前列腺增生与肿瘤的CT表现对比研究

目的：对比观察前列腺增生与肿瘤的ＣＴ表现,以便提高定性诊断率。方法：回顾性分析经病理及临床随访证实的２３例前列腺增生与２０例前列腺肿瘤ＣＴ表现作对比研究分析。结果：前列腺增生与肿瘤在大小,密度,形态,边缘,毗邻关系间存在着显性差异。前列腺增生ＣＴ表现,密度均匀,边缘光滑清晰,不侵蚀周围邻近组织。前列腺肿瘤ＣＴ表现,体积不规则增大,密度不均,边缘模糊且结节状隆起,易累及膀胱及精囊,膀胱精囊角变钝或     

MSCT后尿道排泄造影术对前列腺增生症致膀胱出口梗阻的诊断价值

【摘要】目的：探讨多层螺旋CT后尿道排泄造影成像术（MSCT-VUPU）对良性前列腺增生症（BPH）继发膀胱出口梗阻（BOO）的诊断价值。方法：选取经临床诊断为BPH继发BOO的患者28例,全部患者行MSCT-VUPU扫描。另选取无排尿困难、并经临床检查无前列腺增生的10例受检者作为对照组,同期接受MSCT-VUPU扫描。扫描数据经工作站进行多平面重组（MPR）、最大密度投影（MIP）、容积再现（VR）等后处理,由两名影像医师共同对全部病例的MSCT-VUPU影像学改变做出诊断。结果：28例BPH患者均有不同程度后尿道狭窄。28例中,表现为不同程度膀胱小梁化改变21例,膀胱形态改变9例,膀胱壁增厚及粘膜强化7例。膀胱形态改变及膀胱小梁化程度均与前列腺增生症分期呈正相关（r=0.524、0.514,P<0.05）,膀胱粘膜增厚强化与小梁化程度呈正相关（r=0.485,P<0.05）。后尿道前列腺部上下径与前列腺后叶前后径呈正相关（r=0.729,P<0.0001）。结论：MSCT-VUPU技术使BPH患者在排尿过程中完成扫描并获得到膀胱及尿道全程显影;具有无创、清晰及可以任意方位重组观察等优点,能客观判断BOO引起的后尿道及膀胱的形态并评估膀胱功能。     

高危前列腺增生经尿道前列腺电切手术疗效观察

目的观察高危良性前列腺增生患者经尿道前列腺电切手术治疗效果。方法分别观察63例高危良性前列腺增生患者与同期72例前列腺增生患者手术前后的症状评分、最大尿流率及残余尿量。结果63例患者手术后均恢复自主排尿,IPSS评分、最大尿流率及残余尿量与术前比较,均有意义;IPSS、最大尿流率与同期TURP术72例患者手术疗效对比无显著意义,而残余尿量绝对数值对比有显著差异。结论高危患者能在纠正基础疾病后,积极行TURP术治疗,效果满意。     

前列腺增生的防治

老年男性多患前列腺增生症。这是因为随年龄的增长,睾丸会发生生理性功能减退,使前列腺无所依赖而随之出现退行性变化。所以,老年人即使没有出现病状,其前列腺也有程度不同的增生肥大。 前列腺肥大首先压迫尿道,使排尿受阻,形成尿潴留,膀胱壁会因此张力下降并且增厚;若不及时对症处理,还会影响到输尿管和肾,继发尿路感染、肾积水以至慢性肾功能衰竭。另外排尿不畅或尿残留膀胱     

支架置入治疗前列腺增生所致尿道狭窄

目的：探讨对前列腺增生症尿潴留患者采用X线电视监视下行后尿道内支架置入术的方法及其疗效。方法：应用国产自膨式镍钛记忆合金支架及推送器，通过逆行泛影葡胺尿道及膀胱造影，以后尿道对比剂断端或尿道狭窄处远端为前测点，膀胱颈部前列腺增生叶的最凸点为后测点，两点间距除以1．0一1．3为选用支架的长度。前列腺均匀增生型选用筒状支架；单叶增生型选用靠背型支架。支架后端平后测点为最佳位置，术后1、6、12和36个月复查支架位置、形态及尿潴留量。结果：通过32例患者的介入治疗，置入成功率100％，术中出血6例(18．8％)。1、6、12和36个月复查，未发现支架移位、尿失禁及膀胱结石等并发症，术后均自主排尿通畅。结论：通过尿道造影选用内支架长度，X线监视下内支架置入，定位准确，疗效可靠，创伤小，对不宜外科手术的前列腺增生伴尿潴留患者，可做为首选治疗方法。     

