经尿道等离子前列腺切除前后尿动力学变化

Urodynamic change before and after transurethral plasmakinetic prostatectomy

目的观察经尿道等离子前列腺切除术(Transurethralplasmakineticpro-statectomy,TUPKP)治疗良性前列腺增生的效果。方法57例患者术前P/Q图检查及Schaefer分级和Lin-PURR定量分析确诊为良性前列腺增生伴膀胱出口梗阻(其中Ⅲ级11例,Ⅳ级18例,Ⅴ级21例,Ⅵ级7例),逼尿肌收缩强度弱加(W+)9例、正常减(N-)26例、正常加(N+)17例和强烈(ST)5例,分别进行术前、术后的国际前列腺症状评分和尿流动力学检查。结果与术前相比,IPSS评分由(25.47±4.67)分下降到(12.53±5.23)分,最大尿流率由(5.67±3.43)ml/s上升至(15.48±5.41)ml/s,而最大尿流率时膀胱逼尿肌压由(77.67±26.57)cmH2O下降至(37.12±29.46)cmH2O,膀胱容量由(235.84±157.17)ml升至(389.73±177.54)ml,前列腺长度明显减小,而压力变化不明显。结论经尿道前列腺等离子切除术可显著改善良性前列腺增生患者的膀胱流出道梗阻。

Objective To evaluate the uredynamic outcomes of patients with benign prostatic hyperplasia （BPH） undergoing the transurethral plasmakinetic prostatectomy （TUPKP）.Methods A total of 57 cases diagnosed as benign prostatic hyperplasia with the P/Q study and the Schaefer Gradiug （includingll cases of Ⅲ grade,18cases of Ⅳ grade,21 cases of Ⅴ grade and 7 cases of Ⅵgrade,meanwhile; 9cases with weak＋ detrusor strength,20cases with normal-detrusor strength,17cases with normal＋ detrusor strength, 5cases with stronger tension detrusor strength）were studied before and after the TUPKP with the International Prostatic Symptom Score （IPSS）and the urodynamic examinations（including the uroflowmetry, voiding cystometry, P/Q study and resting urethral pressure profile, rUPP）.Results After operation, the IPSS decreased significantly from 25.47 to 12.53;maximum urinary flow rate （Qmax）increased significantly from 5.67ml/s to 15.48ml/s;detrusor pressure at Qmax（PdetQmax）decreased significantly from 77.67cmH20 to 37.12cmH20;bladder capacity increased significantly from 235.84ml to 389.73ml. However, significantly shortened prostate length was observed, but the changes of pressure was not obvious.Conclusion TUPKP can effectively relieve the bladder outlet obstruction in patients with BPH.