经尿道前列腺电切术后初次拔管失败原因及危险因素分析

Causes of and risk factors for failure in catheter removal after transurethral resection of the prostate

目的:分析经尿道前列腺电切(TURP)术后患者初次拔管失败原因及相关危险因素。方法:搜集2015年6月至2018年5月行TURP 285例BPH患者临床资料,按初次拔管后排尿情况分为拔管成功组和拔管失败组,分析可能影响拔管失败的危险因素。结果:285例患者中,拔管成功组246例,拔管失败组39例。拔管失败组中15例拔管后即刻出现排尿困难,13例拔管后出现严重尿路刺激症状,7例拔管1个月内出现大量肉眼血尿,4例出现尿管拔除后1个月仍有尿失禁。将两组有统计学差异的指标进行Logistics多因素分析,结果显示IPSS评分(OR=5.106,P=0.013)、术前有无合并尿路感染(OR=3.835,P=0.041),前列腺体积(OR=4.160,P=0.011)、导尿管牵拉时间(OR=4.051,P=0.017)是初次拔管失败的独立危险因子。结论:TURP术后拔管失败的常见原因有术后早期尿潴留、术后尿路感染、术后继发性出血及尿失禁。

Objective:To find the causes of the failure in the first catheter removal(CR)after transurethral resection of the prostate(TURP)and the related risk factors.Methods:We collected the clinical data on 285 BPH patients treated by TURP from June 2015 to May 2018.We divided the cases into a successful CR(SCR)and a failed CR(FCR)group and investigated the risk factors for the first CR after TURP by multivariate logistic regression analysis.Results:CR was successfully performed in 246 and failed in 39 of the 285 cases.In the FCR group,post-CR urinary retention occurred in 15 cases immediately after,severe urinary tract irritation in 13,massive gross hematuria in 7 and urinary incontinence in 4 within 1 month.Multivariate logistic regression analysis showed that the independent risk factors for CR failure included IPSS(OR=5.106,P=0.013),preoperative urinary tract infection(OR=3.835,P=0.041),prostate volume(OR=4.160,P=0.011)and catheter compression time(OR=4.051,P=0.017).Conclusion:The common causes of the failure in catheter removal after TURP included early postoperative urinary retention,urinary infection,secondary hematuria and urinary incontinence.