Analysis of surgical efficacy in patients with benign prostate hyperplasia and detrusor underactivity
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摘要: 目的 研究经尿动力学检查(UDS)评估的良性前列腺增生(BPH)合并逼尿肌活动低下(DU)患者的手术疗效。方法 纳入2016年2月—2022年2月诊断为BPH伴或不伴DU，并接受经尿道铥激光前列腺切除术或药物治疗的114例患者，分为DU(+)手术组、DU(+)药物组、DU(-)手术组、DU(-)药物组。术前均进行UDS，膀胱收缩指数(BCI) < 100诊断为DU。比较治疗前后国际前列腺症状评分(IPSS)，相较基线减少≥50%为症状改善。结果 患者随访时长中位数为50(22)个月。所有术后患者症状改善较药物治疗组更显著，且长期维持。DU患者手术治疗的OR值为3.297(P=0.029)，非DU患者OR则为9.641(P=0.036)。结论 经UDS证实为DU且合并BPH的患者可从手术中获益。
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关键词:
- 逼尿肌活动低下 /
- 良性前列腺增生 /
- 尿动力学检查 /
- 经尿道铥激光前列腺切除术
Abstract: Objective To analyze the surgical outcomes and efficacy in patients with benign prostate hyperplasia (BPH) and detrusor underactivity (DU) assessed by urodynamic studies (UDS).Methods From February 2016 to February 2022, 114 male patients diagnosed as BPH with or without DU and treated with transurethral thulium laser prostatectomy (ThuLEP) or medication were identified and categorized into DU (+) surgery group, DU (+) medication group, DU (-) surgery group and DU (-) medication group. All patients underwent UDS. A bladder contractility index < 100 was diagnosed as DU. The improvement of symptoms was defined as a ≥ 50 % reduction in total international prostate symptom score (IPSS) at the follow-up visit compared with baseline.Results The median length of follow-up was 50 months, with an interquartile spacing of 22 months. The improvement was significantly better in all postoperative patients than those with medical treatment and could be maintained over time. The value of OR for surgical treatment in DU and non-DU patients was 3.297 (P=0.029) and 9.641 (P=0.036) respectively.Conclusion Patients with BPH and DU can be benefit from surgery. -
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表 1 患者基线资料
M(IQR) 项目 DU(+) DU(-) 手术组(25例) 药物组(48例) 手术组(33例) 药物组(8例) 年龄/岁 71(9) 70(14.25) 65(12) 63.5(10) 膀胱充盈初感觉/mL 103.4(97.4) 137.65(127.25) 131.1(115.45) 145.2(167.6) 最大膀胱容量/mL 229.2(215.2) 238.3(200.8) 264.9(223.85) 256.25(342.2) Qmax/(mL/s) 4.4(4.2) 3.65(3) 5.8(4.9) 5.95(70.2) PdetQmax/cmH2O 46.1(27.65) 42.25(24.83) 128.3(61.7) 115.05(70.2) BOOI 37.1(24.1) 30.7(22.98) 109.7(65.35) 103.65(68.05) BCI 70.8(40.5) 65.95(32.38) 149.6(57.35) 138.55(77.33) PV/mL 33.89(25.72) 26.10(8.10) 43.49(23.08) 67.50(51.14) PVR/mL 44.09(195.81) 16.57(83.41) 69.87(134.06) 33.13(224.52) 治疗前IPSS评分 18(7) 9(4) 20(9) 9.5(1.75) 治疗前QoL评分 6(1) 6(3) 4(3.5) 5.5(4.25) 
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表 2 IPW调整前后DU(+)组患者基线情况
M(IQR) 项目 未调整 IPW调整后 药物组 手术组 P SMD 药物组 手术组 P SMD 样本量/例 48 25 74.79 65.51 年龄/岁 67.96(9.50) 71.56(6.59) 0.095 0.441 70.06(9.75) 70.85(7.05) 0.746 0.093 膀胱初感觉/mL 151.75(83.18) 109.56(75.53) 0.037 0.531 138.75(74.56) 121.23(72.74) 0.341 0.238 最大膀胱容量/mL 284.70(160.87) 232.19(123.42) 0.158 0.366 261.02(145.96) 241.80(121.89) 0.556 0.143 Qmax/(mL/s) 4.26(2.12) 4.57(2.71) 0.593 0.127 4.29(2.00) 3.95(2.61) 0.594 0.143 PdetQmax/cmH2O 40.93(16.82) 45.60(20.64) 0.301 0.248 41.82(16.66) 43.36(20.66) 0.771 0.082 BOOI 32.41(17.27) 36.47(21.27) 0.382 0.209 33.25(16.88) 35.45(21.20) 0.680 0.115 BCI 62.22(20.05) 68.44(24.84) 0.251 0.276 63.26(19.96) 63.13(24.66) 0.983 0.006 PV/mL 28.17(10.20) 42.09(18.91) < 0.001 0.916 33.37(14.51) 35.21(15.07) 0.675 0.124 PVR/mL 73.19(152.76) 123.30(185.59) 0.221 0.295 88.12(158.89) 102.03(141.95) 0.715 0.092
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表 3 IPW调整前后DU(-)组患者基线情况
M(IQR) 项目 未调整 IPW调整后 药物组 手术组 P SMD 药物组 手术组 P SMD 样本量/例 8 33 45.17 40.73 年龄/岁 65.25(7.89) 65.36(8.86) 0.974 0.014 64.86(5.62) 65.25(8.87) 0.856 0.053 膀胱初感觉/mL 193.18(142.87) 149.15(98.05) 0.305 0.359 168.11(105.21) 156.54(101.56) 0.741 0.112 最大膀胱容量/mL 322.31(200.71) 281.88(142.13) 0.510 0.232 313.75(169.89) 285.47(142.18) 0.694 0.181 Qmax/(mL/s) 5.58(3.48) 7.38(6.65) 0.464 0.341 6.67(3.39) 7.05(6.20) 0.830 0.075 PdetQmax/cmH2O 117.19(44.98) 118.44(48.95) 0.948 0.027 129.82(37.16) 119.11(48.76) 0.519 0.247 BOOI 106.04(48.93) 103.67(56.72) 0.914 0.045 116.48(37.60) 105.02(55.78) 0.478 0.241 BCI 145.06(39.02) 155.36(43.50) 0.544 0.249 163.17(41.25) 154.33(43.51) 0.666 0.209 PV/mL 67.46(36.71) 47.91(26.87) 0.094 0.608 46.65(31.66) 51.65(31.25) 0.700 0.159 PVR/mL 119.61(182.74) 113.00(136.95) 0.909 0.041 66.24(128.88) 110.88(133.49) 0.289 0.34
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表 4 治疗前IPSS及手术治疗对结果的影响
项目 DU(+) DU(-) OR(95%CI) P OR(95%CI) P 原始数据 治疗前IPSS 0.977(0.859~1.111) 0.719 0.889(0.748~1.058) 0.185 手术治疗 7.145(1.412~36.143) 0.017 29.719(2.156~409.633) 0.011 IPW调整后 治疗前IPSS 1.02(0.937~1.111) 0.641 0.881(0.753~1.032) 0.118 手术治疗 3.297(1.128~9.642) 0.029 9.642(1.165~79.804) 0.036
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