脊髓损伤排尿功能障碍患者的尿动力学分析

目的 了解不同节段脊髓损伤后膀胱尿道功能障碍的差异.方法 回顾性分析30例脊髓损伤患者的尿动力学资料.男22例,女8例.年龄17～74岁,平均47岁.病程7～36个月,平均18个月.其中胸腰段脊髓损伤19例,骶髓损伤11例.2组尿动力检查结果行单因素方差分析或秩和检验比较.结果 胸腰段脊髓损伤组与骶髓损伤组自由尿流率参数比较:最大自由尿流率(13.0±5.1)与(13.0±5.8)ml/s,2 s时自由尿流率(6.5±5.1)与(6.9±6.4)ml/s,平均自由尿流率(5.4±2.4)与(3.4±0.5)ml/s,自主排尿量(279.1±131.1)与(450.0±26.6)ml,残余尿量(209.5±180.7)与(434.0±215.0)ml;2组排尿量和残余尿量比较差异有统计学意义(P＜0.05).2组完全性膀胱测压参数比较:最大尿流率(16.0±23.3)与(7.1±3.3)ml/s,平均尿流率(4.6±2.3)与(3.9±2.3)ml/s,排尿后2 s的尿流率(4.6±3.1)与(2.2±3.2)ml/s,排尿量(268.4±113.9)与(129.0±97.9)ml,最大尿流率时的逼尿肌压力(58.8±22.0)与(56.5±14.5)cm H2O(1 cm H2O=0.098 kPa),逼尿肌最大压力时的尿流率(4.8±2.0)与(4.8±4.4)ml/s,逼尿肌最大压力(68.0±31.0)与(54.6±20.2)cm H2O,排尿期平均压力(47.4±20.0)与(42.6±13.9)cm H2O,2组排尿量比较差异有统计学意义(P＜0.05).2组膀胱感觉及膀胱尿道协同性差异无统计学意义(P＞0.05),胸腰段损伤患者中低顺应性膀胱(4/11)发生率较高,骶髓损伤患者中高顺应性膀胱(11/19)发生率较高.结论 骶髓损伤和胸腰段脊髓损伤患者区别主要为膀胱顺应性的差异和膀胱逼尿肌收缩能力的改变,骶髓损伤患者逼尿肌收缩能力降低、高顺应性膀胱发生率较高,胸腰段脊髓损伤患者逼尿肌收缩亢进、低顺应性膀胱发生率较高.

Abstract：

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury.Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group.There were 22 males and 8 females, aged 17 -74 ( mean, 47 ) years, with duration between 7 - 36 ( mean, 18) months.There were nineteen cases of thoracolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group.We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group.They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury.The urodynamic findings of the two groups were comparable.SPSS 16.0 was used to compare the differences between the groups by ANOVA/rank sum test.Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups.The maximum free flow rate was ( 13.0 ±5.1 ) vs ( 13.0 ±5.8) ml/s, the free flow rate at 2 s was (6.5 ±5.1 ) vs (6.9 ±6.4) ml/s, the mean free flow rate was (5.4± 2.4) vs ( 3.4 ± 0.5 ) ml/s, urine output volume was ( 279.1 ±131.1 ) vs (450.0 ± 26.6) ml and the residual urine volume was (209.5 ± 180.7 ) vs (434.0 ± 215.0) ml.The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group (P ＜ 0.05).We also measured the the cystometric parameters.The maximum urinary flow rate was (16.0±23.3) vs (7.1 ±3.3) ml/s, average flow rate was (4.6 ±2.3) vs (3.9 ± 2.3) ml/s, the flow rate after voiding 2 s was (4.6 ± 3.1 ) vs (2.2 ± 3.2) ml/s, urine output volume was (268.4 ± 113.9) vs ( 129.0 ± 97.9) ml, detrusor pressure of maximum flow rate was (58.8 ± 22.0) vs (56.5 ± 14.5) cm H2 O, flow rate of maximum detrusor pressure was (4.8 ± 2.0) vs (4.8 ± 4.4) ml/s,the maximum detrusor pressure was (68.0 ± 31.0) vs (54.6 ± 20.2) cm H2O and the average pressure of voiding period was (47.4 ±20.0) vs (42.6 ± 13.9) cm H2O.The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group ( P ＜ 0.05 ).There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group (P ＞ 0.05).The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients (4/11) was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients (11/19) was higherthan the thoracolumbar group.Conclusions The urodynamics' difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes.Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the cidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher.     

