A. Transurethral vaporization of the prostate Prostatic hyperplasia as the most common disease of lower urinary tract obstruction in elderly men, although benign lesions, but because it causes urinary tract obstruction, affecting urination, accompanied by a variety of symptoms, and even threaten the kidney function, the health and life of patients brought serious danger. The original open surgery may pose a great life threatening and economic burden to the patient. The development of transurethral electro vaporization of the prostate has matured and reached a peak in the United States in the mid to late 1980s, with about 95% of patients with prostate enlargement being treated through this procedure. With the accelerated pace of opening up in China, extensive exchanges between scholars at home and abroad and the advent of the information age, transurethral resection of the prostate has been widely carried out in China from a high starting point. Transurethral electrolysis of the prostate, a minimally invasive surgical method applied to deal with static obstruction at the bladder outlet, can effectively remove the volume of the hyperplastic gland in order to leave the bladder outlet open. In clinical practice, physicians are often willing to use prostate electrosurgery in combination with vaporization, which is more practical and convenient. Electrodesiccation is the most basic operation and has not become obsolete. Vaporization is not a complete substitute for electrodesiccation. Transurethral resection of the prostate, like conventional surgery, has its own indications and contraindications, and some patients can be treated by this method, while others are unable to undergo this procedure due to various factors. The actual fact is that you will be able to get a lot more than just a couple of hours of work. 1, prostatic hyperplasia causes obvious signs and symptoms of obstruction, such as severe urinary frequency, difficulty in urination, thinning of the urinary line, prolonged urination, increased nocturia, excessive residual urine volume >50ml, urinary retention and overflow incontinence; difficulty in urination and inability to urinate on one’s own is often an important reason for surgical treatment. 2.Renal function impairment caused by prostatic hyperplasia obstruction, recurrent urinary tract infection, recurrent hematuria, and massive bleeding. 3, prostatic hyperplasia combined with bladder stones and diverticula. 4.Urinary flow rate abnormal, the maximum urinary flow rate is below 15ml/s. 5. Rectal examinations, ultrasound and cystoscopy show an enlarged prostate. 3. Which patients cannot be treated surgically? 1. Systemic diseases: ①Cardiovascular diseases: Patients with significant bleeding tendency or uncontrolled hypertension and combined with heart failure are at high risk for surgery and need to cooperate with internal medicine physicians for related treatment and consider surgery after the condition is controlled. ②Respiratory system diseases: acute respiratory infections, chronic bronchitis, bronchial asthma, emphysema and other diseases causing severe decompensation of lung function. Emphysema is not necessarily a contraindication to surgery, but severe bronchial asthma must be treated with caution. (iii) Cerebrovascular disease: Late stage is absolutely contraindicated, not only in surgery, but also after surgery, and the danger is difficult to estimate. Even if the external urethral dilator muscle is not damaged during surgery, permanent urinary incontinence can still occur after surgery, and it is especially serious in hemiplegics. Patients with renal insufficiency are best treated with urinary drainage first, and it is better to wait until renal function returns to normal or near normal before proceeding with surgery. ⑤ Liver disease Only more severe and advanced liver disease is contraindicated for surgery. Those with poor liver function are best treated with liver protection first, which can avoid intraoperative and postoperative hemorrhage due to coagulation dysfunction caused by poor liver function. (6) Severe diabetes mellitus Patients with uncontrolled diabetes mellitus are prone to severe intraoperative and postoperative blood glucose fluctuations, inducing ketoacidosis or hyperglycemic coma, etc. They may also have difficulty in wound healing, recurrent hematuria and urinary tract infections after surgery. (7) Mental retardation and psychosis Those with mental retardation cannot cooperate with the treatment. It is better not to consider surgery for this type of patients because they are mentally retarded and cannot relearn to urinate after surgery, and the possibility of urinary incontinence is still very high. The case of psychiatric patients is different and should be studied and determined with the psychiatrist, and should also be discussed with the patient’s family and clearly informed about the possible accidents during and after surgery. (8) Elderly and frail patients Patients of advanced age and frailty may not be particularly found in the preoperative examination, but their vitality has significantly diminished, manifested by less activity, less eating, drowsiness, and mental inactivity, and the incidence of sudden death during and after surgery has significantly increased, so caution must be exercised as to whether surgery is possible. 9 Acute genitourinary tract infection must be controlled by anti-infection treatment before surgical treatment. 2. Non-systemic diseases: ①Urethral stricture, electrodesiccoscope cannot pass through the stricture. ② Combined bladder tumor: single tumor with bladder tumor with tip and small size showing non-invasive growth, TURBT can be performed at the same time, if the bladder tumor is large showing infiltrative growth, the surgical method will be chosen according to the situation. ③ Combined with huge bladder diverticulum. (iv) Highly dilated bladder without contractile function, and too small bladder capacity.