经尿道双极等离子前列腺剜除术治疗良性前列腺增生伴膀胱结石的效果及其对患者性功能的影响

Effect of transurethral bipolar plasmakinetic enucleation of prostate in treatment of benign prostate hyperplasia complicated with bladder stones and its influence on sexual function

目的:探讨经尿道双极等离子前列腺剜除术(PKEP)治疗良性前列腺增生(BPH)伴膀胱结石的疗效及对患者性功能的影响。方法:选取2009年1月至2016年12月贵航平坝医院与贵航安顺医院收治的116例良性BPH伴膀胱结石患者,按随机抽签法分为观察组和对照组。观察组(n=58)实施PKEP治疗,对照组(n=58)实施经尿道双极等离子电切术(PKRP)。比较两组手术基础情况及术后并发症发生情况,术前及术后6个月对患者进行国际前列腺症状评分(IPSS)、生活质量评分(QOL)评分,测定残余尿量(PVR)、最大尿流率(Qmax)及性功能指标[国际勃起功能指数-5问卷表(IIEF-5)评分、逆行射精(RE)及勃起功能障碍(ED)发生率]。结果:两组膀胱碎石时间比较差异无统计学意义(P> 0. 05);前列腺切除时间、术中出血量、术后膀胱冲洗时间、导尿管留置时间及住院时间方面,观察组均显著小于对照组(P <0. 05);术后暂时性尿失禁、膀胱痉挛、膀胱刺激征发生率观察组显著低于对照组(P <0. 05);术后6个月,两组IPSS评分、PVR、Qmax差异均无统计学意义(P> 0. 05),而QOL评分观察组显著低于对照组,且IIEF-5评分观察组显著高于对照组(P <0. 05);观察组ED和RE发生率分别为8. 62%、25. 86%,均显著低于对照组相应的25. 86%、48. 28%(P <0. 05)。结论:PKEP治疗良性BPH伴膀胱结石安全有效,创伤小、术后恢复快、并发症少,对患者的性功能影响小。

Objective: To investigate the efficacy of transurethral bipolar plasmakinetic enucleation of prostate( PKEP) in treatment of benign prostate hyperplasia complicated with bladder stones and its influence on sexual function. Methods: 116 cases of benign BPH patients complicated with bladder stones admitted to Guihang Pingba County Hospital and Guihang Anshun County Hospital from January 2009 to December 2016 were randomly divided into observation group and control group,58 cases in each group. The observation group was treated with PKEP,the control group was treated with transurethral bipolar plasmakinetic resection of prostate( PKRP). The basic situation of surgery and postoperative complications were compared between the two groups. The scores of International Prostate Symptomscore( IPSS) and Quality of Life( QOL) were evaluated before operation and at 6 th months after surgery,the post void residual volume( PVR),maximum flow rate( Qmax) and sexual function indicators [International Erectile Dysfunction Index-5 Questionnaire( IIEF-5) score,retrograde ejaculation( RE)and erectile dysfunction( ED) incidence] were evaluated and compared. Results: There was no significant difference in the lithotripsy time of bladder stones between the two groups( P > 0. 05),while the time of prostatectomy,intraoperative bleeding,postoperative bladder irrigation time,urinary catheter retention time and hospital stay in the observation group were significantly lower than those in the control group( P < 0. 05). The postoperative incidences of temporary incontinence,bladder spasms,bladder irritation in the observation group were significantly lower than the control group( P < 0. 05). There were no significant differences in IPSS score,PVR and Qmaxbetween the two groups at 6 thmonth after operation( P > 0. 05),while the QOL score in the observation group was significantly lower than that in the control group( P < 0. 05),the IIEF-5 score in the observation group was significantly higher than that in the control group( P < 0. 05). The incidence of ED and RE was 8. 62% and25. 86% in the observation group,significantly lower than 25. 86% and 48. 28% in the control group,the difference was statistically significant( P < 0. 05). Conclusion: PKEP for the treatment of benign BPH with bladder stones is safe and effective with the advantages of minimal invasion, quick recovery and fewer complications,which has less disruption of sexual function.