术中超声监视下尿道内置人镍钛形状记忆合金网状支架治疗前列腺增生症

从1994年2月至1997年5月．采用术中超声监视下尿道内置入镍钛形状记忆合金网状支架治疗高危前列腺增生症合并尿潴留54例，疗效满意。作认为经直肠超声监视较经腹壁超声监视更清晰。采用经直肠超声观察尿道口。对单纯中叶增生使尿道内口前移，或单纯一侧叶增生使尿道内口侧移，应选用特制支架。测量前列腺尿道的长度，以经直肠超声法最为精确．经腹壁超声法及膀胱镜下输尿管导管测量皆有较大的误差。采用膀胱镜式置入作支架置入缺点较多，专利主架种植器能迅速无误地将支架植入选定部位．操作更为简便。     

自制导入器在镍、钛记忆合金网状尿道支架置入术中的应用

作者研制出一种导入器,无需尿道镜先插入尿道,再将镍钛记忆合金网状尿道支架置入器导入尿道,从而将其支架顺利置入前列腺尿道部,以治疗前列腺增生症导致的下尿路梗阻,从1996年1月～12月治疗前列腺增生症24例,22例一次置入成功,17例随访3个月～11个月排尿顺利。该导入器可减少置入器对尿道的损伤,且可反复冲洗膀胱保持视野清晰,因此可提高支架置入成功率,具有使用简便、安全可靠等优点。     

尿道支架治疗前列腺增生尿潴留35例报告

尿道支架治疗前列腺增生尿潴留３５例报告孙玉成，王健，卢金生使用前列腺支架替代长期置管正在受到临床重视。现将我院１９９２年２月至１９９３年４月，经膀胱镜置入钛镍合金支架治疗３５例不能手术患者的方法及临床治疗效果报告如下。材料及设备　采用钛镍记忆合金支架...     

后正中线切开修补前列腺术后直肠尿道瘘一例报告

前列腺手术后发生直肠尿道瘘临床罕见 ,处理困难。我们采用后正中线切开尾骨和直肠肛管后壁入路成功修补 1例 ,现报告如下。患者 ,5 9岁。因良性前列腺增生行耻骨上经膀胱前列腺摘除术 ,术中直肠损伤并予修补。术后第 9天出现直肠尿道瘘 ,即行乙状结肠腹壁造口 ,并拔除导尿管和保持膀胱造瘘管引流通畅 ,4个月后行瘘修补。尿道镜和经膀胱造瘘口膀胱镜检查见瘘口位于膀胱颈后唇和后尿道 ,瘘口最大径约 2 .5cm ,窥镜经瘘口可顺利进入直肠。直肠指检时食指可通过瘘道扪及膀胱内造瘘管。术前 3d更换膀胱造瘘管 ,每天用碘伏溶液冲洗膀胱和直肠1次 …     

记忆合金网状支架治疗高危前列腺增生症112例疗效分析

目的 应用记忆合金网状支架置入后尿道，治疗高龄危重前列腺增生症。方法 镜下准确测量前列腺尿道长度并术中应用改进后的置网器纠正位置不妥的网状支架，必要时应用无创性方法取出网状支架。结果 112例高龄危重前列腺增生患，经记忆合金网状支架置入后，77％患排尿比较满意，尿流率及残余尿量改善。术后近远期急迫性尿失禁和尿道黏膜肉芽组织过度增生阻塞支架管腔是较常见且棘手的并发症。结论 网状支架置入术适用于年老体弱或伴重要脏器疾病不能耐受开放手术。选取网状支架恰当的长度和准确的置入位置是提高疗效的关键。     

镍钛记忆合金网状支架治疗前列腺增生的观察

我院从 1 996年 5月～ 1 998年 5月对 2 8例前列腺增生患者采用镍钛记忆合金网状支架置入治疗 ,取得一定的效果 ,现报告如下。1　资料与方法1 .1 　 临床资料本组 2 8例 ,年龄 70～ 88岁 ,平均 ( 80 .0± 3.7)岁。均有尿潴留病史。辅助检查排除膀胱、尿道及前列腺其他疾病。伴有严重高血压、心脏病者 2 3例 ,肺气肿 5例 ,脑梗塞或脑出血 4例 ,糖尿病 6例 ,肾功能不全 2例。1 .2 　 治疗方法网状支架由北京高忆公司提供。前列腺尿道长度采用尿道镜直视下测定 ,支架置入亦在尿道镜直视下进行。 1 0例配合膀胱造口。术后 1 0例患者继续给予保列…     

