Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)

Xian-Tao Zeng; Ying-Hui Jin; Tong-Zu Liu; Fang-Ming Chen; De-Gang Ding; Meng Fu; Xin-Quan Gu; Bang-Min Han; Xing Huang; Zhi Hou; Wan-Li Hu; Xin-Li Kang; Gong-Hui Li; Jian-Xing Li; Pei-Jun Li; Chao-Zhao Liang; Xiu-Heng Liu; Zhi-Yu Liu; Chun-Xiao Liu; Jiu-Min Liu; Guang-Heng Luo; Yi Luo; Wei-Jun Qin; Jian-Hong Qiu; Jian-Xin Qiu; Xue-Jun Shang; Ben-Kang Shi; Fa Sun; Guo-Xiang Tian; Ye Tian; Feng Wang; Feng Wang; Yin-Huai Wang; Yu-Jie Wang; Zhi-Ping Wang; Zhong Wang; Qiang Wei; Min-Hui Xiao; Wan-Hai Xu; Fa-Xian Yi; Chao-Yang Zhu; Qian-Yuan Zhuang; Li-Qun Zhou; Xiao-Feng Zou; Nian-Zeng Xing; Da-Lin He; Xing-Huan Wang

doi:10.1186/s40779-022-00371-6

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Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)

POSITION ARTICLE AND GUIDELINE | Updated：2023-02-28

- Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)
- Military Medical Research Vol. 9, Issue 5, Pages: 515-533(2022)
- Affiliations：
  
  1.Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  2.Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  3.Department of Urology, Tianjin Third Central Hospital Affiliated To Nankai University, Tianjin 300170, China
  4.Department of Urology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou 450003, China
  5.Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  6.Department of Urology, China-Japan Union Hospital of Jilin University, Changchun 130033, China
  7.Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
  8.Department of Urology, Qinghai University Affiliated Hospital, Xi’ning 810012, China
  9.Department of Urology, People’s Hospital of Hainan Province, Hainan Affiliated Hospital of Hainan Medical University Haikou, Haikou 570311, China
  10.Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
  11.Department of Urology, General Hospital of Ningxia Medical University, Yinchuan 750003, China
  12.Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  13.Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
  14.Department of Urology, the Second Hospital of Dalian Medical University, Dalian 116023, Liaoning, China
  15.Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, China
  16.Department of Urology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
  17.Department of Urology Surgery, Guizhou Province People’s Hospital, Guiyang 550002, China
  18.Department of Urology, Xijing Hospital of Air Force Military Medical University, Xi’an 710032, China
  19.Department of Urology, the 980th Hospital of the PLA Joint Logistics Support Force (Bethune International Peace Hospital of PLA), Shijiazhuang 050082, China
  20.Department of Urology, Tangdu Hospital, the Air Force Military Medical University, Xi’an 710038, China
  21.Department of Andrology, Jinling Hospital Affiliated to Nanjing University School of Medicine, Nanjing 210002, China
  22.Department of Urology, Qilu Hospital of Shandong University, Jinan 250012, China
  23.Department of Geriatrics, the Seventh Medical Center of Chinese, PLA General Hospital, Beijing 100027, China
  24.Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  25.Department of Urology, People’s Hospital of Tibet Autonomous Region, Lhasa 850000, China
  26.Department of Urology, South China Hospital, Shenzhen University, Shenzhen 518111, Guangdong, China
  27.Department of Urology, the Second Xiangya Hospital of Central South University, Changsha 410011, China
  28.Department of Urology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  29.Department of Urology, Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou 730030, China
  30.Department of Urology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
  31.Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 88 South Keyuan Road, Chengdu 610041, China
  32.Department of Urology, the First People’s Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650041, China
  33.Department of Urology, the Fourth Hospital of Harbin Medical University, Heilongjiang Key Laboratory of Scientific Research in Urology, Harbin 150001, China
  34.Department of Urology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010059, China
  35.Department of Urology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan, China
  36.Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  37.Department of Urology, Peking University First Hospital, the Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
  38.Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
  39.Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  40.Department of Urology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Author bio：
  
  * xingnianzeng@126.com;
  hedl@xjtu.edu.cn;
  wangxinghuan1965@163.com
- Funds：
- DOI：10.1186/s40779-022-00371-6
  CLC：
- Published：2022-10
- Accepted：
Scan QR Code
Zeng XT, Jin YH, Liu TZ, Chen FM, Ding DG, Fu M, et al. Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition). Mil Med Res. 2022;9(1):14.
DOI：

Zeng XT, Jin YH, Liu TZ, Chen FM, Ding DG, Fu M, et al. Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition). Mil Med Res. 2022;9(1):14. DOI： 10.1186/s40779-022-00371-6.

