良性前列腺增生症出口手术后下尿路症状的评估与管理
Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia.
作者信息
Singla Nirmish, Singla Ajay K
机构信息
Department of Urology, University of Texas, Southwestern Medical Center, 5201 Harry Hines Blvd, Dallas, TX 75235, USA.
Department of Urology, University of Toledo Medical Center, 3000 Arlington Avenue, MS1091, Toledo, OH 43614, USA.
出版信息
Curr Bladder Dysfunct Rep. 2016 Sep;11(3):242-247. doi: 10.1007/s11884-016-0376-1. Epub 2016 Jun 28.
Abstract
There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the patho-physiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients' quality of life.
摘要
在良性前列腺增生（BPH）继发的出口梗阻的外科治疗中有许多选择。虽然大多数患者在干预后下尿路症状（LUTS）有所改善，但高达35%的患者可能会出现持续性或复发性LUTS。在本综述中，我们讨论膀胱出口手术后LUTS的病理生理学，并讨论评估和管理此类患者时的注意事项。我们强调通过完整的尿动力学测试进行全面评估的关键作用，因为单纯梗阻仅占术后LUTS的少数情况。因此，必须评估逼尿肌收缩力、逼尿肌过度活动、尿道括约肌功能和尿失禁，以适当指导后续治疗并改善患者的生活质量。
相似文献
1
Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia.良性前列腺增生症出口手术后下尿路症状的评估与管理
Curr Bladder Dysfunct Rep. 2016 Sep;11(3):242-247. doi: 10.1007/s11884-016-0376-1. Epub 2016 Jun 28.
2
Current consensus and controversy on the treatment of male lower urinary tract symptoms/benign prostatic hyperplasia.男性下尿路症状/良性前列腺增生治疗的当前共识与争议
Tzu Chi Med J. 2017 Jan-Mar;29(1):1-5. doi: 10.4103/tcmj.tcmj_2_17.
3
The resolution of detrusor over activity after medical and surgical treatment in patients with bladder outlet obstruction.膀胱出口梗阻患者经药物和手术治疗后逼尿肌过度活动的缓解情况。
J Med Assoc Thai. 2007 Nov;90(11):2326-31.
4
Predictors of short-term overactive bladder symptom improvement after transurethral resection of prostate in men with benign prostatic obstruction.良性前列腺梗阻男性经尿道前列腺切除术后短期膀胱过度活动症症状改善的预测因素。
Int J Urol. 2014 Oct;21(10):1035-40. doi: 10.1111/iju.12482. Epub 2014 May 13.
5
Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity?经尿道前列腺切除术的短期预后是否受术前膀胱出口梗阻程度、逼尿肌收缩力状态或逼尿肌过度活动的影响？
Int J Urol. 2006 Nov;13(11):1398-404. doi: 10.1111/j.1442-2042.2006.01589.x.
6
Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia.年龄和膀胱出口梗阻与良性前列腺增生患者的逼尿肌过度活动独立相关。
Eur Urol. 2008 Aug;54(2):419-26. doi: 10.1016/j.eururo.2008.02.017. Epub 2008 Feb 25.
7
Precision medicine in the diagnosis and treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia.精准医学在疑似良性前列腺增生的男性下尿路症状诊断与治疗中的应用
Tzu Chi Med J. 2019 Aug 21;32(1):5-13. doi: 10.4103/tcmj.tcmj_107_19. eCollection 2020 Jan-Mar.
8
EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction.EAU 指南：非神经原性男性下尿路症状包括良性前列腺增生的评估。
Eur Urol. 2015 Jun;67(6):1099-1109. doi: 10.1016/j.eururo.2014.12.038. Epub 2015 Jan 19.
9
[Consequences of prostatic obstruction on bladder function, impact of removal, and management of recurrence after surgery].[前列腺梗阻对膀胱功能的影响、切除的影响及术后复发的处理]
Prog Urol. 2018 Nov;28(15):813-820. doi: 10.1016/j.purol.2018.08.013. Epub 2018 Sep 24.
10
Videourodynamic findings of lower urinary tract dysfunctions in men with persistent storage lower urinary tract symptoms after medical treatment.药物治疗后仍有持续性储尿期下尿路症状的男性下尿路功能障碍的影像尿动力学检查结果
PLoS One. 2018 Feb 20;13(2):e0190704. doi: 10.1371/journal.pone.0190704. eCollection 2018.
引用本文的文献
1
Comorbid Diabetes Mellitus Contributes to Residual Overactive Bladder After Transurethral Surgery for Benign Prostatic Hyperplasia.合并糖尿病会导致良性前列腺增生经尿道手术后残留的膀胱过度活动症。
Int J Urol. 2025 Aug;32(8):973-981. doi: 10.1111/iju.70080. Epub 2025 Apr 24.
