经尿道前列腺电切术后下尿路症状改善的原因分析

目的分析存在下尿路症状（lower urinary tract symptoms，LUTS）的男性患者接受经尿道前列腺电切（transurethral resection of prostate，TURP）术后症状改善的原因。方法对2006年3月至2010年2月于北京朝阳区院接受TURP手术后症状改善的65例患者进行回顾性分析。记录术前国际前列腺症状评分（international prostate symptom score，IPSS）和生活质量（quality of life，QOL）评分，尿流率，残余尿及压力一流率检查的各项数据，术后随访并再次记录上述指标。按术前存在膀胱过度活动症（overactive bladder，OAB）及膀胱出口梗阻（bladder outlet obstruction，BOO）与否，分别将患者分为OAB组（n=34）与非OAB亚组（n=31），及B00（n=48）与非B00亚组（n=17）。结果65例患者TURP术中无明显并发症发生，术后5例患者前尿道狭窄，19例逆向射精，11例急迫性尿失禁加重，分别给予针对性处理后症状缓解。整体患者术前、术后相应数据的配对t检验结果显示：术前IPSS评分22．67±4．92，术后IPSS10．51±5．79；术前刺激评分10．27土3．53，术后刺激评分6．32±3．45；术前梗阻评分12．13±3．92，术后梗阻评分4．19±3．33；术前QOL评分4．57±0．89，术后QOL评分2．27±1．30；术前尿流率（5．78±2．91）mL／s，术后尿流率（12．39±5．17）mL／s，术前残余尿（98．98±16．27）mL和术后残余尿（34．43±18．61）mL的配对t检验结果均有显著性意义（P〈0．01），进一步分析两个亚组的相应数据具有统计学意义。站论前列腺增生导致下尿路症状的男性患者经尿道前列腺电切手术前后IPSS评分（刺激评分及梗阻评分），生活质量评分均有显著变化；术前存在B00（伴或不伴OAB）的患者可于TURP术后症状改善、无或可疑BOO的患者也可试行TURP手术，术后症状也有望改善。

Analysis of improved lower urinary tract symptoms following transurethral resection of prostate

Objective To analyze the improvements of lower urinary tract symptoms in patients receiving transurethral resection of the prostate （TURP）. Methods We retrospectively observed 65 patients with benign prostate hyperplasia （BPH）, who received TURP in our department from Mar. 2005 to Feb. 2009 and had a symptomatic improvement after operation. Based on the pre-operation analysis, we divided these patients into （1）OAB group （n=34） in which patients had overactive bladder （OAB） preoperatively and non-OAB group （n = 31） in which patients had no OAB; （2）bladder outlet obstruction （BOO） group （n = 48） in which patients had BOO preoperatively and non-BOO group （n = 17） in which patients had no or equivocal BOO. Results Post-operative distal urethra stricture, retrograde ejaculation, and aggravated urge incontinence were found in 5, 19, and 11 patients respectively, and all complications were treated successfully with further interventions. Significant differences （P〈0.01） were observed between the pre/post-operation clinical data of the patients. Before and after operation, the international prostate symptom score （IPSS） was 2.67±4.92 and 10.51±5.79; the irritative score was 10.27±3.53 and 6.32±3.45; the obstructive score was 12.13±3.92 and 4.19±3.33; quality of life （QOL） was 4.57±0.89 and 2.27±1.30; Qmax was（4.57±0.89）mL/s and （2.27±1.30） mL/s, residual urine was （98.98±16.27）mL and （34.43±18.61）mL. Significant differences （P〈0.01） were also detected in the corresponding data in the OAB/non-OAB group and the BOO/nonor equivocal BOO group. Conclusions Both IPSS and QOL were improved in patients with symptomatic BPH who underwent TURP. Patients with BOO, OAB, non-or equivocal-BOO could benefit from TURP.