记忆合金网状支架治疗高危前列腺增生症尿潴留

目的 探讨记忆合金网状支架治疗前列腺增生症的疗效和适应征。方法 总结１９９４年２月～１９９９年２月应用新型支架、置入器,改进置入技术,汉字９９例高危前列腺增生症伴尿潴留患者的临床疗效。结果 ９７例（９７．９％）有效,ＩＰＳＳ由术前平均３０．６减少至７．８,最大尿流率从术前０增加至１３．８ｍｌ／ｓ,剩余尿从术前尿潴留减少至３０．５ｍｌ。结论 应用新型支架、置入器在经直肠超声监视下置入记忆合金网状支架     

经尿道肾镜下气压弹道联合超声碎石清石术治疗膀胱结石

目的探讨经尿道肾镜下气压弹道联合超声碎石清石术治疗膀胱结石的疗效。方法2005年10月～2008年5月,膀胱结石69例（男63例,女6例）,结石直径1.5～6.0 cm,其中合并前列腺增生55例,神经源性膀胱14例,膀胱憩室结石4例。经尿道置入Wolf F20.8肾镜,采用瑞士EMS公司第3代气压弹道联合超声碎石清石系统治疗膀胱结石69例。气压弹道频率调至8～12 Hz,超声能量设定为50%～60%。合并前列腺增生应用前列腺汽化电切术。结果68例一次碎石、清石成功,手术时间15～40 min,平均25 min。1例膀胱憩室结石术中出现膀胱破裂,改行开放手术。无一例出现尿道狭窄、感染、大出血等严重并发症。68例随访6～10个月,平均9个月,B超或X线腹部平片检查未见结石复发。结论经尿道肾镜下气压弹道联合超声碎石清石术治疗膀胱结石疗效满意。     

前列腺增生伴膀胱结石同期腔内治疗体会(附25例报告)

我院2004年至2006年采用经尿道前列腺等离子体双极电切术(TUPKRP)加经尿道气压弹道碎石术同期治疗25例前列腺增生并膀胱结石患者,取得满意效果,现报告如下。1资料与方法1.1病例资料本组25例,年龄59-81岁,平均70岁。均有典型良性前列腺增生(BPH)的临床症状,术前直肠指检并结合经直肠前列腺彩超检查诊断为Ⅱ-Ⅲ度BPH,经X片检查22例确诊伴膀胱多发性小结石或直径小于3 cm的单发结石。术前常规口服非那雄胺治疗3-7 d。1.2方法患者麻醉后取截石位。置膀胱镜了解尿道、膀胱、前列腺增生情况及结石大小和数目。再改用F8/9.8 wolf输尿管镜,从…     

经电切镜外鞘输尿管镜下钬激光碎石治疗膀胱结石

目的探讨经电切镜外鞘输尿管镜下钬激光碎石治疗膀胱结石的疗效。方法回顾性分析36例膀胱结石患者,其中单纯膀胱结石11例,合并前列腺增生17例,膀胱颈纤维化2例,尿道外口息肉1例,膀胱感染4例,经尿道前列腺电切术后1例,采用经电切镜外鞘置入输尿管镜下钬激光碎石。结果 36例均一次性击碎清除结石,无膀胱穿孔、大出血、尿道狭窄等并发症。结论经电切镜外鞘输尿管镜下钬激光碎石治疗膀胱结石,具有创伤小、操作简单、手术时间短、并发症少等优点,是一种安全、有效的方法 。     

术前导尿降低经直肠前列腺活检术中尿道损伤

目的研究术前导尿对经直肠前列腺穿刺活检术中尿道损伤发生的作用。方法经直肠前列腺穿刺活检患者100例,其中50例术前留置导尿管,其余50例不留置导尿,通过观察术后血尿情况,进而对比两组患者术中尿道损伤发生率。结果术前留置导尿患者肉眼血尿发生率为28%（14/50）,不留置导尿患者为60%（30/50）,两者差异显著。结论术前留置导尿能够降低经直肠前列腺穿刺活检术中尿道损伤的发生。     

Evaluation of transrectal ultrasound in the early detection of prostate cancer

To determine the ability of transrectal ultrasound to detect early localized prostate cancer, unsuspected (nonpalpable) cancer in the contralateral lobe of patients undergoing radical prostatectomy for clinically localized disease was evaluated. A total of 59 patients with palpable prostate cancer clinically confined to 1 lobe underwent transrectal ultrasound before radical prostatectomy and step-sectioning of the radical prostatectomy specimen. Transrectal ultrasound was performed with 5 or 7 MHz. real-time transrectal units. Pathological findings in these 59 cases revealed no tumor in the contralateral lobe in 34 (58%) and the presence of unsuspected tumor in 25 (42%). Transrectal ultrasound detected 13 of 25 unsuspected cancers for a sensitivity of 52%. Of 34 patients with no contralateral lobe lesion transrectal ultrasound was correct in 23 for a specificity of 68%. The positive and negative predictive values for transrectal ultrasound in this study group were 54 and 66%, respectively. There was no significant difference in the pathological size of the clinically suspected and clinically unsuspected cancers as measured by average largest dimension, and transrectal ultrasound sensitivity did not correlate with the size of the cancer. Based on careful sonopathological analysis, transrectal ultrasound may not be a good method to detect clinically unsuspected prostate cancer and the false positive rate would appear to be high.     

