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Objective:To investigate the effect of transurethral prostatectomy (TURP) on patients with detrusor underactivity (DU).Methods:From January 2015 to January 2019, 72 male patients from Peking University People’s hospital who underwent TURP treatment were retrospectively analyzed. The age of all patients range from 51 to 89, with an average age of 72 years old. All patients underwent urodynamic examination before surgery. The patients were divided into three groups according to BCI and P detQmax. DU group(BCI<100 and P detQmax≤40 cmH 2O) consisted of 31 patients. Then DU patients were divided into two groups according to the P detQmax: Group A, P detQmax≤20 cmH 2O, involving 9 patients; Group B, 20 cmH 2O<P detQmax≤40 cmH 2O, involving 22 patients. Non-DU group(BCI≥100 and 40 cmH 2O<P detQmax≤60 cmH 2O), also named the control GroupC, included 41 patients. There was no statistically significant difference in term of age and duration of disease among the three groups ( P<0.05). Preoperative international prostate symptom scores(IPSS)of the three groups were(26.40±5.54), (21.04±4.61)and(18.53±4.41), respectively. The quality of life score (QOL) were(4.70±1.34), (3.37±1.11)and(3.49±1.34), respectively. The Q max were(4.60±2.63), (8.48±2.47)and(11.38±4.00)ml/s, respectively. The residual urine volume (PVR) were(152.90±75.26), (90.78±51.97)and(53.23±38.98)ml, respectively. The preoperative IPSS and QOL of patients in group A were significantly higher than those in group B and group C, and the difference was statistically significant ( P<0.05), whereas the difference between group B and group C was not statistically significant ( P>0.05). The preoperative Q max of group A was significantly inferior than that of group B and C, with statistically significant difference ( P<0.05) and group B was significantly inferior than group C, with statistically significant difference ( P<0.05). The preoperative PVR of group A was significantly higher than that of group B and group C, with statistically significant difference ( P<0.05)and group B was significantly higher than group C, with statistically significant difference ( P<0.05). The above indicators were followed up to compare the improvement for the three groups of patients. Seventy-two patients were followed up for free Q max(fQ max) PVR, IPSS and QOL score from March 2019 to June 2019. Results:The 72 patients were followed up for 3 to 52 months, with an average of 31.1 months. Postoperative IPSS of the three groups were(25.50±2.84), (16.78±4.04)and(14.98±3.41), respectively. The QOL were (2.90±1.29), (2.67±0.88)and(2.53±0.92), respectively. The fQ max was (5.44±2.60), (10.30±3.68)and(13.07±3.51) ml/s, respectively, and PVR was(104.00±46.00), (76.81±46.74)and(35.64±26.17)ml, respectively. Compared with the preoperative parameters, QOL in group A was significantly improved, with statistically significant difference ( P<0.05) and the IPSS, fQ max and PVR in group A were improved, but the difference was not statistically significant ( P>0.05). The IPSS, QOL, fQ max and PVR in group B and C were significantly improved compared with the preoperative parameters, and the difference was statistically significant ( P<0.05). Conclusions:The subjective and objective indicators of DU patients can be improved after TURP, while for those patients whose P detQmax≤20 cmH 2O, only QOL can be improved significantly, and the other indicators can not be improved. Therefore, adequate communication should be made before surgery to inform reasonable expectations for the DU patients.
