Sirls L T, Ganabathi K, Zimmern P E, Roskamp D A, Wolde-Tsadik G, Leach G E
Kaiser Permanente Medical Center, Los Angeles, California.
J Urol. 1993 Nov;150(5 Pt 2):1615-21. doi: 10.1016/s0022-5347(17)35858-5.
The emergence of less invasive therapies has demanded the reassessment of surgical procedures for the treatment of benign prostatic hyperplasia. This study was designed to evaluate the long-term efficacy of transurethral incision of the prostate using objective (urodynamic) and subjective (symptom score and assessment of satisfaction) parameters, and investigate sexual function. The results of transurethral incision of the prostate in 41 men (mean age 63.4 years) were reviewed, with a mean followup of 53 months (range 12 to 96). Preoperative symptom score (based on the Madsen-Iversen score) and urodynamic evaluation were compared to recent post-transurethral incision symptom score, urodynamic evaluation and interview to determine patient satisfaction. Total symptom score, as well as obstructive and irritative components, significantly decreased after transurethral incision of the prostate (p < 0.0001). Mean detrusor pressure at peak flow decreased from 85 to 44 cm. water (p < 0.0001) and mean maximal detrusor pressure decreased from 114 to 55 cm. water (p < 0.0001). Mean peak urine flow rates increased from 10.3 to 15.3 cc per second (p = 0.019). Of the men 32 (82%) reported long-term improvement after transurethral incision of the prostate, with an overall satisfaction rate of 67% (range 0 to 100). Regardless of objective urodynamic criteria (indicating obstruction or relief of obstruction), the number of men reporting subjective improvement and the degree of improvement were similar. Only 4 men (11%) reported new retrograde ejaculation. The proportion of men with improvement after transurethral incision of the prostate compares favorably to long-term data available on transurethral resection of the prostate. Assessing the degree of improvement (overall satisfaction) is unique and has not been previously reported. These results clearly demonstrate that in selected patients transurethral incision of the prostate is an effective procedure for long-term relief of outlet obstruction.
侵入性较小的治疗方法的出现，要求重新评估治疗良性前列腺增生的外科手术。本研究旨在使用客观（尿动力学）和主观（症状评分及满意度评估）参数评估经尿道前列腺切开术的长期疗效，并调查性功能。回顾了41名男性（平均年龄63.4岁）经尿道前列腺切开术的结果，平均随访53个月（范围12至96个月）。将术前症状评分（基于马德森 - 艾弗森评分）和尿动力学评估与最近经尿道前列腺切开术后的症状评分、尿动力学评估及访谈进行比较，以确定患者满意度。经尿道前列腺切开术后，总症状评分以及梗阻性和刺激性成分均显著降低（p < 0.0001）。平均排尿峰值逼尿肌压力从85厘米水柱降至44厘米水柱（p < 0.0001），平均最大逼尿肌压力从114厘米水柱降至55厘米水柱（p < 0.0001）。平均最大尿流率从每秒10.3毫升增加至15.3毫升（p = 0.019）。32名男性（82%）报告经尿道前列腺切开术后有长期改善，总体满意率为67%（范围0至100）。无论客观尿动力学标准（表明梗阻或梗阻缓解）如何，报告主观改善的男性数量及改善程度相似。只有4名男性（11%）报告出现新的逆行射精。经尿道前列腺切开术后改善的男性比例与经尿道前列腺切除术的现有长期数据相比具有优势。评估改善程度（总体满意度）是独特的，此前尚未见报道。这些结果清楚地表明，对于选定的患者，经尿道前列腺切开术是长期缓解出口梗阻的有效方法。
