前列腺癌根治术后拔除尿管时间的meta分析

目的:系统评价前列腺癌根治术术后不同时间拔除导尿管的临床效果和安全性，探讨术后拔除尿管的最佳时间。方法:计算机检索PubMed、EBSCO、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库和维普数据库中关于前列腺癌根治术术后导尿管拔除时间对排尿影响的病例对照研究，检索时间为建库至2023年2月。所有文献依据纳入和排除标准筛选，由2名研究者独立完成质量评价，并采用RvMan 5.4软件进行meta分析。结果:纳入6篇文献，涉及5 959例患者。Meta分析结果显示，与术后>7 d比较，5～7 d拔除导尿管可以预防术后尿失禁(RR=0.93,95%CI:0.90～0.97,P<0.05),术后2～4 d与5～7 d拔除导尿管对尿失禁发生率的影响差异无统计学意义(RR=1.19,95%CI:0.81～1.73,P=0.37)。前列腺癌根治术后患者拔除导尿管的时间对尿潴留发生率的影响差异无统计学意义(RR=4.38,95%CI:0.61～31.49,P=0.14)。结论:与>7 d比较，术后5～7 d拔除尿管能降低尿...     

提高前列腺癌根治术后尿控能力的临床研究

目的：探讨提高前列腺癌根治术后尿控能力的方法。方法：对15例前列腺癌采用保留尿道膜部括约肌及前列腺侧旁神经血管束的方法进行前列腺癌根治术。结果：经6—45个月随访，15例患者排尿通畅，无肿瘤复发，除1例有轻度尿失禁外，余14例6个月内均恢复尿控能力。结论：保留尿道膜部括约肌及前列腺侧旁神经血管束的方法能减低前列腺癌根治术后尿失禁。     

3477例耻骨后前列腺癌根治术患者性功能、控尿及并发症分析

前列腺癌根治术是治疗早期前列腺癌最有效的方法，但由于惧怕术后并发症，许多患者放弃了手术机会。本文对1983年5月至2003年2月3477例连续进行的保留神经的前列腺癌根治术患者的勃起功能、控尿情况和术后并发症进行了分析。所有手术均由同一位外科医生完成，术中视情况保留单侧或双侧神经。     

留置球囊尿管长度的观察

球囊尿管在留置尿管过程中不需胶布固定,且不易脱出,易清洗会阴部而被广泛应用。以往教科书中留置尿管的长度为留置普通尿管的长度［１］,球囊尿管按此长度则插入过浅,球囊部在尿道内充液可引起尿道损伤。我科１９９７年３月至１９９８年１月对１１４例男患者留置球囊尿管的长度进行测量,以避免上述弊端,现报道如下。１　临床资料及方法２２８例男患者,生殖器正常。随机分为甲乙两组各１１４例。甲组年龄１６～８０岁。专人测量１４～２２号球囊尿管（湛江医用乳胶制品厂生产）插入长度,尿管全长３９～４５ｃｍ,球囊部２～３ｃｍ,…     

妇科手术患者留置气囊尿管的护理体会

正留置导尿管是妇科术前准备的最基本的护理措施,不仅利于记尿量、密切观察患者的病情变化,也有利于排空膀胱充分暴露手术野,从而避免术中损伤临近器官。此外,可预防术后尿潴留、减轻手术切口的张力,促进切口的愈合[1]。2014-03—2016-03,我院对584例妇科手术患者留置气囊尿管,现将气囊尿管的护理体会总结如下。1资料与方法1.1一般资料本组584例患者,年龄17~68岁,平均年龄48     

留置尿管致漏尿的相关性分析及护理干预

目的:总结患者留置导尿管发生漏尿的原因及护理干预.方法:按无菌操作导尿术程序留置尿管,发生漏尿及时排除原因,并采取针对性护理措施.结果:护理干预后发生漏尿较干预前显著降低,差异有显著意义(P＜0.05).结论:使用气囊尿管留置导尿过程中,正确的护理干预可以有效地预防和纠正漏尿的发生.     

