前列腺增生合并帕金森病患者的手术时机与围手术期管理策略探讨

Timing of surgery and perioperative management strategies for patients with benign prostatic hyperplasia and Parkinson's disease

摘要

目的 探讨前列腺增生（BPH）合并帕金森病（PD）患者的手术时机与围手术期管理策略，以期为该病的临床决策提供参考。方法 回顾性收集2020年1月-2024年12月于南京医科大学第一附属医院泌尿外科接受经尿道前列腺钬激光剜除术（HoLEP）治疗的BPH合并PD患者的临床资料。根据PD病程将患者分为早期干预组35例（PD病程＜5年），晚期干预组33例（PD病程≥5年）。比较两组患者的主要结局指标:术后的1年国际前列腺症状评分（IPSS）和生活质量评分（QoL）;次要结局指标:术后1年残余尿量及IPSS改善率;安全性指标:围术期并发症、脑深部电刺激（DBS）相关事件、术后谵妄发生率及术后尿失禁发生率。结果 晚期干预组相较于早期干预组术前残余尿量显著增多（P＜0.001），膀胱收缩指数（BCI）显著降低（P＜0.001），膀胱出口梗阻（BOO）阳性率显著降低（48.48%对比82.86%，P=0.007），逼尿肌过度活动（DO）阳性率显著升高（81.82%对比31.43%，P＜0.001）。两组术后IPSS、QoL、残余尿量均较术前显著改善（P＜0.01）;早期干预组术后1年的IPSS[8.0（6.0，10.0）分对比14.0（13.0，17.0）分，P＜0.001]、QoL[2.0（1.0，2.0）分对比3.0（3.0，3.0）分，P＜0.001]及残余尿量[26.0（18.5，39.0）mL对比64.0（54.0，78.0）mL，P＜0.001]均优于晚期干预组。多因素logistic回归分析（强制进入法，校正年龄、术前IPSS、术前残余尿、BCI、BOOI、BOO、DO）显示，晚期干预是术后疗效不佳的独立危险因素（OR=8.50，95%CI:2.73～26.47，P＜0.001）。15例植入DBS的患者术中均保持开机状态，无1例出现DBS相关并发症。两组患者术后尿失禁发生率差异无统计学意义（P＞0.05）。结论 对于BPH合并PD的患者早期手术干预（PD病程＜5年）的疗效显著优于晚期手术干预。BCI＜100不应作为手术排除标准，此类患者仍可从手术中显著获益。HoLEP术中DBS无需关机、无需停用抗PD药物，围术期安全可行。临床决策应综合PD病程、前列腺体积、症状严重程度及BCI等多维信息，实现个体化治疗。

Abstract

Objective To investigate the optimal timing for surgery and perioperative management strategies for patients with benign prostatic hyperplasia（BPH）and Parkinson's disease（PD），so as to provide guidance for clinical decision-making. Methods Clinical data of patients with BPH and PD who underwent transurethral holmium laser enucleation of the prostate（HoLEP）in our hospital during Jan. 2020 and Dec. 2024 were retrospectively collected. The patients were divided into the early intervention group（n=35; PD duration ＜5 years） and late intervention group（n=33; PD duration ≥5 years）. The primary outcome measures，including the international prostate symptom score（IPSS）and quality of life（QoL）score 1 year postoperatively，were compared between the two groups. Secondary outcome measures included post-void residual（PVR）and the IPSS improvement rate 1 year postoperatively. Safety indicators included perioperative complications，deep brain stimulation（DBS）-related events，incidence of postoperative delirium，and incidence of postoperative urinary incontinence. Results Compared with the early intervention group，the late intervention group had significantly higher preoperative PVR（P＜0.001），significantly lower bladder contractility index（BCI） （P＜0.001），significantly lower positive rate for bladder outlet obstruction（BOO） （48.48% vs. 82.86%，P=0.007），and significantly higher positive rate for detrusor overactivity（DO）（81.82% vs. 31.43%，P＜0.001）. Postoperative IPSS，QoL and PVR improved significantly in both groups compared with preoperative levels（P＜0.01）. In the early intervention group，the 1-year postoperative IPSS[8.0（6.0，10.0） vs. 14.0（13.0，17.0），P＜0.001]，QoL[2.0（1.0，2.0） vs. 3.0（3.0，3.0），P＜0.001]，and PVR[26.0（18.5，39.0） mL vs. 64.0（54.0，78.0） mL，P＜0.001] were superior to those in the late intervention group. Multivariate logistic regression analysis（forced entry method，adjusted for age，preoperative IPSS，preoperative post-void residual，BCI，BOOI，BOO，and DO）showed that late intervention was an independent risk factor for poor postoperative outcomes（OR=8.50，95%CI:2.73-26.47，P ＜0.001）. All 15 patients who received DBS implants maintained device activation during surgery，and none experienced DBS-related complications. There were no statistically significant differences between the two groups in the incidence of postoperative urinary incontinence（P＞0.05）. Conclusion For patients with BPH complicated with PD，early surgical intervention（PD duration ＜5 years）yields significantly better outcomes than late surgery. A BCI ＜100 should not be used as a criterion for excluding patients from surgery; such patients can still gain significant benefits from the procedure. During HoLEP，there is no need to turn off the DBS system or discontinue anti-PD medications，making the procedure safe and feasible in the perioperative period. Clinical decision-making should integrate multidimensional information，including PD duration，prostate volume，symptom severity，and BCI，to achieve individualized treatment.

