螺旋形热膨胀前列腺支架置入术26例临床分析
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摘要
目的:探讨经尿道Memokath新型螺旋形热膨胀前列腺支架置入术的手术经验和临床效果。方法:2017年1月至2018年1月,对26例良性前列腺增生(BPH)患者采用经尿道前列腺支架置入术,其中17例采用硬性膀胱镜,9例患者采用软性膀胱镜。手术患者年龄62～91岁,残余尿(67.3±11.2) ml,最大尿流率(6.3±1.8) ml/s,IPSS评分(26.7±5.7)分,前列腺体积32～78 ml。尿潴留患者8例,6例放置导尿管,2例术前行膀胱造瘘术。结果:2例患者支架脱入膀胱,24例患者手术顺利。手术时间15～30 min,2例患者出现血块膀胱栓塞,22例患者术后立即恢复自主排尿。术后3个月复查,24例患者残余尿(21.4±7.7) ml,最大尿流率(18.3±4.7) ml/s,IPSS评分(8.3±2.1)分。13例患者术前后IIEF-5评分无显著差异[(14.1±1.1)分vs(14.3±1.0)分]。随访1年,2例患者反复出现尿路感染,其余患者无明显不良反应,所有24例患者排尿功能改善良好。结论:Memokath新型螺旋形热膨胀前列腺支架置入术手术简便、安全性高、疗效确切、不影响性功能。随访1年并发症少,是一种新型的治疗BPH的有效治疗方案。
Objective: To investigate the surgical techniques and clinical effect of Memokath transurethral spiral thermo-expandable prostatic stent(STEPS) implantation in the treatment of BPH. Methods: From January 2017 to January 2018, 26 BPH patients underwent Memokath transurethral STEPS implantation, 9 under the flexible cystoscope and the other 17 under the rigid cystoscope. The patients were aged 62-91 years old, with a prostate volume of 32-78 ml, postvoid residual urine volume(PVR) of(67.3 ± 11.2) ml, maximum urinary flow rate(Qmax) of(6.3 ± 1.8) ml/s, and IPSS score of 26.7 ± 5.7. Eight of the patients had preoperative urinary retention, of whom, 6 received catheterization and 2 had undergone cystostomy for bladder fistula before STEPS implantation. Results: The operations lasted 15-30 minutes and were successfully completed in 24 cases while stent-shedding occurred in the other 2. Twenty-two of the patients achieved spontaneous urination immediately after surgery and 2 experienced bladder clot embolism. At 3 month after surgery, 24 of the patients showed significant improvement in PVR([21.4 ± 7.7] ml), Qmax([18.3 ± 4.7] ml/s) and IPSS(8.3 ± 2.1), and 13 exhibited no statistically significant difference from the baseline in the IIEF-5 score(14.1 ± 1.1 vs 14.3 ± 1.0, P > 0.05). At 12 months, all the patients were found with markedly improved urination but no adverse events except recurrent urinary tract infection in 2 cases. Conclusion: Memokath STEPS implantation, with its advantages of simple operation, high safety, definite effectiveness, non-influence on sexual function, is a new effective surgical option for the treatment of BPH. Natl J Androl,2019,25(5):414-419
Objective: To investigate the surgical techniques and clinical effect of Memokath transurethral spiral thermo-expandable prostatic stent(STEPS) implantation in the treatment of BPH. Methods: From January 2017 to January 2018, 26 BPH patients underwent Memokath transurethral STEPS implantation, 9 under the flexible cystoscope and the other 17 under the rigid cystoscope. The patients were aged 62-91 years old, with a prostate volume of 32-78 ml, postvoid residual urine volume(PVR) of(67.3 ± 11.2) ml, maximum urinary flow rate(Qmax) of(6.3 ± 1.8) ml/s, and IPSS score of 26.7 ± 5.7. Eight of the patients had preoperative urinary retention, of whom, 6 received catheterization and 2 had undergone cystostomy for bladder fistula before STEPS implantation. Results: The operations lasted 15-30 minutes and were successfully completed in 24 cases while stent-shedding occurred in the other 2. Twenty-two of the patients achieved spontaneous urination immediately after surgery and 2 experienced bladder clot embolism. At 3 month after surgery, 24 of the patients showed significant improvement in PVR([21.4 ± 7.7] ml), Qmax([18.3 ± 4.7] ml/s) and IPSS(8.3 ± 2.1), and 13 exhibited no statistically significant difference from the baseline in the IIEF-5 score(14.1 ± 1.1 vs 14.3 ± 1.0, P > 0.05). At 12 months, all the patients were found with markedly improved urination but no adverse events except recurrent urinary tract infection in 2 cases. Conclusion: Memokath STEPS implantation, with its advantages of simple operation, high safety, definite effectiveness, non-influence on sexual function, is a new effective surgical option for the treatment of BPH. Natl J Androl,2019,25(5):414-419
引文
[1] 薛松,马宏青,葛京平,等.两种术式治疗前列腺增生症的疗效比较.医学研究生学报,2008,21(3):283-286.