女性膀胱流出道梗阻的影像尿动力学检查特点分析

Objective To analyze videourodynamic characteristics of female bladder outlet obstruction (BOO). Methods Retrospective analysis of videourodynamic characteristics were performed in 42 women with BOO. On the basis of the videourodynamic findings, women with BOO were categorized into five groups: bladder neck obstruction, middle urethra (urethral sphincter) obstruction, distal urethra obstruction, external orifice of urethra obstruction, high-grade pelvic organ prolapse. Data of five groups were compared in Qmax, maximum cystometric capacity, Pdet at Qmax, residual urine, detrusor instability and hydronephrosis. Data of all patients were analyzed by SPSS13 statistical software, measurement data by t-test and enumeration data by x2-test. Results Five groups had not significant deviation in the maximum cystometric capacity. however patients with bladder neck obstruction had significant deviation with others in Pdet at Qmax (78. 0 ± 23. 6)cm H2O, residual urine (120. 6±115.2)ml, Qmax (7.0±2.3)ml/s (P<0.05). There was significant deviation between middle urethra (urethral sphincter) obstruction(76.9%)and others in detrusor instability(P<0. 05). In all patients with hydronephrosis, bladder neck obstruction(57. 1 %) had significant deviation with others (P<0. 05). Conclusions Videourodynamic tests could assess lower urinary tract function, and may guide clinic management. The bladder neck obstruction was most serious and harmful to upper urinary tract.     

腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.     

腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.     

腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.     

腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.     

良性前列腺增生患者B超检查发现膀胱小梁形成的临床意义

目的 探讨良性前列腺增生(BPH)患者B超检查发现膀胱小梁形成在判断膀胱出口梗阻程度及膀胱功能状态中的作用.方法 前瞻性比较BPH经腹B超检查显示有膀胱小梁形成与无膀胱小梁形成2组患者临床资料及尿动力学检查参数.结果 有膀胱小梁形成BPH患者36例,无膀胱小梁形成患者68例,年龄分别为(73.7±10.1)岁和(69.6±6.2)岁,国际前列腺症状评分分别为(24.4±6.6)分和(22.8±8.3)分,2组比较差异无统计学意义(P＞0.05);2组最大尿流率时逼尿肌压力分别为(131.7±57.3)cm H2O(1 cm H2O=0.098 kPa)和(92.1±47.8)cm H2O,线性被动尿道阻力关系梗阻程度分级分别为4.6±1.1和3.5±1.5,2组比较差异有统计学意义(P＜0.05);72.2%(26/36)的小梁形成患者膀胱顺应性减低,其中23.1%(6/26)出现双肾积水,造成肾功能损害;无小梁形成组分别为42.6%(29/68)和10.3%(3/29),2组比较差异具有统计学意义(P＜0.05).结论 BPH患者B超检查发现膀胱小梁形成,提示存在膀胱出口梗阻,上尿路积水风险增大;无尿潴留者,膀胱小梁形成提示膀胱功能尚处于代偿期,应及时解除梗阻,有利于膀胱功能恢复,减少并发症的发生.