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Objective:To evaluate the effect of transurethral resection of the prostate on nocturia and sleep quality in men with benign prostatic hyperplasia.Methods:This retrospective study included 122 patients who underwent TURP(transurethral resection of the prostate) for BPH(benign prostatic hyperplasia)from December 2016 to December 2018.The age was(69.7±7.9)years old. There was 20 cases with diabetes and 40 cases with hypertension. The preoperative mean prostate volume was (64.4±41.2)ml and mean BMI was (24.3±2.7)kg/m 2. The preoperative IPSS score was (20.5±5.5) points, the number of nocturia events(assessed by the seventh question of IPSS) was (4.4±1.9) times, hours of undisturbed sleep (HUS) was (1.7±1.0) h, 110 cases with HUS <3 h; nocturia quality-of-life questionnaire (N-QOL) was (24.9±6.3) points, quality of life (QOL) was (4.4±0.9) points. 111 patients had the urodynamic examination done. The maximum urine flow rate was (6.4±3.1) ml/s, the maximum bladder volume was (318.5±83.6) ml, the residual urine volume was (153.9±158.9) ml, and the maximum detrusor pressure was (78.4±35.5)cmH 2O.Detrusor muscle strength decreased in 27 cases, 18 cases had OAB, 9 cases of effective bladder capacity declined and 60 cases had bladder outlet obstruction. 42 cases had an effective bladder volume <200 ml, of which 33 had a maximum bladder capacity >200 ml with nocturia (4.5±1.9) times, 9 cases had a maximum bladder capacity ≤200 ml with nocturia (4.7±1.7) times. All 122 patients were treated with TURP. Result:122 patients were followed up for 3-20 months. After operation the number of nocturia significantly decreased to (1.9±1.23) times ( P<0.05), HUS significantly improved to(3.4±1.3) h ( P<0.05), and 91 cases had HUS ≥3 with 82.7% remission rate; N-QOL significantly improved to (37.3±6.7) points ( P<0.05), IPSS significantly decreased to (4.9±4.2) points ( P<0.05), and QOL significantly decreased (0.8±0.9) points ( P<0.05). 121 patients had nocturia ≥2 voids before surgery, and 96 patients had improved (≥50% reduction of nocturnal frequency). There were 68 patients with nocturia ≥2 voids after operation with total score of preoperative IPSS (21.8±5.3), and 54 patients with nocturia <2 voids with total score of preoperative IPSS (19.2±5.5)( P<0.05). Patients with a effective bladder capacity less than 200 ml were divided into a group with a maximum bladder volume ≤200 ml and a group with a maximum bladder capacity>200 ml. The nocturia did not improve significantly after surgery ( P>0.05) in the group with a maximum bladder volume ≤200 ml, and the nocturia in the group with a maximum bladder capacity >200 ml had significantly improvement ( P<0.05). The group with a maximum bladder capacity ≤200 ml had nocturia (3.4±1.5) times after surgery, which was no significant different from that before surgery ( P=0.12); nocturia (1.9±1.1) times after operation in the group with maximum bladder volume>200 ml, and there was significant difference compared with before surgery ( P<0.05). Conclusion:TURP can significantly prolong the HUS of BPH patients with nocturia, and improve the life and sleep quality of patients. TURP partly reduces the number of nocturia, but some patients still suffer from nocturia after operation. The high total score of IPSS before operation and the maximum bladder volume ≤200 ml are the risk factors for nocturia after operation.
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Objective To evaluate the value of the prostate imaging reporting and data system version 2 (PI-RADS version 2) for the diagnosis of prostate cancer.Methods A total of 243 patients who underwent multiparametric 3T prostate MRI followed by prostate biopsy or radical prostatectomy were included.111 patients were in PSA gray zone(4.0-10.0 ng/ml).PI-RADS version 2 scores for each patient was assigned by two readers independently.Reference standard was obtained by histopathology.Positive predictive value (PPV) for prostate cancer and clinically significant cancer were compared among patients with different PI-RADS Version 2 scores using chi-square trend test.Receiver operating characteristic (ROC) curve was performed to assess diagnostic accuracy of the PI-RADS version 2 scores for prostate cancer detection,and evaluate the difference in diagnostic efficiency between transition zone and peripheral zone.Results Two hundred and eighty five suspicious foci from the 243 patients were finally recruited to this study,131 of which were diagnosed as prostate cancer according to pathology.There was significant difference in PPV for prostate cancer and clinically significant cancer among patients with different PI-RADS version 2 scores (score 1:8.0％;score 2:10.1％;score 3:49.2％;score 4:61.1％ score 5:87.9％,P＜0.01),(score 1:0;score 2:5.1％;score 3:31.1％;score 4:59.3％ score 5:88.9％,P ＜ 0.01).When PI-RADS version 2 score was 3,Youden index was maximum (0.53),the sensitivity was 92.4％ and the specificity was 61.0％.The ROC analysis revealed that the area under the curve (AUC) of prostate cancer incidence in transition zone was similar to that in peripheral zone with 0.86(95％ CI 0.78-0.95) vs.0.83(95％ CI 0.77-0.89).There were 111 patients in PSA gray zone,33 of whom were diagnosed as prostate cancer.If we used PI-RADS version 2 score 3 as the cut-off point,47 out of 111 patients would avoid unnecessary prostate biopsies with 4 misdiagnosed nonsignificant prostate cancer.Conclusions The value of PI-RADS version 2 score is positively associated with PPV for prostate cancer.PI-RADS version 2 seems to have good diagnostic accuracy in prostate cancer detection.Clinical application of PI-RADS version 2 may help to reduce the number of unnecessary biopsy.