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。     

膀胱重量估测与膀胱出口梗阻的相关性研究

目的 探讨良性前列腺增生(BPH)患者膀胱重量与出口部梗阻的相关性.方法 BPH患者58例,平均年龄(67±7)岁;年龄匹配的正常对照20例(无排尿异常症状,尿流率＞25ml/s).以尿动力学检查作为膀胱出口梗阻的诊断依据,梗阻标准:Abrams-Griffiths(A-G)指数≥40,LinPURR梗阻分级≥Ⅱ级.对照组仅行尿流率检查.经腹B超测量膀胱壁厚度,假设膀胱为球形,根据膀胱内容量(剩余尿量+尿量)和膀胱壁厚度估算膀胱重量.结果 膀胱出口梗阻组(49例)膀胱重量(98.6±54.4)g,对照组(38.1±5.9)g,2组比较差异有统计学意义(P=0.000);膀胱重量与A-G指数(r=0.41,P=0.003)、LinPURR梗阻分级呈正相关(r=0.47,P=0.000),与最大尿流率(Qmax)呈负相关(r=-0.52,P=0.000).以膀胱重量55 g作为界值,对膀胱出口梗阻诊断的敏感性为91.8%(45/49),特异性为89.7%(26/29),准确率达91.0%(71/78).结论 B超估测膀胱重量作为非侵入性检查方法,对膀胱出口部梗阻诊断具有良好的预测作用.     

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     

膀胱压减去尿道出口压与最大尿流率比率测定诊断膀胱出口梗阻的临床价值

目的：探讨膀胱压(Pvas)减去尿道出口压(P0)比最大尿流率(Qmax)比率的测定(Pves—P0／Qmax)对诊断膀胱出口梗阻(BOO)的可靠性。方法：采用WIEST尿动力学仪，53例患者分为逼尿肌低压低尿流率、高压高尿流率、高压低尿流率、高压伴正常尿流率、正常逼尿肌压伴正常尿流率5种不同排尿类型，应用Pves-P0／Qmax测定诊断BOO，同时应用ICS标准方法即Pves减去腹压(Pabd)比最大尿流率(Qmax)的测定(Pves—Pabd／Qmax)诊断B00；用两种方法判别BOO并进行自身对比。结果：18例逼尿肌低压低尿流率以及高压高尿流率患者，应用ICS标准方法Pves-Pabd／Qmax测定不能明确诊断有否BOO，但应用Pves—P0／Qmax测定能明确诊断有否BOO；35例逼尿肌高压伴低尿流率或伴正常尿流率以及正常逼尿肌压伴正常尿流率的患者，应用两种方法诊断有否BOO结果基本一致。结论：应用Pves-P0／Qmax测定诊断BOO对各种排尿类型有普遍的可靠性，特别对逼尿肌低压低尿流率或高压高尿流率病例能明确判定有否BOO。     

临床前列腺评分对膀胱出口梗阻的诊断价值

目的　提高传统方法诊断良性前列腺增生致膀胱出口梗阻 (BOO)的客观性。　方法　通过年龄、国际前列腺症状评分 (IPSS)、前列腺体积 (Vp)、最大单纯尿流率 (Qmaxz)和剩余尿指数(PVRr)等传统指标与尿动力学压力 流率分析结果之间及传统指标之间的相关性研究 ,以组特异性尿道阻力因子 (URA)作为应变量行多因素逐步回归分析 ,拟出多元回归方程 ,计算临床前列腺评分(CPS)并检测其诊断BOO的客观性。　结果　年龄、IPSS、Vp、Qmaxz 和PVRr等传统诊断指标均与客观梗阻相关 ,但单一指标不适于客观诊断BOO ;多元回归方程为CPS =4 9.8- 3.3Qmaxz 0 .5IPSS 0 .2Vp 7.5PVRr,CPS与客观梗阻的相关系数为 0 .6 2 9,明显高于单一传统诊断指标。CPS≥ 35时 ,诊断梗阻的敏感性和特异性分别为 83.7%和 85 .8% ;CPS <2 5时 ,BOO可能性仅为 8.6 %。　结论　综合多个传统诊断指标的CPS对BOO有良好的诊断价值。     

