Zhu Zhiwei, Qing Zhibiao, He Junhuan, Wu Xuecheng, Yuan Wuxiong, Duan Yixing, Li Yuanwei, Zeng Mingqiang
Department of Urology, Hunan Provincial People's Hospital, Changsha 410005.
Lower Urinary Tract and Pelvic Floor Function Disease Research Center of Hunan Institute of Geriatrics, Changsha 410005, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Nov 28;49(11):1751-1756. doi: 10.11817/j.issn.1672-7347.2024.240392.
The conventional Fr26 resectoscope is difficult to use in patients with benign prostatic hyperplasia (BPH) complicated by urethral stricture. This study aims to evaluate the safety and efficacy of transurethral plasmakinetic resection of the prostate (PKRP) using a small-caliber (Fr18.5) plasmakinetic resectoscope combined with urethral dilation in patients with BPH and mild urethral stricture.
A retrospective analysis was conducted on 37 patients with BPH and mild urethral stricture treated at the Department of Urology, Hunan Provincial People's Hospital from January 2023 to December 2023. All patients underwent PKRP with a small-caliber plasmakinetic resectoscope, followed by routine placement of a Fr20 three-way Foley catheter for continuous bladder irrigation. International Prostate Symptom Score (IPSS), maximum urinary flow rate (), post-voiding residual urine volume (PVR), and Quality of Life (QOL) scores were compared before and after surgery. Perioperative indicators (intraoperative bleeding, operative time, postoperative catheterization time, and postoperative hospital stay) and complications were recorded.
The median age was 69 years, and the median duration of voiding difficulty was 36 months. Median total prostate specific antigen (T-PSA) was 2.095 ng/mL, free prostate specific antigen (F-PSA) 0.561 ng/mL, and F/T ratio 0.3. Median prostate diameter was 48 mm and volume 41 mL. All 37 surgeries were completed successfully: 11 had external meatal stricture, 19 had mild anterior urethral stricture, and 7 had mild posterior urethral stricture (1 patient with a 1 cm pseudo-blind tract near the membranous urethral). Operative time was (2.4±0.7) hours, blood loss was (40±29) mL, median catheterization duration was 7 days, and median hospital stay was 7 days. No cases of postoperative urinary incontinence, recurrent hematuria, or sepsis occurred, and patients were satisfied with the surgical outcome. At 3 to 6 months follow-up, IPSS, , PVR, and QOL scores significantly improved compared to preoperative levels (all <0.01), with no cases of urethral stricture progression or new-onset stricture.
PKRP using a small-caliber plasmakinetic resectoscope is safe and effective for treating BPH with mild urethral stricture. It offers advantages such as minimal trauma, rapid postoperative recovery, and a lower risk recovery, and a lower risk of aggravating urethral injury.
传统的Fr26电切镜在良性前列腺增生（BPH）合并尿道狭窄的患者中使用困难。本研究旨在评估使用小口径（Fr18.5）等离子电切镜联合尿道扩张术对BPH合并轻度尿道狭窄患者进行经尿道等离子前列腺切除术（PKRP）的安全性和有效性。
对2023年1月至2023年12月在湖南省人民医院泌尿外科接受治疗的37例BPH合并轻度尿道狭窄患者进行回顾性分析。所有患者均使用小口径等离子电切镜进行PKRP，随后常规放置Fr20三腔Foley导尿管进行持续膀胱冲洗。比较手术前后的国际前列腺症状评分（IPSS）、最大尿流率（）、排尿后残余尿量（PVR）和生活质量（QOL）评分。记录围手术期指标（术中出血、手术时间、术后留置导尿时间和术后住院时间）及并发症。
中位年龄为69岁，排尿困难中位病程为36个月。总前列腺特异性抗原（T-PSA）中位值为2.095 ng/mL，游离前列腺特异性抗原（F-PSA）为0.561 ng/mL，F/T比值为0.3。前列腺中位直径为48 mm，体积为41 mL。37例手术均成功完成：11例为尿道口狭窄，19例为轻度前尿道狭窄，7例为轻度后尿道狭窄（1例在膜部尿道附近有1 cm假道）。手术时间为（2.4±0.7）小时，出血量为（40±29）mL，中位留置导尿时间为7天，中位住院时间为7天。未发生术后尿失禁、复发性血尿或脓毒症病例，患者对手术结果满意。在3至6个月的随访中，IPSS、、PVR和QOL评分较术前水平显著改善（均<0.01），无尿道狭窄进展或新发狭窄病例。
使用小口径等离子电切镜进行PKRP治疗轻度尿道狭窄的BPH安全有效。它具有创伤小、术后恢复快、恢复风险低以及加重尿道损伤风险低等优点。
