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OBJECT: To evaluate the effectiveness of selective bipolar plasmakinetic technology based on bladder irrigation fluid color on hemostasis in HoLEP surgwery METHODS: A total of 209 patients who underwent HoLEP surgery from October 2021 to July 2023 were included and divided into Hemostasis Management Group and control group. the color of the irrigation fluid was categorized into 5 levels and the bipolar plasmakinetic technology was applied when the color came to level 4 or up. The following was analyzed: postoperative use of balloon compression, blood loss, irrigation time, length of hospital stay, and the number of a second operation. RESULTS: Only 4 patients in Hemostasis Management Group required postoperative urinary catheter balloon compression, while there are 15 in the control group(p=0.03). The average irrigation time for patients in the HM Group with bipolar plasmakinetic hemostasis was 21.88±13.76 hours, compared to that in patients with catheter balloon compression(p=0.007). CONCLUSION: Based on the bladder irrigation color chart, the selective application of bipolar plasmakinetic hemostasis led to a significant reduction in the number of patients requiring postoperative bladder catheter balloon compression. Secondly, the irrigation time of patients who underwent bipolar plasmakinetic hemostasis also decreased.

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OBJECTIVES: To evaluate the feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate (B-TUERP) in day surgery. METHODS: From January 2021 to August 2022, 34 patients with benign prostatic hyperplasia (BPH) underwent B-TUERP in day surgery in the First Affiliated Hospital of Anhui Medical University. Patients completed the screening and anesthesia evaluation before admission and received the standard surgery which implements "anatomical enucleation of the prostate" and "absolute bleeding control" on the same day of admission, and by the same doctor. Bladder irrigation was stopped, catheter was removed and the discharge evaluation was performed on the first day after operation. The baseline data, perioperative conditions, time of recovery, treatment outcomes, hospitalization costs, and postoperative complications were analyzed. RESULTS: All operations were successfully conducted. The average age of the patients was (62.2±7.8) years, average prostate volume was (50.2±29.3) mL. The average operation time was (36.5±19.1) min, the average hemoglobin and blood sodium were decreased by (16.2±7.1) g/L and (2.2±2.0) mmol/L, respectively. The average postoperative length of hospital stay, and total length of hospital stay were (17.7±2.2) and (20.8±2.1) h, respectively, and the average hospitalization cost was (13 558±2320) CNY. All patients were discharged on the day after surgery except for one patient who was transferred to a general ward. Three patients received indwelling catheterization after catheter removal. The 3-month follow-up results showed a substantial improvement in the International Prostate Symptom Score, quality of life score and maximum urinary flow rate (all P<0.01). Three patients experienced temporary urinary incontinence, 1 patient experienced urinary tract infection, 4 patients were diagnosed with urethral stricture and 2 patients experienced bladder neck contracture. No complications above Clavien grade Ⅱ occurred. CONCLUSIONS: The preliminary results showed that B-TUERP ambulatory surgery is a safe, feasible, economical and effective treatment for appropriately selected patients with BPH.

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【Objective】 To explore the efficacy of transurethral columnar balloon dilation of prostate (TUCBDP) and transurethral bipolar plasmakinetic resection of prostate (TUPKP) for patients with small volume (≤30 mL) benign prostatic hyperplasia (BPH) and the effects on urinary control and sexual function. 【Methods】 Clinical data of BPH patients who underwent surgical treatment during Jun.2021 and Jan.2022 were reviewed. A total of 95 patients with prostate volume ≤30 mL and regular sexual life were selected as subjects, including 45 patients who received TUCBDP as the TUCBDP group and 50 patients who received TUPKP as the TUPKP group. The patients were followed up for 12 months, and the perioperative data and follow-up results were analyzed. 【Results】 The TUCBDP group had shorter operation time, less intraoperative blood loss, less postoperative hemoglobin loss and sodium concentration loss, shorter bladder irrigation time, lower pain score, shorter urinary tube indwelling time and shorter hospital stay than the TUPKP group (P0.05). The TUPKP group had worse ejaculation function score and ejaculation disturbance score after surgery (P0.05), and the two indexes were superior in the TUCBDP group than in the TUPKP group. The TUCBDP group had significantly lower complication rate than the TUPKP group (P<0.05). 【Conclusion】 TUCBDP is safe and effective in the treatment of small volume (≤30 mL) BPH, less trauma, less biochemical interference, less pain, fewer complications, and shorter course of disease. It has little effect on the ejaculation function and erectile function, and is more suitable for patients requiring retention of sexual function. It has a good application prospect in the treatment of small volume BPH.

