单纯碎石取石联合药物治疗良性前列腺增生合并膀胱结石

Lithotripsy or Lithotomy Combined with Medical Treatment for Bladder Calculus Complicated with Benign Prostatic Hyperplasia

目的：探讨良性前列腺增生（ benign prostatic hyperplasia，BPH）合并膀胱结石仅行碎石取石辅助药物治疗，未行前列腺手术治疗的临床效果。方法2006年6月～2013年6月对62例良性前列腺增生合并膀胱结石采用耻骨上膀胱切开取石术、经尿道碎石取石术或体外冲击波碎石治疗膀胱结石，术后给予坦索罗辛和（或）非那雄胺缓解前列腺增生引起的下尿路症状，比较术前与术后1个月IPSS评分、QOL评分、残余尿量及最大尿流率的变化。结果术后1个月IPSS评分（12．9±4．8）分，明显低于术前（22．6±3．6）分（t＝12．918，P＝0．000）；QOL评分（3．2±1．1）分，明显低于术前（4．7±1．0）分（t＝8．279，P＝0．000）；残余尿量中位数13 ml（0～60 ml），明显少于术前中位数29 ml（0～102 ml）（Z＝－3．614，P＝0．000）。术前与术后1个月最大尿流率分别为（11．1±2．3）、（11．8±2．4）ml／s，无统计学差异（t＝－0．755，P＝0．441）。术后膀胱结石复发2例（3．2％），经体外冲击波碎石治疗后结石完全排除，随访未见结石复发。62例平均随访28个月（6～62个月），急性尿潴留2例，继发上尿路积水1例，反复肉眼血尿合并泌尿系感染2例，下尿路梗阻症状严重影响生活质量1例，此6例（9．7％）均行经尿道前列腺电切术。 logistic回归分析显示Qmax是前列腺手术的独立危险因素（ OR＝0．213，P＝0．026，95％CI：0．054～0．835）。结论单纯处理膀胱结石结合药物治疗对改善良性前列腺增生患者的下尿路症状有一定疗效。

Objective To assess clinical outcomes of stone removal and medical treatment, without transurethral resection of the prostate, for bladder calculus complicated with benign prostatic hyperplasia （ BPH） . Methods From June 2006 to June 2013, 62 patients with bladder calculus and BPH underwent suprapubic lithotomy, endoscopic lithotripsy, or extracorporeal shock wave lithotripsy （ESWL） with subsequent administration of Tamsulosin and/or Finasteride for relieving symptoms of BPH.Changes of international prostate symptom score （IPSS）, quality of life score （QOL）, residual urine volume, and maximum flow rate （Qmax） before and after operation were compared. Results The IPSS at 1 month after operation （12.9 ±4.8） were significantly lower than that before operation （22.6 ±3.6, t=12.918, P=0.000）.The QOL at 1 month after operation （3.2 ±1.1） were significantly lower than that before operation （4.7 ±1.0, t=8.279, P=0.000）.The residual urine volume before and after treatment were （30.1 ± 21.2） ml and （17.8 ±17.6） ml, respectively （t=5.107, P=0.000）.The maximum flow rate before and after treatment were （11.1 ±2.3） ml/s and （11.8 ±2.4） ml/s, respectively （t=-0.755, P=0.441）.Recurrence of bladder calculus was found in 2 cases （3.2%） , which were given an additional ESWL and found no recurrence during follow-ups.The follow-up after removal of the bladder calculi averaged 28 months （6-62 months）.There were 2 cases of acute urinary retention, 1 case of hydronephrosis, 2 cases of gross hematuria and urinary tract infection, and 1 case of serious LUTs symptoms.Those 6 cases （9.7%） were given transurethral resection of the prostate.The logistic regression analysis showed that Qmax was positively correlated with the surgery （ OR=0.213, P=0.026, 95%CI： 0.054 -0.835 ） . Conclusion BPH patients associated with bladder stones can be successfully treated with bladder stone removal and medical treatment.