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。     

B超测定BPH体积参数评价膀胱出口梗阻的意义

目的 :探讨经直肠超声 (TRUS)测定良性前列腺增生 (BPH)各项体积参数对诊断膀胱出口梗阻 (BOO)的意义。　方法 :BPH病人 116例 ,年龄 5 9～ 75 (6 8.6± 5 .1)岁。应用TRUS测定前列腺各径数值 ,应用公式V =0 .5 2R1R2 R3 计算出前列腺体积各项参数 ,同时行尿动力学检查 ,并计算AG值。将前列腺体积 (PV)、移行带体积 (TZV)、移行带指数(TZI)与病人年龄、国际前列腺症状评分 (IPSS)、前列腺特异性抗原 (PSA)及AG值进行相关性分析。　结果 :PV、TZV及TZI分别为 (6 9.7± 4 5 .9)ml、(43.5± 2 5 .6 )ml和 0 .5 7± 0 .14。最大尿流率 (Qmax)、最大尿流率时逼尿肌压力 (Pdet.Qmax)及AG值分别为 (8.31± 5 .12 )ml/s、(82 .34± 33.4 7)cmH2 O和 6 6 .72± 30 .4 6。IPSS为 2 5 .3± 4 .7,PSA为 (4.12±3.6 4 )ng/ml。相关分析提示TZI(r=0 .74 2 ,P =0 .0 17)、TZV(r =0 .6 74 ,P =0 .0 31)与AG值有显著的相关性。IPSS与TZI、TZV呈正相关 ,PSA浓度与PV、TZV、TZI呈正相关。　结论 :通过TRUS测定BPH的各项体积参数和尿动力学检查一样 ,能够作为判断BOO的参考指标     

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。     

经直肠超声检查在良性前列腺增生梗阻诊断中的价值

目的　分析经直肠超声 (TRUS)测定前列腺相关指标在良性前列腺增生 (BPH)诊断中的价值。　方法　以排尿困难就诊的BPH患者 92例 ,除外影响排尿的其他因素。分别统计患者年龄、病史、国际前列腺症状评分 (IPSS)和血清PSA水平等。应用灰阶TRUS测定前列腺体积、移行带体积并计算移行带指数 (TZI) ;彩色多普勒记录尿道动脉图像 ,测定最大血流 (PK1)、最小血流 (PK2 ) ,并计算阻力指数 (RI)。测定最大尿流率 (Qmax)、最大尿流率时逼尿肌压力 (PdetQmax)并计算AG值 ,AG =PdetQmax- 2Qmax。　结果　相关性分析结果显示TZI(r =0 .80 2 ,P =0 .0 13)、IPSS(r =0 .70 4 ,P =0 .0 2 3)、RI(r=0 .897,P =0 .0 0 4 )与AG显著相关。多元回归分析结果显示TZI、RI为AG的相关因素 (复相关系数R =0 .94 7,决定系数R2 =0 .897,校正决定系数 =0 .793,P =0 .0 0 3) ,RI对AG的影响强度约为TZI的 1.94倍 (0 .770 /0 .397)。除外TZI的影响后 ,RI为AG的独立相关因素 (偏相关系数r =0 .785 ,P =0 .0 0 4 )。若定义AG≥ 4 0时为梗阻性 ,AG <4 0为非梗阻性 ;以RI≥ 0 .75为标准能诊断 93%(5 3/5 7)的梗阻患者 ,排除 91% (32 /35 )的非梗阻患者。　结论　应用多普勒TRUS测定TZI和尿道动脉的RI对BPH梗阻情况有良好的诊断价值。     

膀胱内前列腺突起程度与前列腺增生临床参数的相关性

目的探讨膀胱内前列腺突起程度(IPP)与常用BPH临床参数的相关性。方法经腹B超(TAUS)测量54例BPH住院患者的IPP,将IPP与年龄、国际前列腺症状评分(I-PSS)、前列腺体积(PV)、排尿后残余尿(PVR)进行相关分析。结果54例年龄平均(67.63±9.33)岁,IPSS(18.93±5.52)分,PVR(183.26±115.87)m l,PV(47.80±24.88)m l,IPP(12.52±7.99)mm。IPP与PV呈显著正相关(r=0.371,p<0.01),与PVR亦呈显著正相关(r=0.785,p<0.01),而与年龄、IPSS无明显相关。结论IPP既反映前列腺体积改变,又反映膀胱出口梗阻状态及程度,采用TAUS评估IPP,对指导判断BPH严重程度和外科干预时机可能有重要临床意义。     

