Micro-invasive treatment of bladder neck contracture following transurethral resection of prostate / 中华泌尿外科杂志

Objective:To investigated the efficacy and safety of transurethral bladder neck incision and laparoscopic modified bladder neck Y-V plasty in the treatment of bladder neck contracture (BNC)after transurethral resection of prostate (TURP).Methods:The clinical data of 57 patients with BNC after TURP who were treated in the Department of Urology, Sixth People's Hospital, Shanghai Jiaotong University School of Medicine from January 2013 to December 2022 were retrospectively analyzed.And the patients were divided into two groups based on the different surgical approaches. There were 22 cases in the transurethral bladder neck incision group, with an average age of (73.75±7.62) years and the preoperative urinary flow Q max of (3.92±2.73) ml/s. The preoperative International Prostate Symptom Score (IPSS) was (26.92±3.34) points, and the quality of life (QOL) score was (4.83±0.72) points. There were 35 cases in laparoscopic modified bladder neck Y-V plasty group, with an average age of (68.57±9.31) years and the preoperative urinary flow Q max of (2.56±1.27)ml/s. The preoperative IPSS was (27.08±3.06) points, and the QOL score was (5.08±0.84) points. The patients underwent transurethral bladder neck incision: Scar tissue was incised at 3, 9, and 12 o'clock in the bladder neck, and the incision depth reached the external fat of the bladder neck at 3 and 9 o'clock. Patients with significantly elevated bladder neck were treated with plasma electrosurgical resection to remove scar tissue. The patients underwent laparoscopic modified bladder neck Y-V plasty: After proper exposition of the bladder neck, the scar tissue was excised. the anterior bladder wall was incised in an inverted Y-shaped manner, the apex of the V-shaped flap was sutured to the distal urethrotomy to create a widened bladder neck. The postoperative urinary flow Q max, IPSS, and QOL of the two groups were compared. Results:All patients underwent surgeries successfully, with a one-time success rate of 94.3% (33/35) in the laparoscopic modified bladder neck Y-V plasty group, which was higher than the one-time success rate of 68.2% (15/22) in the transurethral bladder neck incision group( P<0.01). There were statistically significant difference in operation time [(31.75±12.81)min vs. (68.57±22.36)min] and postoperative hospital stay [(1.73±0.94)d vs. (5.17±2.12)d] between the transurethral bladder neck incision group and the laparoscopic modified bladder neck Y-V plasty group ( P<0.05). The median follow-up period was 12.6 (7.3, 27.8) months. The IPSS of the transurethral bladder neck incision group and the laparoscopic modified bladder neck Y-V plasty group were (9.92±2.56) points and (7.16±2.21) points, respectively. The QOL was (2.76±1.24) points and (1.31±0.95) points, respectively. The urinary flow Q max at 6 months after operation was (15.13±4.68)ml/s and (19.96±4.17)ml/s, respectively. There was statistical significance( P<0.05). Conclusions:Both laparoscopic modified bladder neck Y-V plasty and transurethral bladder neck incision are safe and effective in the treatment of BNC after TURP, and laparoscopic modified bladder neck Y-V plasty has a better clinical therapeutic effect.

Modified transurethral bladder neck incision in treatment of female bladder neck obstruction / 中国医师进修杂志

Objective To evaluate the effect of modified transurethral bladder neck incision in treatment of female bladder neck obstruction. Methods Sixteen female patients with bladder neck obstruction from March 2008 to May 2016 in Beijing Haidian Hospital were selected, and the patients were treated with modified transurethral bladder neck incision at the 3, 6 and 9-O′clock positions. The international prostate symptom score (IPSS), quality of life (QOL) and maximum urinary flow rate (Qmax) were evaluated before surgery and 1 year after surgery respectively. Results All 16 patients underwent successful operation, and the mean operation duration was 20 min, with the blood loss＜10 ml. The difficulty of urination after removing the catheter was significantly improved. Postoperative pathological results were chronic inflammatory changes with fibrous tissue proliferation. There was no complication such as urinary incontinence, vesico-vaginal fistula and urethral stricture after operation. The IPSS, QOL and Qmax after surgery were significantly improved compared with those before surgery: (6.43 ± 3.31) scores vs. (25.21 ± 4.71) scores, (1.41 ± 1.15) scores vs. (4.43 ± 1.36) scores and (15.36 ± 4.82) ml/s vs. (7.49 ± 2.27) ml/s, and there were statistical differences (P＜0.01). Conclusions The modified transurethral bladder neck incision is a safe and effective therapy for female bladder neck obstruction.

Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study

OBJECTIVE: Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS: A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”. RESULTS: Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS: The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique.

