腺性膀胱炎的诊断与治疗(附38例报告)

目的探讨膀胱镜在腺性膀胱炎的诊断和治疗中的应用。方法 膀胱镜检查和活检，病理诊断为腺性膀胱炎38例，电切镜下行病灶电切/电灼术，术后丝裂霉素膀胱灌注化疗（每周1次，共8次，其后每月1次，共10次）。结果38例随访6-12个月，29例治愈，膀胱黏膜逐渐恢复为移行上皮覆盖；症状缓解5例；复发4例。结论膀胱镜检查对腺性膀胱炎的诊断具有重要参考价值，经尿道电切镜下病灶电切/电灼术联合术后丝裂霉素膀膛灌注化疗，对腺性膀胱炎治疗效果明显。     

腺性膀胱炎24例临床分析

目的探讨腺性膀胱炎的诊断与治疗效果。方法经膀胱镜检结合组织活检确诊24例腺性膀胱炎,均行经尿道电气化术治疗。结果24例获得6~45个月随访,平均25个月。18例治愈,6例好转,其中2例,5~12个月复发,无一例癌变。结论膀胱镜检查结合组织活检对腺性膀胱炎的早期诊断具有重要意义;经尿道电切或电灼术是主要的治疗方法。     

腺性膀胱炎96例诊治分析

目的探讨腺性膀胱炎的有效诊断和治疗手段。方法对96例经膀胱镜检查及病理活检明确为腺性膀胱炎病例,行经尿道膀胱黏膜电灼术、电切术（TUR）,术后辅以丝裂霉素或表阿霉素膀胱灌注治疗,并定期复查。结果随诊6～30月,其中86例症状完全消失,7例好转,继续灌注后症状消失,3例复发再次手术后治愈。结论腺性膀胱炎的诊断主要依靠膀胱镜检和病理活检,治疗首选经尿道病变膀胱黏膜电切、电灼加术后有效的膀胱灌注以及膀胱镜定期复查。     

经尿道电切电灼术联合吡柔比星膀胱灌注治疗女性腺性膀胱炎48例报告

目的:探讨经尿道电切电灼术联合吡柔比星治疗女性腺性膀胱炎的方法及疗效。方法:对48例女性腺性膀膀炎患者行经尿道电切加THP膀胱灌注。结果:48例中,临床症状完全消失40例,好转6例,术后复发2例。结论:电切电灼术联合吡柔比星是治疗女性腺性膀胱炎的一种可行有效的方法。     

女性腺性膀胱炎52例报告

目的分析女性腺性膀胱炎的临床表现、发病原肉，探讨治疗措施。方法2004年1月～2007年1月，246例存在膀胱刺激症、镜下血尿或肉眼血尿、反复尿路感染的女性患者施行膀胱镜检查，52例经病理检查证实为腺性膀胱炎，占被检人数的21％，其中32例仔在尿道外口畸形（尿道处女膜融合症20例，尿道外口处女膜伞6例，尿道外口肉阜6例），尿道外口炎性狭窄16例，膀胱结石2例，膀胱内异物2例。行经尿道电切、电灼术，术后丝裂霉素膀胱灌注治疗12个月。结果52例无手术并发症。随访6～12个月，平均8个月。治愈43例，好转6例，复发3例（再次行经尿道电切、电灼术）。结论腺性膀胱炎是女性常见疾病，在充分解除梗阻因素的前提下，经尿道电切及电灼术，膀胱内药物灌注，是治疗腺性膀胱炎的有效方法。     

经尿道等离子电切术治疗女性腺性膀胱炎(附97例报告)

目的:总结女性腺性膀胱炎的临床特点和治疗方法。方法:对97例腺性膀胱炎患者的临床诊治资料进行回顾分析。97例患者年龄23~79岁,平均49.6岁。主要临床症状:尿频、尿急、尿痛37例,血尿24例,膀胱刺激症状伴血尿12例,下腹痛9例,排尿困难8例,无症状经体检发现3例。反复尿路感染或尿常规、尿培养提示感染45例,合并膀胱颈口抬高14例。先期病变为膀胱移行细胞癌,术后9个月发现腺性膀胱炎2例。所有患者均经膀胱镜活检或手术标本病理检查证实为腺性膀胱炎。结果:病变位于膀胱三角区、膀胱颈口86例,膀胱侧壁3例,后壁6例,顶部2例。病变呈滤泡状41例,乳头状23例,绒毛状12例,炎症改变13例,黏膜无显著改变8例。9例给予保守治疗,4例获得随访,时间为3个月~2年,抗感染治疗后症状缓解;88例行手术治疗,全部行经尿道等离子电切术,70例获得随访,时间为8个月~9年,66例未见复发,4例复发,复发间隔时间:13~20个月,平均15.5个月。复发患者1例保守治疗,未行手术,3例再次给予手术治疗,均再次行经尿道等离子电切术。结论:女性腺性膀胱炎多伴有尿路感染及膀胱颈梗阻,病变多较轻,经尿道等离子电切是简单、有效的治疗方法,预后良好。     

