【摘要】 目的 探讨良性前列腺增生（benign prostatic hyperplasia，BPH）伴膀胱结石的有效腔内治疗方法。〖HTH〗方法 2003年6月-2009年12月，使用F26号电切镜外鞘作为撑开器，气压弹道和（或）钬激光粉碎膀胱结石，经尿道前列腺电切术 （transurethral resection of the prostate，TURP） 治疗BPH伴膀胱结石86例。患者年龄58～83岁，平均68.6岁；病程2～8年，平均5.2年。术前患者国际前列腺症状评分（international prostate symptom score，IPSS）为（24.6±3.9）分，生活质量（5.7±0.6）分；前列腺重量（46.5±6.8） g，剩余尿量（185±58） mL，最大尿流率（5.7±2.3） mL/s。 结果 86例均一次手术成功。碎石时间为16~58 min，平均38 min；前列腺电切时间40~100 min，平均65 min。术中无并发症发生。术后 5~8 d拔除尿管，平均6.5 d。术后4 例出现前尿道狭窄，经治疗后痊愈。54例获随访，随访时间2~6个月，平均3个月。术后2个月，54例最大尿流率升至（18.5±4.1） mL/s，剩余尿量下降至（16±22） mL，IPSS评分下降至（7.8±1.6）分，生活质量（2.5±0.3）分，与术前比较差异均有统计学意义（Plt;0.01）。 结论 经尿道碎石术和TURP一次性治疗BPH伴膀胱结石安全、有效、经济。【Abstract】 Objective To explore an effective endourologic treatment method for benign prostatic hyperplasia (BPH) with bladder calculi. Methods From June 2003 to December 2009, ballistic or holmium laser lithotripsy by outer sheath resectoscope and transurethral resection of the prostate (TURP) were performed on 86 patients with BPH and bladder calculi. The patients aged 58 to 83 years old, averaging at 68.6 years. Duration of their disease course ranged from 2 to 8 years, averaging 5.2 years. Before surgery, the international prostate symptom score (IPSS) was 24.6±3.9; the score of quality of life (QOL) was 5.7±0.6; prostatic weight was (46.5±6.8) g; residual urine (RU) volume was (185±58) mL; and the peak urine flow rate (Qmax) was (5.7±2.3) mL/s. Results The operations were completed successfully in all cases with a mean lithotripsy time of 38 min (16-58 minutes) and a mean TURP time of 65 min (40-100 minutes). No complications occurred during the operation. Urethral catheter was withdrawn 5-8 days after operation, with a mean period of 6.5 days. Four patients had anterior urethral stricture after operation, but recovered through treatment. Fifty-four patients were followed up for 2 to 6 months with an average follow-up time of 3 months. Two months after the operations, IPSS decreased to 7.8±1.6; Qmax increased to (18.5±4.1) mL/s; RU decreased to (16±22) mL and QOL was 2.5±0.3. Compared with preoperative conditions, the differences were all statistically significant (P＜0. 01). Conclusion Transurethral lithotripsy combined with TURP is an effective, safe and economical treatment for benign prostatic hyperplasia with bladder calculi.
ObjectiveTo evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).MethodsRandomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.ResultsA total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=−25.95 mL, 95% confidence interval (CI) (−31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=−10.35 h, 95%CI (−18.25, −2.45) h, P=0.042], average duration of bladder irrigation [WMD=−10.28 h, 95%CI (−17.52, −3.04) h, P=0.038], and average length of hospital stay [WMD=−1.24 d, 95%CI (−1.85, −0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=−0.89 m/s, 95%CI (−1.74, −0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).ConclusionsIn the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.
Mechanical stress modulates almost all functions of cells. The key to exploring its biological effects lies in studying the perception of mechanical stress and its mechanism of mechanotransduction. This article details the perception and mechanotransduction mechanism of mechanical stress by extracellular matrix, cell membrane, cytoskeleton and nucleus. There are two main pathways for the perception and mechanotransduction of mechanical stress by cells, one is the direct transmission of force, and the other is the conversion of mechanical signal into chemical signal. The purpose of this study is to provide some reference for the exploration of precise treatment of mechanical stress-related diseases and the optimization of construction of tissue engineered organs by mechanical stress.