经尿道内镜术治疗前列腺术后膀胱出口梗阻

目的：探讨经尿道内镜技术治疗前列腺术后膀胱出口梗阻的疗效。方法：采用经尿道内镜术治疗35例前列腺术后（经耻骨上前列腺除30例，经尿道电切5例）排出困难，经尿道膀胱造影或尿道膀胱镜检查证实为前列腺尿道部或膀胱颈狭窄的病人。结果：35例均获成功，拔除尿管后均排悄通畅，无尿液残余，少部分病人有尿频，但经对症处理很快改善。结论：经尿道内镜术处理前列腺术后膀胱出口梗阻安全、可靠，是首选的治疗方法。     

腔内治疗良性前列腺增生开放术后膀胱颈部梗阻15例临床分析

1994～2004年，我科共治疗良性前列腺增生（BPH）开放手术后膀胱颈部梗阻病例15例，其原因与手术中膀胱颈口处理、术后尿道扩张不当有关。均采用经尿道电切治愈。     

前列腺摘除术后排尿困难19例报告

目的 探讨耻骨上前列腺摘除术后排尿困难的原因和治疗方法。方法 回顾性分析19例耻骨上前列腺切除术后排尿困难患者的临床资料。结果 耻骨上前列腺摘除术后排尿困难19例中膀胱颈梗阻10例,后尿道狭窄7例,腺体残留2例。经尿道电切10例,经尿道电汽化5例,开放手术2例,均一次成功治愈。2例仅行尿道扩张。结论 经尿道电切或电汽化是治疗前列腺术后排尿困难的较好方法。     

经尿道电切治疗老年女性膀胱颈梗阻(附19例报告)

老年女性膀胱颈梗阻是一组由不同原因、不同发病机制引起的膀胱出口梗阻综合征。以往我们采用传统的药物治疗和经膀胱行膀胱颈后唇楔形切除术，效果不甚满意。2001年3月～2005年7月，我们使用电切镜经尿道电切手术治疗19例老年女性膀胱颈梗阻，效果满意，现报道如下。     

女性膀胱颈部梗阻的诊断与治疗

为探讨女性膀胱颈部梗阻的病因、诊断及治疗方法。总结１９８１年５月～１９９６年６月收治女性膀胱颈部梗阻病例３２例。２９例经手术治疗，其中２例行膀胱颈ＹＶ成形术，２７例经尿道膀胱颈部后唇切除术，效果满意。结果认为，女性膀胱颈部梗阻病因为纤维组织增生和慢性炎症所致；尿流率检查是客观评价排尿状况的指标；膀胱镜检查为可靠的诊断手段；经尿道膀胱颈部后唇切除为有效的治疗方法。     

经尿道膀胱颈电切女性膀胱出口梗阻(附24例报告)

为探讨女性膀胱出口梗阻的诊断和治疗方法,对24例患者的诊治资料进行分析.24例患者尿动力学和膀胱镜检查显示最大尿流率低,膀胱颈后唇明显抬高,膀胱壁均有不同程度的小梁增生.经尿道膀胱颈电切术治疗后,22例临床症状消失,剩余尿明显减少,2例症状改善.提示尿动力学检查是客观评价女性膀胱出口梗阻的有效指标,经尿道膀胱颈电切术具有手术痛苦小和住院时间短优点.是治疗女性膀胱出口梗阻的首选方法.     

两种术式治疗耻骨上经膀胱前列腺摘除术后膀胱颈挛缩的疗效比较

目的比较治疗耻骨上经膀胱前列腺摘除术后膀胱颈挛缩的两种手术方法的效果。方法采用病例对照研究,开放手术组26例,行开放膀胱颈后唇楔形切除术或后楔形切除加Y-V成形术,经尿道电切组18例,行经尿道膀胱颈电切术。结果开放手术组平均手术时间为(119.8±20.5)m in,术中出血量平均(91.2±30.8)m l,治愈率为80.8%,并发症发生率为26.9%,术后IPSS评分为(11.5±5.2)分;经尿道膀胱电切组平均手术时间为(20.1±3.7)m in,术中出血量平均(5.5±4.0)m l,有效率100%,并发症发生率5.6%,术后IPSS评分为(7.5±1.5)分,明显优于开放手术组(P<0.05)。结论经尿道膀胱颈电切术治疗耻骨上经膀胱前列腺摘除术后膀胱颈挛缩,其梗阻解除彻底,创伤小,出血少,并发症少,恢复快,是一种较好的治疗方法。     

