经尿道膀胱颈电切术治疗慢性前列腺炎并发膀胱颈梗阻疗效观察

目的 :探讨经尿道膀胱颈电切术治疗慢性前列腺炎并发膀胱颈梗阻的治疗效果。方法 :采用经尿道膀胱颈电切术治疗慢性前列腺炎并发膀胱颈梗阻 11例。 11例慢性前列腺炎病史平均1.67± 0 .34年 ,尿流动力学检查最大尿流率为 11.2 0± 1.33ml/ s,膀胱镜检查见膀胱颈后唇抬高。结果 :术后 1个月复查 ,最大尿流率上升至 19.30± 0 .61ml/ s,前列腺按摩液和精液常规检查未见异常。结论 :对膀胱颈梗阻的男性青壮年患者 ,经药物治疗无效后可慎重选用经尿道膀胱颈电切术来解除膀胱颈梗阻。     

经尿道电切术治疗女性膀胱颈器质性梗阻

目的:探讨女性膀胱颈器质性梗阻经尿道电切术的疗效。方法:采用经尿道膀胱颈部电切术治疗女性膀胱颈器质性梗阻46例。结果:41例获随访,随访时间6个月~24个月,排尿症状均明显改善。尿动力学检查:最大尿流率>19ml/s、平均尿流率>9ml/s、剩余尿量<50ml,均明显改善,未发生尿失禁和尿瘘等并发症。结论:经尿道膀胱颈部电切术是治疗女性膀胱颈器质性梗阻的最佳方法。     

经尿道电切术治疗女性膀胱颈梗阻24例

目的:探讨经尿道电切治疗女性膀胱颈梗阻的治疗效果。方法:采用经尿道电切术(TUR)治疗女性膀胱颈梗阻24例。结果:显示所有患者拔管后恢复正常排尿,最大尿流率(Qmax)为(4.6±1.2)mL/s上升至(18.6±1.2)mL/s(P<0.01)。结论:经尿道电切术是治疗女性膀胱颈梗阻理想的新的电外科技术,疗效显著,有创伤小、恢复快、很少发生并发症等优点,可重复进行,易于被患者接受。     

女性膀胱颈器质性梗阻38例报告

自 198 7至 2 0 0 2年 ,我们采用经尿道膀胱颈电切术治疗女性膀胱颈器质性梗阻 38例 ,疗效满意。现报告如下。材料与方法　本组 38例。年龄 4 2～ 78岁 ,平均 5 9岁 ,其中 >6 0岁 2 2例。病程 6个月～ 18年 ,平均 6 .5年。患者均有不同程度的排尿困难 ,表现排尿费力、尿流缓慢、尿潴留 ,充盈性尿失禁并伴有尿频、夜尿次数增多及急迫性尿失禁等。急性尿潴留 6例 ,慢性尿潴留 9例。排除引起下尿路梗阻的其他病变。尿流率 (UFR)测定 2 7例 ,最大尿流率(Qmax) 7～ 15ml/s,平均 9.6ml/s,均呈低平梗阻曲线 ;排尿时间 (T) 33～ 186s,平均 6 3.4s…     

经尿道双极等离子电切术治疗女性膀胱颈梗阻的临床分析

目的探讨经尿道双极等离子电切术治疗女性膀胱颈梗阻的疗效。方法采用经尿道膀胱颈电切术(TURBN)加钩状电极颈口切开治疗63例女性膀胱颈梗阻。术前均行尿流动力学检查和膀胱镜检查,45例行经尿道膀胱颈后唇切除术,18例行经尿道膀胱颈后唇切除术加膀胱颈12点位纵行切开术。结果平均手术时间15(10～46)min,失血<10ml,无水中毒及尿失禁发生。术后病理报告为膀胱颈黏膜下纤维组织增生伴玻璃样变性,部分平滑肌变性增生及黏膜下炎性细胞浸润。本组63例均获随访,平均13.5(1～24)个月,治疗后生活质量评分由4.3±1.2降至1.6±0.5(P<0.01),最大尿流率由4.8±2.6ml/s升至19.2±5.8ml/s(P<0.01),残余尿量由320.5±168.5ml降至26.3±16.4ml(P<0.01)。结论经尿道双极等离子电切术是治疗女性膀胱颈梗阻的有效方法。     

经尿道双极等离子电切术治疗女性膀胱颈梗阻(附18例临床分析)

