经尿道前列腺切除术与经尿道钬激光剜除术治疗合并膀胱逼尿肌过度活动症的良性前列腺增生症的对比研究

[Transurethral resection of the prostate versus transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia with bladder detrusor overactivity].

作者信息

Shen Jun-Wen, DU Chuan-Jun, Bai Fu-Ding, Wang Rong-Jiang

机构信息

Department of Urology, Huzhou First People's Hospital, Huzhou, Zhejiang 313000, China.

Department of Urology, The Second Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.

出版信息

Zhonghua Nan Ke Xue. 2016 Aug;22(8):720-724.

PMID:29019229

Abstract

OBJECTIVE

To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity.

METHODS

his study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively.

RESULTS

There were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group (［315±59］ vs ［287±76］ ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time (［2.7±0.8］ vs ［5.1±1.2］ d, P<0.05), postoperative bladder contracture time (［4.1±1.9］ vs ［5.8±2.4］ d, P<0.05), postoperative hospital stay (［4.4±1.8］ vs ［5.9±2.5］ d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05).

CONCLUSIONS

Both TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.

摘要

目的

比较和分析经尿道前列腺电切术（TURP）与经尿道钬激光前列腺剜除术（HoLEP）治疗伴有膀胱逼尿肌过度活动症的良性前列腺增生（BPH）的效果。

方法

本研究纳入51例接受TURP治疗的伴有膀胱逼尿肌过度活动症的BPH患者以及另外58例接受HoLEP治疗的患者。我们评估了两组患者恢复期以及术后3个月和6个月时的排尿情况。

结果

两组患者的血PSA水平、前列腺体积、国际前列腺症状评分（IPSS）和生活质量（QOL）等基线数据无统计学显著差异，但有效膀胱容量除外，TURP组的有效膀胱容量高于HoLEP组（［315±59］ vs ［287±76］ ml，P<0.05）。两组患者术后储尿症状均明显改善，TURP组储尿症状评分从术前的12.6±4.9显著降至术后3个月时的7.5±3.9以及术后6个月时的6.1±4.2（P<0.01），HoLEP组从13.7±5.7降至7.9±4.2和7.0±5.1（P<0.01）。HoLEP在术后导尿时间（［2.7±0.8］ vs ［5.1±1.2］ d，P<0.05）、术后膀胱痉挛时间（［4.1±1.9］ vs ［5.8±2.4］ d，P<0.05）、术后住院时间（［4.4±1.8］ vs ［5.9±2.5］ d，P<0.05）以及最大尿流率改善方面明显优于TURP，HoLEP组最大尿流率从术前的（7.9±3.7）ml/s增加至术后3个月时的（16.8±4.3）ml/s，TURP组从（8.6±3.2）ml/s增加至（14.6±4.3）ml/s（P<0.05）。