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前列腺尿道悬吊术

Prostatic Urethral Lift

作者信息

Rahman Adib, Leslie Stephen W., Desai Devang

机构信息

The University of Queensland

Creighton University School of Medicine

Abstract

Prostatic urethral lift (PUL) is a minimally invasive procedure approved by the United States Food and Drug Administration for the amelioration of benign prostatic hyperplasia (BPH) symptoms. PUL utilizes implantable medical devices to retract enlarged prostate tissue mechanically, thereby unobstructing the urethra and enhancing urinary flow. The procedure is devoid of tissue heating, excision, or destruction. PUL can also be conducted in a single session under local anesthesia, with the potential to promptly alleviate BPH symptoms and reduce the dependence on chronic BPH medication. BPH is characterized by a histopathological condition that quantifiably increases the number of stromal and epithelial cells within the prostate. Cellular proliferation leads to a progressive narrowing of the prostatic urethra, culminating in the manifestation of lower urinary tract symptoms (LUTS). These symptoms encompass urgency, increased frequency of urination, nocturnal polyuria, impaired bladder evacuation, initial urinary hesitation, discontinuous urine flow, and a reduced force of the urinary stream. Epidemiological data indicates that BPH-induced LUTS significantly impinges upon 50% to 75% of men advancing beyond the fifth decade of life, and prevalence escalates to 80% to 90% in the demographic exceeding age 70. Although BPH-induced LUTS predominantly diminishes life quality, its morbidity spectrum extends to recurrent urinary tract infections, acute urinary retention, bladder stones, and hematuria.  Standard interventions for BPH-related symptoms involve surgical modalities such as transurethral resection or laser enucleation of the prostate, alongside pharmacological management through sustained oral medication regimens. PUL provides a minimally invasive option in the arsenal of therapeutic modalities.

摘要

前列腺尿道悬吊术(PUL)是一种经美国食品药品监督管理局批准的用于改善良性前列腺增生(BPH)症状的微创手术。PUL利用可植入医疗器械机械性地牵拉增大的前列腺组织,从而使尿道通畅并增加尿流。该手术不涉及组织加热、切除或破坏。PUL也可在局部麻醉下单次进行,有可能迅速缓解BPH症状并减少对慢性BPH药物的依赖。BPH的特征是一种组织病理学状况,可定量增加前列腺内基质和上皮细胞的数量。细胞增殖导致前列腺尿道逐渐变窄,最终导致下尿路症状(LUTS)的出现。这些症状包括尿急、尿频增加、夜尿增多、膀胱排空障碍、排尿初始犹豫、尿流中断以及尿流力量减弱。流行病学数据表明,BPH引起的LUTS显著影响50%至75%年龄超过50岁的男性,在70岁以上人群中患病率升至80%至90%。尽管BPH引起的LUTS主要降低生活质量,但其发病范围还包括复发性尿路感染、急性尿潴留、膀胱结石和血尿。BPH相关症状的标准干预措施包括手术方式,如经尿道前列腺切除术或激光剜除术,以及通过持续口服药物方案进行药物治疗。PUL在治疗方法中提供了一种微创选择。

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