膀胱内前列腺突出程度与良性前列腺增生临床评价指标的相关性

目的:探讨在良性前列腺增生(BPH)患者中,应用经腹超声测量的前列腺向膀胱内突出(IPP)程度与BPH常用临床评价指标的相关性。方法:对275例因下尿路症状就诊的BPH患者行经腹超声通过中线矢状面测量IPP,并且将IPP程度分别与患者年龄、前列腺体积、国际前列腺症状评分(IPSS)、最大尿流率和排尿后残余尿量进行相关分析。结果:275例BPH患者的IPP程度与年龄(r=0.210,P<0.01)、前列腺体积(r=0.534,P<0.01)和排尿后残余尿量(r=0.314,P<0.01)呈正相关关系,与最大尿流率(r=-0.364,P<0.01)呈负相关关系,而与IPSS(r=0.064,P=0.299)无明显相关。结论:IPP程度可能与症状性BPH患者的年龄和前列腺体积存在一定相关性。经腹超声测量IPP可能是一种评价BPH患者膀胱出口梗阻状态及程度的有价值的无创性方法。     

良性前列腺增生术后膀胱痉挛原因的尿动力学分析

1999年9月至2 0 0 2年5月,我们对1 0 2例良性前列腺增生(BPH)患者从尿动力学检查等多因素进行总结、分析,探讨膀胱痉挛相关因素。现报告如下。材料与方法　本组1 0 2例。年龄(6 7.5±7.8)岁。病史(6±5 .4 )年,均有异常排尿症状。均排除神经系统疾病、内分泌疾病史,无盆腔手术和下尿路外伤史。患者入院后行国际前列腺症状评分(IPSS) ,生活质量评分(LP) ,腹部B超测定前列腺体积(Vp) ,记录手术方式,术后有无膀胱痉挛的发生、持续时间及症状存在时间、治疗方法及结果。尿动力学检查记录最大尿流率(Qmax) ,平均尿流率(Qave) ,最大尿流率时…     

良性前列腺增生相关的膀胱痉挛病因分析及治疗

目的:探讨与良性前列腺增生(BPH)有关的膀胱痉挛的发生原因,寻找有效的防治方法。方法:102例BPH患者术前均行尿流动力学检查;应用t检验及χ2检验分析BPH患者的国际前列腺症状评分(IPSS)、前列腺体积(Vp)、生活质量评分(QOL)、手术方式及尿流动力学各项指标与膀胱痉挛发生的相关性。结果:在102例患者尿流动力学检查结果的分类中,低顺应性膀胱和不稳定膀胱的膀胱痉挛发生率为32.1%(9/28例)和42.5%(13/20例)。开放式手术和经尿道前列腺电切术(TURP)后膀胱痉挛发生率分别是50.9%(26/51例)、23.3%(12/51例),两者相比差异有显著性(P<0.05)。结论:低顺应性膀胱、不稳定膀胱及开放手术易产生膀胱痉挛。TURP可以降低BPH术后的膀胱痉挛发生率。     

前列腺增生症尿流动力学分析

目的：研究前列腺增生症（ＢＰＨ）患者尿流动力学状况。方法：对２０例正常成人和３５例ＢＰＨ患者进行尿流动力学研究。结果：ＢＰＨ患者与正常成人各项检测指标有极显著性差异（Ｐ〈０．０１）。在３０例ＢＰＨ患者中随机抽样１０例进行了尿流动力学各项指标的直线相关分析,其相关系数最大尿流率与膀胱顺应性有显著性意义（Ｐ〈０．０５）,膀胱顺应性与膀胱颈压有显著性意义（Ｐ〈０．０５）,膀胱颈压与前列腺体积有显著性意义     

