經尿道攝護腺刮除手術對於膀胱活動低下病人之治療成果
陳昱光1、林志杰1,2、林登龍1,2
1台北榮民總醫院泌尿部 2國立陽明大學醫學院泌尿學科及書田泌尿科學研究中心
Outcome Analysis of Transurethral Resection of the Prostate in patients with Detrusor Underactivity
Yu-Kuang Chen1, Chi-Cheh Lin1,2, Alex TL Lin1,2
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.
2School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taiwan.
Purpose:
Some of patient with bladder outflow obstruction (BOO) due to benign prostate hyperplasia (BPH) present with recurrent urinary tract infection (UTI) or acute urinary retention, eventually received transurethral resection of the prostate (TURP). Among these patients, cystometrogram (CMG) may showed poor compliance of bladder, or even diagnosed with detrusor underactivity (DU). We try to analysis the outcome of these group of patients.
Materials and Methods:
From Jan 2013 to Nov 2016, there were 240 patients underwent TURP, 36 patients have complete data of CMG as well as pressure flow study (PFS). Further, 18 of them matched the criteria of Bladder Contractility Index (BCI, Pdet@Qmax + 5*Qmax) < 100. Complication such as incontinence, symptomatic hematuria, and possible sequelae of underactive bladder (UAB) such as bladder stones, renal impairment or inguinal hernia were documented. Urinary retention is defined as difficult Foley removal or need for clean intermittent catheterization (CIC), recurrent UTI refers to ≥2 infections in the past six months or ≥3 infections in one year. Medication treatment is defined as usage of alpha Blocker, 5ARI, (anti)muscarinic or anticholinergics for more than 3 months. Wilscoxon Signed Rank test and Chi-square tests were deployed for analysis.
Results:
36 patients were enrolled and mean follow up is 9.2 months, 21 men with short term follow up (less than 3 months), which may due to much improvement of lower urinary tract symptoms (LUTS). The average patient age is 70 ± 9.174 (43-85) years old, estimated prostate volume 66.82 ±41.433 (13-219) gm, and resected weight 26.222 ± 20.1935 (5.5-72) gm. Pre-operative Qmean is 3.465±2.0084 (1-8) ml/s and Qmax is 7.319±3.4687 (1-16) ml/s, with Pdet@Qmax: 63.63 ± 23.206 (27-115) cmH2O.
Urinary incontinence occurred in 3 patients, 2 with recurrent UTI. Hematuria and urinary retention occurred in one patient respectively. No patient developed bladder stones, yet 1 renal impairment and 2 inguinal hernia were after surgery. Significant improvement of Qmean (P=0.003) and Qmax (P=0.002) were noted. Reduce Foley indwelling (From 7 to 2, P=0.180) and recurrent UTI (From 6 to 2, P=0.125) were noted, though not statistically significant. Further, medication usage is reduced post-operatively (From 27 to 13 men, P=0.001).
Conclusion:
Transurethral resection of the prostate (TURP) could be considered in patient with benign prostate hyperplasia (BPH) and detrusor underactivity (DU), which may reduce the need for further medication.