前列腺突入膀胱程度与前列腺增生症膀胱出口梗阻的相关性

目的探讨前列腺突入膀胱程度(IPP)能否作为判断前列腺增生症导致膀胱出口梗阻的指标以及其临床应用价值。方法回顾性分析2012年1月至2013年12月在本院诊断前列腺增生症并接受尿动力学检查的患者,按IPP长度≤10mm、10~20mm、≥20mm分成3组,用统计学比较分析IPP和部分尿动力学检查指标与膀胱出口梗阻的相关性。结果各组间前列腺体积、最大尿流率以及膀胱出口梗阻指数和程度均有统计学差异。以IPP≥12mm作为判断膀胱出口梗阻的标准,其敏感性及特异性较高,约登指数约为0.67。结论超声测量IPP可作为除尿动力学检查外另一个诊断膀胱出口梗阻的简便方法。     

剩余分数在前列腺增生致膀胱出口梗阻中应用的评价

目的 :评价剩余分数 (RF) [剩余尿量 (PRV)除以排尿前尿量 (PV) ]在前列腺增生 (BPH)中判断膀胱出口梗阻程度的应用。　方法 :应用B型超声波检测仪及尿流参数自动检测仪对 5 0例患有BPH的门诊病人 (尿潴留及神经源性膀胱病人除外 )进行PV、PRV及最大尿流率 (Qmax)测定。分别用RF、PRV与Qmax作直线相关分析。结果 :RF与Qmax呈极显著负相关 (r =- 0 .385 9,P <0 .0 1) ,PRV与Qmax也呈显著负相关 (r =- 0 .2 831,P <0 .0 5 )。　结论 :RF值越大 ,膀胱出口梗阻愈严重 ,膀胱排尿功能愈差。RF这一评价BPH所致的膀胱出口梗阻程度的指标是对PRV的有益补充。     

良性前列腺增生患者前列腺体积参数与膀胱出口梗阻的相关性研究

目的探讨前列腺体积参数对良性前列腺增生（BPH）患者膀胱出口梗阻（B00）及其程度的诊断价值。方法对BPH患者行自由尿流率检查、压力-流率测定和经直肠前列腺B超检查，测量最大尿流率、Shaefer梗阻级别、AG数、前列腺体积（PV）、移行带体积（TZV）和移行带指数（TZI）。结果共有62例BPH患者入选。PV、TZV、TZI与Qmax的相关系数分别为-0．105、-0．173和-0．258。P值均〉0．05。PV、TZV和TZI与Sharer梗阻级别的相关系数分别为0．277、0．315和0．200。P值均〈0．05。PV、TZV和TZI与AG数的相关系数分别为0．263、0．277和0．282，P值均〈0．05；当40〈PV≤60ml时。PV与AG数呈正相关（r=0．263，P〈0．05）；TZI：0．3是BOO的一个分界点。TZI〉0．3者的AG数明显大于PV≤0．3者（P〈0．05）。结论前列腺体积参数可以预测BPH患者B00及其程度。     

良性前列腺增生膀胱出口梗阻的评估

目的探讨前列腺体积参数对良性前列腺增生（BPH）患者膀胱出口梗阻（BOO）及其程度的诊断价值。方法随机选择住院的BPH患者,行自由尿流率检查、压力-流率测定和经直肠前列腺B超检查,测量前列腺体积（PV）、移行带体积（TZV）,并计算移行带指数（TZI）。结果共有62例BPH患者符合入选标准。PV、TZV和TZI与Shfer梗阻级别的相关系数分别为0.277、0.315和0.200,P均〈0.05。PV、TZV和TZI与AG数的相关系数分别为0.263、0.277和0.282,p〈0.05;当400.3者的AG数明显高于PV≤0.3者（p=0.025）。结论前列腺体积参数可以预测BPH患者BOO及其程度。     

