经尿道双极等离子前列腺剜除术与电切术后尿失禁发生率的随机对照研究

目的:比较经尿道双极等离子前列腺剜除术(PKERP)与经尿道双极等离子前列腺电切术(PKRP)术后尿失禁发生情况,为进一步推广PKERP的临床应用提供科学依据。方法:将180例BPH患者分段均衡随机化分组,其中90例行PKERP(剜除组),90例行PKRP(电切组)。两组患者术后拔除导尿管后第24 h、术后每周分别行尿垫试验。记录研究指标数据:前列腺特异性抗原(PSA)、前列腺体积(PV)、最大尿流率(Qmax)、残余尿(RU),国际前列腺症状评分(IPSS)、生活质量评分(QOL),术后拔除导尿管后24 h、术后4周内每周的尿垫试验结果,进行统计学分析,比较两组手术的术后尿失禁发生情况。结果:剜除组和电切组的尿失禁发生率分别为:术后24 h拔除导尿管后为35.56%和18.89%、术后1周时为20.00%和7.78%,两组间差异均有统计学意义(P0.05)。术后2周后两组间尿失禁发生率(3.33%vs 2.22%)差异无统计学意义(P0.05)。术后各时间点尿失禁程度,两组之间差异无统计学意义(P0.05)。两组均未出现永久性尿失禁。结论:PKERP治疗BPH,虽然暂时性尿失禁的发生率较电切术为高,但程度相同,恢复速度相同,2周后恢复到与电切术相同水平,而真性尿失禁发生率并不增加。

Transurethral bipolar plasmakinetic enucleation and resection versus transurethral bipolar plasmakinetic resection of the prostate for BPH： A randomized controlled trial on the incidence of postoperative urinary incontinence

Objective： To compare the incidence rates of postoperative urinary incontinence between transurethral bipolar plasmakinetic enucleation and resection of the prostate （PKERP） and transurethral bipolar plasmakinetie resection of the prostate （PKRP） , and provide evidence for the clinical application of PKERP. Methods ： Totally, 180 BPH patients were equally and randomly assigned to undergo PKERP and PKRP, respectively. We measured the urinary incontinence of the patients by pad test at 24 hours after extubation and every week after surgery for 4 weeks. Meanwhile, we recorded and compared the PSA level, prostate volume, Qmax, residual urine, IPSS, QOL, and the results of pad test between the two groups before and after surgery. Results： The incidence rates of urinary incontinence in the PKERP and PKRP groups were 35.56% and 18.89% （P 〈0.01 ） at 24 hours after extubation, 20.00% and 7.78% at 1 week after surgery （P 〈 0.05）, and 3.33% and 2.22% at 2 weeks. There was no significant difference in the severity of urinary incontinence between the two groups at any time point （P 〉 0.05）. No permanent urinary inconti- nence was observed in either group. Conclusion ： Compared with PKRP, PKERP has a higher incidence rate of short-term urinary incontinence in the treatment of BPH, but not that of genuine incontinence, with similar severity and recovery time.