经尿道钬激光去顶减压引流术治疗前列腺脓肿临床疗效分析

Transurethral decompression and drainage with holmium laser for prostatic abscess: Analysis of clinical therapeutic effect

目的:探讨经尿道钬激光去顶减压引流术治疗前列腺脓肿的临床疗效与安全性。方法:收集2015年1月至2019年5月期间在我院就诊治疗的共计13例前列腺脓肿患者的临床资料并回顾性分析,其中1例经药物保守治疗治愈,其余12例患者保守治疗效果欠佳,行经尿道钬激光脓肿去顶减压引流术,术后观察患者发热、尿频、尿急、尿痛、里急后重、排尿困难、下腹坠胀等症状改善情况;动态复查血尿常规、血尿培养;随访期间复查MRI,观察是否复发以及并发症情况。临床症状消失、尿白细胞阴性、病原学检查阴性、随访期间复查MRI未见复发视为治愈。结果:所有手术的患者术后临床症状明显改善。体温正常、复查尿常规以及尿培养转阴后拔除尿管,所有患者在术后5~10 d内拔除尿管。拔除尿管后3~5 d尿频、尿急、尿痛等尿路刺激症状均明显改善,排尿顺畅,未见拔除尿管后尿潴留、尿道狭窄等情况。所有患者随访时间3~16个月,随访期间复查MRI均未见脓肿复发。结论:前列腺脓肿一旦确诊,若保守治疗效果欠佳,建议及时选择手术治疗。经尿道钬激光去顶减压引流术治疗前列腺脓肿临床疗效确切,值得推广。

Objective: To investigate the clinical effect and safety of transurethral decompression and drainage with holmium laser in the treatment of prostatic abscess. Methods: We retrospectively analyzed the clinical data on 13 cases of prostatic abscess treated in our hospital from January 2015 to May 2019. One of the patients was cured by drug therapy while the other 12 underwent transurethral decompression and drainage with holmium laser after failure in medication. We recorded such postoperative symptoms as fever, frequent urination, urgent urination, painful urination, tenteria, dysuria and abdominal distension, obtained the dynamical indices of blood and urine routine and culture after surgery, and performed MRI during the follow-up for possible recurrence and complications. Those with disappearance of the clinical symptoms, negative results of urine leukocyte and pathogen examinations, and no recurrence revealed by MRI were considered to be cured. Results: After operation, the clinical symptoms were improved significantly and the urinary catheters removed within 5-10 days in all the cases. At 3-5 days after removal of the catheters, all the patients experienced smooth urination, with no urinary retention or urethral stricture. The patients were followed up for 3-16 months, during which no recurrence was observed. Conclusion:Transurethral decompression and drainage with holmium laser can achieve a definite clinical effect in the treatment of prostatic abscess and therefore deserves to be promoted in clinical practice.