改良的Madigan前列腺切除术31例报告

目的 :总结改良的Madigan前列腺切除术的手术方法以便更好用于临床。方法 :根据不同BPH患者的特点选用改良的Madigan前列腺切除术 ,近膀胱颈部横切口显露尿道 ,或联合膀胱切开行增生腺体切除术并膀胱结石取出术 ,对3 1例前列腺增生患者行手术治疗。结果 :3 1例手术均顺利完成 ,2 6例完整保留尿道 ,5例尿道或膀胱颈部粘膜损伤均一期修复愈合。术中出血 110～ 60 0ml,平均 15 0ml,均未输血。手术时间 90～ 15 0min ,平均 12 0min。 2 1例随访 2～ 6个月 ,IPSS由术前平均 2 7.1分降至术后 8.3分。结论 :利用改良的Madigan术可提高手术前列腺切除术的治疗效果 ,简化Madi gan术式的技术难点 ,拓宽Madigan术式的手术适应证     

良性前列腺增生术后排尿困难的原因与处理分析

目的 探讨良性前列腺增生(benign prostatic hyperplasia,BPH)患者术后排尿困难的发生原因及处理方法.方法 回顾性分析70例前列腺增生手术后排尿困难患者的临床资料(开放手术15例,经尿道前列腺电切术和经尿道前列腺汽化术55例).70例患者中尿道狭窄29例,膀胱颈尿道口狭窄和/或挛缩23例,膀胱颈尿道水肿3例,前列腺尖部腺体残留5例,BPH复发3例,膀胱逼尿肌无力4例,神经源性功能障碍1例,逼尿肌-尿道外括约肌协同失调2例.手术治疗60例.结果 60例手术全部成功.术后随访2～24个月,平均6个月,均排尿通畅. 9例患者保守药物治疗后排尿困难缓解.膀胱造瘘1例.结论 BPH患者术后排尿困难的主要原因是尿道狭窄、膀胱颈尿道口狭窄或挛缩及膀胱颈尿道水肿、腺体残留、BPH复发及膀胱功能障碍.手术及药物治疗是解决BPH术后排尿困难的重要措施.     

保留尿道前列腺摘除术疗效观察(附31例报告)

为提高前列腺切除术的治疗效果，寻找一种既符合解剖生理特点、减少出血量及并发症的发生，又能使患者痛苦小、恢复快的手术方式，对31例前列腺增生患者采用保留尿道前列腺摘除术予以治疗，手术平均时间97．5min，术中平均输血250ml。随访0．5～2年，疗效满意。强调术前留置导尿管或术中放置尿道扩张器的必要性，认为采用睑板拉钩和缝扎牵拉腺体予以暴露，应用脑膜剪刀锐性分离前列腺与尿道、膀胱颈之间的组织和前列腺包膜，切除前列腺腺体，保留完整的尿道膀胱颈粘膜十分有效。     

经尿道前列腺部分汽化电切术治疗小体积前列腺增生

目的探讨经尿道前列腺部分汽化电切术（transurethral vapor resection,TUVP）治疗小体积良性前列腺增生（benign prostateic hyperplasia,BPH）的疗效。方法对40例小体积BPH患者,在行TUVP的同时,行膀胱颈环状纤维5、7点放射状切开（transurethral inciseon of the bladder nect,TUIBN）。结果40例手术时间15-40min,失血量50-100mL,无尿道电切综合征发生;术后随访9-18个月（平均12个月）,IPSS评分、生活质量评分（QOL）及最大尿流率均得到明显改善,无1例出现膀胱颈挛缩。结论TUVP加TUIBN用于治疗BPH引起的膀胱出口梗阻安全性好,且是预防术后膀胱颈挛缩较理想的方法。     

