三种不同手术方式治疗中老年女性压力性尿失禁疗效及对患者膀胱功能和术后并发症的影响

摘要 目的：探讨耻骨后膀胱尿道悬吊术（Burch）、阴道无张力尿道悬吊术（TVT）及经闭孔经阴道尿道中段悬吊带术（TVT-O）三种不同手术方式治疗中老年女性压力性尿失禁（SUI）疗效及对患者膀胱功能和术后并发症的影响。方法：回顾性分析2019.1-2022.4收治的101例中老年女性SUI患者资料，按手术方式分为Burch组（n=30，Burch术治疗）、TVT组（n=31，TVT术治疗）和TVT-O组（n=40，TVT-O术治疗），观察三组患者临床疗效和手术情况[手术时间、出血量、住院时间、尿管留置时间]，并发症发生率，治疗前后膀胱功能[24h排尿次数、膀胱容量、每次排尿量、残余尿量]及尿道功能指标[尿道长度（FUL）、最大尿道闭合压（MUCP）、Valsalva漏尿点压（VLPP）]变化。结果：Burch组、TVT组、TVT-O组治愈及改善率分别为83.34%、87.10%、87.50%，13.33%、12.90%、12.50%，三组之间比较差异无统计学意义（P>0.05）；TVT组、TVT-O组患者手术时间、出血量、住院时间、尿管留置时间均显著短于Burch组（P<0.05），且TVT-O组患者手术时间显著短于TVT组（P<0.05）；治疗后，三组患者24 h排尿次数、残余尿量均显著降低（P<0.05），膀胱容量、每次排尿量、FUL、MUCP、VLPP水平均显著增加（P<0.05），但三组之间比较差异无统计学意义（P>0.05）；Burch组、TVT组、TVT-O组并发症总发生率分别为20.00%、12.91%、15.00%，三组之间比较差异无统计学意义（P>0.05）。结论：三种术式治疗中老年女性SUI疗效相当，均可有效改善膀胱功能及尿道指标，但TVT与TVT-O术患者康复快，TVT-O手术时间最短，TVT并发症低，可依据患者情况酌情选择。     

Sacral anterior root stimulation for bladder control: clinical results

The Brindley bladder stimulator delivers intermittent stimulation to the anterior sacral roots. The stimulus parameters can be adjusted and set specifically for individuals. Its primary purpose is to improve bladder emptying, thereby to eliminate urinary infection and to preserve kidney function. It also assists in defecation and enables male patients to have a sustained full erection. In our unit so far 38 patients with a complete spinal cord lesion have received a Brindley bladder stimulator implant. One patient died 2 weeks after the surgery due to pulmonary embolism. Two other patients died due to unrelated causes during the follow up period. They used their implants for less than 1 year. Results relating to these 2 patients and the remaining 35 patients who regularly use their implant are presented. The follow-up period ranged from 3 months to 12 years. Residual urine volumes are substantially reduced in all patients; in 24 patients the residual urine volume is less than 30 ml. All patients have increased bladder capacity. Thirty-one patients are continent. Out of 33 males 29 can achieve a sustained full erection using the stimulator. Twenty-seven patients use the implant for bowel function. The following complications were encountered: (1.) Cerebro-spinal fluid collection occurred around the implant in 3 patients during the post-operative period; (2.) Receiver failure occurred in 3 patients. A successful replacement with a new receiver block was carried out in these cases. It is concluded that the use of a bladder stimulator in selected patients gives long term favourable results.     

