Unidades Hounsfield: una herramienta no invasiva prometedora para el diagnóstico de la hiperplasia benigna de próstata

ObjectiveThe clinical symptoms in benign prostatic hyperplasia (BPH) are directly proportional to prostate volume. We aimed to show whom and when to intervene in a noninvasive way, correlating the patient's subjective symptoms with objective diagnostic tools.Material and methodInternational Prostate Symptom Score (IPSS) was evaluated in patients who consulted the urology outpatient clinic for the first time with lower urinary tract symptoms (LUTS). Subsequently, PSA, urea, creatinine, complete urinalysis, uroflowmetry, urinary tract ultrasound and non-contrast lower abdominal computed tomography (CT) examinations were requested. Prostate central (transitional zone) zone and peripheral zone HU scores, prostatic urethral length and bladder wall Hounsfield units (HU) scores were recorded by using computed tomography (CT). The ellipsoid formula was used for ultrasonographic and tomographic measurements of prostate size (anteroposterior diameter × transverse diameter × longitudinal diameter × 0.52).ResultsA statistically significant negative correlation was found between the prostate peripheral zone/central zone HU ratio and the maximum flow rate measured in the uroflowmetry test.ConclusionThis is the first study in the literature to evaluate the correlation between voiding parameters such as Qmax, Qave and IPSS scores, and prostate and bladder wall HU scores obtained by computed tomography examination in BPH patients. A significant relationship has been detected between the peripheral zone/central zone HU ratio and Q max. Additional studies with larger patient populations could better clarify the contribution of HU in the diagnosis of BPH and treatment decision making of these patients.     

Reproducibility of uroflowmetry variables in elderly males

Summary In the evaluation of prostatism urodynamics and especially uroflowmetry has received widespread attention. Review of the literature, however, revealed little information on the consistency of flow variables. Therefore eleven male volunteers above fifty years of age were asked to void five times during a short period of time. Each subject was found to reproduce his own flow curve fairly well. Statistical analysis of various flow variables, i.a. Q_1s, Q_max, volume-corrected Q_max, Q_{max time}, Q_ave and volume voided, demonstrated a high degree of reproducibility. In conclusion a single flow curve is sufficient for clinical routine on the assumption that the patient declares the voiding to be typical.     

Does the tension-free vaginal tape procedure affect the voiding phase? Pressure-flow studies before and 1 year after surgery

OBJECTIVE: To evaluate the voiding phase before and 1 year after surgery in women who underwent a tension-free vaginal tape (TVT) procedure for stress incontinence. PATIENTS AND METHODS: The study comprised 45 women with genuine stress urinary incontinence. To assess the voiding phase, patients were asked if their voiding had changed after surgery, and objectively the uroflowmetry, residual urine measurements and pressure-flow data were compared. RESULTS: At 1 year after surgery 39 women (87%) were subjectively cured and six (13%) improved. The objective cure rate was 88%; the pad-test leakage and the number of leakage episodes decreased significantly after surgery. Subjectively, 78% of the patients reported that the voiding phase had become more difficult, and the spontaneous flow curve changed to a more obstructive pattern in 40%, with the mean urinary peak flow rate (Q(max)), the corrected Q(max) and the mean average flow rate decreasing significantly. The residual urine volume increased significantly, although no patient had volumes of > 25% of their bladder capacity. During the pressure-flow study the Q(max) decreased and the urethral resistance factor increased significantly. However, only one patient could be classified as obstructed. Two patients had clinical problems and used self-catheterization once daily 1 year after surgery. CONCLUSION: There were subjective and objective changes in the voiding phase 1 year after the TVT procedure. The significance of these findings remains to be determined. Longitudinal studies are warranted to clarify whether the patients at risk can be characterized from subjective and objective findings.     