经尿道前列腺腔内剜除法电切术治疗Ⅳ度良性前列腺增生安全性及疗效的研究

目的 研究经尿道前列腺腔内剜除法电切术(TUERP)治疗Ⅳ度良性前列腺增生(BPH)的安全性及疗效.方法 对35例Ⅳ度良性前列腺增生行TUERP,观察生命征、术野清晰度、手术时间、术后血红蛋白及血电解质、膀胱刺激征、继发出血、冲洗液转清时间,评价其手术安全性.随访术后排尿情况,3个月后评估国际前列腺症状评分(I-PSS)、生活质量评分(QOL),测定最大尿流率(Qmax),评价其疗效.结果 35例手术均顺利,生命征平稳,术野清晰,手术时间平均(102.3±25.6)min,血红蛋白无明显减少,电解质基本正常,无电切综合征发生.术后膀胱刺激征7例,继发性出血1例,冲洗液转清时间平均(28.5±9.7)h.术后排尿均通畅,压力性尿失禁5例,保守治疗后治愈.术后3个月I-PSS(5.6±1.8)分,QOL(1.1±0.9)分,Qmax(21.3±4.8)ml/s.无尿道狭窄、膀胱颈部挛缩发生.结论 TUERP是对经尿道前列腺电切术(TURP)的改进,本法结合了TURP和开放性手术的优点,用于治疗Ⅳ度BPH手术安全,疗效满意.     

良性前列腺增生及其伴发疾病的同期治疗(附205例报告)

目的 探讨良性前列腺增生症(BPH)及其伴发疾病的同期手术治疗方法及疗效、安全性.方法 对205例BPH合并膀胱结石、腹股沟疝、尿道狭窄或膀胱肿瘤的患者在行耻骨上经膀胱前列腺摘除术或经尿道前列腺等离子电切术时,同期行膀胱取石或碎石术、腹股沟疝无张力修补术、尿道内切开术、经尿道膀胱肿瘤电切术(TURBt).随访期间回顾性...     

经尿道双极等离子体前列腺剜除术的并发症分析

【摘要】 目的 探讨经尿道双极等离子体前列腺剜除术(TUPKEP)治疗良性前列腺增生(BPH)的疗效。方法 对本院2009年3月~2012年4月收治的368例良性前列腺增生患者采用经尿道双极等离子体前列腺剜除术的临床资料进行回顾性分析。结果 368例患者手术均获完成。平均手术时间(55.1±19.2)min,术中平均出血量(88±26)mL,切除腺体平均重量(60.5±26.3)g,留置尿管时间(4.8±1.3)天,术后住院时间(5.9±1.8)天。并发症中,前列腺包膜穿孔4例,其中1例膀胱前列腺连接部穿孔行腹腔引流;12例术后拔除尿管后出现排尿困难,经重置尿管后缓解,轻度尿失禁38例,张力性尿失禁12例,无真性尿失禁发生;膀胱颈挛缩5例,输血6例,逆行射精86例,尿道狭窄10例,阴茎勃起功能障碍(ED)39例,无TUR综合征及再次手术病例。术后患者IPSS、QOL、RVR 、Qmax与术前比较差异有统计学意义(P<0.01)。结论 TUPKEP手术时间、术后留置尿管时间和住院时间较短,术中出血量、并发症少,是治疗前列腺增生的安全有效的方法,其并发症可控可防。     

Madigan前列腺切除术尿道黏膜损伤不修补的临床观察

目的　探讨Madigan前列腺切除术中尿道黏膜损伤不修补的治疗效果 ,以简化手术 ,扩大适应证。　方法　对 15 7例有症状的良性前列腺增生 (BPH)患者行改良Madigan前列腺切除术。术中尿道黏膜损伤 10 5例 ,膀胱颈部黏膜损伤 12例 ,其中修补 4 6例 ,不修补 71例。术后随访 3个月～ 6年。　结果　修补组与未修补组手术时间分别为 (88± 2 3)和 (75± 2 0 )min、膀胱冲洗时间 (41.3± 14 .4 )和 (44 .6± 16 .8)h、术后住院天数 (11.5± 2 .5 )和 (12 .0± 2 .5 )d、术后IPSS(5 .8± 1.5 )和 (6 .3± 1.8)分 ,两组比较差异均无显著性意义 (P >0 .0 5 )。　结论　Madigan前列腺切除术中尿道黏膜损伤不修补并不影响疗效。     

纤维增生型前列腺增生症的处理体会

目的探讨纤维增生型BPH的处理方法。方法对28例纤维增生型BPH采用开放性手术或TURP,术中切除前列腺同时,也处理膀胱颈口。结果28例切除前列腺标本为3-11g,平均(6.8±2.7)g。无手术并发症。术后病理检查提示:28例前列腺标本为前列腺增生症;19例膀胱颈组织为纤维增生,9例膀胱颈组织为黏膜水肿、增厚。21/28术后获得随访3个月,MFR13.9-19.6mL/s,平均(15.7±2.3)mL/s,剩余尿量为10-68mL,平均(23.9±11.4)mL,IPSS评分为3-13分,平均(5.1±2.6)分。结论处理纤维增生型的BPH,在切除前列腺的同时,应处理膀胱颈口。     

