前列腺电切术后腺窝结石形成的原因及对策

目的:探讨前列腺电切术后腺窝结石形成的原因、临床表现和防治对策。方法:报道前列腺电切术后腺窝结石患者11例,患者曾行经尿道前列腺电切术或经尿道前列腺等离子双极电切术,术后反复出现尿频、尿急、尿痛等症状,伴尿路感染,部分伴排尿梗阻症状,抗感染治疗效果不理想。膀胱镜检查见前列腺腺窝结石形成,部分可见焦痂、坏死物质、电切创面不平整及小憩室形成。确诊后行钬激光碎石及再次前列腺电切术1例,其余患者在膀胱镜下用异物钳将结石取出,给予抗感染治疗1～2周。结果:11例患者尿常规均恢复正常,尿频、尿急、尿痛等症状消失。随访3～6个月,未再出现膀胱刺激症状、梗阻症状及尿路感染。结论:前列腺电切术后反复尿频、尿急、尿痛、尿路感染者,应考虑到腺窝结石可能,行膀胱镜检查可明确诊断。治疗可采取膀胱镜下取石或碎石术,必要时可再次行前列腺电切术。预防上应注意创面修平整、控制感染及避免过度电凝。

Calculus formation in the prostatic cavity after transurethral resection of the prostate: causes, treatment and prevention

Objective: To study the causes,clinical manifestations,treatment and prevention of calculus that develops in the prostatic cavity after transurethral resection of the prostate.Methods: We reported 11 cases of calculus that developed in the prostatic cavity after transurethral resection or transurethral plasmakinetic resection of prostate.The patients complained of repeated symptoms of frequent micturition,urgent micturition and urodynia after operation,accompanied with urinary tract infection and some with urinary obstruction,which failed to respond to anti-infective therapies.Cystoscopy revealed calculi in the prostatic cavity,with eschar,sphacelus,uneven wound surface and small diverticula in some cases.After diagnosis,1 case was treated by holmium laser lithotripsy and a second transurethral resection of the prostate,while the other 10 had the calculi removed under the cystoscope,followed by 1-2 weeks of anti-infective therapy.Results: After treatment,all the 11 cases showed normal results of routine urianlysis,and no more symptoms of frequent micturition,urgent micturition and urodynia.Three-to six-month follow-up found no bladder irritation symptoms and urinary tract infection.Conclusion: Repeated symptoms of frequent micturition,urgent micturition,urodynia and urinary tract infection after transurethral resection of the prostate should be considered as the indicators of calculus in the prostatic cavity,which can be confirmed by cystoscopy.It can be treated by lithotripsy or removal of the calculus under the cystoscope,or even a second transurethral resection of the prostate.For its prevention,excessive electric coagulation and uneven wound surface should be avoided and anti-infection treatment is needed.