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。

Transurethral Electro-Resection Combined with Needle Electrode Treatment for Bladder Neck Contracture after Treatments of BPH : Report of 45 Cases

Objective To discuss the efficacy of transurethral electro-resection combined with needle electrode treatment for bladder neck contracture after treatments of benign prostatic hyperplasia （BPH）. Methods A total of 45 cases of bladder neck eontracture that developed after treatments of BPH were treated with transurethral electro-resection combined with needle electrode treatment in our hospital. During the operation, the raised posterior lip of the bladder neck was cut at 6 o＇ clock point, and then the scar tissues at 3 and 9 o＇ clock points were resected to expose the bladder detrusor. The scar tissues at 12 o＇ clock point should be removed as much as possible so that the bladder neck could be repaired easily. Afterwards, the fibrotic ring of the bladder neck was cut through at 5 and 7 o＇ clock points with a needle electrode, the fat tissues covering the bladder could be exposed. Results After the operation, 43 of the cases restored normal urine flow. The other 2 patients could urinate despite of mild dysuria, and the symptom was then improved by oral α1 antagonist and M agonist. Fifteen patients developed mieturition frequency and urgency, and odynuria, and were cured pontaneously in two weeks. No patient showed urinary bleeding, stricture, incontinence, or recto-vesieal fistula. Follow-up was available in the patients for 3 to 30 months （mean, 15 months） , during the period, reexaminations showed a Qmax of 15.5 -24.3 ml/s （mean, 19. 5） , and residual urine after urination of 0 -35 ml （mean, 20）. No relapse of bladder neck contracture occurred in this series. Conclusions Transurethral electro-resection combined with needle electrode treatment is effective for patients with bladder neck eontracture after treatments of BPH. The rate of relapse is low after the operation.