前列腺囊肿微创治疗的选择（附7例报告）

目的：探讨前列腺囊肿的临床特征、诊断与微创治疗方法的选择.方法：回顾性分析7例前列腺囊肿患者的临床资料：3例因排尿不畅、尿线变细及排尿费力等就诊,3例以尿频、尿急及会阴部不适等类似前列腺炎症状就诊,1例因血精就诊.均经B超、MRI检查,对3例靠近前列腺尿道的较小囊肿行经尿道前列腺囊肿去顶术,对4例向尿道及膀胱顶后方突起的较大囊肿行腹腔镜下囊肿切除术.结果：7例患者均经B超、MRI联合确诊.经尿道手术时间30～40 min,出血20～50 ml;腹腔镜手术时间100～160 min,出血 30～80 ml.术后引流2～3天,留置导尿管1～2周.所有患者术后随访1个月～2年,无尿路刺激症状,无排尿困难,阴茎勃起及射精功能正常.结论：经直肠B超和MRI是诊断前列腺囊肿的重要方法.对于靠近前列腺尿道的有症状的囊肿,经尿道前列腺囊肿去顶术疗效确切;当囊肿靠近尿道及膀胱顶的后方时,腹腔镜切除囊肿具有组织显露清楚、不易损伤盆腔组织、创伤小、出血少等优点,是治疗此类前列腺囊肿的最佳选择.     

微创手术治疗前列腺囊肿九例报告

2003年9月至2010年6月,我科收治前列腺囊肿患者9例,采用微创手术治疗,疗效满意.现报告如下. 对象与方法 本组9例.平均年龄36(19～72)岁.因排尿不畅、尿线变细等6～36个月就诊4例,以尿频、会阴部不适等似"前列腺炎"症状7～24个月就诊4例,因血精2个月就诊1例.患者均行经直肠B超、MRI检查诊断为前列腺囊肿,囊肿位于前列腺部尿道后方,大小2 cm×2 cm～5 cm×6 cm.     

前列腺囊肿29例报告

目的总结前列腺囊肿的诊疗经验。方法回顾性分析2000年6月至2008年6月收治的前列腺囊肿患者29例的临床资料。结果 5例伴前列腺增生（BPH）者行经尿道前列腺电切术（TURP）,术后排尿通畅,Qmax〉19 mL/s,RUV〈30 mL。膀胱镜检查发现的5例透明囊肿行经尿道囊肿电切,术后1年膀胱镜检查未复发。3例囊肿直径大于3 cm者在B超引导下经会阴囊肿穿刺治疗,抽出25～50 mL淡黄色液体,穿刺后5～7 d,会阴不适等症状消失,B超检查囊肿直径由3.0～5.0 cm缩小到0.5～1.0 cm。8例囊肿合并慢性前列腺炎（CP）者经过前列腺注药等综合疗法治疗1～2个月,尿频、腰痛等症状消失,囊肿大小无变化。8例囊肿直径小于1.0 cm者随访1～2年,囊肿大小无变化。结论前列腺囊肿合并BPH引起排尿困难者行TURP,透明囊肿行经尿道囊肿电切术,大于3 cm囊肿囊肿穿刺硬化剂治疗,囊肿合并CP按前列腺炎治疗,小于1 cm囊肿门诊随访。     

男性盆腔囊性疾病17例诊治分析

目的:探讨男性盆腔囊性疾病的诊断与治疗。方法:回顾性分析我院泌尿外科2003年5月~2013年5月收治的17例男性盆腔囊性疾病患者的临床资料,探讨各疾病发生机制及辅助检查的应用。结果:17例患者中,前列腺囊肿5例(直径3.0cm)、前列腺囊腺瘤2例、精囊囊肿6例、精囊脓肿2例、精囊腺癌1例、前列腺癌(PCa)伴血肿1例;8例行腹腔镜下囊肿切除术,5例行经尿道囊肿去顶术,2例行经腹囊肿切除术,2例行根治性前列腺切除术;术后随访6个月~10年,未见下尿路症状复发。结论:超声是诊断盆腔囊性疾病的重要方法,根据超声结果,适当选取CT、MRI及膀胱镜检查,可以提高诊断的正确率。当囊肿靠近前列腺尿道时,经尿道囊肿切开术疗效确切;对于靠近膀胱颈及位于精囊的囊性肿物,腹腔镜囊肿切除术为首选;当腹腔镜切除盆腔囊性肿物困难时,可行开腹手术。     