2
Review of simultaneous treatment with intradetrusor onabotulinumtoxinA injections during transurethral prostate surgery for men with bladder outlet obstruction and overactive bladder.经尿道前列腺手术治疗膀胱出口梗阻合并膀胱过度活动症男性患者时联合膀胱内注射A型肉毒毒素的疗效综述
Tzu Chi Med J. 2024 Oct 9;37(1):42-48. doi: 10.4103/tcmj.tcmj_180_24. eCollection 2025 Jan-Mar.
3
Risk factors associated with the severity of overactive bladder among Syrian patients with type 2 diabetes.叙利亚2型糖尿病患者膀胱过度活动症严重程度的相关危险因素。
Sci Rep. 2024 Jul 17;14(1):16547. doi: 10.1038/s41598-024-67326-w.
4
Persistent Lower Urinary Tract Symptoms After BPH Surgery.良性前列腺增生术后持续下尿路症状
Curr Urol Rep. 2024 Jun;25(6):125-131. doi: 10.1007/s11934-024-01202-y. Epub 2024 Apr 5.
5
Treating overactive bladder symptoms after transurethral prostatic surgery for benign prostatic hyperplasia - Which medication to choose?经尿道前列腺手术治疗良性前列腺增生后膀胱过度活动症症状的处理——该选择哪种药物？
Tzu Chi Med J. 2023 Aug 22;35(4):312-316. doi: 10.4103/tcmj.tcmj_123_23. eCollection 2023 Oct-Dec.
6
The relationship between bladder storage function and frequent micturition after TURP.经 TURP 后膀胱储尿功能与尿频之间的关系。
World J Urol. 2022 Aug;40(8):2055-2062. doi: 10.1007/s00345-022-04079-z. Epub 2022 Jul 1.
本文引用的文献
1
Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment.成人膀胱过度活动症（非神经源性）的诊断与治疗：美国泌尿外科学会/女性泌尿外科学会指南修订版
J Urol. 2015 May;193(5):1572-80. doi: 10.1016/j.juro.2015.01.087. Epub 2015 Jan 23.
2
Factors associated with continuing medical therapy after transurethral resection of prostate.经尿道前列腺切除术后继续药物治疗的相关因素。
Urology. 2014 Sep;84(3):675-80. doi: 10.1016/j.urology.2014.04.027. Epub 2014 Jul 22.
3
Evaluation and management of post-transurethral resection of the prostate lower urinary tract symptoms.经尿道前列腺电切术后下尿路症状的评估与管理
Curr Urol Rep. 2014 Sep;15(9):434. doi: 10.1007/s11934-014-0434-1.
4
Pharmacological treatment of chronic pelvic ischemia.慢性盆腔缺血的药物治疗。
Ther Adv Urol. 2014 Jun;6(3):105-14. doi: 10.1177/1756287214526768.
5
Is there a way to predict stress urinary incontinence after holmium laser enucleation of the prostate?是否有方法预测钬激光前列腺剜除术后的压力性尿失禁？
J Urol. 2011 Nov;186(5):1977-81. doi: 10.1016/j.juro.2011.06.063. Epub 2011 Sep 23.
6
Update on AUA guideline on the management of benign prostatic hyperplasia.美国泌尿外科学会良性前列腺增生管理指南更新。
J Urol. 2011 May;185(5):1793-803. doi: 10.1016/j.juro.2011.01.074. Epub 2011 Mar 21.
7
Burden of male stress urinary incontinence: a survey among urologists in Japan.男性压力性尿失禁负担：日本泌尿科医生的调查。
Int J Urol. 2009 Nov;16(11):915-7. doi: 10.1111/j.1442-2042.2009.02385.x. Epub 2009 Sep 30.
8
Urologic diseases in america project: benign prostatic hyperplasia.美国泌尿系统疾病研究项目：良性前列腺增生
J Urol. 2008 May;179(5 Suppl):S75-80. doi: 10.1016/j.juro.2008.03.141.
9
Persistent detrusor overactivity after transurethral resection of the prostate is associated with reduced perfusion of the urinary bladder.经尿道前列腺切除术后持续性逼尿肌过度活动与膀胱灌注减少有关。
BJU Int. 2007 Apr;99(4):831-5. doi: 10.1111/j.1464-410X.2006.06735.x. Epub 2007 Jan 22.
10
Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey.不同种族和民族随机样本中下尿路症状的患病率及其对生活质量的影响：波士顿地区社区健康（BACH）调查
Arch Intern Med. 2006 Nov 27;166(21):2381-7. doi: 10.1001/archinte.166.21.2381.
Zotero 插件