经尿道前列腺电切术后再入院原因及处理对策

目的探讨良性前列腺增生(BPH)行经尿道前列腺电切术(TURP)术后再次入院的原因及防治措施。方法对16例TURP术后再次入院的原因及诊治情况进行回顾性分析。结果 3例中尿道狭窄,经尿道扩张术、尿道成形术、尿道内切开术、冷刀切开术好转。继发出血4例,经保守治疗或电切镜电凝止血。腺体残留4例再次行TURP术。晚期前列腺癌1例,行睾丸切除术+内分泌治疗。2例神经源性膀胱功能障碍,行永久性耻骨上膀胱造瘘术。2例急性附睾炎,经抗感染治疗后治愈。结论尿道狭窄、继发出血、腺体残留等是TURP术后再入院的主要原因。术前准确诊断,合理选择手术方式,术中、术后正确处理是预防和减少TURP术后再次入院的重要措施。     

前列腺增生症术后再入院原因分析

１９８５年１月－１９９３年１２月收治前列腺增生症术后再住院患者６６例，再入院的原因：尿道狭窄，腺体残留，继发出血，尿路感染，尿道狭窄和腺体残留是术后再入院的主要原因。作者对再入院原因进行了分析，并提出了预防要点。     

经尿道前列腺电气化术后再次排尿困难原因分析

目的:探讨经尿道前列腺电气化术(TUVP)后排尿困难发生的原因及治疗办法。方法:对12例TUVP术后排尿困难的原因及治疗办法进行分析。结果:尿道狭窄6例,经尿道外口切开及尿道扩张治愈。腺体残留2例,前列腺复发1例,膀胱颈后唇明显抬高1例,均经再次TUVP治愈。膀胱功能异常2例,对症治疗。结论:针对TUVP术后排尿困难发生的原因,需采取相应的治疗。     

良性前列腺增生术后再入院的原因及治疗探讨(附106例报告)

目的　分析良性前列腺增生 (BPH)切除术后患者再入院的原因 ,探讨治疗方法。　方法　BPH术后再入院患者 10 6例。腺体残留或复发者 4 7例 ,其中TURP术后 4 1例 ,开放术后 6例 ,4 2例再次行TURP ,5例因腺体较大行开放手术 ;尿道狭窄者 32例 ,其中TURP术后 12例 ,开放手术后 2 0例 ,2 7例行经尿道瘢痕组织冷刀内切开术加电切术 ,3例行尿道外口成形术 ,2例行耻骨上膀胱造瘘术 ;TURP术后继发出血 11例 ,行经尿道膀胱冲洗加电凝止血 ;神经原性膀胱功能障碍 7例 ,2例行膀胱颈环状肌切断术 ,3例自行间断导尿 ,2例行耻骨上膀胱造瘘术 ;前列腺癌 6例 ,1例行前列腺癌根治术 ,3例行姑息性TURP加睾丸切除术 ,2例行睾丸切除术 ;TURP术后尿失禁 2例 ,1例使用阴茎集尿器 ,1例转外院行尿道生物胶原注射缩窄尿道 ;腹壁切口疝 1例 ,行疝修补术。　结果　 10 6例患者 ,97例行手术治疗 ,术后随诊 6个月～ 15年 ,平均 5年 8个月。效果满意 84例 (86 .6 % ) ;9例尿道狭窄术后需要定期尿道扩张 ;2例尿道狭窄和 2例神经原性膀胱功能障碍手术失败 ,行耻骨上膀胱造瘘。9例未行手术治疗。　结论　术前准确诊断 ,合理选择手术方式及术中术后正确处理是预防患者再次入院的关键。再次手术应首选经尿道方式。     

前列腺等离子电切术后再次排尿困难的原因分析

目的探讨前列腺电切术后再次排尿困难的原因。方法回顾分析80例前列腺电切术后再次排尿困难的14例患者临床资料。结果夺组14例尿道狭窄6例、继发出血3例、腺体残留1例、尿路感染1例、再发前列腺癌1例、膀胱逼尿肌功能障碍2例。结论尿道狭窄、继发出血、腺体残留是发生前列腺电切术后排尿困难的主要原因，术前行尿流动力学检查与控制感染、精细的于术操作，可以减少术后排尿困难的发生。     

