Objective To compare the effectiveness and safety of transurethral plasma kinetic enucleation of the prostate (TPKEP) and transurethral resection of the plasma (TURP) in patients with benign prostate hyperplasia (BPH) on the basis of bipolar plasma kinetic technology. Methods Eighty BPH patients who met the included criteria were assigned to two groups according to block balanced randomization, of which, 40 received TPKEP and the others received PKRP. We conducted statistical analysis after recording the clinical outcomes including international prostate symptom score (IPSS), quality of life (QOL), maximum flow (Qmax), post void residual urine volume (PVR), rates of prostate coated perforation, blood loss in the operation, duration of operation, time of bladder irrigation, duration of indwelling catheter, post-operative adverse effects, etc. Results The two groups were consistent at baseline before operation. The results of the analysis of clinical outcomes showed that, the TPKEP group was superior to the TURP group in prostate coated perforation (2 cases vs. 8 cases), hemoglobin in flushing fluid (index of blood loss, 10.95±5.02 g vs. 15.8±5.86 g), duration of operation (45.13±11.22 min vs. 53.33±8.69 min), time of bladder irrigation (12.58±2.77 h vs. 22.1±2.33 h), duration of indwelling catheter (65.13±10.67 h vs. 84.5±5.67 h), post-operative irritation sign of the bladder and urethra (5 cases vs. 12 cases), and the event of indwelling catheter after removal (0 cases vs. 4 cases), with significant differences; however, the TPKEP group was higher than the TURP group in the incidence of transient uracratia (10 cases vs. 3 cases), with a significant difference. The results of a 6-month follow-up showed that, no significant difference was found between the two groups in IPSS (2.78±1.03 vs. 2.40±1.13), QOL (1.28±0.45 vs. 1.45±0.51), Qmax (21.10±2.68 vs. 20.58±2.57), and PVR (2.82±2.90 vs. 2.18±2.27), respectively (Pgt;0.05). Long-term uracratia, urethrostenosis and secondary bleeding were not observed after operation in both groups. Conclusions TPKEP and TURP were alike in the short-term effectiveness of operation. TPKEP is safer than the TURP, which is regarded as a fairly ideal method for treating symptomatic BPH. However, the long-term effectiveness of TPKEP is yet to be further proved by large-scale randomized controlled trials with long-term follow-up.
【摘要】 目的 探讨采用不同方法经尿道前列腺等离子双极电切术（plasmakinetic resection of prostate，PKRP）的方法及疗效。 方法 2008年7月-2009年12月，应用不同方法行PKRP治疗156例前列腺增生。患者年龄59~87岁，平均74岁。病程20 d~18年。前列腺重量22~100 g，平均38 g。采用单纯顺行电切法治疗38例，部分剜除分割切除法治疗76例，完全剜除法治疗42例。 结果 156例手术均获成功，手术时间平均90 min。获得前列腺组织12~87 g，平均35 g。术后留置导尿管平均5.5 d，住院时间平均6.5 d。术后组织病理学诊断为良性前列腺增生152例，前列腺癌4例。拔除尿管后均能自主排尿，部分患者术后有尿道刺激症状；术后1个月内出现尿道外口狭窄3例，经尿道扩张治愈。随访时间1~12个月，平均6个月。短期尿失禁3例，时间分别为1周、1个月及3个月；无长期尿失禁。术后3个月国际前列腺症状评分（IPSS）症状评分平均减少24分，生活质量评分平均减少3分。 结论 PKRP安全、有效、并发症少，可针对患者情况采用不同切割方法，效果更佳。【Abstract】 Objective To explore the effects and methods of transurethral plasmakinetic resection of prostate(PKRP). Methods A total of 156 patients with prostatic hyperplasia were treated with various methods of transurethral PKRP from July 2008 to December 2009. Patient’s age ranged from 59 to 87 years,74 years on average. The disease duration was 20 days to 18 years.Method one:anterograde resection in 38 patients; method two:partition retrograde enucleation in 76 patients; method three:completely retrograde enucleation in 42 patients. Results All of the swgeries were successful. The mean duration of the operation was 90 minutes.The collected prostatic specimens were 12-87 g,35 g on average. The mean catheter remaining dwation was 5.5 days.The mean postoperative hospital stay was 6.5 days. Conclusions PKRP is safe and effective. It is effective with various methods of transurethral plasmakinetic resection of prostate.
