Strategies of preserving urinary continence in transurethral plasmakinetic enucleation of the prostate for benign prostate hyperplasia

CHEN Jun-yi; CHEN Dong; WANG Jia-liang; MU Xin; GUO Yi-hong; ZHANG Jian-yu; LI Yi-ning

doi:10.13263/j.cnki.nja.2018.02.008

Abstract：Objective:To explore the strategies of preserving urinary continence in transurethral plasmakinetic enucleation of the prostate (PKEP) for benign prostate hyperplasia (BPH).Methods:We treated 65 BPH patients by PKEP with preservation of urinary continence (UC-PKEP),which involved protection of the external urethral sphincter in the beginning of surgery,proper preservation of the anterior lobe of the prostate to protect the internal urethral sphincter in the middle,and preservation of the integrity of the bladder neck towards the end.We compared the postoperative status of urinary continence of the patients with that of the 54 BPH cases treated by complete plasmakinetic enucleation of the prostate (Com-PKEP).Results:All the operations were performed successfully with the urinary catheters removed at 5 days after surgery.In comparison with Com-PKEP,UC-PKEP achieved evidently lower incidence rates of urinary incontinence at 24 hours (31.49％ vs 13.85％,P ＜ 0.05),1 week (18.52％ vs 4.62％,P ＜ 0.05),2 weeks (14.81％ vs 3.08％,P ＜0.05),1 month (3.70％ vs 1.54％,P ＞0.05),and 3 months (3.70％ vs0％,P ＞0.05) after catheter removal.Compared with the baseline,the maximum urinary flow rate (Qmax) was significantly improved postoperatively in both the Com-PKEP ([7.43 ± 3.26] vs [20.58 ± 3.22] ml,P ＜0.05) and the UC-PKEP group ([8.04 ± 2.28] vs [20.66 ± 3.08] ml,P ＜ 0.05).Conclusion:Transurethral PKEP is a safe and effective method for the management of BPH,during which the strategies of avoiding blunt or sharp damage to the external urethral sphincter in the beginning,properly preserving the anterior lobe of the prostate in the middle and preserving the integrity of the bladder neck towards the end may help to achieve rapid recovery of urinary continence.