经尿道电切电灼术治疗腺性膀胱炎23例

目的探讨经尿道电切电灼术治疗腺性膀胱炎的方法和疗效。方法回顾分析1998年10月至2007年11月23例采用经尿道电切电灼术治疗的腺性膀胱炎患者资料。男11例,女12例,年龄27~68岁,平均48岁。电切范围为所有病变黏膜及与之相邻的正常膀胱黏膜,切除深度一般控制在黏膜及黏膜下层。结果23例腺性膀胱炎患者,治愈13例,好转7例,无效3例,有效率为87.0%(20/23)。1例无效者于发现腺性膀胱炎后近2年发现膀胱移行细胞癌。结论经尿道电切电灼术治疗腺性膀胱炎具有微创、安全、效果好等优点,是一种安全有效的治疗方法。     

腺性膀胱炎的诊断和治疗(附150例报告)

目的探讨腺性膀胱炎临床特征和诊治效果。方法报告腺性膀胱炎１５０例的诊治经验。结果主要症状为膀胱刺激症状、血尿和排尿困难。病变最常见部位为膀胱颈口和三角区,确诊依赖于膀胱镜下活检。３１例腺性膀胱炎与膀胱肿瘤有关。治疗采用经尿道电切,膀胱部分切除和膀胱全切。结合文献讨论了腺性膀胱炎的诊断和治疗。结论腺性膀胱炎有潜在的恶变倾向,需长期随访复查。     

腺性膀胱炎的诊断和治疗（附90例报告）

目的探讨腺性膀胱炎的临床特征和诊治效果。方法分析腺性膀胱炎90例诊治的经验。结果主要症状为膀胱刺激症状，血尿和排尿困难，病变部位最常见膀胱颈121和膀胱三角区，确诊依赖于膀胱镜下活检。治疗采用经尿道电切，膀胱部分切除。结论腺性膀胱炎有潜在的恶变倾向，需长期复查。     

腺性膀胱炎(附30例报告)

目的 总结腺性膀胱炎发病特点,提高腺性膀胱炎诊治水平。方法 回顾分析３０例腺性膀胱炎病例资料、诊断、检查和治疗方法的应用及预后特点。结果 ６３０例中１１例行经尿道电切术,有效率８２％。术后病理发现伴有组织恶变者２例。保守治疗者中２例未经特殊治疗,自然痊愈。结论 膀胱镜检查结合组织活检对腺性膀胱炎的早期诊断具有重要意义;经尿道电切或电灼术是主要的治疗方法。     

经尿道腔内手术治疗女性膀胱颈梗阻（附33例报告）

目的：提高经尿道腔内手术治疗膀胱颈部梗阻的诊治水平。方法：对33例保守治疗无效的膀胱颈部梗阻女性患者行经尿道膀胱颈部电切术。结果：28例患者（84．8％）术后排尿症状明显改善,在手术后6～12周梗阻症状消失。最大尿流率和剩余尿量明显改善,手术前后平均尿流率分别为（6±4）ml／s、（28±10）ml／s（P〈0．05）。切除的膀胱颈部组织病理报告为纤维平滑肌组织增生伴或不伴慢性炎细胞浸润。随访6～58个月,平均18个月,5例在术后2～4年膀胱颈部梗阻症状复发,3例行再次电切后症状改善,2例再次电切,随访3个月无效后行膀胱造瘘术。均未发生尿失禁和尿瘘等并发症。结论：经尿道电切术治疗女性膀胱颈部梗阻手术操作简单、创伤小、出血少,疗效肯定。     