Objective To objectively evaluate the efficacy and safety of plasmakinetic enucleation for prostate (PKEP) vs plasmakinetic resection for prostate (PKRP) in treating benign prostate hyperplasia (BPH). Methods Such databases as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from their establishment to March 2011 for collecting the randomized controlled trials (RCTs) about PKEP vs PKRP for the treatment of BPH, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction conducted by two reviewers independently, meta-analyses were performed by using the RevMan 5.1 software. The level of evidence was assessed by using the GRADE system. Results Eight studies involving 991 patients were included. The results of meta-analyses showed that: a) safety indicator: compared with the PKRP, PKEP had shorter operation time (SMD=1.07, 95%CI 0.19 to 1.94, P=0.02), less intraoperative bleeding (SMD=2.06, 95%CI 1.42 to 2.69, Plt;0.01), much quantity of resectable prostate (SMD= –0.91, 95%CI –1.33 to –0.48, Plt;0.000 1), less intraoperative perforation (RR=4.48, 95%CI 1.43 to 14.02, P=0.01), shorter catheterization time (SMD=1.98, 95%CI 0.39 to 3.57, P=0.01), shorter bladder irrigation time (SMD=3.49, 95%CI 0.51 to 6.47, P=0.02) and shorter hospital stay (SMD=0.89, 95%CI 0.64 to 1.13, Plt;0.01), but there was no significant difference in total postoperative complications (RR=0.82, 95%CI 0.54 to 1.24, P=0.35); and b) efficacy indicator: compared with the PKRP, the International Prostate Symptom Score (IPSS) was lower after 3 months, the Quality Of Life (QOL) was higher after 3 months, and the improvement of residual urine volume (RUV) was better after 6 months; but other efficacy indicators had no significant difference between the two groups (Pgt;0.05). Based on GRADE system, all the evidence was at level C and weak recommendation (2C). Conclusion The current evidence indicates that PKEP is similar to PKRP in the treating effect, but it resects the proliferated prostate more cleanly with shorter operation time, lesser bleeding and more safety than PKRP; for the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are need.
Objective To prepare silver-containing hydroxyapatite coating (hydroxyapatite/Ag, HA/Ag) and investigate its antibacterial property and biocompatibil ity in vitro. Methods Vacuum plasma spraying technique was adopted to prepare HA/Ag coating on titanium alloy substrate (3% Ag). After incubating the HA/Ag and the HA coating under staphylococcus aureus and pseudomonas aeruginosa suspensions of 2% tryptic soy broth (TBS) medium for 2, 4 and 7 days, respectively, the biofilm on the coatings was examined by confocal laser scanning microscope, and the bacterial density and viable bacterial percentage of bacterial biofilm were calculated. Meanwhile, the micro-morphology of bacterial biofilm was observed by SEM, the cytotoxicity was detected via MTT and the biocompatibil ity of biofilm was evaluated by acute aemolysis test. Results Compared with HA coating, the bacterial biofilm’s thickness on the surface of HA/Ag coating witnessed no significant difference at 2 days after culture (Pgt; 0.05), but decreased obviously at 4 and 7 days after culture (P lt; 0.01). The bacterial density of the biofilm increased with time, but there was no significant difference between two coatings (P gt; 0.05) at 2, 4 and 7 days after culture. The viable bacterial percentage of the biofilms on the surface of HA/Ag coating decreased obviously compared with that of HA coating at 2, 4 and 7 days after cultureP lt; 0.01). The MTT notified the cytotoxic grade of both coatings was zero. The acute haemolysis assay showed that the hemolytic rate of HA/Ag and HA coating was 0.19% and 0.12%, respectively. Conclusion With good biocompatibil ity, significant antibacterial property against staphylococcus aureus and pseudomonas aeruginosa, no obvious cytotoxicity and no erythrocyte destruction, the vacuum plasma sprayed HA/Ag coating is a promising candidate for the surface of orthopedic metal implants to improve their osseointegration and antibacterial property.
ObjectiveTo evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).MethodsRandomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.ResultsA total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=−25.95 mL, 95% confidence interval (CI) (−31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=−10.35 h, 95%CI (−18.25, −2.45) h, P=0.042], average duration of bladder irrigation [WMD=−10.28 h, 95%CI (−17.52, −3.04) h, P=0.038], and average length of hospital stay [WMD=−1.24 d, 95%CI (−1.85, −0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=−0.89 m/s, 95%CI (−1.74, −0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).ConclusionsIn the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.