前列腺电切术后排尿困难的原因及治疗

目的探讨经尿道前列腺电切术后再发排尿困难的原因及治疗措施。方法回顾性分析经尿道前列腺电切术后出现排尿困难的58例患者临床治疗资料。结果尿道狭窄28例,膀胱颈部狭窄及挛缩15例,继发岀血7例,腺体残留5例,前列腺癌2例,神经源性膀胱1例。结论尿道狭窄、膀胱颈部狭窄及挛缩、继发岀血、腺体残留是引起术后排尿困难的主要原因。经给予定期尿道扩张、尿道狭窄切开、瘢痕切除、前列腺再次电切、止血等处理后排尿困难症状明显改善,效果良好。     

经尿道前列腺电切术后再入院分析（附122例报告）

目的探讨良性前列腺增生（benign prostate hyperplasia,BPH）经尿道前列腺电切术（transurethral resection prostate,TURP）后再入院的原因及其治疗方法。方法回顾性分析BPH行TURP术后再入院患者122例,其中腺体残留或复发者47例,TURP术后继发出血36例,尿道或膀胱颈狭窄32例,附睾炎6例,气囊尿管乳胶碎片遗留于膀胱1例。结果本组122例,97例行手术治疗,术后随诊6个月至1年,效果满意84例（87.6%）;9例尿道狭窄,术后需要定期尿道扩张。结论术前准确诊断、合理选择手术方式及术中、术后正确处理是预防患者再次入院的关键,再次手术应首选经尿道手术。     

前列腺增生术后排尿困难原因分析(附14例报告)

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,尿道外口狭窄、腺体残留和后尿道炎性粘连狭窄各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.结论:膀胱颈口梗阻为耻骨上前列腺切除术后引起排尿困难的主要原因,而腺体残留则为经尿道前列腺电切术后排尿困难的重要原因.     

TURP术后远期排尿困难的原因及再治疗的临床分析

目的 探讨经尿道前列腺切除术(TURP)术后远期(术后半年以上)排尿困难的原因,同时探讨再治疗方法.方法 回顾性分析29例TURP术后远期出现排尿困难患者的临床资料及治疗方法.结果 术后发生腺体残留复发6例,尿道狭窄9例(其中尿道外口狭窄3例,膀胱颈挛缩6例),逼尿肌功能障碍12例,前列腺癌2例.所有患者经相应治疗,疗效确切.结论 腺体残留、尿道狭窄、逼尿肌功能障碍和前列腺癌是TURP术后远期排尿困难的主要原因.针对病因采取个体化治疗是治疗TURP术后远期排尿困难的有效方式.     

预防耻骨上前列腺摘除术后排尿困难的体会

目的分析耻骨上前列腺摘除术后排尿功能的原因、预防措施。方法回顾分析163例良性前列腺增生术后出现排尿功能困难的5例患者的临床资料，其中尿道内口狭窄2例（其中1例合并膀胱结石），尿道狭窄2例，前列腺腺体残留复发1例。结果经开放性手术取出膀胱结石并尿道内口成形1例，尿道内切开1例，经尿道扩张保持排尿通畅2例，以上4例观察1年以上无排尿障碍。腺体残留复发1例经药物治疗症状明显改善。结论耻骨上前列腺切除术后排尿困难主要是由医源性因素引起。在手术时，采用有效的操作减少出血、巧妙缝合及改良置管方法是有效降低术后排尿困难发生率的关键。     

