Soliman Shady A, Wadie Bassem S, Ibrahim El-Husseiny E, Shehab El-Dein Ahmed B
Department of Urology, Voiding Dysfunction and Incontinence, Urology and Nephrology Center, Mansoura, Egypt.
J Urol. 2007 Mar;177(3):1036-9. doi: 10.1016/j.juro.2007.01.040.
We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate.
A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean+/-SD patient age was 60.76+/-5.85 years in the rotoresection and 64.24+/-6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer's grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis.
At 6 months International Prostate Symptom Score decreased from 26.2+/-4.06 to 5.32+/-1.52 in the rotoresection group and from 22.84+/-4.56 to 7+/-1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87+/-2.24 to 25.29+/-10.39 ml per second in the rotoresection group and from 9.44+/-2.29 to 25.2+/-5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2+/-16.58 to 17.24+/-7.61 ml in the rotoresection group and from 40.6+/-16.93 to 18.28+/-8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84+/-26.8 cm H2O and 4.24+/-0.97 to 38.8+/-18.8 cm H2O and 1.24+/-0.93 in the rotoresection group, and from 63.04+/-21.08 cm H2O and 3.48+/-0.65 to 34.16+/-12.7 cm H2O and 1+/-0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p=0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group.
Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.
我们前瞻性地比较了旋切术与经尿道前列腺切除术的短期疗效。
总共50例因良性前列腺增生导致膀胱出口梗阻的患者被随机分为两组，即旋切术组和经尿道前列腺切除术组。旋切术组患者的平均年龄为（60.76±5.85）岁，经尿道前列腺切除术组为（64.24±6.84）岁。所有患者的国际前列腺症状评分均为8分或更高，最大尿流率低于每秒15毫升，前列腺体积为20至100毫升，前列腺特异性抗原为1至4纳克/毫升。压力流率研究显示存在膀胱出口梗阻（沙弗分级为3级或更高）。在术后1个月、3个月和6个月时，通过国际前列腺症状评分、最大尿流率、经直肠超声、压力流率研究、血红蛋白和尿液分析对患者进行评估。
在6个月时，旋切术组的国际前列腺症状评分从（26.2±4.06）降至（5.32±1.52），经尿道前列腺切除术组从（22.84±4.56）降至（7±1.4）。旋切术组的最大尿流率从（7.87±2.24）增加至（25.29±10.39）毫升/秒，经尿道前列腺切除术组从（9.44±2.29）增加至（25.2±5.8）毫升/秒。旋切术组的前列腺体积从（41.2±16.58）降至（17.24±7.61）毫升，经尿道前列腺切除术组从（40.6±16.93）降至（18.28±8.75）毫升。旋切术组最大尿流时的逼尿肌压力和沙弗分级从（79.84±26.8）厘米水柱和（4.24±0.97）降至（38.8±18.8）厘米水柱和（1.24±0.93），经尿道前列腺切除术组从（63.04±21.08）厘米水柱和（3.48±0.65）降至（34.16±12.7）厘米水柱和（1±0.7）。经尿道前列腺切除术的稀释性低钠血症发生率更高（p = 0.005），但没有患者出现经尿道综合征的表现。旋切术组有4例患者出现轻度压力性尿失禁，经尿道前列腺切除术组有3例。
旋切术是治疗良性前列腺增生导致膀胱出口梗阻的一种安全有效的方法，其疗效与经尿道前列腺切除术相当。