中医多途径综合疗法治疗宫颈癌术后尿潴留的临床效果评价

目的:评价中医多途径综合疗法治疗宫颈癌术后尿潴留的临床效果和安全性。方法:选择2013年12月至2016年9月我院收治的60例宫颈癌术后出现尿潴留症状的患者,按其意愿将其分为对照组(30例)与研究组(30例),对照组接受水流声诱导、盆底肌锻炼等常规治疗方法,研究组在对照组基础上加以中医多途径综合疗法,比较两组治疗前后中医症状症状积分、自主排尿功能恢复时间、膀胱残余尿量、尿路感染率等情况。结果:治疗前,两组排尿无力、小腹坠胀、倦怠乏力、腰膝酸软积分比较差异均无统计学意义(P0.05);治疗后,两组以上指标均较治疗前明显降低,且研究组小腹胀痛、倦怠乏力积分均明显低于对照组,差异具有统计学意义(P0.05);研究组自主排尿功能恢复时间、膀胱残余尿量均明显低于对照组,差异具有统计学意义(P0.05);研究组尿路感染率为6.78%,明显低于对照组(23.33%),差异具有统计学意义(P0.05)。结论:中医多途径综合疗法治疗宫颈癌术后尿潴留的疗效肯定,可明显缩短病程,并降低尿路感染发生率。     

系统保留盆腔自主神经的广泛子宫切除术治疗宫颈癌及子宫内膜癌的临床效果分析

目的:探讨系统保留盆腔自主神经广泛子宫切除术治疗宫颈癌及子宫内膜癌的临床效果及安全性。方法:收集2013年6月至2014年6月我院收治的宫颈癌和子宫内膜癌患者82例,将其随机分为观察组与对照组,每组各41例。观察组行系统保留盆腔自主神经的广泛子宫切除术,对照组行传统根治性子宫切除术,比较两组的手术时间、术中出血量、术后拔除尿管时间、残余尿量、术后排气以及排便时间以及术中及术后并发症的发生情况。结果:两组的手术时间及术中出血量比较无明显差异(P0.05),但观察组的术后拔管时间、尿残余量、排气及排便时间均较对照组显著缩短或降低(P0.05)。两组的手术并发症主要包括便秘、血便、腹泻、尿路感染、尿失禁、尿频尿急,观察组并发症的总发生率较对照组显著降低(P0.05)。结论:广泛子宫切除术中系统保留盆腔自主神经有利于保护宫颈癌及子宫内膜癌患者的膀胱和直肠功能,降低手术相关并发症,提高患者的术后康复质量与生活质量。     

Early development of bacterial community diversity in emergently placed urinary catheters

ABSTRACT: BACKGROUND: Approximately 25% of hospitalized patients have a urinary catheter, and catheter associated urinary tract infection is the most common nosocomial infection in the US, causing >1 million cases/year. However, the natural history of the biofilms that rapidly form on urinary catheters and lead to infection is not well described. FINDINGS: We characterized the dynamics of catheter colonization among catheters collected from 3 women and 5 men in a trauma burn unit with different indwelling times using TRFLP and culture. All patients received antibiotic therapy. Results: Colony-forming units increased along the extraluminal catheter surface from the catheter balloon to the urethra, but no trend was apparent for the intraluminal surface. This suggests extraluminal bacteria come from periurethral communities while intraluminal bacteria are introduced via the catheter or already inhabit the urine/bladder. Richness of operational taxonomic units (OTUs) increased over time on the intraluminal surface, but was constant extraluminally. CONCLUSIONS: OTU community composition was explained best by time rather than axial location or surface. Our results suggest that catheter colonization can be very dynamic, and possibly have a predictable succession.     

Urethral plugs and urine retention in male mice

Because MM male mice suffer from a high incidence of urinary tract infection, an assessment was made as to whether the urethral plugs, which occur in male rodents, might be involved in its aetiology. When killed, males more commonly retained urine in their bladders than females but there was no significant difference between strains or method of killing. Males also voided urine more often during stressful handling followed by abdominal pressure, but also retained some urine more often than females. The study of sexually immature mice demonstrated no sex differences and no urine was retained in any bladder. It was concluded that the high frequency of urine retention in mature males is attributable to the presence of urethral plugs but these could not be implicated in the cause of MM urinary tract infection because of comparable findings in the controls. However, the possibility was considered that the plugs might facilitate infection of the kidneys once a bladder infection had become established.     