静态尿道压力测量在诊断BPH所致膀胱出口梗阻中的作用

目的　探讨静态尿道测压 (UPP)在诊断BPH致膀胱出口梗阻 (BOO)中的作用。方法　 5 1例BPH患者行尿动力学检查 ,经压力 -流率测定其中 42例诊断为BOO ,设为梗阻组 ,另 9例为非梗阻对照 ,比较两组UPP及B超检查的各项指标 ,并行有关的相关分析。结果　 ( 1)UPP测定的前列腺长度与B超测定的前列腺体积呈显著正相关 ( r =0 .91,P <0 .0 5 )。 ( 2 )除最大尿道闭合压外 ,梗阻组的平均膀胱颈压、前列腺长度、控尿区面积及前列腺体积显著大于对照组 (P<0 .0 5 )。 ( 3 )前列腺体积与IPSS评分、梗阻程度之间不存在相关关系。结论　UPP检查主要反映BPH所致后尿道结构和前列腺体积的改变 ,对BPH的治疗有一定指导意义 ,但在诊断膀胱出口梗阻方面的价值不大。     

前列腺光子治疗机治疗良性前列腺增生近期疗效观察(附30例报告)

目的 :观察Dolphin 2 0 0 0前列腺光子治疗机治疗良性前列腺增生 (BPH)的有效性和安全性。 　方法 :用Dolphin 2 0 0 0前列腺光子治疗机经直肠近距离照射 ,总剂量为 72 6～ 810cGy ,治疗 30例重度BPH患者 ,治疗 1个月后复查。疗效观察指标包括国际前列腺症状评分 ,生活质量指数 ,直肠指诊 ,经直肠B超确定前列腺大小重量 ,经腹B超测定膀胱残余尿液 ,前列腺特异性抗原 (PSA)测定 ,测定最大尿流率和平均尿流率。安全性指标包括血常规、尿常规、肝肾功能及其他不良反应等情况。　结果 :治疗 1个月后 ,显效 18例 ,好转 9例 ,较差 3例。治疗后国际前列腺症状评分、前列腺体积、最大尿流率、残余尿均发生明显的变化 (除最大尿流率P <0 .0 5外 ,其余均为P <0 .0 1)。　结论 :Dolphin 2 0 0 0前列腺光子治疗机治疗重度BPH安全有效 ,无创伤 ,方便经济 ,尤其适用于合并有心脑血管疾病及高危的BPH患者。     

前列腺增生症尿动力学检查的临床研究

目的 评价尿动力学检查(UDS)在良性前列腺增生症(BPH)诊治中的意义。方法 对102例BPH病人进行详细尿动力学检查,包括尿流率、充盈期膀胱测压、压力-流率测定、残余尿测定,应用P-Q图进行分析是否存在膀胱出口梗阻。术后随访,行残余尿、尿流率测定。结果 尿流率Qmax<15ml/s 98例;低顺应性膀胱17例,高顺应性膀胱22例,顺应性正常63例;通尿肌不稳定42例;通尿肌收缩力正常或增强84例,减弱18例;压力-流率测定P-Q图示膀胱出口梗阻84例;残余尿<100ml 50例,>100 ml 52例。术后随访80例症状消失,排尿顺畅。结论 尿流动力学检查能明确BPH有无膀胱出口梗阻、逼尿肌的顺应性和收缩功能,对术前合理选择病人和提高手术疗效有重要意义。     

福施乐治疗良性前列腺增生的临床研究

目的:观察福施乐治疗BPH的有效性和安全性。方法:采用多中心、开放性、自身前后对照的临床研究方法,对60例BPH患者采用福施乐治疗12周。以国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、膀胱残余尿(PVR)和前列腺体积为主要疗效指标,以生活质量评分(QOL)和平均尿流率(Qave)为次要疗效指标,来评价福施乐治疗BPH的效果。结果:治疗12周后,患者IPSS评分、Qmax、PVR、QOL评分、Qave均比治疗前明显改善(P<0.01),而前列腺体积治疗前后无显著性差异(P>0.05)。结论:福施乐可明显改善BPH患者的排尿症状,增加尿流率,减少残余尿,无明显不良反应,治疗BPH安全、有效。     