前列腺体积参数与良性前列腺增生临床参数的相关性研究

目的　探讨前列腺体积参数与良性前列腺增生 (BPH)临床参数之间的相关性　方法　回顾性分析 80例资料完整的BPH行开放性手术患者的相关资料。　结果　前列腺体积 (6 7.8± 33.9)ml,移行带体积 (42 .8± 2 4.9)ml,移行带指数 (0 .6 199± 0 .140 0 ) ,前列腺症状评分 (2 5 .0± 5 .5 ) ,标本重 (42 .7± 2 5 .1)g ,PSA(4.0 5± 3.90 )ng/ml。手术标本重量与前列腺体积 (r=0 .872P <0 .0 0 1)、移行带体积 (r =0 .97P <0 .0 0 1)、移行带指数 (r=0 .44 9P <0 .0 0 1)呈显著正相关关系 ;PSA与前列腺体积 (r=0 .2 13P =0 .0 33)、移行带体积 (r=0 .2 2 4P =0 .0 17)、移行带指数 (r =0 .314P =0 .0 36 )呈正相关 ;IPSS与前列腺体积 (r=0 .0 10P =0 .72 5 )无相关 ,与移行带体积 (r=0 .314P =0 .0 36 )、移行带指数 (r=0 .32 1P =0 .0 0 1)呈正相关。尿潴留与非尿潴留组 :前列腺体积 (P >0 .0 5 )差别无显著性意义 ,移行带体积 (P <0 .0 5 )、移行带指数 (P <0 .0 5 )、PSA(P <0 .0 1)组间差别有显著性意义。　结论　前列腺体积参数中移行带体积、移行带指数与临床症状、梗阻程度关系密切 ,能更好地反映BPH的严重程度 ;移行带体积能较好预测增生腺体的大小 ;随着移行带指数增高 ,尿潴留的危险性相应增加。     

前列腺增生组织中4个上调基因的表达及意义

目的良性前列腺增生(BPH)是一种缓慢进展的年龄相关疾病。本研究探究白介素-21受体(IL-21R)、多效生长因子(PTN)、基质重塑相关5(MXRA5)及胰岛素样生长因子(IGF-1)在BPH组织中的定位和表达,分析其与BPH临床进展危险因素的相关性。方法收集经尿道前列腺电切术(TURP)的BPH患者的组织标本104例制备组织芯片,并采用免疫组织化学染色法检测表达。结果相比于正常前列腺组织,IL-21R、PTN、MXRA5及IGF-1在BPH组织中的表达水平显著增加。IL-21R主要表达于前列腺上皮,与BPH患者的前列腺体积(r=0.31,P0.05)、最大尿流率(r=0.14,P0.05)及夜尿次数(r=0.24,P0.05)呈正相关;PTN主要表达于前列腺上皮,与BPH患者的游离PSA水平(r=0.11,P0.05)正相关;MXRA5主要定位于前列腺间质中,与BPH患者的前列腺体积(r=0.27,P0.05)及IPSS评分(r=0.19,P0.01)正相关;IGF-1分布于前列腺上皮及间质中,与BPH患者的前列腺体积(r=0.11,P0.01)及残余尿量(r=0.05,P0.05)正相关。结论 IL-21R、PTN、MXRA5及IGF-1可以单独或联合预测BPH的临床进展。     

前列腺中叶增生与膀胱出口梗阻程度的相关性分析(附131例报告)

目的:分析良性前列腺增生(BPH)患者中叶增生大小与膀胱出口梗阻(BOO)程度之间的相关性。方法:对2008年5月~2010年6月因排尿困难就诊的BPH患者131例,通过经腹超声测定前列腺三径和前列腺突入膀胱的距离(IPP),尿动力学检查测定最大尿流率(Qm ax)、最大尿流率时的逼尿肌压力(Pdet@Qm ax),利用L in-PURR图判断梗阻级别和逼尿肌收缩力,并计算出AG值(AG=Pdet@Qm ax-2Qm ax)。不同IPP梗阻程度的比较采用方差分析,并对前列腺体积(PV)、IPP与AG值进行相关性分析。结果:当IPP>10 mm时,IPP与BOO高度正相关(相关系数r=0.821,P<0.01)。PV与BOO相关度较低(r=0.475,P<0.01)。IPP与Pdet@Qm ax高度正相关(r=0.865,P<0.01)。结论:前列腺中叶增生与BOO存在高度相关性,超声测定中叶突入膀胱的距离是判断BOO程度较为可靠的方法。     