急性肾盂肾炎合并尿路感染危险因素与致病微生物特点的临床分析

目的 探讨急性肾盂肾炎合并尿路感染危险因素与致病微生物的特点。方法 选择2017年4月—2018年4月在本院肾内科就诊的急性肾盂肾炎合并尿路感染患者59例,无菌操作收集患者中段尿,导管收集患者膀胱尿。2 h内送检,采用定量接种的方法,将一定量混匀未离心尿液用接种环接种于血平板或麦康凯平板进行细菌培养。相关性分析采用Pearson相关性检验。结果 糖尿病、肺部感染、尿路结石、脑血管疾病和肿瘤是常见的急性肾盂肾炎（APN）合并尿路感染的危险因素。男性中段尿检出率较高的菌种有大肠埃希菌（E. coli）、金黄色葡萄球菌（S. aureus）等;膀胱尿中检出率较高的菌种有大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）。女性中段尿和膀胱尿中检出率较高的菌种均是大肠埃希菌（E. coli）和金黄色葡萄球菌（S. aureus）。女性总住院时间≥4 d的患者比例明显高于男性。APN患者中合并糖尿病与大肠埃希菌（E. coli）和粪肠球菌（E. faecalis）存在正相关,尿路结石与大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）、屎肠球菌（E. faecium）存在正相关。结论 患者尿液中大肠埃希菌（E. coli）最常见,女性APN患者更容易并发尿路感染,住院时间长于男性患者。合并糖尿病的患者更容易患有大肠埃希菌（E. coli）和粪肠球菌（E. faecalis）感染,合并尿路结石的患者更倾向于大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）、屎肠球菌（E. faecium）感染。     

坦洛新联合托特罗定对老年膀胱过度活动综合症患者P2X3受体表达的影响

目的:探讨坦洛新联合托特罗定对老年膀胱过度活动综合症患者P2X3受体表达的影响。方法:收集我院收治的膀胱过度活动综合症患者60例,随机分为对照组和实验组,每组各30例,对照组患者给予盐酸坦洛新缓释胶囊,实验组患者在对照组的基础上给予酒石酸托特罗定。观察并比较所有患者的最大尿流速率、膀胱残余尿量、排尿次数、单次最大尿量水平以及患者的治疗效果。结果:治疗后,两组患者治疗后单次最大尿量、最大尿流速率均升高(P0.05),膀胱残余尿量、排尿次数以及P2X3水平均降低(P0.05);与对照组相比,实验组患者治疗后单次最大尿量、最大尿流速率较高(P0.05),膀胱残余尿量、排尿次数以及P2X3水平较低(P0.05);实验组患者临床总有效率与对照组相比较高(P0.05)。结论:坦洛新联合托特罗定能够显著提高老年膀胱活动度综合征患者临床疗效,可能与其降低患者血清P2X3受体水平有关。     

Mouse models of short- and long-term foreign body in the urinary bladder: analogies to the bladder segment of urinary catheters.

Catheter-associated bacteriuria is the most common infection occurring in hospitals, where urethral catheters are generally in place for a few days, and in nursing homes, where catheters may be in place for months or years. We developed murine models with intrabladder urinary catheters for studying complications of bacteriuria in short- and long-term catheterization. In the short-term model, a catheter segment was inserted transurethrally and lay free within the bladder lumen. Half of the animals expelled segments during a 2-to-7-day period, durations similar to catheterizations in hospitalized patients. For studies of long-term catheter use, the catheter segment was secured within the bladder by a single suture for up to 12 months. Antibiotics administered for 7 days after catheter placement and housing mice in cages with wire screen floors reduced spontaneous bacteriuria to an acceptably low incidence rate of only 7%. Proteus mirabilis bacteriuria of high concentration provoked the same complications that are common in patients with long-term catheters: acute pyelonephritis, chronic renal inflammation, and struvite stone formation. These models allow inoculation of the bacteria of interest and are suitable for studies of short- and long-term foreign body-associated bacteriuria and its complications.     