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OBJECTIVES@#To evaluate the feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate (B-TUERP) in day surgery.@*METHODS@#From January 2021 to August 2022, 34 patients with benign prostatic hyperplasia (BPH) underwent B-TUERP in day surgery in the First Affiliated Hospital of Anhui Medical University. Patients completed the screening and anesthesia evaluation before admission and received the standard surgery which implements "anatomical enucleation of the prostate" and "absolute bleeding control" on the same day of admission, and by the same doctor. Bladder irrigation was stopped, catheter was removed and the discharge evaluation was performed on the first day after operation. The baseline data, perioperative conditions, time of recovery, treatment outcomes, hospitalization costs, and postoperative complications were analyzed.@*RESULTS@#All operations were successfully conducted. The average age of the patients was (62.2±7.8) years, average prostate volume was (50.2±29.3) mL. The average operation time was (36.5±19.1) min, the average hemoglobin and blood sodium were decreased by (16.2±7.1) g/L and (2.2±2.0) mmol/L, respectively. The average postoperative length of hospital stay, and total length of hospital stay were (17.7±2.2) and (20.8±2.1) h, respectively, and the average hospitalization cost was (13 558±2320) CNY. All patients were discharged on the day after surgery except for one patient who was transferred to a general ward. Three patients received indwelling catheterization after catheter removal. The 3-month follow-up results showed a substantial improvement in the International Prostate Symptom Score, quality of life score and maximum urinary flow rate (all P<0.01). Three patients experienced temporary urinary incontinence, 1 patient experienced urinary tract infection, 4 patients were diagnosed with urethral stricture and 2 patients experienced bladder neck contracture. No complications above Clavien grade Ⅱ occurred.@*CONCLUSIONS@#The preliminary results showed that B-TUERP ambulatory surgery is a safe, feasible, economical and effective treatment for appropriately selected patients with BPH.

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OBJECTIVE: To explore the application prospect and clinical efficacy of transurethral plasmakinetic enucleation of the Giant prostatic hyperplasia. METHODS: The clinical data of 5 patients with Giant prostatic hyperplasia treated by transurethral plasmakinetic enucleation in our department from december 2021 to january 2023 were retrospectively analyzed. RESULTS: All 5 patients successfully completed the operation, aged 69－80 years (73.2±4.32),PSA level was 8.07～42.90ng/ml (22.81±13.97), prostate volume was 321.05－534.26g (388.34±84.26), enucleation time was 120－240 min (174±61.48), Gland processing time 40－120 min（63±32.71). There were 1 case of perforation of prostate capsule and severe hematuria，3 cases of blood transfusion. 2 cases of transient urinary incontinence were improved after 2 weeks and 4 months postoperative respectively. International Prostate Symptom Score (IPSS),and quality of life score (QoL) and Maximum urine flow rate(Qmax) were significantly improved compared with preoperative parameters. CONCLUSION: It is safe and effective to treat GPH with plasma enucleation through urethra with skilled plasma enucleation technique.

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BACKGROUND: Benign prostatic hyperplasia (BPH) is a common chronic progressive disease resulting in urinary obstruction in aging men. It comes to more and more patients with massive BPH with the aging of society and extension of life expectancy. OBJECTIVE: The aim of the study was to compare the clinical efficacy, safety, and complications between transurethral bipolar plasmakinetic enucleation of the prostate (PKEP) and transurethral resection of the prostate (TURP) in the treatment of massive BPH. DESIGN AND SETTING: Patients with BPH were divided into the PKEP group and the TURP group randomly. Intraoperative blood loss (BL), operation time (OT), resected tissue weight (RTW), gland resection ratio (GRR), postoperative indwelling ureter time (IUT), bladder fistula time (BFT) and hospital stay time (HST), preoperative and postoperative serum sodium concentration (SSC), hemoglobin concentration (HGB), prostate weight (PW), postvoid residual (PVR), maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QOL), International Index of Erectile Function (IIEF), and other complications were analyzed and compared respectively. RESULTS: There was no statistical difference in preoperative IPSS, preoperative QOL score, preoperative PVR, preoperative Qmax, postoperative QOL score, postoperative PVR, postoperative Qmax, IPSS difference value (DV), Qmax DV, and PVR DV between the PKEP group and the TURP group (p > 0.05). OT, BL, IUT, BFT, HST, and postoperative IPSS in the PKEP group were significantly lower than that in the TURP group (p < 0.01). RTW and GRR in the PKEP group were significantly higher than that in the TURP group (p < 0.01). QOL DV in the PKEP group was higher than that in the TURP group (p < 0.05). There was statistical difference in SSC DV between the PKEP group and the TURP group (p < 0.05). There was significant statistical difference in postoperative PW, postoperative HGB, PW DV, and HGB DV between the PKEP group and the TURP group (p < 0.01). There was significant statistical difference in IPSS, QOL, PVR, and Qmax between postoperative value and preoperative value in both groups (p < 0.01). The incidence of transurethral resection syndrome, obturator nerve reflex, transient urinary incontinence, and retrograde ejaculation between the PKEP group and the TURP group has no statistical difference (p > 0.05). Capsule perforation, blood transfusion, secondary hemorrhage, bladder neck contracture, and urethral stricture in the PKEP group were lower than that in the TURP group (p < 0.05). Bladder spasm in the PKEP group was significantly lower than that in the TURP group (p < 0.01). There was no statistical difference in preoperative and postoperative IIEF-5, effective erectile frequency, telotism average tension, sustainable telotism average time, and sexual dissatisfaction between the PKEP group and the TURP group (p > 0.05). CONCLUSIONS: PKEP and TURP have similar clinical efficacy in the treatment of massive BPH. PKEP has advantages in shorter OT, less BL, more GRR, and fewer complications, but the long-term therapeutic effect of PKEP needs further follow-up.

