伴有神经源性膀胱和前列腺憩室的前列腺巨大结石1例报告并文献复习  

Giant prostatic calculus with neurogenic bladder disease and prostate diverticulus:A case report and review of the literature

作　　者：李晓石[1] 权昌益[1] 李刚[1] 蔡启亮[1] 胡斌[1] 王久威[1] 牛远杰[1] 

机构地区：[1]天津医科大学第二医院泌尿外科,天津泌尿外科研究所,天津泌尿外科基础医学重点实验室,天津300211

出　　处：《中华男科学杂志》2013年第2期144-148,共5页National Journal of Andrology

摘　　要：目的:探讨和总结伴有神经源性膀胱和前列腺憩室的前列腺巨大结石的病因、临床表现、诊断与治疗。方法:结合相关文献复习并回顾性分析1例伴有神经源性膀胱和前列腺憩室的前列腺巨大结石患者的临床资料。患者男,37岁,尿失禁22年,间断排尿困难伴尿频9年,加重3个月。既往有脊柱裂及耻骨上膀胱切开取石术病史。术前尿常规:WBC 17～20/HPF,RBC 12～15/HPF。腹部平片(KUB)+静脉尿路造影(IVU)及盆腔CT:隐性脊柱裂,神经源性膀胱,前列腺巨大结石。结果:患者行经尿道前列腺电切(TURP)+钬激光碎石术,结石成分为碳酸磷灰石。术后2周复查影像尿动力学:最大尿流率及残余尿量均明显好转。术后至今随访17个月,尿失禁较术前明显减轻,尿线粗。结论:前列腺憩室合并前列腺巨大结石非常罕见,而神经源性膀胱可能为其发病的一个因素。膀胱镜检查是准确的检查方法。对于年轻和需要保留性功能者可采取TURP联合钬激光碎石术,术中结合直肠指检尽量彻底清除结石,术后密切随访。Objective： To study the etiology, clinical manifestation, diagnosis and treatment of giant prostatic calculus with neurogenic bladder disease and prostate divertieulus. Methods ： We retrospectively analyzed the clinical data of a ease of giant prosta- tic calculus with neurogenic bladder disease and prostate diverticulus and reviewed the relevant literature. The patient was a 37-year-old man, with urinary incontinence for 22 years and intermittent dysuria with frequent micturition for 9 years, aggravated in the past 3 months. He had received surgery for spina bifida and giant vesieo-prostatic calculus. The results of preoperative routine urinary exami- nation were as follows： WBC 17 -20 / HPF, RBC 12 - 15 / HPF. KUB, IVU and pelvic CT revealed spina bifida occulta, neurogenie bladder and giant prostatic calculus. Results： The patient underwent TURP and transurethral lithotripsy with holmium-YAG laser. The prostatic calculus was carbonate apatite in composition. Urinary dynamic images at 2 weeks after surgery exhibited significant im- provement in the highest urine flow rate and residual urine volume. Seventeen months of postoperative follow-up showed dramatically improved urinary incontinence and thicker urine stream. Conclusion ： Prostate diverticulum with prostatic giant calculus is very rare,and neurogenic bladder may play a role in its etiology. Cystoseopy is an accurate screening method for its diagnosis. For the yntmg pa- tients and those who wish to retain sexual function, TURP combined with holmium laser lithotripsy can be employed, and intraoperative rectal examination should be taken to ensure complete removal of calculi.

关 键 词：前列腺结石 前列腺憩室 神经源性膀胱 脊柱裂 

分 类 号：R697.34[医药卫生—泌尿科学]