托特罗定联合吲哚美辛栓剂预防性治疗经尿道前列腺电切术后膀胱过度活动症

目的 探讨酒石酸托特罗定联合吲哚美辛栓剂预防性治疗经尿道前列腺电切术后膀胱过度活动症的疗效.方法 收集128例良性前列腺增生症患者基本资料,发病年龄51～82(67.3±8.4)岁,随机分为4组:联合药物组、托特罗定组、吲哚美辛组及对照组各32例.比较各组TURP术后72h内膀胱区阵发性痉挛性疼痛伴(或不伴)急迫性尿失禁的次数及膀胱痉挛持续时间.结果 各治疗组在术后第2、第3天膀胱痉挛次数、膀胱痉挛平均持续时间均少于对照组(P＜0.05);托特罗定组术后第2、第3天膀胱痉挛次数分别为(1.85±0.6)次和(1.08±0.81)次,膀胱痉挛平均持续时间分别为(0.20±0.13)h和(0.21±0.12)h,均少于吲哚美辛组(2.01±0.38)次和(1.66±0.97)次,(0.35±0.31)h和(0.33±0.21)h(P＜0.05);联合药物组(1.25±0.89)次和(0.70±0.7 1)次,(0.1 3±0.1 2)h和(0.11±0.07)h均少于托特罗定组(P＜0.05).拔除尿管时间:联合药物组(5.3±0.7)d、托特罗定组(5.2±0.8)d、吲哚美辛组(5.2±0.9)d均较对照组(6.4±0.5)d短差异有统计学意义(P＜0.05),治疗组间差异无统计学意义.结论 TURP术后早期预防性联合使用酒石酸托特罗定片与吲哚荚辛直肠栓剂是解决患者膀胱痉挛安全、有效的方法.     

酒石酸托特罗定片联合前列安栓防治前列腺电切术后膀胱痉挛20例

目的:评价酒石酸托特罗定片与前列安栓联合应用对前列腺电切术后膀胱痉挛的治疗效果。方法:随机将40例前列腺增生电切术后患者分成观察组和对照组各20例,观察组手术当日酒石酸托特罗定口服片剂;前列安栓塞入直肠。对照组膀胱痉挛症状出现后曲马多100mg肌肉注射。结果:观察组在术后第2、3d膀胱痉挛次数、平均持续时间均少于对照组。结论:酒石酸托特罗定片联合前列安栓对前列腺电切术后膀胱痉挛有较好的治疗效果。     

酒石酸托特罗定片联合吲哚美辛栓剂预防性治疗前列腺电切术后膀胱痉挛

目的评价酒石酸托特罗定片与吲哚美辛栓剂联合应用对前列腺电切术后膀胱痉挛的治疗效果。方法随机将40例前列腺增生电切术后患者分成实验组和对照组。试验组20例，手术当日使用酒石酸托特罗定口服片剂2mg，12h1次；吲哚美辛直肠栓剂25mg，3次／d，至停留置导尿。对照组20例，膀胱痉挛症状出现后用度冷丁50mg与黄体酮20mg肌肉注射对症治疗。结果试验组在术后第2、第3天膀胱痉挛次数、膀胱痉挛平均持续时间及膀胱冲洗转清时间均少于对照组。结论预防性地联合使用酒石酸托特罗定片与吲哚美辛栓剂对前列腺电切术后膀胱痉挛有较满意的治疗效果。     

托特罗定防治良性前列腺增生患者围手术期膀胱痉挛的临床疗效

目的 探讨良性前列腺增生(BPH)患者围手术期膀胱痉挛的有效防治方法.方法 BPH患者112例,随机分为2组,每组56例.治疗组应用酒石酸托特罗定治疗,术前4～5 d,术后3～4 d,2 mg,2次/d.对照组不服用任何对膀胱痉挛有影响的药物.观察比较2组患者经尿道前列腺切除术后膀胱痉挛发生频率、持续时间等.结果 对照组56例患者麻醉效应过后未发生膀胱痉挛7例(12.5%)、轻度膀胱痉挛(偶感耻骨上膀胱区及尿道疼痛不适)8例(14.3%)、膀胱痉挛(膀胱区阵发性疼痛伴尿液自尿管周围溢出)41例(73.2%).治疗组56例患者麻醉效应过后未发生膀胱痉挛49例(87.5%)、轻度膀胱痉挛5例(8.9%)、膀胱痉挛2例(3.6%).2组膀胱痉挛发生率比较差异有统计学意义(P相似文献   

