M受体阻滞剂联合经尿道膀胱颈口电切术治疗女性膀胱过度活动症合并膀胱出口梗阻的效果分析

Clinical efficacy of combined therapy with M receptor blocker and transurethral resection of bladder neck for female overactive bladder with bladder outlet obstruction

目的探讨M受体阻滞剂联合经尿道膀胱颈口电切术(TURBN)治疗女性膀胱过度活动症(OAB)合并膀胱出口梗阻(BOO)的效果。方法回顾性分析2019-01—2020-12郑州大学第一附属医院泌尿外科收治的80例女性OAB合并BOO患者的临床资料。按治疗方案分为M受体阻滞剂联合TURBN组(联合组,34例)和单纯TURBN组(单纯组,46例)。比较2组患者的基线资料。记录术前、术后1个月和3个月的膀胱过度活动症状评分(OABSS)、生活质量(QoL)评分、最大尿流率(Q_(max))、平均尿流率(Q_(ave))、最大膀胱测压容量(MCC)、有效膀胱容量(EBC)、残余尿量(PVR)、初始尿意容量(VFD),以及日均排尿次数和日均夜尿次数等尿动力学指标。结果术后1个月、3个月时,2组患者的各项尿动力学指标均较术前显著改善,差异有统计学意义(P<0.01)。除术后1个月、3个月时2组间的Q_(max)、Q_(ave),以及术后1个月时的MCC、EBC、PVR、VFD差异无统计学意义(P>0.05)外,联合组患者其他术后时间点(除PVR外)的尿动力学指标均优于单纯组,差异均有统计学意义(P<0.05)。2组患者术后第3天均顺利拔除导尿管。术后随访3个月期间均未发生排尿困难及尿潴留。其中联合组发生口干3例、便秘1例、视力模糊1例,药物副作用发生率为14.71%(5/34)。结论TURBN可有效缓解女性OAB合并BOO患者储尿期和排尿期症状,联合应用M受体阻滞剂对提高疗效和患者的生活质量具有积极意义。

Objective To evaluate the clinical efficacy of combined therapy with M receptor blocker and transurethral resection of bladder neck(TURBN)for female overactive bladder(OAB)with bladder outlet obstruction(BOO).Methods Totally 80 cases with OAB and BOO were selected in the department of urology,the First Affiliated Hospital of Zhengzhou University from 2019-01 to 2020-12.Then,in accordance with therapeutic methods,the patients were divided into two groups:combined therapy with TURBN and M receptor blocker group(Combined Group including 34 cases)and TURBN group(Simplex Group including 46 cases).Compare the baseline data of the 2 groups of patients.Overactive bladder symptom score(OABSS),Quality of Life(QoL)score,maximum flow rate(Q(max)),average flow rate(Q(ave)),maximal cystometric capacity(MCC)、effective bladder capacity(EBC)、postvoid residual(PVR)、daily urination times and daily nocturnal urination times and other urodynamic indicators before treatment,1 month after surgery,3 months after surgery of data were recorded.Results At 1 month and 3 months after operation,the urodynamic indexes of the 2 groups were significantly improved compared with those before operation(P<0.01).There were no significant differences in Q(max),Q(ave),MCC,EBC,PVR and VFD between the two groups at 1 and 3 months postoperatively(P>0.05),the urodynamic indexes of combined group were better than those of simple group except PVR at other postoperative time points(P<0.05).All the catheters were removed successfully on the 3rd day after operation in 2 groups.No dysuria and urinary retention occurred during the 3-month follow-up.There were 3 cases of dry mouth,1 case of constipation and 1 case of blurred vision in the combined group.The incidence of side effects was 14.71%(5/34).Conclusion TURBN is effective in relieving symptoms during the storage and voiding phases in women with OAB combined with BOO,and the combined application of M-blockers has positive implications for improving outcomes and patients'quality of life.