微创一期处理前列腺增生并发膀胱多发结石

Mininally invasive treatment of patients with benign prostatic hyperplasia and multiple vesical calculi in one step

目的:探讨微创一期处理前列腺增生并发膀胱多发结石的疗效。方法:回顾分析我院56例患者气压弹道膀胱多发结石碎石+前列腺电切同期处理膀胱多发结石合并前列腺增生的临床资料。结果:无死亡及中转开放手术病例,56例膀胱多发结石均碎石、并成功取石。5例患者术中或术后需输血,3例出现电切综合征,4例术后出现尿路感染,2例出现尿失禁。除1例出现尿道外口狭窄外,其余患者术后排尿通畅满意,国际前列腺症状评分由术前(23.5±4.8)分降为(9.3±1.4)分P<0.01,残余尿手术前后分别为(47.5±9.2)ml,(16.3±7.6)ml(P<0.01),结石清除率100%;术后随访5～27个月,平均16.2月,无膀胱结石复发。结论:腔内处理泌尿系结石合并前列腺增生创伤小、安全高效,并发症少,是治疗前列腺增生并泌尿系结石理想方法。

Objective：To investigate the results of combined transurethral resection of the prostate （TURP） and transurethral lithotripsy （TULT） in the management of benign prostatic hyperplasia （BPH） with vesical calculi.Methods：Through a 5-year period,56 men （aged from 61 to 76 years old） with benign prostatic hyperplasia and multiple vesical calculi underwent TURP followed by transurethral lithotripsy （TULT） for stone clearance.The mean greatest diameter of multiple stones was 15.7 mm （range 6-42 mm）, which were treated using pneumatic ballistic lithotripsy by a ureteroscope being inserted into the bladder via outer sheath of resectoseope.After removal of the calculi ,transurethral resection of the prostate was performed.Results：No death occurred, none conversion to open surgery. Blood transfusion was required in 5 （8.9%） patients either intraoperatively or postoperatively.Postoperatively, 3 （5.4%） had transurethral resection syndrome （TURS）,4 patients （7.1%） had urinary tract infections,2 （3.6%） had urinary incontinence.Satisfactory voiding was achieved in all except one patient developed urethral meatus stricture.The average International Prostate Symptom Score （IPSS） before and after treatment was 23.5±4.8,9.3±1.4（P〈0.01 ）,respectively,and the postvoid residual urine volume was （47.5±9.2）ml and （16.3±7.6） ml （P〈0.01） respectively.The stone free rate was 100%.The follow-up time averaged 16,2 months,ranged （5-27） months.No bladder stones recurred.Conclusion：Transurethral lithotripsy and TURP is an efficient mininally invasive treatment option for the patients with benign prostatic hyperplasia and multiple bladder calculi.