General information
A retrospective collection of data was conducted on 240 patients with BPH admitted to our urology department from January 2015 to February 2023. All patients exhibited varying degrees of symptoms such as urgency, frequency, and difficulty in urination. Based on the surgical approach employed, the patients were divided into a TUPKEP group and a TURP group, with 120 cases in each group. The TUPKEP group received TUPKEP operation and the TURP group received TURP operation.
Inclusion and exclusion criteria
Inclusion criteria: All patients should be treated according to the diagnostic criteria for BPH in the Chinese guidelines for the diagnosis and treatment of urinary system diseases. Diagnosis should be confirmed through imaging examinations such as cystoscopy, MRI, CT, and blood tests. Patients should meet the surgical indications and undergo their first prostate surgery. The age should be greater than or equal to 18 years. Preoperative sexual function examination should show normal results. Patients should have at least a primary school education and good understanding ability.
Exclusion criteria: Abnormal coagulation function, neurogenic bladder, concurrent prostate cancer or urethral stricture, severe underlying diseases such as hyperlipidemia, diabetes, and hypertension, mental or consciousness disorders.
Ethical approval
This study was approved by the Research Ethics Committee, all patients are informed and voluntarily participating in this study.
Treatment Method
The TUPKEP group received TUPKEP:the patients were placed in the lithotomy position under combined intravenous inhalation general anesthesia, sterilized with iodophor gauze, spread with drapes, connected to the electric cutting equipment, adjusted the electric cutting power to 160W, the electrocoagulation power to 80W, suspended 0.9% sodium chloride and use connecting pipe connection. During the endoscopic examination, the urethra and ureteral orifice were observed and cystoscopy was performed simultaneously. The spermatheca was used as the boundary as the distal mark for prostate enucleation. First, the mucosa of the upper edge of the spermaphysis and the middle lobe glands were incised by point incision, and then the inverse loops were resected with electric resection. Push the tissue and peel off the layer. After finding the surgical capsule, use the top of the resection lens to bluntly expand the peeling plane. Then use the scope sheath to squeeze the left and right sides to bluntly separate the interface between the prostate gland and the capsule, and remove the hyperplasia. The loose gap between the prostate and the capsule is determined as the enucleation plane. At this plane, the middle lobe tissue of the prostate is excised, and then the two lobes are bluntly peeled clockwise and counterclockwise from the surgical capsule to the 12 o'clock position. The bleeding is stopped at the edges, and finally converges at the 12 o'clock direction, and then the glands are excised using "harvest cutting" with the resectoscope, and bleeding is stopped immediately. Remove the tissue, check the cut surface again, trim and completely stop bleeding. A three-lumen urinary catheter was left in place, gauze was tied to the urinary catheter and moderate traction was applied to exert compression. Normal saline was continuously flushed. The resected specimens were collected and sent to pathology. The operation was completed [13].
The TURP group performed TURP [14]. General anesthesia or epidural anesthesia was administered based on the patient's condition. The lithotomy position was set up, and standard disinfection was performed, with no abnormalities observed at the urethral orifice. An F26 continuous irrigation cutting scope was inserted into the bladder through the urethra, and a 30° lens was used to observe the degree of prostate hyperplasia, with the posterior lobe lifted by about 30°. The bladder walls were checked for any new growths, and the bilateral ureteral orifices were found to be clear. An electric loop was used, with an electric cutting power of 180 watts and an electric coagulation power of 80 watts, to first remove the middle lobe of the prostate that protruded into the bladder. The circular fibers were slowly incised from the bladder neck, gradually removing the lateral lobes, both lobes, and the apex, reaching the surgical capsule depth, and finally addressing the hyperplastic prostate tissue around the verumontanum. After ensuring that there was no bleeding in the surgical area, the wound was observed for hemostasis. The bladder was rinsed with an irrigator, and the resected prostate tissue was suctioned out and sent for pathology examination. A suitable three-way catheter was selected, and a 50 ml saline solution was injected into the balloon for fixation. The bladder was continuously irrigated with flushing fluid to maintain smooth urine drainage and clear any blood clots in the bladder. A routine indwelling catheter was left after the operation, with compression applied to achieve hemostasis. The color of the flushing fluid was closely monitored, and the catheter was removed in a timely manner.
Observation Indicators
Compare perioperative indicators between two groups of patients. Perioperative indicators include intraoperative blood loss, bladder irrigation time, surgical time, duration of urinary catheterization, and length of hospital stay. ②Compare serum factors between two groups of patients before and 7 days after surgery. Measure the levels of prostate specific antigen (PSA), epidermal growth factor (EGF), and prostacyclin (PGI2). ③Compare urinary flow dynamics between two groups of patients before and 6 months after surgery. Measure residual urine volume (PVR), bladder compliance (BC), and maximum urinary flow rate (Q max). ④Compare sexual function between two groups of patients before and 6 months after surgery. Assess sexual function using the Sexual Life Quality Questionnaire-Quality of Life (SLQQ-QOL) and the International Index of Erectile Function-5 (IIEF-5). The SLQQ-QOL questionnaire consists of 10 scoring items, with scores ranging from -4 to 4. After adding 4 to the scores and converting them to a scale of 0 to 8, the scores are divided by 8 and multiplied by 100 to convert them to a scale of 0 to 100. The IIEF-5 questionnaire consists of 5 scoring items, with scores ranging from 0 to 5. The total score is 25, and the scores from both questionnaires are positively correlated with sexual function levels. ⑤Compare the occurrence of complications between two groups of patients. Record the incidence of retrograde ejaculation, urinary tract infection, bladder injury, transient urinary incontinence, erectile dysfunction, ejaculation pain, and decreased semen volume within 6 months after surgery.
Statistical Methods
The data obtained in this study were entered into the statistical software SPSS 24.0 for testing and comparison. Count data was represented as n (%), and chi-square test was used. Measurement data was represented as (x̅±s), and t test was performed. If P < 0.05, the difference was statistically significant.