Cayuelas Rubio C, Pallás Costa Y, Juan Escudero J, Ramos de Campo M, García Ibáñez J, Mitjana Biosca S, Monzó Cataluña A, Rechi Sierra K, Fernández Arjona M, López Alcina E
Servicio de Urología, Hospital General Universitario de Valencia, Valencia, España.
Servicio de Urología, Hospital General Universitario de Valencia, Valencia, España.
Actas Urol Esp (Engl Ed). 2019 Nov;43(9):488-494. doi: 10.1016/j.acuro.2019.01.007. Epub 2019 May 31.
The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift® system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres.
A prospective study was conducted with 20 patients treated with Urolift® under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument.
The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required.
We consider that the Urolift® system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.
自2005年以来，一直使用Urolift®系统治疗良性前列腺增生继发的下尿路症状，中期效果良好。在这项研究中，我们介绍了在西班牙的两个中心在局部麻醉和镇静下实施该技术的经验。
对2017年4月至2018年4月期间在局部麻醉和镇静下接受Urolift®治疗的20例患者进行了一项前瞻性研究。麻醉方案包括放置2次含冷利多卡因的润滑剂（第一次在干预前10分钟，第二次在插入膀胱镜之前）。三分之一的患者接受了前列腺阻滞（类似于前列腺活检中使用的阻滞），并在手术过程中根据需要添加1mg静脉注射咪达唑仑。我们的主要目标是使用经过验证的视觉模拟量表测量工具评估该手术在局部麻醉下的耐受性。
对来自2个不同中心的20例患者采用相同的麻醉方案进行了该手术。膀胱镜检查过程中视觉模拟量表的平均疼痛评分为1.37，植入物放置时为1.19。当被问及手术过程中或术前膀胱镜检查时的疼痛感是更高、更低还是相同，只有18%的患者回答更高。在所有病例中，患者对该手术耐受性良好，从未需要更改麻醉方案。
我们认为，在局部麻醉和镇静下使用Urolift®系统是治疗良性前列腺增生继发下尿路症状的一种耐受性良好、安全有效的方法。
