膀胱逼尿肌功能改变对前列腺增生手术效果的影响

为探讨膀胱逼尿肌功能改变为前列腺增生（BPH）手术效果的影响，对336例BPH例BPH患者于术前行尿流动力学检查，对82例术后疗效不满意患者行尿流动力学加膀胱镜检查。结果术前膀胱逼尿肌功能异常者326例（97％），其中痉挛109例（32．4％）、低顺应性73例（21．7％）、逼尿肌括约肌功能失调（DSD）43例（12．8％）、功能亢进51例（15．2％）、收缩乏力50例（14．9％）。术后共82例疗效不满意（24．4％），其中膀胱逼尿肌功能紊乱为主要因素者39例（47．6％）；25例术后6个月症状改善，合并神经损害及高龄、膀胱逼尿肌收缩乏力者疗效较差。认为膀胱逼尿肌功能可预测BPH手术效果，并指导术前、术后治疗。     

女性压力性尿失禁严重程度与尿动力学参数的相关性分析

目的 探讨女性真性压力性尿失禁（GSⅠ）患者临床表现严重程度与尿动力学参数的相关性。方法 50例GSⅠ患者安排填写国际尿失禁咨询委员会尿失禁问卷简表（ⅠCⅠ-Q-SF），依据其评分分为三组，Ⅰ组问卷表评分≤7分。Ⅰ组7分〈评分〈14分，Ⅰ组14分≤评分≤21分。分别记录三组排尿日记并测定其尿动力学参数。结果 功能性膀胱容量和valsalva漏尿点压在Ⅰ、Ⅰ、Ⅲ组之间逐渐降低，具显著性差异（P〈0．05）。Ⅰ组最大尿道压、最大尿道闭合压、最大尿流率时逼尿肌压力和最大逼尿肌压力均显著高于Ⅰ、Ⅲ组（P〈0．05）。三组总排尿量、总排尿次数、最大尿流率、膀胱顺应性、最大膀胱压测定容量和功能性尿道长度无显著性差异（P〉0．05）。结论 有选择地应用排尿日记指标和尿动力学参数可有效地评估女性尿失禁患者的严重程度。     

尿动力学检查对前列腺增生症所致膀胱出口梗阻的诊断价值

目的探讨尿动力检查对前列腺增生症（BPH）所致膀胱出口梗阻（BOO）的诊断价值。方法对274例BPH患者行尿动力学检查,联合应用A-G图和LinPURR图诊断BOO并分等级。结果诊断为BOO225例（82．1％）,可疑BOO31例（11．3%）,无BOO18例（6．6%）;逼尿肌不稳定（DI）93例,逼尿肌低顺应性82例,逼尿肌活动低下（DUA）68例,逼尿肌—括约肌协同失调（DSD）19例。随着BOO程度加重,IPSS评分、残余尿、DI和DUA发生率呈升高趋势,而逼尿肌顺应性、最大尿流率（Qmax）呈下降趋势。结论尿动力学检查是诊断BOO的金标准,BPH患者可根据术前的尿动力学检查结果选择治疗方案。     

TURP同期膀胱造瘘术治疗合并逼尿肌收缩力减弱的良性前列腺增生症

目的观察经尿道前列腺电切（TURP）同期膀胱造瘘术治疗合并逼尿肌收缩力减弱良性前列腺增生（BPH）的疗效。方法 60例合并逼尿肌收缩力减弱的BPH患者,按膀胱逼尿肌受损程度分为A组[30 cmH2O≤排尿期膀胱逼尿肌压力（Pdet）30-40 cmH2O]、B组（Pdet 20-30 cmH2O）和C组（Pdet 10-20 cmH2O）,均同期行TURP膀胱造瘘术,术后1 a随访最大尿流率、残余尿量、国际前列腺症状评分（IPSS）和生活质量评分（QOL）。结果 A组24例术后2周均拔除造瘘管,排尿通畅,总有效率100%;B组21例中19例先后拔除造瘘管,排尿良好,2例终生保留造瘘管,总有效率90.5%;C组15例中6例先后拔除造瘘管,排尿良好,9例终生保留造瘘管,总有效率40%。结论 BPH患者,由于单纯膀胱出口梗阻引起逼尿肌收缩力减弱时,如逼尿肌轻度受损或中、重度受损而腹压较高者,可行TURP同期膀胱造瘘术;逼尿肌重度受损且腹压低者,宜行单纯膀胱造瘘术,3个月后如逼尿肌功能明显改善,可行TURP。     

