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1.
Kaohsiung J Med Sci ; 34(3): 172-178, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29475465

RESUMEN

We aim to develop a nomogram to predict re-operation due to secondary hemorrhage after Monopolar transurethral resection of the prostate (M-TURP). We identified patients undergoing M-TURP at Peking University First Hospital from 2000 to 2013. Univariate and multivariate logistic regression models were developed to predict the occurrence re-operation due to secondary hemorrhage. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic curve (ROC), and internal validation was performed via bootstrap resampling. Of the 1901 patients who underwent M-TURP during the study period, 9.1% (173 patients) experienced hemorrhage after M-TURP, and they had a 22.0% re-operation rate (38 patients). Benign prostatic hyperplasia (BPH)-related complications (odds ratio, 0.386; 95% CI, 0.177-0.841), percent of resected prostate (OR, 0.156; 95% CI, 0.023-1.060) and suprapubic cystostomy (OR, 0.298; 95% CI, 0.101-0.881) were independently associated with re-operation. The nomogram accurately predicted re-operation (area under the ROC curve 0.718). The negative predictive value was 88.0%, while the positive predictive value was 47.9%. Re-operation due to secondary hemorrhage after M-TURP was associated with no BPH-related complications, lower percent of resected prostate and no suprapubic cystostomy and was accurately predicted with using the nomogram.


Asunto(s)
Nomogramas , Complicaciones Posoperatorias/diagnóstico , Hemorragia Posoperatoria/diagnóstico , Hiperplasia Prostática/cirugía , Reoperación/estadística & datos numéricos , Resección Transuretral de la Próstata/métodos , Anciano , Área Bajo la Curva , Humanos , Modelos Logísticos , Masculino , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Hemorragia Posoperatoria/fisiopatología , Hemorragia Posoperatoria/cirugía , Valor Predictivo de las Pruebas , Pronóstico , Próstata/patología , Próstata/cirugía , Hiperplasia Prostática/patología , Curva ROC , Estudios Retrospectivos
2.
Asian J Androl ; 20(1): 62-68, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28440263

RESUMEN

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.


Asunto(s)
Cistostomía/efectos adversos , Cistostomía/métodos , Complicaciones Posoperatorias/epidemiología , Prostatectomía/efectos adversos , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Resección Transuretral de la Próstata/efectos adversos , Resección Transuretral de la Próstata/métodos , Anciano , Transfusión Sanguínea , Hematócrito , Hemoglobinas/análisis , Hemorragia/epidemiología , Humanos , Complicaciones Intraoperatorias/epidemiología , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos , Resultado del Tratamiento
3.
Kaohsiung J Med Sci ; 33(3): 144-151, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28254117

RESUMEN

We aim to investigate the correlation of benign prostatic obstruction (BPO)-related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO-related complications and 1078 (46.3%) had BPO-related complications. Compared with patients without BPO-related complications, those with BPO-related complications were older (p = 0.001) and usually had other urologic comorbidities (p = 0.003). Additionally, they tended to have more tissue resected (p < 0.001), a higher American Society of Anesthesiologists grade (p = 0.002), and larger prostates (p < 0.001). Nonetheless, there was no obvious difference in surgical complications between both groups (p > 0.05). Among patients with BPO-related complications, compared with the bladder stone group, only the bladder stone+ group tended to have a greater urinary infection risk after transurethral resection of the prostate. Compared with patients with one or two BPO-related complications, those with three BPO-related complications tended to have a higher risk of pulmonary embolism and acute coronary syndrome (p < 0.05). Despite the widespread use of medication, patients with BPO-related complications were older and had larger prostates; however, transurethral resection of the prostate is still considered a safe and recommended surgical treatment. Nevertheless, those with three or more complications were at a higher risk of severe complication after surgery, and active surgical intervention is needed once BPO-related complications develop.


