Efficacy of Bladder Neck Incision (BNI) Versus Transurethral Resection of Prostate (TURP) in Management of Benign Prostatic Hyperplasia (BPH) Causing Obstruction: A Randomised Controlled Study

Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.

Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasiad-a single-center experience

Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.

Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: A meta-analysis

Objective:To find out whether warm bladder irrigation fluid can decrease the occurrence of perioperative hypothermia,blood loss and shiver in patients treated with benign prostatic hyperplasia(BPH).Method:A comprehensive literature review and meta-analysis that included randomized controlled trials(RCTs)related to temperature of irrigation fluid in the perioperative treatment for BPH was taken by researchers.The relevant literature were searched in Chinese database,such as Retrieval Chinese Journal Full-text Database,VIP Journal Database,Wanfang database,as well as in English search engine and database,including Embase,Cochrane and Medline till January 2018.The study quality was assessed by recommended standards from Cochrane Handbook(version 5.1.0).Results:A total of 28 RCTs and 3858 patients were included.The results showed that the incidences of shiver(risk ratio[RR]Z 0.32,95%confidence interval[CI]:0.28e0.36,p<0.001,I^2 Z 0%)and hypothermia(RR Z 0.36,95%CI:0.21e0.59,p<0.001,I^2 Z 67%)in the group of warm irrigation fluid were lower than the group having room-temperature fluid.Room-temperature irrigation fluid group caused a greater drop in body temperature compared to warm irrigation fluid group(p<0.001,I^2 Z 96%).We performed a narrative descriptive statistics only because of substantial heterogeneity.Conclusions:Warm bladder irrigation fluid can decrease the drop of body temperature and the incidence of hypothermia and shiver during and after the operation for BPH.Warm irrigation fluid should be considered as a standard practice in BPH surgeries.

Cross-sectional and longitudinal studies on interaction between bladder compliance and outflow obstruction in men with benign prostatic hyperplasia

Aim： To explore the interaction between bladder compliance （BC） and bladder outflow obstruction （BOO） in men with benign prostatic hyperplasia （BPH） using cross-sectional and longitudinal studies. Methods： A total of 181 men with BPH were recruited, and 100 of them were followed for one year. Cystometry was performed in a standing or a sitting position with 30 mL/min infusion. BC was manually corrected and defined. Obstruction coefficient （OCO）, linear passive urethral resistance relation and international continence society （ICS） nomogram were used to diagnose BOO. The obstructed parameters were compared between the reduced BC group and the non-reduced group. BC was compared between the first investigation at the beginning of study and the second investigation at the end of study during the one-year follow-up period. Results： The group with reduced BC had increased OCO and linear passive urethral resistance relation. BC was significantly lower in the obstructed group （55.7 mL/cm water） than that in unobstructed and equivocal one （74.9 mL/cm water, P 〈 0.01）. BC gradually reduced with the increased obstructed grade. There was a significantly weak negative correlation between BC and OCO （r = - 0.132, P 〈 0.01）. Over the one-year follow-up period in the longitudinal study, BC for all men changed from 54.4 to 48.8 mL/cm water （P 〉 0.05）, and BC for the group with BOO fell from 58.4 ± 70.1 to 46.5 ± 38.7 mL/cm water （P 〉 0.05）. Conclusion： In men with BPH, a significant systematic decrease occurred in BC in the obstructed group and a significant systematic increase with urethral resistance occurred in the low BC group. A longitudinal study of the tendency of BC reduction in a group with BOO is necessary in the future.

Research Progress of Transurethral Prostatectomy for Benign Prostatic Hyperplasia with Bladder Stones

Benign prostatic hyperplasia,which can be abbreviated as prostatic hyperplasia,is a urinary system disease that has a high incidence in middle-aged and elderly male populations in China.The incidence of benign prostatic hyperplasia is increasing year by year.Patients with benign prostatic hyperplasia are prone to have bladder outlet obstruction,which in turn leads to an increase in residual urine volume in the bladder and impurities in the urine,such as upper urinary calculi that enter the bladder,urine crystals,various exfoliated cells,etc.If these substances stay in the bladder for a long time,stones in the bladder will be generated.Benign prostatic hyperplasia with bladder stones can severely obstruct the urinary tract,causing clinical symptoms such as urinary tract infections,urinary urgency,frequent urination,and dysuria.These symptoms seriously affects the physical and mental health of patients,leading to low levels of normal work and quality of life.With the development of medical technology,surgical treatment is commonly used in clinical practice.Among them,transurethral prostatectomy is widely used in clinical treatment,and has achieved good results.