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Objectives: To compare the safety and efficacy of holmium laser enucleation of prostate (HoLEP) vs bipolar plasmakinetic resection of prostate (BPRP) in the management of large-sized (≥75 g) benign prostatic hyperplasia (BPH). Methods: This randomized-controlled trial recruited 145 symptomatic BPH patients who had failed medical management, and who had undergone either HoLEP (Versa pulse® 100 W; n = 73) or BPRP (AUTOCON® II 400 ESU; n = 72). Both groups were compared using the Mann-Whitney, chi-square, Student-t, or Fisher exact tests as appropriate. Preoperative vs postoperative findings (24 months) were compared using paired t-test or Wilcoxon signed-rank test. Results: The two groups were comparable for most preoperative findings including prostate size (p = 0.629), although HoLEP included more patients on anticoagulants (p = 0.001). HoLEP was associated with significantly less operative duration (p < 0.001), hemoglobin loss (p < 0.001), catheterization duration (p = 0.009), and hospital stay (p < 0.001). There was no significant difference in total complications (p = 0.291) and each separate complication. Blood transfusion was reported only with BPRP (p = 0.058). At 24 months of follow-up, there was significant improvement in all the parameters in each group (International Prostate Symptom Score [IPSS], maximum urinary flow rate [Qmax], quality of life [QoL], and postvoid residual urine [PVRU]; p < 0.001). There was no significant difference between both groups in postoperative IPSS (p = 0.08), Qmax (p = 0.051), QoL (p = 0.057), or PVRU (p = 0.069). There was significantly better percentage improvement of both IPSS (p = 0.006) and QoL (p = 0.025) in HoLEP. HoLEP and smaller removed (resected or enucleated) tissues were associated with a reduction in the primary outcomes (hemoglobin loss and operative duration) in logistic regression analysis. Conclusion: HoLEP showed better safety profile with significantly less operative duration, hemoglobin loss, hospital stay, and catheterization duration. Although both procedures were effective, HoLEP showed significantly better percentage improvement of both IPSS and QoL. ClinicalTrials.gov Identifier: NCT04143399.

