手术治疗并发逼尿肌乏力的良性前列腺增生症效果

目的了解手术治疗良性前列腺增生（BPH）并逼尿肌乏力的临床效果。方法并发逼尿肌收缩力减弱、急性尿潴留的BPH病人46例,根据术前排尿期膀胱逼尿肌压力（Pdet）分为A组（Pdet 1.1~4.0kPa,31例）和B组（Pdet 0~1.0kPa,15例）,两组均同期行经尿道前列腺电切术（TURP）＋膀胱造瘘术,术后3个月随访病人的最大尿流率、残余尿量、国际前列腺症状评分（IPSS）和生活质量评分（QOL）。结果 A组26例术后拔除造瘘管排尿良好,5例终生保留造瘘管,总有效率为83.9%;B组7例术后拔除造瘘管排尿良好,8例终生保留造瘘管,总有效率为46.7%,两组总有效率比较差异有显著性（χ2=6.901,P〈0.05）。两组平均最大尿流率较术前升高,平均残余尿量、IPSS和QOL较术前降低,差异有显著性（t=7.14~29.17,P〈0.01）。结论逼尿肌轻度受损的BPH病人行TURP加膀胱造瘘术治疗可取得较好的效果。

THE EFFECT OF SURGICAL THERAPY ON BENIGN PROSTATIC HYPERPLASIA WITH ACONTRACTILE DETRUSOR

Objective To assess the outcome of surgical treatment for benign prostatic hyperplasia （BPH） with acontractile detrusor. Methods Forty six BPH patients with weak detrusor and acute urinary retention were enrolled in this study. According to bladder detrusor pressure at micturition period, they were divided into group A （n =31, Pdet 1.1-4.0 kPa） and group B （n =15, Pdet 0-1.0 kPa）. Transurethral resection of prostate （TURP） plus suprapubic cystostomy were performed. Qmax, RUV, IPSS and QOL were analyzed three months after surgery. Results In group A, 26 patients could pass urine smoothly after removing the cystostomy drainage tube, and five patients retained a tube for life, the total efficiency being 83.9%. In group B, seven patients urinated well after a suprapubic cystostomy tube was removed, eight retained a tube for life, with a total efficiency rate being 46.7 %. The difference between the two groups was significant （x2 = 6.901, P 〈 0.05）. Compared with pre-operation, Qmax of patients in the two groups elevated after surgery, and RUV, IPSS and QOL declined（t=7.14-29.17,P〈0.01）. Conclusion For BPH patients with slight damage of detrusor, TURP plus cystostomy can get a good result.