比較經尿道攝護腺切除術後尿管牽引位置及併發症之關係
蕭惟中1、陳文榮1、陳順郎1, 2、高育琳1, 2、王紹全1、謝佐宜1
1中山醫學大學附設醫院泌尿科， 2中山醫學大學
Comparison of complications between different traction sites of urethral catheter after transurethral resection of prostate
Wei-Chung Hsiao1, Wen-Jung Chen1, Sung-Lang Chen1, 2, Yu-Lin Kao1, 2, Shao-Chuan Wang1, Tzuo-Yi Hsieh1
1Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan, R.O.C.
2School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.
Objectives: Transurethral resection of prostate (TURP) is currently the mainstay for surgical treatment of benign prostatic hyperplasia (BPH). Postoperative hemorrhage is the major and significant complication of this procedure. In order to control bleeding, traction of urethral catheter was frequently used by the urologists while finishing this surgery. There were two different ways to maintain the tension of traction: fixed with adhesive bands to the thigh or the lower abdomen. This study was undertaken to evaluate and compare the outcomes of the different traction sites of postoperative urethral catheter in terms of short term and long term complications.
Materials and methods: This is a retrospective observational study based on collected data obtained from chart reviews. The single-center data set covers patients diagnosed, treated and followed on from July 1, 2012 to December 31, 2016, at a specialist center. Patients with BPH treated with TURP were included. Study end points included the major complications such as postoperative bleeding, bladder neck contracture and urethral stricture.
Results: A total of 251 patients were included. There were 136 patients set as right-thigh traction (group 1) and 115 as lower abdominal traction (group 2). The mean age, body mass index (BMI) and other preoperative characters of the patients were not statistical difference in each group. The incidence of postoperative hemorrhage, as the major short-term complication, was 2.2% and 4.3% in each group respectively (p=0.273). Otherwise, the incidents of urethral stricture, as the long-term complication, was 3.7% and 1.7% respectively (p=0.298). The operation times were 51.8±23.1 minutes in group 1 and 75.6±33.4 in group 2 (p<0.01). The volumes of the resected prostate were 17.1±9.0 grams in group 1 and 22.6±16.7 grams in group 2 (p=0.01). The operation times and the volumes of resected tissue were statistical difference in patients developed postoperative bleeding compared with patients without complication (92.6±32.6 vs. 62.4±30.7 minutes, p=0.007 and 41.0±22.4 vs. 19.7±13.8 grams, p<0.001)
Conclusions: Although there was no statistical significance of the risk of complication, there was still literally difference. Different styles of urethral traction do not have impact on the postoperative complications. Instead, the aggression of surgeons does have influence of postoperative complications. Patients experienced prolonged surgery and had large prostate also have more risk. The limitations of this study call for further randomized controlled trials with long-term follow-up results.