Clinical study of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia with overactive bladder

Objective To evaluate the efficacy and safety of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia ( BPH) with overactive bladder ( OAB) . Methods 82 patients with OAB and coexisting BPH were randomly divided into tamsulosin group ( n

Pressure-flow studies in patients with benign prostatic hyperplasia:a study comparing suprapubic and transurethral methods

Aim： To compare the use of the suprapubic puncture method versus the transurethral method in pressure-flow studies in patients with benign prostatic hyperplasia. Methods： Twenty-three men with benign prostatic hyperplasia underwent both suprapubic and transurethral pressure-flow studies during a single session. Standard pressure-flow variables were recorded in all patients with both methods, enabling calculation of obstruction using commonly used grading systems, such as the urethral resistance algorithm, the Abrams-Griffith （AG） number and the Schaefer linear nomogram. Results： There were statistically significant differences between the methods in the mean values of maximum flow rate （P 〈 0.05）, detrusor pressure at the maximum flow （P 〈 0.01）, urethral resistance algorithm （P 〈 0.01）, AG number （P 〈 0.01） and maximum cystic capacity （P 〈 0.01）. Of the men in the study, 10 （43.5%） remained in the same Schaefer class with both methods and 18 （78.3%） in the same AG number area. Using the transurethral method, 12 （52.2%） men increased their Schaefer class by one and 1 （4.3%） by two. There were also differences between the suprapubic and transurethral methods using the AG number： 4 （17.4%） men moved from a classification of equivocal to obstructed and 1 （4.3%） from unobstructed to equivocal. Conclusion： The differences between the techniques for measuring intravesical pressure alter the grading of obstruction determined by several of the commonly used classifications. An 8 F transurethral catheter significantly increases the likelihood of a diagnosis of bladder outlet obstruction when compared with the suprapubic method.

Botulinum toxin and benign prostatic hyperplasia

Benign prostatic hyperplasia(BPH)is a clinical condition where lower urinary tract symptoms are caused by both a physically obstructing prostate as well as tight smooth muscles around the bladder outlet.Treatment of this condition with botulinum toxin has been used since 2003,but this interest has somewhat died down after two large randomized controlled trials(RCTs)showing equivalence of results between their treatment and placebo arms.However,with review of animal studies and unexplained exaggerated effect of the placebo arms of the two RCTs,together with recent data of sustained benefits after 18 months of treatment,the place of botulinum toxin in the BPH field is probably still present.

A Review on Urinary Incontinence after Surgery for Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is characterized by the abnormal proliferation of cells, leading to structural changes. It is one of the most common diseases in ageing men. Its clinical presentations are dominated by lower urinary tract symptoms (LUTS). The therapeutic methods can be grouped into two options: the medical option and the surgical option in which prostate enucleation is found. In recent years many studies have reported the onset of urinary incontinence (UI) after prostate enucleation. The management of UI occurring after prostate enucleation is embarrassing for both the practitioner and the patient, and generates additional costs. Purpose: Cite the causes of UI after prostate enucleation for BPH, as well as ways to prevent the onset of UI after this surgery, specifically by the study of the vesicosphincteric system aimed at improving the technique of enucleation;our review will also deal with the therapeutic means of UI. Method: We retrieved studies from Science Direct, Wiley and Pubmed. Results: There are multiple etiologies of UI after prostate enucleation including urethral sphincter insufficiency (USI) and bladder dysfunction (BD). The management of UI after surgery could be conservative, surgical, or use new technologies. Urodynamic assessment before prostate enucleation for BPH is relevant. Conclusion: UI is a common post-operative complication of prostate enucleation. The study of the vesicosphincteric system leads us to believe that prostate enucleation for BPH, partially sparing the mucosa and the external urethral sphincter could decrease the incidence of UI after surgery.

