Efficacy of TURP with preservation of prostatic apex urethral mucosa for benign prostatic hyperplasia and its effects on IPSS score and Qmax, Qave and RUV indexes
Abstract：Objective: To explore the clinical effects of transurethral resection of prostate (TURP) with preservation of prostatic apex urethral mucosa for benign prostatic hyperplasia (BPH).Methods: The clinical data of 92 patients with BPH were retrospectively analyzed. The patients with routine TURP were included in control group (n=40), and the patients with TURP of preservation of prostatic apex urethral mucosa were included in observation group (n=52). The urodynamic parameters [maximum urinary flow rate (Qmax), mean urinary flow rate (Qave), residual urine volume (RUV)], detrusor function [bladder contraction index (BCI)], symptoms severity [International Prostate Symptom Score (IPSS)] and quality of life [quality of life scale of patient with benign prostatic hyperplasia (BPHQLS)] were compared between the two groups before and at 6th month after operation. The levels of urinary cytokines [tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1)] were observed in the two groups before and at 3rd and 7th day after operation. And the perioperative basic indicators and occurrence of complications within 6 months after operation were analyzed in the two groups. Results: At 6th month after operation, the levels of Qmax and Qave were significantly higher than the preoperative levels while the RUV level was significantly lower than the preoperative level (P<0.05), but there were no statistically significant differences in the levels between the two groups (P>0.05). The BCI level in observation group was not significantly different from that before operation (P>0.05), but significantly higher than that in control group at the same time period (P<0.05). The IPSS scores before operation in the two groups were significantly lower than the preoperative levels, and the score in observation group was significantly lower than that in control group at the same time period (P<0.05). The BPHQLS scores before operation in the two groups were significantly higher than the preoperative levels, and the score in observation group was significantly higher than that in control group (P<0.05). At 3rd and 7th day after operation, the urinary TNF-α levels in the two groups were significantly lower than the preoperative levels, and the level in observation group was significantly lower than that in control group at the same time point (P<0.05), and the urinary TGF-β1 levels in the two groups were significantly higher than the preoperative levels, and the level in observation group was significantly higher than that in control group (P<0.05). There were no significant differences in the quality of gland resection and operative time between-groups (P>0.05), but the intraoperative blood loss, bladder irrigation time, catheter indwelling time and postoperative discharge time were significantly less than those in control group (P<0.05). There were no significant differences in the incidence of repeated hematuria, urinary tract infection, bladder injury and retrograde ejaculation between the two groups within 6 months after operation (P>0.05), and the incidence of stress urinary incontinence and urge incontinence in observation group was significantly lower than tha in control group (P<0.05). Conclusions: TURP with preservation of prostatic apex urethral mucosa has equivalent effects for BPH with conventional surgical treatment, but the former one can improve the postoperative recovery efficiency by reducing the incidence of urinary incontinence, and it is helpful to optimize the prognosis and quality of life.
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