IPSS-V/S在TUVP术后下尿路症状评估的临床价值

Clinical value of international prostatic symptom score-voiding/storage subscore ratio in assessing lower urinary tract symptoms after transurethral electrovaporization prostatectomy

摘要:

目的：探讨国际前列腺症状评分的排尿期/储尿期评分比值（international prostatic symptom score-voiding/storage sub－score ratio，IPSS-V/S）在经尿道前列腺汽化电切术（transurethral electrovaporization prostatectomy，TUVP）术后下尿路症状（lower urinary tract symptoms，LUTS）再评估的临床价值。方法：回顾性分析了2015年1月至2016年12月期间234例接受TUVP的良性前列腺增生（benign prostatic hyperplasia，BPH）患者的国际前列腺症状评分（international prostatic symptom score，IPSS）等临床资料。按照IPSS-V/S比值将患者分为A组（IPSS-V/S≤1，80例）和B组（IPSS-V/S>1，154例）。术后6个月再次评估IPSS，储尿期症状评分（international prostatic symptom score-storage，IPSS-S），排尿期症状评分（international prostatic symptom score-voiding，IPSS-V）和生活质量评分（quality of life，QOL）。结果：234例患者术后6个月IPSS和QOL较术前明显降低，差异有统计学意义（t=33.0，P=0.000；t=34.3，P=0.000）。术后6个月B组患者IPSS改善程度明显优于A组[（12.36±3.67）分 vs. （8.20±3.21）分]（t=8.96，P=0.000）。其中A组术后6个月IPSS-S明显高于B组[（9.61±2.88）分 vs. （5.55±2.63）分]（t=10.8，P=0.000）；而2组患者术后6个月时IPSS-V对比无统计学差异（t=1.56，P=0.120）。虽然A组术后6个月的QOL明显改善[（3.59±0.91）分 vs.（5.19±0.55）分]（t=14.8，P=0.000），但是基本满意及以上者仅占13.75%，明显低于B组的70.78%。A组术后6个月IPSS-S各症状评分均有一定改善，改善程度从高到低依次为尿急评分、尿频评分和夜尿评分，其中夜尿评分改善率最低，仅为36.3%（29/80），是A组患者IPSS及QOL改善较小的重要原因。结论：相比IPSS，IPSS-V/S更能准确反映TUVP术后疗效，LUTS排尿期症状改善明显优于储尿期症状。对于以夜尿症为主的BPH/LUTS患者，TUVP对患者QOL改善有限，需要引起临床医师重视。

Abstract:

Objective：To investigate the clinical value of international prostatic symptom score-voiding/storage subscore ratio（IPSS-V/S） in assessing lower urinary tract symptoms（LUTS） after transurethral electrovaporization prostatectomy（TUVP）. Methods：A retro－spective analysis was performed for international prostatic symptom score（IPSS） and other clinical data of 234 patients with benign prostatic hyperplasia（BPH） who underwent TUVP from January 2015 to December 2016. According IPSS-V/S，these patients were divided into group A（80 patients with an IPSS-V/S≤1） and group B（154 patients with an IPSS-V/S>1）. IPSS，international prostatic symptom score-voiding（IPSS-V） score，international prostatic symptom score-storage（IPSS-S） score，and quality of life（QOL） score were reassessed at 6 months after surgery. Results：All 234 patients had significant reductions in IPSS and QOL score at 6 months after surgery（t=33.0 and 34.3，both P=0.000）. At 6 months after surgery，group B had a significantly greater improvement in IPSS than group A[（12.36±3.67） points vs. （8.20±3.21） points，t=8.96，P=0.000]. At 6 months after surgery，group A had a significantly higher IPSS-S score than group B[（9.61±2.88） points vs. （5.55±2.63） points，t=10.8，P=0.000]，while there was no significant difference in IPSS-V score between the two groups（t=1.56，P=0.120）. Although group A had a significant improvement in QOL score at 6 months after surgery[（3.59±0.91） points vs. （5.19±0.55） points，t=14.8，P=0.000]，group A had a significantly lower satisfaction rate than group B（13.75% vs. 70.78%）. At 6 months after surgery，group A had varying degrees of improvement in IPSS-S symptom scores，among which the score of urgency of urination showed the highest degree of improvement，followed by the scores of frequency of urination and nocturia；the score of nocturia had the lowest improvement rate of 36.3%（29/80），which was an important reason for the low degree of improvement in IPSS and QOL. Conclusion：Compared with IPSS，IPSS-V/S can reflect the outcome after TUVP more accurately，and voiding symptoms have sig－nificantly greater improvements than storage symptoms in LUTS. BPH/LUTS patients with nocturia as the main complaint have limited improvement in QOL after TUVP，which should be taken seriously by clinicians.