保留前部纖維肌肉間質的前列腺剜除手術可在移除尿管後達到較大的排尿量與更好的排尿控制

簡佑軒、陳建綸、侯鎮邦、曹書瀚、蔡翰宇、林友翔

林口長庚紀念醫院 外科部 泌尿外科

Anterior fibromuscular stroma preserved prostate enucleation could achieve better continent control in larger first day voiding volume after Foley removal

Yu-Hsuan Chien, Chien-Lun Chen, Chen-Pang Hou, Shu-Han Tsao, Han-Yu Tsai, Yu-Hsiang Lin

Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital

Purpose:

Endoscopic enucleation of prostate is a fascinating procedure in benign prostatic obstruction treatment. However, post operation transient stress/urge urinary incontinence always bother patients and surgeons, although the risk of persistent incontinence is low. Anterior fibromuscular stroma (AFS) would contract to open the bladder neck and initiate the voiding process. AFS injury during the prostate enucleation or transurethral resection of prostate would disturb the synchronization between external sphincter, AFS, and detrusor, which lead to incontinence or dysfunctional voiding. We investigated the continent status of AFS preserved prostate enucleation patients by voiding volume (VV) in the first day of Foley removal and 2 weeks later outpatient department (OPD) follow-up.

Materials and Methods:

We collected patients received prostate enucleation by single experience enucleation surgeon. Patients received traditional en-bloc one lobe enucleation were recruited from July 2017 to December 2017 and patients received AFS preserved prostate enucleation were recruited from July 2019 to December 2019. Patients had basic baseline demographic data、Prostate specific antigen (PSA), Trans-rectal ultrasound of prostate(TRUS), residual urine and uroflow study. We removed Foley catheter on the second post operation day morning. Patient would discharge if smooth voiding with low residual urine after Foley removal and we recorded the largest VV noted before discharge. Two weeks later, there would be a regular OPD follow up and we collected the largest VV recorded by patients at home during this period.

Results:

A total of 94 patients received AFS preserved enucleation and 83 patients received traditional enucleation were enrolled in this study. Their baseline parameter including age, Body mass index, Diabetes mellitus, hypertension, previous cerebrovascular accident, Parkinsonism, PSA level, TRUS, and T zone volume are comparable. However, we have more anti-coagulant usage in the AFS preserved enucleation group (25.5% vs 7.3%, p =0.003). The maximal VV at first day Foley removal was larger in the AFS preserved enucleation group rather than the traditional enucleation group (269cc vs 202cc, p=0.001). The maximal VV after discharge two weeks follows the same pattern as first day after Foley removal, AFS preserved group voided more (356cc vs 270cc, p=0.001). And both the AFS preserved enucleation (263cc vs 356cc, p=0.0018) and traditional enucleation group (202cc vs 271cc, p=0.0001) had a larger VV two weeks after Foley removal.

Conclusion:  

AFS preserved endoscopic enucleation of prostate could reach a better continent control with a larger VV after Foley removal. And patients would have an improving VV two weeks after discharge.