加压注水尿管回推技术处理尿道结石

目的报道一种处理尿道结石的新技术——注水加压尿管回推技术(简称加压回推技术),探讨其处理尿道结石的适应证、临床效果以及安全性。方法应用加压回推技术处理47例尿道结石患者。患者均为男性,年龄7⁸1岁,平均43岁。前尿道结石21例,后尿道结石26例。操作方法:将尿管插入患者尿道,使尿管头端接触结石。手指环形箍住结石下端紧邻结石的阴茎,如为尿道球部结石和后尿道结石、箍住阴茎根部,以形成结石和被箍住尿道之间的密闭腔或相对密闭腔。从尿管注水入密闭腔,增加的水压使结石向尿道近端移动。向膀胱端回推尿管后,再次用箍住阴茎的方法建立尿道相对密闭腔并继续往其中注水,结石被冲回膀胱。并对47例患者的临床资料和处理结果进行分析。结果 47例尿道结石均通过加压回推技术成功回推入膀胱。1例尿道结石在回推过程中被挤碎,无需后续处理。46例回推入膀胱的尿道结石,40例门诊行体外冲击波碎石均碎石成功并顺利排出结石;6例合并膀胱结石和(或)前列腺增生症患者住院行经尿道内镜下膀胱气压弹道碎石术,手术顺利,术中顺利冲吸出膀胱结石。随访181岁,平均43岁。前尿道结石21例,后尿道结石26例。操作方法:将尿管插入患者尿道,使尿管头端接触结石。手指环形箍住结石下端紧邻结石的阴茎,如为尿道球部结石和后尿道结石、箍住阴茎根部,以形成结石和被箍住尿道之间的密闭腔或相对密闭腔。从尿管注水入密闭腔,增加的水压使结石向尿道近端移动。向膀胱端回推尿管后,再次用箍住阴茎的方法建立尿道相对密闭腔并继续往其中注水,结石被冲回膀胱。并对47例患者的临床资料和处理结果进行分析。结果 47例尿道结石均通过加压回推技术成功回推入膀胱。1例尿道结石在回推过程中被挤碎,无需后续处理。46例回推入膀胱的尿道结石,40例门诊行体外冲击波碎石均碎石成功并顺利排出结石;6例合并膀胱结石和(或)前列腺增生症患者住院行经尿道内镜下膀胱气压弹道碎石术,手术顺利,术中顺利冲吸出膀胱结石。随访1¹2个月,平均7.3个月,未见尿道狭窄发生。结论加压回推技术回推尿道结石入膀胱快速简单,安全微创。回推入膀胱的尿道结石按膀胱结石从容处理,成功率高、住院率低、费用低廉、并发症少。

Injection flush and catheter push technique for the treatment of urethral calculi

Objective To report a novel technique named as injection flush and catheter push technique（abbreviated as “flushing and pushing technique”） for the treatment of urethral calculi and to report the indication, clinical effect and safety of this procedure. Methods Flushing and pushing technique was performed on 47 patients of urethral calculi. All patients were male, aged 7-81 years old, mean age was 43 years. Anterior urethral calculi in 21 cases, 26 cases with posterior urethral calculi. Method of operation：The catheter was inserted into the urethra with catheter tip touch the calculi. Fingers hoop the penis at the position slightly lower the urethral calculi, hoop the root of penis if calculi was at bulbous urethra or posterior urethra to form a closed cavity or relatively closed cavity between the calculi and the hooped urethra. Water was injected into the sealed cavity from catheter and urethra calculi moved toward the proximal urethra by the increased water pressure. Push catheter toward the bladder, form a relatively closed cavity and continue water injection, then calculi was flushed back into the bladder. We analyzed the clinical feature and treatment result of these 47 patients. Results Urethra calculi of all the 47 cases was pushed back into the bladder by flushing and pushing technique successfully. Urethral calculi was smashed with 1 case in the process of being crushed back into the bladder, did not need any subsequent processing. Among the 46 cases, 40 underwent extracorporeal shock wave lithotripsy as outpatients and were treated successfully, calculi discharged smoothly. 6 cases complicated with bladder calculi or （and） benign prostatic hyperplasia were treated with transurethral endoscopic bladder pneumatic lithotripsy, operations were successful, bladder calculi was washed and sucked out. Patients were followed up for 1 to 12 months, average 7.3 months, found no urethral stricture. Conclusion Pushing urethra calculi back into the bladder with flushing and pushing technique is rapid,