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OBJECTIVE: To evaluate the clinical application of the endoscopic surveillance system (ESS) in transurethral bipolar plasmakinetic resection of the prostate (TUPKRP). METHODS: We retrospectively analyzed 136 cases of TUPKRP performed with the assistance of ESS from September 2018 to March 2019. According to the prostate volume (PV), we divided the patients into a PV ≥ 60 ml and a PV < 60 ml group, and compared the surgery-related parameters between the two groups of patients. RESULTS: Operations were successfully completed in all the 136 cases. Statistically significant differences were observed between the PV ≥ 60 ml and a PV < 60 ml groups in the operation time (ï¼»78.93 ± 28.63ï¼½ vs ï¼»51.77 ± 14.85ï¼½ min, P < 0.05), intraoperative blood loss (ï¼»261.61 ± 204.25ï¼½ vs ï¼»69.26 ± 61.13ï¼½ ml, P < 0.05) and absorption of the rinse fluid (ï¼»948.20 ± 656.00ï¼½ vs ï¼»347.39 ± 256.53ï¼½ ml, P < 0.05), but not in the postoperative red cell count, levels of hemoglobin, hematocrit and ions, hospital stay, incidence of prostatic perforation or blood transfusion (P > 0.05). The patients also showed statistically significant differences between the baseline and postoperative parameters in red cell count (ï¼»4.62 ± 0.63ï¼½ vs ï¼»4.31 ± 0.74ï¼½ ×1012/L, P < 0.05) and levels of hemoglobin (ï¼»141.83 ± 18.30ï¼½ vs ï¼»135.20 ± 19.91ï¼½ g/L, P < 0.05), K+ (ï¼»4.01 ± 0.43ï¼½ vs ï¼»3.92 ± 0.54ï¼½ mmol/L, P < 0.05) and Na+ (ï¼»141.90 ± 3.11ï¼½ vs ï¼»139.42 ± 3.81ï¼½ mmol/L, P < 0.05), but not in the levels of Cl－ (ï¼»103.74 ± 9.32ï¼½ vs ï¼»103.70 ± 4.50ï¼½ mmol/L, P > 0.05) and Ca2+ (ï¼»2.21 ± 0.13ï¼½ vs ï¼»2.19 ± 0.21ï¼½ mmol/L, P > 0.05). CONCLUSIONS: Large-volume absorption of rinse fluid may overburden the circulatory system and induce left ventricular failure, pulmonary edema or massive bleeding during PKRP for patients with PV ≥ 60 ml due to long operation time and rich blood supply in the hyperplasia gland. The endoscopic surveillance system can provide real-time data on the absorption of rinse fluid and bleeding, reduce complications, and improve surgical safety.

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OBJECTIVE: To investigate the effect of intraoperative lithotomy position (LP) with a head-down tilt (HDT) on the absorption of intraoperative irrigation fluid in patients undergoing bipolar plasmakinetic resection of the prostate (PKRP). METHODS: Eighty BPH patients underwent PKRP, 40 in a conventional 0-degree position (0° LP) and the other 40 in a －10-degree HDT position (－10° LP), with 0.9% saline containing 1% ethanol as intraoperative irrigation fluid. We determined the alcohol concentration in the exhaled breath of the patients with a digital alcohol detector at the start of the operation and every 10 minutes afterwards. Meanwhile we recorded the operation time, the volume of intraoperative intravenous crystalloid infusion and the weight of the resected prostatic tissue, monitored the mean arterial pressure (MAP) and heart rate (HR) at 5 minutes before surgery, 30 minutes after the start of surgery and the end of surgery, and measured the concentrations of Na+, K+, Cl－ and Ca2+ with an arterial blood gas analyzer at 5 minutes before surgery and 1 hour after the start of surgery. RESULTS: There were no statistically significant differences in age, height, body weight and prostate volume, or in intraoperative MAP and HR between the 0° LP and －10° LP groups. Compared with the baseline, at 1 hour after the start of PKRP, the patients in the 0° LP group showed significantly decreased concentrations of K+ (ï¼»3.64 ± 0.29ï¼½ vs ï¼»3.49 ± 0.22ï¼½ mmol/L, P = 0.002) and Ca2+ (ï¼»1.16 ± 0.03ï¼½ vs ï¼»1.13 ± 0.04ï¼½ mmol/L, P = 0.001), increased concentration of Cl－ (ï¼»106.9 ± 2.2ï¼½ vs ï¼»108.7 ± 2.3ï¼½ mmol/L, P = 0.006), but no significant difference in the concentration of Na+ (ï¼»139.7 ± 1.5ï¼½ vs ï¼»139.4 ± 1.6ï¼½ mmol/L, P = 0.231), while those in the －10° LP group exhibited remarkably decreased concentration of Ca2+ (ï¼»1.14 ± 0.04ï¼½ vs ï¼»1.13 ± 0.04ï¼½ mmol/L, P = 0.016) but no statistically significant differences in the concentrations of Na+ (ï¼»140.3 ± 1.8ï¼½ vs ï¼»140.0 ± 2.0ï¼½ mmol/L, P = 0.156), K+ (ï¼»3.49 ± 0.36ï¼½ vs ï¼»3.47 ± 0.34ï¼½ mmol/L, P = 0.506) and Cl－ (ï¼»108.2 ± 2.6ï¼½ vs ï¼»109.1 ± 2.5ï¼½ mmol/L, P = 0.071). Over 1 500 ml of intraoperative irrigation fluid absorption was observed in 6 cases (15%) in the 0° LP group as compared with 4 cases (10%) in the －10°LP group, with no significant difference between the two groups. CONCLUSIONS: Lithotomy position with a 10-degree head-down tilt can reduce PKRP-induced decrease in the concentration of K+ and increase in that of Cl－ without affecting the levels of the other electrolytes.

