Nojiri Yoshikatsu, Okamura Kikuo, Kinukawa Tsuneo, Ozawa Hideo, Saito Shiro, Okumura Kazuhiro, Terai Akito, Takei Mineo
Department of Urology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
Nihon Hinyokika Gakkai Zasshi. 2007 Sep;98(6):770-5. doi: 10.5980/jpnjurol1989.98.770.
We investigated whether continuous bladder irrigation after Transurethral Resection of the Prostate (TURP) would prevent catheter obstruction by the clot.
We analyzed data from 761 patients registered in "a multi-institutional study of TURP clinical pathway" sponsored by the Ministry of Health, Labor and Welfare between 2001 and 2003. The difference of clinical backgrounds of the cases, resected weight, operating time, risk of being feverish, risk of catheter obstruction and chance of postoperative Transurethral Fulguration (TUF) between each institution were investigated. The risk factor of catheter obstruction is characterized and the significance of continuous bladder irrigation is discussed.
The incidence of catheter obstruction in the four institutions, in which 90% or more of patients underwent continuous bladder irrigation, was significantly lower than that in the three institutions, in which continuous bladder irrigation was performed in selected patients whose hematuria was severe (4.4% VS 12.9%, p<0.001). There was no difference in the frequency of either pyrexia or postoperative TUF. Logistic regression analysis showed that significant factors for catheter obstruction are continuous bladder irrigation, resected tissue weight and preoperative urinary infection.
Routine continuous bladder irrigation achieved a lower incidence of catheter obstruction. However, we recommend that urologists should decide whether to perform routine continuous irrigation, considering the frequency of catheter obstruction, safety, labor and cost.
我们研究了经尿道前列腺电切术(TURP)后持续膀胱冲洗是否能预防血凝块导致的导尿管阻塞。
我们分析了2001年至2003年间在厚生劳动省赞助的“TURP临床路径多机构研究”中登记的761例患者的数据。调查了各机构间病例的临床背景差异、切除重量、手术时间、发热风险、导尿管阻塞风险及术后经尿道电灼术(TUF)的发生率。对导尿管阻塞的危险因素进行了特征分析,并讨论了持续膀胱冲洗的意义。
在90%或更多患者接受持续膀胱冲洗的四个机构中,导尿管阻塞的发生率显著低于在血尿严重的特定患者中进行持续膀胱冲洗的三个机构(4.4%对12.9%,p<0.001)。发热或术后TUF的频率没有差异。逻辑回归分析表明,导尿管阻塞的显著因素是持续膀胱冲洗、切除组织重量和术前泌尿系统感染。
常规持续膀胱冲洗可降低导尿管阻塞的发生率。然而,我们建议泌尿外科医生应根据导尿管阻塞的频率、安全性、工作量和成本来决定是否进行常规持续冲洗。