Vol 43 # 3 September 2011 - Kma.org.kw

September 2011
KUWAIT MEDICAL JOURNAL 213
Original Article
Combination of Ballistic Lithotripsy and Transurethral
Plasmakinetic Resection for Treating 200 Men with
Bladder Calculi and Benign Prostatic Hyperplasia:
A Trial with Two-Year Follow-Up
Jiansong Wang, Haifeng Wang, Yigang Zuo, Delin Yang, Mingxia Ding, Ruping Yan
Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
ABSTRACT
Kuwait Medical Journal 2011; 43 (3): 213-215
Objective: To assess the outcome of 200 men with bladder
calculi (BC) and benign prostatic hyperplasia (BPH) who
underwent transurethral ballistic lithotripsy (BL) as well as
transurethral plasmakinetic resection of prostate (PKRP).
Design: Retrospective study
Setting: Department of Urology, The Second Affiliated
Hospital of Kunming Medical University, Kunming, China
Subjects: In a trial at our department, we performed a
retrospective analysis of the results of 200 patients who
underwent endoscopic removal of BC and PKRP.
Intervention: BL and PKRP
Main Outcome Measure(s): International Prostate symptom
score (IPSS), Quality of life scores (QOL), Maximum flow rate
(Qmax), Residual urine volume (RUV) and postoperative
complications
Results: At two years, the results showed that IPSS, QOL,
Qmax and RUV were all significantly different between
preoperative and postoperative data. Urethral stricture,
short-term urinary incontinence, recurrent calculi, and BPH
recurrence developed in 3.5% (n = 7), 5.0% (n = 10), 1.0% (n =
2), and 1.5% (n = 3) of the 200 patients, respectively. Overall,
178 (89.0%) cases did not have any complications.
Conclusion: Combined BL and PKRP is an effective, safe,
and economical way of treating patients with BC and BPH
simultaneously.
KEY WORDS: ballistic lithotripsy, bladder calculi, BPH, follow-up, PKRP
INTRODUCTION
Open surgical removal of bladder calculi (BC) used
to be the mainstay of treatment. But this method is
very traumatic. After 1980, extracorporeal shockwave
lithotripsy (ESWL) and endourologic procedures have
revolutionized the treatment of most lithiases [1] . Since
then, ballistic lithotripsy (BL) became the spare wheel
and was widely used when ESWL was likely to fail
as in patients with a large stone burden. Meanwhile,
BC are usually associated with benign prostatic
hyperplasia (BPH). Endoscopic treatment of BPH,
the method of transurethral plasmakinetic resection
of prostate (PKRP) is a new technology, which has
advantages of being non- traumatic and leads to quick
recovery. Treatment of patients with both BC and BPH
in a single procedure under the same anesthesia is a
practical solution.
From August 2002 to April 2008, nearly 300 patients
with BC and BPH underwent BL as well as transurethral
PKRP. We randomly selected 200 patients who had
been followed up for two years, and performed a
retrospective analysis.
SUBJECTS AND METHODS
Clinical data
This study complies with the current ethical
considerations. The age of 200 patients in this cohort
ranged from 51 to 92 (mean 68 ± 8.5) years. The
duration of their disease ranged from two months to
22 (mean 5.1 ± 4.6) years. All patients had dysuria and
bladder irritation before surgery. All patients were
diagnosed as BPH and BC, and not prostate cancer,
by preoperative digital rectal examination, PSA,
ultrasound, KUB + IVU and other tests. According to
Rous (1985), BPH is divided into four grades. They
are: grade I prostatic hyperplasia (20 – 25 g), grade II
(25 – 50 g), grade III (50 – 70 g) and grade IV (> 70 g).
There were 16 cases of grade I, 69 cases of grade II, 91
Address correspondence to:
Jiansong Wang, Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China. Tel: +86-
13888256716, E-mail: wanghaifeng0871@gmail.com