HoLEP术后尿失禁的临床研究

Clinical Study of Urinary Incontinence After HoLEP

目的探讨低功率经尿道钬激光前列腺剜除术(holmium laser enucleation of the prostate,HoLEP)治疗老年患者良性前列腺增生的应用和临床疗效。方法回顾2017年1月—2019年12月本院行经尿道低功率HoLEP术治疗前列腺增生348例,按年龄分为70岁以下组(A组)190例和70岁以上组(B组)158例,先按24小时尿垫实验初筛尿失禁患者,再分别对两组患者术后1个月、术后3个月、术后6个月的尿失禁情况按ISI索引随访。结果术后1个月时未恢复患者中A组轻度25例、中度10例、重度8例,B组轻度20例、中度15例、重度3例,A组尿失禁严重程度低于B组,比较差异有统计学意义(P <0.05);A组尿失禁恢复患者占比与B组比较差异无统计学意义(P> 0.05)。术后3个月A、B两组尿失禁严重程度比较差异无统计学意义(P>0.05),A组尿失禁恢复患者占比与B组比较差异无统计学意义(P>0.05)。术后6个月时A组仅有轻度尿失禁1例,B组尿失禁患者全部恢复。结论过渡性尿失禁是良性前列腺增生症HoLEP术后常见并发症之一,其恢复与患者年龄、术后时间和尿失禁的康复训练相关。

Objective To explore the application and clinical efficacy of low-power HoLEP operation in treating benign prostatic hyperplasia in elderly patients.Methods From January 2017 to December 2019,348 patients with benign prostatic hyperplasia underwent transurethral lowpower HoLEP surgery in our hospital.They were divided into groups under the age of 70(group A)190 cases and groups over 70(group B)158 cases according to age.According to the 24-hour urinal pad test,urinary incontinence patients were screened,and the urinary incontinence in the first month,the third month,and the sixth month after operation in the two groups were followed up according to the ISI index.Results At the 1 month after operation,among the unrecovered patients,there were 25 mild cases,10 moderate cases and 8 severe cases in group A,20 mild cases,15 moderate cases and 3 severe cases in group B.The severity of urinary incontinence in group A was lower than that in group B,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of patients recovering from urinary incontinence in group A and group B(P>0.05).At 3 months after operation,there was no significant difference in the severity of urinary incontinence between groups A and B(P>0.05),and the proportion of patients who recovered from urinary incontinence in group A was not significantly different from that in group B(P>0.05).At 6 months postoperatively,there was only 1 case of mild urinary incontinence in group A,and all patients in group B recovered.Conclusion Transitional urinary incontinence is one of the common complications of benign prostatic hyperplasia after HoLEP.Its recovery is related to the patient’s age,postoperative time and rehabilitation training for urinary incontinence.