良性前列腺增生前列腺切除术后排尿困难22例诊治分析

良性前列腺增生(BPH)是老年人常见病、多发病,开放手术和经尿道前列腺电切术(TURP)后均有病例因并发症需要再一次手术治疗。我院1989~2002年对267例BPH患者行开放手术,术后发生排尿困难22例,报告如下。1资料与方法本组22例,年龄55~77岁,平均66.3岁。经膀胱前列腺摘除15例,耻骨后保留尿道前列腺切除7例。术后5~12 d拔除气囊导尿管,近期排尿通畅。排尿困难发生时间为1~6个月。症状起初为排尿困难,有时呈滴沥状,排尿时间延长。残余尿量为60~350 m l,平均90 m l,最大尿流率(Qmax)<10m l/s,患者均行B超、CT、尿道造影,尿道膀胱镜检查,后尿…     

直接显著尿道入路的改良Madigan前列腺切除术（附12例报告）

目的 改进Ｍａｄｉｇａｎ前列腺切除术的手术方法。方法 分析前列腺增生（ＢＰＨ）组织标本,认识尿道前列腺部有部分无增生组织覆盖的区域。对１２例前列腺增生患者采用改良Ｍａｄｉｇａｎ前列腺切除术。术中将前列腺包膜横切口移至近膀胱颈部,显露无增生组织覆盖的尿道区域,直视下分离出尿道,完整切除增生腺体,结果 １２例术中均能显露无增生组织覆盖的区域,清晰地分开尿道与增生腺体。１０例尿道保留完整,２例尿道破裂。     

Pelvic fracture‐related injuries of the bladder neck and prostate: their nature,cause and management

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To report our experience of bladder neck injuries, which are a well recognized but rare consequence of pelvic fracture‐related trauma to the lower urinary tract, as we have been unable to find any reference in the English literature to their specific nature, cause and management in adults.

PATIENTS AND METHODS

In the last 10 years we have treated 15 men with bladder neck injuries after pelvic fracture. Two were treated at our centre by delayed primary repair. Thirteen were initially treated elsewhere and presented to us 3 months to 5 years after their injury with intractable incontinence and various other symptoms most notably recurrent urinary infection and gross haematuria. Twelve of the injuries were at or close to the anterior midline and associated with lateral compression fractures or ‘open‐book’ injuries. Five of them were confined to the bladder neck and prostatic urethra; the other seven extended into the subprostatic urethra. Four of these were associated with a coincidental typical rupture of the posterior urethra. All had an associated cavity involving the anterior disruption of the pelvic ring. Two of the injuries, following particularly severe trauma, were a simultaneous complete transection of the bladder neck and of the bulbo‐membranous urethra with a sequestered prostate between. We have seen this in children before but not in adults. Another injury, also after particularly severe trauma, was an avulsion of the anterior aspect of the prostate. We have not seen this described before. Fourteen patients underwent lower urinary tract reconstruction and one underwent a Mitrofanoff procedure. All of the 14 had a layered reconstruction of the prostate and bladder neck and in 13, this was supplemented with an omental wrap.

RESULTS

In all patients with an anterior midline rupture, the primary injury appeared to be to the prostate and prostatic urethra with secondary involvement of the bladder neck and the subprostatic urethra. The Mitrofanoff procedure was successful. Of the 14 patients with a layered reconstruction one, without an omental wrap, broke down but was successfully repaired on a subsequent occasion. The four patients who also had a ruptured urethra had a simultaneous bulbo‐prostatic anastomotic urethroplasty, two of which required further attention. Eight of the 14 reconstructed patients underwent implantation of an artificial urinary sphincter (AUS) for sphincter weakness incontinence, in seven of whom this was successful. Two of these had previously undergone implantation of an AUS with an unsatisfactory outcome and were made continent by bladder neck reconstruction. The other six patients had acceptable urinary incontinence by reconstruction of the bladder neck and urethra alone.

CONCLUSIONS

The primary injury is to the prostate and prostatic urethra. The bladder neck and subprostatic urethra are involved secondarily by extension. These injuries have a particular cause and a particular location with a predictable outcome. They need to be identified and treated promptly as they do not heal spontaneously and otherwise cause considerable morbidity. We also describe two particular types of bladder neck injury that we have not seen described before in adults.     