Comparison of two methods of transurethral surgical treatment for small size prostatic hyperplasia / 重庆医学

Objective To compare the effect of transurethral resection of prostate (TURP) and TURP combine with transure-thral incision of the bladder neck(TUIBN) in the treatment of small size prostate hyperplasia .Methods From March 2002 to Octo-ber 2010 ,124 cases of small-size prostate hyperplasia patients were treated .All patients were randomized to undergo TURP or TURP with TUIBN .There were 62 patients in TURP group .Of which ,54 cases were followed up .There were 62 patients in TURP plus TUIBN group .Of which ,50 cases were followed up .The treatment effect of the two different surgical methods was evaluated by comparing international prostate symptom (IPSS) ,maximum flow rate(Qmax) and post voiding residual urine volume(PVR) et al .Results No statistical difference (P>0 .05)was found in age ,medical histories ,prostatic weight ,IPSS ,Qmax ,PVR between the two groups before operation .But significant difference(P0 .05) in resected tissue weight and follow up between the two groups .The inci-dence rate of bladder neck contracture was 4% in TURP plus TUIBN group ,and it was significantly lower than that of TURP group(11% )(P< 0 .01) .Conclusion TURP plus TUIBN was better for the treatment of small size prostatic hyperplasia than TURP .

Comparison of Transurethral Resection of Prostate Plus Incision of Bladder Neck and Prostate with Transurethral Resection of Prostate in Patients with Benign Prostatic Hyperplasia / 대한남성과학회지

PURPOSE: We evaluated the effectiveness and complications of transurethral resection of the prostate plus incision of the bladder neck and prostate(TUR-P+I) and transurethral resection of the prostate(TUR-P). MATERIALS AND METHODS: We reviewed 101 patients with benign prostatic hyperplasia(BPH) who were randomized to TUR-P+I(N=78; Group I) or TUR-P(N=23; Group II) from December 2000 to March 2002. After TUR of the adenoma, the trigone, bladder neck, and surgical capsule of the prostate were incised with a pointed coagulating electrode at the 5- and 7-o'clock positions from the distal edge of the ureteral orifice to the verumontanum. Patients were evaluated at 1 month, 3 months, and 6 months after operation in terms of the change in International Prostatic Symptom Score(IPSS), peak urinary flow rate, and complications. RESULTS: The mean prostatic weight of Groups I and II was 40.5+/-15.5 g and 36.7+/-10.6 g, respectively. The operative time and resected prostatic weight of Group I were 59.0+/-23.8 min and 16.2+/-11.4 g and those of Group II were 64.1+/-27.5 min and 11.5+/-5.8 g. The postoperative complication rates were similar in the two groups. The preoperative IPSS symptom score and peak urinary flow rate were 22.4+/-6.4 and 9.8+/-5.4 mL/sec, respectively, in Group I and 23.7+/-7.6 and 9.3+/-4.4 mL/sec in Group II. The 1-, 3-, and 6-month IPSS were 13.2+/-6.0, 10.1+/-5.1, and 9.2+/-4.8 in Group I and 13.2+/-5.0, 10.1+/-4.2, and 9.2+/-4.4 in Group II. The peak urinary flow rates at those times were 15.6+/-4.9, 15.8+/-5.6, and 15.9+/-5.1 mL/sec in Group I and 14.6+/-4.2, 14.6+/-3.9, and 14.3+/-4.5 mL/sec in Group II. CONCLUSIONS: The TUR-P+I could be a safe, effective surgical method for BPH. However, longer follow-up and more patients are required to establish the value of this technique.

Transurethral Incision for Ureterocele / 대한비뇨기과학회지

PURPOSE: A transurethral incision of the ureterocele offers several advantages. This study investigated the clinical efficacy of a transurethral incision in a ureterocele. MATERIALS AND METHODS: Twenty two children, 5 boys and 17 girls, received a transurethral incision as the primary treatment for their ureteroceles. Of the children, 12 had intravesical and 10 had ectopic ureteroceles. The initial presentations were abnormal findings in prenatal ultrasonography in 9 cases, fever in 7, UTI in 2, and others in 4. The median patient's age at the transurethral incision of the ureterocele was 3.3 months (range 0.2month to 4.1years). A cold knife or a 3-french Bugbee electrode was used. Their clinical courses were evaluated with a radiological and laboratory examinations. RESULTS: The transurethral incision resulted in the decompression of the ureterocele in 19 (86%), reflux to the upper moiety in 15 (68%), UTI in 2 (9%) and incontinence in 1 (4.5%). Eighteen patients (82%), 8 patients with an intravesical ureterocele and all 10 patients with an ectopic ureterocele, required secondary operations. A transurethral incision proved to be a definitive treatment for 4 (33.3%) patients with an intravesical ureterocele. Secondary operations were performed at 7.3 7.1months postoperatively. CONCLUSIONS: An endoscopic incision may be advocated as a definitive treatment modality for some patients with an intravesical ureterocele. Furthermore, by safely delaying reconstructive surgery, the majority of children can benefit from an endoscopic incision of the ureterocele.