留置尿管拔除后发生尿潴留的预防及护理

全身麻醉下行整形外科手术的患者要留置导尿管，但拔除后极易发生尿潴留，为预防拔除尿管后尿潴留的发生，笔者自2002年1月至2003年9月对68例患者在全麻下行整形手术留置导尿管，在拔除尿管前对患者采用38℃．40℃复合溶液100ml从尿管中注入的方法，均取得了满意的效果，现报道如下。     

针对性护理对留置尿管患者预防尿路感染的影响分析

目的分析针对性护理对留置尿管患者尿路感染的影响。方法对58例留置尿管的住院患者实施针对性预防护理措施,观察留置尿管时间和其间尿路感染的发生率。结果本组患者导尿管留置时间(9.8±1.2)d,尿路感染发生率为5.2%(3/58)。结论对留置尿管患者尿路感染发生的危险因素进行科学评估,并实施针对性预防护理,可有效减少尿路感染的发生率,缩短尿管留置时间。     

骨科手术患者留置尿管的护理干预的对比分析

目的通过对手术留置导尿患者实施护理干预,从而缩短术后留置尿管的时间,减少拔管后尿潴留的发生,提高拔管成功率。方法将152例骨科住院需手术病人随机分为2组,实验组采取在围手术期充分宣教,术后拔管前采取膀胱充盈状态下,擦洗尿道口与自主排尿相结合的方式等护理干预。对照组按常规方式。观察2组拔管后尿潴留发生的几率及拔管成功率的指标。结果试验组拔管成功率明显高于对照组。结论围手术期采取充分的护理干预可提高拔管成功率。     

全麻手术前不同时间留置尿管对患者术后尿管耐受性的影响

目的 探讨全麻手术术前不同时间留置尿管对患者术后尿管耐受性的影响.方法 将307例全麻开胸手术患者随机分成A组(102例)、B组(104例)、C组(101例),分别在病室(A组)、手术室全麻诱导前(B组)、手术室全麻诱导后(C组)留置尿管,观察置管时及术后(拔除气管导管时,术后3 h,术后6 h)4个时段患者对尿管的耐受情况.结果 置管时,C组尿管耐受率100%,显著优于B组(59.61%)和A组(23.53%),而B组耐受率显著优于A组(均P＜0.01).术后,C组拔除气管导管时、术后3 h尿管耐受率与A、B组比较,差异有显著性意义(P＜0.05,P＜0.01),而A、B组比较,差异无显著性意义(均P＞0.05);术后6 h,3组间比较,差异无显著性意义(均P＞0.05).结论 麻醉诱导前留置尿管,患者不适反应轻,术后苏醒期对尿管的耐受性好,是术前留置尿管的最佳时机.     

微视频扫码用于脑血管病介入术患者健康教育

目的提高脑血管病介入术患者健康教育效果和满意度。方法将行脑血管病介入术的84例患者按时间段分为对照组与观察组各42例。对照组采取口头宣教加发放小卡片方式实施健康教育;观察组在常规健康教育基础上开展微视频教育。于术后24 h评价效果。结果干预后,观察组脑血管病介入术知识得分、诊疗依从性及健康教育满意度显著高于对照组(P<0.05,P<0.01)。结论微视频扫码用于脑血管病介入术患者健康教育可有效提高患者知识掌握程度,从而提高诊疗依从性和健康教育满意度。     

Neither alpha-blocker therapy nor cystography is required before early catheter removal after radical prostatectomy

OBJECTIVE: To evaluate the success of early catheter removal from men after radical retropubic prostatectomy (RRP) without using either cystography or giving an alpha-blocker. PATIENTS AND METHODS: We retrospectively analysed 156 consecutive patients who had RRPs between June 2003 and May 2004 to determine the incidence of urinary retention after early catheter removal, with no cystogram or using an alpha-blocker. RESULTS: The mean age of the men was 60 years and 99% were clinical stage T1 or T2; 74% had their catheters removed 8 days after RRP. The incidence of urinary retention was 1.3%, and of haematuria requiring catheter replacement 2.6%. Two patients (1.3%) developed a bladder neck contracture. CONCLUSIONS: In the present study removing an indwelling catheter 1 week after RRP was safe, with a minimal risk of urinary retention or bladder neck contracture. The addition of an alpha-blocker is unlikely to reduce the already low incidence of urinary retention.     

Delayed recovery of urinary continence after laparoscopic radical prostatectomy

AIM: To study the rate at which patients regained urinary continence during our institution's early experience with laparoscopic radical prostatectomy. METHODS: The urinary continence of 34 patients was recorded at various intervals following laparoscopic radical prostatectomy. These data were compared with those from 49 patients who had undergone radical retropubic prostatectomy. RESULTS: For laparoscopic prostatectomy patients, 2.9% had regained urinary continence at 1 month, 29.4% at 3 months, 46.9% at 6 months, 56.0% at 9 months and 60.0% at 12 months. For retropubic prostatectomy patients, the corresponding rates were 22.4% at 1 month, 63.3% at 3 months, 84.1% at 6 months, 92.9% at 9 months and 92.9% at 12 months. Backward stepwise logistic regression analysis indicated that laparoscopic surgery itself significantly predicted urinary incontinence at every interval from 1 to 9 months following surgery (P < 0.05). CONCLUSION: Patients' postoperative recovery of urinary continence was not satisfactory in our early experience with laparoscopic radical prostatectomy. Further efforts to elucidate the reason for this poor functional outcome are mandatory before the procedure is accepted as part of standard practice.     

