经尿道前列腺等离子剜除术中保留尿控的策略

Strategies of preserving urinary continence in transurethral plasmakinetic enucleation of the prostate for benign prostate hyperplasia

目的:探讨经尿道前列腺等离子剜除术(PKEP)中保留尿控的策略及技巧。方法:65例良性前列腺增生(BPH)患者,行保护尿控的PKEP,术中实施控尿策略,前(尿道精阜处):保护尿道外括约肌;中(尿道前列腺部):适当保留前列腺前叶,保护尿道内括约肌功能;后(尿道内口处):保留膀胱颈口完整性。比较同期54例行常规等离子完全前列腺剜除术患者的术后尿控情况。结果:所有患者均顺利完成手术,术后5 d拔除尿管,完全剜除组和保留尿控剜除组的尿失禁发生率:拔尿管后24 h为31.49%和13.85%,拔除尿管后1周为18.52%和4.62%,拔尿管后2周为14.81%和3.08%,两组间差异均有统计学意义(P<0.05)。术后1个月两组间尿失禁发生率分别为3.70%和1.54%,术后3个月为3.70%和0%,两组间差异无明显统计学意义(P>0.05)。两组均未出现永久性尿失禁。术后3个月,两组最大尿流率均明显改善:完全剜除组[术前(7.42±3.26)ml、术后(20.58±3.22)ml,P<0.05]和保留尿控剜除组[术前(8.04±2.28)ml、术后(20.66±3.08)ml,P<0.05]。结论:PKEP治疗BPH安全有效,术中(前)避免尿道外括约肌钝性、锐性损伤,(中)适当保留前列腺前叶保护尿道内括约肌及(后)保存膀胱颈口完整性,有助于术后控尿功能的快速恢复。

Objective： To explore the strategies of preserving urinary continence in transurethral plasmakinetic enucleation of the prostate （PKEP） for benign prostate hyperplasia （BPH）. Methods： We treated 65 BPH patients by PKEP with preservation of urinax3~ continence （ UC-PKEP）, which involved protection of the external urethral sphincter in the beginning of surgery, proper preser- vation of the anterior lobe of the prostate to protect the internal urethral sphincter in the middle, and preservation of the integrity of the bladder neck towards the end. We compared the postoperative status of urinary continence of the patients with that of the 54 BPH cases treated by complete plasmakinetic enucleation of the prostate （ Com-PKEP）. Results ： All the operations were performed successfully with the urinary catheters removed at 5 days after surgery. In comparison with Com-PKEP, UC-PKEP achieved evidently lower inci- dence rates of urinary incontinence at 24 hours （31.49% vs 13.85%, P 〈 0.05）, 1 week （ 18.52% vs 4.62%, P 〈 0.05）, 2 weeks （14.81% vs 3.08%, P 〈0.05）, 1 month （3.70% vs 1.54%, P 〉0.05）, and3 months （3.70% vs0%, P 〉0.05） after catheter removal. Compared with the baseline, the maximum urinary flow rate （ Qmax ） was significantly improved postoperatively in both the Com-PKEP （ [7.43 ± 3.26] vs [20.58 ± 3.221 ml, P 〈0.05） and the UC-PKEP group （ [8.04± 2.28] vs [20.66± 3.08] ml, P 〈 0.05）. Conclusion ： Transurethral PKEP is a safe and effective method for the management of BPH, during which the strategies of avoiding blunt or sharp damage to the external urethral sphincter in the beginning, properly preserving the anterior lobe of the prostate in the middle and preserving the integrity of the bladder neck towards the end may help to achieve rapid recovery of urinm7 continence.