HoLEP治疗良性前列腺增生合并急性尿潴留的临床疗效及安全性研究

Clinical efficacy and safety of HoLEP in treatment of benign prostatic hyperplasia with acute urinary retention

目的:评估钬激光前列腺剜除术(holmium laser enucleation of prostate,HoLEP)治疗良性前列腺增生(benign prostatehyperplasia,BPH)合并急性尿潴留(acute urinary retention,AUR)患者的疗效及安全性。方法:回顾性分析我院2016年2月至2018年2月收治的128例行钬激光前列腺剜除术治疗的良性前列腺增生患者,其中伴有AUR 40例(31.25%)归为AUR组,不伴AUR 88例(68.75%)归为非AUR组。根据既往尿潴留次数是否大1次将AUR组分为A(≤1次,n=25)、B(>1次,n=15)2个亚组。分别比较AUR、非AUR组,A、B组之间的基本信息资料、围手术期资料以及术后随访指标的差异。结果:AUR组患者术前尿常规检查尿白细胞阳性率、尿培养阳性率、前列腺特异性抗原(prostate specific antigen,PSA)、国际前列腺症状评分(International prostatic symptom score,IPSS)及手术时间明显高于非AUR患者组(P<0.05),血红蛋白较非AUR组低(P<0.05)。2组患者血红蛋白变化值、导尿管留置时间、住院天数以及围手术期并发症发生率之间无统计学差异(P>0.05)。术后随访2组患者残余尿(post-voiding residual,PVR)、IPSS及生活质量评分(quality of life score,QoL)较术前均有下降、最大尿流率(maximum urinary flow rate,Qmax)较术前升高(P<0.05)。A、B 2组比较,围手术期资料及术后6个月随访IPSS、QoL、PVR、Qmax之间无统计学差异(P>0.05)。结论:HoLEP术治疗BPH伴发AUR患者安全有效。患者既往尿潴留的次数对手术效果无影响。

Objective:To investigate the clinical efficacy and safety of holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)with acute urinary retention(AUR). Methods:A retrospective analysis was performed in128 patients with BPH who underwent HoLEP in our hospital from February 2016 to February 2018,including 40(31.25%)patients with AUR(AUR group) and 88(68.75%) patients without AUR(non-AUR group). According to the number of urinary retention episodes,the AUR group was divided into two subgroups:subgroup A(≤1 time,n=25)and subgroup B(>1 time,n=15). The basic information,perioperative data,and postoperative follow-up parameters were compared between the AUR group and the non-AUR group and between the subgroup A and the subgroup B. Results:Compared with the non-AUR group,the AUR group had significantly higher urinary white blood cell positive rate,urine culture positive rate,prostate-specific antigen level,and International Prostate Symptom Score(IPSS)(P<0.05),a significantly longer operation time(P<0.05),and a significantly lower hemoglobin level(P<0.05).There were no significant differences in change in hemoglobin level,catheter indwelling time,length of hospital stay,and incidence rate of perioperative complications between the two groups(P>0.05). After surgery,both groups had significantly decreased post-voiding residual(PVR),IPSS,and quality of life(QoL)score(P<0.05)and a significantly increased maximum urinary flow rate(Qmax)(P<0.05). There were no significant differences in perioperative data and IPSS,QoL score,PVR,and Qmax at 6-month follow-up after surgery between the subgroup A and the subgroup B(P>0.05). Conclusion:HoLEP is safe and effective in the treatment of BPH with AUR. The number of urinary retention episodes has no effect on the surgical outcome.