托特罗定治疗前列腺术后留置导尿致膀胱痉挛临床疗效分析

目的 :评价托特罗定 (tolterodine)治疗前列腺术后留置导尿致膀胱痉挛的疗效。　方法 :对 82例前列腺术后留置导尿出现膀胱痉挛的患者给于托特罗定治疗 ,2mg/次 ,2次 /d ,至拔除导尿管前 2 4h。评价指标包括痉挛是否发生、发生频率、持续时间等。　结果 :用药 2 4h后 ,膀胱痉挛完全缓解 2 1例 (2 5 .6 % ) ;部分缓解 4 5例 (5 4 .9% ) ;未缓解 16例 (19.5 % )。 72h后 ,膀胱痉挛完全缓解 4 5例 (5 4 .9% ) ;部分缓解 30例 (36 .6 % ) ;未缓解 7例 (8.5 % )。治疗过程中无严重不良反应发生。　结论 :托特罗定为治疗前列腺术后留置导尿致膀胱痉挛快速、有效、持久、安全的药物。     

托特罗定治疗前列腺摘除术后膀胱痉挛的疗效观察

目的　观察托特罗定对前列腺术后膀胱痉挛的治疗效果 ,并对其耐受性进行评价。方法　采用随机、双盲的方法将 6 3例膀胱痉挛频繁发作患者分为治疗组和对照组 ,治疗组服用托特罗定 2mg ,对照组用度冷丁 75mg肌注 ,时间为 2d。 结果　治疗组显效 2 9例 (90 .6 % ) ,对照组显效 30例 (96 .8% ) ,差异无显著性 (P >0 .0 5 )。治疗组不良反应率 2 1.9%。结论　托特罗定是治疗膀胱痉挛的有效药物。     

自发性高血压大鼠口服托特罗定的中长期耐受性研究

目的：探索自发性良性前列腺增生大鼠模型（f1发性高疵压大鼠,SHR）门服托特罗定的中长期耐受性。方法：雄性13周龄SHR大鼠20只．随机分成4纽,其中3组每组6只,分别给予托特罗定4．2rag／（kg·d）、5．3mR／（kg·d）、7mg／（kg·d）。以生理盐水配成悬液分两次灌胃给药,给药容量为1．5ml／100g;剩余2只为对照组,给予同样体积的生理盐水．连续灌胃4周．灌胃期问观察大鼠的一般表现、进食、饮水、体重增长等．灌胃结束后检测主要脏器组织结构和功能变化情况．结果：灌胃期间各组大鼠表现正常。未出现药物引起的死亡;低剂壁组日均进食、饮水量均较其他组明显增多（P〈0．01）;各剂量组体重与对照组比较差异无统计学意义,但足两周后低剂量组体重增长较中剂量组快（P〈0．05）。余各剂量组间比较差异无统计学意义;中、高剂量组肝脏比重较对照组为低（P〈0．05）．余重要器官比重与对照组比较差异无统计学意义;各剂量组肝功能与对照组相比变化不明显;肾功能水平各剂量组血CREA、UREA水平均对照组为低（P〈0．05）;各组主要脏器组织切片病理学观察未见异常改变．结论：自发性高血压大鼠口服托特罗定的中长期耐受性良好。     

托特罗定和坦索罗辛联合治疗良性前列腺增生

目的:良性前列腺增生引起下尿路症状,常伴有膀胱活动过度。本研究旨在评价托特罗定和坦索罗辛联合治疗良性前列腺增生伴膀胱活动过度的疗效。方法:选择经临床确诊的未经治疗的良性前列腺增生患者53例,分成两组,25例患者单用坦索罗辛(0.2mg,口服,每晚1次);28例服用坦索罗辛(0.2mg,口服,每晚1次)和托特罗定(2mg,每天2次)。两组分别在治疗前和治疗12周后行国际前列腺症状评分(IPSS)、生活质量评分(QOL)及最大尿流率(Qmax)测定,并对出现的不良反应进行记录。结果:53例患者均完成了12周的治疗。坦索罗辛单药治疗组IPSS、QOL分别由治疗前的(21.50±5.42)、(4.58±0.94)分下降到治疗后的(14.80±4.21)、(2.78±0.91)分(P均<0.05);而Qmax治疗后显著提高[(12.20±6.60)ml/svs(16.40±5.13)ml/s,(P<0.05)]。储尿期症状评分由治疗前的(9.87±2.38)分下降到治疗后的(6.45±0.63)分(P<0.05)。坦索罗辛+托特罗定联合治疗组IPSS、QOL分别由治疗前的(20.9±5.15)、(4.61±0.86)分降到治疗后的(14.90±5.32)、(2.12±0.87)分(P均<0.05);Qmax由治疗前的(13.30±7.80)ml/s提高到治疗后的(16.70±6.32)ml/s(P<0.05)。储尿期症状评分由治疗前的(10.12±3.10)分下降到治疗后的(4.77±0.75)分(P<0.05)。结论:坦索罗辛能迅速缓解BPH所引起的下尿路症状,而坦索罗辛+托特罗定联合治疗可以更好的减轻BPH所导致的储尿期症状,改善患者的生活质量。     

