Djaladat Hooman, Mehrsai Abdorasol, Saraji Ali, Moosavi Shahram, Djaladat Yasaman, Pourmand Gholamreza
Department of Urology, Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandarabbas.
J Urol. 2006 Jun;175(6):2083-6. doi: 10.1016/S0022-5347(06)00344-2.
We evaluated the postoperative morbidity and technical complications of a new handmade catheter used for suprapubic prostatectomy.
A total of 146 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from January 2003 to August 2004. Of the patients 96 were treated with a novel technique without a urethral catheter but with a special handmade cystostomy catheter, while the other 50 underwent the traditional procedure using cystostomy and a urethral catheter. The same surgical team operated on the 2 groups. Clot retention episodes, hemoglobin decreases, irritative symptoms, voiding status after cystostomy removal and incontinence were evaluated postoperatively. Three months later we followed the patients with symptom score, maximum flow rate and cystoscopic examination.
Preoperatively mean International Prostate Symptom Score was 31.6 in each group. Postoperatively none of the patients with the novel catheter complained of significant irritative urinary symptoms, clot retention and true or stress urinary incontinence. Of the cohorts 94% were satisfied with voiding but 86% of controls were satisfied. There was no report of urinary tract infection or epididymo-orchitis in the cohorts, while we found epididymo-orchitis in 4 controls (8%). Three months after the operation the mean International Prostate Symptom Score was 4.4 (range 1 to 7) and the mean maximum flow rate was 22.6 ml per second (range 14 to 25) in patients with the novel catheter, and 4.2 (range 1 to 7) and 22.5 ml per second (range 15 to 25), respectively, in those with the traditional catheter. At followup there was no bladder neck contracture but 4 patients (4.1%) showed some degree of membranous urethral stricture. We also noted 7 controls (14%) with urethral stricture.
Transurethral prostate resection has been introduced as the surgical treatment of choice in patients with benign prostatic hyperplasia. However, open adenomectomy still has a place. Urethral catheter-free suprapubic prostatectomy can be safely applied with a low postoperative risk of infection, incontinence and stricture formation.
我们评估了一种用于耻骨上前列腺切除术的新型手工制作导管的术后发病率和技术并发症。
2003年1月至2004年8月，共有146例有开放性前列腺切除术指征的下尿路症状患者纳入本研究。其中96例患者采用了一种新技术，不使用尿道导管，而是使用一种特殊的手工制作的膀胱造瘘导管，另外50例患者接受了使用膀胱造瘘和尿道导管的传统手术。两组均由同一手术团队进行手术。术后评估血凝块潴留情况、血红蛋白下降情况、刺激症状、拔除膀胱造瘘管后的排尿状态及尿失禁情况。三个月后，我们对患者进行症状评分、最大尿流率及膀胱镜检查随访。
术前每组患者的平均国际前列腺症状评分均为31.6。术后，使用新型导管的患者均未出现明显的刺激性尿路症状、血凝块潴留及真性或压力性尿失禁。该组94%的患者对排尿情况满意，而对照组为86%。两组均未报告尿路感染或附睾炎，而我们在4例对照组患者（8%）中发现了附睾炎。术后三个月，使用新型导管的患者平均国际前列腺症状评分为4.4（范围1至7），平均最大尿流率为每秒22.6毫升（范围14至25），使用传统导管的患者平均国际前列腺症状评分为4.2（范围1至7），平均最大尿流率为每秒22.5毫升（范围15至25）。随访时未发现膀胱颈挛缩，但有4例患者（4.1%）出现了一定程度的膜部尿道狭窄。我们还注意到7例对照组患者（14%）有尿道狭窄。
经尿道前列腺切除术已被引入作为良性前列腺增生患者的手术治疗选择。然而，开放性腺瘤切除术仍有其应用价值。无尿道导管的耻骨上前列腺切除术可安全应用，术后感染、尿失禁及狭窄形成的风险较低。
