男性性生活后严重血尿的病因和治疗方法  

Causes and treatment of severe hematuria after sexual activity in men

作　　者：刘贵中[1,3] 胡海兵 吴宝军 白文俊 牛远杰[1] Liu Guizhong;Hu Haibing;Wu Baojun;Bai Wenjun;Niu Yuanjie(Department of Urology,Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Urology,Donghua Hospital Affiliated to Sun-Yatsen University,Guangzhou 523110,China;Department of Urology,Tianjin Jinnan Hospital,Tianjin 300350,China;Department of Urology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]天津医科大学第二医院泌尿外科,300211 [2]中山大学附属东华医院泌尿外科,广州523110 [3]天津市津南医院泌尿外科,300350 [4]北京大学人民医院泌尿外科,100044

出　　处：《中华泌尿外科杂志》2020年第10期769-771,共3页Chinese Journal of Urology

摘　　要：目的:探讨男性性生活后严重血尿的发病机制和治疗方法。方法:回顾性分析2017年1月至2020年1月收治的10例男性性生活后严重血尿患者的病例资料,其中北京大学人民医院4例,中山大学附属东华医院3例,天津医科大学第二医院2例,天津市津南医院1例。患者平均年龄(33.5±7.6)岁。10例均于性生活后1 h内发生严重血尿,伴有血块。入院24 h血常规检查血红蛋白平均(95.8±8.9)g/L。10例在蛛网膜下腔麻醉或硬膜外麻醉下行经尿道膀胱镜下电切术和/或电凝术,术中证实均为后尿道病变出血,病变位于精阜远端4例,前列腺部5例,精阜近端1例。3例为后尿道前列腺部曲张静脉出血,予电凝止血。7例切除病变组织送病理检查。术后留置F16尿管。结果:本组10例手术均顺利完成。7例病理检查结果分别为后尿道血管瘤破裂6例,后尿道息肉1例。术后1周均顺利拔除尿管。术后禁欲1个月。恢复性生活后未见血尿复发,无排尿困难和尿失禁等并发症。结论:男性性生活后严重血尿,多为后尿道病变血管破裂出血所致,首选经尿道膀胱镜下电切术和/或电凝术治疗,效果可靠,预后良好。Objective To explore the pathogenesis and treatment of severe hematuria after sexual activity in men.Methods A retrospective analysis of 10 patients with severe hematuria after sexual activity who were admitted from January 2017 to January 2020,including 4 cases from Peking University People’s Hospital,3 cases from Donghua Hospital Affiliated to Sun Yat-sen University,2 cases from Second Hospital of Tianjin Medical University,and 1 case from Tianjin Jinnan Hospital.The average age of the patients was(33.5±7.6)years old.All 10 cases had severe hematuria and blood clots within 1 hour after sexual activity.The blood routine examination revealed that there were different degrees of hemorrhagic anemia after 24 hours of admission,and the average hemoglobin was(95.8±8.9)g/L.Ten patients underwent transurethral cystoscopy electrosurgical resection and/or electrocoagulation under subarachnoid anesthesia or epidural anesthesia.All patients were confirmed to be bleeding from posterior urethral lesions,including 4 cases located in the distal seminal caruncle,5 cases in the prostate,and 1 case in proximal seminal caruncle.Three cases whose bleeding from varicose veins in the prostate urethra were treated with electrocoagulation in order to stop the bleeding,and lesions were removed in the other 7 cases for pathological examination.The F16 urinary catheter was indwelt after the operation.Results All 10 operations in this group were successfully completed.Six cases of posterior urethral hemangioma rupture and 1 case of posterior urethral polyp were confirmed by the pathological examination in 7 cases.The urinary catheter was successfully removed 1 week after operation.Abstinence was required for 1 month after operation.There was no recurrence of hematuria after resuming sexual activity,and no complications such as dysuria or urinary incontinence.Conclusion Severe hematuria after sexual activity is mostly caused by rupture or bleeding of abnormal blood vessels in the posterior urethra.Transurethral resection and/or electroco

关 键 词：血尿 性生活 后尿道血管瘤 

分 类 号：R696.8[医药卫生—泌尿科学]