经尿道前列腺汽化电切术治疗高龄高危前列腺增生症56例临床分析

目的 总结经尿道前列腺汽化电切术(TUVP)对高龄高危良性前列腺增生症(BPH)的疗效和安全性.方法 对56例高龄高危BPH患者行TUVP手术.总结手术中的技巧以及手术后并发症.对比观察手术前、后国际前列腺症状评分、残余尿量、最大尿流率等指标的差异.结果 手术时间40～100 min,平均55 min;切除腺体重20～80 g,平均48.5 g;术中出血量50～150 ml,平均100 ml.平均随访12个月,患者国际前列腺症状评分由(27.5±3.0)分降至(8.9±2.9)分,残余尿量由(280±30)ml降至(28±10)ml,最大尿流率由(8.7±3.8)ml/s升至(21.2±6.7)ml/s.2例由于其他基础疾病死亡,1例出现尿道狭窄经门诊行尿道扩张后治愈.结论 TUVP可作为治疗高龄高危BPH患者安全有效的方法.     

血压控制在TURP过程中的价值

目的:探讨血压控制在经尿道前列腺切除术(TURP)过程中的价值.方法:回顾性分析106例前列腺增生患者接受(TURP)治疗在术中及术后进行血压控制的效果.结果:全部患者均安全度过围手术期,术后疗效满意,无严重出血的发生,提高了高龄高危患者的生活质量.结论:TULP是治疗前列腺增生的安全有效的方法,术中血压控制是减少出血的关键.     

经尿道电气化术治疗腺性膀胱炎25例临床分析

目的探讨腺性膀胱炎的诊断和治疗方法。方法经膀胱镜结合组织活检确诊的25例腺性膀胱炎患者,均行经尿道电气化术治疗。结果25例均获得12个月随访,22例治愈,3例好转,无1例癌变。结论经尿道电气化术是治疗腺性膀胱炎的主要治疗方法。     

高危前列腺增生合并膀胱复杂性结石的治疗经验——附32例报告

目的 探讨高危前列腺增生(BPH)合并膀胱复杂结石安全有效的治疗方法.方法 采用膀胱切开取石联合经尿道前列腺汽化切割-电切除术(TUVP-TURP)同期治疗高危BPH合并膀胱复杂结石32例.结果 平均手术时间82min,术中、术后均未发生严重并发症,无死亡病例.随访3～10个月.术后3个月国际前列腺症状评分(IPSS)由术前平均25分降至8分,10个月为6分,最大尿流率(MFR)由术前平均7ml/s上升至3个月的16ml/s,10个月为18ml/s.结论 该方法损伤小,安全且疗效确切,并发症少,是治疗高危BPH合并膀胱复杂结石安全有效的治疗方法.     

经尿道前列腺切割术治疗前列腺增生症

目的:分析总结高龄并高危前列腺增生症的疗效和体会。方法:采用英国佳乐等离子切割系统经尿道前列腺切除(TUPKVP)。结果:术中出血少,无水中毒及尿失禁的发生切除腺体完全,疗效满意,90例平均手术时间40min平均失血52 ml,切割获取前列腺组织平均重量46 g。结论:TUPKVP是继TURP和TUVP后又一新的腔内治疗BPH的新疗法:该术具有安全性高、易掌握、并发症少、疗效确切,是治疗高龄并高危BPH的安全有效的方法。     

Is an indwelling catheter necessary for bladder drainage after modified Burch colposuspension?

Catheterization is considered to be a mandatory procedure for adequate bladder drainage following an anti-incontinence operation until the recovery of normal voiding function occurs. We conducted this prospective study to challenge this practice. A total of 86 patients with genuine stress incontinence who underwent a modified Burch coplosuspension were randomized into two groups based on the day of operation. The study group consisted of 42 patients who had the transurethral Foley catheter removed postoperatively the next morning (Group A). The control group was composed of 43 patients who had the transurethral indwelling catheter left in place until the fifth postoperative day (Group B). The percentages of immediate voiding difficulties in Groups A and B were 7.1% and 0%, respectively (P >0.05). The postoperative urinary tract infection rates of Groups A and B were 16.6% and 23.3%, respectively (P >0.05). The success rates of our patients were not compromised after our modified operative procedures (78.6% with dry results and 19.0% with improved symptoms in Group A vs. 74.4% with dry results and 20.9% with improved symptoms in Group B, P >0.05). Our results imply that it is not necessary that an indwelling catheter, for bladder drainage, be left in place until the fifth postoperative day to prevent immediate voiding difficulties. Editorial Comment: The authors have performed a prospective randomized clinical trial of two different bladder management schemes involving a urethral catheter following a modified Burch colposuspension. Group A began their voiding trial on Day 1, Group B began their voiding trial on Day 5 after a 2-day clamped catheter bladder training program. Patients were not discharged until they had normal residuals (<100 ml). There were low, not statistically different, rates of immediate voiding difficulty in either group (7.1% vs. 0%) and therefore the only significant difference between the two groups was the length of hospitalization (5.3 days for Group A and 7.4 days for Group B). They conclude that it is not necessary for a urethral catheter to be left in for 5 days. Very few urogynecologists would disagree with this conclusion. The authors should be commended for performing a prospective randomized study of voiding trials. However, the relevance of this study to clinical practice is extremely limited since most urogynecologists do not perform urethral catheter clamping bladder training programs, nor wait 5 days to start a voiding trial     

