Urology Department, Faculty of Medicine, Cairo University, Giza, 11562, Egypt.
Pediatrics Department, Faculty of Medicine, Cairo University, Giza, Egypt.
Int Urol Nephrol. 2021 Feb;53(2):199-204. doi: 10.1007/s11255-020-02669-7. Epub 2020 Oct 19.
We aimed to evaluate the outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and diagnosed to have weak detrusor contractility by urodynamic study.
A prospective study of 32 male patients had BPH candidate for TURP diagnosed to have impaired detrusor contractility by preoperative urodynamic study. We studied the postoperative outcome after TURP regarding international prostate symptoms score (IPSS), maximum flow rate (Q), post-voiding residual urine (PVR), the patients need for catheter, and urodynamic pressure flow study (PFS) parameters (maximum detrusor contractility, bladder contractility index (BCI), maximum bladder capacity and compliance) after 6 month follow-up.
Twenty-one cases presented with urethral catheter because of chronic or refractory retention. Twenty patients voided preoperatively during PFS with mean detrusor pressure (Pdet) at Q 23.97 ± 25.54 cmH2O and the mean BCI was 51.04 ± 23.86, while twelve patients did not void with mean maximum Pdet 21.75 ± 7.34. After 6 month follow-up, there was significant improvement in IPSS, Q, and detrusor contractility (Pdet at Q and BCI) postoperatively in all patients, and there was no significant postoperative improvement of post-voiding residual urine (p value 0.92). Finally, 11 patients voided normally without RU, 7 patients needed timed triple voiding with crede maneuver and small RU, and 14 patients needed CIC.
There were significant improvements in IPSS, detrusor contractility, and urine flow after TURP in patients with BPH and weak bladder contractility, although the risk of postoperative urine retention in approximately 43% of cases and needed CIC.
我们旨在评估经尿道前列腺切除术（TURP）治疗前列腺增生（BPH）患者的疗效，这些患者通过尿动力学检查被诊断为逼尿肌收缩力减弱。
对 32 名男性 BPH 患者进行前瞻性研究，这些患者在术前尿动力学检查中被诊断为逼尿肌收缩力受损，适合行 TURP 治疗。我们研究了 TURP 术后的结果，包括国际前列腺症状评分（IPSS）、最大尿流率（Q）、残余尿量（PVR）、患者对导尿管的需求以及尿动力学压力-流率研究（PFS）参数（最大逼尿肌收缩力、膀胱收缩性指数（BCI）、最大膀胱容量和顺应性），并在术后 6 个月进行随访。
21 例患者因慢性或难治性潴留而留置尿道导管。20 例患者在 PFS 期间术前排尿，平均逼尿肌压力（Pdet）在 Q 时为 23.97±25.54cmH2O，平均 BCI 为 51.04±23.86，而 12 例患者未在 Q 时排尿，最大 Pdet 平均为 21.75±7.34。术后 6 个月，所有患者的 IPSS、Q 和逼尿肌收缩力（Q 时的 Pdet 和 BCI）均有显著改善，而残余尿量（p 值 0.92）无显著术后改善。最后，11 例患者正常排尿，无残余尿，7 例患者需要定时三次排空并进行耻骨上按压，14 例患者需要留置导尿管。
在 BPH 伴弱膀胱收缩力的患者中，TURP 术后 IPSS、逼尿肌收缩力和尿流率均有显著改善，但仍有 43%的患者有术后尿潴留的风险，需要留置导尿管。