经膀胱途径精囊肿块切除术(附5例报告)

目的:探讨经膀胱途径在精囊疾病外科治疗中的应用。方法:本组5例男性患者,年龄45～69岁,平均51岁。临床症状:3例主要表现为尿频、尿急、排尿不畅等下尿路症状,其中1例同时伴有排便不畅,大便变细。1例因血精就诊,1例因下腹部及会阴部隐痛不适,B超检查发现右侧精囊肿块入院。病程2～18个月,平均9个月。经直肠指检、直肠B超、盆腔CT及MRI等检查诊断为左侧精囊肿块2例,右侧3例,肿块长径3～10cm,平均5cm。5例均行经膀胱途径精囊肿块切除术。结果:5例手术均获得成功,平均手术时间75min,平均出血量140ml,术后平均住院时间10d。病理报告:精囊囊肿伴感染2例,精囊囊腺瘤1例,精囊低度恶性分叶状肿瘤1例,前列腺组织1例。随访时间3～72个月,术后症状消失或明显改善。复查B超及CT未见复发。结论:经膀胱途径精囊肿块切除术,手术切口小,视野清晰,操作简便,易于开展,是精囊疾病外科治疗的有效方法。     

经尿道电切联合针状电极膀胱颈切开术治疗前列腺增生术后膀胱颈挛缩（附45例报告）

目的探讨经尿道电切联合针状电极膀胱颈切开术治疗前列腺增生术后膀胱颈挛缩的疗效。方法对45例确诊为前列腺增生术后膀胱颈挛缩者，6点位电切抬高的膀胱颈后唇，3点及9点位完全电切除瘢痕组织，至显露膀胱逼尿肌，12点尽可能切除瘢痕组织，修整膀胱颈开口。再应用针状电极分别于5、7点处切开膀胱颈，深度要彻底切开颈部纤维环，甚至可见到膀胱外脂肪。结果术后43例排尿通畅，尿线粗；2例仍有轻度排尿困难症状，但能自行排尿，给予α1受体阻断剂及M受体激动剂口服后，症状明显减轻。术后15例有尿频、尿急、尿痛，2周内缓解，无须特殊处置。无继发出血、尿道狭窄、尿失禁、膀胱直肠瘘等并发症发生。45例随访3—30个月，平均15个月：Qmax为15．5～24．3ml／s，平均19．5ml／s；无膀胱颈挛缩复发；排尿后B超测残余尿为0—35ml，平均20ml。结论对于前列腺增生术后膀胱颈挛缩病人，经尿道电切术联合针状电极膀胱颈切开术疗效确切，复发率低，值得推广应用。     

苗勒管囊肿并乳头状囊腺癌1例报告附文献复习

目的:探讨苗勒管囊肿及其恶性肿瘤的诊断与治疗。方法:回顾分析1例苗勒管囊肿并乳头状囊腺癌患者的临床与病理资料,结合文献复习讨论其病理、临床表现、影像学特点及治疗。患者男性,44岁。主要临床表现为间歇性血精伴终末血尿及不育15年,经直肠B超、盆腔CT、MRI、膀胱镜及活检病理检查确诊为苗勒管囊肿并恶性变。结果:患者经耻骨上膀胱后入路行肿块切除术。术中囊性肿物颈部呈楔形穿过近膀胱颈的前列腺止于后尿道区,而不影响邻近的前列腺组织,证实其来自苗勒系统。术后病理检查为乳头状囊腺癌Ⅱ级,侵及囊壁全层,双侧精囊及射精管未见癌组织浸润。术后未予辅助治疗,随访6个月患者症状消失,排尿通畅。经直肠超声及CT检查无肿瘤复发。结论:苗勒管囊肿合并恶性肿瘤,经直肠B超、盆腔CT、MRI及膀胱镜检查有助于诊断,确诊需病理组织学检查。外科手术治疗效果良好。     

腹腔镜下全膀胱切除原位回肠新膀胱重建术(附5例报告)