托特罗定联合吲哚美辛栓剂治疗前列腺术后膀胱痉挛临床观察

目的观察托特罗定联合吲哚美辛栓剂治疗前列腺术后膀胱痉挛临床疗效。方法回顾性分析,将89例前列腺增生术后膀胱痉挛患者随机分为对照组和实验组,对照组患者手术当日口服托特罗定2 mg,2次/d,于拔除导尿管前1 d停药;实验组患者手术当日口服托特罗定2 mg,2次/d,加上吲哚美辛直肠栓剂50 mg纳肛,2次/d,于拔除导尿管前1 d停药。结果实验组在术后72h内膀胱痉挛的发作次数,膀胱痉挛持续时间、膀胱冲洗时间、膀胱冲洗液转清时间均明显优于对照组。结论托特罗定联合吲哚美辛栓剂治疗前列腺术后膀胱痉挛的疗效显著,优于单独应用托特罗定治疗膀胱痉挛的效果。     

托特罗定对于改善留置输尿管支架管引起的下尿路症状的作用

目的评价托特罗定改善留置输尿管支架管患者不适症状的效果。方法 2013年3~12月,共有54例输尿管镜碎石后留置D-J管患者入组本研究。患者随机分为2组。未接受托特罗定治疗的30例患者为空白组,在置管期间接受了托特罗定(4mg/d)治疗的24例患者为治疗组。两组患者在置入支架管和取出支架管前均接受国际前列腺症状评分(IPSS)和世界卫生组织生存质量测定量表简表(WHOQOL-BREF)对患者下尿路症状和生存质量进行评估。结果两组患者在置入支架管前各观察指标比较,差异无统计学意义(P0.05);取出支架管前IPSS平均分空白组为6.60±5.33,治疗组为3.96±3.62,治疗组显著低于空白组(P0.05);生理领域平均分空白组为14.91±2.63,治疗组为16.33±1.67,治疗组显著高于空白组(P0.05)。结论托特罗定可改善D-J管相关下尿路症状以及患者的生活质量。     

3-year followup of urinary symptoms after transurethral resection of the prostate

A total of 84 patients underwent detailed symptom analysis and urodynamic study preoperatively, and 3 and 12 months after transurethral resection of the prostate. In addition, 69 patients were contacted 3 years postoperatively for a detailed symptom analysis. These 3-year data then were compared to earlier evaluations. At 3 years 75 per cent of the patients claimed to have improvement, while 13 per cent stated that they were the same symptomatically. At the 1-year evaluation 84 per cent of the patients believed that they were improved and 10 per cent stated that they were unchanged. At 3 years 18 per cent of the patients had urge incontinence (an increase from 6 per cent at 1 year), while none complained of marked nocturia or frequency. Mean total irritative and obstructive symptoms were minimal and unchanged from the 1-year evaluation. Of the patients 33 per cent noticed decreased or absent erections and most blamed the surgery. One patient required another prostatic resection, while stricture developed in 3 and bladder neck contracture occurred in 6. We conclude that prostatic resection results in reasonable 3-year symptomatic improvement but it is hampered by other complications, including bladder neck contracture and, possibly, impotence.     

