Корреляция симптомов ГАМП после ТУРП с длительностью катетеризации у пациентов с острой задержкой мочи вследствие ДГПЖ

Цель исследования. Определить корреляцию между длительностью катетеризации и частотой развития симптомов гиперактивного мочевого пузыря (ГАМП) после трансуретральной резекции предстательной железы (ТУРП) у пациентов с острой задержкой мочи, связанной с доброкачественной гиперплазией предстательной железы (ДГПЖ).
Материалы и методы. Проведено обсервационное когортное исследование, включавшее 29 пациентов с острой задержкой мочи, связанной с ДГПЖ, которым проводился ТУРП в пяти больницах Паданга с января по август 2019 г. Анализируемые показатели включали характеристики пациентов и длительность катетеризации, и их получали с помощью опросников. Симптомы ГАМП оценивали по общему показателю стандартной шкалы OABSS. Для оценки связи между длительностью катетеризации и показателем опросника OABSS после ТУРП использовали тест Пирсона и программное обеспечение IBM SPSS v23.
Результаты. Средняя длительность катетеризации составила 14,9±8,0 дня, а общий показатель шкалы OABSS составил 4,7±2,5. При двумерном анализе описана слабая положительная корреляция между длительностью катетеризации и общим показателем шкалы OABSS (корреляция Пирсона, r=0,396, p=0,033). Чем длительнее была катетеризация, тем выше общий показатель шкалы OABSS.
Вывод. Длительность катетеризации связана с частотой возникновения симптомов ГАМП после ТУРП. В этой связи необходимо уменьшить длительность катетеризации при острой задержке мочи у пациентов с ДГПЖ, чтобы снизить частоту и тяжесть симптомов ГАМП после ТУРП.

Introduction. Transurethral resection of the prostate (TURP) is the gold standard management for patients with lower urinary tract symptoms (LUTS) caused by benign prostate hyperplasia (BPH), especially BPH with complications with maximum gland size 30–80 ml [1]. Repeated urinary retention is one of the indications to do TURP due to the long-term impact and progression of the disease [2]. The initial treatment for urinary retention in patients with BPH is Foley catheter insertion, followed by TURP as the main treatment for the causative problem [3]. In some cases, storage symptoms of LUTS persist in patients after undergoing TURP. A previous study found that the most common cause of LUTS was detrusor hyperactivity (54%) [4]. Detrusor hyperactivity is often associated with the involuntary contraction of the detrusor muscle and is linked to overactive bladder symptoms (OABS) [5]. Detrusor hyperactivity can occur due to changes in the myogenic, neurogenic, and urotheliogenic factors that give rise to OABS, including symptoms such as urgency, frequency, nocturia, and urinary incontinence [6].

Detrusor hyperactivity can be caused by the physical stimulation of the catheter. Catheter use can stimulate afferent nerves in the bladder, resulting in the release of acetylcholine, which causes involuntary contractions mediated by muscarinic receptors in the detrusor muscle [7]. The use of a catheter may cause irritation of the urinary tract, especially the bladder [8]. Bladder irritation caused by the catheter may cause an uncomfortable feeling, known as catheter-related bladder discomfort (CRBD) that is characterized by an increased urinary frequency, urgency, and pain in the suprapubic region [9]. The incidence of CRBD that occurs in the postoperative period is as much as 47–90% [10]. Compared with other types of surgery, the incidence of CRBD is higher in patients who underwent urological surgery, and this incidence is much higher in post TURP patients [11]. The high incidence of CRBD in TURP patients is not caused by the surgical technique used but the history of using a catheter before the procedure. In one study, it was found that a history of catheter use before surgery was an independent predictor of the severity of CRBD [12].

Chronic irritation due to mechanical factors and increased epithelial proliferation caused by catheter use lead to histological changes observed in patients with long-term catheter use [13]. It is suspected that transmitter compounds are released in the mucosal layer of the bladder and affect the spontaneous contraction of the detrusor. Transmitter named urotheliogenic as the origin of intrinsic activity, these compounds are arranged in the mucosal layer to regulate and increase the intrinsic contraction of the detrusor [14]. Currently, however, its causes have not been identified yet because of the many factors that can affect it. There is no data on incidents in Indonesia, especially in Padang. We conducted a prospective analysis in Padang on patients with urinary retention due to BPH who used catheters before undergoing TURP to find out the correlation between the duration of catheter use and the incidence of OABS post TURP.

Methods

Study Design

This is an observational, analytical research with a cohort approach and prospective analysis. The respondents are patients with urinary retention due to BPH and were observed from the beginning of urinary retention symptoms and using a catheter until TURP. The sample size obtained was 29 samples. The minimum sample size required in this research was obtained through a-priori sample size calculation with survey design and multiple hierarchical regression analysis where one independent variable is abo...

Альфинди Пердинан, Альварино, Чими Ильмиавати, Этриэль Мюх