Asunto(s)
Próstata/cirugía , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Cálculos de la Vejiga Urinaria/cirugía , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/patología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Complicaciones Posoperatorias/patología , Próstata/patología , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/patología , Embolia Pulmonar/etiología , Embolia Pulmonar/patología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Trombosis/etiología , Trombosis/patología , Resección Transuretral de la Próstata/instrumentación , Resultado del Tratamiento , Cálculos de la Vejiga Urinaria/complicaciones , Cálculos de la Vejiga Urinaria/patología , Urodinámica
4.
Beijing Da Xue Xue Bao Yi Xue Ban ; 46(4): 578-81, 2014 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-25131475

RESUMEN

OBJECTIVE: To investigate the application of the Chinese Urological Association (CUA) guidelines on prostatitis and the effects on the clinical practice patterns of diagnosing and treating chronic pelvic pain syndrome (CPPS) among Chinese urologists. METHODS: We conducted a questionnaire investigation of the CUA guidelines on prostatitis among the urologists from 399 hospitals in 63 cities of China, and performed statistical analyses on all the eligible questionnaires collected. RESULTS: Of the 2 251 questionnaires distributed, 2 046 (90.9%) were eligible, of which 92.5% were from the urologists in tertiary or secondary hospitals, of whom 72.3% had senior or intermediate professional titles, and 90.2% had studied the CUA guidelines. Most respondents agreed that Type III prostatitis was a clinical syndrome, of which the diagnosis should be made after other conditions with similar symptoms had been ruled out and the aim was to relieve pain, alleviate urination symptoms and improve quality of life. Those who had and those who had not studied the CUA guidelines differed in their viewpoints on CPPS as illustrated in the guidelines. In clinical practice, the most common treatment options for CPPS were pharmaceutical therapy (95.0%), life style adjustment (88.9%), and psychotherapy (79.9%), and the most frequently prescribed drugs were phytotherapy (84.5%), α-blockers (79.0%) and antibiotics (64.0%). CONCLUSION: CUA guidelines on prostatitis has gained a nationwide application and promoted the standardization of the management of CPPS in China.


Asunto(s)
Dolor Pélvico/diagnóstico , Dolor Pélvico/terapia , Pautas de la Práctica en Medicina , Pueblo Asiatico , China , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Prostatitis/fisiopatología , Calidad de Vida , Encuestas y Cuestionarios
5.
Zhonghua Nan Ke Xue ; 19(2): 127-31, 2013 Feb.
Artículo en Chino | MEDLINE | ID: mdl-23441452

RESUMEN

OBJECTIVE: To investigate the application of the Chinese Urological Association (CUA) Guidelines on Prostatitis and its effects on the clinical practice patterns of diagnosing and treating chronic pelvic pain syndrome (CPPS) among Chinese urologists and andrologists. METHODS: We conducted a questionnaire investigation on the application of the CUA Guidelines on Prostatitis among the urologists and andrologists of 173 hospitals in 21 cities of China, and performed statistical analyses on all the eligible questionnaires collected. RESULTS: Of the 1 056 questionnaires distributed, 851 (80.6%) were eligible, of which 71.6% were from the urologists or andrologists in grade 3 hospitals, 80.7% of them with senior or intermediate professional titles and 97.5% had studied the CUA Guidelines. Most of the subjects agreed that Type III prostatitis is a clinical syndrome, whose diagnosis should exclude other conditions with similar symptoms, and whose treatment should aim at relieving pain, alleviating urination symptoms and improving the quality of life. Those who had and those who had not studied the CUA Guidelines differed in their viewpoints on CPPS as illustrated in the book. In clinical practice, the most common treatment options for CPPS were psychological therapy (80.7%), medication (80.4%) and life style adjustment (79.6%), and the most frequently used drugs were phytotherapy (80.0%), alpha-blockers (68.9%) and antibiotics (61.0%). CONCLUSION: CUA Guidelines on Prostatitis has gained a nationwide application and promoted the standardization of the management of CPPS in China.


Asunto(s)
Dolor Pélvico , Médicos , Prostatitis , Encuestas y Cuestionarios , Humanos , Masculino , Dolor Pélvico/diagnóstico , Dolor Pélvico/terapia , Guías de Práctica Clínica como Asunto , Prostatitis/diagnóstico , Prostatitis/terapia
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