Abstract：
Background: MRI-guided transurethral ultrasound ablation (TULSA) is under investigation for whole-gland ablation of low- and intermediate-risk prostate cancer. The ideal method for post-TULSA bladder drainage through postoperative suprapubic tube (SPT) vs indwelling urethral catheter (UC) has not been established. The objective of this study was to evaluate urinary outcomes after whole-gland TULSA, comparing postoperative SPT with UC. Materials and Methods: Two-institution retrospective analysis of whole-gland TULSA for men with grade group 1 and 2 prostate cancer. One institution placed SPT at the time of TULSA with clamp trials (day 10) and removal once voiding. The second placed UC until void trial (day 7). Outcomes included the International Prostate Symptom Score (IPSS), urinary bother score, catheter reinsertion, stricture, clean intermittent catheterization (CIC), and incontinence. Results: Forty-five patients (median age 67) were analyzed. The UC cohort (N = 26) was older (p = 0.007) than the SPT cohort (N = 19) but with similar baseline prostate volumes, IPSS, and urinary bother scores. Patients receiving UC had fewer days with catheter (p = 0.013). Although UC patients suffered more lower urinary tract symptoms at 1-month post-TULSA, there was no significant difference between IPSS scores at baseline and 6 months after surgery regardless of urinary management strategy, although the UC group noted significantly decreased urinary bother. Rates of infection were similar between groups. Six strictures were observed overall, with more in the SPT group, although the difference was not significant (4/19 [21.1%] SPT; 2/26 [7.7%] UC). At 6 months, incontinence rates were low and similar between groups (2/19 [10.5%] SPT; 4/26 [15.4%] UC) and only one patient (UC) required CIC. Conclusions: Our overall findings suggest that SPT and UC are both acceptable options for postoperative bladder drainage after whole-gland TULSA, with statistically similar rates of urinary complications but a slightly different side effect profile.
摘要：
背景：MRI引导下经尿道超声消融（TULSA）正在研究低风险和中危前列腺癌的全腺体消融。尚未建立通过术后耻骨上导管（SPT）和留置尿道导管（UC）进行TULSA膀胱引流的理想方法。这项研究的目的是评估全腺体TULSA术后的尿路结局，术后SPT与UC比较。材料和方法：两机构回顾性分析1级和2级前列腺癌男性的全腺体TULSA。一家机构在TULSA进行钳夹试验（第10天）时放置SPT，并在排尿后取出。第二次放置UC直到无效试验(第7天)。结果包括国际前列腺症状评分（IPSS），尿路烦恼评分,导管重新插入,狭窄,清洁间歇导管插入术(CIC),和尿失禁。结果：分析了45例患者（中位年龄67岁）。UC队列（N=26）比SPT队列（N=19）年龄更大（p=0.007），但基线前列腺体积相似。IPSS,和尿路得分。接受UC的患者使用导管的天数较少（p=0.013）。尽管UC患者在TULSA后1个月出现更多的下尿路症状，在基线和术后6个月IPSS评分之间没有显着差异，无论泌尿管理策略，尽管UC组注意到尿扰明显减少。两组之间的感染率相似。总共观察到六个狭窄，SPT组的人数更多，虽然差异不显著(4/19[21.1%]SPT;2/26[7.7%]UC).6个月时,两组(2/19[10.5%]SPT;4/26[15.4%]UC)和只有一名患者(UC)需要C.结论：我们的总体发现表明，SPT和UC都是全腺TULSA术后膀胱引流的可接受选择，泌尿系并发症的发生率在统计学上相似，但副作用略有不同。
