保留功能尿道钬激光前列腺剜除术降低术后尿失禁的优势探讨

The advantage of functional urethra sparing Ho LEP in reducing postoperative urinary incontinence

目的探讨保留功能尿道的钬激光前列腺剜除术(functionalurethra sparing-Holmium Laser Enucleation of prostate,Fus-HoLEP)后压力性尿失禁(Stress urinary incontinence,SUI)发生及临床推广的价值。方法回顾了2017年6月至2019年12月期间接受HoLEP治疗的776名患者的数据。患者分为两组,A组接受"保留部分尿道粘膜"技术,B组接受"保留功能尿道"技术。记录术中及术后相关指标。根据国际尿失禁状态推荐的标准,对尿失禁状态和排尿后症状进行评价。结果两组患者年龄分别为75±7.23(62~91)岁和76±7.12(60~88)岁,前列腺体积分别为110±45.5(48~160)ml和108±47.8(50~172)ml,剜除时间分别为35±10.3min和36±12.4min,剜除速度3.2±0.24g/min和3.4±0.28g/min。所有患者均于72小时内拔除导尿管,拔管后即刻压力性尿失禁发生率A组为30.5%,B组为13.2%,B组显著低于A组。术后两周压力性尿失禁发生率分别为18.4%和1.6%,B组显著低于A组。术后一月A组尿失禁发生率为5.4%,B组为0.7%,B组显著低于A组。IPSS、QoL、Qmax及PVR改善两组无明显差异。拔管后A组有7例患者出现尿潴留,其中4例为血块堵塞,再次导尿、膀胱冲洗后均于3天后成功拔管;B组患者拔管后有4例出现尿潴留,2例为血块堵塞,再次导尿、膀胱冲洗后均于3天后成功拔管。所有患者无严重出血、无输血。结论保留功能尿道的钬激光前列腺剜除术可以显著降低术后尿失禁的发生,值得被推广。

Objective To evaluate the occurrence of stress urinary incontinence after functional urethra sparing HoLEP(Fus-HoLEP) and its clinical value. Methods Clinical data of 776 patients who underwent HoLEP from June 2017 to December 2019 were retrospectively analyzed. The patients were divided into two groups. The patients in group A received "partial urethral mucosa preservation" technique, and the patients group B received "functional urethral preservation" technique. The intraoperative and postoperative parameters were recorded. The status of urinary incontinence and symptoms after micturition were evaluated according to the international recommended standards for urinary incontinence. Results The average ages of the two groups were 75±7.23(62~91) years old and 76±7.12(60~88)years old, the prostate volumes were110 ±45.5(48 ~ 160 ml) and 108 ± 47.8(50 ~ 172 ml), the enucleation times were 35 ±10.3 min and 36 ±12.4 min, the enucleation speeds were 3.2±0.24 g/min and 3.4±0.28 g/min. All patients were extubated within 24 hours, and the incidence of stress urinary incontinence immediately after extubation was 30.5% in group A and 13.2% in group B, which was significantly lower than that in group A. Two weeks after operation, the incidence of stress urinary incontinence was 1.6% in group B,which was significantly lower than 18.4% in group A. One month after operation, the incidence of urinary incontinence was5.4% in group A and 0.7% in group B, which was significantly lower than that in group A. There were no significant differences in IPSS, QOL, Qmax and PVR between the two groups. In group A, urinary retention occurred in 7 patients after extubation, including 4 cases of blood clogging.In group B,urinary retention occurred in 4 patients after extubation, including 2 cases of blood clogging, and all catheters removal 3 days later after repeated catheterization and bladder irrigation. All patients had no severe bleeding and blood transfusion. Conclusion Holmium laser enucleation of prostate with functional urethra preservation can significantly reduce the incidence of urinary incontinence after operation, which is worthy of promotion.