【正文】 ukacs B, Matzkin H, et al. Response to daily 10 mg alfuzosin predicts acute urinary retention and benign prostatic hyperplasia related surgery in men with lower urinary tract symptoms. J Urol,2006,176(3):10511056.53. Kumar V, Marr C, Bhuvangiri A, et al. A prospective study of conservatively managed acute urinary retention: Prostate size matters. BJU Int,2000,86(7):816819.54. Klarskov P, Andersen JT, Asmussen CF, et al. Symptoms and signs predictive of the voiding pattern after acute urinary retention in men. Scand J Urol Nephrol,1987,21(1):2328.55. McNeill SA, Hargreave TB, Roehrborn CG, Alfaur study group. Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a doubleblind placebocontrolled study. Urology,2005,65(1):8389.56. Palit V, Shah T, Biyani CS, et al. Long term follow up of men with Alfuzosin who voided successfully following acute urinary retention. Int Urol Nephrol,2005,37(3):507510.57. Choong S, Emberton M. Acute urinary retention. BJU Int,2000,85(2):186–201.58. Emberton M, Anson K. Acute urinary retention in men: An age old problem. BMJ,1999,318(7188):921925.59. McConnell JD, Roehrborn CG, Bautista OM, et al., for the Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The longterm effect of doxazosin, finasteride, and bination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med,2003,349(25):23872398.60. Roehrborn CG, Bruskewitz R, Nickel JC, et al. Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia. J Urol,2004,171(3):11941198.61. O’Leary MP, Roehrborn C, Andriole G, et al. Improvements in benign prostatic hyperplasiaspecific quality of life with dutasteride, the novel dual 5alphareductase inhibitor. BJU Int,2003,92(3):262266.62. Boyle P, Roehrborn C, Harkaway R, et al. 5Alpha reductase inhibition provides superior benefits to alpha blockade by preventing AUR and BPHrelated surgery. Eur Urol,2004,45(5):620626.63. Cathcart P, van der Meulen J, Armitage J, et al. Incidence of primary and recurrent acute urinary retention between 1998 and 2003 in England. J Urol,2006,176(1):200204.64. Daly P, Connolly S, Rogers E, et oute of acute urinary retention: model of Int,2009,83(1):3943. 65. Gesenberg A, Sintermann R. Management of benign prostatic hyperplasia in high risk patients: longterm experience with the Memotherm stent. J Urol,1998,160(1):7276.66. 那彥群,郝金瑞,劉重祿,1995,16(6):354356.67. 王士平,2001,16(7):319.68. 范郁會,趙留存,2001,16(7):299300.69. Isotalo T, Talja M, Valimaa T, et al. A pilot study of a bioabsorbable selfreinforced poly Llactic acid urethral stent bined with Finasteride in the treatment of acute urinary retention from benign prostatic enlargement. BJU Int,2000,85(1):8386.70. Isotalo T, Talja M, Hellstr246。參考文獻1. Fitzpatrick JM, Kirby RS. Management of acute urinary retention. BJU Int,2006,97(Suppl 2):16–20.2. Emberton M, Fitzpatrick JM. The RetenWorld survey of the management of acute urinary retention: preliminary results. BJU Int,2008,101(Suppl 3):27–32.3. Kalejaiye O，Speakman MJ. Management of Acute and Chronic Retention in Men. European Urology Supplements，不推薦在數(shù)日內立即手術治療，推薦在應用α受體阻滯劑后先行TWOC，以后再擇期手術。~7天后TWOC。，但對于感染高危病人和接受某些有創(chuàng)操作（例如經(jīng)尿道前列腺切除術和腎移植）的病人，可考慮使用抗生素治療。，推薦行恥骨上膀胱穿刺造瘺。針刺部位可取合谷、三陰交、足三里等穴位，也可以采用新斯的明穴位注射，效果更明顯。使用開塞露灌腸，可以緩解婦女產(chǎn)后和兒童的急性尿潴留，但對前列腺增生所致急性尿潴留不推薦使用。此類藥物靜脈或肌肉使用時應注意有心跳驟停的可能。此類藥物包括：烏拉膽堿、新斯的明、氯化氨甲酰膽堿、雙吡己胺等。有小樣本報道特拉唑嗪(terazosin)和酚芐明口服后可解除尿道擴約肌痙攣，使部分AUR患者恢復正常排尿而無需留置導尿管。使用過程中應注意眩暈、體位性低血壓、惡心嘔吐等不良反應。第一線藥物推薦阿夫唑嗪緩釋片(alfuzosin)，BPH患者繼發(fā)AUR后留置導尿管，阿夫唑嗪10 mg一日1次能明顯提高2～3 天后拔出導尿管恢復排尿的可能性(61．9％ V47．9％)，并可避免拔除導尿管后再次發(fā)生急性尿潴留，減少患者對導尿管的依賴。根據(jù)急性尿潴留的發(fā)生機理，目前能用于治療尿潴留的藥物主要包括增強膀胱逼尿肌收縮的擬副交感神經(jīng)類藥物和松弛尿道括約肌的α受體阻滯劑類藥物。CISC可用于在AUR發(fā)生后短期替代保留導尿以延期手術，也可用于前列腺切除術后因逼尿肌無力而發(fā)生尿潴留的患者，尤其適用于神經(jīng)源性膀胱患者。研究表明，CISC恢復自主排尿的機會比保留導尿者高，且尿路感染機會更低。（五）間歇性自家清潔導尿（clean intermittent selfcatheterization ，CISC）對AUR病因不能有效治療的患者，CISC是除長期置管之外的另一選擇。前列腺部尿道支架可保持膀胱出口開放，對于不能耐受手術的高危BPH患者行前列腺部尿道支架置入可使患者恢復自主排尿，尿流率增加、膀胱殘余尿量減少，生活質量提高，近期療效滿意。因此，以AUR來就診的BPH患者，推薦在應用α受體阻滯劑后先行TWOC，以后再延期手術，不推薦急診行前列腺手術。AUR發(fā)作后急診行前列腺手術者（發(fā)生AUR數(shù)天內），感染、圍手術期出血的并發(fā)癥發(fā)生率增加，輸血率增高，死亡率增加≤3倍。手術解除AUR發(fā)生的病因可從根本上避免AUR再發(fā)，也可避免長期或重復置管。無誘發(fā)因素的AUR、前列腺體積較大、血清PSA水平升高、留置導尿到TWOC的時間較短、最大尿流率5ml/s、排尿后殘余尿量（PVR）500ml、首次AUR后對阿呋唑嗪治療反應不佳者再發(fā)生AUR的風險較高。BPH患者導尿后服用坦索羅辛3天，同樣可以顯著提高TWOC的成功率。有證據(jù)表明TWOC前應用α受體阻滯劑可增加拔管后成功排尿的機會。拔管后，三組分別有44%、51%和62%的患者成功地恢復自主排尿。保留導尿管時間長短與TWOC能否成功相關。相反，年齡≥65歲，置管時膀胱引流尿量≥1L，既往有下尿路癥狀，尿動力學檢查排尿期逼尿肌收縮壓35cmH2O的患者TWOC失敗的可能性較大。如果TWOC失敗，%的患者接受第二次TWOC，%。前列腺增生患者行TWOC可使手術延期進行，有時可能避免手術。有條件者可選用新型的Seldinger SPC穿刺套裝，膀胱造瘺管可沿著導絲