Position-related changes in uroflowmetric parameters in healthy young men

AIMS: Uroflowmetric measurements are a common procedure in urological examination of patients presenting with lower urinary tract symptoms and it can be influenced by various factors. In this study, we investigated position-related changes in uroflowmetric parameters and postvoiding residual urine (PVR) volume in healthy young men. MATERIALS AND METHODS: Thirty normal healthy male volunteers, whose mean age was 28.6 +/- 0.7 years old were studied and evaluated with uroflowmetry in the standing, sitting, and squatting down voiding positions. Three measurements were obtained for each voiding position and for each man (total 270 urinary flows). PVR were measured by transabdominal ultrasound. The maximum flow rate (Q(max)), average flow rate (Q(ave)), corrected maximum flow rate (cQ(max)), voiding volume (VV), voiding time (VT), and PVR values were compared between the three different voiding positions. RESULTS: The mean Q(max) values for the standing, sitting, and squatting down voiding positions of the patient group were 26.8 +/- 1.3, 31.3 +/- 1.2, 31.0 +/- 1.0 ml/sec, respectively and the mean Q(ave) values were 16.8 +/- 0.6, 18.5 +/- 0.6, 18.6 +/- 0.6 ml/sec, respectively. There were significant differences between voiding positions regarding the Q(max) (P < 0.0001) and Q(ave) (P = 0.0002) values in the patient groups. However, the difference between VT, VV, and PVR in the standing, sitting, and squatting down voiding position of the patient group was not statistically significant. CONCLUSIONS: Our results suggest that the urinary flow rates are affected by the voiding position. Therefore, it is important to perform uroflowmetric measurements in the same position.     

Uroflowmetry in neurologically normal children with voiding disorders

A prospective study was undertaken to delineate the role of spontaneous uroflowmetry as screening procedure for functional infravesical obstruction (detrusor/sphincter dyssynergia). More than 70% of thirty-nine children referred for urinary tract infections and/or enuresis in the absence of neurological deficits underwent a complete diagnostic program including intravenous urography, voiding cystography and cystoscopy as well as spontaneous uroflowmetry, cystometry-emg and pressure-flow-emg study. The incidence of dyssynergia was 22%. However, neither the flow curve pattern nor single flow variables were able to identify children with dyssynergia. Consequently uroflowmetry seems inefficient in the screening for dyssynergia in neurological normal children with voiding disorders in the absence of anatomical bladder outlet obstruction.     

Lower Urinary Tract Reconstruction for Ectopic Ureterocele: What Happens in the Long-term Follow-up?

BackgroundWe aimed to analyze the long-term clinical and lower urinary tract function outcomes in children with duplex system ectopic ureterocele who underwent ureteroneocystostomy and ureterocelectomy.MethodsFifty-one patients (28 females, 23 males) who underwent a series of surgical interventions including lower urinary tract reconstruction in childhood for duplex system ectopic ureterocele in our center between 1998 and 2019, were retrospectively reviewed. The demographic and clinical data, surgical history, and the indication for ureterocelectomy were noted. Lower urinary tract dysfunction (LUTD) status was assessed through dysfunctional voiding symptom scores (DVSS) and uroflowmetry in all patients at the last follow-up. The clinical outcomes, and LUTD were evaluated.ResultsAt the last visit at a mean follow-up of 117.18 ± 57.87 months after ureterocelectomy, ipsilateral persistent lower pole VUR was detected in 5.6% (3/54 renal units, 2 females and 1 male) of the cases, who were treated using the subureteric injection. Abnormal DVSS (median 11, range 9–15) was detected in 27.4% (14/51 pts) of the patients. Out of these, 57.1% (8/14 pts) had storage symptoms, 35.7% (5/14 pts) had voiding symptoms, and 7.1% (1/14 pts) had both storage and voiding symptoms while 71.4%(10/14 pts) had abnormal uroflowmetry findings (plateau shaped flow curve in 2, staccato shaped curve with sustained EMG activity in 3, tower shaped curve in 2, interrupted shaped curve in 3 patients). Five patients had elevated residual volume. Anticholinergics were administered to six patients who had overactive bladder symptoms. In addition, two girls required open bladder neck reconstruction due to stress incontinence caused by bladder neck insufficiency.ConclusionsOur findings showed that clinical success was achieved using the lower urinary tract reconstruction with no need for re-operation in 90.2% of patients with duplex system ectopic ureterocele. However, LUTD was present in 27.4% of our patients in the long-term follow-up. Therefore, LUTD should be carefully assessed in the long-term follow-up of these patients.     