经尿道前列腺汽化切割术与电切术的比较

目的 比较经尿道前列腺汽化切割术(TUVP)和经尿道前列腺电切术(TURP)对良性前列腺增生(BPH)的治疗效果。方法 有症状的BPH患者100例,分成TUVP组50例,TURP组50例。结果 TUVP组与TURP组术前与术后前列腺症状评分(IPSS)、最大尿流率(MFR)、剩余尿(PVR)比较有显著差异(P<0.01),两组间比较无显著性差异(P>0.05)。术后血红蛋白、血细胞比积和血钠两组比较有显著性差异(P<0.05)。手术时间和前列腺切除体质量两组比较无显著性差异(P>0.05)。TUVP组继发出血1例(2.0％),尿道外口狭窄1例(2.0％),阳痿4例(8.0％),尿路刺激症状7例(14.0％),无尿失禁及TRUS发生。TURP组继发出血2例(4.0％),尿道外口狭窄1例(2.0％),阳痿5例(10.0％),TRUS出现1例(2.0％)尿路刺激症状6例(12.0%),无尿失禁发生。结论 TUVP治疗效果确切,达到与TURP完全相同的效果,术中出血明显少于TURP,无TURS发生,是最具潜力的新技术。     

经尿道前列腺电气化术后排尿困难的原因及治疗(附20例报告)

目的：分析经尿道前列腺电气化术（TUVP）后发生排尿困难的原因，以提高TUVP的治疗效果。方法：回顾性分析TUVP后发生排尿困难的20例患者的临床资料。结果：在20例患者中，发生尿道狭窄10例，经尿道灌注治愈；腺体残留3例，经再次TUVP治愈；膀胱功能异常7例，其中5例经非手术方法治愈。结论：尿道狭窄、膀胱功能异常、腺体残留是TUVP后发生排尿困难的常见原因；预防术后狭窄、严格手术指征，可提高TUVP的治疗效果，而再次TUVP切割仍是有效解决手段。     

The surgical treatment of urethral strictures

The authors reviewed the results of surgical management of 233 patients aged 8-76 years who had suffered urethral strictures. A total of 266 operations were made in the period of 1970-1989. Urethral tunneling which had been widely used in clinical practice for strictures of the urethra until 1980 yielded 91.2% recurrences of the disease, which made surgeons modify the surgical policy. During the past decade 127 patients with urethral strictures and obliterations have undergone 138 surgical interventions: 91 (65.9%) urethral resections, 34 (24.6%) internal optical urethrotomies and transurethral resections of scarring tissue, 7 (5.1%) cutaneous urethral plastic surgeries and only 6 (4.4%) urethral tunnelings. The number of relapses was reduced to 13.4%. The authors consider that urethral resection should be the operation of choice in urethral strictures and obliterations. Endoscopic treatment techniques (urethrotomy and transurethral resection) are indicated in short strictures and scarring deformity of the posterior urethra after prostate operation. It is advisable to apply cutaneous urethral plastic surgery in case of extended strictures.     

前列腺增生经尿道汽化切割与电切术的疗效比较

目的 :比较经尿道前列腺汽化切割 (TUVP)与电切术 (TURP)治疗良性前列腺增生 (BPH)病人的疗效。　方法 :2 0 6例BPH病人 (术前估计前列腺重量≤ 6 0 g)被随机分成TUVP(97例 )和TURP(10 9例 ) 2组 ,对病人进行为期 12～ 34(平均 2 0 )个月的随访。　结果 :2组术后第 12、2 4个月国际前列腺症状评分 (I PSS)均较术前下降 (P<0 .0 1) ,膀胱残余尿 (PVR)均较术前减少 (P <0 .0 1) ,最大尿流率 (Qmax)均较术前升高 (P <0 .0 1)。　结论 :TUVP和TURP对增生≤ 6 0g的BPH病人均有良好的治疗作用。TUVP较TURP能缩短手术时间和术后置管时间     

经尿道前列腺电气化术后排尿困难18例分析

目的 探讨前列腺电汽化术（TUVP）后发生排尿困难的原因.方法 对前列腺电汽化术（TUVP）后18例排尿困难患者的临床资料进行分析.结果 发生尿道狭窄8例,经尿道扩张治愈;腺体残留3例,经再次TUVP治愈;膀胱功能异常7例,经非手术方法治愈.结论 尿道狭窄、膀胱功能异常、腺体残留是TUVP后发生排尿困难的常见原因.预防术后狭窄和提高手术技巧可提高TUVP的治疗效果.     

