经尿道等离子前列腺剜除术前后尿动力学变化

Urodynamic change before and after transurethral plasma kinetic enucleation of prostate

目的观察经尿道等离子前列腺剜除术(Transurethral plasma kinetic enucleation of prostate,TUPKEP)治疗良性前列腺增生的效果。方法22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度7例,Ⅳ度8例,Ⅴ度4例,Ⅵ度3例),逼尿肌收缩强度弱加4例、正常减11例、正常加5例和强烈2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(23.43±3.75)分下降到(11.73±3.89)分,最大尿流率由(6.71±3.54)ml/s上升至(16.37±5.49)ml/s,而最大尿流率时膀胱逼尿肌压由(78.67±23.15)cmH2O下降至(38.29±27.43)cmH2O,膀胱容量由(257.84±123.68)ml升至(378.67±182.15)ml,前列腺长度明显减小,而压力变化不明显。结论TUPKEP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 urodynamic outcomes of patients with benign prostatic hyperplasia （BPH） undergoing the transurethral plasmakinetic enucleation of prostate（TUPKEP）. Methods Twenty-two cases were diagnosed as benign hyperplasia associated with outlet obstruction by using the P/Q study and the Schaefer Grading as well Lin-PURR quantitative analysis results includde 7 cases of Ⅲ grade,8cases of IV grade, 4 cases of Ⅴ grade and 3cases of Ⅳ grade; in detrusor strength, 4cases with weak＋, l leases with normal-, 5cases with normal＋, 2cases with stronger tension, were studied before and after the TUPKEP with the lntemational 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 23.43to 11.73;maximum urinary flow rate （Qmax） increased significantly from 6.71ml/s to 16.37ml/s; detrusor preasure at Qmax （PdetQmax）decreased significantly from 78.67 cmH2O to 38.29 cmH2O; bladder capacity increased significantly from 257.84ml to 378.67ml. However, significantly shortened prostate length was observed, but the changes of pressure was not obvious. Conclusion TUPKEP can effectively relieve the bladder outlet obstruction in patients with BPH.