经尿道前列腺扩裂术治疗中年前列腺增生致急性尿潴留的疗效

Value of Transurethral Prostatic Splitting for the Treatment of Acute Urinary Retention in Benign Prostatic Hyperplasia in Middle-aged Patients

目的探讨经尿道前列腺扩裂术(transurethral prostatic splitting,TUPS)治疗中年前列腺增生(benign prostatic hyperplasia,BPH)致急性尿潴留(acute urinary retention,AUR)的安全性和疗效。方法将前列腺扩裂导管插入前列腺段尿道,准确定位后分别向内外囊注水充压至0.3 MPa,维持3~5 min,减压后拔出扩裂导管,更换大球囊尿管并用氯化钠盐水持续冲洗。结果 48例手术均获成功,手术时间(9.6±1.9)min。残余尿量(residual urine volume,RUV)术前(659.2±189.4)ml,术后(12.8±6.4)ml,有显著性差异(t=23.577,P=0.000)。国际前列腺症状评分(International Prostatic Symptom Score,IPSS)由术前(23.7±5.5)分降至术后(5.4±1.8)分(t=21.949,P=0.000)。生活质量(quality of life,QOL)评分由术前(5.8±0.9)分降至术后(1.4±0.7)分(t=26.629,P=0.000)。术后阴茎勃起功能障碍发生率与逆行射精发生率分别为2.1%(1/48)和4.2%(2/48)。46例随访10个月~4年(平均2.6年),无一例急性尿潴留复发。结论 TUPS治疗中年前列腺增生致急性尿潴留具有安全性高、并发症少、疗效好的优点。

Objective To evaluate the safety and efficacy of transurethral prostatic splitting（ TUPS） for the treatment of acute urinary retention（ AUR） in benign prostatic hyperplasia（ BPH） in middle-aged patients. Methods The prostatic dilation catheter was inserted into the urethra segment of the prostate. After accurate positioning,water was injected into the internal and external capsule until the pressure of 0. 3 MPa for 3-5 minutes. After decompression,the dilation catheter was pulled out,the large balloon catheter was replaced and rinsed continuously by using sodium chloride saline. Results The operation was successfully completed in all the 48 patients. The mean operation time was（ 9. 6 ± 1. 9） min. The residual urine volume（ RUV） decreased from（ 659. 2 ± 189. 4） ml preoperatively to（ 12. 8 ± 6. 4） ml postoperatively（ t = 23. 577,P = 0. 000）. The International Prostatic Symptom Score（ IPSS） decreased from（ 23. 7 ± 5. 5） points preoperatively to（ 5. 4 ± 1. 8） points postoperatively（ t = 21. 949,P =0. 000）. The quality of life（ QOL） score decreased from（ 5. 8 ± 0. 9） points preoperatively to（ 1. 4 ± 0. 7） points postoperatively（ t =26. 629,P = 0. 000）. The incidences of erectile dysfunction and retrograde ejaculation were 2. 1%（ 1/48） and 4. 2%（ 2/48）,respectively. A total of 46 patients were followed up for 10 months to 4 years（ mean,2. 6 years） without recurrence. Conclusion As a good treatment for AUR in BPH in middle-ages patients,TUPS is effective and safe,and has few complications.