常规留置导尿失败后处理急性尿潴留临床方法的对比分析

目的 探讨常规留置导尿失败后处理急性尿潴留留置导尿的不同方法,以期提高患者一次性留置导尿成功率,尽早解除尿路梗阻并减少尿道损伤。方法 分析2014年1月～2019年9月我院208例急性尿潴留患者的临床资料,根据治疗方式不同,将患者分为尿道扩张后留置导尿组(尿扩组)和内镜下导丝引导留置组(内镜组),分析两组留置导尿成功率及并发症的差异。结果 尿扩组中所有女性患者、无尿道手术史患者及尿道外口狭窄患者经尿道扩张扩后均能成功留置导尿;内镜组中TUR及TURP患者均可成功留置导尿管。TUR及SP患者两组留置尿管成功率无显著性差异(P0.05)。TURP(P0.001)及RP(P=0.008)患者内镜组留置尿管成功率均显著高于尿扩组。内镜组留置尿管总成功率明显高于尿扩组(95.7%vs 80.9%,P=0.001);内镜组术中VAS疼痛评分(2.2±0.3 vs 5.7±0.9,P0.001)及术中明显肉眼血尿发生率(5.4%vs 23.5%,P0.001)均显著低于尿扩组;术后3个月拔除尿管后,内镜组尿潴留发生率明显低于尿扩组(15.1%vs 28.7%,P=0.02)。结论 女性及无尿道手术史的男性患者大多可经尿道扩张后即可成功留置导尿;而对于合并尿道手术史,尤其合并前列腺手术史的男性患者,内镜下留置导尿管优于单纯尿道扩张。

Comparative analysis of clinical methods for treating acute urinary retention after failure of routine indwelling catheterization

Objective To investigate different methods for treating indwelling catheterization for acute urinary retention after failure of routine indwelling catheterization,so as to improve the success rate of one-time indwelling catheterization for patients,relieve urinary obstruction as soon as possible,and reduce urethral injury.Methods The clinical data of 208 patients with acute urinary retention in our hospital from January 2014 to September 2019 were analyzed.According to different therapeutic regimens,patients were divided into the group performed with indwelling catheterization after urethral dilatation(urethral dilatation group) and the endoscopic guidewire-guided indwelling group(endoscopic group).The differences in success rate and complications of indwelling catheterization between the two groups were analyzed.Results All the female patients,the patients without history of urethra operation and the patients with stricture of external orifice in the group of urinary dilatation were able to indwelling catheterization successfully.In the endoscopic group,TUR and TURP patients could be placed catheter successfully.There was no significant difference in the success rate of indwelling catheter in TUR and SP patients between the two groups(P>0.05).The success rate of indwelling catheter in TURP(P<0.001) and RP(P=0.008) patients in the endoscopic group was significantly higher than that in urethral dilatation group.The overall success rate of indwelling catheterization in the endoscopic group was significantly higher than that in the urethral dilatation group(95.7% vs 80.9%,P=0.001).The intraoperative VAS pain score(2.2±0.3 vs 5.7±0.9,P<0.001) and the intraoperative incidence of obvious macroscopic hematuria (5.4% vs 23.5%,P<0.001) in the endoscopic group were significantly lower than those in the urethral dilatation group.After catheter removal 3 months after surgery,the incidence of urinary retention in the endoscopic group was significantly lower than that in the urethral dilatation group (15.1%vs 28.7%,P=0.02).Conclusion Female patients and male patients with no history of urethral surgery can be successfully performed with indwelling catheterization after urethral dilatation.While for male patients with combined urethral surgery history,especially combined with prostate surgery history,endoscopic indwelling catheterization is better than simple urethral dilatation.