Oyelowo Nasir, Sudi Abdullahi, Awaisu Mudi, Tolani Musliu Adetola, Lawal Ahmad Tijani, Ahmed Muhammed, Bello Ahmad, Maitama Hussaini Yusuf
Division of Urology, Department of Surgery, Ahmadu Bello University Zaria, Nigeria.
Niger Med J. 2024 Apr 21;65(1):75-80. doi: 10.60787/nmj-v65i1-453. eCollection 2024 Jan-Feb.
Bladder spasms due to involuntary contraction of the bladder occur frequently following Transurethral resection of the prostate (TURP). They may be aggravated by the presence of a catheter, blood clots, preoperative overactive bladder, or preoperative ingestion of bladder stimulants like caffeine. These bladder spams are painful, associated with peri-catheter leakage of urine, increased post-operative bleeding, and often refractory to postoperative analgesia. The incidence and risk factors for the occurrence of bladder spasms following TURP need to be reviewed and validated to ensure adequate patient counseling and possible lifestyle modification before surgery. We conducted a prospective review of the determinants of bladder spasms in our patients following TURP.
The study population was patients with benign prostatic obstruction scheduled for TURP between March 2022 and April 2023. Monopolar transurethral resection of the prostate was done using a continuous flow resectoscope. The primary endpoint of the study was occurrences of bladder spasms postoperatively before the trial without a catheter. Pain perception during the spasms was assessed using a visual analog scale. Clinical data were collected and analyzed to determine their association with the occurrence of bladder spasms postoperatively using regression analysis. Sub-group analysis was also done to correlate significant variables with the severity of pain in patients with spasms.
The mean age of the 80 patients reviewed was 66.9 ±8 years. Bladder spasms were seen in 41(51.2%) of the patients. The presence of overactive bladder (OAB) symptoms and the use of bladder stimulants were statistically significant determinants with a p-value of 0.003 and 0.026 respectively. The age of the patient, preoperative indwelling catheter, prostate volume, and resection time were not statistically determinant variables in the occurrence of bladder spasms post-operatively. 61% had severe pains and 39% had mild pains. There was no significant correlation between the presence of OAB or the use of bladder stimulants with the severity of pains in patients with bladder spasms after TURP.
Half of the patients are likely to have bladder spasms after TURP. The risk of having these spasms is higher in patients with preoperative OAB or patients who are exposed to bladder stimulants. The severity of spasms is however independent of these risk factors.
经尿道前列腺切除术（TURP）后，膀胱非自主收缩引起的膀胱痉挛频繁发生。导尿管、血凝块、术前膀胱过度活动症或术前摄入咖啡因等膀胱刺激物可能会加重膀胱痉挛。这些膀胱痉挛会引起疼痛，伴有导尿管周围尿液渗漏、术后出血增加，且术后镇痛往往效果不佳。需要对TURP后膀胱痉挛的发生率和危险因素进行回顾和验证，以确保在手术前为患者提供充分的咨询，并可能改变生活方式。我们对接受TURP治疗的患者膀胱痉挛的决定因素进行了前瞻性研究。
研究对象为2022年3月至2023年4月计划接受TURP治疗的良性前列腺梗阻患者。使用连续灌流切除镜进行单极经尿道前列腺切除术。研究的主要终点是在无导尿管试验前术后膀胱痉挛的发生情况。使用视觉模拟量表评估痉挛期间的疼痛感知。收集并分析临床数据，通过回归分析确定它们与术后膀胱痉挛发生的相关性。还进行了亚组分析，以将显著变量与痉挛患者的疼痛严重程度相关联。
纳入研究的80例患者的平均年龄为66.9±8岁。41例（51.2%）患者出现膀胱痉挛。膀胱过度活动症（OAB）症状的存在和膀胱刺激物的使用是具有统计学意义的决定因素，p值分别为0.003和0.026。患者年龄、术前留置导尿管、前列腺体积和切除时间在术后膀胱痉挛的发生中不是具有统计学意义的决定变量。61%的患者疼痛严重，39%的患者疼痛轻微。TURP后膀胱痉挛患者中，OAB的存在或膀胱刺激物的使用与疼痛严重程度之间无显著相关性。
一半的患者在TURP后可能会出现膀胱痉挛。术前患有OAB或接触膀胱刺激物的患者发生这些痉挛的风险更高。然而，痉挛的严重程度与这些危险因素无关。