非那雄胺联合M受体拮抗剂治疗前列腺增生合并膀胱过度活动症的疗效

目的:探讨非那雄胺联合M受体拮抗剂对前列腺增生合并膀胱过度活动症临床疗效的影响。方法:回顾性研究我院前列腺增生合并膀胱过度活动症的患者60例,随机分为实验组和对照组,每组30例。对照组患者给予M受体拮抗剂,实验组患者在对照组的基础上给予非那雄胺。观察并比较治疗前后两组患者国际前列腺症状评分(IPSS)、膀胱过度活动症评分(OABSS)、残余尿量、最大尿流率、尿急次数以及治疗期间不良反应。结果:与对照组相比,实验组患者IPSS及OABSS较低(P0.05);残余尿量较少,最大尿流率较大,尿急次数较少(P0.05);不良反应发生率较低(P0.05)。结论:非那雄胺联合M受体拮抗剂能够降低前列腺增生合并膀胱过度活动症的不良反应发生率,提高临床疗效,值得在临床上推广应用。     

Common Complications of Hysterectomy

Some of the common complications associated with abdominal and vaginal hysterectomy, performed in a teaching hospital, are reviewed. Case records of 284 abdominal hysterectomies and 101 vaginal hysterectomies are analyzed.The incidence of blood transfusion and of urinary tract infection was greater following vaginal hysterectomy than abdominal hysterectomy. The morbidity rate of vaginal hysterectomy was two and a half times as great as that of abdominal hysterectomy. Neither the age of the patient nor the factor of previous abdominal or major gynecological surgery influenced the morbidity of vaginal hysterectomy.It is apparent that the preoperative recognition and treatment of urinary tract infection and anemia should reduce the incidence of postoperative morbidity and the use of postoperative blood transfusion in both abdominal and vaginal hysterectomy.     

Endoscopic Management of Bladder Diverticula

A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach.     

A case-control study to evaluate urinary tract complications in radical hysterectomy

BACKGROUND: This study has evaluated urinary tract injuries and dysfunction after Radical Hysterectomy (RH) performed in patients with cervical cancer and has compared the cystometric parameters and urinary complications occurring in these patients with those occurring in patients who had undergone Simple Hysterectomy (SH). PATIENTS AND METHODS: A prospective case-control study was conducted to evaluate urinary tract injuries (intra-operative and post-operative) and dysfunction in 50 patients undergoing RH for cervical cancer and to compare them with the same parameters in 50 patients who underwent SH for benign disease. RESULTS: Mean age in the RH group was 46.3 years and in the SH group was 50.1 (p = 0.63). There were no bladder and urethral injuries in either group of patients. There was one intra-operative ureteral injury in the RH patients but none in those who underwent SH. (p < 0.05). In the two weeks after surgery, 15% of RH patients and 11% of SH patients had experienced a urinary tract infection urinary tract infection (p = 0.61). Two week after surgery 62% of RH patients had no urinary symptoms, compared to 84% in the SH group who did (p < 0.02). Urinary residual volume, first urinary sensation and maximal bladder capacity were higher in the RH group, but this was not statistically significant. The only case of a urinary fistula appeared in a patient who received 5000 cGy radiation therapy pre-operatively, but this spontaneously healed after 3 weeks of catheterization. CONCLUSIONS: Intra-operative and post-operative urinary tract complications are comparable in patients undergoing RH and SH and an expert gynaecological oncologist might be able to further decrease complications. However, radiation therapy before surgery may increase the risk of complications.     