Abstract：

Objective To study the role of B-mode ultrasound found bladder trabeculation in evaluating the degree of bladder outlet obstruction (BOO) and the bladder function in benign prostatic hyperplasia (BPH) patients.Methods Conducted prospective research to determine differences in clinical data and urodynamic parameters between BPH patients with and without bladder trabeculation diagnosed by abdominal ultrasound.Results Thirty-six BPH patients with bladder trabeculation were compared with 68 BPH patients without bladder trabeculation.The mean age was (73.7 ± 10.1 ) years for the patients with bladder trabeculation and ( 69.6 ± 6.2 ) years without bladder trabeculation, IPSS was 24.4 ± 6.6 and 22.8 ± 8.3 respectively, in which no significant differences were found ( P ＞ 0.05 ).The detrusor pressure at maximum flow rate was ( 131.7 ± 57.3 ) cm H20 and (92.1 ± 47.8 )cm H2O ) respectively.The linearized passive urethral resistance relation was 4.6 :± 1.1 and 3.5 ± 1.5 respectively, showing a significant difference ( P ＜.05 ) between the two groups.Seventy-two point two percent (26/36) of the patients with bladder trabeculation had a low compliance bladder, among whom 23.1% (6/26) of the patients had bilateral hydronephrosis with renal insufficiency.The percentage for the control group was 42.6% (29/68) and 10.3% (3/29) respectively (P ＜ 0.05).Conclusions The bladder trabeculation found by B-ultrasound in BPH patients suggests the existence of BOO and a high risk of bilateral hydronephrosis.Bladder trabeculation in patients without urinary retention suggests they are in compensation status.Relief of the obstruction is helpful to recovery of bladder function and the reduction of complications.     

女性膀胱流出道梗阻的影像尿动力学检查特点分析

Objective To analyze videourodynamic characteristics of female bladder outlet obstruction (BOO). Methods Retrospective analysis of videourodynamic characteristics were performed in 42 women with BOO. On the basis of the videourodynamic findings, women with BOO were categorized into five groups: bladder neck obstruction, middle urethra (urethral sphincter) obstruction, distal urethra obstruction, external orifice of urethra obstruction, high-grade pelvic organ prolapse. Data of five groups were compared in Qmax, maximum cystometric capacity, Pdet at Qmax, residual urine, detrusor instability and hydronephrosis. Data of all patients were analyzed by SPSS13 statistical software, measurement data by t-test and enumeration data by x2-test. Results Five groups had not significant deviation in the maximum cystometric capacity. however patients with bladder neck obstruction had significant deviation with others in Pdet at Qmax (78. 0 ± 23. 6)cm H2O, residual urine (120. 6±115.2)ml, Qmax (7.0±2.3)ml/s (P<0.05). There was significant deviation between middle urethra (urethral sphincter) obstruction(76.9%)and others in detrusor instability(P<0. 05). In all patients with hydronephrosis, bladder neck obstruction(57. 1 %) had significant deviation with others (P<0. 05). Conclusions Videourodynamic tests could assess lower urinary tract function, and may guide clinic management. The bladder neck obstruction was most serious and harmful to upper urinary tract.     

腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.     

腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.     

