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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 237 -242. doi: 10.3877/cma.j.issn.1674-3253.2024.03.007

临床研究

超选择性前列腺动脉栓塞治疗伴急性尿潴留的高危高龄前列腺增生
潘兴赫1, 董翔2, 杨海洋3, 张雪斌2, 甘卫东4,†()   
  1. 1. 210000　江苏，南京中医药大学鼓楼临床医学院
    2. 南京大学医学院附属鼓楼医院泌尿外科
    3. 212000　南京，江苏大学鼓楼临床医学院
    4. 210000　江苏，南京中医药大学鼓楼临床医学院；南京大学医学院附属鼓楼医院泌尿外科；212000　南京，江苏大学鼓楼临床医学院
  • 收稿日期:2023-10-26 出版日期:2024-06-01
  • 通信作者: 甘卫东
  • 基金资助:
    2022江苏省卫生健康委员会医学科研重点项目(ZD2022013)

Super-selective prostatic artery emboliation for high-risk elderly patients with hyperplasia of prostate associated with acute urinary retention

Xinghe Pan1, Xiang Dong2, Haiyang Yang3, Xuebin Zhang2, Weidong Gan4,†()   

  1. 1. Drum Tower Clinical Medical College of Nanjing University of Chinese Medicine, Jiangsu 210000, China
    2. Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu 210000, China
    3. Drum Tower Clinical Medical College of Jiangsu University, Nanjing 212000, China
    4. Drum Tower Clinical Medical College of Nanjing University of Chinese Medicine, Jiangsu 210000, China; Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu 210000, China; Drum Tower Clinical Medical College of Jiangsu University, Nanjing 212000, China
  • Received:2023-10-26 Published:2024-06-01
  • Corresponding author: Weidong Gan
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潘兴赫, 董翔, 杨海洋, 张雪斌, 甘卫东. 超选择性前列腺动脉栓塞治疗伴急性尿潴留的高危高龄前列腺增生[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 237-242.

Xinghe Pan, Xiang Dong, Haiyang Yang, Xuebin Zhang, Weidong Gan. Super-selective prostatic artery emboliation for high-risk elderly patients with hyperplasia of prostate associated with acute urinary retention[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 237-242.

目的

探讨超选择性前列腺动脉栓塞（PAE）治疗伴急性尿潴留（AUR）的高危高龄前列腺增生（BPH）的安全性和有效性。

方法

回顾性分析2018年8月至2021年10月南京鼓楼医院收治的35例伴AUR的BPH患者，年龄70～88（78±5）岁，均伴有一种或多种心、脑、肺等重要脏器疾病。在数字减影血管造影和C臂锥形束CT双重定位下行超选择性前列腺动脉栓塞，以拔除导尿管后1年内不再发生AUR作为临床评估标准，同时比较术后1、3、6、12个月前列腺体积、最大尿流率（Qmax）、国际前列腺症状评分（IPSS）、生活质量评分（QOL）、无干扰睡眠时间（HUS）、慢性前列腺炎症状评分（NIH-CPSI）。

结果

35例手术均获得成功，术后均未发生严重不良反应。术后1周拔除导管，其中30例恢复自主排尿，5例再次尿潴留继续保留导尿，1～2周后拔除尿管均恢复自主排尿，所有患者术后1个月～1年内未再次发生AUR。与术前相比，患者术后列腺体积显著缩小，夜尿次数减少，IPSS、QOL、HUS和NIH-CPSI等症状及QOL显著改善（P<0.001），与术后一月相比，Qmax随时间推移逐步增加（P<0.001）。

结论

PAE治疗伴AUR的BPH安全有效，可以作为高危高龄BPH可选择的治疗手段。

关键词: 前列腺增生, 慢性前列腺炎症状评分, 急性尿潴留, 前列腺动脉栓塞术, 介入放射学
Objective

To evaluate the safety and effectiveness of superselective prostatic artery embolization (PAE) for treating benign prostatic hyperplasia (BPH) with acute urinary retention (AUR) in high-risk elderly patients.