Early removal of the catheter after laparoscopic radical prostatectomy

PURPOSE: We prospectively tested the safety of routine removal of the catheter as early as 2 to 4 days after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between March 1998 and March 2001, 228 patients underwent laparoscopic radical prostatectomy for clinically organ confined prostate cancer. The last 113 consecutive patients were included in a prospective study according to gravitational cystography performed 2 to 4 days postoperatively. If no leak was seen the catheter was removed. If a leak was apparent the catheter was left indwelling for another 6 days and cystography was repeated. RESULTS: Cystography 2 to 4 days postoperatively showed an anastomosis without a leak in 96 (84.9%) patients who subsequently had the catheters removed. There were 28 patients who had the catheter removed on postoperative day 2, 28 day 3 and 40 day 4. In 17 (15.1%) patients an anastomotic leak was observed, and the catheter was not removed at that time. Of the 96 patients in whom the catheter was removed early 10 (10.4%) had urinary retention that necessitated re-catheterization. This procedure was performed without the need for cystoscopy. After the catheter was removed all patients were able to void 24 hours later. Median followup was 7 months (range 1 to 15) and showed continence rates greater than 93%. No anastomotic stricture, pelvic abscess or urinoma developed in any patient. CONCLUSIONS: Patients who undergo laparoscopic radical prostatectomy can have the catheter safely removed 2 to 4 days postoperatively without a higher risk of incontinence, stricture or leak related problems.     

Percutaneous cystostomy drainage for early removing urethral catheter in robotic-assisted laparoscopic radical prostatectomy: Improving on patients' discomfort

ObjectiveUrethral catheterization is often a major source of discomfort and pain to a patient after a surgical procedure. To better understand the safety and feasibility of the early removal of urethral Foley catheter after robotic-assisted laparoscopic radical prostatectomy by using percutaneous cystostomy drainage, we collected the related data and present our experience.Patients and methodsThis study involved 20 patients. In the study group (10 patients), we used the percutaneous cystostomy device (PCD) and an 18 French urethral catheter together. The urethral catheter was removed at postoperative day (POD) 3 and the PCD was removed at POD 7. In the control group (10 patients), they had standard urethral catheterization with an 18 French catheter and the catheter was removed at POD 7. Demographic and outcome data were measured and analyzed. Urethral pain was recorded using the visual analog scale.ResultsThe two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, clinical tumor stage, surgical duration, estimated blood loss, and surgical times. The study group had significantly less penile pain in POD 3 and POD 7 (mean visual analog scale: 0.9 vs. 2.2, p < 0.001 at POD 3; 0.1 vs. 1.4, p = 0.002 at POD 7). All patients had good urinary continence within 30 days and no urethra stricture was found during the follow up period.ConclusionThe use of a percutaneous cystostomy device is feasible and safe for the early removal of urethral Foley catheter in robotic-assisted laparoscopic radical prostatectomy to decrease penile pain and patient discomfort.     

Early catheter removal 3 days after radical retropubic prostatectomy

AIM: We investigated the feasibility and safety of the early removal of urethral catheters 3 days after radical retropubic prostatectomy. METHODS: Seventy consecutive patients underwent radical retropubic prostatectomy with the intent of early catheter removal on postoperative day (POD) 3. Catheter removal was based on postoperative cystograms performed on POD 2. Patients were analyzed using a validated prostate cancer specific questionnaire (University of California, Los Angeles Prostate Cancer Symptom Index) to determine quality of life outcomes. Multiple logistic regression analysis was also used to evaluate if any of the preoperative or intraoperative parameters were able to predict the success of early catheter removal after radical retropubic prostatectomy. RESULTS: The catheter was removed on POD 3 in 67 of 70 patients (97%) excluding three patients with moderate or severe extravasation on postoperative cystograms. Of the 67 patients, 53 (76%) were successful in early catheter removal, but the remaining 14 (24%) patients experienced urinary retention within 48 h and were treated with simple catheter replacement for 1 or 2 days. Two patients developed anastomotic strictures 3 and 4 months postoperatively, which were managed by dilation alone. Multiple logistic regression analysis showed that no leak during an intraoperative leak test was the only independent predictor of success for early catheter removal (P = 0.0069; odds ratio, 6.667; 95% confidence interval, 1.682-26.428). CONCLUSION: The present study revealed that early catheter removal 3 days after radical retropubic prostatectomy is feasible in patients who show a negative intraoperative leak test. Postoperative monitoring of more patients is needed to determine if the early catheter removal is widely applicable.     