摘要

Abstract

Benign prostatic hyperplasia (BPH) is highly prevalent among older men

impacting on their quality of life

sexual function

and genitourinary health

and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018

we issued the guideline "2018 Standard Edition" . However

much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines

so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative

intraoperative

and postoperative) of TUPKP in the treatment of BPH

postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH

and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak

or in the form of an ungraded consensus-based statement. Finally

we issued 36 statements. Among them

23 carried strong recommendations

and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP

precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention

and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (<80 ml) and large-volume (≥80 ml) BPH compared with transurethral urethral resection prostate

transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing

the time indwelling catheters are needed

principles of postoperative therapeutic use of antibiotics

follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence

postoperative leukocyturia

the treatment measures for the perforation and extravasation of the capsule

transurethral resection syndrome

postoperative bleeding

urinary catheter blockage

bladder spasm

overactive bladder

urinary incontinence

urethral stricture

rectal injury during surgery

postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

关键词

Keywords

references

Gratzke C , Bachmann A , Descazeaud A , Drake MJ , Madersbacher S , Mamoulakis C , et al . EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction . Eur Urol . 2015 ; 67 ( 6 ): 1099 - 109 .

Zhu C , Wang DQ , Zi H , Huang Q , Gu JM , Li LY , et al . Epidemiological trends of urinary tract infections, urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019 . Mil Med Res . 2021 ; 8 ( 1 ): 64 .

Wang XH , Wang HP , Feng ZW , Luo YX , Chen HY , Liu MJ . Transurethral bipolar resection of the prostate . Med J Wuhan Univ . 2002 ; 23 ( 3 ): 258-9+87 (in Chinese) .

Mamoulakis C , Ubbink DT , de la Rosette JJMCH . Bipolar versus monopolar transurethral resection of the prostate: a systematic review and metaanalysis of randomized controlled trials . Eur Urol . 2009 ; 56 ( 5 ): 798 - 809 .

Zeng XT , Weng H . Transurethral bipolar plasmakinetic prostatectomy treatment for benign prostatic hyperplasia in Chinese: development of a national evidence-based clinical practice guideline (2018 standard version) . Natl Med J Chin . 2018 ; 98 ( 20 ): 1549 - 60 .

Ma LL , Wang YY , Yang ZH , Huang D , Weng H , Zeng XT . Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res . 2020 ; 7 ( 1 ): 7 .

EAU guideline-Management of Non-neurogenic Male LUTS . 2020 . https://uroweb.org/guideline/treatment-of-non-neuro genic-male-luts/ https://uroweb.org/guideline/treatment-of-non-neuro genic-male-luts/ .

Guyatt GH , Oxman AD , Kunz R , Falck-Ytter Y , Vist GE , Liberati A , et al . Going from evidence to recommendations . BMJ . 2008 ; 336 ( 7652 ): 1049 - 51 .

Chen Y , Yang K , Marušic A , Qaseem A , Meerpohl JJ , Flottorp S , et al . A reporting tool for practice guidelines in health care: the right statement . Ann Intern Med . 2017 ; 166 ( 2 ): 128 - 32 .

Lerner LB , McVary KT , Barry MJ , Bixler BR , Dahm P , Das AK , et al . Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part II, surgical evaluation and treatment . J Urol . 2021 ; 206 ( 4 ): 818 - 26 .

Nickel JC , Aaron L , Barkin J , Elterman D , Nachabe M , Zorn KC . AUA guideline: Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update . Can Urol Assoc J . 2018 ; 12 ( 10 ): 303 - 12 .

Na YQ , Ye ZQ , Sun YH , Sun G . Guidelines for diagnosis and treatment of urological and andrological diseases in China . Beijing : People’s Medical Publishing House Co., Ltd ; 2014 .

Urinary Health Promotion Branch of China Medical and Healthcare International Exchange Promotion Association , Urology Professional Committee of Chinese Research Hospital Association , National Key R&D Program Minimally Invasive Plasma Surgery System and Cloud Planning Solution Project Team . Chinese experts’ consensus on the safety of transurethral plasmakinetic prostatectomy . J Mod Urol . 2018 ; 23 ( 12 ): 890 - 4 (in Chinese) .

Jin J . Prostate surgery . Beijing : People’s Medical Publishing House Co., Ltd ; 2013 .

