Transurethral Lithotripsy Combined with Transurethral Resection of the Prostate in Treating Benign Prostatic Hyperplasia and Bladder Calculi_West China Medical Journal

Authors：

WANG Anguo , ZHANG Zongping , LI Yunxiang

Department of Urology, the Sceond Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

Keywords：

良性前列腺增生; 膀胱结石; 碎石术; 经尿道前列腺电切术

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【摘要】　目的　探讨良性前列腺增生（benign prostatic hyperplasia，BPH）伴膀胱结石的有效腔内治疗方法。〖HTH〗方法　2003年6月-2009年12月，使用F26号电切镜外鞘作为撑开器，气压弹道和（或）钬激光粉碎膀胱结石，经尿道前列腺电切术（transurethral resection of the prostate，TURP）治疗BPH伴膀胱结石86例。患者年龄58～83岁，平均68.6岁；病程2～8年，平均5.2年。术前患者国际前列腺症状评分（international prostate symptom score，IPSS）为（24.6±3.9）分，生活质量（5.7±0.6）分；前列腺重量（46.5±6.8） g，剩余尿量（185±58） mL，最大尿流率（5.7±2.3） mL/s。　结果　 86例均一次手术成功。碎石时间为16~58 min，平均38 min；前列腺电切时间40~100 min，平均65 min。术中无并发症发生。术后 5~8 d拔除尿管，平均6.5 d。术后4 例出现前尿道狭窄，经治疗后痊愈。54例获随访，随访时间2~6个月，平均3个月。术后2个月，54例最大尿流率升至（18.5±4.1） mL/s，剩余尿量下降至（16±22） mL，IPSS评分下降至（7.8±1.6）分，生活质量（2.5±0.3）分，与术前比较差异均有统计学意义（P lt;0.01）。　结论　经尿道碎石术和TURP一次性治疗BPH伴膀胱结石安全、有效、经济。
【Abstract】　Objective　 To explore an effective endourologic treatment method for benign prostatic hyperplasia (BPH) with bladder calculi. 　Methods　 From June 2003 to December 2009, ballistic or holmium laser lithotripsy by outer sheath resectoscope and transurethral resection of the prostate (TURP) were performed on 86 patients with BPH and bladder calculi. The patients aged 58 to 83 years old, averaging at 68.6 years. Duration of their disease course ranged from 2 to 8 years, averaging 5.2 years. Before surgery, the international prostate symptom score (IPSS) was 24.6±3.9; the score of quality of life (QOL) was 5.7±0.6; prostatic weight was (46.5±6.8) g; residual urine (RU) volume was (185±58) mL; and the peak urine flow rate (Qmax) was (5.7±2.3) mL/s.　Results　 The operations were completed successfully in all cases with a mean lithotripsy time of 38 min (16-58 minutes) and a mean TURP time of 65 min (40-100 minutes). No complications occurred during the operation. Urethral catheter was withdrawn 5-8 days after operation, with a mean period of 6.5 days. Four patients had anterior urethral stricture after operation, but recovered through treatment. Fifty-four patients were followed up for 2 to 6 months with an average follow-up time of 3 months. Two months after the operations, IPSS decreased to 7.8±1.6; Qmax increased to (18.5±4.1) mL/s; RU decreased to (16±22) mL and QOL was 2.5±0.3. Compared with preoperative conditions, the differences were all statistically significant (P＜0. 01).　Conclusion　 Transurethral lithotripsy combined with TURP is an effective, safe and economical treatment for benign prostatic hyperplasia with bladder calculi.

