前列腺尿道角预测良性前列腺增生患者经尿道前列腺等离子电切术后夜尿改善情况

Prostatic urethral angle predicting nocturia after TUPKP in patients with benign prostatic hyperplasia

目的探讨前列腺尿道角预测经尿道前列腺等离子电切术治疗患者良性前列腺增生后夜尿改善情况。方法选择2016年8月‐2017年12月在该院行经尿道前列腺等离子电切术的患者86例,经直肠超声测定前列腺尿道角(PUA)、前列腺体积(PV),经腹超声测定残余尿量(PVR),收集患者国际前列腺症状评分(IPSS)、生活质量指数(QOL)评分及最大尿流率(Qmax)等相关临床参数,将患者按术后夜尿改善情况分为夜尿改善组(<2次/晚)和非改善组(≥2次/晚)。结果经尿道前列腺等离子电切术后,44.2%患者(38/86)夜尿症状得到改善。前列腺尿道角与术后IPSS评分、术后QOL、平均尿流率和最大尿流率、夜尿存在相关性(P <0.05)。受试者操作特征性(ROC)曲线显示,PUA预测术后夜尿的预测值为0.771(95%CI,0.668～0.874;P=0.000),使用35.5°为切点水平,预测经尿道前列腺等离子电切术后夜尿症状改善的敏感度为84.6%,特异度为68.1%。前列腺尿道角更小的患者夜尿症状、IPSS评分[(10.2±0.4)vs.(16.1±0.4),P <0.001]、QOL[(1.9±0.1)vs.(2.9±0.1),P <0.001]更轻。结论 PUA是预测经尿道前列腺等离子电切术后夜尿症状较好的指标,PUA切点选择在35.5°,能较好地预测患者术后的夜尿情况。

【Objective】To evaluate the effect of the prostatic urethral angle(PUA) on nocturia after bipolar transurethral electrovaporization of the prostatectomy(TUPKP) in men with benign prostatic hyperplasia.【Methods】A study of 86 men with benign prostatic hyperplasia who accept TUPKP from August 2016 to December 2017 was performed. PUA and prostate volume(PV) were measured by transrectal ultrasonography, post-void residual urine(PVR) was measured by transabdominal ultrasonography. The international prostate symptom score(IPSS), qualitiy of life(QOL) score, and peak of flow rate(Qmax) were also recorded. Patients were divided into the improved(<2 times of nocturia) and non-improved group(more than 2 times) after administration of TUPKP. 【Result】After TUPKP, 44.2% of patients(38/86) showed improvement of nocturia. PUA has a significant correlation with IPSS, QOL, nocturia after TUPKP, urinary flow rate, Qmax(P <0.05). In receiver operating characteristic(ROC) analysis, the area under the curve using the PUA was 0.771(95% CI, 0.668~0.874;P =0.000). Using 35.5° as a cut-off level, the sensitivity and specificity for predicting the improvement of nocturia after TUPKP reached 84.6% and 68.1%, respectively. Patients with lower PUA(PUA<35.5°) had more improvement of nocturia, lower IPSS score [(10.2 ± 0.4) vs.(16.1 ± 0.4), P <0.001], and better QOL [(1.9 ± 0.1) vs.(2.9 ± 0.1), P <0.001].【Conclusion】PUA is a useful predictor of nocturia after TUPKP. Using 35.5° as a cut-off level can predict nocturia after TUPKP in patients with benign prostatic hyperplasia.