Mohyelden Khaled, Ibrahim Hamdy, Abdel-Kader Osman, Sherief Mahmoud H, El-Nashar Ahmed, Shaker Hosam, Elkoushy Mohamed A
1 Department of Urology, Fayoum University , Fayoum, Egypt .
2 Department of Urology, Suez Canal University , Ismailia, Egypt .
J Endourol. 2016 Feb;30(2):223-8. doi: 10.1089/end.2015.0417. Epub 2015 Oct 8.
To evaluate the impact of rectal balloon (RB) inflation on post-transurethral resection of the prostate (TURP) bleeding in patients with symptomatic benign prostatic hyperplasia.
After institutional review board approval, patients who were eligible for TURP were randomized into two equal groups, depending on whether they received postoperative endorectal balloon (RB) (GII) or not (GI). The tip of three-way Foley catheter was fixed to a balloon by a blaster strip to prepare air-tight RB. Postoperatively, the RB was inflated for 15 minutes by a pressure-controlled sphygmomanometer. Perioperative data were compared between both groups, including hemoglobin (Hb) deficit 24-hour postoperatively and at time of discharge. Functional outcomes, anorectal complaints, and adverse events were assessed perioperatively and after 1 and 3 months.
Fifty patients were enrolled, including 13 (26%) patients who presented with indwelling urethral catheters. Baseline data and mean resected tissue weight were comparable between both groups, including preoperative Hb (p = 0.17). Immediate postoperative Hb deficit was, comparable between GI and GII patients (0.58 ± 0.18 vs 0.60 ± 0.2, p = 0.56) before RB inflation, respectively. However, compared to GI patients, mean Hb deficit significantly decreased in GII patients 24-hour postoperatively (0.2 ± 0.2 vs 0.7 ± 0.3 g, p = 0.002) and at time of discharge (0.8 ± 0.2 vs 1.3 ± 0.4 g, p = 0.003). GII patients needed significantly less postoperative irrigation (2.1 ± 1.6 vs 8.3 ± 1.8 L, p < 0.001), shorter catheterization time (2.3 ± 0.8 vs 3.8 ± 1.3 days, p < 0.001), and shorter hospital stay (2.6 ± 0.5 vs 4.3 ± 1.0 days, p < 0.001). Both groups were comparable in all functional outcomes at the most recent follow-up. Blood transfusion was needed in only one patient (4%) in GI. No patient needed recystoscopy for hematuria or clot retention in either group, while there were no anorectal complaints reported by GII patients.
Post-TURP endorectal balloon inflation seems to be simple, safe, and an efficient procedure to reduce postoperative bleeding and irrigation volume. It is significantly associated with shorter catheterization time and hospital stay.
评估直肠球囊（RB）充气对有症状的良性前列腺增生患者经尿道前列腺电切术（TURP）后出血的影响。
经机构审查委员会批准后，符合TURP条件的患者根据是否接受术后直肠内球囊（RB）（GII组）分为两组，每组人数相等，未接受的为GI组。将三腔Foley导尿管的尖端通过一条爆破带固定在球囊上，以制备气密的RB。术后，通过压力控制血压计将RB充气15分钟。比较两组的围手术期数据，包括术后24小时和出院时的血红蛋白（Hb） deficit。围手术期以及术后1个月和3个月评估功能结局、肛肠不适和不良事件。
共纳入50例患者，其中13例（26%）留置尿道导管。两组的基线数据和平均切除组织重量具有可比性，包括术前Hb（p = 0.17）。RB充气前，GI组和GII组患者术后即刻Hb deficit具有可比性（分别为0.58±0.18 vs 0.60±0.2，p = 0.56）。然而，与GI组患者相比，GII组患者术后24小时（0.2±0.2 vs 0.7±0.3 g，p = 0.002）和出院时（0.8±0.2 vs 1.3±0.4 g，p = 0.003）的平均Hb deficit显著降低。GII组患者术后冲洗量显著减少（2.1±1.6 vs 8.3±1.8 L，p < 0.001），导尿时间缩短（2.3±0.8 vs 3.8±1.3天，p < 0.001），住院时间缩短（2.6±0.5 vs 4.3±1.0天，p < 0.001）。在最近一次随访中，两组在所有功能结局方面具有可比性。GI组仅1例患者（4%）需要输血。两组均无患者因血尿或血块潴留需要再次膀胱镜检查，而GII组患者未报告有肛肠不适。
TURP术后直肠内球囊充气似乎是一种简单、安全且有效的减少术后出血和冲洗量的方法。它与缩短导尿时间和住院时间显著相关。