不同前列腺切除术式与术后膀胱痉挛关系的研究

目的：探讨不同前列腺切除术式与术后膀胱痉挛（BS）的关系。方法：将前列腺重度增生80例随机分为4组（每组20例）,分别采用耻骨上经膀胱前列腺摘除术、保留尿道耻骨后膀胱外前列腺摘除术、经尿道前列腺激光气化术及经尿道前列腺电切术治疗,观察各组术后Bs发作情况。结果：术后共发生BS46例（57．5％）;其中耻骨上经膀胱前列腺摘除组发生20例（100．0％）,耻骨后保留尿道前列腺摘除组9例（45．0％）,经尿道前列腺激光气化组11例（55．0％）,经尿道前列腺电切组6例（30．0％）;耻骨上经膀胱前列腺摘除组BS发生率显著高于其他3组（P〈0．05）。结论：经尿道微创治疗前列腺增生可有效减少BS的发生。     

高危良性前列腺增生症患者经尿道前列腺电切术治疗的效果研究

目的 研究和分析高危良性前列腺增生症患者经尿道前列腺电切术治疗的效果.方法 选取收治的高危良性前列腺增生患者60例为对象进行研究,利用计算机随机将其分为观察组与对照组,各30例.对照组应用传统开放性手术治疗,观察组应用经尿道前列腺电切术治疗.比较分析两组患者的各参数变化以及治疗效果.结果 观察组术后的各参数变化,如最大尿流率、国际前列腺症状评分、膀胱残余尿量以及生活质量评分等,显著优于对照组,且组间差异具有统计学意义(P<0.05).且观察组治疗后的总有效率为96.67%(29/30),而对照组治疗后的总有效率为80.0%(24/30),观察组的显著高于对照组,且对比组间差异具有统计学意义(P<0.05).结论 高危良性前列腺增生症患者经尿道前列前电切术治疗之后,能够获得十分显著的治疗效果,且患者的最大尿流率、国际前列腺症状评分、膀胱残余尿量以及生活质量评分等明显改善.     

经尿道前列腺汽化电切治疗前列腺增生（附150例疗效分析）

目的：探讨经尿道前列腺汽化电切治疗前列腺增生的疗效。方法：采用回顾性分析我院收治的前列腺增生患者的临床资料,依据治疗方式分为观察组和对照组。结果：观察组手术时间长于对照组,术中出血量低于对照组,观察组术后IPSS评分、尿流率、膀胱压力、残余尿明显优于对照组,观察组电切综合征、尿失禁的发生率明显低于对照组,P〈0.05,差异均有统计学意义。结论：经尿道前列腺汽化电切治疗前列腺增生临床疗效良好。     

经尿道激光汽化前列腺切除术和经尿道前列腺电切除术后临床护理对照体会

目的：比较经尿道2μm激光前列腺汽化切除术和经尿道前列腺电切除术的临床效果和护理特点,以提高护理工作质量。方法200例良性前列腺增生患者分为两组,100例接受经尿道2μm激光手术治疗（激光组）,100例患者接受经尿道前列腺电切除术（电切组）治疗。分析两组前列腺增生患者临床资料,对术后出血、膀胱冲洗时间、膀胱痉挛发生率、离床活动时间、平均住院时间等方面总结和分析。结果两组患者手术前后最大尿流率（Qmax）、残余尿（PRV）比较均得到显著改善（P＜0.01）。膀胱冲洗时间和术后并发症患者激光组较电切组住院时间明显减少（P＜0.05）,而术后住院时间（P＞0.05）缩短不明显。结论与经尿道前列腺电切术相比,经尿道2μm前列腺汽化切除术中、术后出血少,术后留置导尿管时间、膀胱冲洗时间均缩短,明显提高护理工作效率。     