目的:介绍腹腔镜下全膀胱切除原位回肠新膀胱重建术的经验。方法:采用腹腔镜下全膀胱切除原位回肠新膀胱重建术治疗浸润性膀胱癌患者5例。方法是经腹壁小切口取出切除物,行回肠去管成形新膀胱,然后在腹腔镜下将新膀胱与尿道连续吻合。结果:5例患者手术成功,手术时间4.5~7.2h。腹腔镜手术中以超声刀及双极电凝行膀胱侧韧带、前列腺血管蒂及前列腺尖部切断止血,未使用钛夹、术中出血量180~550ml,平均输血400ml。术后4~5天恢复饮食,3周拔除输尿管支架管,4周拔除尿管。患者白天可完全控制排尿,2例夜间偶有尿失禁。1例术后尿漏,经引流治愈。结论:腹腔镜下全膀胱切除术具有创伤小、出血少、恢复快等优点;而回肠新膀胱和尿道连续吻合具有操作方便、省时、缝合紧密、可防止尿漏等优点。     

等离子电切术治疗前列腺囊肿1例报告

前列腺是男性特有的性腺器官.在前列腺的腺体中央,有尿道通过,因此前列腺的病变直接影响男性患者的排尿情况.前列腺囊肿虽然是一种少见的男性疾病,但是由于前列腺特殊的解剖位置,前列腺囊肿常常会挤压后尿道或者堵塞膀胱颈,导致患者出现下尿路梗阻症状.华中科技大学同济医学院附属同济医院泌尿外科近期诊治1例前列腺囊肿,采用经尿道前列腺囊肿等离子切除治疗,效果良好,现报告如下.     

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。     

腹腔镜手术治疗小儿前列腺囊肿6例报告

目的腹腔镜手术治疗小儿前列腺囊肿的疗效。方法2006年7月～2012年7月，腹腔镜手术治疗小儿前列腺囊肿6例。术中直视下将膀胱悬吊于前腹壁，2例输尿管导管注水引导暴露前列腺囊肿，4例在尿道镜引导下切除前列腺囊肿，能明确囊肿开口位置，避免过度充盈膀胱影响操作。结果6例腹腔镜手术均成功完成，无中转开放手术。手术时间60—90min，平均75min；术中出血量20－40ml，无输血者。术后皮管引流3d，留置尿管12d。6例随访3～24个月，平均12个月，无排尿困难，无泌尿道感染。结论腹腔镜手术切除囊肿具有安全、显露清楚、创伤小、出血少等优点。     

Anatomical and histological studies of so-called Müllerian duct cyst

BACKGROUND: We examined so-called Müllerian duct cysts both histologically and immunohistochemically with anatomical observation to investigate the etiology of the 'Müllerian duct cyst'. METHODS: Five cystic lesions located in the prostatic midline were obtained from surgical specimens. A communication between the cystic lesion and the urethra via the utricular orifice was looked for and the specimens were subjected to histological and immunohistochemical testing. RESULTS: A communication between the cyst and the urethra was confirmed in four cases, but not in one case. Histological and immunohistochemical examinations of the epithelium lining indicated that its characteristics were identical to those of the prostatic utricle in all cases. CONCLUSIONS: The so-called Müllerian duct cyst exhibits features comparable to those previously described in the prostatic utricle. There is no evidence that these cystic lesions originate from the Müllerian duct remnant, at least in the epithelial lining. We suggest that they should be termed a prostatic utricular cyst or cystic dilation of the prostatic utricle, depending on whether an outlet to the urethra is absent or present, respectively.     

