Efficacy of high-energy transurethral microwave thermotherapy in alleviating medically refractory urinary retention due to benign prostatic hyperplasia
Efficacy of high-energy transurethral microwave thermotherapy in alleviating medically refractory urinary retention due to benign prostatic hyperplasia
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DOI：
10.1016/j.urology.2004.04.074
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发表时间：
2004-10-01
期刊：
影响因子：
2.1
通讯作者：
Fracchia, JA
中科院分区：
文献类型：
--
作者：
Kellner, DS;Armenakas, NA;Fracchia, JA
目标.目的探讨高能经尿道微波热疗（HE-TUMT）治疗良性前列腺增生（BPH）所致难治性完全性尿潴留的疗效。2000年4月至2003年7月，39例BPH尿潴留患者接受了HE-TUMT治疗。在HE-TUMT后重新插入Foley导管，并在3周时取出进行排尿试验。对无法排尿的患者进行再插管，每隔2周重复排尿试验。根据病史和体检、前列腺特异性抗原水平、前列腺体积、膀胱尿道镜检查、国际前列腺症状评分、生活质量评分、尿流峰值和排尿后残留量对患者进行评估。成功定义为HE-TUMT后排尿能力，无需进一步干预。平均（+/-SD）患者年龄为72 ± 9.3岁。平均随访时间为18 ± 10.2个月。20例患者（51%）的特征为美国麻醉医师协会III级或更高。平均前列腺体积为75.2 +/-57.6 CM3。患者在HE-TUMT前依赖于留置Foley导管的平均时间长度为9.6 +/-14.2周。32名患者在HE-TUMT后能够排尿，总体成功率为82%。HE-TUMT后成功排尿的患者平均进行了1.6 +/-0.8次排尿试验，HE-TUMT后平均需要留置导管4.1 +/-2周。只有6例（15%）排尿的患者能够停止BPH药物治疗。我们发现HE-TUMT在缓解BPH患者（包括前列腺体积较大的患者）尿潴留方面的成功率令人鼓舞。对于被认为是手术高风险的患者来说，这是一种可接受的选择。一些患者在自发排尿前需要多次排尿试验，这表明膀胱出口梗阻的改善可能需要HE-TUMT后较长时间。最后，许多患者在HE-TUMT后可能需要继续使用药物。泌尿学64：703 - 706，2004年。(C)2004年爱思唯尔公司
Objectives. To determine the efficacy of high-energy transurethral microwave thermotherapy (HE-TUMT) in treating patients with medically refractory complete urinary retention secondary to benign prostatic hyperplasia (BPH).Methods. Between April 2000 and July 2003, 39 patients in urinary retention due to BPH were treated with HE-TUMT. A Foley catheter was reinserted after HE-TUMT and removed at 3 weeks for a voiding trial. Patients unable to void were recatheterized, and voiding trials were repeated at 2-week intervals. Patients were evaluated according to history and physical examination, prostate-specific antigen level, prostate volume, cystourethroscopy, International Prostate Symptom Score, quality of life score, peak uroflow, and postvoid residual. Success was defined as the ability to urinate after HE-TUMT without the need for further intervention.Results. The mean (+/- SD) patient age was 72 +/- 9.3 years. Mean follow-up period was 18 +/- 10.2 months. Twenty patients (5 1 %) were characterized as American Society of Anesthesiologists class III or higher. The mean prostate volume was 75.2 +/- 57.6 CM3. The mean length of time that patients were dependent on indwelling Foley catheters before HE-TUMT was 9.6 +/- 14.2 weeks. Thirty-two patients were able to void after HE-TUMT, for an overall success rate of 82%. Patients voiding successfully after HE-TUMT had a mean of 1.6 +/- 0.8 voiding trials and required catheters after HE-TUMT for a mean period of 4.1 +/- 2 weeks. Only 6 (15%) of the patients who were voiding were able to stop their medication for BPH.Conclusions. We found an encouraging success rate with HE-TUMT in relieving urinary retention in patients with BPH, including those with large prostate volumes. It is an acceptable option for patients who are considered high risk for surgery. Several patients required multiple voiding trials before spontaneous urination, which suggests that improvements in bladder outlet obstruction might require a prolonged period after HE-TUMT. Finally, many patients might require continued use of medications after HE-TUMT. UROLOGY 64: 703-706, 2004. (C) 2004 Elsevier Inc.