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. 2022 Apr 1;9(1):14.
doi: 10.1186/s40779-022-00371-6.

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

Xian-Tao Zeng #  1   2 , Ying-Hui Jin #  2 , Tong-Zu Liu #  1 , Fang-Ming Chen  3 , De-Gang Ding  4 , Meng Fu  5 , Xin-Quan Gu  6 , Bang-Min Han  7 , Xing Huang  1   2 , Zhi Hou  8 , Wan-Li Hu  1 , Xin-Li Kang  9 , Gong-Hui Li  10 , Jian-Xing Li  5 , Pei-Jun Li  11 , Chao-Zhao Liang  12 , Xiu-Heng Liu  13 , Zhi-Yu Liu  14 , Chun-Xiao Liu  15 , Jiu-Min Liu  16 , Guang-Heng Luo  17 , Yi Luo  1 , Wei-Jun Qin  18 , Jian-Hong Qiu  19 , Jian-Xin Qiu  20 , Xue-Jun Shang  21 , Ben-Kang Shi  22 , Fa Sun  17 , Guo-Xiang Tian  23 , Ye Tian  24 , Feng Wang  25 , Feng Wang  26 , Yin-Huai Wang  27 , Yu-Jie Wang  28 , Zhi-Ping Wang  29 , Zhong Wang  30 , Qiang Wei  31 , Min-Hui Xiao  32 , Wan-Hai Xu  33 , Fa-Xian Yi  34 , Chao-Yang Zhu  35 , Qian-Yuan Zhuang  36 , Li-Qun Zhou  37 , Xiao-Feng Zou  38 , Nian-Zeng Xing  39 , Da-Lin He  40 , Xing-Huan Wang  41   42 ; Chinese Urological Doctor Association (CUDA); Urological Association of Chinese Research Hospital Association (CRHA-UA); Uro-Health Promotive Association of China International Exchange and Promotive Association for Medical and Health Care (CPAM-UHPA)
Affiliations

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

Xian-Tao Zeng et al. Mil Med Res. .

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.

Keywords: Benign prostatic hyperplasia; Guideline; Recommendation; Transurethral plasmakinetic resection of prostate; Treatment.

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Conflict of interest statement

No one reported having stock, being a consultant paid by companies or receiving research funding from companies that have an interest in the guideline. Yin-Huai Wang reported publishing the paper comparing TUPKP and TURP in the treatment of BPH, the paper related to the perioperative management of TUPKP for the treatment of BPH and the paper related to complications of TUPKP for the treatment of BPH. Zhong Wang reported publishing the paper comparing TUPKP and TURP in the treatment of BPH, the paper comparing TUPKP and TUPEP in the treatment of BPH, and applied for the patent related to TUPKP and the patent related to TUPEP for the treatment of BPH. Min-Hui Xiao reported publishing the paper related to complications of TUPKP for the treatment of BPH. Zhi-Ping Wang reported publishing the paper comparing TUPKP and TURP in the treatment of BPH, the paper comparing TUPKP and TUPEP in the treatment of BPH, the paper comparing TUPKP and OP in the treatment of BPH, the paper related to the perioperative management of TUPKP for the treatment of BPH, the paper related to complications of TUPKP for the treatment of BPH, and has applied for the patent related to TUPKP, the patent related to TURP for the treatment of BPH, and the patent related to the perioperative management of TUPKP for the treatment of BPH. Zhi-Ping Wang also reported publishing the paper on prevention of complications of transurethral surgery for BPH and water intoxication. No other disclosures were reported.

References

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