骶神经调控在经尿道前列腺电切术后疗效欠佳的良性前列腺增生合并膀胱活动低下症患者中的初步应用

Preliminary application of sacral neuromodulation in patients with benign prostatic hyperplasia complicated with underactive bladder after transurethral resection of the prostate

摘要

目的 评估骶神经调控（SNM）治疗经尿道前列腺电切术（TURP）术后疗效欠佳的良性前列腺增生症（BPH）合并膀胱活动低下症（UAB）患者的有效性及安全性。方法 回顾性分析东南大学附属中大医院泌尿外科2018年1月-2023年1月收治的10例BPH合并UAB患者的临床资料，所有患者均由同一医师行TURP，术后疗效欠佳，具体表现为患者术后残余尿量无明显缓解，最大尿流率及每次排尿量无明显改善，术后均留置膀胱造瘘管。所有患者均接受Ⅰ期SNM手术，记录患者术前及术后的排尿日记，观察患者的每日排尿次数、每次排尿量、最大尿流率及残余尿量。结果 患者Ⅰ期手术时间（97.6±11.2）min，术后测试2～4周，以残余尿量减少≥50%为有效，其中6例患者有效（60.0%）。与术前比较，6例有效患者术后每日排尿次数[（20.2±3.8）次 vs.（13.2±3.2）次]、每次排尿量[（119.2±56.7）mL vs.（246.5±59.2）mL]、最大尿流率[（8.7±1.5）mL/s vs.（16.5±2.6）mL/s]、残余尿量[（222.5±55.0）mL vs.（80.8±16.0）mL]均有明显改善，差异有统计学意义（P＜0.05）。所有患者术后均无出血、感染、发热、疼痛等并发症发生。6例Ⅰ期手术治疗有效患者均顺利完成Ⅱ期手术，并拔除造瘘管，随访1年，期间疗效稳定，无电极移位、切口感染、刺激部位疼痛等并发症发生。另4例无效患者残余尿量未明显改善，均予以拔除电极并继续留置膀胱造瘘管。结论 SNM治疗TURP术后疗效欠佳的BPH合并UAB患者安全、有效。

Abstract

Objective To evaluate the efficacy and safety of sacral neuromodulation (SNM) in the treatment of patients with benign prostatic hyperplasia (BPH) complicated with underactive bladder (UAB) who respond poorly to transurethral resection of the prostate (TURP). Methods A retrospective analysis was performed on 10 patients with BPH and UAB treated with TURP by the same surgeon in Zhongda Hospital Southeast University during Jan. 2018 and Jan. 2023. The residual urine volume was not significantly relieved after operation, and the maximum urine flow rate and urine volume per discharge were not significantly improved. All patients underwent phase I SNM, and urinary diaries were recorded before and after surgery to observe the average daily frequency of urination, volume per urination, maximum urine flow rate, and residual urine volume. Results The operation time was (97.6±11.2) min. During the postoperative test of 2-4 weeks, if the residual urine volume reduction by more than 50% was deemed as effective, SNM was effective in 6 patients (60.0%). Compared with preoperative results, the daily frequency of urination [(20.2±3.8) times vs. (13.2±3.2) times], volume per urination [(119.2±56.7) mL vs. (246.5±59.2) mL], maximum urine flow rate [(8.7±1.5) mL/s vs. (16.5±2.6) mL/s], and residual urine volume [(222.5±55.0) mL vs. (80.8±16.0) mL] were significantly improved, with statistical significance (P<0.05). There were no complications such as bleeding, infection, fever or pain. The 6 patients who had effective outcomes successfully completed phase II surgery, and the fistula was removed. During the follow-up of 1 year, the curative effect was stable, and there were no complications such as electrode displacement, incision infection, or pain in the irritation sites. The residual urine volume of the other 4 unsuccessful patients did not improve significantly, and the electrodes were removed and the vesicostomy tube was retained. Conclusion SNM is safe and effective in the treatment of BPH with UAB patients with poor curative effects after TURP.

关键词

骶神经调控 / 经尿道前列腺电切术 / 良性前列腺增生症 / 膀胱活动低下症 / 膀胱出口梗阻

Key words

sacral neuromodulation / transurethral resection of the prostate / benign prostatic hyperplasia / underactive bladder / bladder outlet obstruction

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基金资助

国家自然科学基金青年项目(82100732)