Bethanechol Remains the Preferred Drug in Suspected Underactive Bladder: Findings from Nation-Wide Prescription Analysis

Background: Bethanechol chloride, a cholinergic agonist, is often prescribed in suspected underactive bladders to improve detrusor contractility, despite its limited clinical efficacy. We investigated the usage pattern of bethanechol in actual practice with the understanding that it would enable the physicians to make an informed decision on the coherent use of bethanechol. Methods: A nation-wide survey was carried out to obtain the responses of the urologists. Out of the 755 urologists approached, 630 survey responses were considered for analysis. Results: Usage of bethanechol was advocated as very common [318 (50.48%)], common [200 (31.75%)], not so common [107 (16.98%)], and rare [5 (0.79%)] in postoperative urinary retention, where it was preferred either exclusively [255 (40.48%)] or along with alpha blockers [247 (39.21%)]. Predilection to use alpha-blocker [247 (39.21%)], alpha-blocker plus naloxone [4 (0.64%)], naloxone [1 (0.16%)], alpha-blocker plus bethanechol plus naloxone [1 (0.16%)] was also observed. It was also preferred individually in pathologies causing urinary retention such as benign prostatic hyperplasia [125 (19.84%)], diabetic neuropathy [82 (13.02%)], neurological diseases [69 (10.95%)], senile bladder [14 (2.22%)], drugs [13 (2.06%)], and infective/inflammatory conditions [6 (0.95%)]. Other [321 (50.95%)] physicians opted to prescribe bethanechol in two or more of the enumerated indications. Bethanechol was prescribed orally as 25 mg thrice daily [441 (70.00%)], 50 mg thrice daily [86 (13.65%)], 25 mg four times daily [59 (9.37%)], and many “strongly agree” and “agree” that its sustained release formulation may offer better treatment compliance [565 (89.68%)], safety [548 (86.99%)], and efficacy [544 (86.35%)]. Conclusion: Bethanechol was the most prescribed drug for the management of postoperative urinary retention and other pathologies suspected to cause underactive bladder.

Predictive Factors for a Successful Day Case Benign Prostatic Hyperplasia Surgery: A Review

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. Materials and Methods: During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. Results: TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. Conclusion: TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.

基于流固耦合的膀胱颈角对排尿影响程度的应用研究

目的:本研究利用膀胱颈角(BNA)评估膀胱颈开口变形程度,并通过流固耦合分析,评估膀胱颈角对排尿的影响。方法:建立理想化的膀胱、前列腺及尿道的几何模型:BNA正常模型、BNA增大模型。通过流固耦合模拟尿液在膀胱、膀胱颈、尿道内的流速和压力变化及前列腺的位移,评估BNA变化对尿流的影响。回顾性分析2020年6月至2023年6月期间145例就诊于河北医科大学第二医院泌尿外科的下尿路症状患者,根据患者是否合并急性尿潴留(AUR),将其分为AUR组(39例)和无AUR组(106例),并根据前列腺体积及尿流率大小分组,评估BNA对排尿的影响。结果:通过对BNA正常模型与BNA增大模型对比仿真分析发现两组模型流体域总压及流速分布有明显差异(P<0.05),前列腺位移最大的部位为膀胱颈部,BNA正常模型膀胱颈部位移较小且尿道内径未发生变化,BNA增大模型膀胱颈部位移更大且尿道开口内径缩小。通过流固耦合结果分析证明BNA增大对排尿有显著影响。AUR组与无AUR组间PSA、TPV、TZV、IPSS、Qmax、IPP、PUA、BNA存在明显差异(P<0.05)。按照尿流率大小分为3组,各组平均BNA:Qmax<10 ml/s组为83.7°±2.5°、Qmax 10~15ml/s组为67.5°±1.8°,Qmax>15ml/s组为65.1°±4.8°,差异有统计学意义(P<0.05)。使用非参数秩和检验组间对比,Qmax<10ml/s组BNA与另外两组差异有统计学意义(P<0.05)。良性前列腺增生分组各组平均BNA:Ⅳ度组为105.8°±6.0°,Ⅲ度组为82.8°±3.5°,Ⅱ度组为71.5°±2.0°,Ⅰ度组为67.2°±3.1°,正常组为65.0°±3.7°(P<0.05),正常组、Ⅰ度组、Ⅱ度组的组间BNA差异均无统计学意义(P>0.05),Ⅲ度组、Ⅳ度组的组间BNA差异有统计学意义(P<0.05),Ⅲ度组、Ⅳ度组分别与正常组、Ⅰ度组、Ⅱ度组之间BNA差异有统计学意义(P<0.05)。Spearman相关因素分析结果显示BNA与TPV、TZV、IPP、PUA、IPSS、Qmax之间存在很强的相关性(P<0.05)。结论:BNA的改变会对排尿造成影响,且与良性前列腺增生严重程度关系密切。BNA可能是评估良性前列腺增生患者下尿路症状严重程度的重要的解剖学因素。

