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Các triệu chứng đường tiểu dưới sau phẫu thuật cắt tuyến tiền liệt qua niệu đạo
Tóm tắt
Phẫu thuật cắt tuyến tiền liệt qua niệu đạo (TURP) là liệu pháp phẫu thuật tiêu chuẩn cho các triệu chứng đường tiểu dưới (LUTS) do sự phì đại của tuyến tiền liệt. Sau phẫu thuật TURP, các triệu chứng LUTS có thể tồn tại ở một tỷ lệ bệnh nhân. Tình trạng LUTS kéo dài yêu cầu phải được đánh giá và điều trị đúng cách. Trong bài đánh giá này, chúng tôi đã cố gắng mô tả tỷ lệ mắc, sinh lý bệnh và các yếu tố dự đoán tình trạng LUTS sau TURP, cũng như các biện pháp đánh giá và quản lý được khuyến nghị. Giữa các kỹ thuật khác nhau sử dụng để thực hiện TURP, tỷ lệ mắc LUTS sau phẫu thuật là tương tự. Bàng quang bị tắc nghẽn mãn tính đã được chứng minh là có sự thay đổi về sự biểu hiện collagen, yếu tố mô và các thụ thể so với bàng quang bình thường, điều này có thể góp phần vào sinh lý bệnh của LUTS sau TURP. Mặc dù có thụ thể androgen trong biểu mô niệu đạo, nhưng vai trò của hormone sinh dục trong LUTS vẫn chưa rõ ràng. Laser GreenLight có thể dẫn đến các triệu chứng khó chịu sau phẫu thuật do hoại tử mô. Một tỷ lệ lớn bệnh nhân có tình trạng LUTS kéo dài sau TURP, với tỷ lệ tương đương giữa các kỹ thuật khác nhau có thể được sử dụng để thực hiện TURP. LUTS sau TURP cần được đánh giá bằng cách thu thập đầy đủ lịch sử bệnh và khám lâm sàng, bao gồm cả Điểm triệu chứng tuyến tiền liệt quốc tế (IPSS) và cấy nước tiểu để loại trừ nhiễm trùng. Các nghiên cứu dòng nước không xâm lấn, lượng nước tiểu còn lại sau khi đi tiểu và các nghiên cứu động học niệu hoặc soi bàng quang tiếp theo có thể được sử dụng khi cần thiết. Nghiên cứu thêm là cần thiết để có thể dự đoán chính xác hơn về những bệnh nhân sẽ không cải thiện hoặc tình trạng LUTS sẽ tồi tệ hơn sau TURP.
Từ khóa
#cắt tuyến tiền liệt qua niệu đạo #triệu chứng đường tiểu dưới #sinh lý bệnh #luận chứng #điều trịTài liệu tham khảo
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