Late urodynamic findings after treating traumatic rupture of the posterior urethra in boys

OBJECTIVE: To investigate lower urinary tract (LUT) functions in a prospective study in boys treated for posterior urethral distraction (PUD), as posterior urethral stricture, erectile dysfunction and incontinence can occur after various treatments for this rare injury in children. PATIENTS AND METHODS: Eleven boys were treated for PUD and resultant stricture between 1980 and 2000. Their age, the cause of trauma, extent of injury, previous treatment, and continence status were evaluated, and a urodynamic study conducted. Controls were 12 age-matched males who underwent similar cystometrography (CMG) and uroflowmetry. RESULTS: The mean (SD) age at injury was 8 (4) years and the cause was traffic accident in nine and crush injury in two boys. Seven boys had an isolated urethral rupture, two also had a bladder neck injury and two also had a perforated bladder. No gross neurological impairment developed after trauma. Voiding cysto-urethrograms after initial therapy showed vesico-ureteric reflux in five boys, but in only one at the time of the urodynamic studies. At the time of urodynamic study, the mean (SD) age of the patients was 15 (6) years; seven were fully continent, one had intermittent leakage, two were incontinent, and one had nocturnal enuresis. CMG-electromyography (EMG) showed a reduced maximum cystometric capacity in nine patients, reduced compliance in 10, stable detrusor in 11, synergic detrusor-sphincter activity in 11, and residual urine in one. The uroflowmetry-EMG study showed prolonged voiding time and flow time, decreased maximum flow urinary rate (Q(max)) and mean flow rate (Q(avg)). The shape of the flow curve showed an uninterrupted low-amplitude pattern. Comparing these patients with age-matched controls, CMG and uroflowmetry studies showed that the maximum cystometric bladder capacity, compliance, Q(max) and Q(avg) were all significantly lower in patients with PUD, while voiding time and flow time were significantly higher. CONCLUSION: The LUT deteriorates after treating PUD in boys. CMG and uroflowmetry findings are consistent with partial anatomical obstruction distal to the bladder. Our results are preliminary and full urodynamics, including pressure-flow studies, will be useful to support this conclusion. A urodynamic study should be integral in the management of PUD.     

Symptoms of voiding dysfunction: what do they really mean?

Many women presenting with pelvic floor dysfunction will complain of voiding symptoms. This study examines the relationship between such symptoms and uroflowmetry parameters in 414 women with complaints of pelvic floor dysfunction who underwent free uroflowmetry with a weight transducer type flowmeter. Symptoms of voiding dysfunction were ascertained by interview, with symptoms rated positive if they occurred more than occasionally. Symptoms were correlated with maximum urine flow rate and maximum urine flow rate centiles: 356 women voided between 50 and 600 ml; these datasets were used for analysis. Average age was 57.4 years (range: 17–86). Symptoms of voiding dysfunction were common (62%): 26% of women described hesitancy, 28% a poor stream, 26% stop- start voiding, 15% straining to void, and 35% incomplete emptying/need to revoid. As a group, symptoms of voiding dysfunction were associated with reduced maximum urine flow rate centiles (28.1 vs 36.3, p= 0.011). The strength of the association varied markedly, with only hesitancy (p=0.002), poor stream (p<0.001), and stop-start voiding (p=0.014) reaching significance. Hesitancy, poor stream, and stop-start voiding were the only symptoms predictive of voiding impairment. Straining to void and the sensation of incomplete emptying or the need to revoid were not associated with a significant reduction in maximum flow rate centiles.Editorial Comment: Voiding dysfunction is a common complaint in women with pelvic floor dysfunction. This study shows that only the symptoms of hesitancy, poor stream, and stop-start voiding were associated with objective voiding dysfunction on free flowmetry. These symptoms may help to identify women who need further evaluation.     

Effect of abdominal straining on urinary flow rate in normal males

The measurement of urinary flow rate by uroflowmetry and its relationship to voided volume and age have been extensively studied. It is well recognised that some men void with abdominal straining, but any effect of this on the urinary flow rate is usually not taken into account in urological practice. The aim of this study was to determine whether abdominal straining had any significant influence on the urinary flow rate. Three male volunteers performed multiple voidings either with or without abdominal straining. Statistical transformation of the data and the use of co-variant analysis allowed a comparison between "normal" or passive voiding and voiding with abdominal straining. The results showed that abdominal straining caused a significant improvement in both the average and maximum urinary flow rate. If the effect of abdominal straining is not taken into account during the interpretation of uroflowmetry results, incorrect conclusions may be made which could influence subsequent management. It is suggested that the method of voiding should be standardised by instructing patients, if possible, to avoid abdominal straining during uroflowmetry assessment.     

