经尿道前列腺切除术对BPH患者夜尿症及睡眠质量的改善作用

目的:探讨经尿道前列腺切除术(TURP)对伴有夜尿症的良性前列腺增生(BPH)患者夜尿症及睡眠质量的改善作用。方法:回顾性分析2016年12月至2018年12月北京大学人民医院收治的122例BPH患者的病例资料。年龄(69.7±7.9)岁。伴糖尿病20例,高血压病40例。前列腺体积(64.4±41.2)ml,体质指数(24.3±2.7)kg/m 2。术前国际前列腺症状评分(IPSS)(20.5±5.5)分,夜尿次数(IPSS问题7)(4.4±1.9)次,无干扰睡眠时间(hours of undisturbed sleep,HUS)(1.7±1.0)h(其中HUS<3 h者110例),夜尿症生活质量评分(N-QOL)(24.9±6.3)分,生活质量评分(QOL)(4.4±0.9)分。111例完善尿动力学检查,最大尿流率(6.4±3.1)ml/s,最大膀胱容量(318.5±83.6)ml,残余尿量(153.9±158.9)ml,最大逼尿肌压力(78.4±35.5)cmH 2O(1 cmH 2O=0.098 kPa),其中逼尿肌肌力下降27例,膀胱过度活动症18例,膀胱有效容量下降9例,膀胱出口梗阻60例。42例术前有效膀胱容量<200 ml,其中最大膀胱容量>200 ml组33例,夜尿次数(4.5±1.9)次;最大膀胱容量≤200 ml组9例,夜尿次数(4.7±1.7)次。122例均行TURP治疗。记录术后IPSS、夜尿次数(IPSS评分问题7)、HUS、NQOL、QOL变化情况。比较最大膀胱容量≤200 ml组和>200 ml组术后夜尿症状改善情况。结果:122例术后随访3~20个月。术后IPSS(4.9±4.2)分,夜尿次数(1.9±1.2)次,HUS(3.4±1.3)h(其中91例HUS≥3 h,缓解率达82.7%),N-QOL(37.3±6.7)分,QOL(0.8±0.9)分,与术前比较差异均有统计学意义(P<0.05)。96例夜尿次数较术前改善≥50%。术后夜尿≥2次68例,<2次54例,两组术前IPSS总分(21.8±5.3)分与(19.2±5.5)分]差异有统计学意义(P<0.05)。最大膀胱容量≤200ml组术后夜尿次数(3.4±1.5)次,与术前比较差异无统计学差异(P=0.12),最大膀胱容量>200 ml组术后夜尿次数(1.9±1.1)次,与术前比较差异有统计学差异(P<0.05)。结论:TURP可以显著延长伴有夜尿症的BPH患者的HUS,提高患者生活质量及睡眠质量。TURP可减少部分BPH患者夜尿次数,术前IPSS总分高以及最大膀胱容量≤200 ml是伴有夜尿症BPH患者术后夜尿症状无改善的危险因素。

Effect of transurethral resection of the prostate on nocturia and sleep quality in men with benign prostatic hyperplasia

Objective To evaluate the effect of transurethral resection of the prostate on nocturia and sleep quality in men with benign prostatic hyperplasia.Methods This retrospective study included 122 patients who underwent TURP(transurethral resection of the prostate)for BPH(benign prostatic hyperplasia)from December 2016 to December 2018.The age was(69.7±7.9)years old.There was 20 cases with diabetes and 40 cases with hypertension.The preoperative mean prostate volume was(64.4±41.2)ml and mean BMI was(24.3±2.7)kg/m2.The preoperative IPSS score was(20.5±5.5)points,the number of nocturia events(assessed by the seventh question of IPSS)was(4.4±1.9)times,hours of undisturbed sleep(HUS)was(1.7±1.0)h,110 cases with HUS<3 h;nocturia quality-of-life questionnaire(N-QOL)was(24.9±6.3)points,quality of life(QOL)was(4.4±0.9)points.111 patients had the urodynamic examination done.The maximum urine flow rate was(6.4±3.1)ml/s,the maximum bladder volume was(318.5±83.6)ml,the residual urine volume was(153.9±158.9)ml,and the maximum detrusor pressure was(78.4±35.5)cmH2O.Detrusor muscle strength decreased in 27 cases,18 cases had OAB,9 cases of effective bladder capacity declined and 60 cases had bladder outlet obstruction.42 cases had an effective bladder volume<200 ml,of which 33 had a maximum bladder capacity>200 ml with nocturia(4.5±1.9)times,9 cases had a maximum bladder capacity≤200 ml with nocturia(4.7±1.7)times.All 122 patients were treated with TURP.Result 122 patients were followed up for 3-20 months.After operation the number of nocturia significantly decreased to(1.9±1.23)times(P<0.05),HUS significantly improved to(3.4±1.3)h(P<0.05),and 91 cases had HUS≥3 with 82.7%remission rate;N-QOL significantly improved to(37.3±6.7)points(P<0.05),IPSS significantly decreased to(4.9±4.2)points(P<0.05),and QOL significantly decreased(0.8±0.9)points(P<0.05).121 patients had nocturia≥2 voids before surgery,and 96 patients had improved(≥50%reduction of nocturnal frequency).There were 68 patients with nocturia≥2 voids after operation with total score of preoperative IPSS(21.8±5.3),and 54 patients with nocturia<2 voids with total score of preoperative IPSS(19.2±5.5)(P<0.05).Patients with a effective bladder capacity less than 200 ml were divided into a group with a maximum bladder volume≤200 ml and a group with a maximum bladder capacity>200 ml.The nocturia did not improve significantly after surgery(P>0.05)in the group with a maximum bladder volume≤200 ml,and the nocturia in the group with a maximum bladder capacity>200 ml had significantly improvement(P<0.05).The group with a maximum bladder capacity≤200 ml had nocturia(3.4±1.5)times after surgery,which was no significant different from that before surgery(P=0.12);nocturia(1.9±1.1)times after operation in the group with maximum bladder volume>200 ml,and there was significant difference compared with before surgery(P<0.05).Conclusion TURP can significantly prolong the HUS of BPH patients with nocturia,and improve the life and sleep quality of patients.TURP partly reduces the number of nocturia,but some patients still suffer from nocturia after operation.The high total score of IPSS before operation and the maximum bladder volume≤200 ml are the risk factors for nocturia after operation.