一期经尿道前列腺切除术治疗前列腺增生伴非神经源性逼尿肌收缩无力的疗效观察  

Analysis of the effect of one-stage transurethral prostatectomy for benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility

作　　者：张胜威[1] 王晓甫[1] 谷艳辉[1] 王宁 许长宝[1] Zhang Shengwei;Wang Xiaofu;Gu Yanhui;Wang Ning;Xu Changbao(Department of Urology,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450000

出　　处：《中华泌尿外科杂志》2023年第5期359-362,共4页Chinese Journal of Urology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200410)

摘　　要：目的探讨一期经尿道前列腺切除术治疗前列腺增生伴非神经源性逼尿肌收缩无力的有效性及安全性。方法回顾性分析2015年1月至2021年10月郑州大学第二附属医院收治的35例前列腺增生伴非神经源性逼尿肌收缩无力患者的资料。年龄(74.0±7.9)岁,前列腺体积(77.8±44.5)cm^(3),术前总前列腺特异性抗原(tPSA)为(8.9±8.7)ng/ml,术前国际前列腺症状评分(IPSS)(19.1±4.3)分,术前生活质量评分(QOL)5(5,5)分。本组患者均一期行经尿道前列腺切除术+耻骨上膀胱穿刺造瘘术,术后根据情况决定膀胱造瘘管拔除时间。膀胱造瘘管拔除标准为残余尿量<50ml,且上尿路无积水或肾积水较术前无加重。拔除造瘘管后,记录残余尿量、最大尿流率、IPSS、QOL及并发症。治疗成功定义为拔除膀胱造瘘管后恢复自行排尿,且无肾积水或肾积水较术前无加重。结果本组35例均顺利完成手术。30例术后拔出造瘘管恢复自行排尿,治疗成功率为85.7%(30/35),中位恢复自行排尿时间为4.0(3.3,4.5)周。自行排尿后最大尿流率为(12.6±2.3)ml/s,残余尿量为(27.7±9.5)ml。自行排尿后IPSS评分(5.5±2.4)分,较术前明显改善,差异有统计学意义(P<0.001)。术后QOL评分为1(1,2)分,较术前明显降低,差异有统计学意义(P<0.001)。30例恢复自行排尿者中,4例失访;26例术后随访3~69个月,均保持自行排尿,未再出现尿潴留,且无反复泌尿系感染发生。结论一期经尿道前列腺切除术治疗前列腺增生伴非神经源性逼尿肌收缩无力的成功率高、并发症少,明显提高了患者生活质量,是一种可行的治疗方式。Objective To investigate the safety and efficacy of one-stage transurethral prostatectomy for prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility.Methods The clinical data of 35 patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility admitted to The Second Affiliated Hospital of Zhengzhou University from January 2015 to Octorber 2021 were analyzed.The average age was(74.0±7.9)years old.The average volume of prostate was(77.8±44.5)cm^(3).The average total prostate specific antigen(tPSA)was(8.9±8.7)ng/ml.The preoperative international prostate symptom score(IPSS)was(19.1±4.3)and the preoperative quality of life score(QOL)was 5(5,5).All the patients were treated with one-stage transurethral prostatectomy and suprapubic cystostomy.After removing the cystostomy tube,the post-void resident volume(PVR),the maximum urine flow rate(Qmax),IPSS,QOL were recorded,and complications were followed up.Successful treatment is defined as the removal of the cystostomy tube without worsening of upper urinary tract hydronephrosis.Results All the operations were successfully completed.The success rate of treatment was 85.7%(30/35),and the median time to resume spontaneous urination was 4.0(3.3,4.5)weeks.The average postoperative Qmax was(12.6±2.3)ml/s,and the average PVR was(27.7±9.5)ml.The postoperative IPSS was(5.5±2.4),which was significantly improved compared to preoperative(P<0.001).The postoperative QOL score was 1(1,2)points,which was significantly lower than preoperative(P<0.001).The patients voiding spontaneously were followed up for 3-69 months,and no complications such as urinary retention,recurrent urinary tract infection and hydronephrosis occurred.Conclusions One-stage transurethral prostatectomy for patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility has a high success rate and few complications,which greatly improves the quality of life of patients.

关 键 词：前列腺增生 逼尿肌收缩无力 非神经源性 经尿道前列腺切除术 

分 类 号：R699.8[医药卫生—泌尿科学]