Benign prostatic hyperplasia (BPH) is one of the most common benign diseases causing urinary disturbances in middle-aged and older men. The lower urinary tract symptoms caused by BPH are mainly storage phase symptoms, voiding phase symptoms, post-voiding symptoms and related comorbidities.
Surgical treatment is an option when the lower urinary tract symptoms of severe BPH have significantly affected the patient’s quality of life, especially in patients who have failed or refused to accept pharmacological treatment. Surgical procedures include transurethral resection of the prostate (TURP), transurethral resection of the prostate (TUIP), transurethral vaporization of the prostate (TUVP), transurethral plasma bipolar resection of the prostate (TUPKP) laser prostate surgery, and open prostate removal.
TURP is recognized as the “gold standard” of BPH treatment, and is primarily indicated for the treatment of BPH patients with a prostate volume of 80 ml or less. There are major drawbacks to TURP itself.
First, the special irrigation solution can cause electrolyte disturbances and water toxicity in patients, which can lead to “electrosurgery syndrome” and directly endanger lives.
The second is that the operation time must generally be limited to less than one hour, while for large prostate, bleeding prostate can not be adequately treated.
Third, the enlarged prostate tissue resembles a sphere, and it is difficult to ensure that the entire spherical enlarged gland is removed cleanly by removing it from the urethra outward.
Open prostate removal is mainly suitable for patients with prostate volume greater than 80ml, especially those with combined bladder stones, or combined bladder diverticula that need to be operated together. The postoperative recovery is slow and the complication rate is high: urinary incontinence about 1%, retrograde ejaculation about 80%, bladder neck contracture about 1.8%, urethral stricture about 2.6%, etc.
TUPKP is performed using a plasma bipolar electrosurgery system with saline as the intraoperative irrigation fluid, which reduces intraoperative bleeding and the occurrence of TURS.
The laser surgical approach has the disadvantages of relying on laser fibers, cutting interface determined by the operator as not a true surgical envelope, only partial rather than complete enucleation can be achieved, and is more expensive.
The modified plasma enucleation of the prostate (TUERP) makes up for almost all of the shortcomings of electrodesection of the prostate. Transurethral enucleation of the prostate uses the sheath of the electrodesection scope as a finger, combined with the excellent bipolar hemostasis, to gradually peel off the enlarged gland along the true surgical envelope of the prostate under direct vision and then remove it in pieces. Since the TUERP procedure starts by reaching the surface of the prostate surgical envelope and then gradually peeling the gland off on it, it minimizes the residual gland, and its features can be summarized as follows.
(i) true intraluminal enucleation along the surgical envelope, and because the hyperplastic gland is completely stripped, the postoperative urinary flow rate improves significantly, and the patient’s postoperative urination is significantly improved.
(ii) Complete blockage of blood flow and clear visualization.
(iii) Further reduction of complications, due to thorough stripping and clear boundaries, reducing the chance of intraoperative misinjury.
(iv) Complete excision of the gland, even more than open surgery in some cases, because some nodular-like growths, which are often left over from open surgery, can be seen and treated lumpectively.
(v) No need to trim the tip, which is less likely to cause urinary incontinence.
(vi) Reduced attrition and cost effectiveness.
(vii) Reduction in operative time.
⑧ Saline irrigation.
”The TURP is a revolutionary approach to the traditional TURP, as it is not affected by cutting instruments and can be operated with monopolar, bipolar and various laser fibers. It is a subversive breakthrough of traditional TURP. This is a revolutionary breakthrough in traditional TURP because the surgery removes the entire enlarged gland and the theoretical recurrence rate is zero.
The head of our male discipline had a systematic study of this technology at the Zhujiang Hospital in Guangzhou in November 2011, and after returning to the hospital, he received approval from the Medical Department for the establishment of new technology, and has successfully carried out transurethral resection of the prostate in more than 60 cases so far, without any serious complications (only some patients had painful urination, hematuria and transient abnormal urinary control after surgery). The largest gland was 8.8 cm×8.7 cm×7.8 cm, and the weight of the gland was about 256 g. The operation time was 2.5 hours, and the patient recovered well after the operation, and the patient had good urinary control during the two-year follow-up. For conventional glands of about 100 grams, the operation time is about 1 hour for all of them.
Especially for patients with prostatic hyperplasia combined with multiple large stones in the bladder, the normal endoscopic lithotripsy + prostatic electrodesection surgery takes 4 – 5 hours, for elderly male patients who often have abnormal cardiopulmonary function and are prone to surgical complications, even for open surgery, it takes 1.5 hours, but the patient’s prostatic fossa trauma is done with balloon The use of prostate enucleation + small incision for stone extraction can reduce the operation time from 4 – 5 hours to about 1.5 hours, and the surgical incision is 3 – 4 cm, so that the enucleated The surgery can be performed with an incision of 3-4 cm to completely remove the prostate tissue and bladder stones, which significantly reduces the adverse effects of prolonged surgery on the elderly, and can strictly stop the bleeding of the enucleated prostate wound, while achieving the surgical effect of open prostate removal.