The late effect of hysterectomy with or without postoperative radiotherapy on bladder dysfunction in patients with uterine cancer

A serial urodynamic study was performed in 491 patients with uterine cancer following radical hysterectomy (RH) involving postoperative pelvic radiation (RH+RT) and extended hysterectomy (EH) for 10 years after these respective treatments. The following evidence is presented: (1) increased volume of residual urine and sensory impairment occurred 1–2 months after radical hysterectomy with or without radiation, but was rarely seen in the EH group: (2) increased residual urine volume in the RH group gradually subsided 1–3 years after the treatment, while the RH+RT treatment resulted in a slight reduction: (3) late maximum cytometric capacity in the EH and RH groups remained stable throughout the study, but the RH+RT group showed a lower capacity (P<0.05) than the EH group, except in one set of determinations. (4) a high incidence of low bladder compliance in the RH group at 1–2 months decreased thereafter, whereas in the RH+RT group bladder compliance remained poor (23%) up to 7–10 years after treatment. In the EH group low bladder compliance was rarely seen: (5) sensory impairment, urinary incontinence and difficulty on urination remained unimproved in many patients in the RH+RT group, while the incidence of subsequent urological operations in the EH group was lower (P<0.05) than in the RH+RT group. Based on these findings, EH appears to be more beneficial for the retention of normal bladder function and radical hysterectomy with postoperative radiation results in deterioration of bladder activity.Editorial comment: We are gradually learning more about the effects of both radical hysterectomy and radiation therapy on urethrovesical function. It has been fairly well established that radical hysterectomy has variable effects on bladder function. However, less radical procedures have been less well studied and predictably would have a lesser effect than the more radical procedures, as is shown by this study. In addition, the effects of radiation therapy would be expected to be additive to the effects of whatever surgery was performed, with emphasis on the causation of detrusor malfunction, especially a decrease in capacity and compliance. This has been borne out here in this study of 491 patients. This was a difficult study to perform and adds avaluable information to our understanding of urethrovesical function in these circumstances.     

Prospective evaluation of the management of bowel dysfunction in children with neuropathic lower urinary tract dysfunction and its effect on bladder dynamics

Introduction and Aim

Children with neuropathic lower urinary tract dysfunction usually suffer from associated bowel dysfunction, urinary tract infection and vesicoureteral reflux. This work aimed to highlight the impact of bowel management on bladder dynamics.

老年患者全麻非心脏手术后短期认知功能障碍29例临床分析

目的探讨老年患者全麻非心脏手术后认知功能障碍（POCD）发病相关因素及防治措施。方法分析发生术后认知功能障碍的29例全麻非心脏手术老年患者（65岁以上），ASA分级Ⅰ～Ⅲ级。年龄（78．4±13．8）岁，65～70岁7例，70～75岁10例，75岁以上12例。体重（58．4±18．2）kg。术前大部分有焦虑情绪，但无POCD。普外科手术4例、泌尿外科手术5例、普胸外科手术9例、骨外科手术8例、妇科手术3例。术前用药为苯巴比妥钠0．1、东莨菪碱0．03mg／kg，全麻诱导采用咪唑安定、异丙酚、芬太尼、维库溴铵；维持采用静吸复合，异丙酚、维库溴铵靶控输注、辅吸异氟醚。结果患者症状出现在术后3d内，21例持续到术后7d，表现为精神错乱、人格改变等。症状以夜间为重。确诊POCD后，立即进行积极治疗。19例给予安定或咪唑安定5～15mg分次静注有效，7例用咪唑安定无效，改用异丙酚静脉持续泵注1～2mg／（kg·h）。其余10例密切观察病情，未行药物治疗。至出院，全组无一例有严重的精神系统后遗症。结论POCD是老年患者术后常见的并发症，围术期必须进行积极的预防和治疗。     

Management of bladder dysfunction and satisfaction of life after spinal cord injury in Norway

Background

There is limited knowledge about bladder dysfunction and bladder management in persons with spinal cord injury (SCI) after discharge from the hospital in Norway. The impact of bladder dysfunction on satisfaction of life has been rarely explored.

Setting

Community-based survey from Norway.

