经尿道前列腺双极等离子电切联合气压弹道或超声碎石术治疗良性前列腺增生合并膀胱结石

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

目的评价经尿道前列腺双极等离子电切联合气压弹道/超声碎石术治疗良性前列腺增生症(BPH)合并膀胱结石的临床效果。方法 2007年3月至2009年4月,采用前列腺双极等离子电切联合气压弹道或超声碎石术治疗BPH合并膀胱结石患者86例。结果 86例均手术成功,膀胱结石均一次性清除。手术时间45～150min,平均89min,其中膀胱结石清除时间为11～48min,平均29min。术后4～5d拔除导尿管,其中79例排尿通畅,最大尿流率(Qmax)>15ml/s,7例排尿不畅(Qmax<6ml/s),尿动力学检查显示与膀胱逼尿肌功能减退有关,给予膀胱造瘘、药物治疗和膀胱训练2～3个月后排尿通畅。结论前列腺双极等离子电切联合气压弹道或超声碎石术治疗BPH合并膀胱结石安全有效,手术操作简单,并发症少,可避免开放手术所致的伤口感染,是治疗BPH合并膀胱结石的理想方法。

Objective To evaluate the efficacy and safety of combination of transurethral bipolar plasmakinetic resection of the prostate and pneumatic and ultrasound cystolithotripsy in benign prostatic hyperplasia（BPH）with bladder stones.Methods From March 2008 to April 2009,transurethral bipolar plasmakinetic resection of the prostate and pneumatic and ultrasound cystolithotripsy were performed on 86 patients with BPH accompanied with bladder stones.Results The procedure was performed successfully at one-stage in all 86 cases without complications,and complete bladder stones free rate was 100% after operation.The mean operative time was 89 min（45~150）.The mean lithotripsy and evacuation of fragments time was 29 min（11~48）.The urethral catheters were re-moved 4 to 5 days after operation,79 cases were treated successfully and voided fluently（Qmax15 ml/s）.Seven cases resulted in postoperative dysuria（Qmax6 ml/s）.Atony of bladder were shown in the cases according to our urodynamic study,and then achieved satisfactory results（Qmax15 ml/s）after cystostomy and training bladder and pharmacotherapy.Conclusions The experience with transurethral management of BPH with bladder stones using transurethral bipolar plasmakinetic resection of the prostate combined with pneumatic and ultrasound cystolithotripsy suggests that it is not only safe and effective but also has advantages of simple manipu-lation,fewer complications and can avoid wound infection compared with open surgery.