经尿道双极等离子小体积前列腺剜除术中膀胱颈部注射曲安奈德预防膀胱颈挛缩的研究

Intraoperative triamcinolone acetonide injection of bladder neck in transurethral enucleation of small volume benign prostatic hyperplasia to prevent bladder neck contracture

目的:探讨经尿道双极等离子小体积前列腺剜除术(TUKEP)术中即刻膀胱颈部多点注射类固醇激素曲安奈德预防术后膀胱颈挛缩(BNC)的疗效。方法:收集我院2019年1月至2021年9月期间接受TUKEP的30例小体积前列腺增生患者为研究对象,对所有接受TUKEP的患者术中即刻行膀胱颈部3点、5点、6点、7点、9点部位曲安奈德注射治疗。随访12个月,比较手术治疗前后的国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、排尿后残余尿量(PRV)等指标。通过排尿症状、尿流率检查、膀胱镜检查对TUKEP术后BNC进行诊断。结果:30例患者均顺利接受TUKEP+曲安奈德膀胱颈部注射治疗,无不良事件发生。29例患者术后排尿通畅;1例患者术后5个月发生BNC(3.33%),接受经尿道膀胱颈部挛缩组织切除+曲安奈德膀胱颈部多点注射治疗,间隔一月连续膀胱颈部多点注射曲安奈德两次,随访6个月患者排尿通畅。结论:经尿道小体积前列腺增生切除术中行膀胱颈部多点注射曲安奈德能降低膀胱颈挛缩的发生率,操作安全简便。

Objective:To explore the efficacy of intraoperative triamcinolone acetonide injection in bladder neck to prevent postoperative bladder neck contracture(BNC)during transurethral enucleation of small volume benign prostatic hyperplasia(TUKEP).Methods:From January 2019 to September 2021,a total of 30 patients with small volume prostatic hyperplasia(prostate size<30ml)accepted TUKEP in Weifang Hospital of Traditional Chinese Medicine were involved.These patients accepted intraoperative multipoint injection(3,5,6,7,9 o’clock points)of bladder neck with triamcinolone acetonide during TUREP.The International Prostate Symptom Score(IPSS),qual⁃ity of life score(QOL),maximum urinary flow rate(Qmax),post-voiding residual urine volume(PRV)and other indicators of all the 30 cases were recorded and compared pre-operation with post-operation.After the follow-up of 12 months,the diagnosis of BNC after TUKEP was made by the examination of urination symptoms,urine flow rate and cystoscopy.Results:All the 30 patients received TUKEP+triamcinolone acetonide injection in bladder neck successfully.No obvious complications occurred in 29 patients.Only one patient(3.33%)was diagnosed BNC post⁃operative 5 months because of dysuria.This patient accepted transurethral resection of bladdered neck scar tissue and intraoperative triamcinolone acetonide injection in bladder neck twice with interval of 1 month.This patient showed satisfied urination after six months of follow-up.Conclusion:Multipoint intraoperative triamcinolone acetonide injec⁃tion in bladder neck during TUKEP of small volume benign prostatic hyperplasia can significantly reduce the morbidi⁃ty of postoperative BNC,and is safe and simple.