Transrectal ultrasound appearance of transitional cell carcinoma involving the prostate

Prostatic involvement with transitional cell carcinoma of the bladder is common. Surveillance for prostatic invasion consists primarily of cystoscopic examination of the urethra. Unfortunately, transitional cell carcinoma may involve other regions of the prostate that are inaccessible by cystoscopy. A total of 58 men with transitional cell carcinoma of the bladder underwent transrectal ultrasound before cystoprostatectomy or, in some cases, ultrasound-guided prostate biopsies and subsequent cystoprostatectomy. Prostatic involvement was found in 20 patients (34.5%). Of those patients 10 (50%) demonstrated prostatic urethra invasion, 7 (35%) stromal invasion, 4 (20%) ejaculatory duct and seminal vesicle invasion, and 3 (15%) involvement of the periprostatic tissues. Invasion of the prostatic urethra was not detected by transrectal ultrasound but 5 of the 7 stromal lesions exhibited hypoechogenicity. All cancer-laden ejaculatory ducts were hypoechoic on ultrasound examination. All cases of periprostatic involvement were also detectable by corresponding areas of hypoechogenicity. Transrectal ultrasound may enhance the surveillance of men with transitional cell carcinoma.     

经直肠超声造影与经直肠常规超声诊断前列腺癌的比较研究

目的:比较经直肠超声造影与经直肠常规超声诊断前列腺癌的各自优势。方法:选择前列腺癌患者213例,年龄54~83岁,平均71岁。检测PSA为4.12~150.00μg/L,平均22.53μg/L。先行经直肠常规超声检查,再行经直肠前列腺超声造影检查,绘制时间强度曲线(TIC曲线),分别判读常规超声和超声造影结果。随后行12针前列腺系统穿刺活检。结果:213例患者中,常规超声诊断前列腺癌123例,超声造影诊断前列腺癌113例,穿刺活检病理确诊前列腺癌99例。常规超声与病理检查的诊断符合率为53.52%,超声造影与病理检查的诊断符合率为80.28%。两种诊断方法敏感度、特异度、假阳性率、假阴性率、漏诊率、病理检查符合率差异均有统计学意义(P0.05)。结论:经直肠超声造影可灵敏显示前列腺血流分布情况,对前列腺癌的诊断有较高的准确性,值得推广使用。     

Prostate cancer: comparison of digital rectal examination and transrectal ultrasound for screening.

A prostate cancer screening study of 315 asymptomatic men comparing digital rectal examination and transrectal ultrasound identified 23 cancers, for a detection rate of 7.3%. Of the cancers 17 (5.4%) were diagnosed by digital rectal examination. Contrary to the experience of others, this was a higher rate than achieved by transrectal ultrasound (14 cases or 4.4%). Systematic multiple needle biopsies of both lobes with ultrasound guidance were routinely performed. As a result of this technique 7 of 23 cancers (30%) were fortuitously diagnosed. In addition, only unilateral disease was suspected in 4 of 7 patients with bilateral disease on biopsy. Digital rectal examination and transrectal ultrasound identified the same number of patients with small (less than 1.5 cm.) cancers, contrary to other reports that found transrectal ultrasound to be superior. Digital rectal examination is considered an effective screening examination, equivalent to transrectal ultrasound and preferable because of lower cost. An algorithm for screening is outlined with digital rectal examination and prostate specific antigen determinations.     

Urethra actively opens from the very beginning of micturition: A new concept of urethral function

Transvaginal or transrectal ultrasound was carried out in an adult female and a male volunteer during micturition. Although the male urethra was enclosed by the prostate, its construction and the function were almost identical to the female urethra. The anterior fibromuscular stroma was not a part of the prostate, but was a part of the urethral muscle. The urethra was surrounded by a thick single muscle unit, developed only on the anterior and lateral sides of the urethra. When the participant wished to urinate, the initial motion was not a bladder contraction, but an active opening of the urethral lumen by the muscle unit. The same unit closed the urethra when continence was kept. In conclusion, the main function of the urethra is thought to be not a closure, but an opening to control the entire micturition process, rather than the bladder being primarily responsible for the control of micturition.     

