Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Int J Urol. 2012 Apr;19(4):343-50. doi: 10.1111/j.1442-2042.2011.02942.x. Epub 2012 Jan 6.
To evaluate the value of three parameters from preoperative ultrasonography in predicting the outcome of transurethral prostatectomy in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction.
A total of 239 patients with lower urinary tract symptoms suggestive of benign prostatic obstruction entering our department for surgical therapy were prospectively recruited. All of them underwent both ultrasound and urodynamics before receiving standard transurethral prostatectomy by the same team of surgeons. For 202 patients, 6-month follow-up data were available after the surgery, including the International Prostate Symptom Score, the Quality of Life score and the maximum flow rate. Preoperative data stratified by different degree of recovery were compared and the influence of ultrasound parameters on the surgical outcome was analyzed by using logistic regression and receiver-operator characteristic curve analyses.
Baseline transitional zone index, intravesical prostatic protrusion, resistive index, detrusor wall thickness and ultrasonic estimation of bladder weight were significantly different between patients with an effective outcome and those with an ineffective outcome (P < 0.05). Resistive index, detrusor wall thickness and ultrasonic estimation of bladder weight were selected as independent factors correlated with the efficacy of transurethral prostatectomy by logistic regression (P < 0.05). All three factors had adequate area under receiver-operator characteristic curve with resistive index having the largest area (0.816, 95% CI 0.759-0.874). The combined positive predictive value in effective surgical outcome of resistive index, detrusor wall thickness and ultrasonic estimation was 96.3%.
Resistive index, detrusor wall thickness and ultrasonic estimation adequately predict the outcome of transurethral prostatectomy. Measuring these parameters by preoperative ultrasound might aid in determining the need for surgical intervention.
评估术前超声三个参数在预测有下尿路症状的良性前列腺梗阻患者行经尿道前列腺切除术疗效中的价值。
前瞻性纳入 239 例因有下尿路症状疑似良性前列腺梗阻而进入我科接受手术治疗的患者。所有患者在接受由同一手术团队实施的标准经尿道前列腺切除术之前均接受了超声和尿动力学检查。对于 202 例患者，术后 6 个月获得了随访数据，包括国际前列腺症状评分、生活质量评分和最大尿流率。比较不同恢复程度的术前数据，并通过逻辑回归和接收者操作特征曲线分析来分析超声参数对手术结果的影响。
有效组和无效组患者的基线移行区指数、膀胱内前列腺突入、阻力指数、逼尿肌壁厚度和超声估计的膀胱重量差异均有统计学意义（P<0.05）。逻辑回归选择阻力指数、逼尿肌壁厚度和超声估计的膀胱重量作为与经尿道前列腺切除术疗效相关的独立因素（P<0.05）。这三个因素的受试者工作特征曲线下面积均具有足够的预测价值，其中阻力指数的面积最大（0.816，95%置信区间：0.759-0.874）。阻力指数、逼尿肌壁厚度和超声估计的膀胱重量联合对有效手术结果的阳性预测值为 96.3%。
阻力指数、逼尿肌壁厚度和超声估计能充分预测经尿道前列腺切除术的疗效。术前超声测量这些参数可能有助于确定是否需要手术干预。
