Sciarra Alessandro, Salciccia Stefano, Albanesi Luca, Cardi Antonio, D'Eramo Giuseppe, Di Silverio Franco
Department of Urology, University La Sapienza, Rome, Italy.
Urology. 2005 Dec;66(6):1218-22. doi: 10.1016/j.urology.2005.06.090.
To analyze whether the addition of a cyclooxygenase (COX)-2 inhibitor after transurethral resection of the prostate (TURP) offers an advantage compared with TURP alone in reducing postoperative urethral strictures. At urethroscopy, stenosis of the urethra with a circumference of less than 19 mm was defined as stricture.
This was a prospective, unblinded, randomized, single-center study. Between December 2001 and December 2003, 96 consecutive men with benign prostatic hyperplasia underwent TURP. After TURP, patients were randomly assigned to receive or not receive a COX-2 inhibitor (rofecoxib 25 mg/day). In the group given the COX-2 inhibitor, the therapy was started at catheter removal and continued for 20 days. Follow-up was performed on an outpatient basis after 1 month. A diagnosis of postoperative urethral stricture was assessed during a follow-up of 12 months.
At the 1-month visit, the mean and median improvement in the peak urinary flow rate from preoperative values was +6.25 +/- 3.76 mL/s (median 7.30) in the no COX-2 inhibitor group and +9.42 +/- 3.06 mL/s (median 8.75) in the COX-2 inhibitor group. The improvement was significantly (P < 0.0001) greater for the group treated with the COX-2 inhibitor. At 1 year of follow-up, a urethral stricture had been diagnosed in 8.3% of all cases; in particular, in 17% and 0% of cases in the no COX inhibitor group and COX-2 inhibitor group, respectively. Post-TURP COX-2 inhibitor therapy was significantly (P = 0.0039) and inversely (r = -0.2876) associated with urethral stricture development.
We suggest that limited postoperative treatment with a COX-2 inhibitor can effectively prevent post-TURP urethral stricture development by specifically interfering with the inflammatory processes that can precede scar formation.
分析经尿道前列腺电切术（TURP）后加用环氧化酶（COX）-2抑制剂与单纯TURP相比，在减少术后尿道狭窄方面是否具有优势。在尿道镜检查中，尿道周长小于19mm的狭窄被定义为尿道狭窄。
这是一项前瞻性、非盲、随机、单中心研究。2001年12月至2003年12月期间，96例连续的良性前列腺增生男性患者接受了TURP。TURP术后，患者被随机分配接受或不接受COX-2抑制剂（罗非昔布25mg/天）。在给予COX-2抑制剂的组中，治疗在拔除导尿管时开始，并持续20天。1个月后进行门诊随访。在12个月的随访期间评估术后尿道狭窄的诊断。
在1个月的随访中，未使用COX-2抑制剂组的最大尿流率较术前值的平均和中位数改善为+6.25±3.76mL/s（中位数7.30），而COX-2抑制剂组为+9.42±3.06mL/s（中位数8.75）。COX-2抑制剂治疗组的改善明显更大（P<0.0001）。在随访1年时，所有病例中有8.3%被诊断为尿道狭窄；具体而言，未使用COX抑制剂组和COX-2抑制剂组分别有17%和0%的病例出现尿道狭窄。TURP术后COX-2抑制剂治疗与尿道狭窄的发生显著相关（P=0.0039），且呈负相关（r=-0.2876）。
我们认为，COX-2抑制剂的有限术后治疗可通过特异性干扰瘢痕形成前的炎症过程，有效预防TURP术后尿道狭窄的发生。
