Pickard R, Emberton M, Neal D E
University Department of Surgery, Medical School, University of Newcastle upon Tyne, UK.
Br J Urol. 1998 May;81(5):712-20. doi: 10.1046/j.1464-410x.1998.00632.x.
To determine the outcome of men with acute urinary retention undergoing prostatectomy and to assess whether discharge with a catheter before subsequent planned re-admission for prostatectomy had an adverse effect on outcome.
A prospective cohort study was conducted of all men undergoing prostatectomy in five health care regions over a 6-month period in 56 hospitals where prostatectomies were performed under the care of 103 surgeons. The study included 3966 men undergoing prostatectomy, of whom 1242 presented with acute urinary retention; the complication rates and symptomatic outcome were assessed.
Compared with those who underwent elective prostatectomy for symptoms alone, men presenting with acute retention had an excess risk of death at 30 days (relative risk [RR], 26.6, 95% confidence interval [CI], 3.5-204.5) and at 90 days after operation (RR 4.4, 95% CI 2.5-7.6), and an increased risk of perioperative complications. Although men with retention were older, had larger glands and had more comorbidity, these factors did not totally explain the excess risk. The final symptomatic outcome of men with acute retention was no different from that of men presenting for elective treatment. Men with retention who were managed by initial catheterization, sent home and subsequently re-admitted for planned operation had similar pretreatment characteristics, post-operative complications and outcomes to those who were kept in hospital throughout, although the men kept in hospital had a total increased length of stay.
Men with acute retention have a high risk of developing complications after undergoing prostatectomy. We were unable to confirm that a short-term period of catheter drainage at home before re-admission for planned surgery carried increased risks of peri-operative complications.
确定接受前列腺切除术的急性尿潴留男性患者的预后，并评估在计划再次入院接受前列腺切除术之前带导尿管出院是否会对预后产生不利影响。
对56家医院103名外科医生治疗下在6个月期间于5个医疗保健区域接受前列腺切除术的所有男性进行了一项前瞻性队列研究。该研究纳入了3966名接受前列腺切除术的男性，其中1242名表现为急性尿潴留；评估了并发症发生率和症状性结局。
与仅因症状接受择期前列腺切除术的患者相比，表现为急性尿潴留的男性在术后30天（相对风险[RR]，26.6，95%置信区间[CI]，3.5 - 204.5）和90天（RR 4.4，95%CI 2.5 - 7.6）有更高的死亡风险，且围手术期并发症风险增加。尽管尿潴留患者年龄更大、腺体更大且合并症更多，但这些因素并不能完全解释额外的风险。急性尿潴留男性的最终症状性结局与接受择期治疗的男性无异。最初通过导尿管引流、出院并随后再次入院接受计划手术的尿潴留患者，其术前特征、术后并发症和结局与全程住院的患者相似，尽管住院患者的总住院时间有所增加。
急性尿潴留男性在接受前列腺切除术后发生并发症的风险很高。我们无法证实计划手术再次入院前在家进行短期导尿管引流会增加围手术期并发症的风险。