[2] 张斌斌,贺晓龙,张培波,等.两种术式治疗不同体积BPH 75岁以上高龄患者的临床疗效分析.中华男科学杂志,2019,25(2):177-180.
[3] 王建文,张孟冬,平浩,等.前列腺等离子剜切术和钬激光剜除术治疗良性前列腺增生疗效分析.中华男科学杂志,2018,24(12):1084-1088.
[4] Fabian KM.The intra-prostatic "partial catheter" (urological spiral) (author's transl).Urologe A,1980,19(4):236-238.
[5] 崔军,宋永胜,郭恩忠,等.镍钛记忆合金网状支架治疗前列腺增生症远期疗效观察.临床泌尿外科杂志,2003,18(8):470-472.
[6] 钱海宁,屈平保,稽军.镍钛记忆合金网状支架治疗前列腺增生伴尿潴留175例远期疗效评估.中国男科学杂志,2010,24(3):52-54.
[7] Poulsen AL,Schou J,Ovesen H,et al.Memokath:A second generation of intraprostatic spirals.Br J Urol,1993,72(3):331-334.
[8] Agrawal S,Brown CT,Bellamy EA,et al.The thermo-expandable metallic ureteric stent:An 11-year follow-up.BJU Int,2009,103(3):372-376.
[9] Alcantara Montero A,Fernandez L.Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia:Importance of periodic updates based on available evidence.Actas Urol Esp,2018,42(4):280-281.
[10] Kimata R,Nemoto K,Tomita Y,et al.Efficacy of a thermoexpandable metallic prostate stent (Memokath) in elderly patients with urethral obstruction requiring long-term management with urethral Foley catheters.Geriatr Gerontol Int,2015,15(5):553-558.
[11] Barber Neil J,Roodhouse AJ,Rathenborg P,et al.Ease of removal of thermo-expandable prostate stents.BJU Int,2005,96(4):578-580.
[12] Barbalias G,Siablis AD,Liatsikos EN,et al.Metal stents:A new treatment of malignant ureteral obstruction.J Urol,1997,158(1):54-58.
[13] Bott SR,Kahn L,Copland RF.Metallic stents for malignant and benign ureteric obstruction.BJU Int,200,86(3):407.
[14] McCullough,Andrew R.Sexual dysfunction after radical prostatectomy.Rev in Urol,2005,(7 Suppl 2):S3-S10.
[15] Lange D,Bidnur S,Hoag N,et al.Ureteral stent-associated complications — where we are and where we are going.Nat Rev Urol,2015,12(1):17-25.
[2] 张斌斌,贺晓龙,张培波,等.两种术式治疗不同体积BPH 75岁以上高龄患者的临床疗效分析.中华男科学杂志,2019,25(2):177-180.
[3] 王建文,张孟冬,平浩,等.前列腺等离子剜切术和钬激光剜除术治疗良性前列腺增生疗效分析.中华男科学杂志,2018,24(12):1084-1088.
[4] Fabian KM.The intra-prostatic "partial catheter" (urological spiral) (author's transl).Urologe A,1980,19(4):236-238.
[5] 崔军,宋永胜,郭恩忠,等.镍钛记忆合金网状支架治疗前列腺增生症远期疗效观察.临床泌尿外科杂志,2003,18(8):470-472.
[6] 钱海宁,屈平保,稽军.镍钛记忆合金网状支架治疗前列腺增生伴尿潴留175例远期疗效评估.中国男科学杂志,2010,24(3):52-54.
[7] Poulsen AL,Schou J,Ovesen H,et al.Memokath:A second generation of intraprostatic spirals.Br J Urol,1993,72(3):331-334.
[8] Agrawal S,Brown CT,Bellamy EA,et al.The thermo-expandable metallic ureteric stent:An 11-year follow-up.BJU Int,2009,103(3):372-376.
[9] Alcantara Montero A,Fernandez L.Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia:Importance of periodic updates based on available evidence.Actas Urol Esp,2018,42(4):280-281.
[10] Kimata R,Nemoto K,Tomita Y,et al.Efficacy of a thermoexpandable metallic prostate stent (Memokath) in elderly patients with urethral obstruction requiring long-term management with urethral Foley catheters.Geriatr Gerontol Int,2015,15(5):553-558.
[11] Barber Neil J,Roodhouse AJ,Rathenborg P,et al.Ease of removal of thermo-expandable prostate stents.BJU Int,2005,96(4):578-580.
[12] Barbalias G,Siablis AD,Liatsikos EN,et al.Metal stents:A new treatment of malignant ureteral obstruction.J Urol,1997,158(1):54-58.
[13] Bott SR,Kahn L,Copland RF.Metallic stents for malignant and benign ureteric obstruction.BJU Int,200,86(3):407.
[14] McCullough,Andrew R.Sexual dysfunction after radical prostatectomy.Rev in Urol,2005,(7 Suppl 2):S3-S10.
[15] Lange D,Bidnur S,Hoag N,et al.Ureteral stent-associated complications — where we are and where we are going.Nat Rev Urol,2015,12(1):17-25.