Methods

An anonymous cross-sectional postal survey. A questionnaire was sent to the registered members of the Norwegian Spinal Cord Injuries Association. A total of 400 participants, with traumatic or non-traumatic SCI, received the questionnaire.

Results

A total of 248 subjects (62%), 180 men and 68 women, answered the questionnaire. Mean age was 54 years and mean time since injury 13.4 years. A total of 164 participants (66.1%) used intermittent catheterization for bladder emptying (48.5% women versus 72.8% men); more paraplegics than tetraplegics (77.2% versus 55.7%). Recommendations given at the Spinal Cord Units were thoroughly followed by persons who had used catheters more than 5 years. Use of incontinence pads were associated with reduced satisfaction of life.

Conclusions

The most common method of management of bladder dysfunction is clean intermittent catheterization in Norway. Recommendations were followed more thoroughly by persons who have used intermittent catheterization for more than 5 years. Spinal Cord Units are important source for information and guidance.     

The clam enterocystoplasty in the treatment of idiopathic detrusor instability

Enterocystoplasty is being used increasingly frequently in the treatment of both idiopathic detrusor instability and neuropathic bladder dysfunction. After operation, most patients with idiopathic detrusor instability and disabling urinary incontinence refractory to previous treatments, experience improvements in continence and urgency, but residual symptoms are common. Detrusor instability can be demonstrated in over half of patients after operation, but significant decreases in the severity of instability are found after operation as assessed by the volume at first unstable contraction.Enterocystoplasty is a major operation with the potential for postoperative morbidity and mortality. In addition, the improvements in symptoms are bought at a price: increases in residual urine are common, and in the long term many patients need to perform clean intermittent self-catheterization, and some experience recurrent urinary infections. Patients about to undergo enterocystoplasty should be carefully selected and should be trained in the use of CISC. In selected patients with severe refractory idiopathic detrusor instability, the procedure can yield satisfactory results.     

Management of bladder dysfunction and satisfaction of life after spinal cord injury in Norway

Abstract

Background

There is limited knowledge about bladder dysfunction and bladder management in persons with spinal cord injury (SCI) after discharge from the hospital in Norway. The impact of bladder dysfunction on satisfaction of life has been rarely explored.

Setting

Community-based survey from Norway.

Methods

An anonymous cross-sectional postal survey. A questionnaire was sent to the registered members of the Norwegian Spinal Cord Injuries Association. A total of 400 participants, with traumatic or non-traumatic SCI, received the questionnaire.

Results

A total of 248 subjects (62%), 180 men and 68 women, answered the questionnaire. Mean age was 54 years and mean time since injury 13.4 years. A total of 164 participants (66.1%) used intermittent catheterization for bladder emptying (48.5% women versus 72.8% men); more paraplegics than tetraplegics (77.2% versus 55.7%). Recommendations given at the Spinal Cord Units were thoroughly followed by persons who had used catheters more than 5 years. Use of incontinence pads were associated with reduced satisfaction of life.

Conclusions

The most common method of management of bladder dysfunction is clean intermittent catheterization in Norway. Recommendations were followed more thoroughly by persons who have used intermittent catheterization for more than 5 years. Spinal Cord Units are important source for information and guidance.     

Post-irradiation bladder dysfunction: development of a rat model

Summary The aim of this research was to establish a small animal model for the functional and morphological study of post-irradiation bladder dysfunction. Young adult female Wistar rats were X-irradiated with single doses of 10, 15, 20 or 25 Gy. Filling cystometry was performed to assess changes in reservoir function: the volume infused to produce a rise in intravesical pressure of 5 cmH₂O was calculated as an index of compliance. A biphasic reduction in this index was noted in animals receiving 15–25 Gy; the first reduction developed at about 4 weeks, and the second started at 3–4 months and persisted at 6 months. Bladder tissue was taken at this time (6 months post-irradiation) for morphological study. Histological examination demonstrated an increased mast cell density in the irradiated bladders, but was otherwise non-specific; fibrosis was discernible in only half of the 18 animals studied. Electron microscopy showed focal degeneration of smooth muscle cells, and in some areas there was selective degeneration of unmyelinated axon profiles. The biphasic reduction in the compliance index is consistent with the timing of the symptoms of the acute and late irradiation reactions reported by radiotherapy patients. Changes in axon profiles and mast cell density may be of functional significance.     

