Ma Zheng-Zheng, Yang Dan-Dan, Niu Mei-E, Lu Xiang-Min, Du Yan-Ting, Chin Peter, Ding Yan-Hong, Qian Chun-Ya
Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Urology, Suzhou Municipal Hospital, Suzhou, China.
Transl Androl Urol. 2024 May 31;13(5):802-811. doi: 10.21037/tau-24-150. Epub 2024 May 27.
Benign prostatic hyperplasia (BPH) is the most common benign disease causing voiding dysfunction in middle-aged and elderly men. the current "gold standard" for surgical treatment is transurethral resection of the prostate (TURP). Continuous bladder irrigation (CBI) is routinely given for 3 to 5 days after operation. However, this may induce bladder spasm. Bladder spasm not only brings physical and mental pain to patients, delaying the postoperative recovery process, but it also increases the medical economic burden. Therefore, it is important to take active measures to effectively warn and deal with bladder spasm. The color of the drainage fluid is an important indicator and requires close observation during CBI, as it can reflect real-time postoperative bleeding. When the color of drainage fluid is abnormal, effective measures should be undertaken. Grading nursing intervention divides patients into different conditions according to their possible changes, and then recommends targeted nursing intervention. Existing studies have formulated CBI programs from the perspective of quantifying the relationship between drainage fluid color and irrigation speed, but have yet to incorporate bladder spasm prevention and control levels or design corresponding grading nursing intervention programs according to different drainage fluid colors. This study aimed to construct the risk warning classification and intervention plan of bladder spasm under the guidance of CBI speed adjusting card after TURP.
Based on the rate adjustment card of CBI after TURP, we formulated the first draft of an early warning classification of risk in bladder spasm and its intervention plans by combining methods suggested from a literature search with semi-structured interviews and results from 2 rounds of correspondence inquiries with 28 experts by the Delphi method. We further screened and revised grading standards and measures.
The positive coefficients of experts in 2 rounds of correspondence inquiries were both 100%, the authority coefficients were both 0.952, and the Kendall harmony coefficients were 0.238 and 0.326, respectively (P<0.01). In the second round of correspondence inquiries, the coefficient of variation of expert opinions was 0.000-0.154, and the coefficient of variation of all items was <0.25. Finally, a 3-level risk warning classification standard and 23 nursing measures for CBI complicated by bladder spasm was constructed.
The early warning classification of risk in bladder spasm and its intervention plans guided by rate adjustment card of CBI after TURP are scientific and feasible, and can provide a basis and guidance for effective and standardized CBI in patients after TURP.
良性前列腺增生（BPH）是中老年男性最常见的导致排尿功能障碍的良性疾病。目前手术治疗的“金标准”是经尿道前列腺切除术（TURP）。术后常规进行持续膀胱冲洗（CBI）3至5天。然而，这可能诱发膀胱痉挛。膀胱痉挛不仅给患者带来身心痛苦，延缓术后恢复进程，还增加医疗经济负担。因此，采取积极措施有效预警和处理膀胱痉挛很重要。引流液颜色是一项重要指标，在CBI期间需要密切观察，因为它能反映术后实时出血情况。当引流液颜色异常时，应采取有效措施。分级护理干预根据患者可能出现的变化将其分为不同情况，然后推荐针对性的护理干预措施。现有研究从量化引流液颜色与冲洗速度关系的角度制定了CBI方案，但尚未纳入膀胱痉挛的预防和控制水平，也未根据不同引流液颜色设计相应的分级护理干预方案。本研究旨在构建TURP术后在CBI速度调整卡指导下的膀胱痉挛风险预警分类及干预方案。
基于TURP术后CBI的速率调整卡，通过文献检索、半结构化访谈以及两轮德尔菲法与28位专家进行函询的结果相结合的方法，制定膀胱痉挛风险预警分类及其干预方案的初稿。我们进一步筛选并修订分级标准和措施。
两轮专家函询的积极系数均为100%，权威系数均为0.952，肯德尔和谐系数分别为0.238和0.326（P<0.01）。第二轮专家函询中，专家意见的变异系数为0.000 - 0.154，所有项目的变异系数均<0.25。最终构建了膀胱痉挛伴CBI的三级风险预警分类标准及23项护理措施。
TURP术后CBI速率调整卡指导下的膀胱痉挛风险预警分类及其干预方案科学可行，可为TURP术后患者有效、规范地进行CBI提供依据和指导。
