Roehrborn C G, Burkhard F C, Bruskewitz R C, Issa M M, Perez-Marrero R, Naslund M J, Shumaker B P
Department of Urology, University of Texas Southwestern Medical Center at Dallas, USA.
J Urol. 1999 Jul;162(1):92-7. doi: 10.1097/00005392-199907000-00023.
We evaluated the effects of transurethral needle ablation and prostate resection on pressure flow urodynamic parameters in men with benign prostatic hyperplasia (BPH), compared symptomatic and objective parameters of efficacy 6 months after initial treatment, and determined whether urodynamic assessment may predict symptomatic improvement.
We enrolled 121 patients with clinical BPH, American Urological Association symptom index of 13 or greater and maximum urinary flow of 12 ml. per second or less in a randomized study comparing transurethral needle ablation to prostate resection at 7 institutions in the United States. Patients underwent baseline and followup assessments at 6 months, including pressure flow studies.
Patients who underwent each procedure had statistically and clinically significant improvement in symptom index, BPH impact index and quality of life score. After needle ablation and prostate resection maximum flow improved from 8.8 to 13.5 (p<0.0001) and 8.8 to 20.8 ml. per second (p<0.0001), detrusor pressure at maximum flow decreased from 78.7 to 64.5 (p = 0.036) and 75.8 to 54.9 cm. water (p<0.001), and the Abrams-Griffiths number decreased from 61.2 to 37.2 (p<0.001) and 58.3 to 10.9 (p<0.001), respectively. At 6 months the differences in transurethral needle ablation and prostate resection were significant in terms of maximum flow (p<0.001) and the Abrams-Griffiths number (p<0.001) but not detrusor pressure at maximum flow or symptom assessment tools. The presence or absence of urinary obstruction at baseline did not predict the degree of symptomatic improvement in either treatment group.
Transurethral needle ablation and prostate resection induce statistically and clinically significant improvement in various quantitative symptom assessment questionnaires at 6 months. The parameters of free flow rates and invasive pressure flow studies also significantly improve after each treatment. However, transurethral prostate resection induces a significantly greater decrease in the parameters of obstruction. Baseline urodynamic parameters do not predict the degree of symptomatic improvement and they may not be helpful in patient selection for transurethral needle ablation.
我们评估了经尿道针刺消融术和前列腺切除术对良性前列腺增生(BPH)男性患者压力流尿动力学参数的影响,比较了初始治疗6个月后的症状和客观疗效参数,并确定尿动力学评估是否可预测症状改善情况。
在美国7家机构进行的一项随机研究中,我们纳入了121例临床诊断为BPH、美国泌尿外科学会症状指数为13或更高且最大尿流率为每秒12毫升或更低的患者,比较经尿道针刺消融术和前列腺切除术。患者在6个月时接受基线和随访评估,包括压力流研究。
接受每种手术的患者在症状指数、BPH影响指数和生活质量评分方面均有统计学和临床意义上的改善。针刺消融术后和前列腺切除术后,最大尿流率分别从8.8提高到13.5(p<0.0001)和8.8提高到20.8毫升/秒(p<0.0001),最大尿流率时的逼尿肌压力从78.7降至64.5(p = 0.036)和75.8降至54.9厘米水柱(p<0.001),Abrams-Griffiths数值分别从61.2降至37.2(p<0.001)和58.3降至10.9(p<0.001)。6个月时,经尿道针刺消融术和前列腺切除术在最大尿流率(p<0.001)和Abrams-Griffiths数值(p<0.001)方面存在显著差异,但在最大尿流率时的逼尿肌压力或症状评估工具方面无显著差异。基线时是否存在尿路梗阻并不能预测任何一个治疗组的症状改善程度。
经尿道针刺消融术和前列腺切除术在6个月时可使各种定量症状评估问卷有统计学和临床意义上的改善。每次治疗后自由尿流率和侵入性压力流研究参数也有显著改善。然而,经尿道前列腺切除术可使梗阻参数有显著更大程度的降低。基线尿动力学参数不能预测症状改善程度,对经尿道针刺消融术的患者选择可能也无帮助。