综合手术治疗逼尿肌无反射性神经原性膀胱(附10例报告)

本组报告10例,采用经尿道内括约肌切断术和腹直肌转位术的综合手术治疗尿道内括约肌痉挛型的逼尿肌无反射性神经原性膀胱。手术特点:能解除膀胱出口梗阻,改善膀胱逼尿肌的功能障碍。术后病人能自行排尿,术前反复发作急性尿路感染术后均得到控制,术后血肌酐、尿素氮正常者9例,术后残余尿量均小于50ml,最大尿流率15～20ml/s,最大尿道闭合压较术前平均下降7.42kPa,功能性尿道长度较术前平均缩短2cm。     

雄性兔膀胱出口部分梗阻所致逼尿肌功能障碍的研究

目的探讨膀胱出口部分梗阻所致逼尿肌功能改变.方法取新西兰雄性白兔14只,梗阻组和对照组各7只.梗阻组行手术人为造成膀胱出口部分梗阻,饲养5周后解剖膀胱,测定膀胱重量、容量;检测逼尿肌功能;对膀胱逼尿肌细胞超微结构进行观察.结果梗阻组膀胱重量为(12.129±1.627)g,对照组膀胱重量为(3.762±1.067)g(P＜0.05);梗阻组膀胱容量为(64.000±6.272)m1,对照组膀胱容量为(94.432±12.850)ml(P＜0.05);单位重量膀胱逼尿肌对各种刺激反应性均明显下降(P＜0.05或P＜0.01);梗阻膀胱逼尿肌细胞中粗面内质网明显扩张,线粒体水肿.结论通过手术可人为建立膀胱出口部分梗阻动物模型;膀胱出口部分梗阻将导致逼尿肌功能障碍;逼尿肌功能变化与其形态学变化相关.     

同期手术治疗良性前列腺增生并膀胱结石27例报告

目的:探讨良性前列腺增生(benign prostatic hyperplasia,BPH)并膀胱结石的治疗方法及疗效。方法:27例患者中8例用电切镜直接夹取结石,13例经尿道碎石,6例行耻骨上小切口切开取石术,同期均行经尿道前列腺电切术(transure-thral electroresection of prostate,TURP)联合经尿道前列腺汽化电切术(transurethral electrovaporization of prostate,TUVP)。结果:手术均获成功,术中无膀胱穿孔,术中、术后无电切综合征发生,无结石残留,术后3~5d拔除导尿管。结论:对BPH合并膀胱结石的患者,根据结石的直径、数量采取经尿道取石、碎石或经耻骨上小切口取石,同期行TURP联合TUVP治疗BPH,能缩短手术时间,减少并发症。     

两种膀胱灌注方法在浅表性膀胱癌TUR-BT术后的疗效比较

目的 比较吡柔比星（THP）、羟基喜树碱（HCPT）交替疗法及其联合疗法在浅表性膀胱癌术后治疗的疗效.方法 收集2003年5月至2009年5月来本院诊治的113例浅表性膀胱肿瘤患者的临床资料,均行经尿道膀胱肿瘤切除术（TUR-BT）,术后均应用THP＋ HCPT交替法或THP＋ HCPT联合法膀胱内灌注治疗,随访3年,观测两组在3、6、9、12、18、24、36个月时的肿瘤复发率及灌注期间的不良反应发生率.结果 THP＋ HCPT联合组、THP＋ HCPT交替组术后3、6、9、12、18、24、36个月患者的复发率分别为：3.5％、0.0％,8.8％、1.8％,14.0％、1.8％,15.8％、3.6％,19.3％、5.4％,22.8％、8.9％,28.1％、12.5％. THP＋ HCPT交替组的术后复发率低于THP＋ HCPT联合组,术后9个月后两组间的差异均有统计学意义（P＜0.05）.两组尿路刺激症状发生率分别为43.8％、25.0％（P＜0.05）,血尿发生率分别为14.0％、1.8％（P＜0.05）,肝功能损害发生率分别为3.6％、1.8％（P＞0.05）,肾功能损害的发生率分别为5.3％、1.8％（P＞0.05）.结论 浅表膀胱癌在行TUR-BT后,膀胱内灌注THP＋ HCPT交替法预防膀胱癌术后复发疗效确定,较THP＋HCPT联合法复发率低,毒副作用亦低,可能具备一定的临床推广价值.     

