保留与不保留膀胱颈口环状纤维在经尿道前列腺等离子剜除术后尿失禁、逆行射精和膀胱颈口挛缩发生率的对比

Comparison of the incidence of urinary incontinence,retrograde ejaculation,and contracture of the bladder neck after transurethral plasmakinetic enucleation of the prostate with and without preservation of the annular fibers of the bladder neck

目的探讨保留与不保留膀胱颈口环状纤维的经尿道前列腺等离子剜除术(TUPKEP)在术后尿失禁、逆行射精及膀胱颈口挛缩发生率的比较。方法选取2015年1月至2018年1月收治的TUPKEP患者346例。保留颈口组128例,术中尽量保留膀胱颈口环状纤维结构;不保留颈口组218例,常规切除膀胱颈口环状纤维。对比两组术后早期控尿能力、逆行射精发生率及术后随访1年以上膀胱颈口挛缩的发生率。结果两组术后早期最大尿流量(Qm)[(14.41±3.58)mL/s vs.(13.51±3.09)]比较,差异无统计学意义(P>0.05);而术后尿失禁发生率(14.06%vs.21.10%)和逆行射精发生率(26.56%vs.54.59%)及晚期膀胱颈口挛缩发生率(0.78%vs.2.75%)比较,差异均有统计学意义(P<0.05)。结论TUPKEP术中保留膀胱颈口环状纤维结构可明显改善早期控尿、降低逆行射精及术后膀胱颈口挛缩发生率。

Objective To compare the incidence of postoperative urinary incontinence,retrograde ejaculation and bladder neck contracture after transurethral plasmakinetic enucleation of the pros tate(TUPKEP)with or without the preservation of the annular fibers of the bladder neck.Methods A total of 346 patients undergoing TUPKEP from January 2015 to January 2018 were selected.The ring fiber structure of the bladder neck was kept as much as possible during the operation in one group with 128 patients.And in another group with 218 patients,the ring fibers in the bladder neck were routinely removed.The early postoperative urinary control ability,the incidence of retrograde ejaculation and the incidence of bladder neck contracture for more than 1 year after operation were compared.Results There was no statistically significant difference in the early postoperative urinary flow rate improvement(P>0.05).The postoperative urinary incontinence rate,the retrograde ejaculation rate and the bladder neck contracture rate were lower in the group with the preservation of bladder neck ring fiber(P<0.05).Conclusions The treatment of retaining the bladder neck ring fiber structure during prostate plasma kinetic enucleation can significantly improve the early urine control,reduce the incidence of retrograde ejaculation and postoperative bladder neck contractures.