小さい前立腺肥大症患者に対する経尿道的前立腺剥離切除術

Abstract

前立腺肥大症180例に対して剥離TUR-P法を施行し, 切除された内腺の重量で10g未満と10g以上の2群に分け, 比較検討した。1)最大尿流率スコアの減少率で評価すると, 10g未満の症例群では平均73.5%, 10g以上の症例群では平均79.2%の改善を認めた。術前術後の最大尿流率では, 10g未満の症例群で7.03±3.79ml/secから13.9±7.32ml/secへ, 10g以上の症例群では4.96±2.88ml/secから15.2±8.30ml/secへ両群ともに有意な差をもって改善された。2)術中, 小さい前立腺肥大症に対して膀胱頸部の血行温存に留意した結果, 10g未満の症例群では2.63%, 10g以上の症例群では1.98%と術後の後部尿道狭窄症の発生頻度を低く抑えた。3)前立腺偶発癌の検出率は10g未満の症例群では15.2%, 10g以上の症例群では17.8%認められた

The conventional method of transurethral resection of the prostate (TUR-P) is often not beneficial for small benign prostatic hyperplasia (BPH) because of a high frequency of postoperative bladder neck contracture (BNC). Herein, we examined the usefulness of semi-radical transurethral resection of the prostate (semi-radical TUR-P) from the view points of improvement of peak flow rate, the frequency of postoperative BNC and incidental carcinoma of the prostate in 79 cases of small BPH (group A) and 101 cases (group B) of large BPH in which less than 10 g for more than 10 g of the internal glands was resected, respectively. The bladder neck was resected carefully to avoid over resection which may cause BNC in small BPH cases. Satisfactory results were obtained in both groups, that is, the improvement of the peak flow rate from 7.03 +/- 3.79 ml/sec to 13.9 +/- 7.32ml/sec and from 4.96 +/- 2.88 ml/sec to 15.2 +/- 8.30 ml/sec, and the frequency of BNC were 2.53% (2/79) and 1.98% (2/101) in groups A and B, respectively. The frequency of incidental carcinoma of the prostate were 15.2% (12/79) and 17.8% (18/101) in groups A and B. We conclude that semi-radical TUR-P is a favorable maneuver for small BPH because of satisfactory improvement in peak flow rate with low frequency of postoperative BNC and its superiority in screening test for incidental carcinoma of the prostate.