间苯三酚预防前列腺电切术后膀胱痉挛的疗效分析

目的:探讨预防性使用间苯三酚对于经尿道前列腺电切术后膀胱痉挛的疗效。方法:将前列腺电切术后患者,按随机抽样方法分为两组,A组(治疗组)39例,术后3d每日予以间苯三酚80mg静脉滴注,B组(对照组)35例,不予间苯三酚。比较两组患者术后3d内出现膀胱痉挛的次数、持续时间、痉挛性疼痛的程度及不良反应。结果:治疗组患者出现膀胱痉挛(4.3±1.2)次,持续时间(7.2±2.1)min,疼痛视觉模拟评分为(3.2±1.6)分,对照组分别为(7.5±2.4)次、(15.6±6.8)min及(4.7±2.3)分。两组之间具有显著性差异(P<0.05)。治疗组未发现明显不良反应。结论:间苯三酚对于防治前列腺电切术后膀胱痉挛安全有效。     

帕瑞昔布钠超前镇痛在经尿道前列腺电切术的应用

超前镇痛是指伤害性刺激作用于机体之前采取的一种措施,可防止神经中枢敏感化,减少和消除伤害引起的疼痛^[1]。我院2008年11月-2010年10月采用帕瑞昔布钠超前镇痛用于经尿道前列腺电切手术（TURP）,观察其对术后膀胱痉挛性疼痛的影响及不良反应,探讨其超前镇痛的有效性和安全眭。1资料与方法1．1一般资料选择良性前列腺增生症（BPH）患者60例,ASAI～Ⅱ级。年龄51～72岁,平均（68．10±9．60）岁。体重53~78kg,平均（60．51±10．72）kg。     

琥珀酸索利那新片改善经尿道前列腺电切术后膀胱痉挛的疗效观察

目的:探讨琥珀酸索利那新片改善经尿道前列腺电切术后膀胱痉挛的疗效。方法:80例前列腺电切术后患者随机分为两组,治疗组(n=40)术后给予琥珀酸索利那新片5mg,每天1次,口服4天;对照组(n=40)不给予干预性治疗。所有患者被记录膀胱痉挛次数、持续时间、痉挛性疼痛的程度及不良反应。结果:治疗组患者出现膀胱痉挛(4.1±1.1)次,持续时间(7.3±1.9)min,疼痛视觉模拟评分为(3.4±1.4)分,对照组分别为(6.8±2.3)次、(10.2±3.3)min及(5.3±2.4)分。治疗组相对于对照组膀胱痉挛症状有明显改善(P<0.01)。治疗组未发现明显不良反应。结论:琥珀酸索利那新片对于防治前列腺电切术后膀胱痉挛安全有效。     

经尿道膀胱肿瘤电切术加前列腺电汽化术治疗膀胱癌并前列腺增生

近4年来，我院采用经尿道前列腺电气化术(TUVP)治疗前列腺增生(BPH)患者298例，其中并发膀胱肿瘤患者22例同期施行经尿道膀胱肿瘤电切术(TURBt)，取得满意疗效，现报告如下。     

经尿道前列腺汽化电切术结合经尿道前列腺电切术治疗前列腺增生症

目的：探讨经尿道前列腺汽化电切术(TUVP)结合经尿道前列腺电切术(TURP)治疗前列腺增生患者的价值。方法：结合三种电极的特点回顾性分析146例前列腺增生患者接受TUVP和TURP治疗后的疗效。结果：全部患者均安全度过围手术期，术后疗效满意，无严重并发症，提高了高龄高危患者的生活质量。结论：TUVP结合TURP是治疗前列腺增生的安全有效的方法。     

经尿道电汽化术联合电切术治疗前列腺增生症122例

目的探讨经尿道前列腺电汽化术(transurethral electrovaporization of the prostate,TUVP)联合经尿道前列腺电切术(transurethral resection of the prostate,TURP)治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)的效果. 方法 TUVP联合TURP治疗122例BPH.根据Rous提出的前列腺大小估重及分度法,Ⅰ度增生8例,Ⅱ度增生58例,Ⅲ度增生32例,Ⅳ度增生24例. 结果手术时间20～140 min ,平均68 min.术中出血量40～200 ml,平均80 ml.2例术后输血200 ml,无前列腺电切综合征发生.平均留置尿管6 d.122例随访4～19个月,平均10个月,国际前列腺症状评分由术前的(30.2±2.3)分降至术后(10.8±2.5)分(t=10.84,P=0.000),剩余尿量由术前的(252.6±65.3)ml降至术后的 (35.6±10.4)ml(t＝23.52,P=0.000),最大尿流率从(8.5±2.8)ml/s上升至(20.6±3.8)ml/s(t=6.67,P=0.000).术后暂时性尿失禁2例,前尿道狭窄2例. 结论联合应用TUVP及TURP治疗BPH 疗效满意.     

