经尿道前列腺剜除术中预先精准离断前列腺尖部尿道黏膜方法对患者术后尿控的影响

Influence of precision-precise dissection of urethral mucosa at prostatic apex during transurethral enucleation of prostate on postoperative urinary control in patients

目的观察经尿道前列腺剜除术中预先精准离断前列腺尖部尿道黏膜方法对患者术后尿控的影响。方法选取2019年1月至2020年6月在井冈山大学附属医院手术治疗的80例良性前列腺增生患者,采用随机数字表法分为实验组(40例)和对照组(40例)。对照组在前列腺解剖性剜除之后将前列腺尖部尿道黏膜集中到12点后离断,实验组在剜除前预先精准离断前列腺尖部尿道黏膜,之后将前列腺解剖性剜除。比较两组的术后尿失禁发生率、尿控恢复时间、围术期(总手术时间、腺体剥离时间、术中出血量、膀胱冲洗时间、尿管留置时间、术后住院时间)指标及随访效果。结果实验组患者术后的尿失禁发生率低于对照组,差异有统计学意义(P<0.05);实验组患者的尿控恢复时间短于对照组,差异有统计学意义(P<0.05);两组患者的围术期指标(总手术时间、腺体剥离时间、术中出血量、膀胱冲洗时间、尿管留置时间、术后住院时间)和术后国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、残余尿量(PVR)疗效指标比较,差异无统计学意义(P>0.05)。结论经尿道前列腺剜除术中预先精准离断前列腺尖部尿道尿膜方法可降低尿失禁发生率,缩短尿控恢复时间。

Objective To observe the influence of precision-precise dissection of urethral mucosa at prostatic apex during transurethral enucleation on postoperative urinary control in patients.Methods A total of 80 cases of benign prostate hyperplasia in Affiliated Hospital of Jinggangshan University were selected and randomly divided into the experimental group(40 cases)and the control group(40 cases)according to random number table method.In the control group,the urethral mucosa in the apex of the prostate was concentrated to 12 o′clock and then dissected after anatomic enucleation of the prostate.In the experimental group,the urethral mucosa at the apex of the prostate was accurately dissected before enucleation,and then the prostate was anatomically enucleated.The incidence of postoperative urinary incontinence,recovery time of urinary control,perioperative period indexes such as total operative time,time of gland dissection,intraoperative blood loss,bladder irrigation time,catheter indwelling time,postoperative hospitalization time and follow-up results were compared between the two groups.Results The incidence of urinary incontinence in the experimental group was lower than that in the control group,the difference was statistically significant(P<0.05).The recovery time of urinary control in the experimental group was shorter than that in the control group,the difference was statistically significant(P<0.05).There were no significant differences in the indexes of perioperative period indexes such as the total operative time,dissection time,intraoperative blood loss,bladder irrigation time,catheter indwelling time,postoperative hospitalization time and postoperative follow-up efficacy of International Prostate Symptom Scale(IPSS),the score of quality of life(QOL),Qmax,postvoid residual(PVR)between the two groups(P>0.05).Conclusion Precise separation of the urethral membrane of the apex of the prostate during transurethral enucleation of the prostate can reduce the incidence of urinary incontinence and shorten the recovery time of urinary control.