胰激肽原酶对糖尿病神经原性膀胱的疗效观察

目的探讨胰激肽原酶（PK）对糖尿病神经原性膀胱的疗效。方法40例糖尿病神经原性膀胱女性患者随机分为PK治疗组（PK组）、对照组（Con组）各20例。PK组日1次肌注PK40U；Con组日1次肌注维生素B12 500μg。治疗前及治疗后的1个月、2个月检测尿流率、残余尿、最大尿流率、平均尿流率及排尿期逼尿肌压。结果治疗后PK组残余尿量显著降低，最大尿流率、平均尿流率及排尿期逼尿肌压均显著增加（P〈0.05）。Con组治疗后1个月各项结果较治疗前无统计学差异（P〉0.05）。治疗后2个月残余尿量轻度降低，最大尿流率及排尿期逼尿肌压升高，较治疗前差异有统计学意义（P〈0．05）。PK组与Con组比较，残余尿量更低，最大尿流率、平均尿流率及排尿期逼尿肌压更高，差异有统计学意义（P〈0.05）。结论胰激肽原酶可以作为治疗糖尿病神经原性膀胱的用药之一。     

高龄良性前列腺增生中小体积前列腺伴膀胱出口梗阻患者的尿动力学特点

目的探讨高龄良性前列腺增生(BPH)中小体积前列腺伴膀胱出口梗阻(BOO)患者的尿动力学特点。方法年龄>70岁的高龄BPH中有BOO的患者115例,根据前列腺体积分为前列腺体积≤30 ml组45例,>30 ml组70例,比较两组年龄、血清前列腺特异性抗原(TPSA)水平、残余尿量、最大尿流率(Qmax)、平均尿流率、排尿量、排尿时间、膀胱顺应性、Qmax时膀胱压力、逼尿肌收缩能力。结果前列腺体积≤30 ml组年龄、Qmax时膀胱压力及Qmax时逼尿肌压力均明显低于前列腺体积>30 ml组,而残余尿量明显高于前列腺体积>30 ml组(P<0.05);前列腺体积≤30 ml组逼尿肌收缩乏力发生率明显高于前列腺体积>30 ml组(χ~2=3.86,P=0.049)。结论小体积前列腺的BPH,在经尿动力学检查判断为BOO时,合并发生膀胱排空障碍及逼尿肌收缩能力降低的可能性更大。     

开放性手术治疗良性前列腺增生症159例术后3年临床随访

目的评价开放性手术治疗老年人良性前列腺增生症（ＢＰＨ）的远期疗效。方法回顾性分析１９９１年１月至１９９３年１２月耻骨上经膀胱前列腺切除术治疗的老年ＢＰＨ患者１５９例，其中１３０例（８１．８％）得到随访，以填写问答表格的方法，统计患者对疗效的评价。结果术前症状总计分１７．４±８．０分，术后出院时为３．７±３．３分，总分下降幅度７１．３％；梗阻症状评分下降幅度（７７．９％）大于刺激症状评分下降幅度（４０．９％）。术前最大尿流率８．０±３．６ｍｌ／ｓ，平均尿流率２．９±１．９ｍｌ／ｓ；术后２０天左右分别为１６．７±８．１及１０．２±４．８ｍｌ／ｓ。患者对手术效果总满意率为８８．２％。结论开放性手术治疗老年人ＢＰＨ其效果肯定，术后严重并发症少，仍是一种治疗老年人ＢＰＨ的重要手段。     

前列腺增生症的尿流动力学研究

前列腺增生症的尿流动力学研究山东医科大学附属医院（２５００１２）郑宝钟近来的研究表明，ＢＰＨ导致的膀胱出口梗阻可引起膀胱急性过度扩张及供血减少；久之，膀胱内、外层结构快速再生，平滑肌代偿性增生，从而导致膀胱逼尿肌不稳定（发生率为５０％～８０％）及排空...     

