经尿道前列腺汽化电切术后继发囊性膀胱炎(8例报告)
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摘要
目的探讨经尿道前列腺汽化电切术后继发囊性膀胱炎的诊治。方法 2012年1月~2016年12月8例良性前列腺增生行经尿道前列腺汽化电切治疗,术后6~24个月(平均13个月)再次出现尿频、尿急、排尿不畅及间隙性血尿发作,口服α或M受体阻滞剂临床症状改善不明显。膀胱镜检查诊断为部分前列腺残留合并继发囊性膀胱炎,再次行残留前列腺腺体汽化电切和囊泡切除术。结果手术时间8~31 min,平均16 min。术后留置导尿管3~5 d,平均3.3 d。术后病理:前列腺增生合并囊性膀胱炎。8例术后随访3~12个月,8例排尿畅,血尿消失,2例术后6个月仍有轻微尿频、尿急、夜尿增多,采用α受体阻滞剂口服治疗,无尿漏和尿失禁并发症。膀胱镜复查:膀胱颈部及前列腺尿道光整,无囊泡复发。结论经尿道前列腺汽化电切术后腺体残留可继发囊性膀胱炎,再次手术汽化电切残留腺体及囊泡,保持膀胱颈部及前列腺尿道光整,疗效满意。
Objective To explore the diagnosis and treatment of secondary cystic cystitis after transurethral vaporization resection of prostate( TVRP). Methods A total of 8 cases of benign prostate hyperplasia were treated by TVRP from January 2012 to December 2016. During 6-24 months( mean,13 months) after surgery,urinary frequency,urgency of urination,urination difficulty and hematuria happened again. Improvement of clinical symptoms was not obvious by oral α-or M-blockers. Cystoscopy showed residual prostate with secondary cystic cystitis. All the patients were given repeated resection of residual prostate and vesicle.Results The operation time was 8-31 min( mean,16 min). The postoperative indwelling catheter time was 3-5 d( mean,3. 3 d). Postoperative pathology specimens indicated prostate hyperplasia with cystic cystitis. During 6 months of follow-ups,all the patients had smooth urination without interstitial hematuria. Urinary frequency and urgency disappeared in 6 cases and were relieved in 2 cases( α-receptor blocker treatment). Cystoscopy re-examinations showed smooth bladder neck and prostatic urethra without vesicles. Conclusions Residual prostate after TVRP may lead to secondary cystic cystitis. Re-operation of vaporization of residual prostate and vesicles has good curative effects.
Objective To explore the diagnosis and treatment of secondary cystic cystitis after transurethral vaporization resection of prostate( TVRP). Methods A total of 8 cases of benign prostate hyperplasia were treated by TVRP from January 2012 to December 2016. During 6-24 months( mean,13 months) after surgery,urinary frequency,urgency of urination,urination difficulty and hematuria happened again. Improvement of clinical symptoms was not obvious by oral α-or M-blockers. Cystoscopy showed residual prostate with secondary cystic cystitis. All the patients were given repeated resection of residual prostate and vesicle.Results The operation time was 8-31 min( mean,16 min). The postoperative indwelling catheter time was 3-5 d( mean,3. 3 d). Postoperative pathology specimens indicated prostate hyperplasia with cystic cystitis. During 6 months of follow-ups,all the patients had smooth urination without interstitial hematuria. Urinary frequency and urgency disappeared in 6 cases and were relieved in 2 cases( α-receptor blocker treatment). Cystoscopy re-examinations showed smooth bladder neck and prostatic urethra without vesicles. Conclusions Residual prostate after TVRP may lead to secondary cystic cystitis. Re-operation of vaporization of residual prostate and vesicles has good curative effects.
引文
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7 钱余,丁志清,江河,等.女性腺性膀胱炎合并膀胱颈梗阻的微创诊疗.微创医学,2012,7(6):475-478.
8 Riaz A,Casalino DD,Dalton DP,et al.Cystitis cystica and cystitis glandularis causing ureteral obstruction.J Urol,2012,187(3):1059-1060.
9 钱余,姜洋,周恩谱,等.同时处理膀胱出口以下病变治疗女性腺性膀胱炎疗效分析.中国医师进修杂志,2015,38(5):336-338.
2 杨勇.如何正确认识腺性膀胱炎.中华泌尿外科杂志,2013,34(3):165-166.
3 于宁,李锋,汪祖林,等.旺炽型囊性-腺性膀胱炎一例报告.中华泌尿外科杂志,2016,37(4):311-312.
4 Halder P,Mandal KC,Mukherjee S.Prolapsing cystitis cystica causing bladder outlet obstruction:An unusual complication.Indian J Urol,2016,32(4):329-330.
5 徐遵礼,张前兴,朱建平,等.3种术式治疗高危大体积前列腺增生的比较.中国微创外科杂志,2015,15(2):121-125.
6 Zhu JX,Gabril MY,Sener A.A rare case of recurrent urinary obstruction and acute renal failure from cystitis cystica et glandularis.Can Urol Assoc J,2012,6(2):E72-E74.
7 钱余,丁志清,江河,等.女性腺性膀胱炎合并膀胱颈梗阻的微创诊疗.微创医学,2012,7(6):475-478.
8 Riaz A,Casalino DD,Dalton DP,et al.Cystitis cystica and cystitis glandularis causing ureteral obstruction.J Urol,2012,187(3):1059-1060.
9 钱余,姜洋,周恩谱,等.同时处理膀胱出口以下病变治疗女性腺性膀胱炎疗效分析.中国医师进修杂志,2015,38(5):336-338.