Djavan B, Fakhari M, Shariat S, Ghawidel K, Marberger M
Department of Urology, University of Vienna, Austria.
J Urol. 1999 Jan;161(1):144-51.
We evaluate the efficacy and safety of a novel intraurethral prostatic bridge catheter in preventing temporary prostatic obstruction following targeted high energy transurethral microwave thermotherapy in patients with benign prostatic hyperplasia.
A total of 54 patients with benign prostatic hyperplasia underwent high energy transurethral microwave therapy under topical urethral anesthesia followed by placement of a prostatic bridge catheter, which remained indwelling as long as 1 month (prostatic bridge catheter group). Patient evaluation included determination of peak urinary flow rate, International Prostate Symptom Score (I-PSS) and quality of life score at baseline, immediately following transurethral microwave therapy and prostatic bridge catheter placement, and periodically thereafter for 1 month. Results were retrospectively compared with those of 51 patients who underwent transurethral microwave therapy followed by standard temporary urinary catheterization, typically for 24 hours (standard catheterization group).
Immediately following transurethral microwave therapy and prostatic bridge catheter placement significant improvements (p <0.0005) were observed in mean peak flow rate, I-PSS and quality of life score of 59.3, 33.5 and 23.6%, respectively, compared with baseline values. Further improvements were noted up to 1 month, at which time mean peak flow rate, I-PSS and quality of life score had improved 79.0, 54.9 and 56.5%, respectively, versus baseline (p <0.0005). In a retrospective comparison at baseline and 14 days between the prostatic bridge catheter group and standard catheterization group mean baseline peak flow rate, I-PSS and quality of life score were similar. However, at the 14-day followup evaluation in the prostatic bridge catheter group mean peak flow rate was 101.8% higher, and I-PSS and quality of life score were 47.9 and 51.1% lower, respectively, than the corresponding values in the standard catheterization group (p <0.0005). The prostatic bridge catheter was well tolerated and remained indwelling throughout the entire 1-month followup in 48 of 54 patients (88.9%). Early prostatic bridge catheter removal was required in 3 patients (5.6%) due to urinary retention and in 3 (5.6%) due to catheter migration.
Prostatic bridge catheter placement provides an effective and well tolerated option for preventing prostatic obstruction in the acute period after transurethral microwave therapy. This approach avoids the inconvenience and infection risk of standard indwelling catheters or intermittent self-catheterization. Prostatic bridge catheter insertion and removal are rapid, facile, nontraumatic procedures. Prostatic bridge catheter may potentially be used in an array of minimally invasive procedures involving thermal treatment of the prostate gland.
我们评估一种新型尿道内前列腺桥导管在预防良性前列腺增生患者经尿道高能微波热疗后暂时性前列腺梗阻方面的疗效和安全性。
总共54例良性前列腺增生患者在尿道局部麻醉下接受了高能经尿道微波治疗，随后放置前列腺桥导管，该导管留置长达1个月（前列腺桥导管组）。患者评估包括在基线时、经尿道微波治疗及前列腺桥导管置入后即刻、此后1个月内定期测定最大尿流率、国际前列腺症状评分（I-PSS）和生活质量评分。将结果与51例接受经尿道微波治疗后进行标准暂时性导尿（通常为24小时）的患者（标准导尿组）进行回顾性比较。
经尿道微波治疗及前列腺桥导管置入后即刻，平均最大尿流率、I-PSS和生活质量评分与基线值相比分别显著改善（p<0.0005），改善幅度分别为59.3%、33.5%和23.6%。直至1个月时仍有进一步改善，此时平均最大尿流率、I-PSS和生活质量评分与基线相比分别改善了79.0%、54.9%和56.5%（p<0.0005）。在前列腺桥导管组和标准导尿组之间进行基线和14天的回顾性比较，平均基线最大尿流率、I-PSS和生活质量评分相似。然而，在前列腺桥导管组14天的随访评估中，平均最大尿流率比标准导尿组相应值高101.8%，I-PSS和生活质量评分分别低47.9%和51.1%（p<0.0005）。前列腺桥导管耐受性良好，54例患者中有48例（88.9%）在整个1个月的随访期间导管一直留置。3例患者（5.6%）因尿潴留需要早期拔除前列腺桥导管，3例（5.6%）因导管移位需要早期拔除。
放置前列腺桥导管为预防经尿道微波治疗后急性期的前列腺梗阻提供了一种有效且耐受性良好的选择。这种方法避免了标准留置导尿管或间歇性自我导尿带来的不便和感染风险。前列腺桥导管的插入和拔除是快速、简便、无创的操作。前列腺桥导管可能潜在地用于一系列涉及前列腺热治疗的微创手术中。
