經尿道攝護腺手術後膀胱頸攣縮之風險因子分析

陳柏翰¹、陳一中¹、林文榮^1,2、周永強^1,2、蔡維恭^1,2、邱文祥^1,2,3、陳建志^1,2,4

¹台灣基督長老教會馬偕醫療財團法人馬偕紀念醫院 泌尿科；²馬偕學校財團法人馬偕醫學院；³國立陽明大學 醫學院；⁴馬偕學校財團法人馬偕醫護管理專科學校 化妝品應用與管理科

Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate

Bo-Han Chen¹, Yi-Zhong Chen¹, Wun-Rong Lin^1,2, Yung-Chiong Chow^1,2, Wei-Kung Tsai^1,2, Allen W. Chiu^1,2,3, Marcelo Chen^1,2,4

Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan¹; School of Medicine, MacKay Medical College, New Taipei City, Taiwan²; School of Medicine, National Yang-Ming University, Taipei, Taiwan³; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan⁴

Purpose: The aim of the present study was to investigate the preoperative parameters associated with bladder neck contracture (BNC) after transurethral resection of the prostate (TURP) or Thulium vaporesection, vapoenucleation or enucleation of the prostate (ThuP) and to compare the incidence of BNC after TURP and ThuP.

Materials and Methods: Between March 2008 and March 2020, 2,363 patients received TURP and 1,656 patients received ThuP at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC.

Results: Multivariate analysis showed that when compared with patients without BNC, those with BNC had smaller prostates (43.0±18.95 ml vs 57.2±19.84 ml, p<0.001), lower resection weight (11.64±11.75 g vs 16.67±12.84 g, p=0.001), shorter operative times (43.0±30.9 min vs 57.2±34.5, p<0.001), and slower resection speed (0.124±0.081 g/min vs 0.151±0.952 g/min, p=0.041). A greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs 7/124, p=0.009), chronic kidney disease (14/62 vs 11/124, p=0.01), and two or more comorbidities (29/62 vs 27/124, p=0.001). A ROC curve predicted that a prostate volume <42.9cm3 was associated with a notably higher rate of BNC.

Conclusions: This study demonstrated that incidence of BNC was the same in TURP and ThuP and low prostate volume, low resection speed and ≥2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.