resection of the prostate (TURP) in the treatment of advanced prostate cancer with bladder outlet obstruction (BOO).

METHODSWe included in this study 43 cases of advanced prostate cancer with BOO treated by TURP, and analyzed their IPSS, maximum urinary flow rate and relevant risk factors pre-operatively and at 3 and 12 months after TURP.

RESULTSCompared with the baseline, IPSS and the maximum urinary flow rate of the patients showed significant differences 3 months after surgery ([19.60 +/- 0.41] score vs. [9.58 +/- 0.33] score, [4.93 +/- 0.68] ml/s vs. [8.96 +/- 0.47] ml/s, P < 0.05), but not at 12 months ([15.73 +/- 0.66] score, [5.67 +/- 0.44] ml/s). In multiple regression analysis, a good outcome was associated with pre-operative acute urinary retention, while poor prognosis with hormone-refractory prostate cancer.

CONCLUSIONIn the treatment of advanced hormone-refractory prostate cancer with BOO, TURP can reduce IPSS and increase the maximum urinary flow rate in the early period after surgery, but its long-term effect is not so desirable. Meanwhile the operation itself may bring about relevant complications and reduce the patient's quality of life.

Aged ; Aged, 80 and over ; Feasibility Studies ; Humans ; Male ; Middle Aged ; Prostatic Neoplasms ; surgery ; Transurethral Resection of Prostate ; Treatment Outcome ; Urinary Bladder Neck Obstruction ; surgery

OBJECTIVETo investigate the changes and its clinical significance of ultrasound evaluated bladder wall weight (UEBW) pre and after surgery in patients with benign prostatic hyperplasia (BPH).

METHODSThe clinical data of 63 patients of benign prostatic hyperplasia and 30 of contrast control were studied. The bladder wall weight was calculated by subtracting the volume of sphere represented by the urine volume inside the bladder from the volume of the sphere representing the whole bladder (sphere with a radius = internal radius + bladder wall thickness). Bladder outlet obstruction (BOO) and bladder function was evaluated by urodynamic studies. Of the 63 patients with BPH, UEBW was (97 +/- 54) g, while the control group was only (41 +/- 14) g. UEBW was found to be significantly correlated with LinPURR grade (R = 0.47, P < 0.01) and positive residual urine volume (R = 0.48, P < 0.01), and it was negatively correlated with Qmax (R = -0.52, P < 0.01) and detrusor contraction strength (presented as WF, R = -0.4, P < 0.05).

RESULTSA significant difference was found between the UEBW pre and after surgery [(99 +/- 50) g vs. (56 +/- 21) g, t = 5.05, P < 0.01)]. UEBW decreased 43.68%, and IPSS score decreased 16.81 point, while Qmax increased 8.38 ml/s.

CONCLUSIONAs an non-invasive methods, measurement of bladder wall weight appears to be a useful marker in evaluating status before operation and in monitoring the effect of surgery for patients with BPH.

Humans ; Male ; Middle Aged ; Organ Size ; Prostatic Hyperplasia ; complications ; pathology ; surgery ; Time Factors ; Transurethral Resection of Prostate ; Treatment Outcome ; Urinary Bladder ; pathology ; physiopathology ; Urinary Bladder Neck Obstruction ; diagnosis ; etiology ; Urodynamics

ObjectiveTo evaluate the effectiveness and safety of low-concentration hydrogen peroxide solution (HPS) for continuous bladder irrigation after transurethral resection of the prostate (TURP).

METHODSWe retrospectively analyzed the clinical data about 148 cases of benign prostatic hyperplasia (BPH) treated by TURP from January 2013 to January 2016. Seventy-six of the patients received postoperative continuous bladder irrigation with 0.15% HPS (group A) and the other 72 with normal saline (group B). We compared the two groups of patients in their postoperative hemoglobin (Hb) levels, duration of bladder irrigation, frequency of catheter blockage, time of catheterization, and length of hospital stay.

RESULTSThere were no statistically significant differences between the two groups of patients preoperatively in the prostate volume, International Prostate Symptoms Score, maximum urinary flow rate, postvoid residual urine, or levels of serum PSA and Hb (P > 0.05). At 48 hours after operation, a significantly less reduction was observed in the Hb level in group A than in group B (［3.38 ± 2.56］ vs ［7.29 ± 6.58］ g/L, P < 0.01). The patients of group A, in comparison with those of group B, also showed remarkably shorter duration of postoperative bladder irrigation (［32.57 ± 5.99］ vs ［46.10 ± 8.79］ h, P < 0.01), lower rate of catheter blockage (3.3% vs 11.8%, P < 0.01), shorter time of catheterization (［3.74 ± 0.79］ vs ［4.79 ± 0.93］ d, P < 0.01), and fewer days of postoperative hospital stay (［4.22 ± 0.81］ vs ［4.67 ± 0.88］ d, P < 0.01).

CONCLUSIONSLow-concentration HPS for continuous bladder irrigation after TURP can reduce blood loss, catheter blockage, bladder irrigation duration, catheterization time, and hospital stay, and therefore deserves a wide clinical application.

