经尿道内镜手术治疗下尿路异物损伤疗效分析

Efficacy of transurethral endoscopic surgery in treating foreign body-induced lower urinary tract injury

目的探讨经尿道内镜手术治疗下尿路异物损伤的疗效.方法采用回顾性病例系列研究分析1998年1月—2018年1月河南省人民医院收治的31例下尿路异物损伤患者的临床资料,其中男27例,女4例;年龄6~68岁[(27.1±16.3)岁].异物位于膀胱12例,尿道16例,膀胱并尿道3例.异物进入体内方式:自行置入23例,他人置入1例,医源性6例,不明原因1例.患者均行经尿道手术治疗,并根据异物种类、大小、形状、位置、活动度、合并损伤的具体情况制订个体化治疗方案.观察手术成功率、手术时间、住院时间;采用国际勃起功能评分(IIEF-5)评价术前术后已婚男性性功能情况(IIEF-5评分≥22分为正常);采用最大尿流率(Qmax)评价术后排尿情况(Qmax<15ml/s为异常);观察并发症情况.结果患者均经手术成功取出异物,其中单纯经尿道内镜下手术26例(成功率84%),内镜下取异物失败改行开放手术5例.患者均获随访6~36个月[(27.0±7.7)个月].手术时间20~72min[(42.0±21.7)min],住院时间2~7d[(4.0±1.7)d].随访期间11例已婚男性术前IIEF-5为(23.8±0.9)分,术后为(23.4±1.1)分(P>0.05).排尿正常29例[最大尿流率Qmax=(21.7±5.9)ml/s].尿道狭窄2例(最大尿流率Qmax<15ml/s),其中1例定期尿道扩张,另1例行尿道狭窄段切除再吻合,排尿改善均满意.尿路感染发热3例,均经抗感染治疗后2周内恢复正常.均未出现男性性功能障碍、复杂性尿道狭窄、感染中毒性休克等严重并发症.结论经尿道内镜手术治疗下尿路异物损伤的成功率高,对男性患者性功能影响小,并发症发生率低,值得临床推广.

Objective To investigate curative efficacy of transurethral endoscopic surgery for foreign body-induced lower urinary tract injury. Methods A retrospective case series study was conducted to analyze the clinical data of 31 patients with foreign body-induced lower urinary tract injury admitted to Henan Provincial People's Hospital from January 1998 to January 2018. There were 27 males and four females, aged 6-68 years [(27. 1 ± 16. 3)years]. Foreign bodies were located at the bladder in 12 patients, at urethra in 16, and at bladder and urethra in three. The foreign bodies were placed into the body by patients themselves in 23 patients, by other people in one, iatrogenic implantation in six, and by unknown approach in one. All patients underwent urethral surgeries, and individualized treatment plan was formulated according to the specific conditions such as the foreign body type, size, shape, location,activity and combined injury. The success rate, operation time and hospitalization time were recorded. The sexual function of the married males was evaluated by international index of erectile function-5 (IIEF-5)(IIEF-5 score≥22 points as normal) before and after the operation. The urination after the operation was evaluated by the maximum urinary flow rate ( Qmax)( Qmax<15 ml/s as abnormal) and the complications were recorded. Results All the patients underwent successful surgeries and the foreign bodies were removed, including 26 patients who underwent transurethral endoscopic surgery alone with success rate of 84% and five patients underwent open surgery due to failed transurethral endoscopic removal. All patients were followed up for 6-36 months [(27. 0 ± 7. 7)months]. The operation lasted for 20-72 minutes [(42. 0 ± 21. 7) minutes]. The hospitalization time was 2-7 days [(4. 0 ± 1. 7) days]. During the follow-up, 11 married males obtained normal sexual function after surgery [ postoperative IIEF-5:(23. 4 ± 1. 1) points vs. preoperative IIEF-5:(23. 8 ± 0. 9) points]. Twenty-nine patients had normal urination [Qmax=(21. 7 ± 5. 9)ml/s]. Two patients had narrow urinary tract (Qmax<15 ml/s), of whom one patient received regular urethral dilatation and another received resection and anastomosis of urethral stricture, both with satisfactory improvement of urination. Three patients had fever caused by urinary tract infection and recovered within 2 weeks after anti-infection treatment. There were no serious complications such as male sexual dysfunction, complex urethral stricture or septic shock. Conclusions Transurethral endoscopic surgery for foreign body-induced lower urinary tract injury has high success rate, minor impact on the sexual function of male patients and low incidence of complications, which is worthy of clinical practice.