Objective To study the feasibil ity of preparation of the poly-D, L-lactide acid (PDLLA) scaffolds treated by ammonia plasma and subsequent conjugation of Gly-Arg-Gly-Asp-Ser (GRGDS) peptides via amide l inkage formation. Methods PDLLA scaffolds (8 mm diameter, 1 mm thickness) were prepared by solvent casting/particulate leaching procedure and then treated by ammonia plasma. The consequent scaffolds were labeled as aminated PDLLA (A/ PDLLA). The pore size, porosity, and surface water contact angle of groups 0 (un-treated control), 5, 10, and 20 minutes A/ PDLLA were measured. A/PDLLA scaffolds in groups above were immersed into the FITC labelled GRGDS aqueous solutionwhich contain 1-[3-(dimethylamino) propyl]-3-ethylcarbodiimide hydrochloride (EDC.HCl) and N-hydroxysuccinimide(NHS), the molar ratio of peptides/EDC.HCL /NHS was 1.5 ∶ 1.5 ∶ 1.0, then brachytely sloshed for 24 hours in roomtemperature. The consequent scaffolds were labelled as peptides conjugated A/PDLLA (PA/PDLLA). The scaffolds in groups 0, 5, 10, and 20 minutes A/PDLLA and groups correspondingly conjugation of peptides were detected using X-ray photoelectron spectroscopy (XPS). The scaffolds in groups of conjugation of peptides were measured by confocal laser scanning microscope and high performance l iquid chromatography (HPLC), un-treated and un-conjugated scaffolds employed as control. Bone marrow mesenchymal stem cells (BMSCs) from SD rats were isolated and cultured by whole bone marrow adherent culture method. BMSCs at the 3rd–6th passages were seeded to the scaffolds as follows: 20 minutes ammonia plasma treatment (group A/PDLLA), 20 minutes ammonia plasma treatment and conjugation of GRGDS (group PA/PDLLA), and untreated PDLLA control (group PDLLA). After 16 hours of culture, the adhesive cells on scaffolds and the adhesive rate were calculated. After 4 and 8 days of culture, the BMSCs/scaffold composites was observed by scanning electron micorscope (SEM). Results No significant difference in pore size and porosity of PDLLA were observed between before and after ammonia plasma treatments (P gt; 0.05). With increased time of ammonia plasma treatment, the water contact angle of A/PDLLA scaffolds surface was decreased, and the hydrophil icity in the treated scaffolds was improved gradually, showing significant differences when these groups were compared with each other (P lt; 0.001). XPS results indicated that element nitrogen appeared on the surface of PDLLA treated by ammonia plasma. With time passing, the peak N1s became more visible, and the ratio of N/C increased more obviously. AfterPDLLA scaffolds treated for 0, 5, 10, and 20 minutes with ammonia plasma and subsequent conjugation of peptides, the ratio of N/C increased and the peak of S2p appeared on the surface. The confocal laser scanning microscope observation showed that the fluorescence intensity of PA/PDLLA scaffolds increased obviously with treatment time. The amount of peptides conjugated for 10 minutes and 20 minutes PA/PDLLA was detected by HPLC successfully, showing significant differences between 10 minutes and 20 minutes groups (P lt; 0.001). However, the amount of peptides conjugated in un-treated control and 0, 5 minutes PA/PDLLA scaffolds was too small to detect. After 16 hours co-culture of BMSCs/scaffolds, the adhesive cells and the adhesive rates of A/PDLLA and PA/PDLLA scaffolds were higher than those of PDLLA scaffolds, showing significant difference between every 2 groups (P lt; 0.01). Also, SEM observation confirmed that BMSCs proliferation in A/PDLLA and PA/PDLLA groups was more detectable than that in PDLLA group, especially in PA/PDLLA group. Conclusion Ammonia plasma treatment will significantly increase the amount of FITC-GRGDS peptides conjugated to surface of PDLLA via amide l inkage formation. This new type of biomimetic bone has stablized bioactivities and has proved to promote the adhesion and proliferation of BMSCs in PDLLA.