Two-stage transperineal management of posterior urethral strictures or bladder neck contractures associated with urinary incontinence after prostate surgery and endoscopic treatment failures

OBJECTIVES: The treatment of posterior urethral strictures or bladder neck contracture associated with severe urinary incontinence after prostate surgery and failure of endoscopic treatments is controversial. We report our experience with a transperineal approach in two steps: end-to-end urethroplasty/anastomosis and subsequent artificial urinary sphincter implantation. METHODS: Between September 2001 and January 2005, we observed six patients (58-68 yr old), with a combination of severe urinary incontinence and posterior urethral stricture with anastomotic bladder neck contracture after prostate surgery. In all cases, repeated endoscopic treatments of the strictures failed. The patients underwent transperineal end-to-end urethroplasty or anastomosis followed by transperineal artificial urinary sphincter placement after 6 mo. RESULTS: After the first surgical step, all patients were completely incontinent with absence of urethral strictures and complete anastomotic healing in all cases. Therefore, all patients underwent artificial urinary sphincter insertion. After a mean follow-up of 38 mo (range: 18-57 mo), five patients are continent with no postvoid residual urine and a perfectly functioning device. One artificial urinary sphincter was removed due to urethral erosion. CONCLUSIONS: In patients with posterior urethral strictures or bladder neck contractures associated with severe urinary incontinence, an artificial urinary sphincter implantation as a second step allows verification of the outcome of a previous end-to-end urethroplasty or anastomosis and utilizes a dedicated operative field to reduce the risks of prosthesis implants.     

Transurethral electrovaporization of the prostate: is it any better than standard transurethral prostatectomy? 5-year follow-up

BACKGROUND AND PURPOSE: At present, transurethral resection of the prostate (TURP) is regarded as the most effective treatment for benign prostate hyperplasia (BPH). In the present randomized study, we compared TURP with transurethral electrovaporization of the prostate (TUVP). PATIENTS AND METHODS: A series of 77 BPH patients who underwent operation between 1996 and 2001 were included in the study, 40 who had TURP with a standard resection loop and 32 who had TUVP with a Spike loop. All available patients were evaluated preoperatively, at 1 month and 3 months after the operation (N=73), and 5 years after the operation (N=44). The International Prostate Symptom Score (IPSS), sexual function questionnaire, uroflowmetry (Qmax), postvoiding residual urine volume (PVR), and transrectal ultrasonography were used. In addition, postoperative serum sodium concentration, serum hematocrit, duration of catheterization, and operation time were compared. RESULTS: In the TUVP group, the mean IPSS decreased from 17.3 to 6.5, the PVR from 88 to 35 mL, and the prostate volume from 39 to 24 cc, while the Qmax increased from 6.3 to 12.9 mL/sec and the average flow from 2.6 to 7.9 mL/sec. In the TURP group, the mean IPSS decreased from 17.6 to 6.1, the PVR from 95 to 38 mL, and the prostate volume from 38 to 23 cc, while the Qmax increased from 5.9 to 13.2 mL/sec and the average flow from 2.4 to 8.3 mL/sec. Thus, significant improvements were observed in both groups, and the differences between them 5 years later were not significant P>0.05). Postoperative serum hemoglobin and hematocrit were significantly lower in the TURP group (P>0.05). However, no difference was seen in serum sodium concentrations. Also, there was no difference in the duration of the operations. The catheterization period was 22+/-5.7 hours in the TUVP group, while it was 75.7+/-10.5 hours in the TURP group (P<0.001). When morbidities observed during follow-up were evaluated, no significant difference was seen. CONCLUSIONS: The TUVP procedure is as effective as TURP with similar morbidity. The advantages of TUVP are that the urethral catheter is withdrawn earlier, hospitalization is shorter, and bleeding is less. Its disadvantage is that tissue cannot be sampled for histologic diagnosis. In our opinion, in order to exploit the advantages of this technique, TUVP should be preferred in elderly patients without any suspicion of prostate cancer for whom bleeding during operation is a source of risk.     

