To investigate the clinical effect of "3+1" bladder function restoration combined with holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with acontractile detrusor (ACD).
We treated 35 BPH patients with ACD by HoLEP followed by "3+1" bladder function restoration, that is, a 3-phase bladder function training plus simultaneous 1-drug medication after surgery. We recorded and analyzed the detrusor pressure, post-void residual urine volume (PVR), maximum urinary flow rate (Qmax), International Prognostic Scoring System (IPSS) scores, quality of life (QoL), voluntary micturition, satisfaction with the bladder function, hydronephrosis, ureterectasia, renal function, and urinary tract infection of the patients before and after treatment.
Compared with the base line, at 6 months treatment, the patients showed significantly increased detrusor pressure (［35.1±2.7］vs ［50.2±2.3］ cmH2O, P<0.05) and Qmax (［4.2±2.7］vs ［21.1±4.1］ ml/s, P<0.05) but decreases in PVR (［173.0±31.6］ vs ［30.5±12.9］ml, IPSS score (27.3±3.2 vs 5.1±1.4, P<0.05) and QoL (4.1±0.8 vs 0.8±0.1, P<0.05), elevated rates of voluntary urination (0% ［0/35］ vs 100% ［35/35］, P<0.05), regularurination (0% ［0/35］ vs 85.71% ［30/35］, P<0.05), grade Ⅰ satisfaction with bladder function (0% ［0/35］ vs 85.71% ［30/35］, P<0.05), reduced rate of overflowing urinary incontinence (28.57% ［10/35］ vs 5.71% ［2/35］, P<0.05), and increased percentages of normal renal function (34.29% ［12/35］ vs 85.71% ［30/35］, P<0.05) and non-infection of the urinary system (17.14% ［6/35］ vs 94.29% ［33/35］, P<0.05). After treatment, urination was markedly improved in 94.29% (33/35) of the patients.
"3+1" bladder function restoration combined with HoLEP produced a desirable effect on BPH with ACD, though its long-term effect remains to be further investigated.
目的： 探讨“3+1”膀胱功能恢复法联合剜除术治疗良性前列腺增生（BPH）伴逼尿肌无力（ACD）患者的临床疗效。方法： 对我院收治的35例BPH伴ACD的患者行前列腺钬激光剜除术，术后行“3+1”膀胱功能恢复法,即3阶段膀胱功能恢复训练，同时用1种药物辅助治疗。记录并分析患者就诊时、术后3、6个月的膀胱内压、残余尿、最大尿流率、IPSS、QoL、能否自行排尿、能否有规律的排尿、膀胱功能满意等级、肾积水、输尿管扩张、肾功能、泌尿道系感染等指标。结果： 患者术前与术后６个月膀胱内压［（35.1±2.7） cmH2O vs （50.2±2.3） cmH2O,P<0.05］、最大尿流率［（4.2±2.7） ml/s vs （21.1±4.1） ml/s, P<0.05］较术前明显增高，残余尿［（173.0±31.6） ml vs （30.5±12.9） ml, P<0.05］、IPSS［(27.3±3.2)分 vs (5.1±1.4)分, P<0.05］、QoL［(4.1±0.8)分 vs (0.8±0.1)分, P<0.05］较术前明显降低，均具有统计学意义（Ｐ<０．０５）。术前与术后6个月对比，患者均可自行排尿（0/35，0% vs 35/35，100%，P<0.05），大部分患者有了规律（排尿间隔3~4 h）的排尿（0/35，0% vs 30/35，85.71%，P<0.05），膀胱满意度为I级患者显著增加（0/35，0% vs 30/35，85.71%，P<0.05），充盈性尿失禁患者显著减少（10/35，28.57% vs 2/35，5.71%，P<0.05），肾功能正常患者增加（12/35，34.29% vs 30/35，85.71%，P<0.05），无明显泌尿系感染者显著增加（6/35，17.14% vs 33/35，94.29%，P<0.05）。患者症状得到明显改善，经过“３＋１”膀胱功能恢复法后除２例仍排尿困难，其余３３例排尿得到明显改善。 结论： 通过“3+1”膀胱功能恢复法联合剜除术，对BPH伴逼尿肌无力的患者取得了良好的治疗作用, 其长期疗效有待进一步观察。.
Zhonghua nan ke xue = National journal of andrology. 2017 Oct [Epub]
Xiang Wan, Chong Liu, Huan Xu, Meng Gu, Yan-Bo Chen, Yu-Bing Peng, Qi Chen, Zhi-Kang Cai, Zhong Wang
Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.