BPH合并糖尿病患者的尿流动力学变化观察

目的观察良性前列腺增生（BPH）合并糖尿病患者的尿流动力学变化。方法对36例单纯BPH患者和10例BPH合并糖尿病患者进行尿动力学检查。结果 BPH组逼尿肌收缩力减弱6例,FSV为（130.8±63.5）ml、最大膀胱容量为（233.8±96.5）ml、残余尿量为（65.6±35.8）ml、膀胱低顺应性26例,BPH合并DM组分别为7例、（214.9±59.3）ml、（312.7±86.5）ml、（95.7±37.6）ml、3例,两组以上指标相比,P均〈0.05。BPH组25例逼尿肌不稳定,BPH合并DM组5例,两组逼尿肌不稳定发生情况相比P〉0.05。结论与单纯BPH患者相比,BPH合并糖尿病患者逼尿肌和膀胱功能障碍更明显,膀胱出口梗阻更明显。     

BPH伴糖尿病患者尿流动力学观察及意义

目的 观察良性前列腺增生(BPH)伴糖尿病患者的尿流动力学特点.方法 采用加拿大Laborie尿动力检查仪对78例BPH伴糖尿病患者(观察组)和80例单纯性BPH患者(对照组)进行尿流动力学检测,并比较两组检测结果.结果 观察组膀胱初始尿意容量、最大膀胱容量、膀胱残余尿量、膀胱顺应性均明显高于对照组,最大逼尿肌压力明显低于对照组,两组比较,P均＜0.05;观察组膀胱感觉减退者、高顺应性膀胱者、逼尿肌收缩乏力者所占比例均明显高于对照组(P均＜0.05),膀胱出口梗阻者所占比例明显低于对照组(P＜0.05).结论 当BPH合并糖尿病时,其典型的尿流动力学表现为膀胱感觉减退、顺应性增高、逼尿肌收缩乏力、膀胱容量及残余尿量增加,且膀胱逼尿肌受损较单纯性BPH患者更明显,治疗BPH合并糖尿病患者时,应积极控制血糖并及早手术解除膀胱出口梗阻,延缓膀胱逼尿肌功能的损害.     

前列腺增生合并慢性前列腺炎患者膀胱功能的尿动力学特点

目的探讨前列腺增生合并慢性前列腺炎患者膀胱功能的尿动力学特点。方法选取2009年6月至2012年6月在解放军第309医院住院的前列腺增生患者187例。按是否合并前列腺炎分为单纯前列腺增生组（n＝91）及合并前列腺炎组（n＝96）。比较两组尿动力学检查指标,包括膀胱容量、最大逼尿肌压力、膀胱稳定性及最大尿道闭合压的差异。结果两组患者测得的膀胱容量（P＝0.741）、最大逼尿肌压（P＝0.872）、最大尿道闭合压（P＝0.590）比较差异无统计学意义;单纯前列腺增生患者的膀胱稳定性优于前列腺增生合并慢性前列腺炎患者,两组间比较差异具有统计学意义[（158.0±42.7） vs （79.6±30.0）ml,P＝0.032]。结论前列腺增生合并慢性前列腺炎患者尿动力学表现主要以不稳定性膀胱为主,导致患者出现尿频、尿急、尿道不适感。     

年龄对良性前列腺增生患者膀胱尿道功能及手术疗效影响

目的 初步探讨年龄对良性前列腺增生(BPH)患者膀胱尿道功能及手术疗效的影响.方法 依据年龄将经尿道前列腺电切术(TURP)的BPH老年患者分为60～74岁组158例,平均(68±4)岁,75～89岁组47例,平均(80±3)岁.术前1周进行国际前列腺症状评分(IPSS)、生活质量评分(QOL)、经直肠超声和尿动力检查,并在术后3个月随访IPSS、QOL、自由尿流率和残余尿量(PVR).结果 术前75～89岁组逼尿肌过度活跃、低顺应性膀胱、逼尿肌活动低下和良性前列腺梗阻发生率分别为70%、34%、19%和77%.均高于60～74岁组的42%、18%、6%和58%,(χ2值分别为10.623、4.328、5.637、4.771,均P<0.05),而平均最大逼尿肌排尿压为(62±29)cm H2O(1 cm HzO=0.098 kPa),低于60～74岁组的(76±22)cm H2O(t=3.265,P<0.05);79～89岁组前列腺长度、功能性尿道长度和膀胱颈口压分别为(52±8)mm、(63±11)mm和(36±15)cm H2O,均高于60～74岁组的(47±7)mm、(59±6)mm和(25±13)cm H2O(t值分别为4.157、3.388、4.912,均P<0.05).术后两组IPSS、QOL和PVR均低于术前,最大尿流率(MFR)高于术前(60～74岁组t值分别为19.744、64.671、23.342、27.504;79～89岁组t值分别为27.308、19.311、9.694、11.671,均P<0.05).但术后79～89岁组MFR低于60～74岁组,QOL和PVR高于60～74岁组(t值分别为3.493、15.245、10.750,均P<0.05).结论 随着年龄增加,BPH老年患者发生膀胱尿道功能障碍风险增加,手术疗效有所下降,尿动力学检查可为其治疗提供客观依据.     