经膀胱镜输尿管双J管置入治疗小儿上尿路梗阻

目的探讨经膀胱镜留置输尿管双J管在小儿上尿路梗阻中的应用价值。方法回顾性分析2014年12月~2018年5月45例膀胱镜输尿管双J管置入治疗上尿路梗阻的资料,其中先天性肾积水20例,急性输尿管结石梗阻23例,肾盂离断成形术后积水复发2例。均经膀胱镜逆行置入F3、F4或F4.7双J管。结果2例先天性肾积水和3例急性输尿管结石梗阻未能置入输尿管双J管,其余40例留置双J管位置良好。先天性肾积水18例均于术后6个月取出双J管,8例随访3~4年积水未加重,10例因积水加重行腹腔镜肾盂离断成形术;急性输尿管结石梗阻20例于1~2周拔除输尿管双J管,二期输尿管镜钬激光碎石成功;肾盂离断成形术后积水复发2例均于术后6个月拔除输尿管双J管,1例随访1年5个月肾积水无再次加重,1例因肾积水再次加重于拔管后20天行腹腔镜肾盂离断成形术。结论输尿管双J管置入可有效缓解小儿上尿路梗阻,达到缓解肾脏压力的目的,可作为婴幼儿和儿童上尿路梗阻的一线治疗方案。     

前列腺电切术后腺窝结石形成的原因及对策

目的:探讨前列腺电切术后腺窝结石形成的原因、临床表现和防治对策。方法:报道前列腺电切术后腺窝结石患者11例,患者曾行经尿道前列腺电切术或经尿道前列腺等离子双极电切术,术后反复出现尿频、尿急、尿痛等症状,伴尿路感染,部分伴排尿梗阻症状,抗感染治疗效果不理想。膀胱镜检查见前列腺腺窝结石形成,部分可见焦痂、坏死物质、电切创面不平整及小憩室形成。确诊后行钬激光碎石及再次前列腺电切术1例,其余患者在膀胱镜下用异物钳将结石取出,给予抗感染治疗1～2周。结果:11例患者尿常规均恢复正常,尿频、尿急、尿痛等症状消失。随访3～6个月,未再出现膀胱刺激症状、梗阻症状及尿路感染。结论:前列腺电切术后反复尿频、尿急、尿痛、尿路感染者,应考虑到腺窝结石可能,行膀胱镜检查可明确诊断。治疗可采取膀胱镜下取石或碎石术,必要时可再次行前列腺电切术。预防上应注意创面修平整、控制感染及避免过度电凝。     

Cystoprostatectomy for effective palliation of symptomatic bladder invasion by prostate cancer

PURPOSE: We evaluated the palliative effect of cystoprostatectomy (CP) for palliating pelvic symptoms in patients with bladder invasion by prostate cancer. MATERIALS AND METHODS: A total of 38 patients with clinical T4 prostate cancer, including primary tumors in 17 and recurrence following radiation therapy in 21, underwent palliative CP. Local symptoms, the need for surgical procedures to relieve obstruction, and chronic tube drainage for urinary obstruction before surgery and 3 months after surgery were compared. Average followup was 23 months. Time to local and systemic symptom recurrence, biochemical progression and metastasis was measured and disease specific survival was determined. RESULTS: Local symptoms were reported by 34 patients (89%) before surgery and by 8 (21%) after surgery (p = 0.000). Preoperatively a total of 22 tubes were inserted in 13 patients to overcome urinary obstruction. Average indwelling tube duration was 6.9 months. A total of 24 transurethral prostatic tumor resections were performed in 11 patients. Following CP local symptoms were relieved permanently in 30 patients. The average interval between surgery and clinical systemic disease was 26 months. Median time to biochemical progression, metastasis and systemic symptoms was 8, 18 and 26 months, respectively. Median disease specific survival was 31 months (range 1.7 to 81.2). No perioperative deaths occurred. Rectal injuries occurred in 5 cases (13%) during surgery. CONCLUSIONS: Radical CP provides effective and durable palliation in patients with locally advanced prostate cancer. This procedure can be performed with acceptable morbidity in a select group of patients.     

