前列腺剜除术联合小切口膀胱切开术治疗大体积前列腺增生并膀胱结石的疗效观察

目的:探讨"半微创技术"即经尿道2μm激光前列腺剜除术联合小切口膀胱切开术,治疗大体积良性前列腺增生(BPH)合并大体积或多发膀胱结石的疗效。方法:对21例大体积BPH合并膀胱结石患者,采用经尿道2μm激光剜除前列腺,后经耻骨上正中切口显露膀胱,将所剜除腺体及结石取出。结果:21例手术均成功,手术时间明显缩短,患者均未输血。术后4~6d拔除尿管。术前与术后6个月Qmax分别为(6.1±2.6)ml/s和(20.5±4.3)ml/s;剩余尿分别为(125.7±61.5)ml与(19.0±5.8)ml;国际前列腺症状评分(IPSS)分别为(21.6±5.2)分与(5.4±3.0)分;生活质量评分(QOL)分别为(4.3±0.5)分与(1.9±0.8)分。四项指标手术前后比较差异均有统计学意义(P0.01)。术后随访3~6个月,2例出现暂时性尿失禁,全部患者无尿瘘、切口感染等手术并发症。结论:经尿道2μm激光前列腺剜除术结合小切口膀胱切开术,一次性治疗大体积BPH合并多发膀胱结石能明显减少手术时间,具有安全、高效的优点,对于大体积BPH合并膀胱多发结石或质硬、直径3cm结石的高龄患者值得推荐应用。     

经尿道等离子分割剜除联合小切口治疗中重度前列腺增生合并膀胱多发结石

目的探讨经尿道等离子前列腺分割法剜除联合耻骨上小切口治疗中重度前列腺增生合并膀胱多发结石的有效性和安全性。方法 选择18例中重度前列腺增生合并膀胱多发结石患者，应用等离子电切镜经尿道将增生前列腺从精阜水平沿外科包膜分块（两块或三块）剜除后推入膀胱，于耻骨上作小切口（3～4 cm）将剜除的前列腺组织块及膀胱结石完全取出。结果18例患者均顺利完成手术，前列腺组织65～256 g，平均87.6 g，膀胱结石3～21枚，平均6.3枚。剜除前列腺时间20～40 min；经耻骨上小切口取出腺体和膀胱结石时间15～30 min；术中出血量50～100 mL。术后生理盐水持续膀胱冲洗时间24～48 h，拔除尿管时间4～5 d。1例出现暂时性尿失禁，经提肛训练5 d症状消失。18例随访2～34个月，平均19.8个月，无再出血，排尿良好。术后1个月国际前列腺症状评分（IPSS）由术前平均25.6分降至术后7.4分；最大尿流率（Qmax）从术前平均6.3 mL/s提高至17.6 mL/s。结论 经尿道等离子前列腺分割剜除联合耻骨上小切口治疗中重度前列腺增生合并膀胱多发结石安全有效，手术操作简单，并发症少，可以临床推广。     

前列腺腔内剜除术联合小切口膀胱取石术治疗前列腺增生合并膀胱结石

目的探讨前列腺腔内剜除术联合小切口膀胱取石术治疗前列腺增生（benign prostatic hyperplasia,BPH）合并膀胱结石的疗效。方法 2007年5月～2011年1月对30例BPH合并膀胱结石先行前列腺腔内剜除术,然后在电切镜监视下,经耻骨上小切口用卵圆钳将膀胱结石及剜除腺体组织取出。结果 30例均一次手术成功,手术时间40～90 min,平均60 min：其中前列腺剜除术时间30～50 min,平均40 min;取石时间8～20 min,平均15 min。无大出血、经尿道电切综合征、尿外渗等并发症。术后住院5～9 d,平均6.5 d。30例术后随访3～24个月,平均9个月,无结石复发;术后6～24个月IPSS降至0～8分,残余尿量20 ml以下,Qmax〉15 ml/s。结论前列腺腔内剜除术联合小切口卵圆钳膀胱取石术治疗BPH合并膀胱结石,具有创伤小、手术时间短、操作简单等优点,是治疗BPH合并膀胱结石的一种安全、有效的方法。     

前列腺电切加剜除治疗膀胱突入明显的大体积前列腺增生

目的 探讨前列腺电切加剜除治疗膀胱突入明显的大体积前列腺增生的临床效果.方法 58例经尿道前列腺电切加剜除治疗的膀胱突入明显的大体积前列腺增生患者,回顾性分析其临床资料及随访情况.结果 本组前列腺体积(125.4 ±39.7) ml,向膀胱突入(3.4 ±1.6)cm,均先行电切突入膀胱部分前列腺组织,后行经尿道前列腺剜除术,手术时间(69.8±14.4) min,术中无膀胱颈部穿孔,术中出血(115.6±35.2)ml,术前、术后国际前列腺症状评分、生活质量评分、最大尿流率比较有显著统计学意义.结论 前列腺电切加剜除治疗膀胱突入明显的大体积前列腺增生的临床效果可靠,提高了手术速度,减少了出血,膀胱颈部穿孔等并发症少,值得临床推广应用.     