Vesical neuropathy in systemic vasculitis: 3 cases

Bladder neuropathy was diagnosed in 3 patients with systemic vasculitis (temporal arteritis: 1 case; periarteritis nodosa: 2 cases). Clinical characteristics were: dysuria, diminished or abolished bladder sensation leading to indolent bladder retention. Urodynamic investigation showed hypotonic and underactive detrusor, increased detrusor compliance, hyposensitive bladder, and/or overactive urethral closure. Needle electrode examination showed signs of denervation of periurethral muscles; sacral evoked latencies were increased, favouring pudenal nerve alterations. Symptoms and urodynamic abnormalities resolved following corticosteroid therapy. Clinical and therapeutic implications of bladder neuropathy in necrotizing vasculitis are emphasized.     

Changes in Urodynamics and Lower Urinary Tract Symptoms after Radical Prostatectomy: Implications of Preoperative Detrusor Contractility

Objectives: Our goal was to identify changes in urodynamic parameters and lower urinary tract symptoms (LUTS) in men followed for1 year after radical prostatectomy (RP) compared to the preoperative measures with a specific focus on detrusor contractility. Methods: This study enrolled 43 patients who received RP (laparoscopic 27, retropubic: 16) and pressure flow studies (PFS) pre‐RP as well as 12 months (M) after RP. No patients complained of urinary incontinence preoperatively. Urodynamic studies and questionnaires regarding LUTS and urinary continence were conducted before and 12 M after RP. Detrusor underactivity (DU) was defined as <10 (W/m²) in preoperative maximum watts factor value. Results: Urodynamics demonstrated that RP improved urodynamic parameters by releasing bladder outlet obstruction without affecting overall detrusor contractility. Meanwhile, RP did not affect bladder capacity, bladder compliance, or detrusor contractility. LUTS in the International Prostate Symptom Score (IPSS), including the IPSS subscore, was not improved. The quality of life score was significantly better at 12 M after RP and continence rates were gradually improved to be at a satisfactory level in more than 80% of patients by 12 M after RP. DU was preoperatively identified in 21(49%) patients, influencing urodynamic parameters and LUTS preoperatively. However, DU did not affect urodynamic parameters and LUTS after RP. Conclusion: Although RP improves urodynamic parameters, it does not significantly affect LUTS. Urinary continence gradually improves and is satisfactory within 1 year after RP. The status of preoperative detrusor contractility did not affect urodynamic parameters or LUTS after RP.     

The association between urodynamic findings and microvascular complications in patients with long-term type 2 diabetes but without voiding symptoms

Diabetic cystopathy is a common complication of diabetes mellitus, which is assessable by urodynamic study. The purpose of this study was to determine the association between urodynamic findings and microvascular complications (neuropathy, retinopathy, nephropathy) in patients with long-term type 2 diabetes but without voiding symptoms. A total of 66 consecutive patients (26 males and 40 females, age 57.00+/-9.50 years, diabetes duration 14.44+/-6.78 years) with documented type 2 diabetes, low scores at the International Prostate Symptom Score (IPSS) and no subjective complaint of voiding problems were included in the study. Seven urodynamic parameters were considered: detrusor activity, bladder capacity, bladder compliance, first sensation of filling, flow rate, bladder outlet status and post-voiding residue. The following independent associations were found: between female sex and increased bladder capacity (p=0.004), between male sex and both decreased bladder compliance (p=0.023) and bladder outlet obstruction (p=0.001), between old age and both low flow rate (p=0.022) and outlet obstruction (p=0.047), between detrusor instability and shorter duration of diabetes (p=0.044) and between peripheral somatic neuropathy and low flow rate (OR=5.208; 95%CI=1.277-21.277). The Spearman's correlation coefficient for the latter association was 0.356 (p=0.005) and remained significant even after controlling for age, sex, HbA1c and diabetes duration (rho=0.310; p=0.019). In conclusion, searching for microvascular complications might be used to screen for some components of diabetic cystopathy in its asymptomatic phase.     