关键词

前列腺增生 / 帕金森病 / 膀胱收缩指数 / 尿动力学

Key words

benign prostatic hyperplasia / Parkinson's disease / bladder contraction index / urodynamics

参考文献

[1] EGAN KB. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates[J]. Urol Clin North Am, 2016, 43(3): 289-297.

[2] MCDONALD C, WINGE K, BURN DJ. Lower urinary tract symptoms in Parkinson's disease: prevalence, aetiology and management[J]. Parkinsonism Relat Disord, 2017, 35: 8-16.

[3] VURTURE G, PEYRONNET B, PALMA JA, et al. Urodynamic mechanisms underlying overactive bladder symptoms in patients with parkinson disease[J]. Int Neurourol J, 2019, 23(3): 211-218.

[4] ARAKI I, KITAHARA M, OIDA T, et al. Voiding dysfunction and Parkinson's disease: urodynamic abnormalities and urinary symptoms[J]. J Urol, 2000, 164(5): 1640-1643.

[5] ZEKRAOUI O, BHOJANI N, ZORN KC, et al. Management and treatment of benign prostatic hyperplasia symptoms: current insights[J]. Res Rep Urol, 2025, 17: 401-420.

[6] MITSUNO R, KANEKO H, SUZUKI Y, et al. Parkinson Disease imposes risk of kidney function decline[J/OL]. Nephrol Dial Transplant, 2026: gfag086. doi: 10.1093/ndt/gfag086. Online ahead of print.

[7] KAMO H, BURKE RM, MEHTA TR, et al. Urinary tract infections in hospitalized patients with parkinson's disease: risk factors and outcomes[J]. Mov Disord Clin Pract, 2026, 3(7): 1673-1680.

[8] SPEAKMAN MJ, CHENG X. Management of the complications of BPH/BOO[J]. Indian J Urol, 2014, 30(2): 208-213.

[9] YIM RLH, LEUNG KMM, POON CCM, et al. Peri-operative management of patients with Parkinson's disease[J]. Anaesthesia, 2022, 77(Suppl 1): 123-133.

[10] OZLUK E, OZTURK G. Risk factors for delirium occurring after deep brain stimulation surgery in patients with Parkinson's disease[J]. Acta Neurochir (Wien), 2024, 166(1): 474.

[11] CHARALAMPOUS I, TSIKOPOULOS I, MITKANI C, et al. Does surgical treatment for benign prostate enlargement (BPE)-related bladder outlet obstruction (BOO) benefit patients with central nervous system diseases? A systematic review[J]. J Clin Med, 2024, 13(19): 5846.

[12] LI FF, CUI YS, YAN R, et al. Prevalence of lower urinary tract symptoms, urinary incontinence and retention in parkinson's disease: a systematic review and meta-analysis[J]. Front Aging Neurosci, 2022, 14: 977572.

[13] WINGE K, FOWLER CJ. Bladder dysfunction in Parkinsonism: mechanisms, prevalence, symptoms, and management[J]. Mov Disord, 2006, 21(6): 737-745.

[14] ZENG X, KANG T, HUANG W, et al. How should the BCI and BOOI index be correctly applied in patients with low-compliance bladder?[J]. Neurourol Urodyn, 2025, 44(6): 1382-1384.

[15] ISSA MM. Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP[J]. J Endourol, 2008, 22(8): 1587-1595.

[16] MEYRING K, ZEHNDER A, SCHMID RA, et al. Thoracic surgery in patients with an implanted neurostimulator device[J]. Interact Cardiovasc Thorac Surg, 2017, 25(4): 667-668.

[17] KIM JH, KWON TH, KOH SB, et al. Parkinsonism-hyperpyrexia syndrome after deep brain stimulation surgery: case report[J]. Neurosurgery, 2010, 66(5): E1029.

[18] ÖZDEN H, ÇELIK FND, ÜSTÜNER F, et al. Retrospective multicenter analysis of withdrawal syndrome in parkinson's disease patients after cessation of deep brain stimulation[J]. Diagnostics (Basel), 2026, 16(4): 644.

[19] SHASHKIN C. Complications of deep brain stimulation for movement disorders: literature review and personal experience[J]. Acta Neurochir Suppl, 2023, 130: 121-126.

[20] 中华医学会神经外科分会功能神经外科学组, 中国医师协会神经外科医师分会功能神经外科学组, 中国医师协会神经调控专业委员会, 等. 神经外科手术机器人辅助脑深部电刺激手术专家共识（2026版）[J]. 中华医学杂志, 2026, 106(5): 406-413.