Value of urinary flow patterns in the follow-up of children who underwent Snodgrass operation

The urinary flow patterns and the Toguri nomogram were compared in the intermediate functional results of the tubularized-incised plate urethroplasty (TIPU) to repair distal and midpenile hypospadias by using uroflowmetry. 28 children who were toilet trained, were able to void volitionally, and had no fistulas following hypospadias repair were eligible for the study. The study did not include children who had persistent fistula, meatal stenosis or urethral stricture, and did not return for follow-up. The mean age was 8.4 years and the mean follow-up period was 18 months. The urinary flow pattern, maximum (Q(max)) and average flow rate (Q(ave)) were measured; the results were expressed as percentiles and compared to the Toguri values from normal children. The Q(max) and Q(ave) were considered normal if they were in >25th percentile, equivocally obstructed in the 5-25th percentile and obstructed if <5th percentile. The flow pattern was classified as bell ring shape, plateau or intermittent. According to the Toguri nomogram, 22 of 28 patients (78.5%) were considered normal, 4 patients (14.2%) as equivocally obstructed, and 2 patients (7.1%) as obstructed group. A normal bell-shaped flow curve was obtained in 23 (82.1%) of the children. 4 patients (14.2%) had a plateau flow pattern. Only 1 of the patients had an intermittent shape flow curve. The flow pattern was normal bell-shaped for all of the patients, except 1, with Q(max) above the 25th percentile according to the Toguri nomogram. Of children with Q(max) below the 5th percentile, both of them had a plateau flow pattern and were found to have an asymptomatic meatal stenosis, which was improved with urethral dilatation. However, of the 4 patients with Q(max) between 5 and 25 percentiles, 2 had a plateau flow pattern and the others had a bell-shaped flow pattern. The flow patterns of the 2 patients determined as obstructive by the Toguri nomogram were plateau-shaped. TIPU provides satisfactory functional results for distal and midpenile hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. There are no studies in the literature which only used flow patterns for the evaluation of urination for follow-up after the hypospadias repair. Our study showed that the evaluation of obstruction according to the Toguri nomogram may not be necessary in patients with a normal bell-shaped flow pattern in uroflowmetry.     

Urinary flow curve patterns and their prognostic value in males over the age of 50 years

Flow curves from two groups of men over the age of 50 years were compared. One group consisted of 112 initially asymptomatic men, controlled with history, uroflowmetry, and symptom score over a 7-year period. The other group consisted of 85 men treated for benign prostatic hyperplasia. Five flow curve patterns were defined, and each flow curve was classified according to the definitions. A significant difference was found comparing untreated and treated males, as 78% of the flow curves in the untreated group were type 1 or 2 and 16% were type 3 or 4 compared to 56% and 37%, respectively, in the treated group. The risk of need of operation in the initially asymptomatic group as a whole was 17% over a 7-year period versus 25% to 44% if the initial flow curve was type 3 or 5, i.e., severely abnormal. Analysis of the influence of age on flow curve pattern revealed a significant shift from “normal” to “abnormal” as age advanced. In conclusion, flow curve patterns, reflecting the voiding process, shifts from normal to abnormal even in subjectively normal men as age advances. At the same time the flow curve seems to be of some prognostic value as to need of operative treatment in voiding problems.     

A normal flow pattern in women does not exclude voiding pathology

It is a widespread assumption that normal micturition behaviour is reflected in a normal flow pattern. This would also mean that a normal flow curve would correspond with normal voiding and would even permit to exclude voiding difficulties. In our study we investigated the value of a normal flow pattern in four different groups: stress incontinent women, women with bladder overactivity, healthy middle-aged volunteers and healthy students. These women voided with a bell-shaped flow curve on pressure flow in 50, 65, 57 and 50%, respectively. Women who strained to void, a major component of dysfunctional voiding, managed to void a bell-shaped flow curve in 46, 60, 70 and 100%, respectively. Our study demonstrates that a normal bell-shaped flow curve does not exclude voiding dysfunction in women.Editorial Comment: It is assumed that normal voiding behavior is reflected in a normal flow pattern, but it is unknown whether one can assume the correlate, that is whether a normal flow curve corresponds to normal voiding. To answer this question, the authors prospectively evaluated free flow and pressure flow patterns in four groups—women with SUI, women with OAB, healthy middle-aged women and young healthy female students. They found that normal bell-shaped free-flow curves were found in 67–83% and bell-shaped pressure flow curves were found in 50–65%. They then showed that bell-shaped flow curves were found in 24 patients who had evidence of abdominal straining during micturition     

Uroflowmetric parameters measured by spontaneous uroflowmetry and instrumented uroflowmetry in the same patient

