Effect of history of acute urinary retention on the short-term prognosis of benign prostatic hyperplasia treated with MoLEP
Wu Yangyang1,2, Lv Kaikai1,2, Hao Xiaowei1,2, Lai Wenhui3, Xia Xinze4, Huang Shuai3, Luo Zhenjun5, Song Tao1,2, Yuan Qing1,2,*
1Graduate School, Medical School of Chinese PLA, Beijing 100853, China; 2Senior Department of Urology, the Third Medical Center of PLA General Hospital, Beijing 100039, China; 3Graduate School, Hebei North University, Zhangjiakou 075051, China; 4Second School of Clinical Medicine, Shanxi Medical University, Taiyuan 030001, China; 5Clinical Medicine, Weifang Medical University, Weifang 261053, China
摘要目的:探讨急性尿潴留(AUR)病史对摩西钬激光前列腺剜除术(MoLEP)治疗良性前列腺增生症(BPH)早期预后的影响。方法:回顾性分析中国人民解放军总医院第三医学中心泌尿外科医学部2021年1月至10月接受MoLEP治疗的BPH患者120例,根据是否有AUR病史分为AUR(+)组41例和AUR(-)组79例。比较两组患者围手术期指标和术后并发症的差异,探究AUR病史对术后3个月最大尿流率(Qmax)、残余尿(PVR)、国际前列腺症状评分(IPSS)及生活质量评分(QOL)的影响。结果:AUR(+)组相比AUR(-)组BMI较小[23.88(21.77,25.40) kg/m2 vs 24.80(23.25,26.22) kg/m2, P=0.018],前列腺体积较大[80.00(52.00,91.00) ml vs 58.00(47.00,80.50) ml, P=0.044],术前尿白细胞阳性比例较高[22(53.7%)vs 9(11.4%), P<0.001]差异均有统计学意义。两组患者术后3个月Qmax、PVR、IPSS评分、QOL评及并发症的差异均无统计学意义(P>0.05)。两组患者术后3个月IPSS评分和QOL评分均有明显改善(P<0.001)。结论:AUR病史对MoLEP治疗BPH的早期预后无不利影响。
Abstract:Objective: To investigate the influence of history of acute urinary retention (AUR) on the short-term prognosis of MoLEP for benign prostatic hyperplasia (BPH). Methods: A total of 120 patients with BPH receiving MoLEP from January to October 2021 in the Department of Urology Medicine of the Third Medical Center of the Chinese People’s Liberation Army General Hospital were retrospectively analyzed. They were divided into AURgroup(79 cases) and non-AUR group (41 cases) according to their history of AUR. The differences in perioperative indexes and postoperative complications between the two groups were compared, and the correlation between the history of AUR and the maximum flow rate (Qmax), post-voiding residual urine volume(PVR), International Prostate Symptom Score (IPSS) and quality of life score (QOL) at 3 months after operation was tested. Results: The body mass index (BMI) was lower[23.88 (26.22, 21.77) kg/m2vs.24.80(23.25,26.22)kg/m2, P=0.018] and prostate volume was larger [80.00 (52.00,91.00) vs. 58.00 (52.00,91.00)mL, P=0.044] in AUR group than those in non-AUR group. There were significant differences in the proportion of positive urine leukocytes [22(53.7%) vs. 9(11.4%), P<0.001]. There was no significant difference in Qmax, PVR, IPSS, QOL and complications between the two groups at 3 months after operation (P>0.05). The IPSS and QOL scores were significantly improved in both groups at 3 months after surgery(P<0.001). Conclusion: The history of AUR has no adverse effect on the short-term prognosis of BPH treated with MoLEP.
[1] KIM EH, LARSON JA, ANDRIOLE GL.Management of benign prostatic hyperplasia[J]. Annu Rev Med,2016,67:137-151. [2] BERRY SJ, COFFEY DS, WALSH PC, et al.The development of human benign prostatic hyperplasia with age[J]. J Urol,1984,132(3):474-479. [3] MCCONNELL JD, ROEHRBORN CG, BAUTISTA OM, et al.The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia[J]. N Engl J Med,2003,349(25):2387-2398. [4] THORNE MB, GERACI S.Acute urinary retention in elderly men[J]. Am J Med,2009,122(9):815-819. [5] OELKE M, SPEAKMAN MJ, DESGRANDCHAMPS FA.Acute urinary retention rates in the general male population and in adult men with lower urinary tract symptoms participating in pharmacotherapy trials: a literature review[J]. Urology,2015,86(4):654-665. [6] VERHAMME KM, DIELEMAN JP, VAN WIJK MA, et al.Low incidence of acute urinary retention in the general male population: the triumph project[J]. Eur Urol,2005,47(4):494-498. [7] CHEN JS, CHANG CH, YANG WH, et al.Acute urinary retention increases the risk of complications after transurethral resection of the prostate: a population-based study[J]. BJU Int,2012,110(11 Pt C):E896-E901. [8] 王金亮,徐丁,钱苏波,等.无创检测方法预测中国良性前列腺增生患者急性尿潴留风险[J].中国男科学杂志,2018,32(6):14-18. [9] MILONAS D, SAFERIS V, JIEVALTAS M.Transition zone index and bothersomeness of voiding symptoms as predictors of early unfavorable outcomes after transurethral resection of prostate[J]. Urol Int,2008,81(4):421-426. [10] KURITA Y, MASUDA H, TERADA H, et al.Transition zone index as a risk factor for acute urinary retention in benign prostatic hyperplasia[J]. Urology,1998,51(4):595-600. [11] 朱瑞,刘航,李茂,等.HoLEP治疗良性前列腺增生合并急性尿潴留的临床疗效及安全性研究[J].重庆医科大学学报,2019 (8):1074-1080. [12] 王成明,陶俊,曹强,等.经尿道前列腺钬激光剜除术治疗良性前列腺增生伴发急性尿潴留患者的疗效和安全性分析[J].南京医科大学学报:自然科学版,2016,36(6):757-760. [13] 张海宁. 急性尿潴留患者留置尿管时间与尿路感染的关系[J].中国现代药物应用,2016,10(17):93-94. [14] MULHALL AB, CHAPMAN RG, CROW RA.Bacteriuria during indwelling urethral catheterization[J]. J Hosp Infect,1988,11(3):253-262. [15] 罗欣,杨翔,林宇峰,等.急性尿潴留增加患者经尿道前列腺电切术后早期并发症的风险[J].岭南现代临床外科,2014,14(2):186-189. [16] ROEHRBORN CG, SIAMI P, BARKIN J, et al.The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study[J]. Eur Urol,2010,57(1):123-131. [17] KABALIN JN, MACKEY MJ, CRESSWELL MD, et al.Holmium: YAG laser resection of prostate (HoLRP) for patients in urinary retention[J]. J Endourol,1997,11(4):291-293. [18] ANDERSON CB, HELFAND BT, MCVARY KT.Holmium laser prostatic resection for patients presenting with acute urinary retention[J]. BJU Int,2008,102(11):1623-1628. [19] GAUHAR V, GILLING P, PIROLA GM,et al.Does Moses technology enhance the efficiency and outcomes of standard Holmium laser enucleation of the prostate? Results of a systematic review and meta-analysis of comparative studies[Z]. Eur Urol Focus,2022, S2405-S4569. [20] CHO SY, RO YK, KIM H, et al.Preoperative urinary retention increased the risk of urinary retention after photoselective vaporization of the prostate[J]. World J Mens Health,2015,33(3):182-187.