Baker Nora, Tong Carmen, Simhan Jay
Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA.
Urologic Trauma, Reconstruction and Prosthetics, Einstein Healthcare Network, Temple Health and the Fox Chase Cancer Center, 1200 Tabor Road, Moss/3 Sley, Philadelphia, PA, 19141, USA.
Curr Urol Rep. 2017 Apr;18(4):27. doi: 10.1007/s11934-017-0678-7.
Technological advancements in urologic endoscopy within the last decades have improved outcomes following bladder outlet reduction surgery while minimizing risks of short- and intermediate-term complications. This review aims to examine late complications of endoscopic reduction of the prostate and the various treatment options available.
Urinary incontinence, ejaculatory dysfunction, urethral strictures, bladder neck contractures, and fistula formations are the most common delayed complications following bladder outlet reduction surgery. Evaluation of these complications typically involves a combination of endoscopic examination, urodynamic findings, pelvic imaging, and review of pre-existing symptoms. Treatment options range from conservative measures such as pelvic floor muscle therapy to complex reconstructive procedures including anti-incontinence surgery, urethral reconstruction, and permanent urinary diversion. Although rare, late complications of bladder outlet reduction surgery are important to recognize in order to manage appropriately. Careful evaluation involving multiple diagnostic modalities with consideration for referral to a dedicated reconstructive urologist may be warranted in complex cases.
过去几十年间,泌尿外科内镜技术的进步改善了膀胱出口缩小手术后的治疗效果,同时将短期和中期并发症的风险降至最低。本综述旨在探讨前列腺内镜下缩小术的晚期并发症以及现有的各种治疗选择。
尿失禁、射精功能障碍、尿道狭窄、膀胱颈挛缩和瘘管形成是膀胱出口缩小手术后最常见的延迟并发症。对这些并发症的评估通常需要结合内镜检查、尿动力学检查结果、盆腔影像学检查以及对既往症状的回顾。治疗选择范围从盆底肌肉治疗等保守措施到包括抗尿失禁手术、尿道重建和永久性尿流改道等复杂的重建手术。尽管膀胱出口缩小手术的晚期并发症很少见,但为了进行适当的管理,认识到这些并发症很重要。对于复杂病例,可能需要进行涉及多种诊断方法的仔细评估,并考虑转诊给专门的重建泌尿外科医生。