不同尿控策略对经尿道前列腺等离子剜除术后尿流动力学及性功能的影响

Effect of different urinary control strategies on urodynamics and sexual function after transurethral plasma enucleation of prostate

目的对比不同尿控策略对经尿道前列腺等离子剜除术后尿流动力学及性功能的影响。方法选择本院自2017年1月-2022年1月确诊的108例行经尿道前列腺等离子剜除术的前列腺增生患者作为研究对象,随机分为观察组和对照组,各54例;在不同尿控策略的选择上,对照组术中完全剜除,观察组术中保留尿控剜除。记录两组术中术后相关指标,随访3个月,比较两组最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺症状评分(IPSS评分)、勃起功能专项评分(IIEF-EF评分)、尿失禁发生率、性功能障碍发生情况。结果两组患者均完成手术,获得随访,在手术时间、术中出血量、术后膀胱冲洗时间和术后住院时间上均无差异(P>0.05);观察组术后3个月的Qmax大于对照组,PVR小于对照组,IPSS评分低于对照组,IIEF-EF评分高于对照组(P<0.05);观察组术后1 d、1周、2周的尿失禁发生率均低于对照组(P<0.05);两组术后1个月、3个月的尿失禁发生率比较无差异(P>0.05)。结论经尿道前列腺等离子剜除术中保留尿控结构对改善前列腺增生患者尿流动力学的疗效优于完全剜除,前者能有效减少术后初期尿失禁发生,对患者性功能的影响更小,值得推广应用。

Objective To compare the effects of different urinary control strategies on urodynamics and sexual function after transurethral plasma enucleation of the prostate.Methods 108 patients with prostatic hyperplasia who underwent transurethral plasma enucleation of prostate in our hospital from January 2017 to January 2022 were selected as the research objects.They were randomly divided into observation group and control group,54 cases in each group.In the selection of different urinary control strategies,the control group had complete enucleation during the operation,while the observation group retained urinary enucleation during the operation.The intraoperative and postoperative related indicators were recorded and followed up for 3 months.The maximum urinary flow rate(Qmax),residual urine volume(PVR),international Prostate symptom score(IPSS),erectile function specific score(IIEF-EF),incidence of urinary incontinence and occurrence of sexual dysfunction were compared between the two groups.Results All patients completed surgery and were followed up.There were no differences in operation time,intraoperative blood loss,postoperative bladder irrigation time and postoperative hospital stay between the two groups(P>0.05).The Qmax of the observation group was higher than that of the control group,PVR was lower than that of the control group,IPSS score was lower than that of the control group,and IIEF-EF score was higher than that of the control group at 3 months after surgery(P<0.05).The incidence of urinary incontinence 1 day,1week and 2 weeks after operation in the observation group was lower than that in the control group(P<0.05).There was no difference in the incidence of urinary incontinence between the two groups at 1 month and 3 months after operation(P>0.05).Conclusions Retention of urinary control structure in transurethral plasma enucleation of prostate is better than complete enucleation in improving urodynamics in patients with prostatic hyperplasia,the former can effectively reduce the occurrence of urinary incontinence at the initial stage after operation,and has less influence on the sexual function of patients,which is worthy of promotion and application.