逼尿肌無反射之尿滯留能否在前列腺手術後恢復排尿機能？

Can Patients with Detrusor Areflexia Regain Voiding Ability Following Prostatic Surgery for Urinary Retention

郭漢崇(Hann-Chorng Kuo) ； 張世忠(Shih-Chung Chang) ； 許悌(Tsi Hsu)

《慈濟醫學雜誌》 4卷4期 (1992/12) Pp. 223-229

https://doi.org/10.6440/TZUCMJ.199212.0223

摘要

During the period between July 1988 and May 1992, 46 in 580 consecutive patients undergoing prostatic surgeries for their urinary retention were noted to have detrusor areflexia preoperatively. Thirty-Three patients underwent transurethral resection of the prostate (TURP), 11 underwent transurethral incision of the prostate (TUIP) and retropubic prostatectomy was performed in 2. In the follow-up period of 6 months to 4 years, 38 patients (83%) were able to void smoothly, while 8(17%)failed the bladder training and a suprapubic cystostomy was necessary for urinary diversion. The mean age was significantly higher in the patients failed the surgery (77.9±6.2 vs 72.8±7.2 years, P＜0.05). However, there was no statistical significance in the prostatic size, end-filling pressure, bladder filling sensation nor in the upper tract deterioration with relevance to the prediction of recouery of voiding function. Among 38 patients able to urinate, 20 had to be trained for ≥14 days, 18 for ＜14 days, with a mean of 22.7±23.9 days (range 3-107).There was also no statistical significance in age, prostatic size or end-filling pressure between these two groups of patients. Upper tract deterioration was noted in 12 patients, 11 with a high end-filling pressure and 1 with a normal pressure (P＜0.05). Seven patients were demonstrated to regain detrusor contractility on the second pressure flow study. Among them, 5 were high pressure and 2 were normal pressure preoperatively. This study concludes that prostatic surgery is the choice of treatment in the elderly with urinary retention no matter there is a prominent prostatic adenoma or not. In case of detrusor areflexia noted preoperatively, a suprapubic cystostomy is necessary for further bladder training after surgery and expecting for the recovery of voiding function. A high percentage of patients, either with a high or normal end-filling pressure will eventually regain their detrusor contractility and voiding ability.

關鍵字

前列腺肥大 ； 逼尿肌無反射 ； 排尿機能障礙

並列摘要

During the period between July 1988 and May 1992, 46 in 580 consecutive patients undergoing prostatic surgeries for their urinary retention were noted to have detrusor areflexia preoperatively. Thirty-Three patients underwent transurethral resection of the prostate (TURP), 11 underwent transurethral incision of the prostate (TUIP) and retropubic prostatectomy was performed in 2. In the follow-up period of 6 months to 4 years, 38 patients (83%) were able to void smoothly, while 8(17%)failed the bladder training and a suprapubic cystostomy was necessary for urinary diversion. The mean age was significantly higher in the patients failed the surgery (77.9±6.2 vs 72.8±7.2 years, P＜0.05). However, there was no statistical significance in the prostatic size, end-filling pressure, bladder filling sensation nor in the upper tract deterioration with relevance to the prediction of recouery of voiding function. Among 38 patients able to urinate, 20 had to be trained for ≥14 days, 18 for ＜14 days, with a mean of 22.7±23.9 days (range 3-107).There was also no statistical significance in age, prostatic size or end-filling pressure between these two groups of patients. Upper tract deterioration was noted in 12 patients, 11 with a high end-filling pressure and 1 with a normal pressure (P＜0.05). Seven patients were demonstrated to regain detrusor contractility on the second pressure flow study. Among them, 5 were high pressure and 2 were normal pressure preoperatively. This study concludes that prostatic surgery is the choice of treatment in the elderly with urinary retention no matter there is a prominent prostatic adenoma or not. In case of detrusor areflexia noted preoperatively, a suprapubic cystostomy is necessary for further bladder training after surgery and expecting for the recovery of voiding function. A high percentage of patients, either with a high or normal end-filling pressure will eventually regain their detrusor contractility and voiding ability.

並列關鍵字

benign prostatic hypertrophy ； detrusor areflexia ； voiding dysfunction