良性前列腺增生患者膀胱小梁化程度与尿动力学检查结果的相关性研究

目的　分析良性前列腺增生 (BPH)患者由膀胱内窥镜观测到的膀胱小梁化程度和尿动力学检查结果间的相关性。　方法　 35 8例BPH患者 ,按照膀胱镜下膀胱小梁化的严重程度分为 4级 :0级 :无小梁化 ;1级 :轻度到中度小梁化 ;2级 :重度小梁化 ;3级 :重度小梁化伴假性憩室形成。结合相应的最大自由尿流率、膀胱测压最大尿流率、最大尿流时逼尿肌压力 (PQmax)、最大瓦特因子(WFmax)、膀胱顺应性、剩余尿量及国际前列腺症状评分 (IPSS)等相关指标 ,进行方差分析和相关分析检验。　结果　膀胱小梁化程度 :0级 2 1例 ,1级 2 2 8例 ,2级 82例 ,3级 2 7例。随膀胱小梁化程度加重 ,最大自由尿流率呈现显著性降低趋势 ,0级 (11.5 0± 1.13)ml/s ,1级 (10 .2 8± 2 .2 9)ml/s,2级 (9.80± 0 .98)ml/s,3级 (7.36± 1.37)ml/s(F =2 2 .4 3,P <0 .0 0 1) ;剩余尿量显著增多 ,0～ 3级分别为 (5 3.38± 8.4 5 )、(81.5 1± 4 0 .33)、(83.5 6± 7.6 3)、(130 .89± 2 7.4 9)ml(F =2 4 .0 4 ,P <0 .0 0 1) ;PQmax显著增高 ,0～ 3级分别为 (4 0 .31± 2 0 .73)、(5 0 .11± 16 .2 4 )、(6 6 .5 3± 2 3.6 1)、(85 .33± 32 .5 2 )cmH2 O(1cmH2 O =0 .0 98kPa,F =2 2 .6 5 ,P <0 .0 0 1) ;WFmax显著增高 ,0～ 3级分别为 (8.98±     

血清PSA与良性前列腺增生临床病理的相关性研究

目的分析血清前列腺特异性抗原(PSA)与良性前列腺增生(BPH)临床病理的相关性。方法回顾性分析561例有下尿路梗阻症状经手术治疗后病理诊断为BPH的患者资料。年龄(68.3±6.3)岁,术前国际前列腺症状评分(IPSS)21.1±7.4,生活质量评分(QoL)4.5±0.8,尿流率(7.3±3.3)ml/s,前列腺体积(69.8±36.8)ml,剩余尿(81.9±105.8)ml,血清PSA值＜4 ng/ml者247例(44.0%),4～10 ng/ml者223例(39.8%)、＞10 ng/ml者91例(16.2%)。结果血清PSA水平与患者年龄、IPSS、QoL、最大尿流率、剩余尿量无明显相关性(r=0.08、0.03、0.06、0.04、0.09,P＞0.05),而与前列腺体积呈显著正相关(r=0.42,p＜0.01)；血清PSA水平升高与前列腺体积(F=93.45,P＜0.05)及尿潴留发生率(x~2=59.1,P＜0.01)间有统计学意义。BPH组织标本中以腺体增生为主(x~2=16.14,P＜0.01)或伴有梗死病灶(x~2=36.06,P＜0.01)患者的血清PSA水平明显升高。结论50%以上接受手术治疗的BPH患者血清PSA水平升高,前列腺体积增大、尿潴留以及表现为腺体增生为主或伴有梗死灶的BPH是血清PSA水平升高的主要原因。     

Interactions between prostate volume, filling cystometric estimated parameters, and data from pressure-flow studies in 565 men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