小体积前列腺增生致膀胱出口梗阻电切疗效观察

目的探讨小体积前列腺增生所致膀胱出口梗阻的电切疗效。方法回顾分析19例小体积前列腺增生,行经尿道电切术(TURP)和膀胱颈纤维环切开术(TUIBN)临床资料。结果术后随访,患者IPSS评分及最大尿流率(MFR)均有明显改善,无出血、尿失禁及后尿道狭窄等并发症发生。结论小体积前列腺增生开放手术较难剥离,行经尿道前列腺电切和膀胱颈纤维环切开术是治疗小体积前列腺增生所致膀胱出口梗阻的较理想的术式。     

小体积前列腺增生的手术治疗

目的:探讨对小体积前列腺增生的手术治疗方法。方法:对32例小体积前列腺增生患者,在行经尿道前列腺电切术(TURP)的同时,行膀胱颈环状纤维5、7点放射状切开。结果:术后随访6~18个月(平均12个月),IPSS评分及最大尿流率均得到明显改善,无一例出现膀胱颈挛缩。结论:TURP加膀胱颈环状纤维放射状切开,是治疗小体积前列腺增生引起的膀胱出口梗阻,并预防术后膀胱颈挛缩较理想的方法。     

前列腺增生症患者的尿动力学诊断价值评估

目的　评估尿流动力学检查在前列腺增生症患者所致的下尿路症候群中的诊断价值。方法　采用自制半卧位床 ,常规行尿流率、压力 流率测定及尿道测压 ,并同步测定尿道外括约肌肌电图及残余尿量 ;并记录膀胱逼尿肌受损情况、膀胱顺应性和尿道外括约肌协调情况。联合应用A G图、P Q图及DS诊断BOO(膀胱出口梗阻 ) ,结果进行统计处理。结果　本组患者 338例 ,312例诊断为BOO ,71例可疑 ,5例无BOO。其中伴膀胱低顺应性 12 3例 ,膀胱逼尿肌功能受损 10 8例 ,尿道外括约肌功能失调 15 7例 ,不稳定膀胱 134例。随着BOO程度加重 ,Pdet Qmax、Popen、DS、IPSS积分及前列腺体积呈升高趋势 ,膀胱顺应性、Qmax呈下降趋势。结论　前列腺增生症患者排尿障碍的机制是排尿过程中机械因素和动力学因素共同作用的结果 ,尿流动力学检查在其诊断评估中扮演着一个极其重要的角色。BOO程度与Pdet Qmax、Popen、DS、IPSS积分及前列腺体积呈正相关 ,与膀胱顺应性、Qmax呈负相关     

Association between benign prostatic hyperplasia,body mass index,and metabolic syndrome in Chinese men

Previous studies have showed that men suffering from diabetes mellitus, metabolic syndrome (MetS) and obesity have a higher risk of benign prostatic hyperplasia (BPH). The present study aimed to examine the association between BPH, obesity, and features of MetS among men of the Hunan area of China. For this cross-sectional study, 904 males (aged 50–59 years) were included. MetS parameters, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) levels, total prostate volume (TPV), postvoid residual volume (PVR) and maximum urine flow rate (Qmax) were measured. Results showed that MetS was associated with TPV (P = 0.048), PVR (P = 0.004) and IPSS (P = 0.011), but not with other indicators of BPH progression such as PSA levels or Qmax. MetS was associated with the voiding symptoms score (P < 0.05), but not with the storage symptom score. In addition, body mass index and fasting blood glucose positively correlated with TPV (r = 0.416, P < 0.001; and r = 0.310, P= 0.011, respectively). In conclusion, results suggest that MetS is associated with higher prostatic volume, prostate symptom score and voiding symptoms, but not with other features of prostatic hyperplasia such as PSA levels or Qmax. Changes in lifestyle factors, including physical activity and prevention of MetS, might be useful to prevent BPH and its progression, but further studies are needed.     

