Enikeev Dmitry, Glybochko Petr, Rapoport Leonid, Snurnitsyna Olesya, Potoldykova Natalia, Novoselova Tamara, Laukhtina Ekaterina, Taratkin Mark, Margulis Vitaly
Research Institute for Uronephrology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya st, 2-1, Moscow, Russia, 119991.
Department of Medical Statistic, Sechenov University, Moscow, Russia.
Int Urol Nephrol. 2018 Dec;50(12):2173-2177. doi: 10.1007/s11255-018-2007-6. Epub 2018 Oct 22.
Benign prostatic hyperplasia (BPH) can be associated with marked intravesical protrusion, placing ureteral orifices at risk for injury during bladder outlet procedures.
To determine whether ureteral stenting is necessary in cases of ureteral orifice injury during laser enucleation.
Retrospective study included 465 patients with bladder outlet obstruction (IPSS > 20, Qmax < 10) secondary to BPH who were managed with thulium fiber laser (ThuFLEP) or holmium laser enucleation of the prostate (HoLEP). In seven patients, the ureteral orifices were injured during surgery (3-HoLEP; 4-ThuFLEP). Three of the seven patients underwent intraoperative stenting of the upper urinary tract (1-HoLEP; 2-ThuFLEP). In four cases, stenting was not performed (2-HoLEP; 2-ThuFLEP). The follow-up period was 6 months.
Postoperatively, none of the patients with a stent in the upper urinary tract exhibited signs of pelvicalyceal system (PCS) dilatation or inhibited urine flow from the kidney (assessed with abdominal ultrasound at 1, 3, 10, and 30 days after surgery). In two patients without stents, follow-up revealed no dilatation of the PCS. The other two patients without stents developed asymptomatic dilatation of the PCS (the pelvis-up to 1.5 cm; the calyx-up to 0.5 cm). At 1 month after surgery, no patients had dilatation of the PCS.
Upper urinary tract stenting in cases of intraoperative ureteral orifice injury during laser enucleation of the prostate for BPH may not be warranted.
良性前列腺增生（BPH）可伴有明显的膀胱内突出，在膀胱出口手术过程中使输尿管口有受伤风险。
确定在激光剜除术中输尿管口损伤的情况下输尿管支架置入是否必要。
回顾性研究纳入了465例因BPH继发膀胱出口梗阻（国际前列腺症状评分＞20，最大尿流率＜10）并接受铥光纤激光（ThuFLEP）或钬激光前列腺剜除术（HoLEP）治疗的患者。7例患者在手术过程中输尿管口受损（3例HoLEP；4例ThuFLEP）。7例患者中有3例接受了上尿路术中支架置入（1例HoLEP；2例ThuFLEP）。4例未进行支架置入（2例HoLEP；2例ThuFLEP）。随访期为6个月。
术后，上尿路置入支架的患者均未出现肾盂肾盏系统（PCS）扩张迹象或肾脏尿流受阻（术后1、3、10和30天通过腹部超声评估）。2例未置入支架的患者随访显示PCS无扩张。另外2例未置入支架的患者出现了无症状的PCS扩张（肾盂最大直径达1.5 cm；肾盏最大直径达0.5 cm）。术后1个月，无患者出现PCS扩张。
对于BPH患者在前列腺激光剜除术中术中输尿管口损伤的情况，可能无需进行上尿路支架置入。
