ABSTRACT
Objective To discuss the treatment and nursing effect for prevention of cystospasm in patients after prostatic surgery with irrigation of resinieratoxin (RTX) into urinary bladder. Methods Twenty patients were divided into the control group and observation group with 10 cases in each group according to the date of hospitalization.Four milliliters of RTX and 100 ml of normal saline were irrigated into the bladder 3 days before operation in the observation group.Only 104 ml normal saline was irrigated into the bladder in the control group.The frequency,intension and duration of cystospasm and clearing time of bladder flushing fluid were observed.The international prostatic symptom score (IPSS) and score of life quality were evaluated at the first,second and 4th week after removing of urinary catheter and bladder stoma. Results The outcome in the observation group and the control group were as followed: the incidence rate of cystospasm was 20% and 80%,the clearing time of bladder flushing fluid was (2.8±1.7)d and (5.2±1.0)d,the indwelling time of bladder stoma was (4.0±1.6)d and (5.8±1.1)d,the indwelling time of urinary catheter was (9.3±1.3)d and (11.8±1.1)d,the VAS score was (2.3±1.3)d and (4.6±1.1)d, the IPSS score at the first,second and 4th week were (11.1±3.3)and (16.0±3.0), (9.5±1.4) and (12.7±13.2), (8.4±1.6) and (11.3±2.7),the score of life quality at the 4th week was (1.6±0.5) and (2.8±0.9), respectively. All the above results had statistical difference between the observation group and the control group (P<0.05). Conclusion Standard bladder irrigation,rigorous monitoring of patients condition and maintenance of smooth flush of bladder were the important nursing basis to ensure the exertion of best effect of RTX irrigation.
ABSTRACT
Objective To investigate the influence of tethered cord syndrome (TCS) on the up-per urinary tract and its etiology. Methods Forty patients with TCS diagnosed by spinal MRI were enrolled in this study. There were 21 males and 19 females with mean age of 23 years old. The course of disease ranged from 1 to 40 years. Urinalysis, mid-stream urine culture, serum creatinine(SCr), urinary system ultrasound, IVU, eystography and urodynamic study were carried out on all patients. Results Urinary tract infection was found in 17 patients and increased level of SCr was found in 6 pa-tients (251.64±98.5μmol/L). Of the 29 patients who underwent urinary system ultrasound examina-tion, 12 cases had hydronephroais and dilated upper ureter. Of the 30 patients who underwent IVU, 10(33.3%) had ureterectasia and hydronephrosis, 22 cases had bladder turriform or Christmas tree like deformity with diverticulum and trabeculum. Of the 22 patients accepted cystography, 17 cases had vesieoureteral reflux on 27 sides. Post-void residual (PVR) was evaluated in 35 patients and found increased in 31 cases. Cystometry had been done in 33 patients. The mean value of maximal detrusor pressure (Pdetmax) during filling phase was 41.2±20.9 cm H2O. The detrusor compliance was 22.35±18.8 ml/cm H2O. During voiding phase, detrusor-sphincter dyssynergia(DSD)was observed in 16 patients, detrusor areflexia was observed in 16 patients and detrusor underactivity was observed in 13 patients. Resting urethral pressure profilemetry was measured in 16 patients. Maximal urethral closure pressure (MUCP) was 76.1±33.1 cm H2O. The upper urinary tract deterioration was de-fined as increased SCr, hydronephrosis or vesicoureteral reflux. There were 20 patients diagnosed as upper urinary tract deterioration. The compliance of the upper urinary tract deteriorating group and the no-deteriorating group was 9.4±7.8 vs 19.3±15.8 ml/cm H2O, Pdetmax was 43.1±21.2 vs 24.0±11.9 cm H2O, PVR 189.0±138.0 vs 47.8±36.8 ml, MUCP 86.2±32.4 vs 46.8 5±20.8 cm H2O, incidence of damaged detrusor 100.0% vs 69.2% and DSD 65.0% vs 23.1%, respectively. There were significant differences between the 2 groups(P<0.05). And when comparing the VUR group with no VUR group, the incidence of urinary tract infection was 94.1%(16/17) vs 20.0%(1/ 5) (P=0.003). And when comparing urinary tract infection group with no infection group, the inci-dence of upper urinary tract deterioration was 88.2% (15/17) vs 21.7%(5/23)(P=0.000). Condn-sion Low compliance bladder, high Pdetmax during filling phase, increased PVR, high MUCP, damage of detrusor contractive function and DSD are the risk factors for upper urinary tract deteriora-tion in the TCS patients.