逼尿肌过度活动对BPH患者膀胱排空的影响及其原因和意义的探讨

目的：研究逼尿肌过度活动（DO）对BPH患者膀胱排空能力的影响,探讨该影响的原因及意义。方法：选取70例BPH病例,按尿流动力学结果有无DO分为两组,运用统计学方法进行回顾性研究。结果：无DO组剩余尿量（PVR）、最大尿流率（Qmax）分别为194．38（±205．830）ml、5．94（±3．692）ml／min;有DO组分别为96．00（±103．120）ml、8．19（±3．704）ml／min,相比差异均有统计学意义（P〈0．05）。两组中并发上尿路积水者共5例,占7．1％,并发上尿路积水者在两组中的分布差异无统计学意义（P〉0．05）。两组中已出现逼尿肌收缩功能受损（DU）者15例,占21．4％,有DO者从下尿路症状（LUTS）出现进展至逼尿肌收缩功能受损的病程明显长于无D0者（P〈0．05）。结论：BPH患者中有DO者与无DO者相比,剩余尿量少、最大尿流率高。DO的存在并不增大上尿路受损风险。推测DO可能是逼尿肌代偿性增厚以外的另一种代偿机制,它增大膀胱排空能力,还可能通过减少排尿时逼尿肌能量消耗来延缓逼尿肌收缩功能受损的发生。

The Impact of Detrusor Overactivity on Bladder Voiding Function in BPH Patients, Its Reason and Significance

Objective：To analyze the impact of detrusor overactivity on bladder voiding function in BPH patients and to discuss the reason and significance. Methods：70 BPH cases were divided into two groups according to urodynamic results with or without DO. The statistical methods were used to analyze the data retrospectively. Results：Postvoid residual（PVR） and maximum flow rate （Qmax） were 194.38（±205. 830）ml, 5.94（±3. 692）ml/min in patients without DO vs 96.00（±103. 120）ml, 8. 19（±3. 704）ml/min in patients with DO. There were statistically significant difference respectively （P〈0.05）. There were totally 5 patients （7.1%） with upper urinary impairment in two groups, and there was no statistically significant difference in number of this kind of patients between two groups （P〉0.05）. There were totally 15 patients （21.4%） with detrusor undercontractility. The time from onset of LUTS to impairment of detrusor contractility in patients with DO was significant longer than that in patients without DO （P〈0.05）. Conclusions： Patients with BPH combined with DO have less PVR and higher Qmax than those with pure BPH. DO doesn＇t add risk of upper urinary impairment. We infer that DO is another compensatory mechanism besides hypertrophy of detrusor. It can increase voiding strength, and probably delay the impairment of detrusor contractility by reducing energy consumption during urination.