骶神經調控在經尿道前列腺電切術后療效欠佳的良性前列腺增生合并膀胱活動低下癥患者中的初步應用

Preliminary application of sacral neuromodulation in patients with benign prostatic hyperplasia complicated with underactive bladder after transurethral resection of the prostate

LIU Ning¹，ZHANG Yan²，LI Tao¹，HU Qiang¹，LU Kai¹，ZHANG Lei¹，WU Jianping¹，CHEN Shuqiu¹，XU Bin¹，CHEN Ming¹

（1.Department of Urology，Zhongda Hospital Southeast University，Nanjing 210009; 2.Out-patient Department，The Second Affiliated Hospital of Nanjing Medical University，Nanjing 210000，China）

ABSTRACT：Objective To evaluate the efficacy and safety of sacral neuromodulation （SNM） in the treatment of patients with benign prostatic hyperplasia （BPH） complicated with underactive bladder （UAB） who

respond poorly to transurethral resection of the prostate （TURP）.Methods A retrospective analysis was performed on 10 patients with BPH and UAB treated with TURP by the same surgeon in Zhongda Hospital Southeast University during Jan.2018 and Jan.2023.The residual urine volume was not significantly relieved after operation，and the maximum urine flow rate and urine volume per discharge were not significantly improved.All patients underwent phase I SNM，and urinary diaries were recorded before and after surgery to observe the average daily frequency of urination，volume per urination，maximum urine flow rate，and residual urine volume.Results The operation time was （97.6±11.2） min.During the postoperative test of

2-4 weeks，if the residual urine volume reduction by more than 50% was deemed as effective，SNM was effective in 6 patients （60.0%）.Compared with preoperative results，the daily frequency of urination [（20.2±3.8） times vs. （13.2±3.2） times]，volume per urination [（119.2±56.7） mL vs. （246.5±59.2） mL]，maximum urine flow rate [（8.7±1.5） mL/s vs. （16.5±2.6） mL/s]，and residual urine volume [（222.5±55.0） mL vs. （80.8±16.0） mL] were significantly improved，with statistical significance （Plt;0.05）.There were no complications such as bleeding，infection，fever or pain.The 6 patients who had effective outcomes successfully completed phase II surgery，and the fistula was removed.During the follow-up of 1 year，the curative effect was stable，and there were no complications such as electrode displacement，incision infection，or pain in the irritation sites.The residual urine volume of the other 4 unsuccessful patients did not improve significantly，and the electrodes were removed and the vesicostomy tube was retained.Conclusion SNM is safe and effective in the treatment of BPH with UAB patients with poor curative effects after TURP.

KEY WORDS：sacral neuromodulation; transurethral resection of the prostate; benign prostatic hyperplasia; underactive bladder; bladder outlet obstruction

摘要：目的 評估骶神經調控（SNM）治療經尿道前列腺電切術（TURP）術后療效欠佳的良性前列腺增生癥（BPH）合并膀胱活動低下癥（UAB）患者的有效性及安全性。方法 回顧性分析東南大學附屬中大醫院泌尿外科2018年1月—2023年1月收治的10例BPH合并UAB患者的臨床資料，所有患者均由同一醫師行TURP，術后療效欠佳，具體表現為患者術后殘余尿量無明顯緩解，最大尿流率及每次排尿量無明顯改善，術后均留置膀胱造瘺管。所有患者均接受Ⅰ期SNM手術，記錄患者術前及術后的排尿日記，觀察患者的每日排尿次數、每次排尿量、最大尿流率及殘余尿量。結果 患者Ⅰ期手術時間（97.6±11.2）min，術后測試2～4周，以殘余尿量減少≥50%為有效，其中6例患者有效（60.0%）。與術前比較，6例有效患者術后每日排尿次數[（20.2±3.8）次 vs.（13.2±3.2）次]、每次排尿量[（119.2±56.7）mL vs.（246.5±59.2）mL]、最大尿流率[（8.7±1.5）mL/s vs.（16.5±2.6）mL/s]、殘余尿量[（222.5±55.0）mL vs.（80.8±16.0）mL]均有明顯改善，差異有統計學意義（Plt;0.05）。所有患者術后均無出血、感染、發熱、疼痛等并發癥發生。6例Ⅰ期手術治療有效患者均順利完成Ⅱ期手術，并拔除造瘺管，隨訪1年，期間療效穩定，無電極移位、切口感染、刺激部位疼痛等并發癥發生。另4例無效患者殘余尿量未明顯改善，均予以拔除電極并繼續留置膀胱造瘺管。結論 SNM治療TURP術后療效欠佳的BPH合并UAB患者安全、有效。

關鍵詞：骶神經調控；經尿道前列腺電切術；良性前列腺增生癥；膀胱活動低下癥；膀胱出口梗阻

中圖分類號：R699.6"" 文獻標志碼：A

DOI：10.3969/j.issn.1009-8291.2025.01.008

膀胱活動低下癥（underactive bladder，UAB）是一種常見的疾病，臨床表現為排尿費力、尿流緩慢，常伴尿頻、尿急、夜尿增多等癥狀。……