Pathophysiology of lower urinary tract symptoms in aged men without bladder outlet obstruction

OBJECTIVE: To assess the pathophysiology of lower urinary tract symptoms (LUTS) in aged men without bladder outlet obstruction in a videourodynamic study. METHODS: In a videourodynamic study of 324 consecutive men with moderate to severe LUTS suggestive for bladder outlet obstruction, 112 were found to be urodynamically nonobstructed. International prostatic symptom score (IPSS), uroflowmetry and transrectal sonography of the prostate were assessed before videourodynamic study. The pressure flow expression and the obstructive parameters were compared between the 212 obstructed and 112 nonobstructed men. RESULTS: Of the 112 nonobstructed men investigated, 25 had a normal bladder and urethral trace (22.3%), 5 had detrusor instability (4.5%), 17 had a hypersensitive bladder and a normal urethra (15.2%), 3 had detrusor underactivity and a normal urethra (2.7%), while 61 were found to have a poorly relaxed external sphincter and low detrusor contractility (54.5%). Most of the patients in the normal and hypersensitive groups had normal voiding pressure and high flow (NPHF) tracings, whereas men with detrusor underactivity or a poorly relaxed external sphincter had normal voiding pressure and low flow (NPLF) tracings. Only the maximal flow rate and voided volume were significantly higher in patients with NPHF than in patients with NPLF tracings. However, both groups showed a significantly lower IPSS, less residual urine, and a smaller transition zone index than the obstructive group. After medical treatment, 78 patients (69.6%) had satisfactorily improved, 31 patients (27.6%) remained stationary, while 3 (2.7%) worsened. CONCLUSION: Nonobstructed men with LUTS have various pathophysiologies other than benign prostatic obstruction. In this study 54.5% of these patients had poorly relaxed external sphincter on videourodynamic study. Identification of the underlying pathology can not only prevent unnecessary prostate surgery but can also enable proper medical treatment to be selected.     

Utility of the American Urological Association symptom index in the diagnosis of women with voiding dysfunction

The objective of the study was to determine the applicability of the American Urological Association (AUA) symptom index to the assessment and treatment of women with voiding dysfunction while investigating the specificity of the index to men with benign prostatic hyperplasia (BPH).One hundred and two consecutive adult patients (45 females, 57 males) with symptoms of dysfunctional micturition were prospectively evaluated using both the AUA symptom index and videourodynamic studies. According to urodynamic criteria, the patients were placed into three groups: 45 women with stress incontinence and/or detrusor instability but without bladder outlet obstruction (BOO); 23 men with detrusor instability (DI) without BOO; and 34 men with BPH and BOO. Correlation between symptom index scores and patient characteristics were examined. The mean index score for the 45 women was 17.0 (range 4–33). In contrast, the men scored mean values of 18.9 (range 7–28) and 20.5 (range 12–27) for the BPH with BOO and DI without BOO groups, respectively. The total score was statistically correlated with age, duration of bladder symptoms, cystometric capacity and maximum urine flow rate.The quantification of voiding symptoms, using the AUA symptom index, yields strikingly similar results in both women and men with voiding dysfunction, despite vastly different bladder and urethral pathologies. The etiology of voiding symptoms, whether detrusor dysfunction or bladder outlet obstruction, cannot be determined by the AUA symptom index. The index should, however, prove to be useful in evaluating treatment outcome in both men and women with voiding dysfunction.     