膀胱癌合并良性前列腺增生不宜同期行经尿道膀胱肿瘤电切术+经尿道前列腺电切术

<正>膀胱癌是我国泌尿外科临床上最常见的肿瘤之一,经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)既是非肌层浸润型膀胱癌的重要诊断方法,同时也是主要的治疗手段[1]。良性前列腺增生(benign prostatic hyperplasia,BPH)是引起中老年男性排尿障碍最为常见的一种良性疾病[2],经尿道前列腺电切术(transurethral resection     

经尿道等离子前列腺汽化电切术与经尿道前列腺电切术的近期疗效比较

目的比较经尿道等离子前列腺汽化电切术（TUPKRP）与经尿道前列腺电切术（TURP）的近期疗效。方法将前列腺增生（benign prostatic hyperplasia，BPH）患者随机分为两组，分别行TUPKRP和TURP，比较两组术前和术后6个月检查的各项指标并进行统计学分析。结果术前两组一般情况比较无统计学意义（P〉0．05）；术后6个月两组国际前列腺症状评分、生活质量评分、最大尿流率比术前均得到明显改善（P〈0．01）；术中输血量、电切综合征发生率、术后平均膀胱冲洗时间、置管时间和住院时间，TUPKRP组明显小于TURP组（P〈0．01）。结论TUPKRP治疗BPH具有与TURP近期疗效相似；术中并发症发生率及患者术后恢复时间明显少于TURP，有良好的应用前景。     

经尿道前列腺等离子双极电切和经尿道前列腺电切治疗良性前列腺增生的临床结果比较

目的比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的临床疗效及安全性。方法PKRP组78例,TURP组78例,比较2组手术时间、术中出血量,术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)及并发症发生率。结果PKRP组手术时间、术中出血量、术后2个月内暂时性尿失禁发生率、术后4周内继发性出血及3个月内尿道狭窄发生率分别为(64±21)min,(247±84)ml,26．9％(21／78),1．3％(1／78)和2．6％(2／78),TURP组分别为(78±18)min,(432±132)ml,48．7％(38／78),10．3％(8／78)和12．8％(10／78),2组比较差异均有统计学意义(P<0．05)。2组均未发生电切综合征(TURS)。PKRP组术后IPSS为4．6±1．2,QOL为1．1±0．8,Qmax为(26．1±4．6)ml／s; TURP组分别为4．8 4±1．1、1．3±0．8、(25．3．4±4．2)ml／s;均较术前明显改善(P<0．01),但组间差异无统计学意义。结论PKRP与TURP比较,治疗BPH疗效相近,但安全性更好,是治疗BPH的理想方法。     

经尿道前列腺电切术后膀胱痉挛的护理

<正>良性前列腺增生是老年男性常见疾病。经尿道前列腺电切术(TURP)是世界卫生组织推荐的治疗前列腺增生首选方法。与开放手术相比具有手术时间短、创伤小、恢复快等优点,但术后常常发生膀胱痉挛。2004-05～2010-12,我科共发生TURP,术后膀胱痉挛21例,经综合护理干预,效果良好,报告如下。     

Hyponatraemia after transurethral resection of the prostate

Transurethral resection (TUR) syndrome is a complication of transurethral resection of the prostate characterized by bradycardia, hypotension and postoperative confusional state, which is generally attributed to hyponatraemia occurring during or immediately after operation. In a prospective study of 100 consecutive patients undergoing transurethral resection of the prostate, changes in serum sodium were estimated before and after operation and correlated with various parameters including weight of prostate resected, volume of irrigant fluid and resection time. Seven patients showed a significant drop (greater than 10 mmol/litre) in serum sodium: two of these had the clinical features of TUR syndrome and one of them died. The pathogenesis and management of this syndrome are discussed.     

Subacute hyponatraemia after transurethral resection of the prostate

We present a case of subacute hyponatraemia which developed 3 days after a transurethral resection of the prostate. Symptoms consisted of nausea, vomiting and headache. Release of vasopressin due to excessive surgical bleeding, combined with liberal oral and intravenous administration of sodium-free fluids, was considered to be the cause.     

