前列腺增生合并输尿管及膀胱结石的同期腔内处理

Endoscopic treatment of patients with benign prostatic hyperplasia and uretal/bladder stones

目的控讨气压弹道碎石+前列腺电切同期处理膀胱、输尿管结石合并前列腺增生的临床疗效。方法该组治疗前列腺增生合并泌尿系结石患者76例,首先采用输尿管镜下气压弹道碎石术治疗输尿管结石或膀胱结石,膀胱结石碎石时采用电切镜外鞘内置入输尿管镜下气压弹道碎石取石。随后行前列腺电汽化术。结果无死亡及中转开放手术病例,54例膀胱结石及19例输尿管结石患者均碎石并成功取石,3例输尿管中段结石上移肾盂。国际前列腺症状评分由术前(26.2±3.8)分降为(8.5±0.8)分(P<0.01),残余尿手术前后分别为(46.4±11.2)、(15.9±8.6)mL(P<0.01)。术后随访3～24个月,2例出现前尿道狭窄,余患者排尿通畅满意,无严重并发症发生。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） followed by ureteroscopic pneumatic lithotripsy （UPL） in the management of BPH coincident with urinary calculi. 【Methods】 A retrospective analysis of the results of seventy-six patients. Which underwent UPL of the ureteral or bladder stones （the bladder calculi were treated using pneumatic ballistic lithotripsy by a ureteroscope being inserted into the bladder via outer sheath of resectoscope）. After removal of the ureteral or bladder calculi,transurethral re-section of the prostate was performed. 【Results】No death occurred,none conversion to open surgery. All the bladder and 19 cases of ureteral stones were successfully evacuated except 3 case of the middle ureteral calculi migrating to the kidney pelvis. The International Prostate Symptom Score before and after treatment was （26.2±3.8） and （8.5±0.8） （P〈0.01）,respectively. The postvoid residual urine volume was （46.4±11.2） mL and （15.9±8.6） mL （P〈0.01） respectively. The follow-up time averaged 15.3 months （range 3-24）,two patients developed anterior urethral stricture,no serious complications occurred. Satisfactory voiding had been achieved in all.【Conclusions】Combined transurethral lithotripsy and TURP is an efficient treatment of choice in cases of benign prostatic hyperplasia with uretal/bladder stones.