Transurethral incision for male urethral stricture or atresia: Report of 55 cases / 中国微创外科杂志

Objective To study the curative effect of transurethral incision for male urethral stricture or atresia. Methods A retrospective) review was made on 55 male patients with urethral stricture or atresia treated by transurethral incision. Results The success rate of the operation on one session was 90.9% (50/55), while the remaining 5 patients were cured by two times of operations.Forty-seven patients were followed for 6~12 months (mean,10 months).Urethral dilatation was performed for once within 1 week after the remorval of catheter in 10 patients,for 3~5 times within 3 months after operation in 21 patients,and after the third postoperative month in 16 patients. Conclusions Transurethral incision for male urethral stricture or atresia is effective.

Diagnosis and treatment of functional bladder outlet obstruction / 中华泌尿外科杂志

Objective To present the diagnosis and treatment of functional bladder outlet obstruction and to assess the results of transurethral bladder neck incision and alpha-blockers with regard to symptoms and urodynamic findings. Methods From October 1995 to October 2002,39 male patients (age range from 24 to 48 years,with a mean of 37 years) who had dysuria and underwent urodynamic examination,cystourethrography and urethral exploration were diagnosed with functional bladder outlet obstruction.The mean IPSS was 22.5.The mean maximum urinary flow rate was 10.2 ml/s and the mean residual volume was 124 ml.All the patients were treated with transurethral incision of bladder neck and alpha blockers. Results The mean operative duration was 15 min;mean blood loss was 50 ml;mean postoperative hospital stay was 3.5 d.During 1-year follow-up,most of the patients were satisfied with the treatment results.Subjective assessment showed a statistically significant reduction of the voiding complaints.The mean IPSS was 10.1 .The mean maximum urinary flow rate was 22.1 ml/s (range,12.7 to 42.1 ml/s) and the mean residual volume was 49 ml (range,0 to 84 ml). Conclusions Urodynamic examination,voiding cystourethrography and urethral exploration with dilator facilitate the diagnosis of functional bladder outlet obstruction.Treatments with transurethral incision of the bladder neck and alpha-blockers are effective and safe for functional bladder outlet obstruction.

Clinical Observation of the Ureterocele: 29 Cases / 대한비뇨기과학회지

Ureterocele, congenital dilatation of the terminal or intramural portion of the ureter, may be classified as either simple or ectopic and has a broad spectrum of presentation, anatomy and treatment must be individualized. From February, 1986 to March, 1994, our experiences with 8 single system ureteroceles and 12 duplex system ureteroceles were reviewed. Their presentation, radiographic findings, operative management and postoperative results were discussed. The patients in this series were distribution from 1 year old to 66 years old and the male and female ratio was 4:16. The most presenting symptom was flank pain, affecting 7 cases, and ureterocele was associated with ureteral stone: 7 cases, VUR: 2 cases, renal cyst: 1 case, and IgA nephropathy:1 case. In 8 cases of single system ureterocele, Transurethral incision(TUI) of ureterocele in 1 case, ureterocelectomy with ureteroneocystostomy in 3 cases were done. In 12 cases of duplex system ureterocele, TUI of ureterocele in 2 cases, heminephrectomy with partial ureterocelectomy in 2 cases were done. After operation was done, there was no evidence of complication. We conclude that the surgical approach to the problems associated with a ureterocele is modified by patient age, renal anomaly and the pathological condition of the lower urinary tract.

Transurethral Incision of the Prostate for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Transurethral incision of the prostate(TUIP) was designed two decades ago as a new surgical management for certain patients in whom transurethral resection of prostate( TURP) was not indicated. TUIP was performed on 24 patients in 26 months. We incised the prostate in 5 and 7 o'clock direction or 6 o'clock direction. Uroflowmetry and residual urine volume were checked preoperatively and 3 months after TUIP in 20 patients. Mean peak urine flow rate increased from 7.8+/-6.4 ml to 13.1+/-8.5 ml per second (p=0.015). Mean postvoid residual urine volume decreased from 67.2+/-l9.3 ml to 25.4+/-l2.6 ml (p<0.00l). l5 patients were interviewed or completed questionaire with mean follow-up period of 16.8 months, which demonstrated that 73.3% were satisfied with the long-term outcome. Operating time, estimated blood loss, time to catheter removal postoperatively were all significant in favor of TUIP. Based on objective and subjective criteria, TUIP is an effective treatment option for selected men with benign prostatic hyperplasia.

A case of infertility because of ejaculatory duct obstruction / 대한비뇨기과학회지

The prevalence or azoospermia .in the general population has been estimated to be 2 percent. Azoospermia is found in up to lO to 20 per cent of the men who present to an infertility clinic. The main causes are testicular failure and ductal obstruction. The ejaculatory duct obstruction was reported about 6 percent of the ductal obstruction. We present a case of a young adult azoospermic male patient with bilateral obstruction of the terminal ejaculatory duct who was treated successfully by transurethral incision using Collings cold knife in the area of the ejaculatory ducts.