The University of Tennessee experience with the Indigo 830e laser device for the minimally invasive treatment of benign prostatic hyperplasia: interim analysis

Benign prostatic hyperplasia (BPH) is the most common benign tumor in men and is responsible for urinary symptoms in the majority of men older than 50 years of age. Although transurethral resection of the prostate (TURP) is the gold standard, its complications have impacted upon its utility. As a consequence, new pharmacologic and minimally invasive approaches to the management of BPH have been developed. One minimally invasive approach that employs interstitial laser coagulation by the Indigo 830e LaserOptic system heats the prostate to the point of irreversible necrosis while preserving the urethral lining, potentially resulting in fewer complications. To test the efficacy of this device we evaluated the interim results obtained in 25 patients treated for BPH. Parameters evaluated included the AUA symptom score, uroflowometry, post-void residual, and prostate size. Following treatment, patients were discharged home and the catheter was removed within 3–7 days. Patients were assessed at 1 month and at subsequent 3-month intervals following the procedure using a questionnaire, AUA symptom score, and uroflowometry. The results of the paired t-tests demonstrated a significant increase in the maximal and average flow rates from baseline. The mean baseline maximal flow rate was 8.3 ml/s and increased to 10, 12.7, 14.1, and 12.0 ml/s at 1, 3, 6, and 9 months, respectively, and the mean baseline average flow rate was 4.4 ml/s and increased to 5.3, 6.0, 6.6, and 6.2 ml/s at 1, 3, 6, and 9 months, respectively. The AUA symptom scores decreased from 20.2 to 9.8 at 9 months. There was no intraoperative complication. Six patients developed transient retention. No patient developed bladder neck contractures, urinary incontinence, impotence, or urinary tract infections. One patient developed retrograde ejaculation and one patient required retreatment by TURP. Hence, improvements in symptom scores and voiding parameters suggest that the laser interstitial coagulation prostatectomy is safe and effective for the treatment of BPH.     

PKVP结合气压弹道碎石术治疗BPH合并膀胱结石55例报告

目的：回顾性探讨经尿道前列腺双极等离子汽化电切术（PKVP）配合气压弹道碎石术治疗良性前列腺增生症（BPH）并膀胱结石的疗效.方法：联合应用经电切镜外鞘肾镜下气压弹道碎石术和PKVP治疗BPH并膀胱结石患者55例.结果：所有患者均一次治疗成功,手术时间40～100 min.切割获取前列腺组织重量（60±15）g,无水中毒发生.术后随访排尿困难症状明显改善,国际前列腺症状评分（IPSS）及最大尿流宰（MFR）、剩余尿量（RV）术前术后比较差异有统计学意义（P〈0.01）.结论：PKVP结合气压弹道碎石术是治疗BPH并膀胱结石的一种安全有效的方法,能有效提高BPH患者的生活质量,于高龄高危患者具有明显的优越性.     

中老年男性代谢综合征与前列腺增生关系的研究

目的 探讨中老年男性人群中代谢综合征和前列腺增生(benign prostatic hyperplasia, BPH)的关系。方法 随机选择2015年5月至2016年2月本院体检中心体检的中老年男性350例作为研究对象。调查所有研究对象的一般情况,包括年龄、身高、体质量、血压、既往史、国际前列腺症状评分(IPSS)等;抽取空腹静脉血检测血糖、三酰甘油、高密度脂蛋白和前列腺特异性抗原(PSA);腹部超声测量前列腺体积, 并检测Qmax。比较代谢综合征组和非代谢综合征组BPH患病率及严重程度。结果 代谢综合征组100例,合并BPH者30例（30%）;非代谢综合征组250例,合并BPH者35例（14%）。代谢综合征组的BPH患病率较高,与非代谢综合征组相比,代谢综合征组IPSS、前列腺体积和血清PSA值存在差异,差异有统计学意义（P<0.05）,两组间Qmax差异无统计学意义（P=0.057）。结论 代谢综合征患者的BPH患病率较高,代谢综合征影响BPH患者的IPSS、前列腺体积和PSA。肥胖、高脂血症、高血压、空腹血糖高或糖尿病是BPH的危险因素。BPH患者诊疗的同时还需要考虑是否合并代谢综合征。     