The aim of this study was to establish the characteristics and to investigate the interactions between prostate volume, degree of obstruction, bladder contractility, the prevalence of residual volume, bladder compliance, bladder capacities, and the prevalence of instability in a large, well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). The 565 consecutive men included in this study met the criteria of the International Consensus Committee on BPH and voided more than 150 mL during uroflowmetry. Their residual urine volume and prostate size were estimated, and filling cystometry and pressure-flow studies were performed. Fifty-three percent of the men appeared to have obstruction. We found a positive correlation between prostate volume and Sch?fer's obstruction grade, except that mean prostate volume decreased at Sch?fer's grades 5 and 6. Significant negative correlations existed between Sch?fer's grade and cystometric bladder capacity and effective capacity. Bladder outlet obstruction results in incomplete emptying. Of all men, 26% had a significant residual volume ( > 20% of cystometric capacity). Thirty-nine percent did not have residual volume. Of the 565 men, 46% had an unstable bladder. In particular, patients with an unstable bladder in the sitting and lying positions have a significantly higher Sch?fer's grade and contractility grade and a significantly lower cystometric and effective bladder capacity compared with patients without instability. Patients with a residual volume or instability were significantly older. We conclude that in men with LUTS suggestive of BPH, abnormalities of bladder and bladder outlet function vary greatly and have complex mutual interactions.     

BPH梗阻致膀胱功能改变的尿动力学研究

为探讨前列腺增生症（ＢＰＨ）梗阻致膀胱功能改变的临床意义，对５９例ＢＰＨ病人进行全面尿动力学检查。结果：（１）最大逼尿肌等容收缩压（Ｐｉｓｏ）与逼尿肌收缩速度呈正相关（ｒ＝０．７１６７，Ｐ＜０００１）。（２）Ｐｉｓｏ随膀胱充盈量增加而显著下降（Ｐ＜０００１）。（３）Ｐｉｓｏ与ＢＰＨ梗阻程度呈正相关性（ｒ＝０．６７８１，Ｐ＜０００１）。（４）当剩余尿量≥１００ｍｌ，逼尿肌储能显著下降（Ｐ＜０００１）。（５）不稳定膀胱组的Ｐｉｓｏ显著高于稳定膀胱组。结果认为：不稳定膀胱是引起ＢＰＨ病人临床症状的主要因素之一，膀胱等容收缩试验应用于ＢＰＨ病人有重要的临床价值     

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。     

Acute urinary retention: defining the need and timing for pressure-flow studies

OBJECTIVE: To investigate the utility of "late" pressure-flow studies in predicting the outcome of prostatectomy for acute urinary retention. PATIENTS AND METHODS: Fifty-eight patients with acute urinary retention were prospectively assessed using the International Prostate Symptom Score and pressure-flow studies at a median (range) of 24 (13-60) days after the episode of retention, and before transurethral resection of the prostate. Bladder outlet obstruction and bladder contractility were graded using a modified adaptation of Sch?fer's passive urethral linear resistance relation. RESULTS: Fifty-six (97%) patients generated a voluntary detrusor contraction, with a mean (range) detrusor pressure at maximum flow of 72.7 (5-144) cmH2O, and 43 (75%) patients were deemed to be obstructed. Eight (16%) patients failed to void after prostatectomy and required clean intermittent catheterization. There were statistically significant differences between successful and unsuccessful patients in mean (SD) age, at 66.30 (6.9) vs 78.8 (2.6) years (P = 0.001), detrusor instability (49% vs 0%, P = 0.01), inability to void during pressure study (8% vs 75%, P = 0.001), and maximal detrusor pressure in the voiding phase, at 80 (36.0) vs 19 (11.2) cmH2O (P = 0.001). CONCLUSIONS: In patients with acute urinary retention, pressure-flow studies undertaken after a period of adequate bladder rest (> 3 weeks) are useful in predicting the surgical outcome. Old age, absence of bladder instability, inability to void during the pressure-flow study and a maximal detrusor pressure of < 20 cmH2O are associated with a poor outcome after prostatectomy.     

Urethral resistance factor (URA) versus Schäfer's obstruction grade and Abrams-Griffiths (AG) number in the diagnosis of obstructive benign prostatic hyperplasia

Different methods of analyzing pressure/flow plots to quantify bladder outlet resistance in men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) were developed in the past. The aims of this study were to quantify the degree of agreement between the diagnosis of obstruction by the different methods, and to compare the applicability of the different methods in the evaluation of bladder outflow conditions, in a large group of these men. In consecutive men with LUTS basic initial evaluations, recommended diagnostic tests, and urodynamic investigations were performed. From pressure/flow studies, the group-specific resistance factor (URA), Sch?fer's obstruction grade, and Abrams-Griffiths (AG) number were estimated. Men with 21 cm H(2)O < or = URA < or = 29 cm H(2)O and men with Sch?fer's grade equal 2 were classified as equivocal. In conformity with the provisional ICS definition, men with 20 < or = AG number < or = 40 were classified as equivocal. In 78% of the 565 included men Sch?fer's classification agreed with URA classification. In 82% ICS classification agreed with URA classification. Most agreement (94%) existed between Sch?fer's classification and ICS classification. All differences were near the points of intersection of the different boundaries, and a decision whether to perform surgery on a patient is not likely to be influenced by this disagreement. Males with relatively low detrusor pressure at maximum flow and relatively low maximum flow had a high prevalence among those in whom URA and Sch?fer's classifications and among those in whom URA and ICS classifications differed.     