小体积前列腺增生致膀胱出口梗阻电切疗效观察

目的探讨小体积前列腺增生所致膀胱出口梗阻的电切疗效。方法回顾分析19例小体积前列腺增生,行经尿道电切术(TURP)和膀胱颈纤维环切开术(TUIBN)临床资料。结果术后随访,患者IPSS评分及最大尿流率(MFR)均有明显改善,无出血、尿失禁及后尿道狭窄等并发症发生。结论小体积前列腺增生开放手术较难剥离,行经尿道前列腺电切和膀胱颈纤维环切开术是治疗小体积前列腺增生所致膀胱出口梗阻的较理想的术式。     

耻骨上前列腺摘除术后排尿困难的原因与治疗(附22例报告)

报告自１９７２～１９９７年收治耻骨上前列腺摘除术后排尿困难者２２例，以探讨耻骨上前列腺摘除术后排尿困难的原因和治疗办法。其中后尿道狭窄１０例，尿道内口闭锁３例，后唇瓣膜２例，腺体残留２例，增生复发３例，前列腺癌２例。尿道狭窄是排尿困难的主要原因。经冷刀内切开治疗一次成功１１例，冷刀内切开失败改开放手术２例，开放手术４例。认为经尿道冷刀内切开是首选治疗方法     

经尿道等离子体前列腺切除联合抗雄治疗合并膀胱颈梗阻晚期高危前列腺癌

目的 探讨经尿道等离子体前列腺切除联合抗雄治疗合并膀胱颈梗阻晚期高危前列腺癌的临床意义.方法 采用经尿道前列腺等离子切除术、去势术以及间歇雄激素阻断等综合方法治疗合并膀胱出口梗阻的晚期高危前列腺癌患者14例.结果 所有手术均成功施行.术前及术后3个月复查尿动力学指标,患者最大尿流率由(8.0±3.2)ml/s上升为(1...     

前列腺增生术后排尿困难原因分析

目的；分析前列腺增生术后排尿困难的原因，为预防和治疗提供依据。方法：回顾性分析１４例前列腺增生术后出现排尿困难病例的临床资料。结果：９例耻骨上前列腺切除术病例中，膀胱颈梗阻６例，尿道外口一残留和后尿道为性粘连狭窄各１例，５例经尿道前列腺电切术病例中，腺体残留３例，血块堵塞和前尿道狭窄各１例。     

经精囊面吊带悬吊膀胱颈技术在腹腔镜前列腺根治切除术中的应用

目的:探讨经精囊面吊带悬吊膀胱颈技术在腹腔镜前列腺癌根治术中的应用,评价其效果。方法:2013年10月~2014年6月,在12例前列腺癌根治手术中采用经精囊面吊带悬吊膀胱颈技术行膀胱颈离断。记录手术时间、术中出血量、膀胱颈切缘阳性率、术后短期尿控情况及术后并发症的发生。结果:12例患者,平均手术时间(98±21.5)min,平均术中出血量(134±26.4)ml。术后病理报告示膀胱颈切缘均为阴性。术后3个月仅1例发生轻度尿失禁。无尿漏、肾积水等并发症发生。结论:经精囊面吊带悬吊膀胱颈技术用于腹腔镜前列腺癌根治术中膀胱颈的离断安全性好,更好地保留了膀胱颈口,易于其与尿道的吻合,减少了术后并发症的发生。     

前列腺癌患者根治术后尿失禁的预防

目的探讨保护尿道膜部括约肌和神经血管束及重建膀胱颈部对前列腺癌根治术后尿失禁的预防作用。方法对32例前列腺癌采用保护尿道膜部括约肌和前列腺旁神经血管束,并在重建膀胱颈部黏膜充分外翻后的后壁行折叠缝合1针的方法,进行前列腺癌根治术,观察术后尿失禁发生情况。结果经6～72个月随访,全部患者排尿通畅,无肿瘤复发,除2例发生轻度尿失禁外,其余30例在6个月内均恢复尿控能力。结论保护尿道膜部括约肌和前列腺旁神经血管束,在充分外翻膀胱黏膜的重建膀胱颈后壁折叠缝合,能减少前列腺癌根治术后尿失禁的发生。     

前列腺增生术后排尿障碍尿动力学检查

目的 分析前列腺增生术后排尿困难的原因,为预防和治疗提供依据。方法 对38例前列腺增生术后仍有排尿障碍的患者,进行全套尿动力学检查。结果 膀胱逼尿肌功能紊乱10例,尿道狭窄9例,膀胱出口梗阻18例。结论 通尿肌功能紊乱、尿道狭窄是引起术后症状无改善的主要原因。尿动力学检查对术前合理选择病例,术后分析症状原因具有重要价值。     