良性前列腺增生患者膀胱内前列腺突人程度的超声测定

目的 探讨良性前列腺增生(BPH)患者膀胱内前列腺突入程度(IPP)测定对膀胱出口梗阻及膀胱功能的预测与评价. 方法 BPH患者206例,年龄55～84岁,均为首次就诊,有不同程度的尿频、尿急等下尿路症状.行经腹B超测定IPP并根据程度分2组:研究组78例(IPP>10mm)和对照组128例(IPP≤10 mm),分析2组患者临床资料及尿动力学检查结果 间的关系. 结果 研究组和对照组前列腺体积[(73.7±35.9)、(62.8±36.5)ml]、前列腺特异性抗原[(1.81±0.67)、(1.64±0.36)ng/ml]、残余尿量[(290.2±217.2)、(228.2±167.9)ml]、急性尿潴留发生率(33.3%、18.0%)及膀胱小梁化发生率(23.1%、11.7%)比较差异均有统计学意义(P<0.05).IPP与前列腺体积、残余尿量呈正相关(r分别为0.401,0.342).2组患者排尿期最大尿流率[(7.6±4.1)、(9.1±3.6)ml/s]、膀胱过度活动症发生率(82.1%,17.2%)、膀胱顺应性降低率(35.9%,12.5%)、最大逼尿肌压力[(109.8±84.9)、(84.9±44.1)cm H2O,1 cm H2O=0.098 kPa]及膀胱出口梗阻指数(75.2±27.1、65.9±34.6)比较差异均有统计学意义(P<0.05); IPP与最大尿流率呈负相关(r=-0.284),与最大逼尿肌压力及膀胱出口梗阻指数呈正相关(r分别为0.252,0.456).经保守治疗后,2组患者急性尿潴留复发率分别为64.3%(9/14)和23.5%(4/17)(P<0.05). 结论 IPP可以作为初步预测及评价膀胱出口梗阻程度和膀胱功能的指标之一;前列腺突入膀胱的BPH患者膀胱出口梗阻及膀胱功能受损程度明显高于无突入患者,对于前列腺突入膀胱的BPH患者.尤其是合并急性尿潴留患者应及早采取外科手术治疗.     

前列腺增生伴逼尿肌无力患者电切术治疗后的临床分析

目的 探讨良性前列腺增生（BPH）膀胱出口梗阻（BOO）致膀胱逼尿肌收缩功能无力（DU）患者的临床诊断及治疗方式.方法 2006年1月至2010年12月经治的60例BPH老年患者,均行经尿道前列腺电切术（TURP）.根据逼尿肌收缩压力（Pdet）分为4组：A组逼尿肌正常组（Pdet＞ 40 cm H2O）,B组逼尿肌无力组（Pdet＜40 cm H2O）,再将B组细分为：B1组（轻度逼尿肌无力组）（20 cm H2O ＜Pdet＜40 cm H2O）及B2组（重度逼尿肌无力组）（Pdet＜20 cm H2O）,分别对其术后的排尿症状进行了2～6年的随访.结果 统计学比较术后A、B组间及B1、B2组间的生活质量评分（QOL）、排尿梗阻症状及刺激症状,差异无统计学意义（P＞0.05）.结论 BPH患者BOO解除后,逼尿肌功能状态可能并不影响下尿路症状（LUTs）的改善.因此对BPH合并DU的患者进行必要的沟通后行手术治疗解除梗阻,可改善患者生活质量.     

良性前列腺增生患者膀胱出口梗阻和逼尿肌功能的分析

目的：探讨尿动力学检查对BPH患者膀胱出口梗阻（BOO）和逼尿肌功能的诊断意义.方法：对95例BPH患者进行压力-容积和压力-流率测定.结果：95例BPH患者中BOO 57例,无BOO23例,其余15例为可疑或分析困难.BOO组前列腺体积大于无BOO组（62.4±16.1）cm^3 vs（41.0±7.1）cm^3（P＜0.05）,最大尿流率（Qmax）小于无BOO组（5.4±1.9）ml/s vs（12.4±5.0）ml/s（P＜0.05）,两组IPSS评分无差别（23.7±4.4）分vs（25.2±4.9）分（P＞0.05）.BOO组有逼尿肌不稳定收缩（DD34例,无BOO组D119例.结论：尿动力学检查有助于判断有无BOO存在,了解BPH患者的逼尿肌功能.IPSS不能判断患者的下尿路症状（LUTS）是否因BOO导致.BPH患者前列腺体积不足很大,但LUTS明显时,应行尿动力学检查.自由尿流率测定对BOO诊断有一定帮助.DI是无BOO患者发生LUTS的重要因素.     

