Cataldo P A, Senagore A J
Department of Surgical Research, Ferguson Hospital, Grand Rapids, Michigan.
Dis Colon Rectum. 1991 Dec;34(12):1113-6. doi: 10.1007/BF02050073.
Urinary retention is the most common complication after anorectal surgery, with rates as high as 52 percent reported. With the trend toward early discharge, avoidance of this complication is particularly important. Perioperative fluid restriction and the use of short-acting anesthetics have been shown to be effective in decreasing postoperative urinary retention rates but are not applicable in all cases. Reflex sympathetic stimulation, possibly as a result of perianal pain, may lead to increased muscular tone of the internal sphincter at the bladder neck. This theory had led to the effective use of alpha-adrenergic blockade in the treatment of established cases of urinary retention after anorectal surgery, herniorrhaphy, and major pelvic surgery. However, the prophylactic role of alpha blockade after anorectal surgery has not been studied. In a double-blind, prospective, randomized study, 51 patients were treated with either prazosin and alpha-adrenergic blocker or placebo prior to and immediately after elective anorectal surgery. Urinary retention rates were similar in the two groups. At this time, prophylactic alpha-adrenergic blockade is not recommended for the prevention of urinary retention after anorectal surgery.
尿潴留是肛肠手术后最常见的并发症，报道发生率高达52%。随着早期出院趋势的发展，避免这一并发症尤为重要。围手术期液体限制和使用短效麻醉剂已被证明可有效降低术后尿潴留发生率，但并非适用于所有病例。反射性交感神经刺激，可能是由于肛周疼痛所致，可能导致膀胱颈内括约肌肌肉张力增加。这一理论已促使α-肾上腺素能阻滞剂在治疗肛肠手术、疝修补术和大型盆腔手术后已确诊的尿潴留病例中得到有效应用。然而，肛肠手术后α-阻滞剂的预防作用尚未得到研究。在一项双盲、前瞻性、随机研究中，51例患者在择期肛肠手术前及术后立即接受哌唑嗪（一种α-肾上腺素能阻滞剂）或安慰剂治疗。两组的尿潴留发生率相似。目前，不建议使用预防性α-肾上腺素能阻滞剂来预防肛肠手术后的尿潴留。
