经尿道前列腺电切在合并神经源性因素的前列腺增生伴逼尿肌活动低下患者中的运用

Application of transurethral resection of the prostate in patients with benign prostatic hyperplasia and neurogenic detrusor underactivity

目的探讨经尿道前列腺电切术(TURP)在良性前列腺增生(BPH)伴合并神经源性因素的逼尿肌活动低下患者中的临床运用及治疗效果。方法 47例BPH伴逼尿肌活动低下患者通过经详细询问病史、查体、尿动力及影像学等辅助检查后分为两组。A组:合并神经源性因素组;B组:不合并神经源性因素组。比较两组患者TURP手术前后的国际前列腺症状评分(IPSS)、IPSS储尿期及排尿期亚评分、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量。结果两组患者术后3月时的IPSS、储尿期及排尿期评分、QOL、Qmax、残余尿量均较术前改善,术前与术后比较,差异具有统计学意义(P<0.05)。A组Qmax手术前后的改善差值低于B组,差异具有统计学意义(P<0.05),两组间IPSS、储尿期及排尿期评分、QOL、残余尿量改善差值相比,差异无统计学意义(P>0.05)。结论对于经选择的合并神经源性因素的前列腺增生伴逼尿肌活动低下患者,TURP能解除泌尿道梗阻,短期内改善排尿症状、提高生活质量。

Objective To investigate the effect of transurethral resection of the prostate(TURP)in patients with benign prostatic hyperplasia(BPH)combine with neurogenic detrusor underactivity.Methods 47 patients with BPH and detrusor underactivity were divided into two groups after inquiry of medical history,physical examination,urodynamic study and imaging examination.Patients in group A were of BPH combined with neurogenic detrusor underactivity and patients in group B were without neurogenic factors.The difference in International Prostate Symptom Score(IPSS),storage subscore and voiding subscore,quality of life score(QOL),maximum urinary flow rate(Qmax)and residual urine volume between before and after operation were compared between the two groups.Results There were statistically significant differences in IPSS,storage subscore and voiding subscore,QOL,Qmax,residual urine volume between preoperation and 3 months after operation in the two groups(P<0.05).Improvement in Qmax in group A was lower than that in group B(P<0.05)while no statistically significant difference was found in improvement in IPSS,storage subscore and voiding subscore,QOL and residual urine volume between the two groups(P>0.05).Conclusions TURP can alleviate the bladder outlet obstruction,short-term voiding symptom and improve the quality of life of patients with BPH and neurogenic detrusor underactivity.