早期经尿道前列腺隧道式电切治疗前列腺癌近距离照射治疗术后尿潴留(英文)

Early channel transurethral resection of the prostate for patients with urinary retention after brachytherapy

研究目的：探讨早期经尿道前列腺隧道式电切治疗前列腺癌近距离照射治疗术后尿潴留的适应症及其对近距离照射治疗疗效的影响。创新要点：前列腺癌近距离照射治疗已经成为75岁以上患者的首选，前列腺癌近距离照射治疗术后尿潴留发生率为1．5％～22．0％。经尿道前列腺电切常用于药物治疗无效的反复尿潴留患者，且手术时机多在近距离照射治疗术后6个月以后。经尿道前列腺隧道式电切治疗前列腺癌近距离照射治疗术后尿潴留可在6个月内进行，患者尿道症状从IV（出现尿潴留，需要导尿）下降为0级（没有症状）或Ⅰ级（轻度，中度尿频，2～3次／晚），较术前改善明显，且对近距离照射治疗疗效无明显影响。研究方法：浙江大学医学院附属邵逸犬医院2009年2月至2013年7月问所有接受前列腺癌近距离照射治疗的病例共190例，其中9例（4．7％）患者术后出现反复尿潴留，且早期行经尿道前列腺隧道式电切术治疗，回顾分析其临床资料。重要结论：前列腺癌近距离照射治疗术后反复尿潴留，在严格防护下早期行经尿道前列腺隧道式电切是安全有效的，且电切后对近距离照射治疗疗效无明显影响。

Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP （cTURP） within six months post-implant for patients with refractory urinary retention. Methods： One hundred and ninety patients with localized prostate cancer of clinical stages Tlc to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. Results： The median interval between prostate brachytherapy and cTURP was three months （range 1.5 to 5.0 months） There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months （range 6 to 26 months） after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen （PSA） of the patients who underwent cTURP was 0.42 ng/ml （range 0.08 to 0.83 ng/ml） at the end of their follow-up. Conclusions： Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.