Riehmann M, Knes J M, Heisey D, Madsen P O, Bruskewitz R C
Department of Surgery, University of Wisconsin, Hospital and Clinics, Madison, USA.
Urology. 1995 May;45(5):768-75. doi: 10.1016/S0090-4295(99)80081-8.
To evaluate longer term effects of transurethral resection (TURP) and incision (TUIP) of the prostate in randomized patients.
In a randomized, prospective study, 120 patients with symptoms of bladder outlet obstruction caused by smaller benign prostates (estimated resectable weight less than 20 g) were assigned to TURP or TUIP. Patients were evaluated preoperatively and at intervals postoperatively as to urinary symptoms (Madsen's questionnaire), sexual function, and uroflowmetry. Overall evaluation of outcome of surgery was also assessed at follow-up visits.
Fifty-six patients received a TURP and 61 a TUIP. Three patients refused to participate in the project after randomization, and 5 patients were lost to or excluded from follow-up. A group of 112 patients were obtainable for postoperative evaluation with a mean follow-up time of 34 months (1 to 82 months). Improvements in mean urinary peak flow rates were seen in both groups throughout the study period. The peak flow rates generally were higher (but not statistically so) in the TURP group. Postoperative irritative, obstructive, as well as total symptom scores decreased significantly at all follow-up visits after both TURP and TUIP (P < or = 0.034). Preoperatively and at all postoperative follow-up there was no statistically significant difference in irritative, obstructive, or total symptom scores between TURP and TUIP. The patients indicated an overall subjective improvement at all follow-ups in both groups, with no statistically significant difference between the treatment groups. Fifteen of 22 (68%) patients receiving TURP and 8 of 23 (35%) in the TUIP group who were sexually active before and after surgery developed postoperative retrograde ejaculation (P = 0.020). Postoperatively, 9 (16%) of the patients in the TURP and 14 (23%) in the TUIP group received further treatment for benign prostatic hyperplasia (BPH)-related infravesical obstruction. This difference was not statistically significant (P = 0.908).
In small prostates TURP and TUIP were generally equally effective in relieving bladder outlet obstruction secondary to BPH. Most surgically treated BPH cases can be well managed by the incision technique, which is an underutilized procedure.
评估经尿道前列腺切除术（TURP）和前列腺切开术（TUIP）对随机分组患者的长期影响。
在一项随机前瞻性研究中，120例因较小良性前列腺（估计可切除重量小于20 g）导致膀胱出口梗阻症状的患者被分配接受TURP或TUIP。术前及术后定期对患者进行尿症状（马德森问卷）、性功能和尿流率评估。随访时还对手术结果进行总体评估。
56例患者接受了TURP，61例接受了TUIP。3例患者在随机分组后拒绝参与该项目，5例患者失访或被排除在随访之外。112例患者可进行术后评估，平均随访时间为34个月（1至82个月）。在整个研究期间，两组患者的平均尿流峰值率均有所改善。TURP组的峰值流率通常较高（但无统计学差异）。TURP和TUIP术后所有随访时，刺激性、梗阻性以及总症状评分均显著降低（P≤0.034）。术前及术后所有随访中TURP和TUIP在刺激性、梗阻性或总症状评分方面均无统计学显著差异。两组患者在所有随访中均表示总体主观改善，治疗组之间无统计学显著差异。手术前后均有性生活的22例接受TURP的患者中有15例（68%）发生术后逆行射精，TUIP组23例中有8例（35%）发生术后逆行射精（P = 0.020）。术后，TURP组9例（16%）患者和TUIP组14例（23%）患者因良性前列腺增生（BPH）相关膀胱下梗阻接受了进一步治疗。这种差异无统计学意义（P = 0.908）。
对于较小前列腺，TURP和TUIP在缓解BPH继发的膀胱出口梗阻方面通常同样有效。大多数接受手术治疗的BPH病例可用切开技术良好处理，而该技术未得到充分利用。