In order to evaluate the obstructive effects of microtip transducer catheters on flowmetry parameters, 156 patients had a spontaneous uroflowmetry (SU) followed by an instrumented uroflowmetry (IU), with intravesical pressure recording for comparison of maximum flow rate (Q_max), corrected maximum flow rate for volume voided (Q_max.corr.), time to maximum flow rate (TQ_max), and flow curve patterns. With SU and IU, Q_max values were 26±11 ml/s compared with 21±11 ml/s (P<0.001), Q_max.corr. as 29±10 m/s compared with 21±11 ml/s (P<0.0001) and TQ_max values were 11±9 s compared with 30±52 s (P<0.0001). Vesical opening pressure (VOP) was higher in patients with a low TQ_max (< 15 s) (23 cmH₂O±20) than with a higher TQ_max (17 cmH₂O±16) (P<0.04). Curve patterns with both methods show good correlations in 71% of patients, no correlations in 14% and doubtful correlations in 15%. The occlusive effect of the catheter during micturition induces a decrease in Q_max and Q_max.corr. and an increase in TQ_max values, due to a lowered VOP in many patients, but little difference in curve pattern interpretation.     

Home and office uroflowmetry for evaluation of LUTS from benign prostatic enlargement

A group of 107 patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE) participated to the HOUSE Study (Home and Office Uroflowmetry Specific Evaluation). Patients received routine investigation, consisting of medical history taking, physical examination including digital rectal examination, prostate-specific antigen (PSA), assessment of symptoms listed both on the International Prostate Symptom Score and on ICS-male questionnaire. We examined the results of uroflowmetry evaluation in this population; data were analysed to observe if any circadian changes of parameters obtained with home uroflowmetry could be detected. We searched a correlation between Q(max), Q(ave) and ICS-benign prostatic hyperplasia symptom score: a significantly inverse correlation was found only for Q(max), confirming Q(max) as a reliable parameter to quantify subjective symptoms. When examining the multiple flow curves recorded in the same patient with home uroflowmetry, voided volume and flow time had usually higher values during night-time: the existence of circadian changes of uroflowmetry parameters in patients with LUTS from BPE was confirmed, and lower values of average and maximum flow rates during sleep hours were recorded in the same patient. In conclusion, when evaluating the natural history or treatment outcome of individual patients or group of patients in clinical trials for evaluation of BPE and LUTS, an assessment including multiple measurements may be useful and of value.     

Factors associated with voiding function in women with lower urinary tract symptoms: a mathematic model explanation

AIMS: The aim of this study was to explore the relationship between voiding function and factors such as age, gravidity, parity, menopause, and anterior vaginal wall relaxation. METHODS: One hundred twenty-five women were identified from urodynamic records, 83 premenopausal and 42 postmenopausal. All had had a sonographic assessment of the lower urinary tract and a full urodynamic study, including a pressure-flow study. None had diabetes mellitus, overt neurologic disease, pelvic surgery, anticholinergic medication or estrogen therapy, or voiding difficulty symptoms. Voiding parameters included the following urodynamic variables: maximum flow rate, average flow rate, residual urine, the ratio of residual urine to total bladder volume on spontaneous uroflowmetry, maximum flow rate, and detrusor pressure at maximum flow on a pressure-flow study. RESULTS: Uroflow rates were significantly correlated with age, parity, and urethral mobility. As a whole, the scatter plots of maximum and average flow rates versus voided volume on uroflowmetry displayed a significant correlation (P < 0.0001 and P < 0.0001, respectively). But, there was no association between maximum flow rate and detrusor pressure at maximum flow in the pressure flow study (P = 0.132). Age, menopause, parity, and urethral mobility may have affected the correlation on uroflowmetry but have no effect on pressure-flow plot. On subgroup analysis, significant correlation was identified only in women aged between 30 and 70, with parity greater than three, and urethral mobility greater than 70 degrees. These groups all had a reduced urethral pressure profile. CONCLUSIONS: Age, menopause, parity, and urethral mobility may change the hydrodynamics of the lower urinary tract and have varying impact on the voiding function by altering urethral distensibility. Moreover, poor detrusor power in the postmenopausal women may complicate the analysis of voiding function.     