Prognostic value of a combination of IPSS,flow rate and residual urine volume compared to pressure-flow studies in the preoperative evaluation of symptomatic BPH

OBJECTIVE: Evaluate the predictive value of a combination of IPSS, uroflowmetry and ultrasound determination of residual urine volume in the determination of bladder outflow obstruction (BOO) and in predicting treatment outcome. METHODS: Forty-five out of a group of 60 BPH symptomatic patients were included. Preoperative evaluation: urine culture, PSA, uroflowmetry with sonographic measurement of post-void residual urine, DRE, IPSS with quality of life questions and pressure-flow study. Selection criteria for surgery were IPSS > 16 and Qmax < 10 ml/s. Transurethral resection of the prostate was performed in these patients; the control visit was performed at 3 months. Treatment success was defined as Qmax above 15 ml/s, residual urine of less than 100 ml, a 50% reduction in IPSS and absence of urinary retention. RESULTS: Urodynamic abnormalities were found in 42 patients (93.3%): 19 had detrusor instability, 5 patients showed impaired contractility, 37 patients had proven BOO, and 8 patients were unobstructed or mildly obstructed. The overall success rate was 86% when measured by the IPSS. Its preoperative value was 16.9, and dropped significantly to 4 (P = 0.005). The score improved significantly after surgery only in the obstructed group compared to the non-obstructed group (P = 0.001), however preoperative IPSS did not correlate with objective treatment results. CONCLUSIONS: A high proportion of patients successfully operated (71.1%) had a combination of IPSS > 16 and Qmax < 10 ml/s, although BOO could not be accurately predicted with non-invasive methods alone. Patients with no or mild infravesical obstruction had only minimal improvement of IPSS and uroflowmetry following surgery.     

逼尿肌活动过度对良性前列腺增生患者的影响分析

目的 探讨逼尿肌活动过度(DO)对BPH患者的影响.方法 对临床怀疑因BPH导致下尿路症状(LUTS)的47例患者按术前尿动力学检查中DO存在与否分为2组,其中有DO组22例,无DO组25例.2组均行TURP,分别记录患者相关临床资料,术前IPSS和QOL,Q~(max),残余尿及压力-流率检查等数据;术后随访并再次记录上述指标,采用SPSS10.0软件,对2组数据进行t检验.结果 DO组、无DO组前列腺体积分别为(77±25)、(56±27)ml(P=0.02),初尿意时膀胱容量(104±36)、(161±54)ml(P=0.001),急迫尿意时膀胱容量(245±73)、(328±94)ml(P=0.006),术前残余尿(71±49)、(149±125)ml(P=0.015),linPURR梗阻级别4.63±0.95、3.35±1.90(P=0.014).2组间手术前后IPSS及QOL比较差异均无统计学意义(P＞0.05).结论 前列腺体积大、膀胱出口梗阻明显的患者易存在DO.DO组患者膀胱容量及术前残余尿量明显少于无DO组.DO存在与否并不明显影响BPH患者的IPSS及QOL.     

Interrelationships of bladder compliance with age, detrusor instability, and obstruction in elderly men with lower urinary tract symptoms

