Petersen M S, Collins D N, Selakovich W G, Finkbeiner A E
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock.
Clin Orthop Relat Res. 1991 Aug(269):102-8.
Urinary retention following total hip and knee arthroplasty is a common problem frequently necessitating either prolonged urethral catheter drainage or intermittent catheterization. The direct relationship of urinary tract instrumentations, procedures, and infections to deep sepsis in total hip replacements is well documented. Pharmacologic therapy to stimulate voiding or augment bladder emptying is thus theoretically preferable to the use of catheterization. Prasozin hydrochloride, an alpha blocker, relaxes the smooth musculature of the posterior urethra and prostrate and has been used to treat urinary obstruction secondary to benign prostatic hypertrophy. A prospective study in 60 male patients showed a statistically significant decrease in postoperative urinary retention with the perioperative administration of prazosin (p less than 0.01). A higher incidence of urinary tract infection was seen in patients who developed urinary retention (3% versus 20%) (p less than 0.01). Uroflowmetry parameters were not predictive of the patient at risk for retention and were unaltered with the administration of prazosin. Prazosin can be an effective adjunct in the prophylaxis of postoperative urinary tract infections and may decrease the potential risk for total joint sepsis.
全髋关节和膝关节置换术后的尿潴留是一个常见问题，常常需要长期留置尿道导管引流或间歇性导尿。尿路器械操作、手术及感染与全髋关节置换术中深部脓毒症的直接关系已有充分文献记载。因此，从理论上讲，刺激排尿或增强膀胱排空的药物治疗优于使用导尿术。盐酸哌唑嗪是一种α受体阻滞剂，可松弛后尿道和前列腺的平滑肌，已被用于治疗良性前列腺增生继发的尿路梗阻。一项针对60例男性患者的前瞻性研究表明，围手术期给予哌唑嗪后，术后尿潴留发生率有统计学意义的显著降低（p<0.01）。发生尿潴留的患者中尿路感染发生率更高（3%对20%）（p<0.01）。尿流率参数不能预测有尿潴留风险的患者，且给予哌唑嗪后也未改变。哌唑嗪可作为预防术后尿路感染的有效辅助药物，并可能降低全关节脓毒症的潜在风险。
