| Objective To observate the efficacy of photoselective vaporization of the prostate and simultaneous suprapubic cystostomy for benign prostatic hyperplasia in patients with mild to severe detrusor underactivity, providing a theoretical basis for such patients' clinical treatment.Methods To collect 104 cases of patients suffering BPH with DU that were treated in union medicine centre from June 2012 to February 2015. These patients were divided into 3 groups according to the severity of DU: Group A( mild DU group, 30?Pdetmax <40cm H2O) 43 cases, group B(moderate DU group,, 20?Pdetmax <30cm H2O) 38 cases, group C( severe DU group, 10?Pdetmax <20cm H2O) 23 cases. PVP and simultaneous suprapubic cystostomy was performed on 3 groups. The catheter was removed 3 days after operation. Two weeks later, bladder fistula was intermittent closed and make a normal voiding habits(voiding every 3-4h once at daytime, bladder fistul remain open at night and the and of urination) to improve bladder function, then measure Qmax and RUV. After two weeks, 1,3,6,12 months regular follow-up, a patient who was detected Qmax>10ml / s and RUV<50ml for three consecutive days would do urodynamics, when Pdetmax?40cm H2 O, bladder fistula will be removed; when Qmax <10ml / s or RUV> 50 ml or Pdetmax <40cm H2 O,We will continue to retain bladder fistula. The preoperative and postoperative urodynamic parameters at 12 months, including the detrusor pressure at maximum flow(Pdetmax), maximum urinary flow rate(Qmax),bladder compliance(BC), residual urine volume(RVU), International Prostate Symptom Score(IPSS), and quality of life(QOL) were evaluated.Results The efficiency was 90.7% with 39 cases including cure and improvement in total 43 patients of Group A when removed the bladder fistula at 12 months after the operation; the total efficiency was 81.2% in group B with 31 cases cure and improvement when the fistula was removed, while 7 cases failed in urination and reserved the fistula; In total 23 patients of Group C, only 10 cases voiding good when removed the bladder fistula at 12 months after the operation, 13 cases still reserved the fistula, with a low efficiency 43.5%. The total efficiency in mild and moderate DU group was significantly higher than the severe group(P<0.05); When compared with the preoperative values, each group were significantly improved in Pdetmax, BC, Qmax, PVR, IPSS, and QOL scores at 12 months after the operation(P<0.05); Furthermore, there was a significant difference in above parameters at 12 months postoperatively in Group A and B compared to Group C(P <0.01). When compared with the average of preoperative and postoperative bladder compliance in three group, the value of mild DU and moderate DU group recovered to normal(preoperative BC> 10ml/cm H2 O and postoperative BC>20ml/cm H2O). However, the bladder compliance value have a poor recovery in severe DU group(preoperative BC<10ml/cm H2 O and postoperative BC<20ml/cm H2O). It suggested that the value of preoperative bladder compliance have an important reference value to postoperative recovery of the damaged detrusor.Conclusions To BPH patients with DU simply cased by BOO, as mild to moderate DU with normal or slightly reduced bladder compliance(BC>10ml/cm H2O), a simple surgery of PVP is suitable; The PVP and simultaneous suprapubic cystostomy seems to be an appropriate treatment for BPH patients with moderate DU and obvious reduced bladder compliance(BC<10ml / cm H2O), according postoperative bladder function recovery to decide whether removal of the bladder fistula. While BPH patients with severe DU should suffer a simple suprapubic cystostomy, the results of DU value in postoperative urodynamic review decide whether do a surge of PVP in second-stage. Preoperative bladder compliance slightly reduced(>10ml/cm H2O), the postoperative detrusor function recovered well. On the country, preoperative bladder compliance with severe reduced(<10ml / cm H2O), the postoperative detrusor function have a poor recovery. |
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