α-金环蛇毒作用于尿道外括约肌对脊髓损伤大鼠排尿功能的影响

 目的通过在尿道外括约肌(EUS)局部使用高选择性神经肌接头阻滞剂α-金环蛇毒,以明确EUS松弛后能否改善雄性脊髓损伤(SCI)大鼠的排尿功能.方法分别在正常和SCI大鼠的EUS局部注射α-金环蛇毒100μg/kg,同时比较用药前后尿流动力学和肌电图的改变.结果α-金环蛇毒可以完全抑制EUS的收缩,使SCI鼠排尿量及残余尿减少,排尿阈值降低,排尿效率得到提高,排尿压明显降低;正常鼠用药后,排尿量减少,残余尿量明显增加,排尿效率下降,排尿压没有改变.结论 EUS功能对正常排尿活动是必需的,阻断SCI鼠的EUS活动则有助于改善其排尿功能,这对于治疗人类SCI后的排尿异常有借鉴意义.     

儿童扩张的前列腺囊影像学诊断

目的：探讨儿童扩张的前列腺囊影像学特点。方法回顾性分析13例儿童临床诊断为扩张的前列腺囊病例,其中6例行排泄性膀胱尿道造影(VCUG)检查,5例行 MRI 检查,2例行 VCUG 及 MRI 检查。结果8例 VCUG 均在排尿时后尿道后方膀胱后下方见类圆形或长圆形囊腔影,3例囊腔可见管状影与后尿道相通,另5例囊腔影与尿道影重叠,囊腔与后尿道相通管道显示不清。7例 MRI 检查,均在膀胱后方中线区见上下走行长圆形囊状长 T1长 T2信号,穿过前列腺中心。5例囊腔可见条形高信号与后尿道高信号相通,5例发现睾丸炎、附睾炎、阴囊炎,1例发现右肾缺如。结论VCUG 和 MRI 检查是儿童扩张的前列腺囊重要检查方法,两者各有优缺点。     

Nonobstructive posterior urethral widening (spinning top urethra) in boys with bladder instability.

Seven boys between the ages of 5 and 10 years with symptoms of urinary frequency and urgency and daytime wetting were studied with urodynamics and were shown to have bladder instability and a dilated posterior urethra. In two the dilatation occurred predominantly during bladder filling. Unstable contractions caused filling of the posterior urethra, and leakage was prevented by voluntary contraction of the distal urethral sphincter; with voiding, the urethra showed a more normal appearance. In the remaining five, there were similar changes during filling, but dilatation persisted during voiding. In six the measured urine flow rate was normal, and none showed any evidence of anatomic obstruction. The mechanism of urethral distention appears to be similar to that previously shown in girls with spinning top urethra: Unstable contractions resisted by voluntary sphincter contraction cause posterior urethral dilatation. Boys with dilated posterior urethras who have urinary frequency and urgency and daytime wetting and normal urine flow rates should be assumed to have bladder instability.     

小儿前列腺囊的X线诊断

目的 探讨小儿前列腺囊的影像学特点及诊断方法。资料与方法 对16例经手术证实或经膀胱镜、尿道镜等检查证实的前列腺囊患儿资料进行回顾性分析。16例中13例经排泄性膀胱尿道造影(VCUG)检查确诊,2例经B超检查确诊,1例在尿道成形术中发现。结果 13例VUG在后尿道后方中线处均显示对比剂充盈的类圆形囊腔,大小不等,囊壁较光滑。结论 VCUG检查是诊断小儿前列腺囊的首选方法。     

Madigan前列腺切除术

目的：探讨Madigan前列腺切除术治疗前列腺增生症（BPH）的经验,方法：回顾性分析17例BPH患者的临床资料。结果：14例尿道完整,3例尿道破裂,术中出血100－600ml,平均200ml,均未输血,手术时间90－140分钟,平均105分钟,术后随访2－26个月,IPSS由术前平均26．3降至术后平均6．8,Qmax由术前平均7．9ml/s至术后平均18．7ml/s,无尿道狭窄,尿失禁 ,性功能丧失等并发症,结论;保留尿道前列腺切除术术后出血少,恢复快,并发症少,住院时间短,是治疗BPH较为理想的开放手术术式。     

