经尿道钬激光前列腺切除的尿动力学研究

Urodynamic study of the transurethral holmium laser prostatectomy

目的 对经尿道钬激光前列腺切除术 (Transurethralholmiumlaserprostatectomy ,TUHLP)前后的尿动力学变化进行观察研究。方法 76例患者术前P/Q图检查及Schaefer分级确诊为良性前列腺增生伴膀胱出口梗阻 (其中Ⅲ级 17人、Ⅳ级 2 5人、Ⅴ级 2 8人、Ⅵ级 6人 ) ,分别进行术前、术后的国际前列腺症状评分和尿动力学检查。结果 与术前相比 ,IPSS评分由 ( 2 3 45± 4 43 )分下降至到 ( 14 5 7± 6 2 5 )分 ,最大尿流率由 ( 6 79± 2 3 5 )ml/s上升至 ( 13 2 1± 6 5 4)ml/s ,而最大尿流率时膀胱逼尿肌压由 ( 74 5 2± 2 8 3 5 )cmH2 O下降至 ( 5 2 17± 3 2 2 8)cmH2 O ,膀胱容量由 ( 2 92 3 5ml± 13 8 2 7)升至( 3 46 5 2± 15 9 67)ml ,前列腺长度明显减少 ,而压力变化不明显。

Objective To evaluate the urodynamic outcomes of patients with benign prostatic hyperplasia (BPH) undergoing the transurethral holmium laser prostatectomy(TUHLP). Methods A total of 76 cases diagnosed as benign prostatic hyperplasia with the P/Q study and the Schaefer Graph(including 17 cases of Ⅲ grade, 25 cases of Ⅳ grade, 28 cases of Ⅴ grade and 6 of Ⅵ grade) were studied before and after the TUHLP with the International Prostatic Symptom Score (IPSS) and the urodynamic examinations(including the uroflowmetry, voiding cystometry, P/Q study and resting urethral pressure profile, rUPP). Results After operation, the IPSS decreased significantly from 23 45 to 14 57; maximum urinary flow rate (Q max ) increased significantly from 6 79 ml/s to 13 21 ml/s; detrusor pressure at Q max (PdetQ max ) decreased significantly from 74 52 cmH 2O to 52 17 cmH 2O; bladder capacity increased significantly from 292 35 ml to 346 52 ml. However, significantly shortened prostate length was observed, but the changes of pressure was not obvious. Conclusion TUHLP can effectively relieve the bladder outlet obstruction in patients with BPH.