Anti-Infective Agents, Local ; administration & dosage ; Catheter Obstruction ; Humans ; Hydrogen Peroxide ; administration & dosage ; Length of Stay ; Male ; Postoperative Hemorrhage ; prevention & control ; Postoperative Period ; Prostatic Hyperplasia ; blood ; surgery ; Quality of Life ; Retrospective Studies ; Therapeutic Irrigation ; methods ; statistics & numerical data ; Transurethral Resection of Prostate ; Treatment Outcome ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; prevention & control ; Urinary Retention

OBJECTIVETo investigate a new surgical method for the treatment of prostate cancer with bladder outlet obstruction.

METHODSForty-seven patients with prostate cancer complicated with bladder outlet obstruction were treated by combined use of transurethral electrovaporization ablation of the prostate (TUVP) and transurethral resection of the prostate (TURP).

RESULTSThe operations were successful, with satisfactory results and no serious complication. IPSS decreased from (26.5 +/- 4.8) pre-operatively to (8.5 +/- 2.2) post-operatively (P < 0.05); Qmax increased from (4.6 +/- 1.5) ml/s to (14.5 +/- 3.6) ml/s (P < 0.05); and PSA decreased from (58.1 +/- 7.2) microg/L to (3.6 +/- 1.8) microg/L (P < 0.01).

CONCLUSIONThe combined use of TUVP and TURP is a safe and ideal method for the treatment of prostate cancer with bladder outlet obstruction.

Aged ; Aged, 80 and over ; Electrosurgery ; Follow-Up Studies ; Humans ; Male ; Orchiectomy ; Prostate-Specific Antigen ; metabolism ; Prostatic Neoplasms ; complications ; surgery ; Transurethral Resection of Prostate ; methods ; Treatment Outcome ; Urinary Bladder Neck Obstruction ; complications ; surgery

OBJECTIVETo explore the etiology and management of disappointing early urination in patients with benign prostatic hyperplasia (BPH) following transurethral resection of the prostate (TURP).

METHODSThe clinical data and management of 58 cases of disappointing urination within 3 months after TURP were reviewed.

RESULTSOf the total number of patients with disappointing early urination after TURP, 7 (12%) underwent a second operation, 6 (10%) received outpatient treatment, and the other 45 (78%) showed spontaneous improvement within 1 year with no further treatment.

CONCLUSIONThe causes of disappointing early urination after TURP included bladder neck contracture, urethral stricture and urinary tract infection, which necessitate secondary treatment. And a greater proportion of the patients showed functional lability of the bladder detrusor muscle, which could be spontaneously improved within 1 year after TURP.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Prostatic Hyperplasia ; surgery ; Reoperation ; Transurethral Resection of Prostate ; adverse effects ; Urinary Bladder Neck Obstruction ; etiology ; prevention & control ; Urination Disorders ; etiology ; surgery

PURPOSE: To assess the impact of intravesical prostatic protrusion (IPP) on the outcomes of robot-assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS: The medical records of 1094 men who underwent RALP from January 2007 to March 2013 were analyzed using our database to identify 641 additional men without IPP (non-IPP group). We excluded 259 patients who presented insufficient data and 14 patients who did not have an MRI image. We compared the following parameters: preoperative transrectal ultrasound, prostate specific antigen (PSA), clinicopathologic characteristics, intraoperative characteristics, postoperative oncologic characteristics, minor and major postoperative complications, and continence until postoperative 1 year. IPP grade was stratified by grade into three groups: Grade 1 (IPP≤5 mm), Grade 2 (5 mm10 mm). RESULTS: Of the 821 patients who underwent RALP, 557 (67.8%) experienced continence at postoperative 3 months, 681 (82.9%) at 6 months, and 757 (92.2%) at 12 months. According to IPP grade, there were significant differences in recovering full continence at postoperative 3 months, 6 months, and 12 months (p<0.001). On multivariate analysis, IPP was the most powerful predictor of postoperative continence in patients who underwent RALP (p<0.001). Using a generalized estimating equation model, IPP also was shown to be the most powerful independent variable for postoperative continence in patients who underwent RALP (p<0.001). CONCLUSION: Patients with low-grade IPP have significantly higher chances of recovering full continence. Therefore, the known IPP grade will be helpful during consultations with patients before RALP.
Aged, 80 and over ; Humans ; Laparoscopy/methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/etiology ; Prostatectomy/*methods ; Prostatic Neoplasms/complications/*surgery ; *Recovery of Function ; *Robotic Surgical Procedures ; Urinary Bladder Neck Obstruction/*diagnostic imaging/etiology ; *Urination

PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.
Abscess/etiology/radiography/*surgery ; Aged ; Aged, 80 and over ; Calcinosis/complications/surgery ; Drainage/methods ; Holmium ; Humans ; Lasers, Solid-State/*therapeutic use ; Male ; Middle Aged ; Prostatic Diseases/etiology/radiography/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Transurethral Resection of Prostate/*methods ; Treatment Outcome ; Urinary Bladder Neck Obstruction/complications/surgery