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Objective: To evaluate the hemostasis and coagulation effect of Hemocoagulase Bothrops Atrox in benign prostatic hyperplasia (BPH) patients undergoing transurethral bipolar plasmakinetic prostatectomy (TUPKP). Methods: This study adopted a multicenter, prospective, and real world design. BPH patients undergoing TUPKP were divided into two groups according to whether they adopted Hemocoagulase Bothrops Atrox (group B) or not (group A) during perioperative period. The electronic clinical data on every included subject, including the international prostate symptom score (IPSS) and the quality of life scale (QoL), maximum urinary flow rate (Qmax), complete blood count, coagulation screening test and adverse events, were measured and compared between the two groups. Results: Finally, 695 patients, 443 in group A and 252 in group B were included. Baseline characteristics showed no significant difference between two groups. In group A, compared with baseline, IPSS decreased 15.66 (95% CI = -16.45 to -14.87), QoL decreased 3.08 (95% CI = -3.30 to -2.87), prothrombin time prolonged 1.02 s (95% CI = 0.56 to 1.48), while white blood cells, neutrophils, lymphocytes, and hemoglobin also significantly changed; white blood cells, neutrophils and platelets increased, while lymphocytes decreased by 0.14×109/L (95% CI = -0.21 to -0.08) before discharge. In group B, compared with baseline, IPSS decreased 16.12 (95% CI = -17.02 to -15.21), QoL decreased 3.32 (95% CI = -3.56 to -3.07), and white blood cells, neutrophils, lymphocytes, and hemoglobin were also significantly changed, along with white blood cells and lymphocytes that tested before discharge (p < 0.01); however, prothrombin time was not significant prolonged (MD= 0.48, 95% CI = -0.05 to 1.01). When compared with group A and group B, the average hospitalization time in group A was longer than group B (p < 0.01), transfusion risk was similar in the two groups (OR = 1.582, 95% CI = 0.552 to 4.538). Parameters had no substantial difference between the two subgroups whether prostate volume was more than 80 mL or not. Conclusion: Our study indicated that Hemocoagulase Bothrops Atrox can shorten the prothrombin time, hospitalization time and is probably safe among BPH patients undergoing TUPKP, exhibiting fine hemostasis and coagulation efficacy, and would not be influenced by prostate volume.

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Objective: To evaluate the effectiveness and safety of transurethral bipolar plasmakinetic prostatectomy in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China. Methods: The PubMed, Cochrane Library, CBM, CNKI and WanFang databases were searched with computer for collecting relevant interventional case series from establishment dates to September 14, 2018. After quality evaluation and data extraction independently conducted by two authors, the Meta-analysis was performed using the Comprehensive Meta-analysis V2 software. Results: Eighteen studies involving 1 899 patients are included. Maximum flow rate increased to 12.28 ml/s (95%CI: 8.42-16.14), 12.88 ml/s (95%CI: 9.85-15.92) ,14.32 ml/s (95%CI: 10.47-18.18), 14.93 ml/s (95%CI: 10.19-19.67) and 20.00 ml/s (95%CI: 19.08-20.92) in 1, 3, 6, 12 and 24 months after surgery, respectively. International prostate symptom score decreased to -18.60 (95%CI: -23.20--14.00), -17.62 (95%CI: -20.21--15.03), -19.14 (95%CI: -20.70--17.59), -19.06 (95%CI: -21.53--16.60) and -22.90 (95%CI: -24.26--21.54), respectively. Quality of life decreased to -2.38 (95%CI: -4.26--0.50), -3.39 (95%CI: -4.57--2.21),-3.75 (95%CI: -4.14--3.36), -3.36(95%CI: -4.56--2.16), and -4.58(95%CI: -4.75--4.41). Post void residual decreased to -231.16 ml (95%CI: -288.30--174.01), -76.10 ml (95%CI: -116.71--35.50), -159.90 ml(95%CI: -207.21--112.59) and -87.70 ml (95%CI: -91.91--83.48). The event rate of postoperative adverse reactions all were not high. Conclusion: Transurethral bipolar plasmakinetic prostatectomy has better clinical efficacy and no obvious side effects in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China.

