Electroresection of the prostate in the anterior urethral wall

Transurethral resection of the prostate (TURP) remains the gold standard for the treatment of prostatic hyperplasia (enlarged prostate). Every year, there are about 10 million cases of transurethral resection of the prostate (TURP) worldwide and 2 million cases in China, making it the second most common operation after cataract. However, for severe prostatic hyperplasia > 80 grams, TURP is prone to massive bleeding and water intoxication (TURP syndrome), which poses a great threat to patients.

In the past ten years, scholars at home and abroad have carried out a lot of explorations, such as holmium laser, green laser and 2 micron laser prostate vaporization, transurethral prostate vaporization, transurethral enucleation of the prostate, etc., or due to the long operation time, prostate residue, transient and permanent urinary incontinence, often bothering doctors and patients.

In 2000, Professor Zhang Jiahua put forward a new view of urinary control, "under the premise of normal extraurethral factors (innervation, external urethral sphincter), the length and function of the functional urethra (urethral elasticity, pressure, and plug effect of mucosal pads) are the two most important factors for urethral control of urine", on this basis, several new surgeries were designed, among which "transurethral preservation" of part of the anterior urethral wall "prostatic enucleation", which was clinically applied by 200 patients, It can completely remove the hyperplasia of prostate tissue (comparable to simple prostate enucleation and better than open surgery), urinate very smoothly, and the maximum urinary flow rate is 20ml/s; All serious postoperative complications, especially urinary incontinence, are avoided.

1. No electroresection syndrome and increased surgical safety:

The hyperplastic prostate was removed and resected in the surgical (sham) capsule, and the smooth capsule had minimal water absorption, and there was no significant change in blood Na.K.Cl-Hct before and after surgery, and there was no serious water intoxication and perioperative hemorrhage.

Second, the prostatic hyperplasia tissue was completely resected and the surgical effect was very good

It can not only remove the main body of prostatic hyperplasia around the sperm mons, achieve the tissue resection rate of open surgery, but also remove the pseudocapsular hyperplasia tissue near the bladder neck, and achieve the degree of resection of the bladder neck during transurethral resection, reduce the postoperative recurrence rate, and the urinary flow rate is very significantly increased (mean maximum uroflow rate 22.5 ml/s; In one patient, the maximum urinary flow rate was 58 ml/s at 3 months and 42.5 ml/sec at 6 months after surgery.

3. Shorten the length of hospitalization and greatly save health resources:

The indwelling urinary catheter time is short, with an average of 18 hours (the shortest 8 hours) extubation (3-5 days for extubation after traditional TURP and enucleation), shortening the hospital stay by 3-5 days, and reducing the patient's cost by 5,000 yuan/case; At the same time, the turnover of beds is accelerated, saving health resources.

During the operation, the anterior wall tissue equivalent to the "urethral crest" is preserved, and the prostatic hyperplasia in this area is not obvious and does not cause obstruction; On the contrary, the anterior wall of the urethra is retained, and the tissue stretches to form a funnel during urination, which reduces the valve resistance effect of the steep section of the prostate tip during simple prostatic enucleation, and reduces the effect on urodynamics.

4. Greatly reduce the incidence of delayed massive bleeding: after surgery, the wound surface of the prostatic fossa is a smooth pseudocapsule, the electroresection wound is very rare, the scab detachment is reduced, and there is no delayed massive bleeding in this group;

5. No postoperative urinary incontinence: the preserved "urethral crest" plays the role of a plug for the mucosal pad during the urinary storage period, increasing the urethral pressure and the closed area of the urethra, and there is no urinary incontinence (including transient urinary incontinence) in this group.

6. It can prevent and reduce the occurrence of bladder neck contracture: the preserved "urethral crest" can prevent and reduce bladder neck contracture.

7. Fast recovery: mucosal tissue can grow from both ends to the center and in rings, so the epithelial coverage is faster and the recovery time is reduced.

8. Greatly reduce retrograde ejaculation: During ejaculation, the "urethral crest" and the pseudocapsular tissue of the bladder neck close the bladder neck, greatly reducing retrograde ejaculation.

Therefore, the surgery is safe, efficient and economical, avoids all complications, brings good news to patients, relieves doctors of worries, and is expected to replace TURP as the 'gold standard' for the surgical treatment of prostatic hyperplasia."