Liu Lei, Hou Xiao-fei, Ma Lu-lin, Zhao Lei, Zhang Hong-xian
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Aug 18;47(4):597-600.
To evaluate the efficacy and outcome of palliative transurethral resection of the prostate (pTURP) in patients with server bladder outlet obstruction (BOO) due to prostatic obstruction induced by advanced prostate cancer.
All the 16 patients who had a pTURP between November 2007 and January 2015 due to BOO (high residual urine volume combined with hydronephrosis or urinary retention refractory to medical treatment) at our institution were retrospectively assessed. All the patients were diagnosed with advanced prostate cancer (III stage or IV stage). The clinical data, functional and oncological follow-up results were evaluated. The cancer specific survivals were estimated by Kaplan-Meier analysis.
The mean age of the patients was 73.8 years (63-81 years). Five cases were graded in stage III of prostate cancer and 11 in stage IV. The indications for pTURP were refractory urinary retention in 12 cases, and high residual urine volume with hydronephrosis in 4 cases. The mean prostate volume at pTURP was 43.2 mL (28-78 mL) and the mean PSA (prostate specific antigen) level before pTURP was 48.2 μg/L (2-107 μg/L). The patients had mean residual urine volume 166.4 mL (50-450 mL) and mean urinary flow rate 3.6 mL/s (0-6 mL/s, n=7) before pTURP. It took mean 62.9 min (35-94 min) in pTURP with mean estimated blood loss 126.9 mL (30-263 mL) and mean resected tissue 14.1 g (10-22 g). There were no transfusion cases. Postoperative mean serum PSA 20.5 μg/L (1-41 μg/L), residual urine volume 43.4 mL (0-400 mL) and urinary flow rate 10.1 mL/s (7-16 mL/s, n=7) were shown in these cases. A patient encountered persistent hematuria needing irrigation. Compared with preoperation, the patients had significantly lower serum PSA level (P<0.001), less residual urine volume (P<0.001) and more urinary flow rate (P=0.001) after pTURP. The mean follow-up after pTURP was 36 months (1-86 months). In addition, 2 patients received repeated pTURP. At the time of the latest analysis, 3 patients died from prostate cancer progression. As estimated by Kaplan-Meier analysis, the 2-, 3- and 5-year cancer specific survival rates after pTURP were 91%, 78% and 58%, respectively.
Despite less resected tissue, greater delay in urination and reoperation rates, pTURP is a fairly effective procedure in patients with server BOO. Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 3- and 5-year cancer specific survival rates in this series seem to justify this intervention.
评估姑息性经尿道前列腺切除术（pTURP）对晚期前列腺癌所致前列腺梗阻引起的严重膀胱出口梗阻（BOO）患者的疗效及预后。
回顾性评估2007年11月至2015年1月期间在我院因BOO（高残余尿量合并肾积水或药物治疗无效的尿潴留）接受pTURP的16例患者。所有患者均被诊断为晚期前列腺癌（III期或IV期）。评估临床资料、功能及肿瘤学随访结果。采用Kaplan-Meier分析估计癌症特异性生存率。
患者平均年龄73.8岁（63 - 81岁）。前列腺癌III期5例，IV期11例。pTURP的适应证为药物治疗无效的尿潴留12例，高残余尿量合并肾积水4例。pTURP时平均前列腺体积为43.2 mL（28 - 78 mL），术前平均前列腺特异性抗原（PSA）水平为48.2 μg/L（2 - 107 μg/L）。pTURP术前患者平均残余尿量166.4 mL（50 - 450 mL），平均尿流率3.6 mL/s（0 - 6 mL/s，n = 7）。pTURP平均用时62.9分钟（35 - 94分钟），平均估计失血量126.9 mL（30 - 263 mL），平均切除组织14.1 g（10 - 22 g）。无输血病例。术后这些患者平均血清PSA 20.5 μg/L（1 - 41 μg/L），残余尿量43.4 mL（0 - 400 mL），尿流率10.1 mL/s（7 - 16 mL/s，n = 7）。1例患者出现持续性血尿需要膀胱冲洗。与术前相比，pTURP术后患者血清PSA水平显著降低（P < 0.001），残余尿量减少（P < 0.001），尿流率增加（P = 0.001）。pTURP术后平均随访36个月（1 - 86个月）。此外，2例患者接受了再次pTURP。在最新分析时，3例患者死于前列腺癌进展。根据Kaplan-Meier分析估计，pTURP术后2年、3年和5年的癌症特异性生存率分别为91%、78%和58%。
尽管切除组织较少、排尿延迟时间较长且再次手术率较高，但pTURP对严重BOO患者是一种相当有效的手术。虽然不能排除pTURP对生存有潜在负面影响，但本系列中估计的3年和5年癌症特异性生存率似乎证明了这种干预的合理性。