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OBJECTIVE: To investigate the influence of plasmakinetic energy transurethral resection of the prostate (PKRP) versus that of transurethral bipolar plasmakinetic enucleation and resection of the prostate (PKERP) on the bladder function, sexual function and incidence of complications in BPH patients with the prostate volume <100 ml. METHODS: We randomly assigned 140 BPH patients with the prostate volume <100 ml to receive PKRP (n = 70) or PKERP (n = 70) in our hospital from July 2013 to July 2015. We compared the maximum urinary flow rate (Qmax), residual urine volume (RUV), and the rates of ED and retrograde ejaculation before and after surgery as well as the incidence of postoperative complications between the two groups of patients. RESULTS: The Qmax and RUV of the patients were (25.11 ± 7.12) ml/s and (4.06 ± 1.74) ml in the PKERP group postoperatively, significantly improved as compared with the baseline (ï¼»8.60 ± 2.33ï¼½ ml/s and ï¼»66.85 ± 14.33ï¼½ ml, P < 0.05), and even better than (18.87 ± 4.07) ml/s and (9.45 ± 2.66) ml in the PKRP group (P < 0.05). The incidence rates of ED and retrograde ejaculation were 61.43% and 28.57% in the PKRP group, significantly higher than in the PKERP group (40.00% and 14.29%) (P < 0.05) and the baseline (35.71% and 10.00%) (P < 0.05). The postoperative incidence rate of transient urinary incontinence was remarkably higher in the PKERP than in the PKRP group (22.86% vs 8.57%, P < 0.05). There were no statistically significant differences between the two groups in the incidence rates of secondary hemorrhage, urethral injury, or genuine urinary incontinence after operation (P > 0.05). CONCLUSIONS: Compared with PKRP, PKERP can effectively improve the clinical symptoms and signs and protect the bladder function of the BPH patients with the prostate volume <100 ml, but may increase the risk of transient urinary incontinence.

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Objective To evaluate the safety and efficacy of transurethral frontfiring photoselective vaporesection for the treatment of cystitis glandularis,by comparing with the transurethral bipolar plasmakinetic resection.Methods From January 2014 to July 2016,41 patients with pathologically diagnosed cystitis glandularis in our hospital,were divided into two groups,including 22 cases underwent transurethral frontfiring photoselective vaporesection(the observation group),and the other 19 cases underwent transurethral bipolar plasmakinetic resection(the control group).All patients were regularly treated with postoperative intravesical instillation chemotherapy with pirarubicin.The clinical data of two groups were statistically analyzed to compare the differences of the safety and efficacy.Results All the surgeries were performed successfully.There were no statistical significances in perioperative data,the operation time,the decreased concentration of hemoglobin(Hb)and Na+,operative related complications, indwelling catheter duration and hospitalization duration between the two groups.The first-time cure rate and the effective rate of transurethral frontfiring photoselective vaporesection showed significantly better than those of transurethral bipolar plasmakinetic resection(P<0.05 for each).Conclusion Comparing the traditional transurethral bipolar plasmakinetic resection for the treatment of cystitis glandularis,tansurethral frontfiring photoselective vaporesection with postoperative intravesical instillation chemotherapy with pirarubicin,is a safer,simpler,and more effective method,which could be a new optional method in the conditional hospitals,deserving the worthy of clinical popularization.

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Objective To introduce the surgery procedure of pin-shaped bipolar plasmakinetic transurethral en bloc resection of non muscle-invasive bladder urothelial carcinoma and investigate the clinical outcomes.Methods 42 cases of non muscle-invasive bladder urothelial carcinoma who received bipolar plasmakinetic transurethral en bloc resection from May 2015 to March 2016 were recruited in the present study.Male 29 cases, female 13 cases, average age 52-82 years old, average (65.6 ±12.3) years old.Wide basal tumors were noticed by preoperative cystoscopy, bladder tumors were confirmed by tumor biopsy.Full-thickness specimens were obtained in procedures, including tumor, mucosa, lamina propria layer, muscular layer, to accurately assess tumor infiltration depth and staging.Results All 42 cases were done by this procedure successfully.A total of 65 pieces of tumors were excised:36 in lateral wall, 19 in posterior wall, 10 in bladder triangle.Tumor diameter ranged from 0.5 to 3.5 cm, with an average (2.1 ± 0.6) cm.Postoperative pathological stages were clear:16 cases were Ta stage and 49 cases were T1 stage ( of which 32 were T1 G3 ) .Intraoperative obturator nerve reflex happened in 2 cases.Followed up for 2-11 months, average 6 months.Tumor recurrence in 3 cases, no progression case.Conclusions Pin-shaped bipolar plasmakinetic electrode transurethral en bloc resection of non muscle-invasive bladder urothelial carcinoma is safe and reliable and should be recommended in management of non muscle-invasive bladder urothelial carcinoma.Full-thickness postoperative specimens can provide accurately judgement of the depth of tumor invasion and pathological staging.

