合并组织学前列腺炎的良性前列腺增生患者TURP手术对下尿路症状的影响

目的:探讨合并组织学前列腺炎的良性前列腺增生(BPH)患者行经尿道前列腺电切术(TURP)对下尿路症状的影响。方法:对2009年5月至2011年5月行TURP术后病理诊断证实为BPH的432例患者进行研究。剔除术前和术后合并有影响下尿路症状因素的病例,参照国际前列腺炎组织学分类诊断标准,分为A组:单纯BPH组(30例)、B组:合并轻度炎症组(55例)、C组:合并中度炎症组(31例)、D组:合并重度炎症组(28例)。采取国际前列腺症状评分(IPSS)评估各组术前及术后1个月的下尿路症状,将得分进行统计学分析。结果:合并组织学前列腺炎患者399例,检出率为92.4%。其中轻度炎症组269例(67.4%)、中度炎症组86例(21.6%)、重度炎症组44例(11.0%)。术前各组IPSS评分为:A组(21.43±6.09)分、B组(21.75±5.97)分、C组(27.84±4.18)分、D组(31.00±2.92)分,仅A组和B组差异无统计学意义(P=1.000),其余各组间差异均有统计学意义(P值均<0.01)。术后各组IPSS评分为:A组(5.60±2.16)分、B组(7.36±2.77)分、C组(11.55±3.39)分、D组(16.89±3.37)分,各组间差异均有统计学意义(P值均<0.01)。手术治疗后各组IPSS评分均较术前明显降低,差异有统计学意义(P值均<0.01)。合并炎症的BPH患者的病理切片中浸润的炎性细胞几乎均为淋巴细胞。结论:BPH大都合并有组织学慢性前列腺炎。合并组织学炎症的BPH患者手术前和手术后的下尿路症状严重程度要高于无炎症的BPH患者,且与炎症分级程度呈正相关。对合并中、重度炎症患者,术后仍需积极运用药物控制下尿路症状。

LUTS in BPH patients with histological prostatitis before and after transurethral resection of the prostate

Objective: To investigate the effects of transurethral resection of the prostate(TURP) on lower urinary tract symptoms(LUTS) in patients with benign prostatic hyperplasia(BPH) complicated by histological prostatitis.Methods: This study included 432 cases of BPH pathologically confirmed after TURP.Excluding those with LUTS-related factors before and after surgery and based on the international prostatitis histological classification of diagnostic criteria,the remaining 144 cases were divided into groups A(pure BPH,n=30),B(mild inflammation,n=55),C(moderate inflammation,n=31),and D(severe inflammation,n=28).Each group was evaluated for LUTS by IPSS before and a month after surgery.Results: A total of 399 cases(92.4%) were diagnosed as BPH with histological prostatitis,269(67.4%) mild,86(21.6%) moderate and 44(11.0%) severe.The preoperative IPSS was 21.43±6.09 in group A,21.75±5.97 in B,27.84±4.18 in C and 31.00±2.92 in D,with statistically significant differences among different groups(P<0.001) except between A and B(P = 1.000);the postoperative IPSS was 5.60±2.16 in A,7.36±2.77 in B,11.55±3.39 in C and 16.89±3.37 in D,with statistically significant differences among different groups(P<0.01),and remarkably lower than the preoperative one(P<0.001).Almost all the infiltrating inflammatory cells in BPH with histological prostatitis were lymphocytes.Conclusion: BPH is mostly complicated with histological chronic prostatitis.The severity of LUTS is higher in BPH patients with histological prostatitis than in those without before and after TURP,and positively correlated with the grade of inflammation.Those complicated with moderate or severe histological prostatitis should take medication for the management of LUTS.