Benign Prostatic Hyperplasia Diagnosis, Treatment And Health Management Guide Ⅲ

5 Postoperative rehabilitation and follow-up management

5. 1 Management of postoperative rehabilitation

5. 1. 1 Rehabilitation of postoperative pain

First, we need to determine the cause and degree of pain. We recommend using the visual analog scale (VAS) because it is simple and intuitive and easy for patients to use [82]. For mild pain, non-steroidal anti-inflammatory drugs can be used for symptomatic analgesia. . right
For moderate to severe pain after surgery, it is necessary to analyze whether the pain is caused by bladder spasm, prostate wounds, or other reasons. It is recommended to leave an F18-F22 urinary catheter in place after surgery. The amount of water injected into the catheter balloon can be adjusted appropriately according to the size of the prostate. If necessary, lidocal can be added to the bladder flushing fluid.
Therefore, keep it for 20 minutes and then discharge it [83]. For patients with postoperative bladder spasm, M-blockers such as solifenacin can be used for symptomatic treatment. Studies have shown that M-blockers have a significant effect on LUTS in the early recovery period after prostatic hyperplasia surgery [84].
Of course, analgesics can also be used to combat bladder spasm [85]. The latest research shows that transcutaneous acupoint electrical stimulation can effectively prevent the occurrence of catheter-related bladder discomfort after TURP, improve the severity, reduce the need for early postoperative analgesia, and improve the quality of patients' early recovery [86].

HERB CISTANCHE BEBEFITS FOR PROSTATE HEALTH

5. 1. 2. Recovery of urinary function after surgery

About 10% to 20% of BPH patients with large amounts of bladder residual urine have detrusor weakness. In the past, it was considered that this group of patients would still be unable to restore normal bladder function even if their BOO was relieved, and they were a relative contraindication to benign prostatic hyperplasia surgery.
Studies have shown that combining 3 stages of bladder function training after enucleation can achieve good recovery results. After the first stage, individualized urinary habits are established and a tube clamping time interval table is established. The second stage is to train urinary awareness and reflex urination. The third stage In the first stage, special training was provided for those with poor recovery results, and the vast majority of patients were able to urinate regularly on their own [87].

HERB CISTANCHE BEBEFITS FOR PROSTATE HEALTH

5.1.3 Recovery of Postoperative Urinary Control Function

Urinary incontinence after BPH surgery often occurs within a few days to a few weeks after surgery, manifested as stress urinary incontinence and urgency urinary incontinence. Although most patients can recover urinary control through comprehensive treatment, temporary urinary incontinence after surgery causes great psychological pressure and inconvenience in life for patients.
It is recommended that all patients start Kegel training 1 week before surgery to prevent the occurrence of postoperative urinary incontinence. After pelvic floor muscle training, most temporary urinary incontinence will improve on its own. Patients who still have urine leakage 2 weeks after surgery can control urinary incontinence on the basis of Kegel training combined with M receptor blockers. Most patients recover within 2 months after surgery. For those who still have urine leakage 2 months after surgery, pelvic floor electrical stimulation therapy can be used to regulate the function of the sphincter. Patients who still have urine incontinence 6 months after surgery can undergo periurethral injection combined with traditional Chinese medicine acupuncture treatment. For patients with persistent true urinary incontinence 1 year after surgery, bulbar urethral suspension or artificial sphincter treatment can be performed according to the patient's condition [88-89]. Bulbar urethral suspension is simple and minimally invasive, but the tightness of the sling needs to be adjusted according to the surgeon's experience. Artificial sphincter has high urinary control efficiency, but is expensive.

5.1.4 Postoperative sexual function rehabilitation

For some patients, ED will seriously affect the patient's physical and mental health, so the rehabilitation of sexual function after BPH surgery is particularly important. The circular sphincter of the bladder neck and the supporting tissues on both sides of the spermatic cord are involved in the ejaculation process. Preserving these tissues is the key point in the operation. The rate of retrograde ejaculation in prostate surgery performed according to this principle is lower than that of traditional surgery [90].
The IIIEF-5 questionnaire was used to evaluate the patient's sexual function 1 week, 1 month, 3 months and 6 months after surgery. For patients with ED after surgery, PDE5 inhibitors can be used to promote the rehabilitation of penile endothelial function [91].
Penile negative pressure suction is one of the non-invasive methods for treating ED in clinical practice. Patients can undergo this method to recover penile function one month after surgery [92].
For relatively young patients with organic ED lasting for more than one year, artificial prosthesis implantation can achieve a satisfactory sex life [93].
Psychological factors have a great impact on the recovery of sexual function after surgery. Due to surgical trauma and inner anxiety, some patients are cautious about sex life, suppress their sexual desire, and have a negative impact on erectile function. Therefore, while clinicians solve patients' organic disorders, they should also pay attention to counseling preoperative and postoperative psychological disorders, help patients rebuild their sexual psychology, and make their sexual function reach a state corresponding to their age and physical condition.

5. 2. Management of postoperative follow-up

If the medical center or department performs surgical treatment for prostatic hyperplasia as a day surgery, telephone or online monitoring and follow-up should be conducted within 1 week after the patient is discharged from the hospital. The content includes: asking the patient about the general condition after surgery, whether there is any special discomfort, and asking about urination, whether there is urination difficulty, frequent urination, urgency, urinary pain, hematuria, urinary incontinence, etc. [94].
If it is not performed as a day surgery, the first follow-up time should be 1 month after surgery or 4 to 6 weeks after the removal of the catheter [95-96]. The main purpose is to understand the patient's overall postoperative recovery and related symptoms that may occur in the early postoperative period. Depending on the surgical treatment method chosen by the patient, the follow-up content may not be exactly the same. It mainly includes whether there are urination symptoms in the early postoperative period, such as frequent urination, urgency, urinary pain, urinary difficulty, urinary incontinence, gross hematuria, etc., as well as the postoperative recovery status. QOL score, IPSS score, urinary flow rate and bladder residual urine measurement, IIIEF-5 score, Male Sexual Health Questionnaire-Ejaculatory Disorders (MSHQ-ED) etc. can be performed [95-98]. It is recommended to recheck PSA every six months or one year after surgery. For patients with abnormal PSA before surgery and benign pathology, there is no clear clinical evidence to recommend it. The expert group recommends rechecking PSA every six months or one year if PSA is normal after 3 months after surgery. If PSA is still abnormal after 3 months after surgery, it is recommended to follow up PSA every 3 months and closely monitor the changes in indicators. If PSA indicators continue to rise, MRI examination or prostate puncture biopsy is recommended.

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