经尿道手术治疗神经性排尿功能障碍

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

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〉10ml／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。

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 bad urinary retention and ureter dilation. Twenty-nine patients had renal function damage. Residual urine volume was 151--700 ml （mean 420 ml）. 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 （male） to treat neurogenic urinary dysfunction could be an effective method.