膀胱颈部电切结合曲安奈德注射治疗前列腺增生术后复发性膀胱颈部挛缩

Transurethral resection of the bladder neck combined with triamcinolone injection for the treatment of recurrent bladder neck contracture after benign prostate hyperplasia surgery

目的良性前列腺增生术后的膀胱颈部挛缩,因其易于反复复发,成为泌尿外科较难处理的并发症之一。复发的原因在于瘢痕增生,曲安奈德是皮肤科治疗瘢痕最为常用的药物之一,我们尝试采用经尿道膀胱颈部电切结合曲安奈德注射的方法治疗复发性膀胱颈部挛缩。方法本研究为前瞻性研究,选取2015年8月至2016年8月8例复发性膀胱颈部挛缩的患者接受膀胱颈部电切结合曲安奈德注射术。手术切除瘢痕至环状纤维,之后膀胱颈部分8个点均匀注射曲安奈德共80mg,术后留置导尿2周。术后每月膀胱镜下再次注射曲安奈德,连续3次。术后3、6、12月复查尿流率、国际前列腺症状评分(IPSS)及生活质量评分(QoL)。结果 8例患者平均年龄64岁;前列腺增生术后膀胱颈部挛缩电切后,3例复发1次,2例复发2次,2例复发3次,1例复发6次;末次术后复发时间为(2.2±1.2)月,接受治疗后,患者术后尿流率显著增加,平均保持至术后9个月(仍在随访中);2例患者术后复发(1例6个月,1例8个月):其中1例患者出现附睾炎,1例患者出现血尿。所有患者术后均未接受尿道扩张。结论膀胱颈部电切结合曲安奈德注射治疗前列腺增生术后复发性膀胱颈部挛缩安全有效且简单易学。

Objective To present our experience with the management of recurrent bladder neck contracture （BNC） after transurethral resection of prostate （TURP）, by using transurethral resection of the scar combined with triamcinolone injection. MethodsDuring Aug. 2015 and Aug. 2016, 8 patients with recurrent BNC and multiple prior attempts of endoscopic treatment were managed with resection and steroid injection. The stenosis was resected until the circular fibers at the bladder neck, and then triamcinolone （2 mL, 40 mg/mL） was injected at the incision sites （8 points） using Williams cystoscopic Injection needle （Cook）. The 3F20 catheter was then inserted and indwelt for 2 weeks. The injection under cystoscopy was repeated every 4 weeks for 3 times. The urinary flow rate, IPSS and Qol were monitored 3, 6 and 12 months after surgery. If these indicators showed evidence of stenosis, another resection and injection were performed as described above. ResultsThe patients＇ average age was 64 years. All patients previously underwent repeated transurethral resection of the bladder neck, and the average duration of recurrence was （2.2±1.2） months after surgery. The urinary flow rate increased significantly after surgery and maintained at least for 9 months. Recurrence occurred in 2 patients, epididymitis in 1, and hematuria in 1. None patients received dilatation after surgery. ConclusionTransurethral resection of the stenosis area and injection of triamcinolone for BNC after TURP had a success rate of 75% in this small series, which suggests that our protocol is a safe and valuable option in treating recurrent BNC.