Chen Ye-Hui, Li Xiao-Dong, Ke Zhi-Bin, Chen Jia-Yin, Lin Tian, Lin Ting-Ting, Zhu Jun-Ming, Zheng Qing-Shui, Xue Xue-Yi, Wei Yong, Xu Ning
Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China; Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Asian J Surg. 2023 Jan;46(1):373-379. doi: 10.1016/j.asjsur.2022.04.076. Epub 2022 May 4.
This study was to explore the risk factors for postoperative bladder neck contracture (BNC) after transurethral operation of prostate in patients with small-volume prostatic obstruction.
Clinicopathologic data at our center from February 2016 to January 2020 were retrospectively collected and analyzed. Clinicopathological characteristics between patients with and without BNC were compared. Multivariate logistic regression was used to determine the risk factors for postoperative BNC.
There were a total of 39 patients (8.53%) with postoperative BNC. Multivariate logistic regression analysis demonstrated that preoperative bladder neck diameter (BND), intravesical prostatic protrusion (IPP), surgical methods (transurethral resection of prostate (TURP)/anatomical endoscopic enucleation of the prostate (AEEP)), and postoperative urinary tract infection (UTI) were independent risk factors for postoperative BNC in patients with small-volume prostatic obstruction (P < 0.05). The incidence of postoperative BNC in patients undergoing AEEP was significantly decreased compared with those undergoing TURP. The optimal cut-off value of preoperative IPP was 6.10 mm while the optimal cut-off value of preoperative BND was 2.52 cm.
Larger preoperative bladder neck and higher preoperative IPP lead to decreased incidence of postoperative BNC in patients with small-volume prostatic obstruction. Active management of postoperative UTI could effectively prevent the occurrence of postoperative BNC. Compared with TURP, complete AEEP would contribute to reduce BNC in patients with small-volume prostatic obstruction.
本研究旨在探讨小体积前列腺梗阻患者经尿道前列腺手术后膀胱颈挛缩（BNC）的危险因素。
回顾性收集并分析了2016年2月至2020年1月我院中心的临床病理资料。比较了发生和未发生BNC患者的临床病理特征。采用多因素logistic回归分析确定术后BNC的危险因素。
共有39例患者（8.53%）发生术后BNC。多因素logistic回归分析显示，术前膀胱颈直径（BND）、膀胱内前列腺突入（IPP）、手术方式（经尿道前列腺切除术（TURP）/解剖性内镜下前列腺剜除术（AEEP））及术后尿路感染（UTI）是小体积前列腺梗阻患者术后BNC的独立危险因素（P<0.05）。与接受TURP的患者相比，接受AEEP的患者术后BNC的发生率显著降低。术前IPP的最佳截断值为6.10mm，术前BND的最佳截断值为2.52cm。
术前较大的膀胱颈和较高的术前IPP可降低小体积前列腺梗阻患者术后BNC的发生率。积极处理术后UTI可有效预防术后BNC的发生。与TURP相比，完整的AEEP有助于减少小体积前列腺梗阻患者的BNC。
