经尿道前列腺电切联合肾镜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

Combining transurethral resection of the prostate with pneumatic or ultrasound cystolithotripsy in benign prostatic hyperplasia with bladder stones

目的评价经尿道前列腺电切(transurethral resection of the prostate,TURP)联合肾镜气压弹道或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 2010年1月～2011年7月,对48例前列腺增生伴膀胱结石患者同期采用气压弹道碎石或超声碎石取石联合经尿道前列腺电切术进行治疗。结果 48例均一次手术成功,膀胱结石均一次性清除,总手术时间55～145min,平均(78.6±10.6)min,其中膀胱结石清除时间为12～45min,平均(26±4.3)min;术中无膀胱破裂、严重失血、TUR综合征等严重并发症发生;术后4～7d拔除导尿管,其中46例排尿通畅,最大尿流率(Qmax)>15 mL/s;2例排尿不畅(Qmax<6mL/s),术前尿动力学检查显示与膀胱逼尿肌功能减退有关,术中给予膀胱造瘘、术后行膀胱训练2个月后排尿通畅。IPSS评分由术前平均(27.8±4.0)分下降至术后(7.4±3.1)分,生活质量评分(QOL)由术前平均(5.2±0.7)分下降至(2.0±0.5)分,最大尿流率(Qmax)由术前平均(4.8±3.3)mL/s上升至(18.8±3.6)mL/s。术后随访2～18个月,患者均排尿通畅,无结石复发。结论 TURP联合肾镜气压弹道或超声碎石术治疗BPH合并膀胱结石安全有效,结石清除率高,碎石时间短,术后并发症少。具有创伤小,恢复快,并发症少的优点,不受结石成分限制,是微创治疗BPH合并膀胱结石的理想方法。

【Objective】 To evaluate the clinical effect of combining transurethral resection of the prostate with pneumatic or ultrasound cystolithotripsy in benign prostatic hyperplasia（BPH） with bladder stones.【Methods】 From January,2010 to July,2011,48 patients who have BPH with bladder stones were performed transurethral resection of the prostate and pneumatic or ultrasound cystolithotripsy.【Results】 All the operation of these 48 cases were successful without any complications,and all of the bladder stones were removed after operation.The total operative time was（55～145）min,the mean time was（78.6±10.6）min.The total lithotripsy and evacuation off ragments time was（12～45）min,the mean time was（26±4.3）min;there was no complication accured,such as bladder rupture,seve bleeding and TURP syndrome and so on.4 to 7 days after operation,the urethral catheters were removed,46 cases were treated successfully with voiding fluently（Qmax15mL/s）;2 cases resulted in postoperative dysuria（Qmax6mL/s）,which was showed in our urodynamic study preoperative,the function of detrusor of bladder in these 2 cases was atoned,and then achieved satisfactory results after cystostomy and training bladder with 2 months.The International Prostate Symptom Score Preoperative and Postoperative was（27.8±4.0）and（7.4±3.1）,respectively,The Quality of Life Score was（5.2±0.7）and（2.0±0.5）,respectively,Qmax was（4.8±3.3）mL/s and（18.8±3.6）mL/s,respectively.The follow-up was 2～18 months after operation,all of the patients voided smoothly,the calculi was not recurrent.【Conclusion】 The urethral management of BPH with bladder stones using transurethral resection of the prostate combined with pneumaticand or ultrasound cystolithotripsy is safety and effective,has much advantage,such as high rate of removing stone,shorter time of galleting,fewer complications,little trauma,guicker recovery and so on.So it is an ideal minimally invasive mathod of treating benign prostatic hyperplasia with bladder stones.