攝護腺肥大患者接受極光雷射捥除手術後之膿尿及泌尿道感染
楊旻鑫1、高育琳1,2、王紹全1、陳文榮1、謝佐宜1、陳順郎1,2
1中山醫學大學附設醫院泌尿科; 2中山醫學大學醫學系
Pyuria and post-operation urinary tract infection following Diode laser (980 nm) enucleation of the prostate for benign prostate obstruction
Ming-Hsin Yang1、Yu-Lin Kao1,2、Shao-Chuan Wang1、Wen-Jung Chen1、Zuou-Yi Shieh1、and Sun-Lang Chen1,2
1Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan;
2Institute of Medicine, ChungShan Medical University, Taichung, Taiwan
Purpose: Transurethral resection of prostate (TURP) remains the golden standard for benign prostate obstruction (BPO). Recently evolved laser surgical technique provides less perioperative complications with equivalent outcomes. Long catheter indwelling time and highly retreated rate preclude the usefulness in clinical practice. New developed laser enucleation offers better hemostasis and shortens catheterization duration and hospital stay. However, postoperative urinary tract infection sequelae (POUTIs) seem to be increased in patients with diode laser enucleation (DiLEP). We conduct a retrospective study to compare the POUTIs between DiLEP and TURP.
Materials and Methods: From July 2011 to September 2014, we retrieved records on patients with lower urinary tract symptoms due to BPO underwent monopolar TURP and DiLEP. Demographic characteristics were recorded from a single center computerized database, including history of the underlying disease, use of anticoagulant or antibiotic before operation, the duration of indwelling catheter, PSA level, history of transrectal ultrasound (TRUS) biopsy, perioperative and postoperative details, hospitalization period. The parameters of uroflowmetry, International Prostate Symptom Score (IPSS) were assessed at baseline and after the surgery during follow-up period to predict the functional improvement of each group.
Results: One hundred and twelve patients underwent DiLEP and 81 received monopolar TURP with the same surgeon at the same period. The mean age of the patients was 72.6±7.9 years in DiLEP group and 69.9±7.6 years in TURP group (p=0.022). There was more anticoagulant used in DiLEP group than in TURP group (17.9% vs 7.4 %, p=0.038). Operation time was longer and post-operation normal saline irrigation interval was shorter in DiLEP in comparison with TURP respectively (61.8±20.7 vs 47.4±22.1 mins, p<0.001; 2.1±0.3 vs 2.5±0.9 days, p<0.001).
The difference of post operation infection between groups is statistically significant in epididymitis (9.8% vs 1.2%, p=0.015) and POUTIs related hospitalization (8% vs 1.2 %, p=0.037). The subjective and objective improvements were comparable between the DiLEP and TURP groups and were sustained during a follow-up of up to 1 year, except that DiLEP resulted in more dysuria (27.6%vs 11.2%, p<0.001) and presented with longer pyuria period (15.48±10.3 vs 10.62±7.2 weeks, p=0.005).
Conclusion: According to our study, DiLEP offers a safe and feasible procedure in the management of patients with symptomatic BPO, even in patient with anticoagulant. However, aged patients with advanced co-morbidities may suffer from more POUTIs possibly caused by longer pyuria period. Further larger prospective study is necessary for the evaluation the association between post-operative pyuria and POUTUIs.