Does the tension‐free vaginal tape procedure (TVT) affect the voiding function over time? Pressure‐flow studies 1 year and 3½ years after TVT

AIM: The aim was to evaluate the voiding function over time after the TVT procedure for stress incontinence. MATERIALS AND METHODS: Thirty-eight women with urodynamic stress urinary incontinence were included in the study. For voiding function assessment the patients were asked if voiding had changed postoperatively, and objectively uroflowmetry, residual urine measurement and pressure-flow were performed preoperatively, 1 year and 3(1/2) years postoperatively. RESULTS: At 1/3(1/2) years follow-up 87%/69% were subjectively cured and 13%/26% improved, respectively. The objective cure rate was 89%/74%. Subjectively 77%/63% of the patients felt an altered voiding function towards more difficult voiding one and 3(1/2) years after surgery, respectively. Objectively all the uroflowmetry variables deteriorated and residual urine volume increased over time although the changes were not statistically significant between the 1 and 3(1/2) years follow-up. Pressure-flow variables were essentially unchanged. CONCLUSION: The changes in voiding function after a TVT do not reverse over time. This may imply a potential risk of development of clinically important impaired emptying function.     

Are voiding symptoms really associated with abnormal urodynamic voiding parameters in women?

Objectives: To examine the relationship between voiding symptoms and objective measurements of voiding dysfunction. Methods: We prospectively collected data from 116 consecutive women attending for urodynamic investigations. Symptoms of voiding dysfunction and objective voiding parameters including uroflowmetry and post‐void residual volume were evaluated. Results: Sixteen (14%) patients reported a symptom of straining, 21 (18%) double voiding, 32 (27%) post‐micturition dribbling, 10 (8%) poor stream and 34 (29%) incomplete emptying. Using receiver–operator curves we were unable to determine a cut‐off value for flow or residual volume where symptoms became more prevalent. Poor stream was, however, a good predictor for a residual volume of >100 mL and >150 mL. Strain predicted a residual volume of >100 and >150 mL and it correlated with maximum flow rate <15 mL/s. The other three symptoms did not correlate with any of the cut‐off values. Conclusions: Poor steam and strain are weakly predictive of abnormal voiding function.     

Detrusor pressure uroflowmetry studies in women: effect of a 7Fr transurethral catheter

PURPOSE: We evaluated whether a 7Fr transurethral catheter affects urinary flow in women undergoing pressure flow studies for voiding symptoms. MATERIALS AND METHODS: We reviewed a urodynamic database of 600 consecutive women referred for the evaluation of voiding symptoms. Before urodynamics all patients voided privately using a standard toilet and free flow was recorded. Urodynamics were performed using a 7Fr double lumen transurethral catheter. At functional bladder capacity patients were asked to void in the sitting position and pressure flow studies were performed. All uroflowmetry tracings were inspected and analyzed manually. Only patients who voided similar volumes varying by less than 20% on the free and pressure flow studies were assessed. Free and pressure flow parameters were compared according to voided volume category, main urodynamic diagnosis, uroflowmetry pattern and pre-void bladder volume. RESULTS: A similar volume was voided on the free and pressure flow studies of 100 women. In each voided volume category and urodynamic diagnosis pressure flow parameters were significantly different from the equivalent free flow parameters in all but 4 cases. Specifically the maximum flow rate was significantly less and flow time was significantly longer on pressure versus free flow studies (each p <0.01). An intermittent flow pattern was more common on pressure than in free flow measurements (43% versus 9%). CONCLUSIONS: A 7Fr transurethral catheter may adversely affect uroflowmetry parameters in women undergoing pressure flow studies for lower urinary tract symptoms. This finding may have further clinical implications regarding the interpretation of these parameters as well as establishment of an accurate diagnosis.     

脊髓型颈椎病患者的排尿功能障碍及术后近期效果

目的:探讨脊髓型颈椎病患者产生排尿障碍的影响因素及其术后近期的改善情况。方法:对51例脊髓型颈椎病患者的病程、首发症状、合并症进行分析,并按术前脊髓功能状况评分分组观察术前、术后排尿功能和尿流率改变。结果:51例中术前有排尿障碍者27例（529％）,术后近期症状改善19例（70.4％）;术前尿流率异常者29例（56.9％）,术后最大尿流率较术前显著增加。病程超过1年、以下肢症状起病、合并颈椎OPLL及脊髓功能评分低的患者易出现排尿障碍和尿流率异常。结论:上述因素易造成脊髓型颈椎病患者发生排尿功能障碍;术后近期其排尿功能障碍可获得显著改善。