IPSS-V/S在TUVP术后下尿路症状评估的临床价值

Clinical value of international prostatic symptom score-voiding/storage subscore ratio in assessing lower urinary tract symptoms after transurethral electrovaporization prostatectomy

目的:探讨国际前列腺症状评分的排尿期/储尿期评分比值(international prostatic symptom score-voiding/storage subscore ratio,IPSS-V/S)在经尿道前列腺汽化电切术(transurethral electrovaporization prostatectomy,TUVP)术后下尿路症状(lower urinary tract symptoms,LUTS)再评估的临床价值。方法:回顾性分析了2015年1月至2016年12月期间234例接受TUVP的良性前列腺增生(benign prostatic hyperplasia,BPH)患者的国际前列腺症状评分(international prostatic symptom score,IPSS)等临床资料。按照IPSS-V/S比值将患者分为A组(IPSS-V/S≤1,80例)和B组(IPSS-V/S>1,154例)。术后6个月再次评估IPSS,储尿期症状评分(international prostatic symptom score-storage,IPSS-S),排尿期症状评分(international prostatic symptom score-voiding,IPSS-V)和生活质量评分(quality of life,QOL)。结果:234例患者术后6个月IPSS和QOL较术前明显降低,差异有统计学意义(t=33.0,P=0.000;t=34.3,P=0.000)。术后6个月B组患者IPSS改善程度明显优于A组[(12.36±3.67)分vs.(8.20±3.21)分](t=8.96,P=0.000)。其中A组术后6个月IPSS-S明显高于B组[(9.61±2.88)分vs.(5.55±2.63)分](t=10.8,P=0.000);而2组患者术后6个月时IPSS-V对比无统计学差异(t=1.56,P=0.120)。虽然A组术后6个月的QOL明显改善[(3.59±0.91)分vs.(5.19±0.55)分](t=14.8,P=0.000),但是基本满意及以上者仅占13.75%,明显低于B组的70.78%。A组术后6个月IPSS-S各症状评分均有一定改善,改善程度从高到低依次为尿急评分、尿频评分和夜尿评分,其中夜尿评分改善率最低,仅为36.3%(29/80),是A组患者IPSS及QOL改善较小的重要原因。结论:相比IPSS,IPSS-V/S更能准确反映TUVP术后疗效,LUTS排尿期症状改善明显优于储尿期症状。对于以夜尿症为主的BPH/LUTS患者,TUVP对患者QOL改善有限,需要引起临床医师重视。

Objective:To investigate the clinical value of international prostatic symptom score-voiding/storage subscore ratio(IPSS-V/S)in assessing lower urinary tract symptoms(LUTS)after transurethral electrovaporization prostatectomy(TUVP). Methods:A retrospective analysis was performed for international prostatic symptom score(IPSS)and other clinical data of 234 patients with benign prostatic hyperplasia(BPH)who underwent TUVP from January 2015 to December 2016. According IPSS-V/S,these patients were divided into group A(80 patients with an IPSS-V/S≤1)and group B(154 patients with an IPSS-V/S>1). IPSS,international prostatic symptom score-voiding(IPSS-V)score,international prostatic symptom score-storage(IPSS-S)score,and quality of life(QOL)score were reassessed at 6 months after surgery. Results:All 234 patients had significant reductions in IPSS and QOL score at 6 months after surgery(t=33.0 and 34.3,both P=0.000). At 6 months after surgery,group B had a significantly greater improvement in IPSS than group A [(12.36 ±3.67) points vs.(8.20 ±3.21) points,t =8.96,P =0.000]. At 6 months after surgery,group A had a significantly higher IPSS-S score than group B [(9.61 ±2.88) points vs.(5.55 ±2.63)points,t=10.8,P=0.000],while there was no significant difference in IPSS-V score between the two groups(t=1.56,P=0.120). Although group A had a significant improvement in QOL score at 6 months after surgery[(3.59±0.91)points vs.(5.19±0.55)points,t=14.8,P=0.000],group A had a significantly lower satisfaction rate than group B(13.75% vs. 70.78%). At 6 months after surgery,group A had varying degrees of improvement in IPSS-S symptom scores,among which the score of urgency of urination showed the highest degree of improvement,followed by the scores of frequency of urination and nocturia;the score of nocturia had the lowest improvement rate of 36.3%(29/80),which was an important reason for the low degree of improvement in IPSS and QOL.Conclusion:Compared with IPSS,IPSS-V/S can reflect the outcome after TUVP more accurately,and voiding symptoms have significantly greater improvements than storage symptoms in LUTS. BPH/LUTS patients with nocturia as the main complaint have limited improvement in QOL after TUVP,which should be taken seriously by clinicians.