经尿道前列腺激光汽化电切术后发生尿失禁危险因素分析及应对措施

The risk factors for urinary incontinence after transurethral laser prostatectomy and corresponding countermeasures for the risk factors

目的分析经尿道前列腺激光汽化电切术(TULP)后发生尿失禁(UI)危险因素,并提出相应的应对措施。方法回顾性分析在我院接受TULP手术治疗的110例良性前列腺增生(BPH)患者的临床资料,根据术后是否发生UI分为UI组与非UI组,收集患者的各项临床资料进行危险因素分析。结果110例BPH患者TULP术后24例发生UI,发生率21.82%,其中轻度15例(13.64%),中度7例(6.36%),重度2例(1.82%);UI组和非UI组年龄、糖尿病、前列腺体积、术前盆底肌训练、手术时间、膀胱冲洗液温度、导尿管气囊注水量、导尿管堵塞、术后便秘比较,差异有统计学意义(P<0.05);年龄、糖尿病、前列腺体积、手术时间、膀胱冲洗液温度、导尿管气囊注水量、导尿管堵塞、术后便秘是TULP后发生UI的独立危险因素,术前盆底肌训练是TULP后发生UI的独立保护因素(P<0.05)。结论UI是BPH患者TULP术后的常见并发症,年龄大、合并糖尿病、前列腺体积大、手术时间长、膀胱冲洗液温度低、导尿管气囊注水量多、导尿管堵塞及术后便秘均可增加UI发生风险,而术前盆底肌训练有助于降低风险。

Objective To analyze the risk factors for urinary incontinence(UI)after transurethral laser prostatectomy(TULP),and to propose corresponding countermeasures.Methods The clinical data of 110 patients with benign prostatic hyperplasia(BPH)who underwent TULP in our hospital were retrospectively analyzed.According to the occurrence of postoperative UI,the patients were divided into the UI group and the non-UI group.The various types of clinical data of the patients were collected for risk factor analysis.Results In the 110 BPH patients,there were 24 cases with UI after TULP including 15 mild cases(13.64%),7 moderate cases(6.36%),and 2 severe cases(1.82%)and the incidence was 21.82%.There were significant differences in age,diabetes,prostate volume,preoperative pelvic floor muscle training,operative time,temperature of bladder lavage fluid,water injection volume of catheter balloon,urinary catheter occlusion and postoperative constipations between the two groups(P<0.05).Age,diabetes,prostate volume,operative time,temperature of bladder lavage fluid,water injection volume of catheter balloon,urinary catheter occlusion and postoperative constipation were independent risk factors for UI after TULP while preoperative pelvic floor muscle training was an independent protective factor(P<0.05).Conclusion UI is a common complication of patients with BPH after TULP.Older age,diabetes,large prostate volume,long operative time,low temperature of bladder lavage fluid,large water injection volume of catheter balloon,urinary catheter occlusion and postoperative constipation can increase the risk of UI while preoperative pelvic floor muscle training can help to reduce the risk.