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.
摘要：
良性前列腺增生（BPH）在老年男性中非常普遍，影响他们的生活质量，性功能,和泌尿生殖健康，并已成为全球重要的疾病负担。经尿道前列腺等离子电切术（TUPKP）是治疗BPH的最重要的手术方法之一。它已在临床实践中得到很好的确立，具有良好的疗效和安全性。2018年，我们发布了指南“2018标准版”。然而，现在已经出现了许多新的直接证据，这可能会改变以前的一些建议。制定新的循证指南的时机已经成熟,所以我们成立了一个由临床专家和方法学家组成的工作组。指导组成员提出了31个与BPHTUPKP管理相关的问题，涵盖以下领域：与围手术期相关的问题（术前，术中,和术后）TUPKP治疗BPH，术后并发症和外科医生的手术技术水平。我们在文献中搜索了TUPKP治疗BPH的直接证据，并使用欧洲泌尿外科协会的等级标准评估其确定性产生的建议。建议不是强就是弱,或以未分级的基于共识的声明的形式。最后,我们发表了36份声明。其中,23提出了强有力的建议，和13对所述程序提出了薄弱的建议。它们涵盖了与上述三个领域有关的问题。术前TUPKP治疗BPH包括TUPKP的适应症和禁忌症,尿潴留引起的肾功能损害和尿路感染患者的术前准备注意事项，术前预防性使用抗生素。与术中相关的问题包括外科手术技术以及膀胱爆炸的预防和管理。不同人群应用TUPKP治疗正常体积(<80ml)和大体积(≥80ml)BPH与经尿道前列腺电切术比较的有效性和安全性,经尿道等离子前列腺摘除术和开放性前列腺切除术；TUPKP在高危人群和服用抗凝（抗血栓）药物的人群中的疗效和安全性。与术后期间相关的问题包括冲洗时间和速度，需要留置导管的时间，术后治疗使用抗生素的原则，随访时间和随访内容。与并发症相关的问题包括并发症的类型及其发生率，术后白细胞增多,胶囊穿孔和外渗的治疗措施，经尿道电切综合征,术后出血,导尿管堵塞,膀胱痉挛,膀胱过度活动症,尿失禁,尿道狭窄,手术中的直肠损伤，术后勃起功能障碍和逆行射精。最后的问题与执行TUPKP治疗BPH时的外科医生技能有关。我们希望这些建议可以帮助支持医护人员照顾患有TUPKP的患者治疗BPH。