Qiang W , Jianchen W , Macdonald R , Monga M , Wilt TJ . Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: a systematic review . J Urol . 2005 ; 173 ( 4 ): 1175 - 81 .

Weng H , Wu KJ , Li T , Li XD , Zeng XT , Wang XH , et al . Efficacy and safety of Fosfomycin trometamol for urinary tract infection: a Meta-analysis . J Mod Urol . 2017 ; 22 ( 4 ): 262 - 70 (in Chinese) .

The General Office of the National Health and Family Planning Commission , the Office of the State Administration of Traditional Chinese Medicine and the Pharmaceutical Equipment Bureau of the Ministry of Health of the General Logistics Department of the People’s Liberation Army . Guiding Principles for the Clinical Application of Antimicrobial Drugs (2015 Edition) (Annex [2015] No. 43 of the National Health Office) 2015 . http://www.gov.cn/xinwen/2015-08/27/content_2920799.htm http://www.gov.cn/xinwen/2015-08/27/content_2920799.htm .

McDougal WS , Wein AJ , Kavoussi LR , Partin AW , Peters CA . Campbell–Walsh urology 11th edition review . Amsterdam : Elsevier ; 2015 .

Wang YB , Yan SY , Huang X , Guo XP , Deng YQ , Lou JX , et al . Efficacy and safety of transurethral plasmakinetic resection of prostate versus trans urethral resection for benign prostatic hyperplasia: a systematic review and meta-analysis . Yixue Xinzhi Zazhi . 2021 ; 31 ( 2 ): 115 - 31 (in Chinese) .

Huang SW , Tsai CY , Tseng CS , Shih MC , Yeh YC , Chien KL , et al . Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis . BMJ . 2019 ; 367 : 15919 .

Li XH , Zi H , Huang X , Wang YB , Yan SY , Lou JA , et al . Efficy and safety of transurethral plasmakinetic resection of prostate versus transurethral plasmakinetic enucleation of prostate in treating benign prostate hyperplasia: a systematic review and meta-analysis . Yixue Xinzhi Zazhi . 2021 ; 31 ( 2 ): 100 - 14 (in Chinese) .

Ji Y , Hu XS , Gy G . Comparison of the efficacy of transurethral plasmakinetic resection of the prostate and suprapubic transcystic prostatectomy in the treatment of benign prostatic hyperplasia . Chin J Gerontol . 2012 ; 32 ( 21 ): 4638 - 40 (in Chinese) .

Zhang ZY , Zhao MJ , Ba H , Ma LL , Yh J , Zeng XT , et al . A systematic review and meta-analysis of the effects of transurethral bipolar plasmakinetic prostatectomy in the treatment of high-risk elderly benign prostatic hyperplasia in China . Natl Med J Chin . 2019 ; 99 ( 10 ): 778 - 82 (in Chinese) .

Rai P , Srivastava A , Singh S , Dhayal IR . Comparison of bipolar plasmakinetic transurethral enucleation and resection of prostate gland in patients receiving anticoagulants and/or platelet aggregation inhibitors . Minerva Urol Nefrol . 2019 ; 71 ( 3 ): 286 - 93 .

Li BH , Tang SD , Wang YB , Yan SY , Lou JA , Deng YQ , et al . Complications of transurethral plasmakinetic resection of prostate: a systematic review and meta-analysis . Yixue Xinzhi Zazhi . 2021 ; 31 ( 2 ): 88 - 99 (in Chinese) .

Huang X , Shi HB , Wang XH , Zhang XJ , Chen B , Men XW , et al . Bacteriuria after bipolar transurethral resection of the prostate: risk factors and correlation with leukocyturia . Urology . 2011 ; 77 ( 5 ): 1183 - 7 .

Li BH , Yu ZJ , Wang CY , Zi H , Li XD , Wang XH , et al . A preliminary, multicenter, prospective and real world study on the hemostasis, coagulation, and safety of hemocoagulase bothrops atrox in patients undergoing transurethral bipolar plasmakinetic prostatectomy . Front Pharmacol . 2019 ; 10 : 1426 .

Cao J , Ding Y , Huang YL , Zhang KX , Wang D , Lv C , et al . Effect of warming bladder rinse solution on bladder spasm after TURP surgeries: a metaanalysis . Nurs J Chin PLA . 2017 ; 34 ( 12 ): 39 - 42 (in Chinese) .

