经尿道前列腺切除术对前列腺增生患者尿流动力学和前列腺症状评分的影响

The effect of transurethral plasmakinetic resection of the prostate on urodynamics and prostate symptom scores in patients with benign prostatic hyperplasia

摘要:

目的 探讨经尿道前列腺切除术对前列腺增生（BPH）患者的尿流动力学和前列腺症状评分的影响。方法 选取2021年6月—2023年2月武警四川总队医院收治的93例BPH患者，通过随机数字表法分为观察组和对照组，分别有47和46例。对照组接受传统的经尿道前列腺电切术，观察组接受经尿道前列腺切除术。评价两组手术指标（手术时间、术中出血量、造瘘管留置时间、尿管留置时间），术前和术后3、6和12个月的尿动力学参数［最大射尿流率（MFR）、残余尿量（RUV）］、美国国立卫生研究院慢性前列腺炎症状指数（NIH-CPSI）评分、国际前列腺症状（IPSS）评分及术后性功能状况。结果 对照组术中出血量多于观察组，造瘘管留置时间、尿管留置时间均长于观察组（P <0.05）。两组平均手术时间比较，经t 检验，差异无统计学意义（P >0.05）。两组术前和术后3、6和12个月MFR、RUV水平比较，经重复测量设计的方差分析，结果 ①不同时间点MFR、RUV水平比较，差异均有统计学意义（均P <0.05）；②两组MFR、RUV水平比较，差异均有统计学意义（均P <0.05），观察组术后MFR较对照组高，RUV较对照组低；③两组MFR、RUV水平变化趋势比较，差异均有统计学意义（均P <0.05）。两组术前和术后3、6和12个月NIH-CPSI评分比较，经重复测量设计的方差分析，结果 ①不同时间点NIH-CPSI评分比较，差异有统计学意义（P <0.05）；②两组NIH-CPSI评分比较，差异有统计学意义（P <0.05），观察组术后较对照组低；③两组NIH-CPSI评分变化趋势比较，差异有统计学意义（P <0.05）。两组术前和术后3、6和12个月IPSS评分比较，经重复测量设计的方差分析，结果显示：①不同时间点IPSS评分比较，差异有统计学意义（P <0.05）；②两组IPSS评分比较，差异有统计学意义（P <0.05），观察组术后较对照组低；③两组IPSS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组性功能恢复优于对照组（P <0.05）。结论 经尿道前列腺切除术治疗BPH患者，能够显著改善患者的尿流动力学参数和前列腺症状评分，为慢性前列腺炎合并勃起功能障碍患者提供了一种有效的治疗选择。

Abstract:

Objective To evaluate the effects of transurethral plasmakinetic resection of the prostate on urodynamics and prostate symptom scores in patients with benign prostatic hyperplasia.Methods This study included 93 patients with benign prostatic hyperplasia admitted to our hospital from June 2021 to February 2023. They were divided into an observation group and a control group using a random number table method, with 46 cases and 47 cases in the two groups, respectively. The control group received conventional transurethral resection of the prostate, while the observation group received transurethral plasmakinetic resection of the prostate. The surgery-related indicators (operative duration, intraoperative bleeding, duration of drainage tube placement, and duration of urinary catheter use), urodynamic parameters [maximum flow rate (MFR) and residual urine volume (RUV) ], National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores, International Prostate Symptom Score (IPSS) and postoperative sexual function in the two groups were evaluated.Results The intraoperative blood loss was more and the duration of drainage tube placement and that of urinary catheter use were longer in the control group than in the observation group (P < 0.05). There was no difference in the mean operative duration between the two groups analyzed using the t-test (P > 0.05). In the comparison of MFR and RUV between the two groups before surgery and 3, 6, and 12 months after surgery via the repeated measures analysis of variance, there were significant differences among the time points (P < 0.05) and between the groups (P < 0.05). Specifically, the observation group had a higher MFR and a lower RUV after surgery compared with the control group. The change trends of the MFR and the RUV were also different between the groups (P < 0.05). The NIH-CPSI scores before surgery and 3, 6, and 12 months after surgery were compared via the repeated measures analysis of variance, which demonstrated that they were different among the time points (P < 0.05) and between the groups (P < 0.05), and that they were lower in the observation group than in the control group after surgery. Besides, the change trends of the NIH-CPSI scores were different between the groups (P < 0.05). The IPSS scores before surgery and 3, 6, and 12 months after surgery were compared via the repeated measures analysis of variance, and the results revealed that they were different among the time points (P < 0.05) and between the groups (P < 0.05), and that they were lower in the observation group than in the control group after surgery. The change trends of IPSS scores were different between the groups (P < 0.05). The recovery of sexual function in the observation group was better than that in the control group (P < 0.05).Conclusions Transurethral plasmakinetic resection of the prostate can significantly improve urodynamic parameters and prostate symptom scores in patients with benign prostatic hyperplasia, providing an effective treatment option for patients with chronic prostatitis complicated with erectile dysfunction.