Surgical atlas: anastomotic urethroplasty
Surgical atlas: anastomotic urethroplasty
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手术图谱：尿道吻合术
DOI：
10.1111/j.1464-410x.2006.06228_2.x
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发表时间：
2006
影响因子：
4.5
通讯作者：
Krishan Ramsoobhag
中科院分区：
文献类型：
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作者：
D. Sharma;L. Goetz;M. Rampaul;G. Bajrangee;Philip Ayoung;Krishan Ramsoobhag
我祝贺Domachevsky等人。[1]这是第一项研究，以确定性交（实际上是射精本身）是尿试纸分析（DUA）蛋白尿的良性原因之一，其他原因包括重体力活动，脱水，姿势改变（直立姿势），发烧和情绪紧张[2]。他们评估了一小群性活跃的海军人员（22名男性和11名女性），可能是年轻的海军人员（没有给出年龄组的数据）。除了22名男性中的6名外，没有女性在性交后出现蛋白尿，因此这表明蛋白尿是射精后残留在尿道中的精液（由各种蛋白质组成）或逆行射精到膀胱的结果。根据这一理论，在精液被尿流的最初部分冲洗出来后，中期或终末尿样（未在研究中使用）可能是DUA的一种简单解决方案，以避免在性交后对男性进行进一步不必要的蛋白尿检查，尽管这使得DUA作为家庭程序变得更加困难。这与培养技术中使用的原理相同，通过使用10 mL尿流的初始部分作为“排尿膀胱”（VB 1）和中段尿（VB 2）来区分微生物来源，无论是来自尿道还是膀胱[3]。此外，我认为即使是性交后12小时的蛋白尿持续时间也不能从这6名蛋白尿阳性受试者中确定，其中只有两名受试者用连续系列的尿液样本进行了评估，并且蛋白尿在1.5小时和8小时后消失。这项研究也让人想起射精对血清PSA水平的影响;虽然射精也可以增加老年男性的血清PSA水平[4]，但它不是年轻男性血清PSA水平的因素[5]。此外，临床或亚临床逆行射精也可能受到年龄的影响，由于老化的膀胱颈部关闭不充分。总的来说，虽然可能有不同的生理病理机制，但射精后蛋白尿也应该在不同年龄组进行检查。
I congratulate Domachevsky et al.[1] for this first study to determine that sexual intercourse (actually ejaculation itself) is one of the benign causes of proteinuria on dipstick urine analysis (DUA) among the other causes, eg heavy physical activity, dehydration, postural change (upright position), fever and emotional stress [2]. They assessed a small group (22 men and 11 women) of sexually active, possibly young (no data given for the ages of the group) navy personnel. No women but six of the 22 men had proteinuria after intercourse, and thus this indicated that the proteinuria was a result of residual semen, composed of various proteins, in the urethra after ejaculation, or of retrograde ejaculation to the bladder. From this theory it is possible that after the semen is washed out by the initial part of the urine stream, a mid or terminal urine sample (not used in the study) might be a simple solution for DUA to avoid further unnecessary investigations for proteinuria in men after intercourse, although this makes the DUA as a home procedure rather more difficult. This is the same principle as used in culture technique to discriminate the source of microorganisms, whether from the urethra or the bladder, by using the 10-mL initial portion of the urine stream as ‘voided bladder’(VB1) and the midstream urine (VB2)[3]. In addition, I did not think that even the 12-h duration of proteinuria after intercourse could be determined from these six positive subjects with proteinuria, of whom only two were assessed with a consecutive series of urine samples, and where the proteinuria had disappeared after 1.5 h and 8 h.This study is also reminiscent of the effect of ejaculation on serum PSA levels; while ejaculation can also increase serum PSA levels in elderly men [4], it is not a factor in serum PSA levels in younger men [5]. Moreover, clinical or subclinical retrograde ejaculation might also be affected by age, due to insufficient closure of the neck of the ageing bladder. Overall, although different physiopathological mechanisms might be possible, proteinuria after ejaculation should also be checked in different age groups.