膀胱出口梗阻诊断标准的研究

膀胱出口梗阻(Bladderoutletobstruction,BOO)是泌尿外科的一个老问题。近年来关于BOO的诊断有了很多新的见解,提出了一些新的评价方法,现予介绍。1　定性1.1　临床症状评分、剩余尿和最大尿流率(Qmax)此三者是较早的评价方法,现对其提出质疑。临床症状评分无论是用IPSS还是用AUA表,梗阻患者及非梗阻患者均可有较高的积分,但同一患者作某种处理前后的积分增减仍很有意义〔1,2〕。剩余尿的解释也是这样。在除外原发性逼尿肌无力(如糖尿病性逼尿肌病变等)后,Qmax仍是BOO的定性指标。1.2　最大排尿压在逼尿肌功能正常的前提下,最大排尿…     

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.     

剩余分数在膀胱出口梗阻中应用的评价

目的 评价剩余分数在膀胱出口梗阻中的应用。方法 应用B型超声波检测仪及尿流参数自动检测仪对60名患有良性前列腺增生症的门诊患者(尿潴留及神经原性膀胱患者除外)进行排尿前尿量、剩余尿量及最大尿流率测定。分别用剩余分数、剩余尿量与最大尿流率作直线相关分析。结果剩余分数与最大尿流率呈负相关,且相关系数具有极显著意义(r=-0.3425,P<0.01),剩余尿量与最大尿流率也呈负相关,其相关系数具有显著意义(r=-0.2587,p<0.05)。结论 剩余分数值越大,膀胱出口梗阻愈严重,膀胱排尿功能愈差。剩余分数较剩余尿量更能准确地反映膀胱出口梗阻情况。     

Residual fraction as a parameter to predict bladder outlet obstruction in men with lower urinary tract symptoms

Objectives:   To determine whether noninvasive tests including the residual fraction are reliable for the diagnosis of bladder outlet obstruction (BOO).
Methods:   A total of 212 men (median age 68, range 44–89 years) were included in the present study. The median serum prostate-specific antigen level and prostate volume were 1.3 ng/mL (range 0.2 to 9.4) and 37.9 mL (range 11.3 to 148.0), respectively.
Results:   Among the variables analyzed in the multivariate model, the likelihood of BOO varied by the total prostate volume, with a 3.6-fold higher odds for ≥40 mL than for <40 mL (odds ratio [OR], 3.616; 95% confidence interval [CI], 1.217–10.749; P  = 0.021). In the same model, a low maximal flow rate (Qmax) (OR, 2.840; 95% CI, 1.260–6.401; P  = 0.012) and high residual fraction (OR, 7.103; 95% CI, 1.924–26.225; P  = 0.003) were associated with an increased likelihood of BOO. The sensitivity and specificity for predicting BOO using a total prostate volume of 40 mL or greater were 73.7% and 65.2%, respectively. Using a Qmax cut-off of 12 mL/s or less for predicting BOO, the sensitivity and specificity were 77.2% and 54.2%, respectively. Prediction of the BOO by the residual fraction only had a sensitivity and specificity, for a residual fraction of less than 20%, of 75.4% and 67.7%, respectively.
Conclusions:   The presence or absence of BOO might be predicted using non-invasive methods. The residual fraction may help with patient management by better predicting the likely patient classification from pressure-flow studies.     

Prediction of bladder outlet obstruction in men with lower urinary tract symptoms using artificial neural networks