Retrovesical mass in men: pitfalls of differential diagnosis

PURPOSE: We review the differential diagnosis and treatment of retrovesical masses in men. MATERIALS AND METHODS: During the last 8 years 21 male patients 3 to 79 years old (mean age 47.1) presented with symptoms or signs of a retrovesical mass. Clinical features and diagnostic findings were reviewed, and related to surgical and histopathological findings. RESULTS: The retrovesical masses included prostatic utricle cyst in 3 cases, prostatic abscess in 1, seminal vesicle hydrops in 6, seminal vesicle cyst in 2, seminal vesicle empyema in 3, large ectopic ureterocele in 1, myxoid liposarcoma in 1, malignant fibrous histiocytoma in 1, fibrous fossa obturatoria cyst in 1, hemangiopericytoma in 1 and leiomyosarcoma in 1. In 17 patients various symptoms were seen and in 4 the mass was incidentally detected. A mass was palpable on digital rectal examination in 16 cases and visible on sonography in 20. For a cystic mass medial location relative to the bladder neck was suggestive of prostatic abscess or utricle cyst, while lateral location was suggestive of seminal vesicle cyst/hydrops or empyema, ectopic ureter or ureterocele. In 6 patients diagnosis was established only by exploratory laparotomy and histopathological examination. CONCLUSIONS: Digital rectal examination and sonography reliably detect a retrovesical mass. Nevertheless, clinical signs and median or lateral location relative to the bladder neck on ultrasound are diagnostic only for cystic lesions. Computerized tomography and magnetic resonance imaging are useful for staging malignant tumors. However, needle or open biopsy is required in most cases to establish a histopathological diagnosis. Exploratory laparotomy and histopathological examination are the procedures of choice when other findings are equivocal.     

Histopathological study of the müllerian duct remnant: clarification of disease categories and terminology.

PURPOSE: We determined by histopathological studies whether there is an etiological difference in 2 distinct categories of müllerian duct remnant diseases. In addition, we clarified the nomenclature of these diseases. MATERIALS AND METHODS: We recently performed radical prostatectomy in a patient with prostate cancer associated incidentally with a so-called müllerian duct cyst in the prostatic midline. The specimen was examined by pathological and immunohistochemical testing with special attention to the relationship of the cyst and utricle. We also investigated the histology of so-called enlarged prostatic utricles or vagina masculinus extirpated from patients with severe hypospadias or intersex disorder. RESULTS: The round cyst removed with the prostate seemed to arise from the verumontanum and it contained fluid with a high concentration of prostate specific antigen. Histological and immunohistochemical examination of its lining epithelium demonstrated that cyst characteristics were identical to those of the prostatic utricle. On the other hand, pouches extirpated from patients with pediatric problems were lined by squamous epithelium. CONCLUSIONS: The so-called müllerian duct cyst appeared to originate from the prostatic utricle, and so should be termed a utricular cyst or cystic utricle. Conversely the so-called enlarged prostatic utricle should be termed a vagina masculinus or male vagina. The term müllerian duct remnant, which would include these 2 abnormalities, may usefully be replaced by the term utricular abnormalities.     

Adult müllerian duct or utricle cyst: clinical significance and therapeutic management of 65 cases

PURPOSE: We define guidelines for the exploration and treatment of adult müllerian duct cysts. MATERIALS AND METHODS: From January 1988 through September 1999 a diagnosis of enlarged prostatic utricle was made in 65 adults based on transrectal ultrasound findings. Echographic criteria to define simple versus complicated cysts were detailed. We reviewed the clinical presentation, diagnostic modalities, indications for invasive procedures and postoperative outcome. RESULTS: The usual clinical presentations were hematospermia in 40% of cases, other ejaculatory disturbances in 20%, recurrent testicular or pelviperineal pain in 33%, lower urinary tract irritation symptoms in 25%, lower urinary tract infection in 18.5%, male infertility in 12% and incidental finding in 18.5%. Cyst dimensions did not influence the indication for invasive procedures, which were performed in only 27 of the 65 patients (41.5%) to treat disabling symptoms in 28% and obstructive infertility in 5%, and investigate complicated cysts on transrectal ultrasound in 6%. These procedures included transperineal or transrectal puncture in 9 patients, simple endoscopic section of the utricle meatus in 12 and large marsupialisation in 6. Complete and sustained cure was noted in half of the patients treated with cyst puncture only, although echographic relapse was the rule. Endoscopic procedures definitely improved or cured 82% of the patients at a mean followup of 51 months, during which neither early nor late complications were noted. CONCLUSIONS: Since almost 60% of adults diagnosed with a müllerian duct cyst did not experience any cyst related symptoms or ejaculatory-fertility impairment, we recommend that investigation and/or treatment should only be done in symptomatic or infertile patients.     