三维超声在前列腺疾患诊断中的应用：（附301例报告）

应用奥地利Ｃｏｍｂｉｓｏｎ３３０型三维超声诊断仪经腹、经直肠同时观察３０１例前列腺获得高质量的前列腺声象图。直肠途径（ＴＲＡ）超声显像准确率１００％，明显高于腹壁途径（ＴＡＡ），前者能够清晰显示前列腺内部结构；直观尿道排尿发现尿道梗阻动态变化与前列腺体积不成正比，与增生结节压迫程度及部位有关；由于在同一部位可取得三个径线，并自动计算而使前列腺体积测量准确性提高。     

医源性尿道假道的诊断与治疗(附8例报告)

目的：探讨后尿道狭窄并发医源性尿道假道的诊断及治疗方法。方法：对８ 例后尿道狭窄并发尿道假道患者均采用尿道造影及尿道 Ｂ超检查；除 １ 例行直视下尿道内切开加 Ｔ Ｕ Ｒ 术外，余 ７ 例均行开放性手术治疗。结果：７ 例为强行尿道扩张所致，１ 例为不正规膀胱镜操作所致。８ 例经开放性手术或腔内治疗均获成功。结论：经尿道 Ｂ超诊断尿道假道优于尿道造影，而开放性手术治疗更多的是选择旷置假道的手术方式。     

Three-dimensional transrectal ultrasound of the male urethral rhabdosphincter

The rhabdosphincter of the male urethra is an omega-shaped loop of striated muscle fibers that surrounds the membranous urethra at its lateral and anterior aspects. We investigated whether this muscle can be visualized by means of three-dimensional ultrasound to define morphological and dynamic ultrasound criteria. We examined the rhabdosphincter of the male urethra in 77 patients by means of this new imaging technique; 37 patients presented with urinary stress incontinence after transurethral resection of the prostate or radical prostatectomy while 40 were fully continent after radical prostatectomy and served as a control group. Contractility of the muscle was quantified by a specially defined parameter (rhabdosphincter–urethra distance). The anatomical arrangement and the contractions of the rhabdosphincter-loop could be clearly visualized in three-dimensional transrectal and transurethral ultrasound; during contraction the rhabdosphincter retracts the urethra, pulling it towards the rectum. We detected defects and postoperative scarrings in the majority of the patients with postoperative urinary stress incontinence. Furthermore, the patients presented with thinnings in parts of the muscle and atrophies of the rhabdosphincter. The rhabdosphincter–urethra distance was significantly lower in the incontinent group than in the continent group (59 vs. 1.42 mm). Our study shows that the rhabdosphincter of the male urethra can be visualized by means of three-dimensional transrectal ultrasound. The sonographic pathomorphological findings of postoperative urinary stress incontinence are well correlated well with the clinical symptoms     

The value of power Doppler imaging to predict the histologic components of benign prostatic hyperplasia

BACKGROUND: The response of symptoms caused by benign prostate hypertrophy (BPH) to alpha blockade is related to the area density of the smooth muscle of the prostate. If this density could be determined by ultrasound examination, ultrasound might be useful in predicting the efficacy of alpha-blocker therapy. In this study, various ultrasonographic parameters obtained by transrectal method (TRUS) were compared with histologically measured components. METHODS: Before surgery, ultrasonic power Doppler imaging (PDI) of the prostate was performed using a transrectal probe. The volume of total prostate, transition zone (TZ), and the presumed circle area ratio (PCAR) [1,2] were calculated. Pulsatile blood flow was recorded, and the resistive index (RI) was calculated. Based on the serum concentration of total prostate specific antigen (PSA), ratio of PSA to prostate volume (PSAD), and ratio of PSA to TZ (PSAT) were calculated. Prostate tissues were obtained from 26 patients undergoing transurethral resection, suprapubic prostatectomy, or radical cystectomy, and were analyzed by quantitative morphometry. Computer image analysis was used to determine the mean area densities of the smooth muscle (SM), connective tissue (CT), glandular epithelium (GE) and lumen (GL), and vascular lumen (V). Correlations between ultrasonographic parameters and morphometric data were studied. RESULTS: On microscopic examination, the specimens showed a wide variety, ranging from normal prostate to typical glandular hyperplasia. There was a correlation between RI and the ratios of the four components (SM: r = -0.42 P = 0.034; CT: r = -0.42 P = 0.030; GE: r = 0.42 P = 0.032; GL: r = 0.46 P = 0.018). However, correlations between the other five transrectal parameters and the composition of the prostate were not so clear. This may have been because the blood vessels are compressed within the surgical capsule together with the urethra. CONCLUSIONS: The present study demonstrates that when RI is calculated by PDI, it can be quite useful for predicting component ratios, thereby making it possible to predict the therapeutic efficacy of alpha-blockers in individual patients.