不同功率HoLEP联合钬激光碎石术在治疗良性前列腺增生合并膀胱结石的疗效及安全性分析

目的:研究不同功率钬激光前列腺剜除术(HoLEP)联合钬激光碎石术(HLC)在治疗良性前列腺增生(BPH)合并膀胱结石的疗效及安全性分析。方法:收集2019年1月至2024年1月丹阳市人民医院收治的110例BPH合并膀胱结石患者的临床资料,根据手术方式,将接受高功率HoLEP联合HLC的患者纳入HP组(n=62),接受低功率HoLEP联合HLC的患者纳入LP组(n=48)。比较两组围术期指标、排尿功能、应激指标、术后并发症。结果:HP组手术时间(68.49±15.36)min、剜除组织质量(41.42±10.59)g、膀胱冲洗时间(1.86±0.66)d、术后尿管留置时间(2.34±0.85)d与LP组[(70.15±15.71)min、(42.81±9.93)g、(1.81±0.72)d、(2.58±0.92)d]比较差异无统计学意义(P>0.05);HP组腺体剜除时间(35.80±7.21)min、住院时间(3.62±0.64)d短于LP组[(41.64±7.83)min、(3.86±0.50)d],剜除效率(1.15±0.25)g/min、血红蛋白下降幅度(8.05±1.58)g/L高于LP组[(1.02±0.18)g/min、(7.36±1.72)g/L],差异有统计学意义(P<0.05);术后3个月,HP组Qmax、PVR、PSA治疗前后差值与LP组比较差异无统计学意义(P>0.05);术后24h,HP组SP、PGE2、NE治疗前后差值与LP组比较差异无统计学意义(P>0.05);HP组术后并发症(12.88%)与LP组(10.40%)比较,差异无统计学意义(P>0.05)。结论:高功率、低功率HoLEP联合HLC对BPH合并膀胱结石的疗效相当,高功率HoLEP剜除效率更高,腺体剜除时间、住院时间更短,低功率HoLEP的止血效果更好。

新术式治疗前列腺增生术后膀胱颈挛缩防治的研究进展

膀胱颈挛缩(BNC)为前列腺增生术后远期并发症之一,主要症状为排尿困难等,可能由炎症因子刺激及微血管病变等原因所致。BNC可通过术前治疗前列腺炎症及改善微循环,术中行预防性膀胱颈切开及调整器械用法,术后治疗尿路感染及监测瘢痕形成指标进行预防。BNC的手术方式一般为经尿道膀胱颈手术,难治性BNC可采用膀胱颈成形术。本文将从新术式治疗前列腺增生术后BNC的发生机制、预防手段及治疗方式展开综述,以帮助临床工作的开展。

普乐安联合琥珀酸索利那新治疗良性前列腺增生术后膀胱过度活动症的效果观察

目的探讨普乐安联合琥珀酸索利那新治疗良性前列腺增生(BPH)术后膀胱过度活动症(OAB)的临床效果。方法回顾性选取2022年5月至2023年6月在丽水市人民医院行经尿道前列腺钬激光剜除术后发生OAB的60例BPH患者为研究对象,其中普乐安联合琥珀酸索利那新治疗(联合组)31例,仅琥珀酸索利那新治疗(单药组)29例;比较两组患者术后膀胱过度活动症状评分(OABSS)、OAB缓解率(OABSS降低至3分以下且1 d内未明显升高)、残余尿量、生活质量评分(QOL)、国际前列腺症状评分(IPSS)等疗效指标,采用单因素及多因素Cox回归分析OAB缓解的影响因素。结果联合组术后半个月及1个月OABSS均低于单药组(均P<0.05),术后半个月及1个月OAB缓解率均高于单药组(均P<0.05);两组患者术后3个月OABSS、OAB缓解率、残余尿量、QOL、IPSS比较,差异均无统计学意义(均P>0.05)。联合治疗方案(HR=0.562)是OAB缓解的独立保护因素,术后用药前OABSS尿急评分4~5分(HR=2.082)、术后用药前QOL 4~6分(HR=2.180)、吸烟(HR=3.466)是OAB缓解的独立危险因素,差异均有统计学意义(均P<0.05)。结论普乐安联合琥珀酸索利那新治疗能加快缓解BPH患者术后OAB症状,是OAB缓解的独立保护因素。

