Leocádio Dean E, Frenkl Tara L, Stein Barry S
Department of Urology Rhode Island Hospital, Providence, Rhode Island 02905, USA.
J Urol. 2007 Nov;178(5):2052-4; discussion 2054. doi: 10.1016/j.juro.2007.07.029. Epub 2007 Sep 17.
We evaluated the efficacy and feasibility of performing office based transurethral needle ablation of the prostate with analgesia and local anesthesia.
A total of 56 consecutive patients underwent transurethral needle ablation of the prostate for symptomatic benign prostatic hyperplasia. Oral rofecoxib (50 mg) and ciprofloxacin (250 mg) were administered before the procedure with 25 mg hydroxyzine and 50 to 100 mg meperidine intramuscularly. A combination of 2% lidocaine solution and jelly was used for anesthesia. Patients rated discomfort during anesthesia administration and the procedure using a 10-point scale of 0--no discomfort to 10--the worst pain/discomfort ever experienced in the patient life. Overall satisfaction with the procedure was assessed with a 4-point scale of 1--very satisfactory to 4--very unsatisfactory. Followup was 12 months for uroflow and 36 months for International Prostate Symptom Score.
The mean age of 47 patients was 65.4 years. Mean discomfort ratings were 3.6 and 4.9 for anesthesia administration and the procedure, respectively. Average operative time was 34.4 minutes, excluding anesthesia administration. The mean overall satisfaction score was 1.5. The mean preoperative International Prostate Symptom Score was 23.1, which improved to 10.9, 11.2, 12.3, 13.8 and 11.3 at 3, 6, 12, 24 and 36 months, respectively. Mean maximum uroflow improved from 8.2 ml/sec at baseline to 12.8, 13.9 and 13.3 ml/sec at 3, 6 and 12 months, respectively.
Administration of an intramuscular narcotic combined with oral analgesic and topical lidocaine provided adequate pain control for transurethral needle ablation of the prostate, making it a feasible office procedure.
我们评估了在门诊进行经尿道前列腺针刺消融术并采用镇痛和局部麻醉的疗效及可行性。
共有56例连续性患者因有症状的良性前列腺增生接受经尿道前列腺针刺消融术。术前口服罗非昔布（50毫克）和环丙沙星（250毫克），并肌内注射25毫克羟嗪和50至100毫克哌替啶。采用2%利多卡因溶液和凝胶联合进行麻醉。患者使用0（无不适）至10（患者一生中经历过的最严重疼痛/不适）的10分制对麻醉给药期间及手术过程中的不适进行评分。采用1（非常满意）至4（非常不满意）的4分制评估对手术的总体满意度。对尿流情况随访12个月，对国际前列腺症状评分随访36个月。
47例患者的平均年龄为65.4岁。麻醉给药和手术过程中的平均不适评分分别为3.6和4.9。排除麻醉给药时间，平均手术时间为34.4分钟。总体满意度平均评分为1.5。术前国际前列腺症状评分平均为23.1，在3、6、12、24和36个月时分别改善至10.9、11.2、12.3、13.8和11.3。平均最大尿流率从基线时的8.2毫升/秒分别改善至3、6和12个月时的12.8、13.9和13.3毫升/秒。
肌内注射麻醉剂联合口服镇痛药和局部利多卡因可为经尿道前列腺针刺消融术提供充分的疼痛控制，使其成为一种可行的门诊手术。
