3种术式治疗男性性生活相关血尿的临床经验总结

Three surgical strategies for the treatment of intercourse-related hematuria in males:A summary of clinical experience

目的:总结分析应用活检钳钳夹、电切镜电凝及钬激光灼烧3种术式治疗男性性生活相关性血尿的临床经验。方法:回顾分析2018年7月至2022年4月我院收治的11例男性患者,年龄29~47岁,临床表现为性生活后或勃起后可见肉眼血尿、尿道口滴血或尿中有凝血块,无痛性,其中3例伴有精液带血症状。术前均行泌尿系影像学检查排除上尿路及膀胱病变,所有患者均行丙泊酚静脉注射全身麻醉,术中首先进行膀胱尿道镜镜检后尿道及膀胱,均可发现后尿道精阜周围有不同范围的血管扩张现象,5例患者可见后尿道曲张血管活动性出血,伴有血精的3例患者首先应用4.5 Fr内窥镜行经前列腺小囊精囊镜镜检术,根据曲张血管的范围及数量,其中5例应用电切镜电凝,2例用钬激光灼烧,4例用活检钳钳夹破坏血管组织的方法进行治疗,术后留尿管3~7 d,禁欲1个月,随访6个月。结果:11例患者手术及随访完成顺利,其中10例预后良好,未见血尿复发,1例应用电切镜电凝的患者术后仍时有血尿及尿中凝血块症状,术后3个月出现性生活后排尿困难,B超提示:膀胱凝血块形成伴尿液潴留,急诊手术将凝血块冲洗后仔细镜检后尿道,既往手术区域愈合良好,尿道括约肌周围可见若干曲张血管,再次用电切镜电凝,术后未见复发。所有患者术后均有不同程度的尿道刺激症状及肉眼血尿,观察1~4周后自行缓解,无勃起功能障碍、射精痛、射精困难及射精乏力等并发症。结论:在排除其他泌尿生殖系统疾病情况下,男性患者出现性生活后无痛性血尿、尿中伴有凝血块、甚至排尿困难等症状时应考虑后尿道精阜周围静脉曲张可能,治疗方式可根据静脉曲张的位置、数量及程度选择活检钳钳夹破坏血管组织、电切镜电凝及钬激光灼烧的术式,均可达到满意效果。

Objective:To summarize the clinical experience in the treatment of sexual intercourse-related hematuria in males using biopsy forceps,electrocoagulation and holmium laser cauterization.Methods:From July 2018 to April 2022,we treated 11 male patients with intercourse-related hematuria using biopsy forceps,electrocoagulation and holmium laser cauterization.The patients ranged in age from 29 to 47 years,with clinical manifestations of gross hematuria,blood dripping from the urethral orifice or blood clots in the urine after sexual intercourse or erection,3 with hemospermia,but none with pain.All the patients received urological imaging around the posterior urethral verumontanum under the cystourethroscope in all the cases,5 with active bleeding in the posterior varicose vessel.The 3 cases with hemospermia first underwent trans-prostatic utricle seminal vesiculoscopy.According to the range and number of varicose vessels,5 of the patients were treated by electrocoagulation with the resectoscope,2 by holmium laser cauterization and the other 4 with biopsy forceps to destroy the vascular tissue.After the operation,urinary catheters were retained for 3-7 days,abstinence lasted 30 days,and the patients were followed up for 6 months.Results:The operations were successfully completed in all the cases,10 with good prognosis and none with recurrence.Occasional postoperative hematuria and blood clots in the urine were observed in 1 of the patients treated by electrocoagulation under the resectoscope,with dysuria at 3 months after operation,who underwent repeated electrocoagulation and experienced no more recurrence thereafter.Different degrees of postoperative urethral irritation and gross hematuria were found in all the cases,which spontaneously disappeared within 1-4 weeks,with no such complications as ED,ejaculation pain,ejaculation difficulty and ejaculation weakness.Conclusion:In the absence of other genitourinary diseases,painless hematuria,blood clots in the urine or even dysuria in males after sexual intercourse can be considered as the results of possible varicose veins around the posterior urethral verumontanum,which can be treated satisfactorily by destroying the vascular tissue with biopsy forceps,electrocoagulation with the resectoscope or holmium laser cauterization according to the location,number and degree of varicose veins.