钬激光前列腺剜除术与电切术安全性及疗效比较

目的 比较并探讨钬激光前列腺剜除术(HoLEP)和传统经尿道前列腺电切术(TURP)的安全性及疗效,旨在为良性前列腺增生症的临床治疗提供理论依据.方法 回顾性分析哈尔滨医科大学附属第四医院2015年1月-2016年1月收治的349例良性前列腺增生症患者的病例资料,并将其随机分成两组.其中172例患者选择行钬激光前列腺剜除术,另外177例患者选择行传统经尿道前列腺电切术.比较两组患者术中出血量、手术时间、术后导尿管留置时间、术后住院天数以及术后并发症(尿失禁、膀胱痉挛、出血)的发病率.随访3个月,重新评估IPSS、QOL、Qmax指标并比较疗效.结果 与传统经尿道前列腺电切术组相比,钬激光前列腺剜除术组患者的手术时间明显缩短、术中出血量及术后住院天数显著降低(P＜0.05),术后导尿管留置时间[钬激光前列腺剜除术组:(2.4±0.5)d;传统经尿道前列腺电切术组:(5.7±0.6)d,P＜0.05].明显减少,术中切除前列腺重量明显增加,术后并发症的发病率[钬激光前列腺剜除术组:5/172(2.9％);传统经尿道前列腺电切术组:19/177(10.7％),P＜0.01]显著下降.3个月后,两组术后PVR、IPSS、QOL以及Qmax较术前相比明显改善(P＜0.01),组间比较差异无统计学意义(P＞0.05).结论 钬激光前列腺剜除术与传统经尿道前列腺电切术相比疗效相当,但安全性更高.钬激光前列腺剜除术治疗临床前列腺增生症具有重要意义.     

Contractile properties of human prostate adenomas and the development of infravesical obstruction

The contractile response of human prostate adenomas to KCl, phenylephrine (alpha 1 adrenergic agonist), UK 14304 (alpha 2 adrenergic agonist), and carbachol (muscarinic cholinergic agonist) was evaluated in tissue specimens obtained from men with symptomatic and asymptomatic BPH. Prostate specimens were obtained from 5 men with asymptomatic BPH undergoing cystoprostatectomy, 11 men with symptomatic BPH undergoing open prostatectomy, and 11 men with symptomatic BPH undergoing transurethral resection of the prostate (TURP). Quantitative symptom score analysis and urinary flow rate determination documented the absence of bladder outlet obstruction in men undergoing cystoprostatectomy and confirmed the presence of bladder outlet obstruction in men undergoing prostatectomy. The magnitude of the contractile response (Emax) and the potency of phenylephrine-induced contractions (EC50) in prostatic preparations obtained from men with symptomatic and asymptomatic BPH were similar. The IC50 for the inhibition of phenylephrine-induced contractions by prazosin was 3.2 nM, confirming that phenylephrine-induced contraction in the human prostate is mediated by the alpha 1 adrenoceptor. The contractile responses of prostate adenomas to muscarinic cholinergic and alpha 2 agonists were negligible. This study demonstrates that the development of bladder outlet obstruction in men with BPH is not related to alterations in the functional response of the smooth muscle component of the prostate adenoma.     

排尿期尿道测压在BPH中的应用价值

目的探讨前列腺增生症（ＢＰＨ）致膀胱流出道梗阻（ＢＯＯ），及其相关问题。方法采用排尿期尿道测压（ＭＵＰＰ）检测４３例ＢＰＨ患者，以压力下降梯度（ＭＵＰＰＧ）计算梗阻程度，同时行膀胱等容收缩试验测最大逼尿肌等容收缩压（Ｐｉｓｏ）；进行国际前列腺症状评分（ＩＰＳＳ），经腹壁Ｂ超测前列腺体积（Ｖ）。结果４３例ＢＰＨ中３８例存在ＢＯＯ（８８％），梗阻位于膀胱颈部２８例（７７％）；ＭＵＰＰＧ与ＩＰＳＳ、Ｖ、Ｐｉｓｏ呈正相关。结论ＭＵＰＰ能检测并计算ＢＯＯ程度；ＢＯＯ是ＢＰＨ的病理基础，临床症状、逼尿肌代偿与其相关。