经尿道手术治疗小体积前列腺增生所致膀胱出口梗阻

目的探讨经尿道前列腺电切(transurethral resection of prostate,TURP)+经尿道膀胱颈切开术(transurethralincision of bladder neck,TUIBN)治疗小体积前列腺增生所致膀胱出口梗阻的疗效。方法 2002年3月～2007年1月,采用TURP+TUIBN治疗小体积前列腺增生所致膀胱出口梗阻31例,其中有完整随访资料的25例,年龄46～71岁,平均56岁,病程8～77个月,平均32个月,前列腺重量15～30 g,平均24 g。比较术前、术后国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿量(PVR)等指标,以评估疗效。结果手术时间25～47 min,平均38 min。经尿道切除前列腺组织重量6～17 g,平均9.8 g。术后病理报告25例均为良性前列腺增生(其中20例为纤维增生型),15例伴慢性前列腺炎。术后随访6～24个月,平均15个月。23例排尿通畅,1例尿道狭窄(行尿道扩张后排尿通畅),1例膀胱颈挛缩。术前、术后6个月IPSS评分分别为(26.60±3.07)分、(6.92±1.26)分,Qmax为(7.96±2.30)ml/s、(19.60±2.31)ml/s,PVR为(132.80±64.84)ml、(18.60±7.97)ml,差异均有显著性(P=0.000)。结论 TURP+TUIBN是治疗小体积前列腺增生所致膀胱出口梗阻的一种较为理想的术式。

Transurethral Procedure for Bladder Outlet Obstruction Caused by Small-size Prostatic Hyperplasia

Objective To study the efficacy of transurethral resection of prostate(TURP) plus transurethral incision of the bladder neck(TUIBN) in the treatment of bladder outlet obstruction caused by small-size prostatic hyperplasia.Methods From March 2002 to January 2007,totally 31 cases of bladder outlet obstruction that was caused by small-size prostatic hyperplasia received TURP+TUIBN in our hospital.Of the patients,25 cases were followed up.The mean age of these 25 patients was 56 years(range,46-71 years),their mean disease course was 32 months(range,8-77 months),and the mean prostatic weight was 24 g(range,15-30 g).We evaluated the international prostate symptom(IPSS),maximum urinary flow rate(Qmax) and post-void residual urine volume(PVR) of the patients to determine the efficacy of the procedures.Results The mean operation time was 38 minutes(range,25-47 minutes),and a mean of 9.8 g(range,6-17 g) of prostatic tissues were resected.Postoperative pathological examination reported benign prostatic hyperplasia in all the 25 cases,20 of them were fibrosis prostatic hyperplasia,and 15 of them were complicated with chronic prostatitis.Postoperative follow-up was 15 months in average(range,6-24 months),during which 23 patients voided well(one of them received urethral dilation,and one patient developed vesical neck contracture).Six months after the procedures,the IPSS of the patients decreased to 6.92±1.26,Qmax increased to(19.60±2.31) ml/s,and PVR reduced to(18.60±7.97) ml all P=0.000 compared to preoperation: 26.60±3.07,(7.96±2.30) ml/s,and(132.80±64.84) ml].Conclusion TURP plus TUIBN is an ideal treatment for patients with bladder outlet obstruction caused by small-size prostatic hyperplasia.