A randomized controlled trial comparing transurethral resection of the prostate,contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: urodynamic effects

PURPOSE: We compared urodynamic and uroflowmetry improvements in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) after transurethral prostate resection, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS: A prospective randomized controlled trial was performed in men with lower urinary tract symptoms suggestive of BPH who met the criteria of the International Scientific Committee on BPH, had a prostate volume of between 20 and 65 ml., and a Sch?fer obstruction grade of 2 or greater. Before and 6 months after treatment urodynamics and free uroflowmetry were performed. RESULTS: A total of 50, 45 and 46 men were randomized to transurethral prostate resection, laser treatment and electrovaporization, respectively. Baseline characteristics were similar in the 3 groups. Detrusor contractility did not change in any of the treatment groups. The average maximum free flow rate increased by a factor of 2.4 after transurethral prostate resection, 2.5 after laser prostatectomy and 2.4 after electrovaporization. The Sch?fer obstruction grade decreased by a factor of 0.3 in all groups. Obstruction (Sch?fer grade greater than 2) was not noted after transurethral prostate resection or electrovaporization but it was evident in 2 patients after laser prostatectomy. Effective capacity increased by a factor of 1.5 or more. The incidence of detrusor instability was decreased by half in all groups. The incidence of significant post-void residual urine volume decreased in all groups. CONCLUSIONS: There were no significant differences in the improvement in urodynamic and uroflowmetry parameters 6 months after treatment when comparing transurethral prostate resection, contact laser prostatectomy and electrovaporization in men with lower urinary tract symptoms suggestive of BPH.     

腺性膀胱炎复发风险预测模型的建立和验证

目的 探讨并分析腺性膀胱炎（CG）初治后复发的主要临床危险因素,并构建定量预测模型指导临床早期识别高危患者。方法 回顾性总结2015年8月至2020年7月在本院经病理确诊的138例CG患者的临床资料,采用随机数字表法分为模型组（92例）和验证组（46例）,以病理和临床症状联合诊断为复发共62例,其中模型组43例（46.7%）和验证组19例（41.3%）。首先采用单因素分析比较模型组中复发与未复发患者的临床资料,然后采用多因素Cox比例风险模型筛选主要危险因素,根据权重赋值建立定量预测模型,采用受试者工作特征（ROC）曲线分析预测模型在模型组和验证组中的诊断效能,最后根据预测模型将模型组和验证组进行风险分层（低、中和高）,采用Kaplan-Meier曲线比较复发风险。结果 模型组的单因素分析结果显示,与未复发患者比较,复发患者的年龄更大,留置尿管时间延长,尿路感染、尿路结石、鳞状上皮化生和非典型增生的发生率升高（均P<0.05）。Cox分析结果显示,年龄、留置尿管时间、尿路感染、尿路结石、鳞状上皮化生和非典型增生是CG复发的主要危险因素（均P<0.05）。ROC曲线分析结果显示,预测模型在模型组和验证组中诊断复发的准确性分别为0.876和0.845（P<0.001）。Kaplan-Meier曲线分析结果显示,模型组和验证组的高风险患者的复发风险高于中风险患者,中风险患者的复发风险高于低风险患者（均P<0.05）。结论 CG有较高的病理和临床症状复发率,年龄、留置尿管时间、尿路感染、尿路结石、鳞状上皮化生和非典型增生可能是CG复发的主要危险因素,通过构建定量预测模型对诊断CG复发和风险分层有较高的准确性和应用价值。     

膀胱粘膜增生性病变的临床及病理特点(附42例报告)

目的　探讨膀胱粘膜上皮增生性病变的病因学及临床和病理特点。　方法　对 12 0例有下尿路刺激症状、排尿困难和血尿的患者进行尿道膀胱镜检和活检 ,结合病史、尿常规和尿动力学检查 ,对其中 4 2例膀胱粘膜上皮增生性病变进行分析。　结果　 4 2例患者中 ,存在下尿路感染征象者 3 7例 ( 88% ) ,有下尿路梗阻表现者 2 4例 ( 5 7% ) ,下尿路梗阻患者均合并有感染。 3例合并移行细胞癌 ,1例尿细胞学检查发现癌细胞。　结论　膀胱粘膜上皮增生性病变 ,尤其是膀胱镜下粘膜无显著改变型增生性病变 ,是慢性下尿路感染和梗阻患者尿路上皮较常见的变异现象 ,慢性下尿路感染和梗阻可能是其致病原因。建议根据病变范围和组织学类型采取不同的治疗措施。     

Obstructive uropathy induced bladder dysfunction can be reversible: bladder compliance measures before and after treatment