经尿道等离子前列腺分区剜除术治疗高危前列腺增生症的临床分析

【摘要】〓目的〓探讨经尿道前列腺分区剜除术治疗高危前列腺增生患者的临床疗效。方法〓经尿道等离子前列腺分区剜除术治疗高危前列腺增生患者89例,对其手术前后前列腺体积、残余尿量、国际前列腺症状评分(IPSS)、生活质量评分(QoL)和最大尿流率(Qmax)等指标进行统计学分析。结果〓89例患者均顺利完成手术,术中、术后均无严重并反症发生,手术时间30~110 min,平均45±12.6 min;术中切除前列腺组织净重20~60 g,平均30.6±13.2 g;出血量50~300 mL,平均110±27 mL。平均随访3个月,患者国际前列腺症状评分(IPSS)由21.6±3.9分降至11.8±5.1分,残余尿量由120.2±27.6 mL降至20.2±12.3 mL,最大尿流率由7.1±4.4 mL/s升至14.6±5.2 mL/s,与术前比较有显著性差异(P<0.05)。结论〓经尿道等离子前列腺分区剜除术治疗高危前列腺增生安全、有效。充分的术前准备,以及个体化的手术方案是手术成功的关键。     

经尿道等离子前列腺剜除联合膀胱小切口治疗重度前列腺增生

目的探讨等离子电切镜经尿道剜除前列腺,联合耻骨上膀胱小切口治疗重度前列腺增生的价值。方法应用等离子电切襻和镜鞘将增生前列腺从精阜上缘延外科包膜逆行推入膀胱,于耻骨上膀胱小切口将前列腺组织或膀胱结石取出。结果80例均顺利完成手术,剜除前列腺时间25～45min,（34.3±11.4）min;经耻骨上膀胱小切口取出腺体或膀胱结石时间15～25min,（20.4±5.8）min;术中出血量50～150ml,（80.2±16.5）ml,均未输血。术后膀胱冲洗时间14～24h,（16.5±4.8）h,拔除尿管时间3～6d,平均4.4d。无电切综合征、尿外渗、闭孔神经反射,1例出现暂时性尿失禁,未做特殊处理,1个月后症状消失。80例随访3～12个月,平均9.6月,无再出血和逆行射精等,术后1个月IPSS由术前（25.3±5.2）分降至术后（11.2±1.6）分（t=36.308,P=0.000）;Qmax从术前（6.9±3.1）ml/s提高至（16.7±2.9）ml/s（t=-18.725,P=0.000）。结论经尿道等离子前列腺剜除联合膀胱小切口治疗重度前列腺增生或合并膀胱结石的患者,具有独特的临床应用价值。     

等离子前列腺剜除联合经膀胱前列腺旋切治疗大体积前列腺增生

目的探讨经尿道等离子前列腺剜除术联合耻骨上经膀胱前列腺旋切治疗大体积前列腺增生的疗效及安全性。方法 2015年6~12月收治前列腺体积100 ml的良性前列腺增生28例,前列腺体积(112.6±9.8)ml,行等离子前列腺剜除,将腺体推入膀胱,扩大膀胱造瘘口,置入10 mm trocar,将10 mm妇科腹腔镜子宫肌瘤旋切器置入膀胱,以前列腺电切镜作为观察镜,用大抓钳钳夹旋切腺体并自trocar取出。结果 28例手术时间(85.8±26.5)min,其中前列腺剜除手术时间(38.3±11.3)min,旋切取出的手术时间(47.5±20.2)min。2例超声提示较多冲洗液外渗至耻骨后间隙,未予特殊处理。拔除尿管后2例暂时性压力性尿失禁,均在4周内恢复。术后随访3~6个月,无尿道狭窄,术后3个月IPSS评分(13.5±3.6)分。结论经尿道等离子前列腺剜除术联合耻骨上经膀胱前列腺旋切治疗大体积前列腺增生安全可行。     

