经电切镜外鞘碎石术和TURP治疗伴膀胱结石的良性前列腺增生

Lithotripsy by outer sheath of resectoscop combined with TURP in the treatment of benign prostatic hyperplasia companied with bladder stones

目的探讨伴膀胱结石的前列腺增生有效的腔内治疗方法。方法应用经电切镜外鞘气压弹道或钬激光碎石术和经尿道前列腺电切术(TURP)治疗伴膀胱结石的良性前列腺增生58例。结果58例均一次手术成功,碎石时间20～90min,平均45min;前列腺电切时间40～100min,平均75min。术中术后无电切综合征、膀胱穿孔和结石残留等并发症发生。术后7d拔除尿管后无排尿困难。1例术后3周出现前尿道狭窄,2例出现暂时性尿失禁,经治疗后痊愈。术后三个月,国际前列腺症状评分由22.8±4.6分下降至7.6±1.4分(P<0.01),最大尿流率由6.5±1.8ml/s升至19.2±3.6ml/s(P<0.01),生活质量评分由4.1±1.3分降至2.1±0.6分(P<0.01)。结论经电切镜外鞘碎石术和TURP治疗伴膀胱结石的良性前列腺增生有效、安全和经济。

Objective To explore an effective endoumlogic treatment method for benign prostatic hyperplasia companied with bladder stones. Methods Ballistic or holmium laser lithotripsy by outer sheath resectoscope and transurethral resection of the prostate （TURP） were performed on 58 patients with benign prostatic hyperplasia companied with bladder stones. Results The operations were completed successfully in all the cases with a mean lithotripsy time of 45 min （20-90 min）, and mean TURP time of 75 min （40- 100 min）. No TUR syndrome, bladder perforation, or residual stone occurred during and after the operations. Urethral catheter was withdrawn 7 days after operation. 1 patients occurred anterior urethral stricture 3 weeks after operation, 2 patients had temporary incontinence. Three months after the operations, IPSS decreased from 22. 8 ±4.6 to 7.6 ±1.4 （P〈0. 01）; maximum urinary flow rate increased from 6. 5±1.8 ml/s to 19. 2±3.6 ml/s （P〈0. 01）; and QOL decreased from 4.1±1.3 to 2.1±0.6 （P〈0. 01）. Conclusions Ballistic or holmium laser lithotripsy by outer sheath resectoscope combined with TURP is an effective, safe and economical treatment for benign prostatic hyperplasia companied with bladder stones.