比較傳統與雷射經尿道前列腺切除之術後膀胱頸攣縮
梁心柔1、張玉君3、黃勝賢2、張進寶2、嚴孟意2、江恒杰2
陳俊吉2、林介山2、張建祥2、黃國軒2、陳柏華2、王百孚2
1彰化基督教醫院外科部 2彰化基督教醫院外科部泌尿外科 3彰化基督教醫院流行病學暨生物統計研究室
Comparison between traditional and laser surgery of transurethral resection of prostate in post-operative bladder neck contracture
Hsin-Rou Liang1, Yu-Jun Chang3, Sheng-Hsien Huang2, Chin-Pao Chang2, Mon-I Yen2, Herng-Jye Jiang2, Chun-Chi Chen2, Je-sun Lin2, Jian-Xiang Chang2, Kuo-Hsuan Huang2, Pao-Hwa Chen2 and Pai-Fu Wang2
1 Department of Surgery；2 Division of Urology, Department of Surgery；3 Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
Purpose:
To determine incidence, onset time and risk factors of postoperative bladder neck contracture (BNC) after transurethral resection of prostate (TURP).
Materials and Methods:
The data of the 1851 patients who underwent TURP for benign prostatic hyperplasia (BPH) and 526 patients who underwent transurethral incision of the bladder neck (TUIBN) for BNC from January 2011 to September 2018 were evaluated retrospectively. We reviewed patients received TUIBN for BNC after TURP, and recorded age, operation method of TURP, pre-operative prostate volume on ultrasound, pre-operative PSA level, resected prostate volume, time interval between TURP and TUIBN, and recurrence of BNC.
Results:
1851 patients who received TURP were included. 965 of them (52.1%) received non-laser TURP (included monopolar and bipolar), the other 886 patients (47.9%) received laser TURP. During 3 years follow up, 199 patients of who received TURP (10.8%) developed BNC and needed TUIBN following TURP. The incidence of BNC after TURP was significantly higher in laser group than non-laser group (15.2% versus 6.6%, p<0.001). The median time intervals between TURP and TUIBN were similar, though it was significantly shorter in laser group than non-laser group (6.33 months versus 7.25 months, p=0.021). However, there was no significant difference in recurrence rate of BNC. In non-laser group, patients whose pre-operative prostate volume less than 45.3 cm3 had significant higher incidence of BNC (p=0.014). In laser group, patients who developed BNC were somehow younger (72 versus 73, p=0.019). They also had larger resected volume (32 gm versus 25 gm, p=0.001) and higher resected / pre-operative volume ratio (0.59 versus 0.44, p<0.001). In ROC curve analysis, resected volume more than 28.5 gm in laser group may lead higher incidence of BNC (p<0.001). Older age (HR: 0.980), laser surgery (HR: 2.303) and higher resected / pre-operative volume ratio (HR: 1.532) were found to be independent risk factors of post-operative BNC.
Conclusion:
The independent risk factors of BNC following TURP include age, method of TURP, pre-operative prostate volume and resected prostate volume. Prostate volume seems has different effects on post-operative BNC in different operation methods.