点状电极与钬激光治疗射精后血尿的临床观察

Point electro-cauterization versus holmium laser cauterization in the treatment of post-ejaculation hematuria

目的:探讨点状电极烧灼术与钬激光烧灼术在治疗射精后血尿患者效果、症状改善及焦虑情绪改善方面所存在的优势与劣势。方法:选取2015年1月至2018年12月在我院就诊的射精后血尿患者,经3个月保守治疗无效者共计73人,拟进行手术治疗。年龄24~63(36.8±4.2)岁。点状电极烧灼术组(35例)与钬激光烧灼术组(38例),观察两组患者实际在院时间、住院总费用、尿流率、汉密尔顿焦虑评分(HAMA)、术后血尿持续时间、术后3个月复发率、术后6个月复发率。结果:所有患者在术后1个月开始首次排精,均未再发生射精后血尿。点状电极组、钬激光组术后3个月复发率分别为5.71%、2.63%,术后6个月复发率分别为8.57%、5.26%,差异均统计学意义(P>0.05)。术后1个月点状电极组最大尿流率由(18.56±2.53) ml/s降为(13.68±3.31) ml/s,差异有统计学意义(P<0.05);平均尿流率由(14.35±2.26) ml/s降为(9.69±1.84) ml/s,差异有显著性(P<0.01);钬激光组在上述尿流率检测指标方面,术前术后均无差异。患者术前普遍存在轻度到中度焦虑,无职业、无固定收入、症状频发、病程长的患者,焦虑评分更高。焦虑的程度与年龄、文化程度、婚姻状况无相关性。点状电极组HAMA焦虑评分由术前的(18.65±4.33)分降至术后的(12.35±3.63)分,钬激光组HAMA焦虑评分由术前的(16.88±2.11)分降至术后的(6.87±4.36)分,两者存在显著性差异(P<0.01)。点状电极组住院时间为(5.2±1.3) d,总费用为(0.635±0.120)万元,钬激光组住院时间为(3.4±0.5) d,总费用为(1.272±0.215)万元,钬激光组住院时间更短(P<0.01),但总费用更高(P<0.05)。结论:两种治疗方法均可安全完成手术,效果确切。在术后3、6个月复发率方面无明显差别,远期效果有待进一步随访。点状电极烧灼可能造成患者术后尿流率负面结局的风险增加。钬激光烧灼在改善患者焦虑状态方面更具优势,且至少比后者提前1天获得安全出院,术后血尿持续时间也更短。但是点状电极烧灼治疗方法的总治疗费用明显较低。

Objective: To investigate the advantages and disadvantages of point electro-cauterization(PEC) and holmium laser cauterization(HLC) in the treatment of post-ejaculation hematuria. Methods: From January 2015 to December 2018, 73 patients with post-ejaculation hematuria, aged 24-63(36.8 ± 4.2) years, underwent PEC(n = 35) or HLC(n = 38) after failure to respond to 3 months of conservative treatment. We compared the hospital days, total hospitalization expenses, maximum urinary flow rate(Qmax), average urinary flow rate(Qavg), Hamilton Anxiety Rating Scale(HAMA) score, postoperative duration of hematuria, and recurrence rate at 3 and 6 months after surgery. Results: All the patients experienced first ejaculation but no post-ejaculation hematuria at 1 month after operation. The recurrence rates were lower in the PEC than in the HLC group at 3 months(5.71% vs 2.63%, P > 0.05) and 6 months postoperatively(8.57% vs 5.26%, P > 0.05). Compared with the baseline, the Qmax was decreased from(18.56 ± 2.53) ml/s to(13.68 ± 3.31) ml/s(P < 0.05) and the Qavg from(14.35 ± 2.26) ml/s to(9.69±1.84) ml/s in the PEC group at 1 month after surgery(P < 0.01), but neither showed any statistically significant difference in the HLC group. Mild to moderate anxiety was prevalent in the patients preoperatively, particularly in those without job or regular income and those with a long disease course or frequent onset, the severity of which was not correlated with age, education or marital status. The HAMA score was decreased from18.65 ± 4.33 before to 12.35 ± 3.63 after surgery in the PEC group(P < 0.01), and from 16.88 ± 2.11 to 6.87 ± 4.36 in the HLC group(P < 0.01). The mean hospital stay was significantly longer in the former than in the latter group([5.2 + 1.3] vs [3.4 ± 0.5] d, P < 0.01), while the total cost markedly lower([6.35 ± 1.20] vs [12.72 ± 2.15] thousand RMB $, P < 0.05). Conclusion: Both PEC and HLC are safe and effective for the treatment of post-ejaculation hematuria, with no significant difference in the recurrence rate at 3 and 6 months after operation, but their long-term effect needs further follow-up studies. PEC may increase the risk of negative outcomes of the postoperative urinary flow rate, while HLC has the advantages of better relieving the patient’s anxiety, sooner discharge from hospital and earlier recovery from postoperative hematuria, though with a higher total cost than the former. Natl J Androl, 2020, 26(10): 888-894.