Choi Se Young, Kim Tae-Hyoung, Myung Soon Chul, Moon Young Tae, Kim Kyung Do, Kim Young Sun, Kim Hye-Ryoun, Chang In Ho
Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea.
Korean J Urol. 2012 Jan;53(1):23-8. doi: 10.4111/kju.2012.53.1.23. Epub 2012 Jan 25.
Following the introduction of medical therapy for benign prostatic hyperplasia (BPH), we determined the effect of the change in trends in medical therapy on the indication and outcome of surgical intervention for BPH.
We compared the basic characteristics of, weight of resected tissue of, transfusions in, and postoperative complications of patients who underwent surgery between 1985 and 1989 (before the advent of medical therapy for BPH), between 1995 and 1999 (when medical therapy was developed and became widely used as alternative treatment), and between 2005 and 2009 (when medical therapy superseded surgical intervention to become first-line treatment and when combination therapy became widely adopted).
At our institution, the mean age and BMI of patients increased over the past two decades (p<0.001). Hypertension, operation history, and other comorbidities also increased significantly (p<0.001, p=0.005, and p<0.001, respectively). The indications for surgery in 1985 to 1989, 1995 to 1999, and 2005 to 2009 were as follows: acute urinary retention in 34.7%, 20.2%, and 15.1% of patients and symptomatic deterioration in 61.1%, 72.3%, and 73.0% of patients, respectively. Prostate volume and the weight of resected tissue increased from 34.4±14.5 ml to 61.3±32.4 ml and from 7.2±6.4 g to 10.8±7.6 g, respectively, over two decades. Patients who underwent surgery in 2005 to 2009 had their catheters removed earlier (p<0.001). Secondary hemorrhage within four postoperative weeks and repeat transurethral resection of the prostate within 1 year decreased significantly (p=0.03 and p=0.003, respectively). No statistically significant change in impaired detrusor contractility was found (p=0.523).
Although patients who underwent surgery were older after widespread use of medical therapy for BPH, advancements in surgical techniques have benefitted these patients.
在良性前列腺增生（BPH）药物治疗引入后，我们确定了药物治疗趋势变化对BPH手术干预指征及结果的影响。
我们比较了1985年至1989年（BPH药物治疗出现之前）、1995年至1999年（药物治疗发展并广泛用作替代治疗时）以及2005年至2009年（药物治疗取代手术干预成为一线治疗且联合治疗广泛采用时）接受手术患者的基本特征、切除组织重量、输血情况及术后并发症。
在我们机构，过去二十年患者的平均年龄和体重指数增加（p<0.001）。高血压、手术史及其他合并症也显著增加（分别为p<0.001、p=0.005和p<0.001）。1985年至1989年、1995年至1999年以及2005年至2009年的手术指征如下：急性尿潴留患者分别占34.7%、20.2%和15.1%，症状恶化患者分别占61.1%、72.3%和73.0%。二十年间前列腺体积和切除组织重量分别从34.4±14.5 ml增加至61.3±32.4 ml，从7.2±6.4 g增加至10.8±7.6 g。2005年至2009年接受手术的患者导尿管拔除时间更早（p<0.001）。术后四周内继发性出血及一年内重复经尿道前列腺切除术显著减少（分别为p=0.03和p=0.003）。未发现逼尿肌收缩功能受损有统计学显著变化（p=0.523）。
尽管BPH药物治疗广泛应用后接受手术的患者年龄更大，但手术技术的进步使这些患者受益。
