逼尿肌活动低下在下尿路症状中的临床特征及诊疗策略分析

目的:探讨逼尿肌活动低下(DU)在下尿路症状(LUTS)患者中的流行病学现状、临床特征及诊疗策略。方法:回顾性分析了我院1 019例排除神经源性膀胱及解剖结构异常的LUTS患者的尿流动力学检查结果及随访资料,探讨DU在LUTS中的流行病学及临床诊治特点,并对106例DU患者治疗前后行尿流动力学检查,结合文献进行临床分析。结果:在就诊患者中,储尿期症状最为多见,在男性患者中,排尿期症状稍多于储尿期症状,而女性患者储尿期症状明显多于排尿期症状。男性患者中膀胱出口梗阻(BOO)的患者为57.9%,而女性患者中压力性尿失禁(SUI)患者达到了43.3%。27.4%男性及23.2%女性诊断为DU,男性及女性患病率差异无统计学意义。DU患者与非DU患者的临床表现无明显差异,均以LUTS为主要表现。DU可能合并有逼尿肌过度活动或BOO。DU随着年龄的增加,患病率逐渐增加。106例DU患者经治疗后行尿动力学检查发现逼尿肌收缩力有一定提高,治疗前后逼尿肌肌力差异有统计学意义。结论:DU是LUTS患者的常见病因,并有可能同时合并有逼尿肌过度活动或BOO。目前针对DU患者的治疗有一定效果。

Clinical features and treatment strategy of detrusor underactivity among people with lower urinary tract symptoms

Objective：To identify the prevalence,clinical features and treatment strategy of detrusor underactivity（DU）among people with lower urinary tract symptoms（LUTS）.Method：The clinical data of 1 019 patients who had undergone a urodynamic study for LUTS without neurological or anatomical conditions at Nanjing Drum Tower Hospital was retrospectively analyzed.We discussed the prevalence and clinical characters of DU in people with LUTS.A urodynamic study was taken among 106 patients with DU before and after treatment,and clinical analysis was performed in combination with the relevant literature.Result：Storage symptoms were more prevalent than voiding or post-micturition symptoms in all patients.Of the male patients,voiding symptoms were more prevalent than storage symptoms.Of the female patients,storage symptoms were commoner than voiding symptoms.Bladder outlet obstruction（BOO）was diagnosed in 57.9% of men,and stress urinary incontinence（SUI）was diagnosed in 43.3% of women.The diagnoses of DU were confirmed in 27.4% of men and 23.2% of women.There was no statistical difference between the prevalence of men and women.Types of clinical symptoms showed no significant differences between patients with and without DU.Their main symptoms were LUTS.Patients with DU may suffer from detrusor overactivity or bladder outlet obstruction simultaneously.The prevalence of DU increased with age.Urodynamic test showed that the detrusor contractility increased after treatment in 106 patients.The statistical discrepancy of detrusor contractility before and after the treatment was significant.Conclusion：DU was a common mechanism in patients with LUTS.The patients with DU may also experience overactive bladder（OAB）or BOO.The treatment was efficacious for patients with DU.