目的探讨经尿道双极等离子电切术治疗女性膀胱颈梗阻的疗效。方法采用经尿道双极等离子膀胱颈电切术治疗18例女性膀胱颈梗阻患者。结果平均手术时间16(11～48)min,失血<10ml,无水中毒及尿失禁发生。术后病理报告为膀胱颈粘膜下纤维组织增生伴玻璃样变性,部分平滑肌变性增生及粘膜下炎性细胞浸润。本组18例患者均获随访,平均12(4～23)个月,治疗后生活质量评分由4.2±1.1降至1.7±0.5(P<0.01),最大尿流率由(3.8±2.9)ml/s升至(16.0±6.4)ml/s(P<0.01),残余尿量由(355.5±196.5)ml降至(34.5±18.9)ml(P<0.01)。结论经尿道双极等离子电切术是治疗女性膀胱颈梗阻有效的腔内治疗方法。     

经尿道电切术治疗女性膀胱颈梗阻12例

目的探讨经尿道电切治疗女性膀胱颈梗阻的疗效。方法对12例女性膀胱梗阻患者行径尿道膀胱颈电切术治疗,年龄51±13岁,病程3个月-5年,尿流率3.8±11.4ml／s,残余尿200-800ml术后随诊6个月以上。结果手术均获成功,手术时间15-50min,平均25min,术中出血〈20ml。12例患者排尿症状评分,最大尿流率平均18ml／s,残余尿均〈50ml。最大尿流率、残余尿量等均较术前显著改善,随访无尿失禁、尿瘘发生。结论经尿道电切术治疗女性膀胱颈梗阻疗效显著,并发症少。     

经尿道低温双极等离子技术治疗前列腺增生术后膀胱颈挛缩

目的 探讨经尿道低温双极等离子技术治疗前列腺增生术后膀胱颈挛缩的疗效.方法 前列腺增生术后膀胱颈挛缩患者共35例,采用等离子探针式电极和等离子袢状电切环两种设备经尿道分别置入后切除膀胱颈后唇瘢痕组织,扩大膀胱颈口.结果 所有患者术后症状均得到改善,最大尿流率(18.1±3.3)ml/s和平均尿流率(8.4±1.3)ml/s,均高于术前,差异具统计学意义(P＜0.05);随访9至30个月,除2例复发经再次手术治愈外,其余均一次治愈.结论 经尿道低温双极等离子技术治疗前列腺增生术后膀胱颈挛缩,是一种安全、疗效确切的微创手术方法.     

经尿道双极等离子电切术治疗女性膀胱颈梗阻的临床分析

目的探讨经尿道双极等离子电切术治疗女性膀胱颈梗阻的疗效。方法采用经尿道膀胱颈电切术（TURBN）加钩状电极颈口切开治疗63例女性膀胱颈梗阻。术前均行尿流动力学检查和膀胱镜检查,45例行经尿道膀胱颈后唇切除术,18例行经尿道膀胱颈后唇切除术加膀胱颈12点位纵行切开术。结果平均手术时间15（10～46）min,失血〈10ml,无水中毒及尿失禁发生。术后病理报告为膀胱颈黏膜下纤维组织增生伴玻璃样变性,部分平滑肌变性增生及黏膜下炎性细胞浸润。本组63例均获随访,平均13.5（1～24）个月,治疗后生活质量评分由4.3±1.2降至1.6±0.5（P〈0.01）,最大尿流率由4.8±2.6ml/s升至19.2±5.8ml/s（P〈0.01）,残余尿量由320.5±168.5ml降至26.3±16.4ml（P〈0.01）。结论经尿道双极等离子电切术是治疗女性膀胱颈梗阻的有效方法。     

经尿道膀胱颈电切术治疗女性膀胱颈梗阻

目的探讨经尿道膀胱颈电切术(TURBn)治疗女性膀胱颈梗阻的疗效。方法采用经尿道膀胱颈电切术治疗女性膀胱颈梗阻52例。结果52例均一次性手术成功,拔除尿管后排尿通畅,无尿失禁。随访6~48个月,疗效稳定。结论经尿道膀胱颈电切术治疗女性膀胱颈梗阻,疗效确切、安全、损伤小、痛苦小、恢复快。     

