经尿道等离子前列腺剜除术治疗TURP术后复发的应用体会

Transurethral enucleation and resection of the prostate in patients with recurrent BPH after TURP

目的探讨良性前列腺增生(BPH)经尿道前列腺电切术(TURP)后复发的临床特点,以及再次行经尿道等离子前列腺剜除术(TUERP)治疗的可行性及技术路线。方法收集2015年1月至2020年1月于大连医科大学附属第二医院因BPH行TURP术后复发再行TUERP的15例患者的临床资料。所有患者均表现为不同程度的进行性排尿困难,其中11例肉眼血尿。泌尿系彩超、前列腺MRI及膀胱镜检查,均提示BPH或前列腺术后组织残留,前列腺平均体积为(66.7±22.62)mL,1例伴膀胱结石。15例患者术前最大尿流率(Qmax)(7.2±1.31)mL/s,尿道梗阻指数(OBI)压力(66.7±9.05)cmH2O,残余尿量(PVR)(117.2±30.68)mL,国际前列腺症状评分(IPSS)(26.2±3.26)分,生活质量评分(QOL)(4.6±0.58)分。分析15例患者行TUERP的手术时间、术中出血量、切除腺体重量、术后持续膀胱冲洗时间、术后留置导尿时间、术后病理、术后及随访情况。结果本组患者TUERP手术时间(67.1±22.26)min,术中平均出血量(125.2±23.29)mL,切除腺体重量(51.2±10.12)g,术后病理为BPH。拔除尿管后,均排尿满意,无血尿;2例术后短暂性尿失禁,术后1个月内恢复。拔除尿管后,患者Qmax为(14.3±2.93)mL/s,PVR(18.8±7.43)mL,IPSS(5.8±1.87)分,QOL(1.7±0.12)分。与术前相比,差异均有统计学意义(P<0.001)。所有患者随访12~56个月。随访12个月时,患者Qmax为(15.6±3.12)mL/s,PVR(15.2±6.67)mL,IPSS(5.1±1.68)分,QOL(1.5±0.24)分。与术前相比,差异均有统计学意义(P<0.001)。随诊期间,无增生复发和再手术。结论需要手术治疗的TURP术后复发患者常合并严重血尿,既往TURP手术后后尿道解剖结构改变,不影响TUERP的实施,分叶法TUERP是安全可行的术式选择。

Objective To investigate the clinical characteristics of recurrent benign prostatic hyperplasia(BPH)after transurethral resection of the prostate(TURP)and the feasibility and technical route of transurethral plasma prostate enucleation(TUERP)for the subsequent treatment.Methods From January 2015 to January 2020,a total of 15 patients in the Second Affiliated Hospital of Dalian Medical University underwent TURP for BPH and subsequently TUERP due to recurrence.All patients had varying degrees of progressive dysuria,with 11 patients treated with moderate-to-severe hematuria.Urological color Doppler ultrasound,prostate MRI and cystoscopy all indicated BPH or residual tissue after prostatic surgery.The average prostate volume was(66.7±22.62)mL,with 1 case accompanied by bladder stones.The preoperative maximum flow rate(Qmax)was(7.2±1.31)mL/s,urethral obstruction index(OBI)pressure was(66.7±9.05)cmH2O,residual urine volume(PVR)was(117.2±30.68)mL,international prostate symptom score(IPSS)was 26.2±3.26,and quality of life(QOL)was 4.6±0.58.The operation time,intraoperative blood loss,weight of the resected prostatic gland,continuous bladder irrigation time,postoperative indwelling catheterization time,postoperative pathology and postoperative status of the 15 patients,who underwent TUERP,were analyzed.Results The operation time was(67.1±22.26)min,the average intraoperative blood loss was(125.2±23.29)mL,the resected prostatic gland weight was(51.2±10.12)g,and the postoperative pathology confirmed BPH.After catheter removal,all patients had satisfactory urination with no hematuria;two patients experienced transient postoperative urinary incontinence and recovered within 1 month.After catheter removal,the patients had Qmax of(14.3±2.93)mL/s,PVR of(18.8±7.43)mL,IPSS of 5.8±1.87,and QOL of 1.7±0.12,which compared with preoperative differences were significant(P<0.001).All patients were followed up for 12-56 months,and at the 12-month follow-up,Qmax was(15.6±3.12)mL/s,PVR was(15.2±6.67)mL,IPSS was 5.1±1.68,and QOL was 1.5±0.24,which compared with preoperative differences were significant(P<0.001).No recurrence of hyperplasia or reoperation was observed during the follow-up period.Conclusion Patients with recurrent BPH after TURP requiring surgical treatment often present with severe hematuria.The anatomy of the posterior urethra changes after previous TURP surgery do not affect the implementation of TUERP,and lobulated TUERP is a safe and feasible surgical option.