前列舒通胶囊联合索利那新治疗老年良性前列腺增生合并膀胱过度活动症术后疗效及其影响因素分析

目的探讨前列舒通胶囊联合索利那新治疗老年良性前列腺增生(BPH)合并膀胱过度活动症(OAB)术后的临床疗效,并分析影响疗效的相关因素。方法回顾性选取医院泌尿外科2020年3月至2023年3月收治的老年BPH合并OAB患者102例,根据用药方案的不同分为对照组(49例)和观察组(53例)。两组患者均口服琥珀酸索利那新片,观察组患者加用前列舒通胶囊,均连续治疗2个月。比较两组患者的总有效率,以及最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺症状评分(IPSS)、BPH生活质量(BPHQOL)评分、OAB症状量表(OABSS)评分。采用单因素方差分析影响前列舒通胶囊治疗老年BPH合并OAB术后疗效的相关因素,并采用多因素Logistic分析其独立危险因素。结果观察组总有效率为90.57%,显著高于对照组的71.43%(P<0.05)。治疗后,两组患者Qmax显著升高,PVR显著降低,IPSS评分、BPHQOL评分、OABSS评分均显著降低(P<0.001),且观察组显著优于对照组(P<0.01)。观察组和对照组患者不良反应发生率相当(32.08%比40.82%,P>0.05)。单因素方差分析结果显示,术前IPSS评分、OABSS评分、前列腺体积、PVR与术中出血量均为影响前列舒通胶囊疗效的相关因素(P<0.05)。多因素Logistic回归分析结果显示,术前前列腺体积、IPSS评分与PVR为独立危险因素(P<0.05)。结论前列舒通胶囊联合索利那新治疗老年BPH合并OAB术后的临床疗效较好,可有效改善患者生活质量。术前前列腺体积、IPSS评分与PVR对老年BPH合并OAB患者的临床疗效有一定预测价值。

氢质子磁共振波谱中胆碱水平对良性前列腺增生合并膀胱过度活动症的诊断价值分析

目的探讨氢质子磁共振波谱(^(1)H-MRS)分析中胆碱(Cho)水平对良性前列腺增生患者合并膀胱过度活动症(OAB)的诊断价值。方法选取2022年7月至2023年3月合肥市第二人民医院诊治的60例BPH患者作为研究对象。根据膀胱过度活动症自我评价量表(OABSS)将其分为BPH合并OAB组(n=32)与单纯BPH组(n=28)。采用^(1)H-MRS检测两组膀胱壁中Cho、肌酸(Cr)水平,计算Cho/Cr比值。绘制受试者工作特征(ROC)曲线分析相关指标对BPH合并OAB的诊断效能。结果BPH合并OAB组膀胱壁中Cho、Cho/Cr较单纯BPH组显著升高,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,Cho/Cr、膀胱壁厚度(BWT)是诊断BPH合并OAB的因素。ROC曲线结果显示,Cho/Cr可作为诊断BPH合并OAB的指标,截断值为0.70,Cho/Cr联合BWT诊断的效能更高,灵敏度、特异度分别为84.40%、67.90%,截断值为0.47。结论^(1)H-MRS分析中膀胱壁Cho与BPH合并OAB密切相关,Cho/Cr联合BWT具有良好的诊断价值。

