前列腺增生症术后排尿困难的原因与防治(附26例分析)

The cause, prevention and treatment of dysuria after prostatectomy

目的 分析各种常见前列腺切除术后排尿困难的原因,为预防和治疗提供依据。方法 回顾分析26例前列腺切除术后发生梗阻患者的资料。耻骨上前列腺切除术后排尿困难22例,TURP术后4例。患者均有不同程度的排尿困难、尿线变细,12例呈滴沥状排尿,5例发生急性尿潴留。结果 膀胱颈挛缩6例(23％),后尿道狭窄6例(23％),腺体残留或复发4例(15.4％),膀胱颈水肿3例(11.6％),血块或脱落组织堵塞2例(7.7％),逼尿肌无力2例(7.7％),输尿管间嵴肥厚2例(7.7％),前尿道狭窄1例(3.9％)。除2例逼尿肌无力者分别行自家清洁导尿和永久性膀胱造瘘外,余经处理均愈。结论 前列腺增生症术后排尿困难的原因较多,主要是手术操作及术前、术后处理不当所致。一旦发生,则可根据不同原因采取不同方法治疗,效果较佳。

Objective To explore the frequent cause of dysuria after prostatectomy for the purpose of its prevention and treatment. Methods The clinical data of 26 patients with dysuria post-prostatectomy, 22 of them received suprapubic transvesical prostatectomy and 4 TURP, were analyzed retrospectively. All of them suffered from varied degree of dysuria and weak steam of urine. 12 patients had trickle micturition and acute urine retention occurred in 5 cases. Results The edma of bladder neck accounted for 3 cases (11. 6 % ) , blood clot or exfoliated tissue obstruction 2 cases (7.7%). bladder neck restriction 6 cases (23%), relapse of BPH 4 cases (15. 4%), posterior urethal stricture 6 cases (23%), anterior urethral stricture 1 case (3. 9%), weakness of bladder detrusor 2 cases (7. 7%), interureteric fold thickness 2 cases (7. 7%). All was cured except 2 cases of detrusor weakness undertook self-cleaning catheterization or permanent suprapubic cystostomy respectively. Conclusions The causes of dysuria after prostatectomy are very complex, included the unappropriate operative manipulation and perioperative treatment. The rational treatment should be adopted according to the different cause once the dysuria occurred. As a rule, the outcomes are latively well.