Xiong ZF , Tang LP . Application effect of bladder irrigation fluid heating method in postoperative bladder irrigation patients . Contemp Med . 2018 ; 24 ( 6 ): 18 - 20 (in Chinese) .

Burkhard FC , Bosch JLHR , Cruz F , Lemack GE , Nambiar AK , Thiruchelvam NA . Urinary incontinence . Arnhem : EAU Guidelines Office ; 2020 .

Jaidane M , Arfa NB , Hmida W , Hidoussi A , Slama A , Sorba NB , et al . Effect of transurethral resection of the prostate on erectile function: a prospective comparative study . Int J Impot Res . 2010 ; 22 ( 2 ): 146 - 51 .

Poulakis V , Ferakis N , Witzsch U , De Vries R , Becht E . Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients . Asian J Androl . 2006 ; 8 ( 1 ): 69 - 74 .

Hatzimouratidis K , Giuliano F , Moncada I , Munner A , Salonia A , Verze P . Male sexual dysfunction . Arnhem : EAU Guidelines Office ; 2019 .

Deng CH , Jiang H , Shang XJ , Andrology Branch of Chinese Medical Association . Guideline for the diagnosis and treatment of erectile dysfunction in China (2016 version) . Beijing : People’s Medical Publishing House Co., Ltd ; 2017 .

Jiang H , Deng CH , Shang XJ , Zhang ZC , Dai YT , Chen B , et al . Chinese expert consensus: Tadalafil 5mg once a day for the treatment of erectile dysfunction . Chin J Androl . 2018 ; 32 ( 1 ): 57 - 62 (in Chinese) .

Liao J , Zhang X , Chen M , Li D , Tan X , Gu J , et al . Transurethral resection of the prostate with preservation of the bladder neck decreases postoperative retrograde ejaculation . Wideochir Inne Tech Maloinwazyjne . 2019 ; 14 ( 1 ): 96 - 101 .

Parnham A , Serefoglu EC . Retrograde ejaculation, painful ejaculation and hematospermia . Transl Androl Urol . 2016 ; 5 ( 4 ): 592 - 601 .

Colpi G , Weidner W , Jungwirth A , Pomerol J , Papp G , Hargreave T , et al . EAU guidelines on ejaculatory dysfunction . Eur Urol . 2004 ; 46 ( 5 ): 555 - 8 .

Jarvi K , Lo K , Grober E , Mak V , Fischer A , Grantmyre J , et al . The workup and management of azoospermic males . Can Urol Assoc J . 2015 ; 9 ( 7–8 ): 229 - 35 .

Xiong W , Sun M , Ran Q , Chen F , Du Y , Dou K . Learning curve for bipolar transurethral enucleation and resection of the prostate in saline for symptomatic benign prostatic hyperplasia: experience in the first 100 consecutive patients . Urol Int . 2013 ; 90 ( 1 ): 68 - 74 .

Feng L , Song J , Zhang D , Tian Y . Evaluation of the learning curve for transurethral plasmakinetic enucleation and resection of prostate using a mentor-based approach . Int Braz J Urol . 2017 ; 43 ( 2 ): 245 - 55 .

Hirasawa Y , Kato Y , Fujita K . Transurethral enucleation with bipolar for benign prostatic hyperplasia: 2-year outcomes and the learning curve of a single surgeon’s experience of 603 consecutive patients . J Endourol . 2017 ; 31 ( 7 ): 679 - 85 .

Cao W , Zhang CY , Zhou L . Learning curve for transurethral plasmakinetic resection of prostate on benign prostate hyperplasia . J Harbin Med Univ . 2015 ; 49 ( 1 ): 70 - 3 (in Chinese) .

Wang Q , Huang C , Li J , Jiang TD , Lu P , Zhao MJ , et al . Investigation and analysis of conflicts of interest and economic evidence in the clinical practice guidelines issued by China in 2017 . Chin J Evid Based Med . 2018 ; 18 ( 4 ): 379 - 87 (in Chinese) .

Gui YL , Han S , Zeng XT , Wu B . The methodological quality assessment checklist of economic evaluation: an introduction . J Henan Univ (Med Sci) . 2017 ; 36 ( 2 ): 129 - 32 (in Chinese) .

Zeng XT , Liu TZ , Gong K , He DL , Wang XH . The BPSC: a prospective study investigating the clinical effect of interventional therapy and the risk factors for bladder cancer and benign prostatic hyperplasia in Chinese population . J Evid Based Med . 2018 ; 11 ( 1 ): 64 - 7 .

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