PURPOSE: To evaluate the performance of a backpropagation artificial neural network (ANN) in the diagnosis of men with lower urinary tract symptoms (LUTS) and to compare its performance to that of a traditional linear regression model. MATERIALS AND METHODS: 1903 LUTS patients referred to the University Hospital Nijmegen between 1992 and 1998 received routine investigation, consisting of transrectal ultrasonography of the prostate, serum PSA measurement, assessment of symptoms and quality of life by the International Prostate Symptom Score (IPSS), urinary flowmetry with determination of maximum flow rate (Qmax), voided volume and post-void residual urine and full pressure flow studies (PFS). Using a three-layered backpropagation ANN with three hidden nodes, the outcome of PFS, quantified by the Abrams-Griffiths number (AG-number), was estimated based on all available non-invasive diagnostic test results plus patient age. The performance of the network was quantified using sensitivity, specificity and the area under the ROC-curve (AUC). The results of the neural network approach were compared to those of a linear regression analysis. RESULTS: Prostate volume, Qmax, voided volume and post void residual urine showed substantial predictive value concerning the outcome of PFS. Patient age, PSA-level, IPSS and Quality of life did not add to that prediction. Using a cut-off value in predicted and true AG-numbers of 40 cm. H2O, the neural network approach yielded sensitivity and specificity of 71% and 69%, respectively. The AUC of the network was 0.75 (standard error = 0.01). A linear regression model produced identical results. CONCLUSIONS: This study shows that at an individual level, the outcome of PFS cannot be predicted accurately by the available non-invasive tests. The use of ANNs, which are better able than traditional regression models to identify non-linear relations and complex interactions between variables, did not improve the prediction of BOO. Thus, if precise urodynamic information is considered important in the diagnosis of men with LUTS, PFS must be carried out. Both neural networks and regression analysis appear promising to identify patients who should undergo PFS, and those in whom PFS can safely be omitted. Furthermore, the ability of ANNs and regression models to predict treatment result should be evaluated.     

女性膀胱流出道梗阻的影像尿动力学检查特点分析

目的 探讨女性膀胱出口梗阻(BOO)患者影像尿动力学检查特点及意义.方法 女性BOO患者42例,根据梗阻部位分为膀胱颈梗阻(7例)、中段尿道梗阻(13例)、远端尿道梗阻(15例)、尿道外口梗阻(3例)、盆腔器官重度脱垂(4例)5组.患者术前均行影像尿动力学检查,比较5组病例Qmax、最大膀胱容量、Pdet atQmax、残余尿、逼尿肌无抑制收缩、双侧肾积水等指标.结果 42例患者中以尿频、尿急等储尿症状为主者17例(40.5%),以排尿困难等为主者4例(9.5%),混合症状者21例(50.0%).42例Qmax(10.9±5.6)ml/s、最大膀胱容量(253±140.7)ml、Pdet atQmax(53.3±25.7)cm H2O、残余尿量(76.2±70.3)ml,逼尿肌无抑制收缩者21例(50.0%);5组患者比较:最大膀胱容量差异无统计学意义;膀胱颈梗阻组Pdet atQmax最高、残余尿量最多、Qmax最低、肾积水比例最高,与其他各组比较差异有统计学意义(P<0.05);逼尿肌无抑制收缩在外括约肌部梗阻患者中10例(76.9%),与其他各组比较差异有统计学意义(P<0.05).结论 影像尿动力学检查能有效评估女性BOO下尿路功能,提示梗阻部位并指导临床治疗.女性BOO患者中膀胱颈梗阻程度是影响上尿路损害的主要因素.     

Effects of the selective acetylcholinesterase inhibitor TAK-802 on the voiding behavior and bladder mass increase in rats with partial bladder outlet obstruction

PURPOSE: We examined the effects of the selective acetylcholinesterase (AChE) inhibitor TAK-802 on voiding behavior and residual urine volume in rats with partial bladder outlet obstruction (BOO) vs rats treated with the nonselective AChE inhibitor distigmine and the muscarinic agonist bethanechol. In addition, the effect of repeat doses of TAK-802 on the bladder mass increase associated with BOO was also examined. MATERIALS AND METHODS: Male rats with BOO were used. Six to 8 days after obstruction voiding behavior was observed in a metabolic cage. The animals were then treated orally with 1 drug, and voiding frequency and urine volume at each void were measured for 3 hours. Subsequently the volume of urine retained in the bladder (residual urine) was measured. In another experiment bladder weight in rats with BOO was measured after early repeat doses of TAK-802. RESULTS: BOO increased voiding frequency and decreased average voided volume. TAK-802 and distigmine increased average voided volume, while not causing any change in voiding frequency. On the other hand, bethanechol increased voiding frequency without affecting average voided volume. While all 3 drugs significantly decreased residual urine volume, TAK-802 was most efficacious. In addition, bladder weight in the control BOO group was greater (approximately 2.2-fold) than that in the sham operated group and early repeat administration of TAK-802 prevented the bladder mass increase. CONCLUSIONS: AChE inhibitors decreased residual urine volume by restoring voiding function in rats with BOO, although only the effect of TAK-802 was dose dependent. Bethanechol also decreased residual urine volume in a dose dependent manner but by increasing voiding frequency. The prevention of a bladder mass increase by TAK-802 treatment may be attributable to its effect on restoring voiding.     