腹腔镜下保留尿道的前列腺剜除术后膀胱颈挛缩的预测模型建立及预防措施

目的:探究腹腔镜下保留尿道的前列腺剜除术(Madigan)后膀胱颈挛缩(BNC)的预测模型建立及预防措施。方法:选择2019年1月至2022年3月于贵州医科大学附属医院行腹腔镜下Madigan术的BPH患者362例为研究对象,纳入训练集;根据术后是否发生BNC,分为发生BNC组(45例)和未发生BNC组(317例)。按照相同标准另选2022年3~11月于贵州医科大学附属医院行腹腔镜下Madigan术的BPH患者120例纳入验证集。评价手术疗效并收集患者的临床资料。通过LASSO以及多因素Logistic回归分析术后BNC发生的影响因素,构建预测评分模型并评价。结果:与术前相比,术后3个月患者的国际前列腺症状评分(IPSS)、生活质量评分(QOL)以及残余尿量(PVR)均更低(P<0.05),最大尿流率(Qmax)更高(P<0.05)。LASSO回归分析筛选出8个非零特征预测因子,多因素Logistic回归分析结果显示,低年资术者、合并前列腺炎、膀胱冲洗液温度<34℃、导尿管堵塞、导尿管气囊注水量>40ml以及术后便秘,均是术后BNC发生的独立危险因素(P<0.05)。训练集和验证集的最佳界值均为2.36分。预测评分模型的评价结果显示,其区分度良好。结论:腹腔镜下Madigan术是治疗BPH安全有效的方法。低年资、合并前列腺炎、膀胱冲洗液温度<34℃、导尿管堵塞、导尿管气囊注水量>40 ml以及术后便秘,均是术后BNC发生的独立危险因素。本研究所构建的预测评分模型区分度良好,且简单易行,可为临床腹腔镜下Madigan术治疗BPH患者术后BNC评估提供参考。

膀胱控制自我评价问卷评估良性前列腺增生患者下尿路症状的效果

目的:评价膀胱控制自我评价问卷(B-SAQ)评估良性前列腺增生(BPH)患者下尿路症状(LUTS)的效果。方法:采用方便抽样法,选取2021年10月—2022年11月在上海市浦东新区公利医院和上海交通大学医学院附属第九人民医院就诊的300例BPH患者进行调查,以10岁为1个年龄段,分为5个年龄段,应用B-SAQ和国际前列腺症状评分(IPSS)评估患者LUTS发生情况。采用生活质量指数评分(QoL)评价患者的自我生活质量感觉。应用受试者工作特征(ROC)曲线评价B-SAQ在评估BPH患者LUTS中的敏感度、特异度。应用Pearson相关分析验证B-SAQ和IPSS评估BPH患者LUTS的相关性。结果:300例BPH患者均在5 min内完成了2项问卷调查。随着年龄的增加,BPH患者LUTS发生率随之升高,但66~75岁发生率稍高于76~85岁;IPSS、QoL及B-SAQ评分分别相应增加(P<0.05)。IPSS与B-SAQ症状和困扰程度评分存在相关性(r=0.947、0.934,P<0.05)。B-SAQ各症状评分与IPSS各条目评分之间存在相关性(P<0.001);在评估BPH患者LUTS严重程度方面,IPSS和B-SAQ存在相关性(r=0.976,P<0.05)。B-SAQ筛选LUTS的敏感度为94.01%,特异度为87.88%,ROC曲线下面积为0.949。结论:与IPSS相比,B-SAQ同样是一种简单、快捷、有效地评估BPH患者LUTS的工具,并且适用于筛选人群LUTS。

曲安奈德多点注射联合低功率钬激光治疗前列腺电切术后膀胱颈挛缩的效果观察

目的分析曲安奈德多点注射联合低功率钬激光治疗经尿道前列腺电切术后膀胱颈挛缩的效果。方法选择西安大兴医院148例经尿道前列腺电切术后膀胱颈挛缩患者作为研究对象,随机分为治疗组和对照组,各74例。治疗组予以曲安奈德多点注射联合低功率钬激光治疗,对照组单纯予以低功率钬激光治疗。比较两组手术时间、术中出血量、住院时间、最大尿流率(Qmax)、残余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、复发率情况。结果两组均完成手术并随访,两组患者手术时间、术中出血量、住院时间相当,差异均无统计学意义(P>0.05);术前,两组Qmax和PVR差异均无统计学意义(P>0.05);术后3、6个月,治疗组Qmax大于对照组,PVR小于对照组(P<0.05);术前,两组IPSS和QOL差异均无统计学意义(P>0.05);术后3、6个月,治疗组IPSS、QOL均低于对照组(P<0.05);两组术后3个月复发率比较无差异(P>0.05);术后6个月,治疗组复发率低于对照组(P<0.05)。结论曲安奈德多点注射联合低功率钬激光治疗经尿道前列腺电切术后膀胱颈挛缩的效果明确,且优于传统单纯低功率钬激光治疗,在促进术后康复、减少复发率上具有优势,值得临床推广应用。