Methods

A retrospective analysis was conducted on 35 cases of BPH patients with AUR treated at Nanjing Drum Tower Hospital from August 2018 to October 2021. The patients' age ranged from 70 to 88 years (mean age 78±5 years), and all patients had one or more significant comorbidities involving vital organs such as the heart, brain, and lungs. Using digital subtraction angiography and C-arm cone-beam CT dual localization, super-selective prostate artery embolization was performed. The clinical evaluation criterion was the absence of AUR within 1 year after the removal of the urinary catheter. Additionally, comparisons were made for prostate volume, maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life score (QOL), undisturbed sleep time (HUS), and national institutes of health chronic prostatitis symptom index (NIH-CPSI) at 1, 3, 6, and 12 months postoperatively.

Results

The surgeries were successful for all 35 patients, and there were no serious adverse reactions postoperatively. Urinary catheters were removed one week after surgery, with 30 cases recovering spontaneous urination, while 5 cases experienced recurrent urinary retention and continued catheterization. In these 5 cases, self-urination was reestablished after catheter removal within 1 to 2 weeks. None of the patients experienced AUR again within one month to the first year postoperatively. Compared to the preoperative status, there was a significant reduction in prostate volume and nocturia frequency after surgery, symptoms such as IPSS, QOL, HUS, and NIH-CPSI showed significant enhancement (P<0.001). Compared to one month after surgery, Qmax gradually increased over time (P<0.001).

Conclusion

The utilization of PAE in the management of BPH accompanied by AUR is both safe and efficacious. Therefore, PAE can be considered as a viable therapeutic option for elderly or high-risk BPH patients.

