Midwestern University College of Osteopathic Medicine, Downers Grove, Illinois, USA.
Division of Urology, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Endourol. 2022 Jul;36(7):969-976. doi: 10.1089/end.2021.0911. Epub 2022 Feb 4.
Lower urinary tract symptoms among adult men can significantly impact quality of life. We evaluated complications based on prostate size following plasmakinetic enucleation of the prostate. Patients were grouped into the small prostate group (SPG, <75 g) and large prostate group (LPG, >75 g) based on preoperative imaging. Patient data on demographics, comorbidities, preoperative international prostate symptom score (IPSS), bother index (BI), prostate-specific antigen (PSA) if indicated, postvoid residual volume (PVR), indwelling catheter or self-catheterization status, and any prior surgical intervention were evaluated. Postoperative IPSS, BI, and PVR values were assessed at 6 weeks, 4 months, and yearly. Postoperative urge urinary incontinence (UUI), stress urinary incontinence (SUI), and pad use were assessed. Between September 2015 and December 2020, 296 patients who underwent bipolar enucleation with minimum follow-up of 4 months were evaluated. Postoperative IPSS, BI, PVR, and PSA values at all time points were significantly decreased compared with preoperative values ( < 0.05). There was no significant difference in the complications between groups. Univariable and multivariable analysis found that size <75 g was predictive of stricture formation and bladder neck contracture (BNC). UUI was more common at 6 weeks in the SPG, and SUI was more common at 6 weeks in the LPG, but no difference was noted at the 4-month and 1-year time points. Pad use was equal between the two groups at all time points. Plasmakinetic enucleation of the prostate provides an effective treatment option for prostates of all sizes; however, prostates <75 g have a higher rate of BNC and urethral strictures compared with those >75 g.
男性下尿路症状会显著影响生活质量。我们评估了基于前列腺大小的等离子前列腺剜除术后的并发症。根据术前影像学检查，将患者分为小前列腺组（SPG，<75g）和大前列腺组（LPG，>75g）。评估患者的人口统计学、合并症、术前国际前列腺症状评分（IPSS）、困扰指数（BI）、前列腺特异性抗原（PSA）（如果需要）、剩余尿（PVR）、留置导尿管或自我导尿状态以及任何先前的手术干预情况。术后 6 周、4 个月和每年评估 IPSS、BI 和 PVR 值。评估术后急迫性尿失禁（UUI）、压力性尿失禁（SUI）和使用尿垫情况。2015 年 9 月至 2020 年 12 月，对 296 例接受双极剜除术且随访时间至少为 4 个月的患者进行了评估。与术前相比，所有时间点的术后 IPSS、BI、PVR 和 PSA 值均显著降低（<0.05）。两组之间的并发症无显著差异。单变量和多变量分析发现，体积<75g 是狭窄和膀胱颈挛缩（BNC）形成的预测因素。SPG 组在术后 6 周时 UUI 更为常见，而 LPG 组在术后 6 周时 SUI 更为常见，但在术后 4 个月和 1 年时无差异。两组在所有时间点的尿垫使用情况相同。等离子前列腺剜除术为所有大小的前列腺提供了一种有效的治疗选择；然而，与>75g 的前列腺相比，<75g 的前列腺发生 BNC 和尿道狭窄的风险更高。