PURPOSE: We demonstrated that abnormal bladder compliance in the setting of obstructive uropathy can be improved by relief of bladder outlet obstruction. MATERIALS AND METHODS: A cohort of 9 men with nonneurogenic lower urinary tract symptoms and videourodynamics proven bladder outlet obstruction were identified prospectively from a university urology practice. Study exclusion criteria ensured absence of active urinary infection, hematuria and neurourological pathology. Testing specifically focused on assessment of the bladder compliance curve, and a compliance value was calculated (ml./cm. H2O). Treatment intervention consisted of transurethral incisions or resection of the prostate in 8 cases and transurethral balloon dilation of a urethral stricture in 1. Followup videourodynamics testing was performed 1 month after treatment to confirm relief of outlet obstruction and reassess bladder compliance. RESULTS: Mean patient age was 75.2 +/- 6.16 years. Pretreatment mean bladder compliance +/- SE was 3.06 +/- 0.45 ml./cm. H2O. At 1 month after treatment videourodynamics testing confirmed relief of obstruction in the cohort. Posttreatment mean bladder compliance +/- SE was 13.53 +/- 0.45 ml./cm. H2O. Nonparametric paired t test analysis determined that the difference between pretreatment and posttreatment bladder compliance was statistically significant at p = 0.0117. CONCLUSIONS: This pilot study suggests that relief of obstructive uropathy even in elderly patients with long-standing lower urinary tract symptoms, can significantly improve bladder compliance.     

经尿道电灼术治疗女性腺性膀胱炎疗效与心理因素分析

目的：分析经尿道电灼术治疗女性腺性膀胱炎的手术效果与心理因素的关系.为腺性膀胱炎的综合治疗提供依据.方法：随访99例行经尿道腺性膀胱炎电灼术的女性患者 对其中18例术后9个月以上辅助检查结果正常、症状未消失的女性腺性膀胱炎患者行焦虑和抑郁现况调查.结果：随访9～38个月.99例中症状消失27例,症状改善38例,症状无改善34例 膀胱镜、尿常规等辅助检查结果正常57例,异常42例.其中辅助检查结果正常,症状未消失18例焦虑和抑郁发生率、得分不仅高于中国常模,亦高于普通腺性膀胱炎患者.结论：单纯行经尿道电灼术治疗女性腺性膀胱炎疗效欠佳者,可能与患者合并焦虑和抑郁状态相关,有必要行心理干预和综合治疗.     

Long-term followup of randomized transurethral microwave thermotherapy versus transurethral prostatic resection study

PURPOSE: We evaluate the durable effect of high-energy transurethral microwave thermotherapy and transurethral prostatic resection for treatment of patients with lower urinary tract symptoms suggestive of bladder outflow obstruction. MATERIALS AND METHODS: Between January 1996 and March 1997, 155 patients with lower urinary tract symptoms suggestive of bladder outflow obstruction were randomized to receive transurethral microwave thermotherapy (Prostatron*; device and commercial software) (82) or undergo transurethral prostatic resection (73). Initial patient evaluation was performed according to international standards. Patients were followed annually with the International Prostate Symptom Score (I-PSS) and uroflowmetry (maximum flow rate). The Kaplan-Meier survival analysis was used to calculate the cumulative risk of re-treatment, adjusted for loss to followup. RESULTS: A total of 78 patients received transurethral microwave thermotherapy and 66 underwent transurethral prostatic resection. Median followup was 33 months. In the thermotherapy group mean maximum urinary flow rate improved from 9.2 ml. per second at baseline to 15.1, 14.5 and 11.9 ml. per second at 1, 2 and 3 years, and mean I-PSS decreased from 20 to 8, 9, and 12, respectively. In the resection group the corresponding numbers for maximum urinary flow rate were 7.8, 24.5, 23.0 and 24.7 ml. per second at 1, 2 and 3 years, and for I-PSS were 20, 3, 4 and 3, respectively. At 36 months, 14 patients in the thermotherapy and 8 from the resection groups underwent re-treatment, and the cumulative risk was 19.8% (95% confidence interval 10.4% to 29.3%) and 12.9% (4.5% to 21.3%), respectively (p = 0.28). CONCLUSIONS: Transurethral microwave thermotherapy and transurethral prostatic resection achieve durable improvement in patients with lower urinary tract symptoms suggestive of bladder outflow obstruction, while the magnitude of improvement is higher with resection. The repeat thermotherapy is based on failure of therapy whereas repeat resection is based on complications of therapy.