The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation

BACKGROUND AND OBJECTIVES: The aim of our study was to compare the three different regional anaesthesia methods in patients who underwent transurethral resection of the prostate (TURP) and to determine the ideal anaesthesia method for TURP operation. METHODS: Totally 77 ASA II-III patients were preloaded with 500 ml 0.9% NaCl solution before regional anaesthesia. In group E (n:27) epidural anaesthesia were achieved by applying 75 mg bupivacaine heavy + 50 microg fentanyl in the L3-L4 intervertebral space. In group SP (n:28) 15 mg bupivacaine heavy + 50 microg fentanyl were used for spinal anaesthesia (L3-L4 intervertebral space) while in group SA (n:30) 10 mg bupivacaine heavy + 50 microg fentanyl were used with saddle blockade. Systolic arterial pressure (SAP), heart rate (HR), peripheral oxygen saturation (SpO2), serum sodium measurement was recorded before and after hydration and during operation. The motor block and sensory level have been measured. RESULTS: Intraoperative SAP values were more stable than the other groups in group SA. The decrease in HR values were significant 15 minutes after prehydration in three groups (p < 0.05). SpO2 values of the groups were stable during the operation. The time to reach the maximum block was very short in patients in Group SA (p < 0.0001). There was a statistically significant difference between the groups in terms of motor block values (p < 0.0001). No fully paralysed sample was seen in Group SA even though there was a sufficient surgical anaesthesia. CONCLUSIONS: Saddle block has some advantages compared to spinal and epidural anaesthesia methods such as achieving adequate anaesthesia, stable haemodynami, the lower degree of motor blockage and no full blockage in patients. Saddle block is an the most optimal anaesthesia method for TURP operation.     

经尿道电切术治疗女性膀胱颈部梗阻36例

目的探讨经尿道膀胱颈部电切术治疗女性膀胱颈梗阻的疗效。方法回顾性分析采用经尿道电切术治疗的36例女性膀胱颈部梗阻患者的临床治疗情况。结果术后生活质量指数、排尿症状评分、最大尿流率(Qmax)、平均尿流率(AFR)、尿量均得到显著改善,无严重并发症发生。随访期间疗效稳定,上述指标无显著变化,膀胱镜复查未有异常发现。结论经尿道膀胱颈部电切术治疗女性膀胱颈梗阻具有安全、效果好、创伤小的优点,是首选手术方法。     

经尿道等离子前列腺汽化剜除术与前列腺电切术对良性前列腺增生患者性功能影响的对比研究

目的:对比经尿道等离子体前列腺汽化剜除术(transurethral plasmakinetic vaporization enucleation of the prostate,TPVEP)与经尿道前列腺电切术(transurethral resection of the prostate,TURP)对良性前列腺增生患者性功能的影响。方法:将2012年12月至2014年12月于我院接受手术治疗的92例患者按自愿原则分为TPVEP组与TURP组,术前1d及出院时检查患者生活质量指数QOL、前列腺症状评分IPSS、最大尿流量Qmax及残余尿量RUV,记录手术时间、术中出血量及术中并发症发生率,随访期调查阴茎勃起功能障碍ED与逆行射精(RE)的发生率。结果:(1)两组的手术时间不存在显著差异(P0.05),而TPVEP组切除腺体的重量大于TURP组,术中出血量、术后置管时间、住院时间均要明显低于TURP组(P0.01),且其术中、术后并发症发生率也显著低于TURP组(P0.05);(2)与术前相比,两组患者术后的QOL、IPSS、RUV均显著下降,Qmax显著升高,差异均有统计学意义(P0.05)。除IPSS评分TPVEP组显著低于TURP组外,其余指标组间对比均无统计学差异(P0.05);(3)术后6个月,TPVEP组的ED发生率及RE发生率均显著低于TURP组(P0.05)。术后9个月,两组的发生率均有一定程度的下降,但TPVEP组仍旧显著低于TURP组(P0.05)。结论:TPVEP术综合了剜除术与等离子汽化系统的优点,具有切除彻底、创伤小、恢复快、疗效确切、并发症少等优点,可显著改善患者尿动力学指标,促进前列腺功能与性功能的恢复。     

高危前列腺增生症经尿道前列腺电汽化切除的围手术期处理

目的总结高危前列腺增生症(BPH)围手术期处理体会,提高手术治疗的疗效和安全性。方法进行全面详细的临床检查,客观评价重要脏器功能,有效治疗内科原有疾病,然后采用经尿道前列腺电汽化切除术(TUVP)治疗高危患者96例。结果平均随访6.8个月,前列腺症状评分、生活质量评分、最大尿流率和残余尿量均较术前明显改善。结论TUVP治疗BPH期间,加强围术期处理措施,不仅其疗效显著,且可做到创伤小、安全性高和并发症少。