经尿道手术治疗神经性排尿功能障碍

目的 总结经尿道手术治疗神经性排尿障碍的疗效及适应证.方法 神经性排尿功能障碍患者41例.男13例,女28例.年龄12～43岁,平均27岁.其中骶椎裂36例、骶脊膜膨出术后2例、骶神经瘤切除术后1例、腰椎外伤术后2例.临床表现为排尿困难、尿线细.B超检查提示膀胱残余尿及双肾输尿管积水,尿动力学检查提示神经原性膀胱.手术采用局麻,女性患者在5、6、7点电切膀胱颈至环状纤维;男性患者在11、1点垂直部分切断外括约肌.结果 41例均获随访,平均随访85(2～252)个月.手术成功36例(88%),患者排尿通畅,尿流率增加>10 ml/s,肾输尿管积水减少或消失.无效5例(12%).结论 经尿道电切治疗骶神经损伤所致下尿路排尿功能障碍方法简便易行、费用低、效果好.

Transurethrai resection of bladder neck(female)and urinary sphincter(male)to treat neurogenic urinary dysfunction

Objective To explore the efficacy of transurethral resection of bladder neck(female)and urinary sphincter(male)to treat neurogenic urinary dysfunction. Methods Forty-one patients(28 women and 13 men)with neurogenic urinary dysfunction(dysuria)were retrospectively analyzed.All patients had sacral neurological damage.The mean patient age was 27(12-43)years.All patients had urinary retention and ureter dilation.Twenty-nine patients had renal function damage.Residual urine volume was 151-700 ml(mean 420 m1).MFR was 4-14 ml/s.After local anesthesia,bladder neck(female)was incised at 5,6,7 o'clock to the circle fiber.Urinary sphincter(male) was cut off at 11,1 o'clock and was dilated using sound(F24-F27).The catheterization time was 1-2 weeks. Results All 41 patients were followed up,from 2 months to 252 months,average 85 months.Thirty-six patients(88%)were completely recovered with no residual urine,no dilation of ureter and pelvis,no renal function damage.of these 36 cases,surgery was carried out once for 1 patient,twice for 20 and 3 times for 15.Five patients(12%)were not improved. Conclusion Transurethral resection of bladder neck(female)and urinary sphincter(reale)to treat neurogenic urinary dysfunction could be an effective method.