沙培林膀胱灌注对浅表性膀胱癌患者术后疗效观察

目的 研究沙堵林(OK-423)膀胱灌注预防浅表性膀胱癌术后的疗效及安全性.方法 将78例浅表型膀胱癌患者随机分成两组.沙培林组(40例)术后1周开始常规灌注沙培林5KE,膀胱内灌注保留2h,每周1次连续6周,之后每月1次连续8个月.对照组(38例)灌注吡柔比星30mg,灌注方法 同沙墙林组.结果随访6～36个月.原发...     

老年脊柱手术患者术后早期认知功能障碍的影响因素分析

目的研究老年脊柱手术患者术后早期认知功能障碍(POCD)的影响因素。方法选择2012-04-2015-10期间在我院接受脊柱手术的老年患者68例为研究对象,通过简易精神状态量表(MMSE)评分来判断认知功能障碍,采集临床信息并分析认知功能障碍的影响因素。结果 68例患者中,发生POCE15例,发生率22.06%;单因素分析显示:POCD组患者的年龄、受教育年限、术后血糖水平高于非POCD组,合并糖尿病多于非POCD组(t/x~2=6.119~13.061,P0.05),性别、BMI、合并高血压、合并冠心病、麻醉时间、手术时间以及术后谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(Scr)、尿素氮(BUN)水平无统计学意义(t/x~2=0.070~0.8541,P0.05);Logistic回归分析显示:高龄、术后血糖水平高、合并糖尿病是POCD发生的危险因素,受教育年限长是POCD发生的保护因素(OR=0.361~2.581,95%CI=0.185~3.295,Wals X~2=9.385~12.885,P0.05)。结论高龄、受教育年限短、糖代谢异常的老年脊柱手术患者更加容易发生术后早期认知功能障碍,应当针对高危人群进行早期预防、严格控制围手术期血糖水平。     

术后早期肠系膜静脉血栓形成的诊断与治疗

目的 分析腹部术后早期肠系膜静脉血栓形成的临床特点及诊断与治疗。方法 回顾性总结我院14年间7例腹部术后早期肠系膜静脉血栓形成患者的临床资料。结果 患者均体胖，主要临床表现为持续剧烈的腹痛和呕吐，腹部体征相比较轻；有2例甚至出现全身中毒症状。腹部X线检查均提示肠梗阻；4例腹部CT检查，其中3例提示本病；6例术前腹腔穿刺出血性液体。7例患者均予以手术探查，分别切除长度不一的坏死小肠段。2例术后出现短肠综合征，其中1例因严重营养不良，衰竭死亡。4例术后反复出现门静脉、肠系膜静脉和髂静脉血栓，需出院后长期服用肠溶阿斯匹林或华法令钠。结论 术后早期肠系膜静脉血栓形成在临床上无何特异性的症状和体征，极易误诊。治疗方面应强调及时地剖腹探查并配合使用全身性的抗凝溶栓药物。     

手术切除配合术后早期放疗对瘢痕疙瘩的疗效分析

目的:观察手术切除结合早期放射治疗瘢痕疙瘩的临床效果。方法:对87例瘢痕疙瘩采用瘢痕疙瘩直接切除后放疗,术后12～24h内开始对手术部位给予电子线照射治疗。结果:瘢痕疙瘩术后放疗切口无明显缝线反应,愈合良好,切口愈后呈细线状,术后随访4个月～3年,所随访病例手术部位均未见瘢痕疙瘩复发。结论:手术切除配合术后早期放疗是治疗瘢痕疙瘩的有效方法。     