经皮膀胱镜钬激光联合经尿道前列腺汽化电切术治疗高危前列腺增生合并膀胱结石的临床疗效分析

目的对高危前列腺增生(BPH)合并膀胱结石患者给予经皮膀胱镜钬激光联合经尿道前列腺汽化电切术治疗,分析其临床疗效。方法选取2010年至2016年本院收治的行经皮膀胱镜钬激光联合经尿道前列腺汽化电切术治疗的高危前列腺增生合并膀胱结石患者76例,对其临床资料进行回顾性分析,观察临床疗效。结果所有患者均手术成功,碎石平均时间为(24.3±5.2)分钟;前列腺电切平均时间为(70.8±24.6)分钟,术后均未出现明显并发症,住院平均时间为(6.2±2.3)天。与术前比较,术后3个月国际前列腺症状评分(IPSS)、生活质量评分及残余尿量等均明显降低,最大尿流率(Qmax)明显升高,差异具有统计学意义(P<0.05)。结论对高危前列腺增生合并膀胱结石患者给予经皮膀胱镜钬激光联合经尿道前列腺汽化电切术治疗具有创伤小,手术时间短,恢复快等优势,是治疗BPH合并膀胱结石的有效方法。     

经尿道前列腺剜除联合耻骨上经膀胱前列腺粉碎治疗巨大前列腺增生

目的 探讨经尿道前列腺完全性剜除联合耻骨上经膀胱前列腺粉碎术治疗巨大前列腺增生的临床应用价值.方法 切除前列腺腺体超过100 g的前列腺增生患者12例,年龄62～78岁,平均（68±3）岁,术前经直肠超声（TRUS）等计算前列腺体积162～263ml,平均（183±21）ml,均采用经尿道前列腺完全性剜除联合耻骨上经膀胱前列腺粉碎术.分析手术的疗效及安全性.结果 12例患者均手术成功,手术时间95～126min,平均（103±11）min,其中完全性剜除前列腺耗时45～78min,平均（65±13）min,腺体粉碎并取出耗时15～35min,平均（22±5）min;切除腺体105～168 g,平均（124±16）g;术后当天血红蛋白下降15～36 g,平均（23±5）g.均未输血;未发生电切综合征、下肢深静脉血栓等并发症.拔除尿管后均排尿通畅,6例发生压力性尿失禁,均在2周内恢复;11例术后住院9d,1例因尿管引流不畅,膀胱造瘘口漏尿,术后住院13d.结论 经尿道前列腺完全性剜除联合耻骨上经膀胱前列腺粉碎术治疗巨大前列腺增生的方法安全可行,可缩短手术时间.     

小切口联合经尿道前列腺电切术治疗前列腺增生合并膀胱结石

目的探讨前列腺增生症合并膀胱结石患者同期行膀胱取石和前列腺切除的临床效果。方法回顾性分析2000年9月～2004年6月我院32例采用小切口联合经尿道前列腺电切术(transurethralresectionoftheprostate,TURP)治疗前列腺增生合并膀胱结石的临床资料,腹壁小切口取出膀胱结石,利用此切口留置膀胱造瘘,再行TURP。结果32例均一次手术成功,取石率100%。手术时间45～120min,平均60min。术中出血量50～200ml,平均100ml。术后留置膀胱造瘘管2～3d,三腔气囊尿管3～7d。术后住院5～8d,平均6d。32例随访4～16个月,8例尿道狭窄,经尿道扩张后排尿正常,术后最大尿流率>15ml/s。结论对前列腺增生症合并膀胱大结石或多发结石患者,可首选小切口开放取石联合TURP。     

A prognostic index (bladder prognostic index) for bilharzial-related invasive bladder cancer

PURPOSE: Bladder cancer is still the most common solid tumor among adult males in Egypt because of the prevalence of bilharzial infestation, especially in the countryside. In this prospective study, we have recorded the prognostic factors for 180 patients with invasive bladder cancer for whom standard radical cystectomy had been performed to develop a prognostic index (bladder prognostic index) that defines high risk patients who are more vulnerable to disease relapse after surgery and who may benefit from additional therapy. PATIENTS AND METHODS: The study was performed between January 1997 and December 1999, in which 180 patients with histopathologically proved invasive bladder cancer associated with bilharziasis underwent radical cystectomy or anterior pelvic exenteration. After surgery, patients were regularly followed for a minimum of 2 years. RESULTS: Our patients included 141 males and 39 females. Squamous cell carcinoma was the most common type (53.3%), and most of the tumors were grade II (61.1%). A total of 173 patients had their tumors operable, while 7 were inoperable. We had 5 (2.8%) operative related mortalities. At 5 years postoperatively, free and overall survival rates for the whole group of patients were 31.44%+/-5.9% and 32.5%+/-6.8%, respectively. Tumor pathologic stage, grade, and nodal affection were the only significant factors with impact on survival (P=0.008, 0.051, and 0.004, respectively). These 3 prognostic indexes were used to design a model to predict an individual patient's risk factor for recurrence. Patients were then assigned to one of the 4 risk groups according to the score achieved in this prognostic index (0=low risk, 1=intermediate risk, and 2 or 3=higher risk). These 4 risk groups had distinctly different rates of disease-free survival, i.e., 91.7%, 53%, 13%, and 7% for low, intermediate, and higher risk groups, respectively. CONCLUSION: Although this prognostic index appears to be of a significant clinical relevance, it needs to be more validated on a larger number of patients, and it could be a surrogate variable for biologic factors responsible for the heterogeneity of bladder cancer.     

