前列腺增生合并膀胱大结石的腔镜下联合微创治疗

A combined endourologic approach in treatment of benign prostatic hyperplasia with larger vesical calculus

目的探讨经尿道气压弹道/超声碎石清石术联合等离子体电切术微创治疗前列腺增生合并膀胱大结石的方法、疗效。方法采用瑞士EMS第3代气压弹道/超声碎石清石系统和经尿道前列腺等离子体电切术(PKRP)治疗前列腺增生合并膀胱大结石患者27例。结果27例均1次手术成功,碎石时间40～65 min,平均55 min;前列腺等离子体电切时间50～110 min,平均85 min。术中术后均无输血,无电切综合征、膀胱穿孔、结石残留等并发症。术后6 d拔除尿管,无排尿困难、永久性尿失禁等。病理结果均为良性前列腺增生。术后3个月,最大尿流率由(5.4±1.5)mL/s升至(18.6±3.2)mL/s。结论经尿道气压弹道/超声碎石清石术联合等离子体电切术能有效地治疗良性前列腺增生合并膀胱大结石。

[ Objective ] To assess the efficacy and advantages of a combined endourologic approach to treat benign prostate hyperplasia and associated large vesical calculus. [Methods] A total of 27 patients with benign prostate hyperplasia and associated vesical calculus of 40 mm or greater were treated with pneumatic and uhrasenie lithotripsy followed by transurethral plasma kinetic resection of prostate （PKRP）. [ Results ] All operations were performed successfully and no significant complications developed. The lithotripsy time ranged from 40 to 65 minutes （a median of 55 min）. The mean PKRP time was 85 minutes （range 50 to 110min）. Blood transfusion was not needed during the operation. No electroresection syndrome, vesical perforation or residual stone was observed. No dysuria and permanent urine incontinence developed in any ease after the removal of Foley catheters 6 days after surgery. The urodynamic tests showed the maximum flow was significantly improved [from （5.4±1.5）mL/s to （18.6±3.2）mL/s] in all patients 3 months after. [ Conclusion ] The combined pneumatic and ultrasonic lithotripsy with PKRP is technically feasible and effective for the management of BPH and associated vesical calculus of 4 cm or greater in particular.