骶神经根磁刺激治疗经尿道前列腺钬激光剜除术后下尿路功能障碍的临床研究

Efficacy of sacral nerve root magnetic stimulation for lower urinary tract dysfunction after holmium laser enucleation of prostate

目的探讨骶神经根磁刺激治疗经尿道前列腺钬激光剜除术(HoLEP)后下尿路功能障碍的临床疗效。方法选取2017年6月至2020年6月在杭州市第三人民医院行HoLEP且术后出现下尿路功能障碍的患者72例,其中术后予盆底肌群训练+骶神经根磁刺激治疗36例,为观察组;仅予盆底肌群训练36例,为对照组。比较两组患者治疗前后国际前列腺症状评分(IPSS)、视觉模拟评分(VAS)、生活质量指数(QoL)、尿动力学指标[包括最大尿流率(Q_(max))、平均尿流率(Q_(avg))]以及下尿路功能障碍(排尿困难、尿频/尿急、暂时性尿失禁、膀胱痉挛等)改善情况。结果治疗前,两组患者IPSS、VAS、QoL、Q_(max)、Q_(avg)以及排尿困难、尿频/尿急、暂时性尿失禁、膀胱痉挛等下尿路功能障碍发生率比较,差异均无统计学意义(均P>0.05)。观察组治疗后IPSS、VAS、QoL以及下尿路功能障碍发生率均明显低于治疗前,Q_(max)、Q_(avg)均明显高于治疗前,且均较对照组改善更明显,差异均有统计学意义(均P<0.05)。结论骶神经根磁刺激联合盆底肌群训练能显著改善HoLEP术后出现的下尿路功能障碍,提高患者生活质量。

Objective To explore the efficacy of sacral nerve root magnetic stimulation in treating lower urinary tract dysfunction in patients with benign prostatic hyperplasia after transurethral holmium laser enucleation of prostate(HoLEP).Methods Seventy-two patients with benign prostatic hyperplasia,who underwent HoLEP in Hangzhou Third People's Hospital from June 2017 to June 2020 and developed lower urinary tract symptoms after the operation.Among them,36 patients were treated with pelvic floor muscle training+magnetic stimulation of sacral nerve root after operation(study group),36 patients were treated with pelvic floor muscle group training only(control group).The international prostate symptom score(IPSS),quality of life score(QoL),visual analogue scale(VAS),_(max)imum urine flow rate(Q_(max))and average urine flow rate(Q_(avg))were evaluated before and after treatment and compared between two groups.Results The IPSS and VAS were significantly improved after treatment in both groups.The QoL,Q_(max) and Q_(avg) were significantly improved after treatment in the study group,while they were not significantly improved in the control group(all P>0.05).After treatment there were significant differences in all above indicators between the two groups(all P<0.05).Conclusion Sacral nerve root magnetic stimulation combined with bladder function training can significantly improve lower urinary tract symptoms and the quality of life of patients after HoLEP surgery.