Clinical Study on the Application of Preserved Urethral Mucosa at the Prostatic Apex in Transurethral Plasmakinetic Resection of the Prostate

Abstract

ObjectiveTo explore the differences in the clinical efficacy, complications, and safety of transurethral plasmakinetic resection of the prostate (PKRP) by the conventional approach versus the approach preserving the urethral mucosa at the prostatic apex in the treatment of benign prostatic hyperplasia (BPH).MethodsA total of 90 patients with PKRP admitted to the First Hospital of Qinhuangdao from December 2018 to March 2021 were selected and divided into a control group (conventional PKRP, n = 45) and an observation group (PKRP with preserved urethral mucosa at the prostatic apex, n = 45). The clinical efficacy, safety, and sexual function of the groups were evaluated using the patients’ International Prostate Symptom Score (IPSS), quality of life (QoL), prostate volume, maximum flow rate (Qmax), post-void residual (PVR), blood loss, surgical resection efficiency, and surgical complication data.ResultsThe differences in the preoperative indicators, glandectomy quality, and glandectomy rate between the groups were not statistically significant (P > 0.05). However, in the observation group, the surgery time and blood loss were significantly lower compared with the control group, and the resection efficiency was significantly higher, with statistical significance (P < 0.05). In the follow-up, one month after surgery, the IPSS and QoL were lower in the observation group than in the control group, and the differences were statistically significant (P < 0.05); three months after surgery, the PVR, IPSS, QoL, and Qmax scores were similar between the groups, with no statistical significance (P > 0.05). In terms of surgical complications, the incidences of urinary incontinence and other complications after catheter extraction were significantly lower in the observation group than in the control group, and the differences between the groups were statistically significant (P < 0.05).ConclusionCompared with conventional PKRP, PKRP with preserved urethral mucosa at the prostatic apex can lead to immediate urinary continence after catheter extraction, reduce intraoperative blood loss, and shorten the surgery time, thus improving the surgical efficiency.

Influence of urethral mucosa preservation of prostatic apex during monopolar transurethral resection of the prostate on postoperative functional outcomes: A retrospective comparative study

“…Of them, 4 were healed within 1 week and 2 within 3 months. This UI rate decreased over time, which is consistent with previously published studies 5,6 . The urge UI zero rate in patients who underwent m-TURP with prostate apex preservation may be due to less prostate damage or less detrusor instability in such patients.…”

“…Whereas in the early series, the incidence rates of intraoperative bleeding during M-TURP requiring blood transfusion were reported of up to 22%, the incidence has decreased to 0.4% to 7.1% in our study 21,22 . Our study revealed greater intraoperative bleeding in group A than in group B, with a statistically significant difference (305 ± 63.4 versus 212.5 ± 65, P < 0.0001), similar to previous reports 5,6 . These reports reported a similar method of urethral mucosa preservation of the prostatic apex during endourologic prostate resections of BPH with a shorter operative time, less intraoperative bleeding, and low postoperative urge UI incidence, as mentioned by Liang et al and Liu and Yang 5,6 .…”

“…Previous studies reported a significant improvement in IPSS and Q max with or without apical prostate resections 5,6 . Similarly, our study revealed IPSS and Q max improvement in both groups without statistically significant differences during the 6-month follow-up period.…”

“…Resectioning the urethral mucosa of the prostate apex is one of the challenging steps in TURP surgery. Few studies revealed the association of preserved urethral mucosa at the prostatic apex with a lower occurrence of postoperative urge UI 5,6 . However, the efficacy of these methods remains unclear, because they may be associated with a high regrowth rate, which subsequently increases the need for second procedures 7 .…”

尿道黏膜瓣渐进式预离断可改善经尿道前列腺等离子剜除术患者尿控功能

“…男性尿控主要依靠尿道膜部周围的远端括约肌系统和膀胱颈周围的近端括约肌系统。其中，作为平滑肌的前列腺前括约肌构成了近端括约肌系统，而前列腺被动括约肌（膜部尿道平滑括约肌）、前列腺-膜部尿道横纹括约肌和外括约肌（尿道周围横纹括约肌）则共同构成了远端括约肌系统 ［ 8 ， 10 ］ 。常规的前列腺剜除术需360°剜除增生的腺体，可能会不同程度地损伤内括约肌，从而影响近端括约肌系统的功能 ［ 11 ］ 。因此，在保护膀胱颈口的同时，远端括约肌系统的保护对于前列腺剜除术后早期尿控的恢复显得尤为重要。刘尚文等 ［ 8 ］ 研究表明，前列腺剜除术中保留12点处尿道黏膜可以减少短期尿失禁的发生，与以往研究中的观点一致 ［ 12 - 13 ］ 。但在以往研究中，保留尿道黏膜是在开始剜除之前或在剜除期间进行 ［ 14 - 15 ］ ，本研究则强调术中尿道黏膜预离断的渐进性，除常规保留12点处尿道黏膜以外，还采用了边剜除边预离断的尿道黏膜保留策略，以更清楚地显露尿道黏膜瓣、尿道外括约肌及增生腺体，更准确地评判尿道黏膜瓣与增生腺体之间的平面，从而更好地保护远端括约肌系统，这也是最后获得良好的术后即刻尿控的重要原因。为了更好地辨认这些重要结构，国内有学者还建立了超声精准导航的经尿道前列腺汽化剜切术/经尿道前列腺汽化剜除术，该技术能在术中实时监测电极与重要结构的相对位置，以最大程度地保护这些结构，促进患者术后的功能恢复 ［ 16 ］ 。…”