Kim Sung Han, Oh Seung-June
Department of Urology, Prostate Cancer Center, National Cancer Center, Goyang, South Korea.
Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
PLoS One. 2014 Jun 5;9(6):e98979. doi: 10.1371/journal.pone.0098979. eCollection 2014.
To investigate changes in nonspecific genitourinary discomfort or pain (GUDP) before and after holmium laser enucleation of prostate (HoLEP). GUDP associated with lower urinary tract symptoms (LUTS) is a common complaint among benign prostatic hyperplasia (BPH) patients, but very little is known about this clinical entity.
From February 2010 to August 2011, 100 HoLEP patients with complete clinical data at a single institution were enrolled in the study to analyze the degree of GUDP with a visual analog scale (VAS) from 0 to 10 points at baseline and at 3 and 6 months postoperatively, and to investigate any relationships between GUDP and urodynamics, uroflowmetry, and scores from the International Prostate Symptom Score (IPSS) questionnaire.
Fifty-six patients had LUTS only, while the remaining 44 had both LUTS and GUDP. Pain was located in the suprapubic (42.0%), perineal/penile (33.0%), back (17.0%), and perianal (8.0%) regions. During the post-operative period, at six months, the VAS, IPSS, peak flow rate and post-void residual volume had improved significantly in 44 GUDP patients (p<0.010). GUDP had completely resolved in 40 (90.9%) patients and had decreased in four (9.1%) patients, while seven (12.5%) patients developed GUDP with voiding in the urethral and perineal areas by the third month postoperatively. When compared to patients with complete resolution, those with persistent GUDP were found to have a significantly higher preoperative presence of bladder outlet obstruction (BOO) as an independent risk factor (OR 6.173, 95% CI 1.132-1.323).
Both GUDP and LUTS improved significantly after HoLEP. Patients with significant preoperative BOO tended to have persistent GUDP after surgery.
研究钬激光前列腺剜除术（HoLEP）前后非特异性泌尿生殖系统不适或疼痛（GUDP）的变化。与下尿路症状（LUTS）相关的GUDP是良性前列腺增生（BPH）患者的常见主诉，但对这一临床实体了解甚少。
2010年2月至2011年8月，选取在单一机构有完整临床资料的100例HoLEP患者纳入研究，采用0至10分的视觉模拟量表（VAS）分析基线时、术后3个月和6个月时的GUDP程度，并研究GUDP与尿动力学、尿流率以及国际前列腺症状评分（IPSS）问卷得分之间的关系。
56例患者仅有LUTS，其余44例既有LUTS又有GUDP。疼痛位于耻骨上区（42.0%）、会阴/阴茎区（33.0%）、背部（17.0%）和肛周区（8.0%）。在术后6个月时，44例有GUDP的患者的VAS、IPSS、最大尿流率和残余尿量均有显著改善（p<0.010）。40例（90.9%）患者的GUDP完全缓解，4例（9.1%）患者的GUDP减轻，而7例（12.5%）患者在术后第三个月出现尿道和会阴区排尿时的GUDP。与完全缓解的患者相比，发现持续性GUDP患者术前膀胱出口梗阻（BOO）的发生率显著更高，这是一个独立危险因素（OR 6.173，95%CI 1.132 - 1.323）。
HoLEP术后GUDP和LUTS均有显著改善。术前有明显BOO的患者术后往往会持续存在GUDP。