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Objective To discuss the diagnosis and treatment of the postoperative acquired primary hyperfibrinolysis secondary to bipolar plasmakinetic transurethral resection of the prostate ( BP-TURP ) . Methods A case with benign prostatic hyperplasia was retrospectively reviewed, who was an 88-year-old patient admitted on 14th October, 2013 because of repeated urinary retention for 10 years, and catheter indwelling for 20 days.Blood pressure was 101/59 mmHg on admission (1 mmHg=0.133 kPa).Digital rectal examination showedⅡ°prostate, smooth surface, rubbery and no nodules.Routine blood showed the leucocyte 4.6 ×109/L, neutrophils 0.62, hemoglobin 108 g/L, red blood cells 3.30 ×1012/L, platelet 90 ×109/L.Preoperative coagulation function showed prothrombin time (PT) 12.8 s (10-14), activated clotting time live enzymes (APTT) 34.8 s (21 -37), fibrinogen (FiB-C) 2.38 g/L (2 -4), D-dimer 0.50 mg/L (0-0.55), fibrin degradation products (FDP) 2.0 mg/L ( <5.0).Abdominal ultrasound showed hyperplasia of prostate ( 52 mm ×46 mm ×37 mm ) , protruding into the bladder about 20 mm. Abdominal CT scanning showed bladder diverticulum and stones, hyperplasia of prostate and calcification. The operation time of BP-TURP was 90 min with no significant intraoperative bleeding, and continuous bladder irrigation drainage was clear.Results Four hours after the operation, continuous bladder irrigation drainage became bright red.Seven hours after operation, blood pressure was 83/56 mmHg, and blood routine showed white blood cells 8.1 ×109/L, neutrophils 0.92, red blood cells 2.93 ×1012/L, hemoglobin 95 g/L, platelet 67 ×109/L.Transfusion of 4.5 U red blood cell suspension was administered.The prostatic fossa hemorrhage was suspected and bleeding was not alleviated after adjusting the catheter.Prostatic fossa electro-coagulation hemostasis was performed and bladder neck obvious oozing of blood was detected intraoperatively, and no venous sinus bleeding or obvious blood clots were detected.Four hours after the secondary surgery, continuous bladder irrigation drainage became pink again, and the conservative treatment had no effect.Blood coagulation function showed PT 16.9 s, APTT 43.5 s, FiB-C 0.34 g/L, D-dimer 1.70 mg/L, FDP 57.4 mg/L.The patient was diagnosed as postoperative acquired primary hyperfibrinolysis, and repeat plasma, red blood cell suspension, and tranexamic acid transfusion was administered.Continuous bladder irrigation drainage gradually became clear.Blood coagulation function index gradually returned to normal.Routine urine test showed red blood cells ( microscopy ) 4 -5/HPF. Conclusions After BP-TURP, acquired primary hyperfibrinolysis may occur.The outcome is good after timely diagnosis and effective treatment.

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PURPOSE: To report the 5-year follow-up results of a randomized controlled trial comparing bipolar transurethral resection of the prostate (TURP) with standard monopolar TURP for the treatment of benign prostatic obstruction (BPO). MATERIALS AND METHODS: A total of 220 patients were randomized to bipolar plasmakinetic TURP (PK-TURP) or monopolar TURP (M-TURP). Catheterization time was the primary endpoint of this study. Secondary outcomes included operation time, hospital stay, as well as decline in postoperative serum sodium and hemoglobin levels. All patients were assessed preoperatively and followed-up at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Parameters assessed included quality of life, transrectal ultrasound, serum prostate-specific antigen level, postvoid residual urine volume, maximum urinary flow rates (Qmax), and International Prostate Symptom Score. Patient baseline characteristics, perioperative data including complications, and postoperative outcomes were compared. Complication occurrence was graded according to the modified Clavien classification system. RESULTS: PK-TURP was significantly superior to M-TURP in terms of operation time, intraoperative irrigation volume, resected tissue weight, decreases in hemoglobin and sodium, postoperative irrigation volume and time, catheterization time, and hospital stay. At 5 years postoperatively, efficacy was comparable between arms. No differences were detected in safety outcomes except that the clot retention rate was significantly greater after M-TURP. CONCLUSION: Our results indicate that PK-TURP is equally as effective in the treatment of BPO, but has a more favorable safety profile in comparison to M-TURP. The clinical efficacy of PK-TURP is long-lasting and comparable with M-TURP.