胆囊切除术后Oddi括约肌功能障碍的诊治

目的 探讨胆囊切除术后Oddi括约肌功能障碍的诊断和治疗效果。方法 回顾性分析10例胆囊切除术后Oddi括约肌功能障碍的临床资料,全组均施行MRCP和定量动态肝胆核素闪烁扫描、胆道排泄试验。结果 10例均经施行Oddi括约肌切开术,其中开腹Oddi括约肌切开成形术6例,内镜下Oddi括约肌切开术（EST）4例,全部治愈。结论 定量动态肝胆核素闪烁扫描、胆道排泄试验和MRCP是可取的诊断方法;内镜下Oddi括约肌切开术或开腹Oddi括约肌切开成形术是有效的治疗措施。     

苯扎溴铵和吡柔比星膀胱灌注预防浅表性膀胱癌术后复发的疗效比较

目的:比较苯扎溴铵(BB)和吡柔比星(THP)膀胱内灌注预防浅表性膀胱移行细胞癌(SBTCC)术后复发的有效性及安全性.方法:将120例SBTCC患者术后随机分成2组,BB组60例,术后立即膀胱内灌注1‰BB 300ml,并保留灌注液15分钟,共1次.THP组60例,THP30 mg溶于50 mL生理盐水中,膀胱灌注,每周1次,共8次,然后改为每月1次,持续1年.定期膀胱镜检查进行随访.结果:随访24个月,BB、THP组的复发率分别为6.6%和20.0%,BB组明显低于THP组(P＜0.05),其中高分化、单发、初发肿瘤、BB膀胱灌注较低分化、多发、复发肿瘤以及THP膀胱灌注的复发率低.而肿瘤大小和手术方式对患者的复发率的影响无差异.BB组的尿路刺激症状、血尿和WBC＜4×109/L发生率分别为5.0%、1.7%和0,THP分别为16.7%、11.7%和8.3%,BB组低于THP组(P＜0.05).2组肝肾功能受损发生率无差异.结论:BB膀胱灌注预防SBTCC术后复发的效果明确,疗效较THP好,费用低廉,无明显全身毒副作用,患者耐受性好.由于观察病例数较少,随访时间不长,远期疗效如何有待进一步积累临床资料和长期随访.     

绿激光汽化治疗浅表性膀胱肿瘤

目的：总结应用绿激光（KTP）治疗浅表性膀胱肿瘤的安全性,可靠性及有效性。方法：2004年2月～2006年4月,采用Laserscope公司的KTP激光,经尿道汽化治疗73例浅表性膀胱肿瘤,男66例,女7例,年龄34～87岁（平均70岁）。肿瘤单发55例,多发18例。病理分级G1～G2,分期T1～T2,肿瘤直径0.3～3.5cm。40例伴有心肺疾病。结果：所有患者均可耐受手术。手术平均时间25min,术中出血量少,无闭孔神经反射、继发出血等并发症,1例因膀胱憩室内肿瘤发生膀胱穿孔。术后均行膀胱内灌注化疗。术后随访3～24个月,平均15个月．复发5例,均在汽化以外部位,复发率7％。结论：经尿道绿激光汽化治疗膀胱肿瘤具有操作简单,疗效确切,术中、术后无严重并发症等优点,尤其适合伴有严重心肺功能异常的老年患者。     

The effects of dopamine infusion during operation on the postoperative liver dysfunction

Dopamine improves renal function and renal blood flow by increasing cardiac output but its effect to ameriolate postoperative liver dysfunction has not yet been defined. Effect of 3–5µg·kg^–1·min^–1 dopamine was studied in 22 patients who had total gastrectomy (dopamine group), and was compared with 22 patients who underwent the same operation and without dopamine infusion (control group).Liver function was evaluated from serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) values. Although postoperative SGOT and SGPT values in both groups were increased significantly higher than the preoperative values, the increases in SGOT (40 ± 14IU) and SGPT (32 ± 15IU) values in the dopamine group were significantly less than those in the control group (67 ± 27IU, 43 ± 19IU) (P < 0.05, P < 0.01).In conclusion, these results suggested that this observation might be explained by amelioration of the postoperative liver dysfunction by infusion of dopamine. Dopamine infusion at a small dose during upper abdominal surgery is benefitial for liver function.(Sari A, Kawai K, Nagayama M, et al.: The effects of dopamine infusion during operation on the postoperative liver dysfunction. J. Anesth 5: 388–391, 1991)