创伤性后尿道断裂术后尿动力学分析

Urodynamic analysis after operative treatment of traumatic posterior urethral disruption

目的利用尿动力学检查方法,探讨创伤性后尿道断裂术后排尿困难和尿失禁的病因及发生机制。方法41例后尿道断裂根据病情不同而采用不同治疗方法,行Ⅰ期、Ⅱ期尿道吻合术18例,后尿道会师术23例,术后拔除尿管1周(近期)及3个月(远期),分别行尿动力学测定。以最大尿流率(Qmax)>12ml/s为正常组(A组),Qmax≤12ml/s为异常组(B组)。结果近期出现排尿困难5例,Qmax为(9.45±2.62)ml/s,其中尿道狭窄2例、前列腺增生2例、膀胱逼尿肌收缩无力1例;远期因尿道瘢痕挛缩继发排尿困难6例,Qmax为(6.28±3.26)ml/s,与正常组尿动力学参数比较,差异均有统计学意义(P<0.01)。尿失禁8例,最大尿道关闭压均低于40cmH2O〔(30.31±7.88)cmH2O〕,其中急迫性尿失禁3例,储尿期最大逼尿肌压力>15cmH2O〔(25.34±4.89)cmH2O〕;压力性尿失禁4例,漏尿点压力测定<60cmH2O〔(43.61±7.89)cmH2O〕;尿道“人工假道”性尿失禁1例。结论创伤性后尿道断裂术后尿动力学检查可以分析排尿困难和尿失禁的病因所在,有效指导临床治疗。

Objective To explore the pathogeny and incidence mechanism of dysury and urinary incontinence after operative treatment of traumatic posterior urethral disruption by means of urodynamics.Methods Corresponding treatment according to illness state was performed in 41 cases of urethral disruption, of which 18 cases were treated with Ⅰ and Ⅱ stage urethral anastomosis and 23 with urethral realignment. Urodynamic observation was done one week and three months after removal of urinary catheter.Qmax 〉 12 ml/s was used as Group A and Qmax ≤ 12 ml/s as Group B. Results One week after removal of urinary catheter, dysury appeared in five cases with Qmax for （9.45：1：2.62） ml/s, of which two cases were with posterior urethral stricture, two with benign prostatic hyperplasia and one with weak detrusor contraction. Three months after removal of urinary catheter, six cases led to secondary dysuresia due to posterior urethral stricture and had Qmax for （6.28±3.26） ml/s, with significant difference compared with urodynamic parameters of normal group （ P 〈 0.01 ）. Urinary incontinence occurred in eight cases,with PUCP below 40 cm H2O, ie, （30.31±7.88） cm H2O, of which three cases had acute urinary incontinence, with Pdetmax over 15 em H2O, ie, （25.34 ＋4.89） cm H2O, four stress urinary incontinence, with VLLP below 60 cm H2O, ie, （43.61±7.89） cm H2O, and one urethra “artificial way”urinary incontinence. Conclusion The urodynamic examination can analyze pathogeny for dysury and urinary incontinence after operative treatment in traumatic posterior urethral disruption.