临床评估同时切除前列腺和膀胱肿瘤对膀胱肿瘤复发的影响(附47例报告)

目的：评估同时切除前列腺和膀胱肿瘤对膀胱肿瘤在膀胱颈部和（或）前列腺窝处复发的影响。方法：回顾性研究47例同时行经尿道膀胱肿瘤电切术和经尿道前列腺切除术的患者,分为膀胱肿瘤单发组26例和多发组21例,记录随访时间、肿瘤的复发时间、复发位置、复发数量以及肿瘤的进展,综合评价同时切除前列腺搜膀胱肿瘤和膀胱肿瘤复发的关系。结果：所有患者随访1～4年,平均随访2、9年;膀胱肿瘤的平均复发率为68.1%,单发组复发率为53.8％,多发组复发率为85.7％,两组复发率差异有统计学意义（P〈O．05）;肿瘤平均复发时间15.1个月,单发组复发时间17.5个月,多发组复发时间12.4个月;在膀胱颈和（或）前列腺窝肿瘤复发10例（21.3%）：在前列腺窝膀胱肿瘤平均复发时间为21.3个月,在单发组为26.O个月,而在多发组为20.6个月。3例患者（6.3％）最后发展为浸润性膀胱癌而行膀胱全切术。结论：同时切除前列腺和膀胱肿瘤是一种比较安全的手术策略,对膀胱肿瘤在膀胱颈和前列腺窝处的复发没有影响。     

Prospective study of transitional cell carcinoma in the prostatic urethra and prostate in the cystoprostatectomy specimen. Incidence, characteristics and preoperative detection

OBJECTIVES: To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the prostatic urethra and prostate in the cystoprostatectomy specimen, investigate characteristics of bladder tumours in relation to the risk of involvement of the prostatic urethra and prostate and examine the sensitivity of preoperative loop biopsies from the prostatic urethra. MATERIAL AND METHODS: Preoperatively, patients were investigated with cold cup biopsies from the bladder and transurethral loop biopsies from the bladder neck to the verumontanum. The prostate and bladder neck were submitted to sagittal whole-mount pathological analysis. RESULTS: The incidence of TCC in the prostatic urethra and prostate in the cystoprostatectomy specimen was 29% (50/175 patients). Age, previous bacillus Calmette-Guérin treatment, carcinoma in situ (Cis) in the cold cup mapping biopsies and tumour grade were not associated with the risk of TCC in the prostatic urethra/prostate. Cis, multifocal Cis (> or = 2 locations) and tumour location in the trigone were significantly more common in cystectomy specimens with TCC in the prostatic urethra and prostate: 21/50 (42%) vs 32/125 (26%), p=0.045; 20/50 (40%) vs 27/125 (22%), p=0.023; and 20/50 (40%) vs 26/125 (21%), p=0.01, respectively. Preoperative resectional biopsies from the prostatic urethra in the 154 patients analysed identified 31/47 (66%) of patients with TCC in the prostatic urethra/prostate, with a specificity of 89%. The detection of stromal-invasive and non-stromal involvement was similar: 66% and 65%, respectively. CONCLUSIONS: The incidence of TCC in the prostatic urethra and prostate was 29% (50/175) in the cystoprostatectomy specimen. Preoperative biopsies from the prostatic urethra identified 66% of patients with such tumour growth. Our findings suggest that preoperative cold cup mapping biopsies of the bladder for detection of Cis add little extra information with regard to the risk of TCC in the prostatic urethra and prostate.     

Simultaneous Transurethral Resection of Bladder Tumor and Benign Prostatic Hyperplasia: Hazardous or A Safe Timesaver?

PurposeWe evaluated the effect of simultaneous transurethral resection of bladder tumor (TURBT) and benign prostatic hyperplasia (TURP) on recurrences at the bladder neck and prostatic urethra.Material and MethodsDuring the 10-year study period 51 patients fulfilled the entry criteria of past simultaneous TURBT and TURP, histologically confirmed transitional cell carcinoma of the bladder and benign prostatic hyperplasia, a preserved bladder and a minimal followup of 12 months. Their records were analyzed retrospectively. Patients were divided into 28 with single (group 1) and 23 with multiple (group 2) bladder tumors.ResultsDuring the 12 to 120 months of followup (mean 37.3) the average tumor recurrence rate was 68.6%, that is 53.6% in group 1 and 86.9% in group 2. Recurrences appeared within an average of 14.9 months, that is within 18 (range 4 to 36) in group 1 and 13.5 (range 3 to 36) in group 2. Tumor recurrence was at the bladder neck and/or prostatic urethra in 11 of the 51 cases (21.5%). Average time to recurrence at the prostatic fossa was 23.8 months, that is 27 (range 13 to 46) in group 1 and 21.6 (range 4 to 60) in group 2. Only 1 patient had a single recurrence in the prostatic fossa, while the others also had synchronous and metachronous recurrences at other bladder sites. Tumor progression to invasiveness was diagnosed in 3 of the 51 patients (5.9%).ConclusionsOur data indicate that simultaneous TURBT and TURP do not negatively affect tumor recurrence at the bladder neck and prostatic urethra.     