Outcomes after robot-assisted laparoscopic radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy （RALRP） using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology. Controversy has surrounded the procedure since it was first performed in 2000, with many critics highlighting the lack of evidence to support its use. However, despite the lack of level I evidence, many large studies of patients have confirmed that the procedure is feasible and safe, with low morbidity. Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy. Functional outcomes also seem satisfactory, although randomized controlled trials are lacking. This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.     

De novo detrusor underactivity after laparoscopic radical prostatectomy

Objective: The aim of this study was to investigate bladder function following laparoscopic radical prostatectomy, with a focus on de novo detrusor underactivity. Methods: Records on pre‐ and postoperative urodynamic studies were retrospectively investigated in 110 patients who underwent laparoscopic radical prostatectomy. Patients exhibiting de novo detrusor underactivity were selected on the basis of an overt strain voiding pattern during the postoperative pressure flow study with detrusor pressure at a maximum flow rate <10 cm H₂O accompanied by an increase in abdominal pressure. In these patients, a follow‐up urodynamic study was performed to assess subsequent long‐term changes in the bladder function. Results: Of the 110 patients, 10 (9.1%) were observed to exhibit de novo detrusor underactivity during the postoperative urodynamic study. During the voiding phase of the pre‐ and postoperative pressure flow study in these 10 patients, the mean detrusor pressure at maximum flow rate showed a significant decrease postoperatively from 57.6 to 3.0 cm H₂O (P < 0.001), although the mean abdominal pressure at maximum flow rate significantly increased from 23.1 to 102.5 cm H₂O (P < 0.001). The follow‐up urodynamic study performed on seven patients at 36 months following surgery revealed no significant change in each urodynamic parameter. De novo detrusor underactivity persisted even over the long term following surgery, and no improvement in bladder function was observed. Conclusions: Detrusor contractility may be impaired during radical prostatectomy. Postoperative detrusor underactivity following radical prostatectomy seems to be an irreversible phenomenon persisting even over the long term.     

基于回授法的多元化健康教育模式在泌尿外科腹腔镜手术患者健康教育中的应用

目的 探讨基于回授法的多元化健康教育模式在指导泌尿外科腹腔镜手术患者术后活动、有效咳嗽、咳痰,降低并发症的效果.方法 将2021年1月—5月期间于我院泌尿外科行腹腔镜手术治疗的120例患者随机分为干预组与对照组,每组各60例.对照组采用传统健康教育模式,干预组采用基于回授法的多元化健康教育模式;比较两组患者术后活动依从...     

腹腔镜下根治性前列腺切除术治疗TURP术后偶发前列腺癌的配对分析

目的探讨经尿道前列腺切除术(TURP)后偶发前列腺癌行腹腔镜根治性前列腺切除术(LRP)在外科手术、肿瘤学及尿控等方面的影响。方法回顾性分析自2012年1月至2017年12月北部战区总医院泌尿外科285例接受了LRP治疗的男性患者的临床资料。其中37例患者术前已接受过TURP治疗(TURP组),另外选取37例没有接受过TURP的患者与之配对(对照组)。运用相关统计学方法比较两组患者在围手术期并发症、外科手术、肿瘤及尿控等方面的差异。结果两组患者在年龄、体质指数、血清前列腺特异性抗原(PSA)水平以及术前和术后Gleason评分等方面无统计学差异。TURP组与对照组相比患者出血量较多[(555.4±238.4)vs.(237±111.3)mL,P<0.05]、手术时间较长[(256.7±65.3)vs.(215.2±62.3)min,P<0.05]、输血概率大(5.4%vs.0.0%,P<0.05)、并发症发生率较高(43.2%vs.13.5%,P<0.05)。TURP组的手术阳性切缘率与对照组相比(35.1%vs.24.3%)差异无统计学意义(P=0.353)。手术后12个月的尿控率两组相似,但在3个月时TURP组的尿控率较低(40.5%vs.70.2%)。在平均随访36.5个月后,TURP组和对照组分别有10.8%和8.1%的患者出现生化复发,差异无统计学意义。结论TURP后LRP需要更长的手术时间、失血更多、并发症发生率更高和更差的短期尿控,但两组患者远期肿瘤切除效果及远期尿控没有差异,所以TURP后行LRP的疗效是安全可靠的。