Department of Urology, Aberdeen Royal Infirmary - NHS Grampian, Aberdeen, UK.
Academic Urology Unit (AUU), University of Aberdeen, Aberdeen, UK.
BJU Int. 2022 Nov;130(5):619-627. doi: 10.1111/bju.15761. Epub 2022 May 17.
To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO).
A regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal-Wallis and chi-squared statistical tests were used.
A total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow-up. Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378).
This is the largest reported cohort of men, with the longest follow-up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an 'absolute indication' for BPO surgery, as is stated in the Non-neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates.
确定是否≥40 岁的男性膀胱结石（BS）患者可从良性前列腺增生症（BPO）的治疗中获益。
使用前瞻性收集的数据库，对 2011 年 1 月至 2018 年 12 月间接受 BS 手术的患者进行了一项区域性回顾性研究。主要结局为成功清除 BS 后结石复发。采用 Kruskal-Wallis 和卡方检验进行统计学分析。
共 174 例患者接受了 BS 清除术，其中 71 例（40.8%）因 BS 继发于 BPO 以外的原因而被排除。因此，103 名年龄≥40 岁的男性成功清除了 BS，其中 40%有上尿路结石病史。这些患者分为三组：同时接受 BPO 药物、手术或无治疗。BPO 治疗组之间年龄、糖尿病、既往尿路结石和既往 BPO 手术情况匹配良好。随访 46 个月后，共有 18 名（17%）患者出现 BS 复发。BPO 手术后复发率显著降低；34 名患者中有 1 例（3%），28 名无 BPO 治疗患者中有 5 例（18%），41 名接受 BPO 药物治疗的患者中有 12 例（29%）（P = 0.048）。药物和无 BPO 治疗的复发率相似（P = 0.280）。三组患者的 BPO 并发症发生率相似（P = 0.378）。
这是目前报道的最大规模的队列研究，BS 清除术后随访时间最长。大多数年龄≥40 岁的 BS 患者从 BPO 手术中获益。然而，研究结果也支持 BS 的多因素病因，这对 BS 是 BPO 手术的“绝对适应证”这一教条提出了质疑，这一教条在《欧洲泌尿外科协会非神经源性男性下尿路症状指南》中有所阐述。评估和处理所有致病因素可能有助于选择哪些患者将从 BPO 手术中获益，并降低 BS 复发率。