Diverticula of the female urethra. A radiological and ultrasound study

The authors analyzed the clinical, radiographic and sonographic findings of diverticulum of the female urethra, reporting on 47 cases. Lower urinary tract infections, urgency and post-urinary dribbling were the most common symptoms. Either voiding cystourethrography or positive pressure urethrography was carried out in all patients, while US was performed in 18 cases only. Radiographs showed diverticula to be usually solitary (87%); their size ranged from 1 to 3 cm (72%). They were most commonly found in the mid-third of the urethra (83%), and stones were present in 12.7% of patients. Suprapubic and transrectal US demonstrated cystic lesions, usually dyshomogeneous, located under the bladder base and the uterine cervix. The authors believe that both examinations should be performed, as they provide with complementary information. X-ray study allows the evaluation of the exact number and position of diverticula, while US demonstrates both the extension of inflammatory changes and the size of diverticula not completely filled during voiding cystourethrography.     

前列腺增生合并膀胱癌一期开放手术治疗(附42例报告)

目的探讨前列腺增生合并膀胱癌一期手术安全性与疗效,以及与膀胱癌复发的影响。方法对42例前列腺增生合并膀胱癌患者,行膀胱部分切除术和前列腺摘除术的临床资料进行回顾性分析。结果所有病例术后均排尿通畅,残余尿<15ml,36例获得随访,随访时间2～6年,复发率为16.7%。所有复发病例再次手术发现肿瘤部位不在前列腺窝或膀胱颈处。结论前列腺增生症致尿路梗阻是膀胱癌复发的重要因素,对膀胱癌合并前列腺增生症致尿路梗阻者,解除梗阻可降低膀胱癌的复发率;同期手术是安全和有益的。     

Contrast ultrasound of the urethra in children

The aim of this study was to report our experience with transperineal ultrasound in studying the urethra, as a complementary technique to contrast-enhanced voiding urosonography (VUS). The VUS was performed in 350 patients (244 males, 106 females) less than 4 years of age, and complemented with perineal US. Ultrasound of the kidneys and bladder was obtained before and during bladder filling and post-voiding. The urethra and the neck of the bladder were evaluated sagittally by transperineal ultrasound (5–7.5 MHz) before, during, and after voiding. Only cases of posterior urethral valves diagnosed at VUS were followed by voiding cystourethrography (VCUG), which was performed on a different day. A satisfactory evaluation of the urethra was obtained in 332 cases (94.86%): (a) normal urethra (n=328); and (b) posterior urethral valves (n=4). In the latter 4 cases there was concordance between results at VUS and VCUG. Eighteen cases (5.14%) were excluded from the study because the quality of the examination was suboptimal. Transperineal US offers an initial imaging modality for studying urethral pathology and thus may complement VUS. This paper was presented at the IPR meeting 2001, in Paris.     

Prostatic Tissue Elimination After Prostatic Artery Embolization (PAE): A Report of Three Cases

CardioVascular and Interventional Radiology - We report three cases of spontaneous prostatic tissue elimination through the urethra while voiding following technically successful prostatic artery...     

绿激光前列腺气化术同期联合无张力疝修补术治疗良性前列腺增生合并腹股沟疝（附13例报告）

目的探讨绿激光前列腺气化术同期联合无张力疝修补术治疗良性前列腺增生合并腹股沟疝的安全性及有效性。方法对13例良性前列腺增生合并腹股沟疝患者,先行无张力性腹股沟疝修补术,后行经尿道绿激光前列腺气化术,观察手术疗效及并发症。结果手术均顺利,无输血及死亡病例,术后国际前列腺症状评分、生活质量评分、最大尿流率、残余尿量均较术前显著改善,无手术切口感染,随访3～15个月无复发疝发生。结论同期行经尿道绿激光前列腺气化术和无张力疝修补术;临床疗效良好,患者具有良好的耐受性,避免了二次手术,减轻了患者经济负担,可作为老年良性前列腺增生合并腹股沟疝患者的较佳选择。     

Sonourethrography: technique for evaluation of prostatic urethra

Sonoendoscopy of the prostate was extended to include the prostatic urethra, using the transrectal approach so as to show the urethra during voiding. In addition to the normal urethra, nodules impinging upon and displacing the prostatic urethra were clearly demonstrated, as well as clinically unsuspected carcinomas and other abnormalities.