目的:探讨经尿道双环双极等离子切除治疗前列腺增生症的有效性及安全性。方法:采用美国顺康双环双极等离子电切系统(ACMI vista CTR)治疗BPH268例;随访6个月。结果:手术时间20~140 min,平均手术时间(60.88±29.95) min;输血6例;无电切综合征发生;术后留置尿管3~5天,平均(3.91±0.84);术后平均住院时间(7.05±2.10)天。最大尿流率(Qmax)由术前的(5.89±3.59) mL/s上升至术后6个月的(18.98±4.67) mL/s (Plt;0.01);前列腺症状评分(IPSS),术前为(22.04±7.02)分,术后6个月降至(6.82±3.81)分(Plt;0.01)。结论:双环双极等离子切除治疗前列腺增生疗效好,手术安全,并发症少。
【摘要】 目的 探讨经尿道超脉冲等离子体腔内逆行剜除汽化切除术治疗良性前列腺增生的有效性和安全性。 方法 2008年4月－2009年4月，应用Gyrus超脉冲等离子体行经尿道前列腺腔内逆行剜除汽化切除术124例，前列腺重量为（62.3±21.7） g。术中首先用电切镜鞘、电切环钝锐性相结合将前列腺增生腺体沿外科包膜逆行剥离、剜除，同时断血供，然后推至膀胱颈处后切除。统计手术时间、术中出血量及收集到的前列腺组织质量，术后留置尿管时间、住院时间、手术后前列腺特异性抗原（prostatic specific antigen，PSA）、残余尿量（post voiding residual volume，PVR）、最大尿流率（Qmax）、国际前列腺症状评分（international prostatic symptom scores，IPSS）及生活质量评分（quality of life，QOL）等指标的变化。 结果 124例手术顺利完成。手术时间（48.1±19.4） min，腺体组织质量（57.6±19.6） g，平均失血量（86.2±20.7） mL，仅1例需要输血，出血量和手术时间随前列腺体积和重量的增加而相应增加和延长。术后留置尿管时间（3.1±1.6） d，住院时间（5.8±1.4） d。随访6～18个月，所有患者术后1、6个月Qmax、PVR、IPSS、QOL均较术前得到改善，与术前比较差异均有统计学意义（Plt;0.05）。术后6个月血清PSA降至（0.90±0.26） ng/mL，与术前比较差异有统计学意义（Plt;0.05）。继发尿道外口狭窄3例，经尿道扩张治疗后恢复排尿通畅；继发尿失禁2例，经保守治疗分别于术后1～6个月恢复；无永久性尿失禁、再次手术止血患者，无手术死亡者，未发生经尿道前列腺电切综合征。 结论 经尿道超脉冲等离子体腔内逆行剜除汽化切除术治疗良性前列腺增生安全有效，值得临床推广使用。【Abstract】 Objective To evaluate the safety and clinical efficacy of superpulse plasmakinetic body in transurethral intracavitary retrograde enucleation and vaporization resection of the prostate (TUEVRP) for the treatment of benign prostatic hyperplasia (BPH). Methods Between April 2008 and April 2009, Gyrus TUEVRP was performed on 124 patients with obstructive BPH whose mean prostatic weight was (62.3±21.7) g. The hyperplasia prostate glands were retrogradely dissected and enucleated along surgical capsule to the bladder neck by sharp and blunt dissection combination of the resectoscope tip or loop. Simultaneously, the blood supply of the gland was clamped. The changes of such indexes as operating time, perioperative blood loss, collected prostatic specimen weight, postoperative catheterization time, hospitalization time, prostatic specific antigen (PSA), post voiding residual volume (PVR), maximum urinary flow rate (Qmax), international prostatic symptom score (IPSS), and quality of life (QOL) were assessed. Results All surgeries were successfully carried out with an average operation time of (48.1±19.4) minutes ranged from 25 to 175 minutes. The mean collected prostatic specimen weight was (57.6±19.6) g ranged from 20.2 to 125.7 g. The blood loss was ranged from 45 to 350 ml, averaging at (86.2±20.7) mL during the operation. Blood transfusion was needed in only one case. Blood loss and operation time were increased and prolonged in accordance with the increase of prostatic volume and weight. The postoperative catheterization time was ranged from 2 to 5 days, averaging at 3.1±1.6. The mean hospitalization time was (5.8±1.4) days ranged from 5 to 8 days. All patients were followed up for 6 to 18 months. Qmax, PVR, IPSS and QOL-score six months after operation were significantly improved compared with those before operation (Plt;0.05). There were three cases of external urethral stricture, and they were treated with urethral dilatation successfully. Two cases of urinary incontinence recovered 1 and 6 months later, respectively, by traditional treatment. There were no cases of permanent urinary incontinence, reoperation for hemostasis, operative death, or transurethral resection syndrome. Conclusion TUEVRP is safe and clinically efficacious in the treatment of BPH, and is worthy of clinical promotion.