Detection of urinary bladder cancer with flow cytometry and hexaminolevulinate in urine samples

OBJECTIVES: Urinary bladder urothelial carcinoma is diagnosed by a combination of cystoscopy and biopsy, with cytology as a valuable additional technique. The accuracy of cytological diagnosis depends on the experience of the cytologist and can inevitably vary from one cytologist to another. There is a need for an easy, reliable and objective diagnostic method. In the present study a new method was designed for the detection of bladder cancer cells in urine. METHODS: Flow cytometry was utilized to detect protoporphyrin IX in an artificial model consisting of normal urinary bladder transitional epithelial cells (NBECs) from healthy volunteers' urine and an established human urinary bladder carcinoma cell line, TCCSUP, after incubation with hexaminolevulinate (HAL). In addition, urine samples from 19 patients with histopathologically confirmed superficial bladder cancer were examined. RESULTS: Incubation of NBECs or TCCSUP cells with HAL for 1 hour resulted in production of protoporphyrin IX only in the TCCSUP cells. Incubation of a mixture of NBECs and TCCSUP cells with HAL gave rise to a separated subpopulation of cells with protoporphyrin IX fluorescence. After cell sorting by flow cytometry the protoporphyrin IX-containing subpopulation of cells was confirmed as TCCSUP cells on cytological examination. It was possible to detect 5% TCCSUP cells in the mixture of NBECs/TCCSUP cells. To test the feasibility of the method in clinica diagnosis, urine samples from patients with bladder cancer were also measured with comparable, although preliminary and limited, results to those of cytological examination. CONCLUSIONS: The preliminary results show that the technique may be feasible for the detection of bladder cancer cells in urine with possible advantages of simplicity, reliability and objectivity.     

Urodynamic findings in chronic retention of urine and their relevance to results of surgery.

Fifty-five consecutive male patients aged 18-77 with chronic retention of urine were investigated urodynamically. All were shown to have obstructed micturition. Inflow cystometry defined two groups, one with high-pressure and one with low-pressure filling. Recent-onset enuresis and upper-tract dilatation as seen on radiography were significantly associated with high-pressure bladder filling. Postoperative studies showed that patients with high-pressure filling on preoperative cystometryhad a better response to outflow-tract surgery. The poor response of the patients with low-pressure filling was due to a high incidence of inadequate detrusor contraction leading to persistent residual urine. Thus urodynamic studies may be used to indicate which patients are likely to benefit from prostatectomy and, after the operation, whether the obstruction has been relieved.     

内毒素和降钙素原在妇科术后尿路感染中的鉴别诊断价值

目的评价中段尿内毒素和血清降钙素原在妇科术后不同种类细菌尿路感染中的鉴别诊断价值。方法收集临床1205例妇科术后患者中段尿进行细菌培养及内毒素检测,同时对患者进行血清降钙素原检测,比较结果对尿路感染的鉴别诊断价值。结果1205份标本中尿培养出阳性350例,感染率为29．04％,其中298例为均存在留置导尿管,而在剩余400例尿培养阴性的患者中仅仅120例留置导尿管。两组之间差异有统计学意义（χ2=26．78,P〈0．05）。其中革兰阴性杆菌189例（54％）,革兰阳性菌112例（32％）,真菌49例（14％）。在三组患者中,中段尿内毒素在革兰阴性菌引起的术后尿路感染较革兰阳性菌和真菌的患者中明显升高,差异均有统计学意义（P〈0．05）。而对于血清降钙素原在革兰阴性菌和革兰阳性菌感染的患者明显高于真菌尿路感染的患者,差异均有统计学意义（P〈0．05）。而在革兰阴性菌和革兰阳性菌感染的患者中差异无统计学意义（P〉0．05）。结论妇科术后尿路感染与留置导尿管密切相关,革兰阴性菌是引起妇科术后尿路感染的主要致病菌,中段尿内毒素有助于鉴别诊断出革兰阴性菌引起尿路感染,而血清PCT升高时则有助于排除真菌尿路感染。     