同期手术治疗良性前列腺增生并重度痔疮36例报告

目的:探讨良性前列腺增生(benign prostatic hypertrophy,BPH)并重度痔疮的治疗方法及疗效。方法:36例中28例采用内痔外剥内扎术,5例采用内痔环形切除术,3例采用吻合器痔上粘膜环切术(procedure for prolapse and hemorrhoids,PPH),同期均行经尿道前列腺电切术(transurethral resection of prostate,TURP)联合经尿道前列腺汽化电切术(transurethral electrovapor-ization of the prostate,TUVP)。结果:所有手术均获成功,术中无膀胱穿孔,术中、术后无电切综合征发生,5~9d后拔除导尿管,排尿通畅,无肛门失禁、狭窄,大便通畅。结论:对BPH合并重度痔疮的患者,根据痔的严重程度,采用内痔外剥内扎术、内痔环形切除术及PPH,同期行TUVP联合TURP治疗BPH,能免除患者多次手术的痛苦,改善患者的生活质量,又可减少多次住院费用。     

A bioabsorbable self-expandable,self-reinforced poly-L-lactic acid urethral stent for recurrent urethral strictures: long-term results

BACKGROUND AND PURPOSE: Biodegradable urethral stents have been used clinically for some years mainly in order to prevent postoperative urinary retention after minimally invasive thermotreatment of benign prostatic hyperplasia. We previously reported a 15-month-follow-up pilot study of a bioabsorbable self-expandable, self-reinforced poly-L-lactic acid (SR-PLLA) urethral stent in combination with optical urethrotomy in the treatment of recurrent urethral strictures. The present aim was to evaluate the long-term results of this new treatment modality. PATIENTS AND METHODS: A series of 22 patients with severe urethral strictures (mean number of earlier urethrotomies 2.5) were involved. An SR-PLLA spiral stent with a bioabsorption time of 10 to 12 months was inserted into the urethra at the stricture site immediately after optical urethrotomy. Uroflowmetry, measurement of postvoiding residual urine, urine culture, and urethroscopy were performed preoperatively and at 1 and 3 months and then every 3 months up to 12 months, with subsequent follow-up visits every 6 months. The mean follow-up was 46 months. RESULTS: The treatment was successful in 8 of the 22 patients (36%). Six recurrences were found within the stented area and 15 outside. Patients with failure have since been treated with several urethrotomies and repeat self-dilatations or free skin urethroplasties. CONCLUSIONS: The results of the use of a bioabsorbable SR-PLLA urethral stent for the treatment of recurrent strictures were encouraging. Without this additional therapy, the recurrence rate of strictures might have been much higher. The main problem was sudden collapse of the stent, possibly induced by outer compression. A new generation of bioabsorbable stents is already under development.     

Risk factors for the development of prostate brachytherapy related urethral strictures

PURPOSE: We identified clinical, treatment and dosimetric parameters associated with the development of urethral strictures following permanent prostate brachytherapy. MATERIALS AND METHODS: From April 1995 through April 2003, 1,186 consecutive patients underwent prostate brachytherapy for clinical stage T1b-T3a NxM0 (2002 American Joint Committee on Cancer) prostate cancer. The treatment plan included supplemental XRT in 625 patients (52.7%) and androgen deprivation therapy in 465 (39.2%). Median followup was 4.3 years. Multiple clinical, treatment and dosimetric parameters were evaluated in univariate and multivariate analyses to identify independent predictors for urethral stricture disease. RESULTS: A total of 29 patients had brachytherapy related urethral strictures. All strictures involved the BM urethra with a 9-year actuarial risk of 3.6% and a median time to development of 2.4 years. The mean radiation dose to the BM urethra was significantly greater in patients with vs without stricture (p = 0.002). On multivariate analysis the BM urethral dose and supplemental XRT predicted urethral stricture. All except 3 patients were successfully treated with urethral dilation or internal optical urethrotomy. CONCLUSIONS: Brachytherapy related urethral stricture disease correlates highly with the radiation dose to the BM urethra. Careful attention to brachytherapy preplanning and intraoperative execution along with the judicious use of supplemental XRT is essential to minimize the incidence of stricture disease.