经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察

目的:评估经尿道膀胱颈内切开术治疗女性原发性膀胱颈梗阻(PBNO)的长期疗效。方法:56例女性患者通过排泄性膀胱尿道造影及尿动力学检查确诊为PBNO,在膀胱颈上选取2点及10点位置,所有患者行经尿道膀胱颈内切开术。结果:术后随访6~72个月(平均26.2个月)。56例接受手术的患者中47例(83.9%)术后恢复良好,未见严重并发症。随访过程中,平均国际前列腺症状评分(IPSS)由21.2降至7.6(P<0.05),生活质量评分(QOL)由4.2降至2.3(P<0.05),最大尿流率(Q_max)由8.63ml/s增至17.36ml/s(P<0.05),残余尿量(PVR)由106.32ml降至21.46ml(P<0.05),最大尿流率时逼尿肌压力(Pdet at Q_max)由68.42cmH_2O降至19.86cmH_2O(1cmH_2O=0.098kPa,P<0.05)。术后出现的并发症有血尿、二次行膀胱颈内切开术、压力性尿失禁、尿道狭窄。所有这些并发症按Clavien分类评估为Ⅲa级。3例(5.3%)术后出现出血,经延长尿管留置时间、膀胱冲洗治愈,均未输血治疗;4例(7.1%)出现压力性尿失禁,行经阴道无张力尿道中段吊带术后恢复;4例(7.1%)出现尿道狭窄,间断尿道扩张后好转。结论:PBNO不常见,排泄性膀胱尿道造影及尿动力学检查可确诊,通过经尿道膀胱颈内切开术治疗安全有效。在膀胱颈的2点和10点方向仔细地、足够深度地行颈内切开可以保证手术的成功。     

经尿道膀胱颈电切术治疗慢性前列腺炎合并膀胱颈梗阻

目的探讨经尿道膀胱颈电切术治疗慢性前列腺炎合并膀胱颈梗阻的临床效果。方法经尿道膀胱颈部电切术治疗慢性前列腺炎合并膀胱颈梗阻23例,并进行术前术后临床症状和尿流动力学检查及对比。结果所有患者术后排尿通畅,效果满意。随访1～3个月,最大尿流率由（10．78±1．35）mL／s上升至（21．30±0．63）mL／s,差异有统计学意义（P〈0．05）;前列腺液及精液检查正常。结论对于慢性前列腺炎合并膀胱颈梗阻患者经药物治疗无效后,可选用经尿道膀胱颈部电切术治疗膀胱颈梗阻。     

膀胱颈部梗阻的腔内手术治疗

目的：评价腔内手术治疗膀胱颈部梗阻（BNO）的长期疗效。方法：采用经尿道膀胱颈部切除术（TURN）治疗BNO44例。结果：44例平均随访48个月。1次手术治愈33例；复发4例，经再次或3次手术治愈；无效7例。总有效率84％，复发率11％。结论：TURN治疗BNO远期疗效满意，伴慢性前列腺炎及女性BNO者手术应慎重，部分患者术后需辅以激素补充疗法及长期尿道扩张以预防症状复发。     

经尿道针状电极膀胱颈内切开治疗膀胱颈挛缩

目的:探讨治疗膀胱颈挛缩的有效手术方法。方法:对17例膀胱颈挛缩患者行经尿道针状电极膀胱颈内切开术。结果:17例患者术后无明显残余尿,最大尿流率为12.3~27.2ml/s,主诉症状好转。结论:经尿道针状电极膀胱颈内切开治疗膀胱颈挛缩,疗效确切,术后不易复发。     

Complications of endoscopic bladder neck suspension

Endoscopic bladder neck suspension for female urinary incontinence can result in both intraoperative and postoperative complications. Intraoperative complications include hemorrhage and injury to the urethra, bladder or ureters. Postoperative complications include infection, myocardial infarction, pulmonary embolus, suprapubic pain, persistent incontinence, bladder calculi and urinary retention. All of these potential complications can be managed successfully by applying the guidelines outlined.     

女性膀胱颈梗阻的诊断与治疗

目的：探讨女性膀胱颈阻的诊断和治疗方法。方法;对２７例女性膀胱颈梗阻患者行尿流动力学检查和膀胱检查,对其中２２例行经光颈电切术（ＴＵＲＢｎ）５例行非选手治疗。结果：２２例行ＴＵＲＢＮ治疗者术后无明显乘余尿,２０例临床症状消失;５例非手术治疗者经定期饔主药物治疗,效果满意。结论：女性膀胱颈梗阻的尿流动客观评价排尿状况的有效指标;ＴＵＴＢＮ是治疗女性膀胱劲梗阻的首选方法,具有手术小和住院时间短等优点。     

Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck

PURPOSE: We describe the presentation, clinical characteristics, treatment and followup of a series of women with primary bladder neck obstruction (PBNO). MATERIALS AND METHODS: A patient data base was searched for women who underwent transurethral resection for bladder outlet obstruction diagnosed by videourodynamic study (VUDS) according to the Blaivas-Groutz nomogram for female bladder outlet obstruction between 1993 and 2002. A total of 37 women with obstruction were identified. Patients with neurogenic, traumatic, anatomical or iatrogenic causes of obstruction were excluded. Seven patients remained who had been diagnosed with PBNO, of whom all underwent transurethral bladder neck resection. Office records were reviewed for history, presentation, surgical treatment and clinical outcome. RESULTS: Seven patients were diagnosed with PBNO. Age was 39 to 81 years. Six of 7 patients presented with symptoms of obstruction, including a weak or intermittent stream and urinary hesitancy. These 6 patients had unremarkable physical examination findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. One patient presented with abdominal swelling, which on physical examination was found to be a markedly distended bladder containing more than 1000 cc urine. All patients had overt urethral obstruction on VUDS. In 6 of 7 patients obstruction was clearly at the vesical neck and in 1 the obstruction site was equivocal. Three patients were treated or had previously been treated pharmacologically with alpha-blockers. All patients were subsequently treated with intermittent self-catheterization. All patients then underwent transurethral bladder neck resection at the vesical neck and proximal urethra. Surgical specimens weighed 1 to 5 gm and showed urethral fragments or fibromuscular tissue without specific pathological findings. Followup was 1 to 10 years (median 3) and it included physical examination, uroflowmetry, post-void residual urine measurement and videourodynamic study. Six patients considered themselves cured of lower urinary tract symptoms and 1 was improved. In 1 patient the obstruction site was not clear. One patient had mild stress incontinence under rare circumstances not severe enough to require protective pads. The average change in flow was 6 +/- 10 vs 30 +/- 17 ml per second (p <0.03). The average change in voided volume was 194 +/- 170 vs 416 +/- 206 ml per second (p <0.06). Average change in post-void residual urine was 680 +/- 445 vs 173 +/- 366 ml (p <0.05). CONCLUSIONS: PBNO is an exceedingly rare condition, which is easily treatable when properly diagnosed by VUDS. The presentation of patients in urinary retention in middle age suggests that PBNO may be more common in less apparent forms than has previously been recognized.     

The bladder neck in neurological degenerative disorders

Bladder neck incompetence occurs frequently in the Shy-Drager syndrome. The behavior of the bladder neck in patients with multiple sclerosis and Parkinson's disease, however, has not been well defined. Complete urodynamic studies were performed on 48 patients with urgency incontinence and one of the following neurological diagnoses: Parkinson's disease (13 patients), Shy-Drager syndrome (13 patients), and multiple sclerosis (22 patients). Complete studies were also performed on 73 patients with no neurological diagnoses and no incontinence. None of the patients had ever undergone prior transurethral surgery. All patients with a neurological diagnosis had detrusor hyperreflexia on cystometrogram. Bladder neck function was evaluated with fluoroscopy as well as with intraluminal-pressure measurements utilizing a 10 French triple-lumen catheter. Only 11 (22%) of the neurological patients had an incompetent bladder neck on fluoroscopy (6 with Shy-Drager, 3 with Parkinson's, and 2 with multiple sclerosis). Mean bladder neck pressures of the 48 neurological patients were as follows: Parkinson's: 12 cm H₂O, SE = 5; multiple sclerosis: 15 cm H₂O, SE = 1.2; and Shy-Drager: 7 cm H₂O, SE = 2. Bladder neck incompetence, commonly seen in Shy-Drager and strongly suggestive of sympathetic dysfunction, is uncommon in incontinent patients with other degenerative neurological disorders and detrusor hyperreflexia.     

女性膀胱颈梗阻的诊断

目的：探讨女性膀胱颈梗阻的诊断方法,提高女性膀胱颈梗阻的诊治水平。方法：对42例女性膀胱颈梗阻患者的临床资料和腔内治疗情况进行回顾性分析。结果：诊断的42例患者行经尿道膀胱颈电切术,效果满意,无尿失禁及尿瘘发生。结论：临床症状结合膀胱尿道镜检查和压力-尿流率测定是该病可靠的诊断手段,经尿道膀胱颈电切术是治疗女性膀胱颈梗阻的首选方法。     

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。