Pubic symphysitis after transurethral resection of the prostate

Purpose

Pubic symphysitis (PS) after urological operations is uncommon. This is a systematic single-institution review of patients with transurethral resection of the prostate (TUR-P) with the aim to determine the incidence of PS after TUR-P and to identify a risk profile.

Materials and methods

In the past 15 years, 12,118 transurethral operations were performed in our department, 33.4 % (n = 4045) were TUR-P, and 84.6 % (n = 3421) had routine suprapubic trocar placement. A systematic retrospective analysis identified 12 patients, who developed PS (0.297 %).

Results

Median age was 69.5 years (64–83). All patients had voiding difficulties. Urine culture had been positive in three cases. All 12 TUR-Ps were monopolar resections, and n = 11 patients had a suprapubic trocar. Median resection weight was 47.5 g (10–100). Two patients had a perforation of the capsule. Histopathological examination revealed chronic prostatitis in nine cases. After 1.0 ± 1.2 months, all patients developed pain in the pubic region. All patients underwent MRI, which suggested PS. Symptomatic and antibiotic medications were administered. Final outcome was resolution of symptoms in all patients after 3.8 ± 5.6 months. No patient retained voiding difficulties.

Conclusion

PS remains a rare complication after TUR-P. We could not identify a single cause for developing PS. In our study, suprapubic trocar placement (11/12), chronic prostatic inflammation (9/12), previous UTI (3/12) and extended resection (2/12) were overrepresented. Inflammatory, thermic and/or surgical damage of the capsule may be causative. Patients require antibiotic and symptomatic medication. However, prognosis for remission is excellent.

     

'Cardiac' enzymes after transurethral resection of the prostate

Postoperative serial determinations of serum total creatine kinase (CK) and the CK-B subunit (by immunoinhibition), and of total lactate dehydrogenase (LD) and isoenzyme LD-1 (by immunoprecipitation), were performed in 16 and 9 patients, respectively, after uncomplicated transurethral resection of the prostate (TURP). Total CK remained unchanged. An early, modest increase in serum CK-B activity, accompanied by an unusually high CK-B/total CK relation, correlated significantly with duration of operation and amount of tissue resected. A slight, early elevation of the total LD level was not accompanied by an increase in LD-1. If the possibility of small increases in CK-B and LD from the prostate is taken into consideration, routine criteria for diagnosing myocardial damage may be applied after TURP.     

Prophylactic antibiotics after transurethral resection of prostate

We studied whether or not prophylactic use of antibiotics following transurethral resection of prostate (TUR-P) was needed. The subjects were 152 patients preoperatively passing sterile urine who underwent TUR-P. They were divided into three groups: 35 with no use of antibiotics (no prophylaxis group), 70 with one day use of antibiotics (one day-prophylaxis group) and 47 with use of antibiotics until pyuria disappeared (long term-group). The three groups did not differ in their rates of fever episodes (greater than or equal to 38.0 degrees C) during the first two weeks nor in the time of disappearance of pyuria. The no prophylaxis group and the one day-group differed statistically in their cumulative rates of bacteriuria (greater than 10(4) CFU/ml) on the postoperative third day: 4 patients (11.4%) in the no prophylaxis group and none in the one day group (p less than 0.01). On the 90th day, however, no significant difference was found in that rate: 22 patients (62.9%) in the no prophylaxis group and 32 patients (45.7%) in the one day group, 70% of the bacteria isolated from urine during the follow up were Gram positive cocci. The time to the elimination of pyuria was not influenced by the use of antibiotics. Our study suggests that postoperative antibiotics for patients passing sterile urine is not necessary following TUR-P.     

前列腺腔内术后尿道狭窄原因及处理

目的探讨前列腺患者腔内手术后尿道狭窄的原因及处理方法。方法经尿道前列腺汽化电切术后尿道狭窄32例，术前均行膀胱镜检未见尿道狭窄，术后出现排尿困难，经尿道探杆检查、膀胱镜检及尿道造影明确诊断为尿道狭窄。其中14例为尿道外口狭窄，9例为尿道球膜部狭窄，4例为阴茎部尿道狭窄缘于尿道扩张造成，5例为前列腺尿道部疤痕狭窄。18例行尿道扩张治愈，7例行尿道内切开加尿道扩张治愈，4例前列腺部尿道狭窄再次电切治愈，3例行尿道成形术。结果32例治疗后能维持通畅的排尿，其中4例患者须定期尿扩随访。结论经尿道前列腺汽化电切术后尿道狭窄主要发生于尿道外口及前尿道，与器械、留置尿管、感染及尿道扩张等因素相关。治疗方法主要为尿道扩张及尿道内切开，尤应重视术后的尿扩随访。