Inflammatory pseudotumor (pseudosarcoma) of the bladder

Inflammatory pseudotumor (pseudosarcoma) of the bladder is a benign proliferative lesion of the submucosal stroma easily mistaken for a malignant neoplasm clinically and histologically. The lesion was first described as a separate entity in a report of 2 patients. Three additional cases have been reported since then. We describe pseudosarcomatous bladder tumors arising in 2 adolescents. Both patients presented with sudden onset of gross painless hematuria related to large polypoid and ulcerated bladder masses found on endoscopy. Initial pathological analysis was interpreted as poorly differentiated sarcoma in both patients but subsequent reviews were consistent with a benign process resembling nodular fasciitis. Simple excision in both patients has been successful in eradicating the lesion. The findings in these 2 patients are described with a discussion of the pathophysiology and review of the literature.     

Malignant mesodermal (mesenchymal) tumors of bladder

Malignant mesodermal tumors originating in the bladder are rare. Only a few cases could be found in large series of autopsies or in gathered series of primary retroperitoneal space tumors. Sarcomas originating in the bladder wall grow rapidly and usually infiltrate into neighboring tissues. Two cases of such rare tumors are presented. The polar discrepancy between the clinical situation and the histopathologic findings are emphasized. Therapeutic outlines for these rare cases are suggested.     

Transurethral resection of bladder tumour (TURBT)

The goals of transurethral resection of bladder tumour (TURBT) are to identify and eradicate visualized bladder tumour if technically safe and feasible and to obtain a specimen of satisfactory quality to enable accurate histological diagnosis. In the setting of high grade bladder tumour this generally entails the inclusion of detrusor muscle and assessment for the presence of associated carcinoma in situ (CIS), lymphovascular involvement or any variant form of bladder cancer. This will assist in determining risk stratification and prognostication of the bladder cancer and guides further treatment planning. Conversely, if suboptimal TURBT is performed there will be detrimental consequences on patient outcomes in regards to undergrading or understaging, increased recurrence or progression, and subsequently need for further treatments including more invasive interventions. This review article firstly summarises the key principles and complications of TURBT, as well as significance of re-TURBT. We also discuss a number of modifications and advances in detection technology and resection techniques that have shown to improve perioperative as well as pathological and oncological outcomes of bladder cancer. They include enhanced cystoscopy such as blue light cystoscopy (BLC), narrow band imaging (NBI) and en bloc resection of bladder tumour (ERBT) technique using various types of energy source.     

Spinal-injured neuropathic bladder antisepsis (SINBA) trial

OBJECTIVE: To determine whether Methenamine Hippurate (MH) or cranberry tablets prevent urinary tract infections (UTI) in people with neuropathic bladder following spinal cord injury (SCI). STUDY DESIGN: Double-blind factorial-design randomized controlled trial (RCT) with 2 year recruitment period from November 2000 and 6 month follow-up. SETTING: In total, 543 eligible predominantly community dwelling patients were invited to participate in the study, of whom 305 (56%) agreed. METHODS: Eligible participants were people with SCI with neurogenic bladder and stable bladder management. All regimens were indistinguishable in appearance and taste. The dose of MH used was 1 g twice-daily. The dose of cranberry used was 800 mg twice-daily. The main outcome measure was the time to occurrence of a symptomatic UTI. RESULTS: Multivariate analysis revealed that patients randomized to MH did not have a significantly longer UTI-free period compared to placebo (HR 0.96, 95% CI: 0.68-1.35, P=0.75). Patients randomized to cranberry likewise did not have significantly longer UTI-free period compared to placebo (HR 0.93, 95% CI: 0.67-1.31, P=0.70). CONCLUSION: There is no benefit in the prevention of UTI from the addition of MH or cranberry tablets to the usual regimen of patients with neuropathic bladder following SCI.