Are biopsies from the prostatic urethra useful in patients with superficial bladder carcinoma?

Fifty male patients entered a Mitomycin C trial for superficial bladder cancer and biopsies in the prostatic urethra were taken with a cold cup biopsy forceps. In one patient this procedure failed. In 21 of 49 patients no abnormalities were detected but in the remaining 28 patients (57.1%) histological changes were found in the prostatic urethra. In 13 of these patients (26.5%) the changes were either carcinoma in situ (CIS) or superficial bladder carcinoma. Carcinoma in situ in the prostatic urethra was found in nine patients (18%) and in all but one it was combined with CIS in the bladder. These results indicate that biopsies from the prostatic urethra must be taken routinely in order to plan adequate therapy.     

Evaluation and treatment of dyssynergic bladder neck obstruction Is synchronous pressure-flow cystourethrography necessary?

Eighteen male patients underwent unilateral bladder neck incision for relief of bladder neck obstruction. The presence of obstruction was determined by clinical symptoms, residual urine, and uroflowmetry only. The decision to perform bladder neck incision was based on the typical endoseopic appearance of the prostatic urethra and bladder neck. Sixteen of 18 patients (89 per cent) had normal postoperative uroflowmetry. Subjectively, all patients judged themselves improved by the procedure. In those patients who are judged to be obstructed by clinical symptoms and uroflowmetry, dyssynergic bladder neck obstruction may be diagnosed by classic endoscopic findings rather than the routine use of synchronous pressure flow cystourethrography.     

Indications and techniques in urethrectomy

The indications for urethrectomy during cystectomy for bladder cancer have substantially changed during the last years. Many years ago, prophylactic urethrectomy was performed in most patients undergoing cutaneous diversion. Today, transitional cell carcinoma at the level of the prostatic urethra or at the bladder neck is recognized to be the most important risk factor of urethral recurrence. Since the development of bladder substitutions, the indications for prophylactic urethrectomy have been dramatically reduced. Pre - and intra operative evaluation of the prostatic urethra in men and that of the bladder neck in women is the major determinant in the appropriate treatment strategy for the urethra in patients with bladder cancer.     

Madigan前列腺切除术

目的：总结Ｍａｄｉｇａｎ前列腺切除术治疗前列腺增生症（ＢＰＨ）的经验。方法：回顾性分析２６例ＢＰＨ患者的临床资料。结果：２１例尿道完整,２例膀胱颈和５例尿道损伤后均缝合修复。术后随访３－２５个月,无尿道狭窄,,尿失禁,性功能丧失等并发症。结论;本术式适应证为以侧叶增生为主,中叶无明显增生,无膀胱内疾病,未接受过射频,微波,注射及电切等治疗的ＢＰＨ患者。     

Long-term results of transvaginal colposuspension for the treatment of genuine stress incontinence combined with vaginal hysterectomy

We assessed the long-term efficacy of a modified transvaginal needle bladder neck suspension, combined with vaginal hysterectomy, for the treatment of female stress incontinence. Thirty-two women who underwent this procedure were followed up clinically and urodynamically 1 and 5 years postoperatively. A total of 27 women (84.4%) were cured 1 year postoperatively. Of the 29 women who were followed up 5 years postoperatively, 21 (72.4%) had a satisfactory result (p = 0.157). No significant differences were observed in maximum urine flow rate, residual volume of urine, and functional length of the urethra. On the contrary, the maximum urethral closure pressure was significantly decreased (p = 0.004). Although the results of our study show a decline in success rate by time, the overall long-term efficacy of this technique is undoubtedly satisfactory. This technique is promising as an easy and minimally invasive surgical procedure for bladder neck suspension.