New classification of midline cysts of the prostate in adults via a transrectal ultrasonography-guided opacification and dye-injection study

OBJECTIVES

To reclassify midline cysts (MLCs) of the prostate according using the results from transrectal ultrasonography (TRUS)‐guided opacification and dye injection.

PATIENTS AND METHODS

Eighty‐six patients (mean age 60.9 years) who had MLCs detected in the pelvis by TRUS were investigated. In all patients the size of the MLC was measured and they had transperineal aspiration under TRUS guidance. After aspiration of the MLC a mixture of water‐soluble contrast medium and indigo carmine dye was injected to check for communication with the urethra or seminal tract by endoscopic and pelvic X‐ray examination.

RESULTS

We classified MLCs into four categories: (i) type 1 (nine cases), MLC with no communication into the urethra (traditional prostatic utricle cyst); (ii) type 2a (60 cases), MLC with communication into the urethra (cystic dilatation of the prostatic utricle, CDU); (iii) type 2b (14 cases), CDU which communicated with the seminal tract; (iv) type 3 (three cases), cystic dilation of the ejaculatory duct. The location, shape and volume of the MLC, and the prostate‐specific antigen level of MLC fluid, did not influence the classification.

CONCLUSIONS

The most common type of MLC was CDU. A new classification that depends on the communication with the urethra or seminal tract is proposed.     

术中输尿管镜检查在诊断会阴型尿道下裂并发前列腺囊的应用

目的：探讨输尿管镜在诊断会阴型尿道下裂并发前列腺囊的应用价值。方法：对214例尿道下裂患儿中的会阴型尿道下裂25例,于手术中均行输尿管镜检查。输尿管镜检查在后尿道可明显观察到两个管腔,前方的为尿道,可进入膀胱;后方的为前列腺囊,可呈盲端或腔道。结果：本组共发现前列腺囊11例。结论：术中输尿管镜检查可早期发现前列腺囊,并可同时手术处理,减少术后并发症,提高尿道下裂手术的成功率。     

前列腺囊肿的诊断与治疗

目的：分析前列腺囊肿的诊治现状，以提高前列腺囊肿的诊治水平。方法：回顾性分析1994年1月～2006年9月收治的18例前列腺囊肿患者的临床资料；2例患者采用TURP术治疗，12例采用超声引导下经会阴前列腺囊肿穿刺硬化剂治疗，4例保守治疗。结果：2例手术患者梗阻解除，排尿满意；12例穿刺患者症状于1～3周后逐渐消失，无不良反应和并发症；4例小囊肿随访1～1．5年，囊肿增大不明显。结论：选择治疗方案应根据患者的年龄、临床症状、囊肿大小、囊肿部位定。前列腺囊肿穿刺硬化剂治疗，具有损伤小、疗效满意、并发症少、治疗过程简单的优点，是一种比较理想的治疗方法。     

Congenital dilatation of the prostatic utricle. Embryologic review, diagnosis and treatment. Apropos of 2 pseudo-tumoral cases, without hypospadias]

The authors report two pediatric cases of congenitally dilated prostatic utricle. First a newborn with prenatal ultrasound diagnosis of abdomino-pelvic cystic mass and secondly a 4-year-old boy with urinary incontinence and lower abdominal mass. Unilateral renal hypoplasia was noted in both cases, but no hypospadias. The study of embryogenesis and pathogenesis shows that the anomaly happens before the 8th week of pregnancy. When hypospadias is associated, the anomaly develops later and has a hormonal cause. Prostatic utricle is not only an embryologic Müllerian remnant, but comes from the mesodermic and endodermic tissues. The first clinical signs are often urinary signs or an abdominopelvic mass. The prostatic implantation and the median localization of this cystic mass are both revealed by urethrography and ultrasonography. Computed tomography and especially Magnetic Resonance Imaging may be performed. MRI provides a detailed demonstration of the anatomy and a large field of view in all three planes. It helps to plan surgical therapy. The treatment of prostatic utricle may be percutaneous, endoscopic or surgical. The indications are based on the symptoms, but the risk of malignancy must be kept in mind. In our cases, the marked dilatation of the prostatic utricle led to surgical treatment and retrovesical excision was successful.