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。     

前列腺增生致膀胱出口梗阻后逼尿肌功能改变对尿动力学参数的影响

目的探讨良性前列腺增生症（BPH）致膀胱出口梗阻（BOO）后逼尿肌功能改变对尿动力学参数的影响。方法109例具有完整尿动力学结果的BPH患者根据有无B00分为梗阻组和非梗阻组;梗阻组根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级4组;逼尿肌收缩力分为逼尿肌收缩力减弱（DCA）与收缩力正常组;逼尿肌不稳定（DI）分DI与非DI;膀胱顺应性（BC）分高、正常、低顺应性三组;28例患者行经尿道前列腺切除术（TURP）术前及术后尿动力参数对比。结果BOO组的前列腺体积（PV）、国际前列腺症状评分（IPSS）、DI、急性尿潴留（AUR）发生率明显高于非BOO组（P〈O．05）;BOO组的最大尿流率（Qmax）、BC值、DCA发生率明显低于非BOO组（P〈0．05）;逼尿肌收缩力正常组的残余尿（RV）与BC值明显低于减弱组（P〈0．05）,而BOO和DI的发生率明显高于减弱组（P〈0．01）;DI组的年龄、BC值及DCA的发生率明显低于非DI组（P〈0．05）,而B00级别和AUR的发生率明显高于非DI组（P〈0．01）;低BC组IPSS、BOO级别、AUR发生率明显高于正常及高BC组（P〈0．05）,而DCA发生率明显低于正常及高BC组（P〈0．01）;术后Qmax、BC值较术前明显升高（P〈0．05）,RV、IPSS、DI发生率较术前明显减小（P〈0．01）。结论①BOO常与低顺应性膀胱、DI、AUR合并存在;②IPSS评分不能提示是否存在DI,DI的存在不影响IPSS评分;③TURP是治疗前列腺增生的金标准;④尿动力检查能全面了解有无BOO及BOO所致逼尿肌功能改变情况,对BPH的临床鉴别诊断、预后估计及选择恰当治疗方案都具有重要意义。     

Urodynamic parameters for the diagnosis of bladder outlet obstruction in women

INTRODUCTION: Bladder outlet obstruction (BOO) is often overlooked in the diagnosis of women with lower urinary tract symptoms. Although the incidence of BOO is not high in the female population with lower urinary tract symptoms, a correct diagnosis for BOO is important. This study was designed to compare the urodynamic parameters in women with bladder outlet obstruction (BOO), stress urinary incontinence (SUI) and asymptomatic volunteers. MATERIALS AND METHODS: Videourodynamic study was performed in 76 patients who were clinically diagnosed as BOO, 265 with stress urinary incontinence (SUI). In addition, 30 asymptomatic female volunteers were recruited and served as controls. Voiding pressure (P(det.Qmax)), maximum flow rate (Qmax), and urodynamic parameters were compared among the BOO, SUI and control groups and the criteria values for BOO in women were estimated. RESULTS: BOO was identified in 30 women with bladder outlet stricture, 40 women with dysfunctional voiding, and 6 women with high-grade cystocele. The mean P(det.Qmax) was significantly higher and the mean Qmax was significantly lower in the obstructed groups. When a P(det.Qmax) > or =35 cm H(2)O was set as the criteria for BOO, the sensitivity was 96.1% and specificity was 89.0%, whereas a P(det.Qmax) of > or =30 cm H(2)O had a sensitivity of 100% but the specificity was only 65.5%. If the criteria of BOO was set as P(det.Qmax) > or =35 cm H(2)O combined with Qmax < or =15 ml/s, the sensitivity for BOO was 81.6% and specificity was 93.9%. CONCLUSIONS: Our results demonstrate a P(det.Qmax) of > or =30 cm H(2)O is a good index value for screening of female BOO. When a P(det.Qmax) of > or =35 cm H(2)O combined with a Qmax < or =15 ml/s was found, a high suspicion of BOO should be raised, for which a specificity of 93.9% and sensitivity of 81.6% for BOO was obtained.     

