目的:获得性前列腺瘘(PF)定义为前列腺尿道和直肠之间的连接,联合,腹膜,或在前列腺周围自由终止。本研究旨在报告我们在PF演示中的经验,诊断,和治疗。
方法:从2014年1月至2024年2月,我们回顾性分析了来自两家泌尿外科大学医院的前瞻性维护数据库,以确定患有后天性PF的男性。诊断基于干预后的症状,包括气尿,Fecaluria,直肠漏尿,前列腺周围炎症或脓肿,通过使用逆行尿道图的放射学评估完成,CT,或MRI。标准膀胱镜检查和/或直肠乙状结肠镜检查评估膀胱和直肠完整性。前列腺切除术后瘘的患者被排除在外。
结果:确定了13例患者,平均年龄为66.54±7.40岁。最常见的症状是尿毒症/气尿54%,直肠尿漏31%,和复发性尿路感染31%。从最初治疗到瘘发展的平均时间为22.28±20.53个月(0.1-59个月),从诊断到修复的时间为3.5±3个月(1-12个月)。第一次和第二次尝试后的累积闭合率(成功率)分别为77%(10例)和92%(12例),分别;一名患者拒绝接受确定性手术,膀胱引流后保持持续性瘘。
结论:临床怀疑和详细诊断对于制定针对前列腺瘘的量身定制治疗计划至关重要,这在许多患者中都是可以成功控制的。复杂的案例受益于多学科方法,根据病因进行个体化治疗,严重程度,和PF的复发,促进有效关闭。
OBJECTIVE: Acquired prostatic fistula (PF) was defined as a connection between the prostatic urethra and the rectum, symphysis, peritoneum, or ending freely in the periprostatic area. This study aims to report our experience with PF presentation, diagnosis, and treatment.
METHODS: From January 2014 to February 2024, we retrospectively analyzed a prospectively maintained database from two urologic university hospitals to identify men with acquired PF. Diagnosis was based on post-intervention symptoms, including pneumaturia, fecaluria, rectal urine leakage, periprostatic inflammation or abscess, completed by radiological assessment using retrograde urethrogram, CT, or MRI. Standard cystoscopy and/or rectosigmoidoscopy assessed bladder and rectal integrity. Patients with post-prostatectomy fistulas were excluded.
RESULTS: Thirteen patients with a mean age of 66.54 ± 7.40 years were identified. The most commonly presenting symptoms were fecaluria/pneumaturia 54%, rectal urine leakage 31%, and recurrent urinary tract infection 31%. The mean time from the initial treatment to fistula development was 22.28 ± 20.53 months (0.1-59 months), and from diagnosis to repair was 3.5 ± 3 months (1-12 months). Cumulative closure rates (success rate) post-first and second attempts were 77% (10 patients) and 92% (12 patients), respectively; one patient declined definitive surgery, maintaining a persistent fistula after bladder drainage.
CONCLUSIONS: Clinical suspicion and detailed diagnosis are essential for formulating a tailored treatment plan for prostatic fistulas, which are successfully manageable in many patients. Complex cases benefit from a multidisciplinary approach, with individualized therapy based on etiology, severity, and recurrence of PF, facilitating effective closure.