剥离式经尿道前列腺电切术对前列腺增生症患者性功能、尿流动力学及生活质量的影响

目的:探讨剥离式经尿道前列腺电切术(TURP)对前列腺增生症(BPH)患者性功能、尿流动力学及生活质量的影响。方法:回顾性分析我院2016年1月~2019年2月期间收治的267例BPH患者的临床资料,根据手术方式的不同分为A组(n=130,TURP术)和B组(n=137,剥离式TURP术),对比两组患者围术期指标、性功能、尿流动力学、生活质量及并发症发生情况。结果:两组手术时间比较无差异(P>0.05),B组膀胱冲洗时间、拔除导尿管时间、术后住院时间短于A组,术中出血量少于A组,切除组织重量多于A组(P<0.05)。两组术后6个月国际勃起功能指数-5(IIEF-5)各项评分、生活质量评分(SF-36)各维度评分均改善,且B组优于A组(P<0.05)。两组患者术后6个月最大尿流(Qmax)升高,且B组高于A组(P<0.05);膀胱残余尿量(RU)降低,且B组低于A组(P<0.05)。B组术后并发症发生率低于A组(P<0.05)。结论:与TURP术式相比,BPH患者应用剥离式TURP可获得更好的治疗效果,在性功能、尿流动力学、生活质量等方面的改善效果确切,并发症较少。     

Continuous complete collection of uncontaminated urine in conscious rodents.

We describe a novel technique for complete and continuous bladder urine collection in conscious unrestrained rats. After urethral ligation, a silastic catheter is placed through a flexible steel tether, tunneled subcutaneously from the posterior neck area to a suprapubic incision, and inserted and fixed into the exposed urinary bladder. The catheter drains by gravity into a dependent collecting vessel protected from contamination by feces or food.     

Measurement of the residual urine index in insulin-dependent and non-insulin dependent diabetic men with and without neuropathy

Value of the residual urine index was evaluated in 40 individuals both insulin-dependent (IDDM) and non-insulin dependent (NIDDM) diabetic male patients with and without an objective evidence of neuropathy and in 20 age matched non-diabetic men serving as controls using post void bladder ultrasonographic technique. These studies revealed striking results in the neuropathic group. Both IDDM and NIDDM diabetic patients with neuropathy exhibited a significant (P < 0.005) increase in residual-volume in comparison with the controls of the same age group and a direct correlation between residual urine retention and neurogenic bladder was found to be established thus suggesting a generalized massive hypotonia of the bladder in these patients. However, non of the two types of non-neuropathic diabetic patients showed significant difference in the above-mentioned parameters compared to that their respective controls. A non-significant association in the values of the study parameters between insulin dependent and non-insulin dependent diabetic men (with and without neuropathy) was also observed. These findings thus suggest a probable neuropathic involvement in the pathway of urinary tract in both IDDM and NIDDM diabetic men with neuropathy. The greater impairment of the values of residual urine index in these patients may be due to overall greater severity of neuropathy with sympathetic as well as parasympathetic damage irrespective of their type of diabetes.     

Failure of Urinary Beta-Glucuronidase Activity to Localize the Site of Urinary Tract Infection

The differentiation of renal from bladder bacteriuria is difficult on clinical grounds alone. To evaluate the correlation between site of infection and urinary beta-glucuronidase activity, 46 patients with well documented recurrent bacteriuria were studied by bilateral ureteral catheterization. Urinary beta-glucuronidase activity was also determined in 46 control subjects. In general, asymptomatic patients with renal bacteriuria, either unilateral or bilateral, had levels of enzyme activity in their urine comparable to patients with infection confined to the bladder and to normals. Only 4 of 25 patients with renal bacteriuria had significant elevations of urinary beta-glucuronidase. After localization of infection, 9 of 10 patients treated with kanamycin, a potentially nephrotoxic drug, developed significant elevations of urinary beta-glucuronidase. The results of these studies indicate that determination of beta-glucuronidase activity in urine is not useful in predicting the site of infection in patients with bacteriuria but may find a role in screening for early nephrotoxicity.