Data on the interrelationships of bladder compliance (BC), detrusor instability (DI), and bladder outflow obstruction (BOO) in elderly men with lower urinary tract symptoms (LUTS) are scarce and were therefore assessed in this study. Principle inclusion criteria for this study were men aged > or = 50 years suffering from LUTS as defined by an International Prostate Symptoms Score (IPSS) of > or = 7 and a peak flow rate (Qmax) of < or = 15 ml/sec. Patients with previous surgery of the bladder, prostate, or urethra as well as a pathological neurourological status were excluded from this study. The following parameters were studied in all patients: IPSS, prostate volume calculated by transrectal ultrasonography, free uroflow study, post-void residual volume determined by transurethral catheterization, and a multichannel pressure flow study (pQS). A group of 170 men were included in the analysis. The mean BC in the overall group was 32 +/- 2 ml/cm H2O (mean +/- standard error of the mean [SEM]; range, 4-100 ml/cm H2O). In 36.5% of patients, BC was significantly reduced (< or = 20 ml/cm H2O), and in a further 37.1%, it ranged from 20 to 40 ml/cm H2O. BC decreased statistically significantly (p < 0.05) in patients with advanced age, lower Qmax, higher voiding pressures, and larger prostates. In men with DI (n = 61), mean BC was significantly lower (22 +/- 3 ml/cm H2O) compared to those without (37 +/- 3 ml/cm H2O; p = 0.001; n = 109). Patients with severe BOO as defined by a linear passive urethral resistance relationship of > or = 3 (n = 109), had a significantly lower BC (23 +/- 2 ml/cm H2O) compared to those without or minimal obstruction only (39 +/- 3 ml/cm H2O; p = 0.0002; n = 61). Stepwise logistic regression analysis revealed that DI, a low bladder capacity, and a high maximum detrusor pressure were independent predictors of markedly reduced BC (< 20 ml/cm H2O). BC is decreased in elderly men with high voiding pressures, BOO, and DI. The mechanism leading to the reduction of BC under these circumstances is largely unknown and could result from cytostructural alterations of the detrusor and changes in detrusor innervation.     

Clinical diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms: reliability of commonly measured parameters and the role of idiopathic detrusor overactivity

AIMS: There is no generally accepted consensus how to evaluate patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO). We have tried to determine whether the most frequently used objective variables as prostate volume, IPS-score, maximum flow rate, residual urine volume, functional bladder capacity, and pressure-flow study are reliable for diagnosis of BOO and we investigated the influence of idiopathic detrusor overactivity (IDO) on this condition. METHODS: A total of 153 men with LUTS and suspected BOO were systematically examined with routine investigation including digital rectal examination, transrectal ultrasound (TRUS), post-void residual urine volume measurement, uroflowmetry, and pressure-flow study. All patients completed IPS-score. Patients were divided into groups based on Sch?fer's grade of obstruction and incidence of IDO and clinical and urodynamical variables were compared. RESULTS: At baseline, 45.8% of the patients were urodynamically moderately obstructed and 37.9% were found to be severely obstructed. The grade of obstruction did not correlate with age. Prostate volume, post-void residual volume (PVR), and maximum flow rate correlated significantly with the degree of obstruction. The mean IPS-score remained almost unchanged throughout all obstruction groups. The incidence of IDO was 40.5% and increased from 16% in the minor obstruction group to 38.6% and 53.4% in the moderate and severe obstruction group, respectively. The patients with IDO were older, had larger prostates and were more obstructed. There was no impact of IDO on symptomatology of BOO. CONCLUSIONS: These data indicate that IPS-score does not achieve sufficient diagnostic accuracy and its role in the assessment of BOO is limited. The grade of obstruction is more related to prostate volume, PVR, and maximum flow rate. BOO and IDO seem to be related and have numerous mutual interactions.     

膀胱重量与前列腺增生临床参数的相关性研究

目的探讨膀胱重量（Bw）与常用BPH临床参数的相关性。方法81例BPH患者分为尿潴留与非尿潴留组,经腹B超（TAUS）测量其BW,将BW与年龄、国际前列腺症状评分（I—PSS）、生活质量评分（QOL）、前列腺体积（PV）、排尿后残余尿（PVR）、最大尿流率（Qmax）和前列腺特异抗原（PSA）进行相关分析。结果81例患者年龄平均（71．73&#177;5．80）岁,IPSS（15．89&#177;3．44）分,QOL（3．88&#177;0．93）分,PV（61．55&#177;19．67）m1．PVR（71．11&#177;30．83）ml,Qmax（9．93&#177;2．74）ml／s,PSA（3．30&#177;2．63）rig／ml,BW（75．85&#177;18．45）g;两组间年龄、QOL、PV、PRV、Qmax、PSA和BW存在显著性差异,而I—PSS差异无显著性;BW与年龄、IPSS、QOL、PV、PRV、PSA呈显著正相关,相关系数分别为（r=0．587,r=0．481,r=0．816,r=0．911,r=0．784,r=0．864,P〈0．001）,而与Qmax呈显著负相关（r=-0．769,p〈0．001）。结论BW能反映BPH的严重程度,对指导判断BPH严重程度和外科干预时机可能有重要的临床意义。