超声监视球囊扩张治疗老年等离子前列腺切除术后尿道狭窄的近期效果

Short-term Effect of Ultrasound Monitoring Balloon Dilatation on Urethral Stricture After Plasma Prostatectomy in the Elderly

目的探讨超声监视高压球囊扩张(balloon dilation,BD)治疗老年患者经尿道双极等离子前列腺切除术(transurethral plasma kinetic prostatectomy,TUPKP)后尿道狭窄的近期临床效果。方法2016年6月~2019年1月我院20例老年TUPKP术后尿道狭窄接受超声监视BD治疗。亲水导丝通过尿道狭窄段进入膀胱,以导丝为引导引入等离子勾状刀将狭窄段尿道切开,使高压(30 atm)球囊导管顺利进入尿道狭窄部位,在超声实时监测下,精确定位、掌控高压球囊扩张全过程,使狭窄段尿道安全、有效地扩张。结果手术时间(31.1±6.5)min,术中出血量(12.4±5.2)ml,保留尿管时间(2.7±0.7)d,住院时间(6.8±1.7)d。术后3个月最大尿流率(19.2±2.1)ml/s,较术前(7.2±1.2)ml/s明显升高(t=-23.875,P=0.000);术后3个月平均尿流率(10.5±1.2)ml/s,明显高于术前(3.9±0.8)ml/s(t=-18.051,P=0.000);术后3个月残余尿量(21.9±6.8)ml,较术前(107.8±46.2)ml明显降低(t=9.062,P=0.000);术后3个月国际前列腺症状评分(5.4±1.6)分,较术前(25.1±2.8)分明显降低(t=25.997,P=0.000);术后3个月生活质量评分(1.9±0.8)分,较术前(4.8±0.9)分明显降低(t=11.588,P=0.000);术后3个月膀胱过度活动调查评分(48.0±7.1)分,较术前(78.3±7.8)分明显降低(t=10.331,P=0.000);术后6个月国际勃起功能指数问卷表-5评分(7.3±1.8)分,与术前(7.5±1.8)分比较差异无显著(t=1.831,P=0.083)。拔除尿管后发生尿失禁1例,协助排尿功能锻炼后症状好转;术后1年内尿道狭窄复发1例,行尿道狭窄内切开术治疗。结论超声监视BD治疗老年TUPKP术后尿道狭窄,安全、有效地改善患者近期排尿功能,改善术后生活质量。

Objective To investigate the short-term effect of ultrasound monitoring balloon dilatation(BD)on urethral stricture after transurethral plasma kinetic prostatectomy(TUPKP)in elderly patients.Methods From June 2016 to January 2019,20 elderly patients with urethral stricture after TUPKP were treated with ultrasound monitoring BD.The hydrophilic guide wire was entered the urethral stricture segment,and a plasma hook knife was used to open the stricture segment so the high-pressure(30 atm)balloon catheter could enter the urethral stricture site.Under the real-time ultrasonic monitoring,accurate positioning and control of the high-pressure BD made the urethra stricture expanding safely and effectively.Results The operation time was(31.1±6.5)min,the intraoperative blood loss was(12.4±5.2)ml,the catheter retention time was(2.7±0.7)d,and the hospital stay was(6.8±1.7)d.Three months later,the Qmax[(19.2±2.1)ml/s]was significantly higher than preoperative level[(7.2±1.2)ml/s,t=-23.875,P=0.000],the Qave[(10.5±1.2)ml/s]was significantly higher than preoperative level[(3.9±0.8)ml/s,t=-18.051,P=0.000],the residual urine volume(RUV)[(21.9±6.8)ml]was significantly lower than preoperative level[(107.8±46.2)ml,t=9.062,P=0.000],the International Prostate Syndrome Score(IPSS)[(5.4±1.6)points]was lower than preoperative level[(25.1±2.8)points,t=25.997,P=0.000],the quality of life(QOL)score[(1.9±0.8)points]was lower than preoperative level[(4.8±0.9)points,t=11.588,P=0.000],and the Questionnaire for Overactive Bladder(OAB-q)score[(48.0±7.1)points]was lower than preoperative level[(78.3±7.8)points,t=10.331,P=0.000].Six months later,the International Index of Erectile Function-5(IIEF-5)score[(7.3±1.8)points]had no significant difference as comparing to preoperative level[(7.5±1.8)points,t=1.831,P=0.083].One case of urinary incontinence occurred after removal of the urinary tube,but the symptoms improved with the exercise of urination function.Postoperatively 1 case of urethral stricture recurred and was treated by endotomy.Conclusion Ultrasonic monitoring BD for urethral stricture after TUPKP in elderly patients is safe and effective in improving patients’urination function and postoperative quality of life.