HoLEP治疗良性前列腺增生合并急性尿潴留的临床疗效及安全性研究

Clinical efficacy and safety of HoLEP in treatment of benign prostatic hyperplasia with acute urinary retention

摘要:

目的：评估钬激光前列腺剜除术（holmium laser enucleation of prostate，HoLEP）治疗良性前列腺增生（benign prostatehy－perplasia，BPH）合并急性尿潴留（acute urinary retention，AUR）患者的疗效及安全性。方法：回顾性分析我院2016年2月至2018年2月收治的128例行钬激光前列腺剜除术治疗的良性前列腺增生患者，其中伴有AUR 40例（31.25％）归为AUR组，不伴AUR 88例（68．75％）归为非AUR组。根据既往尿潴留次数是否大1次将AUR组分为A（≤1次，n=25）、B（＞1次，n=15）2个亚组。分别比较AUR、非AUR组，A、B组之间的基本信息资料、围手术期资料以及术后随访指标的差异。结果：AUR组患者术前尿常规检查尿白细胞阳性率、尿培养阳性率、前列腺特异性抗原（prostate specific antigen，PSA）、国际前列腺症状评分（Interna－tional prostatic symptom score，IPSS）及手术时间明显高于非AUR患者组（P＜0.05），血红蛋白较非AUR组低（P＜0.05）。2组患者血红蛋白变化值、导尿管留置时间、住院天数以及围手术期并发症发生率之间无统计学差异（P>0.05）。术后随访2组患者残余尿（post-voiding residual，PVR）、IPSS及生活质量评分（quality of life score，QoL）较术前均有下降、最大尿流率（maximum urinary flow rate，Qmax）较术前升高（P＜0.05）。A、B 2组比较，围手术期资料及术后6个月随访IPSS、QoL、PVR、Qmax之间无统计学差异（P>0.05）。结论：HoLEP术治疗BPH伴发AUR患者安全有效。患者既往尿潴留的次数对手术效果无影响。

Abstract:

Objective：To investigate the clinical efficacy and safety of holmium laser enucleation of the prostate（HoLEP） in the treat－ment of benign prostatic hyperplasia（BPH） with acute urinary retention（AUR）. Methods：A retrospective analysis was performed in 128 patients with BPH who underwent HoLEP in our hospital from February 2016 to February 2018，including 40（31.25%） patients with AUR（AUR group） and 88（68.75%） patients without AUR（non-AUR group）. According to the number of urinary retention episodes，the AUR group was divided into two subgroups：subgroup A（≤1 time，n=25） and subgroup B（>1 time，n=15）. The basic information，perioperative data，and postoperative follow-up parameters were compared between the AUR group and the non-AUR group and between the subgroup A and the subgroup B. Results：Compared with the non-AUR group，the AUR group had significant－ly higher urinary white blood cell positive rate，urine culture positive rate，prostate-specific antigen level，and International Prostate Symptom Score（IPSS）（P<0.05），a significantly longer operation time（P<0.05），and a significantly lower hemoglobin level（P<0.05）. There were no significant differences in change in hemoglobin level，catheter indwelling time，length of hospital stay，and incidence rate of perioperative complications between the two groups（P>0.05）. After surgery，both groups had significantly decreased post-void－ing residual（PVR），IPSS，and quality of life（QoL） score（P<0.05） and a significantly increased maximum urinary flow rate（Qmax）（P<0.05）. There were no significant differences in perioperative data and IPSS，QoL score，PVR，and Qmax at 6-month follow-up after surgery between the subgroup A and the subgroup B（P>0.05）. Conclusion：HoLEP is safe and effective in the treatment of BPH with AUR. The number of urinary retention episodes has no effect on the surgical outcome.