Hyponatraemia after transurethral resection of the prostate

Transurethral resection (TUR) syndrome is a complication of transurethral resection of the prostate characterized by bradycardia, hypotension and postoperative confusional state, which is generally attributed to hyponatraemia occurring during or immediately after operation. In a prospective study of 100 consecutive patients undergoing transurethral resection of the prostate, changes in serum sodium were estimated before and after operation and correlated with various parameters including weight of prostate resected, volume of irrigant fluid and resection time. Seven patients showed a significant drop (greater than 10 mmol/litre) in serum sodium: two of these had the clinical features of TUR syndrome and one of them died. The pathogenesis and management of this syndrome are discussed.     

Subacute hyponatraemia after transurethral resection of the prostate

We present a case of subacute hyponatraemia which developed 3 days after a transurethral resection of the prostate. Symptoms consisted of nausea, vomiting and headache. Release of vasopressin due to excessive surgical bleeding, combined with liberal oral and intravenous administration of sodium-free fluids, was considered to be the cause.     

Pubic symphysitis after transurethral resection of the prostate

Purpose

Pubic symphysitis (PS) after urological operations is uncommon. This is a systematic single-institution review of patients with transurethral resection of the prostate (TUR-P) with the aim to determine the incidence of PS after TUR-P and to identify a risk profile.

Materials and methods

In the past 15 years, 12,118 transurethral operations were performed in our department, 33.4 % (n = 4045) were TUR-P, and 84.6 % (n = 3421) had routine suprapubic trocar placement. A systematic retrospective analysis identified 12 patients, who developed PS (0.297 %).

Results

Median age was 69.5 years (64–83). All patients had voiding difficulties. Urine culture had been positive in three cases. All 12 TUR-Ps were monopolar resections, and n = 11 patients had a suprapubic trocar. Median resection weight was 47.5 g (10–100). Two patients had a perforation of the capsule. Histopathological examination revealed chronic prostatitis in nine cases. After 1.0 ± 1.2 months, all patients developed pain in the pubic region. All patients underwent MRI, which suggested PS. Symptomatic and antibiotic medications were administered. Final outcome was resolution of symptoms in all patients after 3.8 ± 5.6 months. No patient retained voiding difficulties.

Conclusion

PS remains a rare complication after TUR-P. We could not identify a single cause for developing PS. In our study, suprapubic trocar placement (11/12), chronic prostatic inflammation (9/12), previous UTI (3/12) and extended resection (2/12) were overrepresented. Inflammatory, thermic and/or surgical damage of the capsule may be causative. Patients require antibiotic and symptomatic medication. However, prognosis for remission is excellent.

     

'Cardiac' enzymes after transurethral resection of the prostate

Postoperative serial determinations of serum total creatine kinase (CK) and the CK-B subunit (by immunoinhibition), and of total lactate dehydrogenase (LD) and isoenzyme LD-1 (by immunoprecipitation), were performed in 16 and 9 patients, respectively, after uncomplicated transurethral resection of the prostate (TURP). Total CK remained unchanged. An early, modest increase in serum CK-B activity, accompanied by an unusually high CK-B/total CK relation, correlated significantly with duration of operation and amount of tissue resected. A slight, early elevation of the total LD level was not accompanied by an increase in LD-1. If the possibility of small increases in CK-B and LD from the prostate is taken into consideration, routine criteria for diagnosing myocardial damage may be applied after TURP.     

七叶皂苷片促进合并组织学炎症的前列腺增生患者术后下尿路症状的改善

目的探讨将七叶皂苷片应用于合并前列腺组织学炎症的前列腺增生（BPH）患者,观察其对经尿道前列腺电切术（TURP）后早期下尿路症状（LUTS）的改善作用。 方法2015年11月至2018年5月,我院116例合并前列腺组织学炎症的BPH患者,随机分为治疗组（n=58）和对照组（n=58）,均行TURP。治疗组在对照组基础上,从手术后第3天起开始口服七叶皂苷片2片/次,2次/d,直至拔导尿管后4周。记录两组患者术前、拔管后第7天和拔管后第28天的国际前列腺症状评分（IPSS）和生活质量（QOL）评分,并记录两组急性尿潴留（AUR）和急迫性尿失禁（UUI）发生的例数。 结果两组患者术后IPSS和QOL评分均较术前有明显下降,但治疗组较对照组的IPSS和QOL评分下降幅度更大,差异有统计学意义（P<0.05）,治疗组发生UUI的例数明显少于对照组,差异有统计学意义（P<0.05）,而两组发生AUR的例数差异无统计学意义。 结论七叶皂苷片可以促进合并前列腺组织学炎症的BPH患者TURP术后早期LUTS的改善。