Key words: Benign prostatic hyperplasia, NIH-CPSI, Acute urinary retention, Prostatic artery embolism, Interventional radiology
图1 高危BPH患者超选择性前列腺动脉栓塞前后影像学资料注：图a为左侧超选择前列腺动脉DSA，显示导管球囊左下方前列腺动脉丰富染色区，图中箭头1所示为球囊位置，箭头2所示为导管位置，箭头3所示为左侧前列腺动脉染色区；图b为左侧超选择前列腺动脉C臂锥形束增强CT扫描，确认DSA显影区域即为前列腺的解剖位置；图c为左侧前列腺动脉超选择栓塞后DSA，显示前列腺染色区域完全消失
表1 35例急性尿潴留的前列腺增生患者超选择性前列腺动脉栓塞（PAE）术后1、3、6、12个月各项数据分别与术前比较（±s）
评估指标 IPSS（分） QOL（分） HUS（h） NIH-CPSI（分） 夜尿（次） 前列腺体积（ml） Qmax（ml/s）*
PAE术前 27.50±4.35 5.38±0.58 2.02±0.76 33.46±2.59 4.50±1.41 118.25±38.39 -
术后1个月 13.75±5.88 2.92±1.14 2.73±1.38 16.42±4.84 3.13±1.31 099.29±29.57 5.34±2.89
t值 16.35 10.55 -2.76 18.65 8.88 5.03 -
P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 -
术后3个月 10.42±4.76 2.33±1.05 2.88±1.45 12.21±3.81 2.50±1.26 085.95±28.09 7.63±1.25
t值 19.36 14.31 -3.25 33.78 8.28 4.75 -6.65
P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
术后6个月 07.38±4.25 1.48±1.10 3.02±1.54 07.75±4.43 2.19±1.33 077.25±28.60 9.09±2.39
t值 21.26 17.95 -3.58 33.00 8.58 4.35 -6.93
P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
术后12个月 06.35±4.07 1.03±0.95 3.52±1.25 06.33±4.15 2.12±1.52 71.27±18.4 10.69±3.580
t值 22.86 21.49 -3.73 38.97 8.38 4.04 -4.41
P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
[1]
Madersbacher S, Sampson N, Culig Z. Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: a mini-review[J]. Gerontology, 2019, 65(5): 458-464.
[2]
Bhatia A, Maini A, Bhatia S. Prostatic artery embolization: technical pearls[J]. Semin Intervent Radiol, 2022, 39(6): 555-561.
[3]
Lloyd GL, Marks JM, Ricke WA. Benign prostatic hyperplasia and lower urinary tract symptoms: what is the role and significance of inflammation?[J]. Curr Urol Rep, 2019, 20(9): 54.
[4]
Bengtsen MB, Heide-Jørgensen U, Blichert-Refsgaard LS, et al. Positive predictive value of benign prostatic hyperplasia and acute urinary retention in the Danish national patient registry: a validation study[J]. Clin Epidemiol, 2020, 12: 1281-1285.
[5]
Langan RC. Benign prostatic hyperplasia[J]. Prim Care Clin Off Pract, 2019, 46(2): 223-232.
[6]
Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary retention in adults: evaluation and initial management[J]. Am Fam Physician, 2018, 98(8): 496-503.
[7]
Bengtsen MB, Heide-Jørgensen U, Borre M, et al. Acute urinary retention in men: 21-year trends in incidence, subsequent benign prostatic hyperplasia-related treatment and mortality: a Danish population-based cohort study[J]. Prostate, 2023, 83(1): 87-96.
[8]
Marchi A, Pellerin O, Querub C, et al. Long-term outcomes of prostate artery embolization for acute urinary retention: an analysis of 88 patients[J]. Diagn Interv Imaging, 2023, 104(6): 292-296.
[9]
Lepor H. Managing and preventing acute urinary retention[J]. Rev Urol, 2005, 7(Suppl 8): S26-S33.
[10]
Nguyen DD, Trinh QD, Bhojani N. Combination of tadalafil and finasteride for the treatment of urinary tract symptoms related to benign prostatic hyperplasia: commercialization of the prescribing cascade[J]. Eur Urol, 2022, 81(4): 323-324.
[11]
Bengtsen MB, Heide-Jørgensen U, Borre M, et al. Long-term risk of benign prostatic hyperplasia-related surgery and acute urinary retention in men treated with 5-alpha reductase inhibitor versus alpha-blocker monotherapy in routine clinical care[J]. Prostate, 2023, 83(10): 980-989.
[12]
Teichgräber U, Aschenbach R, Diamantis I, et al. Prostate artery embolization: indication, technique and clinical results[J]. Rofo, 2018, 190(9): 847-855.
[13]
白宇, 赵卫, 罗罡, 等. 前列腺动脉栓塞术治疗良性前列腺增生[J]. 中国介入影像与治疗学, 2016, 13(4): 204-207.
[14]
陈毅, 李雷, 王嵘, 等. 超选择前列腺动脉栓塞术治疗TURP术后复发的前列腺增生的临床疗效[J/OL]. 中华介入放射学电子杂志, 2022, 10(2): 185-189.
[15]
Veyg D, Mohanka R, Rumball I P, et al. Comparison of 24 month clinical outcomes after prostatic artery embolization in prostate glands larger versus smaller than 80 ml: a systematic review[J]. J Vasc Interv Radiol, 2023, 34(4): 578-584.e1.
[16]
Richardson AJ, Acharya V, Kably I, et al. Prostatic artery embolization: variant origins and collaterals[J]. Tech Vasc Interv Radiol, 2020, 23(3): 100690.
[17]
Bilhim T, Pisco J, Rio Tinto H, et al. Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement[J]. Cardiovasc Intervent Radiol, 2013, 36(2): 403-411.
[18]
Magistro G, Westhofen T, Stief CG, et al. A matched-pair analysis of patients with medium-sized prostates (50 cc) treated for male LUTS with HoLEP or TURP[J]. Low Urin Tract Symptoms, 2020, 12(2): 117-122.
[19]
欧阳群忠, 王芳军, 杨水贤, 等. 不同粒径PVA颗粒在介入栓塞治疗高龄高危良性前列腺增生中的应用[J]. 中外医疗, 2019, 38(21): 89-91.
[20]
Lord J, Britton H, Spain S G, et al. Advancements in the development on new liquid embolic agents for use in therapeutic embolisation[J]. J Mater Chem B, 2020, 8(36): 8207-8218.
[21]
楚世魁, 孙政育, 吕文竹. 前列腺动脉栓塞术治疗良性前列腺增生的分析[J]. 中外医疗, 2021, 40(5): 45-47, 54.
[22]
曾繁汉. 前列腺动脉栓塞术在良性前列腺增生症患者中的短期治疗效果观察[J]. 现代医用影像学, 2023, 32(4): 684-687.
[23]
Abt D, Müllhaupt G, Hechelhammer L, et al. Prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: two-year outcomes of a randomised, open-label, single-centre trial[J]. Eur Urol, 2021, 79: S83.
[24]
李军, 汪静, 韩涛, 等. 前列腺动脉栓塞术与经尿道前列腺电切术治疗良性前列腺增生的疗效比较[J]. 宁夏医学杂志, 2022, 44(3): 258-260.
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