逼尿肌活力低下对良性前列腺增生患者经尿道前列腺电切术后下尿路症状改善的影响

Effects of detrusor underactivity on the improvement of lower urinary tract symptoms in patients with benign prostatic hyperplasia undergoing transurethral resection of the prostate

摘要

目的 探讨逼尿肌活力低下（DU）对良性前列腺增生（BPH）患者经尿道前列腺电切术（TURP）后下尿路症状（LUTS）改善情况的影响。方法 回顾性分析2021年1月-2025年6月于深圳市龙华区人民医院接受TURP的229例BPH患者的临床资料。所有患者均接受尿动力学检查，根据膀胱收缩指数（BCI）将患者分为DU组（BIC<100，n=111）与非DU组（BIC≥100，n=118）。比较两组患者术前及术后3个月的国际前列腺症状评分（IPSS）、储尿期症状评分（IPSS-S）、排尿期症状评分（IPSS-V）及生活质量评分（QoL）。以IPSS改善成功为状态变量构建ROC曲线，确定DU患者中BCI的最佳临界值，并据此将DU组进一步细分为轻度DU组和重度DU组。比较轻度DU组和重度DU组患者术前及术后3个月的IPSS、IPSS-S、IPSS-V、QoL以及各指标的改善成功率差异，并分析DU对TURP术后LUTS改善的影响。结果 术后3个月，DU组与非DU组的IPSS[7（5，13）分对比6（4，7）分]、IPSS-S[4（3，7）分对比4（3，5）分]、IPSS-V[3（2，6）分对比2（1，3）分]及QoL[1（1，3）分对比1（1，1）分]比较，差异均有统计学意义（P<0.05）。在LUTS改善成功率方面，DU组的IPSS（73.0%对比89.0%）、IPSS-S（73.9%对比84.7%）、IPSS-V（75.7%对比86.4%）及QoL（73.9%对比92.4%）改善成功率均低于非DU组，差异有统计学意义（P<0.05）。以IPSS改善成功为基准的BCI的ROC曲线显示，BCI为67时约登指数最大，据此将DU患者划分为轻度DU组（67≤BCI<100，61例）和重度DU组（BCI<67，50例）。轻度DU组的IPSS（83.6%对比60.0%）、IPSS-S（85.2%对比60.0%）、IPSS-V（83.6%对比66.0%）及QoL（85.2%对比60.0%）改善成功率均高于重度DU组，差异具有统计学意义（P<0.05）。结论 TURP可改善合并不同程度DU的BPH患者的LUTS主观评价指标，但合并重度DU患者的改善成功率较低。术前应充分告知此类患者术后预期，并在术后管理和康复指导中加强关注，采取针对性措施，以进一步提高患者术后生活质量。

Abstract

Objective To investigate the impact of detrusor underactivity (DU) on the improvement of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) following transurethral resection of the prostate (TURP). Methods Clinical data of 229 BPH patients who underwent TURP at the People's Hospital of Longhua District in Shenzhen during Jan.2021 and Jun.2025 were retrospectively analyzed. All patients underwent urodynamic evaluations, and were divided into the DU group (BIC<100, n=111) and the non-DU group (BIC≥100, n=118) based on the bladder contractility index (BCI). Preoperative and three-month postoperative assessments of the international prostate symptom score (IPSS), storage symptom score (IPSS-S), voiding symptom score (IPSS-V), and quality of life score (QoL) were compared between the two groups. A receiver operating characteristic (ROC) curve was plotted using success rate of IPSS improvement as the outcome variable to determine the optimal BCI cutoff for DU patients. Based on this threshold, the DU group was subdivided into the mild and severe DU subgroups, and the differences in IPSS, IPSS-S, IPSS-V, Qol, and success rates of improvement preoperatively and three months postoperatively were compared to explore the effects of DU on the improvement of LUTS after TURP. Results Postoperative differences between the DU and non-DU groups were statistically significant for IPSS [7(5,13) vs. 6(4,7)], IPSS-S [4(3,7) vs. 4(3,5)], IPSS-V [3(2,6) vs. 2(1,3)], and QoL [1(1,3) vs. 1(1,1)] (P<0.05). Regarding success rate of LUTS improvement, the IPSS (73.0% vs. 89.0%), IPSS-S (73.9% vs. 84.7%), IPSS-V (75.7% vs. 86.4%), and QoL (73.9% vs. 92.4%) in the DU group were lower than those in the non-DU group, with significant differences (P<0.05). The ROC analysis based on success improvement of IPSS identified a BCI of 67 as the optimal cutoff, yielding the maximum Youden index. Accordingly, DU patients were classified into a mild DU group (67≤BCI<100, n=61) and a severe DU group (BCI<67, n=50). The success rate of IPSS improvement (83.6% vs.60.0%), IPSS-S (85.2% vs.60.0%), IPSS-V (83.6% vs.66.0%) and QoL (85.2% vs.60.0%) in the mild DU group were significantly higher than those in the severe DU group, with all intergroup comparisons reaching statistical significance (P<0.05). Conclusion In BPH patients with varying degrees of DU, subjective measures of LUTS improved following TURP. However, patients with severe DU exhibited a lower success rate in the improvement of symptoms. It is essential to fully inform patients of the postoperative expectations during preoperative consultations, and postoperative management and rehabilitation should be tailored and more intensively focused to enhance patients' quality of life.

关键词

逼尿肌活力低下 / 良性前列腺增生 / 经尿道前列腺电切术 / 下尿路症状 / 膀胱收缩指数 / 尿流动力学

Key words

detrusor underactivity / benign prostatic hyperplasia / transurethral resection of the prostate / lower urinary tract symptoms / bladder contractility index / urodynamics

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