Bladder neck involvement in pathological stage pT4 radical prostatectomy specimens is not an independent prognostic factor

PURPOSE: Bladder neck invasion by prostate cancer in radical prostatectomy specimens is uncommon and, thus, its influence on disease recurrence has not been well defined. Consequently the classification of bladder neck invasion in the TNM staging system is controversial. We studied our cohort of patients with stage pT4 disease and bladder neck invasion to clarify the true clinical behavior and prognostic significance of bladder neck invasion in radical prostatectomy specimens. MATERIALS AND METHODS: The study group consisted of 4,090 consecutive patients treated with radical prostatectomy at one of our institutions between 1983 and 2001. Median followup was 53.1 months (range 1 to 189). After excluding from analysis patients treated with neoadjuvant androgen withdrawal or preoperative irradiation 72 of the remaining 2,571 (2.8%) with bladder neck invasion were classified with stage pT4 disease and their specimens were reviewed. Progression-free probability was determined by Kaplan-Meier analysis. Using the Cox proportional hazards model the independent prognostic significance of bladder neck invasion was assessed after controlling for pretreatment prostate specific antigen, final Gleason sum, extracapsular extension, surgical margins status, seminal vesicle invasion and lymph node involvement. RESULTS: Of the 72 patients categorized with stage pT4 disease 14 (19%) had poorly differentiated Gleason sum 8 to 10 cancer, 38 (53%) had established extracapsular extension, 24 (33%) had seminal vesicle invasion and 8 (11%) had lymph node involvement. However, 26 patients (36%) had cancer confined to the prostate and 28 (39%) had negative surgical margins except for the bladder neck site. The mean 5-year progression-free probability plus or minus SD in all stage pT4 cases was 68% +/- 7%, which was better than in cases of seminal vesicle invasion (52% +/- 5%, log rank test p = 0.0156) but worse than in those of extracapsular extension (84% +/- 4.1%). Univariate analysis of the stage pT4 cohort revealed that higher prostatectomy Gleason sum, more extensive extracapsular extension and seminal vesicle invasion were significantly associated with an adverse prognosis. However, in a multivariate model that included all radical prostatectomy cases the finding of bladder neck invasion or stage pT4 disease did not independently predict prostate specific antigen recurrence. CONCLUSIONS: Stage pT4 disease comprises a heterogeneous group of tumors with various pathological features and inconsistent outcomes. Assigning the pT4 stage to cases of microscopic bladder neck invasion provides no independent ability for predicting disease progression after adjusting for other adverse disease features. Due to this and previously reported data the definition of stage pT4 disease should be modified in the next version of the TNM staging system.     

Bladder neck reconstruction using an anterior bladder flap in post-prostatectomy incontinence

Bladder neck reconstruction using an anterior bladder flap was used in 10 patients with total diurnal urinary incontinence, persistent 1 year after suprapubic (n = 6) or transurethral (n = 4) prostatectomy. 8 patients achieved symptomatic improvement, 6 of them with excellent or good results. Bladder neck reconstruction is undoubtedly able to correct post-prostatectomy incontinence, provided there is no residual bladder neck obstruction or alteration of the bladder musculature due to previous surgery. These cases should be considered for artificial sphincter implantation.     

A second bladder-neck intervention following open transvesical prostatectomy (author's transl)]

Over a 10-year period 27 patients required a second transurethral revision operation after previous open transvesical prostatectomy. The so-called sphincter-sclerosis, residual and recidivous adenoma, and prostatic cancer were the causes of repeated bladder neck obstruction. Prostatic cancer after prostatectomy seems to be more benign clinically, more differentiated histologically and is diagnosed sooner because it presents with earlier symptoms than does primary prostatic cancer.     

前列腺增生症术后症状无改善的原因分析

目的 :探讨前列腺切除术后症状无改善的原因。方法 :对前列腺切除术后 43例症状无改善患者的临床资料进行分析。结果 :膀胱逼尿肌功能紊乱 1 9例 ,尿道狭窄 1 4例 ,腺体残留 7例 ,膀胱结石 3例。结论 :逼尿肌功能紊乱、尿道狭窄是引起术后症状无改善的主要原因。尿流动力学检查对术前合理选择病例 ,术后分析症状原因具有重要价值。小体积前列腺增生或前列腺增生伴有慢性炎症者 ,宜采用经尿道前列腺电切术治疗 ,以减少术后尿道狭窄的发生。     

Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique

Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.