良性前列腺增生患者并发膀胱过度活动症与膀胱出口梗阻的关系

目的：研究分析BPH患者并发膀胱过度活动症（OAB）与膀胱出口梗阻（BOO）程度的相关性。方法：163例BPH患者,根据OAB症状评分（OABSS）将患者进行严重程度分级：0级无尿急等OAB症状;OABSS为1级≤5分;2级6-11分;3级≥12分。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（Q_max）、剩余尿,最大尿流率时的逼尿肌压力（P＆_det@Q_max）,并计算出AG值,进行方差分析和相关性分析检验。结果：按OAB症状严重程度分为四组：0级44例,1级35例,2级46例,3级38例。OAB症状程度轻重与患者年龄、前列腺体积、最大自由尿流率等无相关。IPSS评分随OAB症状加重而增高,0～3级分别为（8．4±4．2）、（12．7±3．8）、（15．6±3．6）、（18．5±4．1）分（F=49．931,P=0．000）;前列腺中叶增生程度（IPP）呈现显著性升高趋势,0～3级分别为（0．4±0．3）、（0．8±0．5）、（1．1±0．7）、（1．3±0．6）cm（F=21．385,P=0．000）;剩余尿量显著增多,0-3级分别为（50．6±36．1）、（64．5±29．0）、（68．3±30．8）、（72．71±39．2）ml（F=3．345,P=0．021）;P_det@Q_max显著增高,0～3级分别为（48．3±7．5）、（53．6±27．9）、（58．7±29．1）、（70．4±26．8）cmH2O（1cmH2O=0．098kPa,F=3．722,P=0．012）。BOO（AG〉40）发生率分别为：0级36．4％（16／44）、1级54．3％（19／35）、2级58．7％（27／46）、3级73．7％（28／38）,显示OAB症状与AG值呈正相关（r=0．263,P=0．001）。结论：BPH患者并发膀胱过度活动症与膀胱出口梗阻存在显著相关性。     

前列腺增生患者逼尿肌收缩曲线下面积相关参数与膀胱出口梗阻的关系

目的 分析逼尿肌收缩曲线下面积相关参数与BOO的关系,探讨逼尿肌收缩曲线下面积相关参数用于诊断BOO的可行性. 方法 2006年10月至2008年10月对138例BPH患者行尿动力学检查,通过AG数和直线被动尿道阻力关系(Lin-PURR)将患者分为无梗阻、可疑梗阻和梗阻3组.计算排尿时逼尿肌收缩曲线下面积(AUCdet)、排尿时逼尿肌收缩曲线下面积与排尿量的比值(AUCdet/Vol),并与AG数和Lin-PURR做相关性检验,使用线性区别分析方法 对AUCdet/Vol 关于无梗阻、可疑梗阻和梗阻的分类与传统方法 进行比较. 结果 AUCdet、AUCdet/Vol与AG数、Lin-PURR具有很好的相关性(均P＜0.001).109例患者根据AG数和Lin-PURR进入下一步分析,其中无梗阻33例、可疑梗阻32例、梗阻44例.3组患者AUCdet分别为(766±354)、(1214±800)、(2294±1166)cm H2O·s,AUCdet/Vol分别为(5.47±2.26)、(9.65±4.94)、(20.03±10.86)crn H2O·s/ml,组间比较差异均有统计学意义(均P＜0.001).AUCdet/Vol诊断BOO与传统分组方法 的总符合率为68.8%(75/109),其中诊断无梗阻、可疑梗阻和梗阻的符合率分别为90.9%(30/33)、43.8%(14/32)和70.5%(31/44). 结论 应用逼尿肌收缩曲线下面积相关参数可以很好地反映BOO情况.