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Objective To evaluate the perioperative nursing of transurethral bipolar plasmakinetic resection of prostate(TUPKRP).Methods One hundred and thirty BPH patients underwent transurethral prostatectomy with the bipolar plasmakinetic technique.All patients received preoperative mental nursing,holistic nursing care and health education before operation.Results All patients passed through the surgery and were given nursing intervention.They were discharged after rehabilitation.Conclusions TUPKRP is an important miro-invasion operation for treatment of BPH.The important points are preoperative mental nursing,rational use of drug,postoperative bladder irrigation and prevention of hemorrhage.

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Objective To evaluate the efficacy and safety of transurethral plasmakinetic resection of the prostate(PKRP).Methods A total of 56 patients with symptomatic benign prostatic hyperplasia(BPH) underwent the PKRP.The weight of the prostate ranged 36~110 g(mean,50.3?26.4 g).All the patients were followed for 1~6 months postoperatively.Results The duration of the procedure was 25~100 min(mean,56?26 min),the weight of resected prostate was 10~89 g(mean,50?22 g),and the intraoperative blood loss,35~200 ml(mean,75?49 ml).No transurethral resection syndrome occurred.On 1,3,and 6 postoperative months of follow-up,the peak flow rate(Qmax) increased from 6.7?2.9 ml/s preoperatively to 17.4?5.1 ml/s,20.8?3.9 ml/s,and 21.6?4.6 ml/s,respectively,the international prostate symptom score(IPSS) decreased from 23.2?3.8 preoperatively to 6.9?1.7,6.1?2.1,and 5.9?1.5,respectively,and the quality of life(QOL) decreased from 5.7?1.5 preoperatively to 2.7?0.7,2.4?0.5,and 1.9?0.9,respectively.The differences between pre-and post-operative periods in the three indicators were all statistically significant(P

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Objective To assess the efficacy and safety of transurethral bipolar plasmakinetic resection of the prostate(TUPKRP) for the treatment of benign prostatic hyperplasia(BPH).Methods The operation was completed using a bipolar plasmakinetic resection system(CIRCON ACMI).Three trenches were created at 5,7,and 12 o'clock position,respectively,to divide the middle,left,and right lobes of the prostate gland for resection.The bladder neck was widened in overlapping vaporizing swathes to create a wide-necked funnel down to the level of the surgical capsule.The apical tissue was resected to the anterior border of the seminal colliculus.With a F_(20) or F_(22) three-cavity catheter indwelling for 3~5 d,normal saline irrigation was used for 1~2 d postoperatively.Results The duration of the procedure was 20~180 min(53.2?28.7 min),and resected tissue weighed 8~130 g(23.5?21.6 g).The intraoperative blood loss was 10~300 ml(65.4?46.8 ml) and no blood transfusion was required.No perforation of the prostatic capsule or transurethral resection syndrome occurred.The peak urinary flow rate(Qmax) increased from 8.4?1.9 ml/s preoperatively to 18.4?1.8 ml/s 1 month postoperatively(q=55.498,P﹤0.05).The residual urine(RU) decreased from 80.8?59.7 ml preoperatively to 19.5?10.0 ml postoperatively(q=17.287,P﹤0.05). The international prostate symptom score(IPSS) decreased from 25.7?5.5 preoperatively to 5.7?2.4 postoperatively(q=52.969,P﹤0.05).The scores of quality of life(QOL) decreased from 4.4?1.0 preoperatively to 1.1?0.2 postoperatively(q=42.146,P﹤0.05). Conclusions Transurethral bipolar plasmakinetic resection of the prostate for the treatment of benign prostatic hyperplasia is effective and safe,with few complications.

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Objective To assess the efficacy and safety of transurethral bipolar plasmakinetic resection of benign prostatic hyperplasia (BPH). Methods A total of 45 cases of BPH were treated by transurethral bipolar plasmakinetic resection of prostate (PKRP) and were followed up for 3-10 months.Results The weight of the resected prostate was 28-105 g with an average of (47?16) g, the operation time was 15-120 min with an average of (50?12) min. No case needed blood transfusion during the operation and no transurethral resection syndrome occurred. The mean catheterization time was 4 d and the mean postoperative hospital stay was 7 d. Peak urine flow increased from (7.3?1.5) ml/s to (16.2?4. 4) ml/s and IPSS decreased from (27.6?1.3) to (5.8?1.0) in 3 months postoperatively. Conclusion Transurethral bipolar plasmakinetic resection of prostate is effective and safe with less complications.