膀胱出口部分梗阻对逼尿肌生物力学特性的影响

目的 探讨膀胱出口部分梗阻(P-BOO)对膀胱逼尿肌生物力学特性的影响及机制.方法 采用Wistar雄性大鼠,膀胱颈不全结扎法建立P-BOO动物模型.依据梗阻时间分为假手术组、梗阻6周组(P-B006W)及梗阻12周组(P-B0012W),其中P-B006W组根据充盈性膀胱测压所示逼尿肌是否稳定分为逼尿肌稳定组(DS)和逼尿肌不稳定组(DI).采用灌流肌槽,以拟胆碱药物(氯化氨基甲酰胆碱)作为刺激因素,用拉力传感器测定离体逼尿肌条的主动收缩功能.充盈性膀胱测压检测最大膀胱容量、膀胱漏尿点压及膀胱顺应性的变化.结果P-BOO模型均成功建立,DI组最大膀胱容量、膀胱漏尿点压、膀胱顺应性[(10.8±3.0)ml,(39.4±7.1)cm H20,(0.27±0.08)ml/cm H20]、DS组[(10.3±1.9)ml,(35.9±6.2)cm H2O,(0.29±0.05)ml/cm H2O]及P-B0012W组[(9.5±2.3)ml,(48.6±9.5)cm H20,(0.21±0.05)ml/cm H2O]均明显高于假手术组[(2.1±0.3)ml,(16.2±2.1)cm H2O,(0.13±0.03)ml/cm H2O],差异有统计学意义(P＜0.05).DI组逼尿肌条拟胆碱药物刺激产生的收缩力显著低于假手术组和DS组.P-B0012W组逼尿肌条均未检测到明确的收缩波(波幅＜0.05 g).结论 P-BOO后膀胱逼尿肌生物力学特性发生了改变:DI组逼尿肌收缩功能受损,DS组发生代偿,但如果梗阻未解除,则逼尿肌收缩性损害,最终导致不可逆的收缩功能丧失;梗阻后膀胱顺应性增大与膀胱容积显著增加密切相关,逼尿肌稳定性对其影响不显著.     

良性前列腺增生并发膀胱过度活动症的尿动力学诊断

目的 探讨良性前列腺增生(BPH)合并膀胱过度活动症(OAB)的尿动力学特点,为正确合理的治疗提供参考.方法 回顾性分析2009年1月至2010年5月就诊的235例BPH患者的尿动力学检查资料.患者年龄52～88岁,平均(68±8)岁.根据患者主诉有无OAB症状分为BPH组和BPH合并OAB组;根据尿动力学检查有无逼尿肌过度活动(DO)又将其分为单纯性BPH组、单纯性BPH合并DO组、BPH合并OAB无DO组及BPH合并OAB伴DO组,比较各组年龄、国际前列腺症状评分(IPSS)、前列腺体积、最大尿流率、残余尿量、初感容量、强烈尿感容量、梗阻指数和逼尿肌收缩力情况.结果 最终入选219例患者,年龄56～88岁,平均年龄(66±8)岁,平均前列腺体积(35±24)ml,平均最大尿流率(11±6)ml/s.33.8%(74/219)的患者尿动力学检查出现DO.与BPH组(104例)比较,BPH合并OAB组(115组)年龄更大、IPSS评分更高、前列腺体积更大、初感容量及强烈尿感容量更小、梗阻指数及逼尿肌收缩力减弱比例更高(P＜0.05).单纯BPH组、BPH合并DO组、BPH合并OAB无DO组及BPH合并OAB伴DO组分别为93例(42.5%)、11例(5.0%)、52例(23.7%)、63例(28.8%).BPH合并OAB伴DO与BPH合并DO两组比较,前者DO最大逼尿肌压更高、持续DO时间更长.结论 了解BPH合并OAB患者的尿动力学特点对于合理治疗和预测疗效具有重要意义.