Citation： WANG Anguo,ZHANG Zongping,LI Yunxiang. Transurethral Lithotripsy Combined with Transurethral Resection of the Prostate in Treating Benign Prostatic Hyperplasia and Bladder Calculi. West China Medical Journal, 2011, 26(9): 1345-1347. doi: Copy

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3.	桂泽红, 张策, 王树声, 等. 两种方法治疗前列腺增生症合并膀胱结石的比较[J]. 实用医学杂志, 2005, 21(4): 389-390.
4.	李颂, 郅焱, 施国强, 等. 前列腺增生症伴膀胱结石腔内治疗体会(附16例报告)[J]. 国际医药卫生导报, 2007, 13(8): 27-29.
5.	张军晖, 邢念增, 李建兴, 等. TURP 联合肾镜下弹道超声波碎石清石术治疗前列腺增生并发膀胱结石(附43例报告)[J]. 临床泌尿外科杂志, 2008, 23(2): 109-110.
6.	Shah HN, Hegde SS, Shah JN, et al. Simultaneous transurethral cystolithotripsy with holmiumlaser enucleation of the prostate: a prospective feasibility study and review of literature[J]. BJU Int, 2007, 99(3): 595-600.
7.	Tugcu V, Polat H, Ozbay B, et al. Percutaneous versus transurethral cystolithotripsy[J]. J Endourol, 2009, 23(2): 237-241.
8.	卢剑, 肖春雷, 马潞林, 等. 经电切镜外鞘气压弹道治疗膀胱结石20 例报道[J].中国微创外科杂志, 2006, 5(3): 221-222.
9.	Chtourou M, Ben Younes A, Binous MY, et al. Combination of ballistic lithotripsy andtransurethral prostatectomy bladder stones with benign prostatic hyperplasia: report of 120 cases[J]. J Endourol, 2001, 15(8): 851-853.
10.	龚隽, 葛京平, 周水根, 等. 三种膀胱结石治疗方法的临床比较[J]. 临床泌尿外科杂志, 2010, 25(1): 8-10.

1. 　Papatsoris AG, Varkarakis I, Dellis A, et al. Bladder lithiasis: from open surgery to lithotripsy[J]. Urol Res, 2006, 34(3): 163-167.
2. 　候岩松, 蒋振华, 俞增福, 等. 前列腺增生症合并膀胱结石的微创手术治疗[J]. 中国内镜杂志, 2009, 15(2): 188-189.
3. 　桂泽红, 张策, 王树声, 等. 两种方法治疗前列腺增生症合并膀胱结石的比较[J]. 实用医学杂志, 2005, 21(4): 389-390.
4. 　李颂, 郅焱, 施国强, 等. 前列腺增生症伴膀胱结石腔内治疗体会(附16例报告)[J]. 国际医药卫生导报, 2007, 13(8): 27-29.
5. 　张军晖, 邢念增, 李建兴, 等. TURP 联合肾镜下弹道超声波碎石清石术治疗前列腺增生并发膀胱结石(附43例报告)[J]. 临床泌尿外科杂志, 2008, 23(2): 109-110.
6. 　Shah HN, Hegde SS, Shah JN, et al. Simultaneous transurethral cystolithotripsy with holmiumlaser enucleation of the prostate: a prospective feasibility study and review of literature[J]. BJU Int, 2007, 99(3): 595-600.
7. 　Tugcu V, Polat H, Ozbay B, et al. Percutaneous versus transurethral cystolithotripsy[J]. J Endourol, 2009, 23(2): 237-241.
8. 　卢剑, 肖春雷, 马潞林, 等. 经电切镜外鞘气压弹道治疗膀胱结石20 例报道[J].中国微创外科杂志, 2006, 5(3): 221-222.
9. 　Chtourou M, Ben Younes A, Binous MY, et al. Combination of ballistic lithotripsy andtransurethral prostatectomy bladder stones with benign prostatic hyperplasia: report of 120 cases[J]. J Endourol, 2001, 15(8): 851-853.
10. 　龚隽, 葛京平, 周水根, 等. 三种膀胱结石治疗方法的临床比较[J]. 临床泌尿外科杂志, 2010, 25(1): 8-10.

West China Medical Journal

Transurethral Lithotripsy Combined with Transurethral Resection of the Prostate in Treating Benign Prostatic Hyperplasia and Bladder Calculi

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