经尿道气压弹道/超声碎石清石术联合TURP治疗BPH合并膀胱结石

Combination of transurethral pneumatic and ultrasound cystolithotripsy and transurethral resection of prostate in benign prostatic hyperplasia with bladder stones

目的探讨经尿道气压弹道/超声碎石清石术联合TURP治疗良性前列腺增生症(BPH)合并膀胱结石的疗效。方法2005年7月至2006年6月,采用经尿道气压弹道/超声碎石清石术联合TURP治疗BPH合并膀胱结石21例。结石直径平均17.8mm(10～55)mm。其中单发结石13例,两个结石5例,多发结石3例(最多6枚)。术前前列腺重量53.4(22～143)g。国际前列腺症状评分(IPSS)21.8(9～25)分。QOL4.5(4～6)分。最大尿流率6.5(3～14.8)ml/s。残余尿158(20～389)ml。结果所有患者均一次碎石成功,结石清除率100%。手术平均时间85.3(42～215)min。其中粉碎并清除结石平均时间为25.6(8～45)min;前列腺电切平均时间51.8(16～87)min。术后导尿管留置时间30.6(24～48)h,术后平均留院天数1.3(1～4)d。术后6个月随访,IPSS平均4.3(0～7)分。QOL平均1.2分(0～3)分。最大尿流率>15ml/s。无严重并发症发生及结石复发。结论经尿道气压弹道/超声碎石清石术联合TURP治疗BPH合并膀胱结石是一种高效、安全的方法。

Objective To evaluate the efficacy and safety of combination of transurethral pneumatic and ultrasound cystolithotripsy and transurethral resection of prostate （TURP） in benign prostatic hyperplasia with bladder stones. Method From Jul 2005 to Jun 2006, 21 cases were operated. The mean greatest diameter of stone was 17.Smm （range 10-55） mm. There was one stone in 13 patients, two stones in 5, and multiple stones in 3. The mean prostate weight was 53.4 （22-143） g. The score of international prostate symptom score （IPSS） and quality of life （QOL） was 21.8 （9-25） and 4.5（4-6）, respectively. The peak flow rate （Qmax） and postvoidal residual urine volume （PVR） was 6. 5 （3-14.8） ml/s and 158 （20-389） ml, respectively. Results Complete stone free rate （KUB and ultrasound） was 100% after operation. The mean operative time was 85.3 （42-215） min. The mean lithotripsy and evacuation of fragments time was 25.6 （8-45） rain; the mean resection time of BPH was 51.8 （16-87） min. The average duration of catheterization and hospital stay was 30.6 （24-48） h and 1.3 （1-4） d, respectively. After follow-up of 6 months, the score of IPSS and QOL was 4.3（0-7） and 1.2（0-3）, respectively. The Qmax 〉 15 ml/s. No long-term complication or stone racurrence was noted in any patient. Conclusion Combination of transurethral pneumatic and ultrasound cystolithotripsy and transurethral resection of prostate in benign prostatic hyperplasia with bladder stones is effective and safe.