The effect of age on lower urinary tract function: a study in women

OBJECTIVES: To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO). DESIGN: Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO. SETTING: Community-based volunteers, evaluated in research laboratory. PARTICIPANTS: Eighty-five ambulatory, nondemented, community-dwelling female volunteers, with and without bladder symptoms suggestive of DO, recruited by advertising, mean age 54 (range 22-90); 75% Caucasian, 21% African American. MEASUREMENTS: Comprehensive assessment included bladder diary, uroflowmetry, and detailed videourodynamics. Predefined urodynamic and diary variables were examined for association with age and DO. Mean values of these variables were calculated for subgroups aged 20 to 39, 40 to 59, and 60 and older (14 subjects > or =70). RESULTS: Maximum urethral closure pressure, detrusor contraction strength, and urine flow rate declined significantly with age (P<.001, P<.001, P=.006, respectively), regardless of whether DO was present. Most elderly individuals continued to empty their bladder almost completely, with normal voiding frequency. Mean number of nocturnal voids was less than one in all age groups. Bladder capacity did not decrease with age (mean 522 mL in oldest group) but was smaller in subjects with DO. Bladder sensation diminished significantly with age (P<.001) but was stronger in subjects with DO. CONCLUSION: Female bladder and urethral function appear to deteriorate throughout adult life, whether DO is present or not. Specifically, detrusor contractility, bladder sensation, and urethral pressure decline. The common belief that bladder capacity shrinks with age may be related to DO rather than to aging itself.     

超声测量逼尿肌厚度预测老年男性下尿路梗阻

目的 探讨老年良性前列腺增生(BPH)患者膀胱逼尿肌厚度与膀胱出口梗阻的相关性.方法 106例BPH患者行尿动力学检查,以尿动力学检查结果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.经腹B超在膀胱充盈量至150 ml时测定逼尿肌厚度.结果 最大尿流率和平均尿流率梗阻组[(10.1±3.0)ml/s、(5.5±2.2)ml/s]均明显低于非梗阻组[(17.4±3.1)ml/s、(11.2±2.2)ml/s](t=10.26和11.03,均P<0.01),而残余尿量、逼尿肌最大收缩压力梗阻组[(47.6±24.3)ml、(39.3±14.4)cm H2O]高于非梗阻组[(17.0±5.6)ml、(26.8±8.0)cm H2O,t=6.32和4.07,P<0.01和0.05].逼尿肌厚度与逼尿肌最大收缩压力呈正相关(r=0.419,P<0.01),与最大尿流率(r=-0.749,P<0.01)、平均尿流率(r=-0.853,P<0.01)和排尿量(r=-0.556,P<0.01)呈负相关.逼尿肌厚度梗阻组(3.0±0.2)mm,高于非梗阻组(2.5±0.2)mm(t=11.2,P<0.05).以逼尿肌厚度≥3.0 mm为标准诊断男性下尿路梗阻的灵敏度为90%,特异性为84.6%,阳性预测值93.1%,阴性预测值为78.6%.结论 逼尿肌厚度大于3 mm可预测老年男性膀胱出口梗阻.     

Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non-neurogenic bladder dysfunction

We aimed to compare the short-term outcomes of men who had urodynamic evidence of detrusor underactivity (DU) or detrusor overactivity (DO) of a non-neurogenic etiology as well as bladder outlet obstruction (BOO) and who underwent Holmium Laser Enucleation of the prostate (HoLEP). A database of 322 patients who underwent HoLEP between 2010 and 2014 was analyzed. Patients were classified into three groups according to the results of a preoperative urodynamic study. Preoperative parameters such as International Prostate Symptom Score (IPSS), Quality of Life (QoL) index, IPSS grade, uroflowmetry were compared with postoperative parameters measured at 6 months. There were 138 patients with BOO-only and 89 patients with BOO and detrusor dysfunction including 56 with DO and 33 with DU. The degree of improvement in IPSS-total (BOO: 10.7, DO: 8.3, DU: 7.0; p = 0.023) was greater in the BOO-only group than in the DU group. There were more patients whose IPSS grade improved in the BOO-only group (71%) than in the detrusor dysfunction group (DO: 53.6% and DU: 45.5%). Postoperative IPSS-voiding (4.5 vs 7.0), and Qmax (18 vs 13.7) in the BOO-only group were significantly better than those in the DU group. Additionally, postoperative IPSS-storage (4.7 vs 6.7), and IPSS-total (9.1 vs 12.3) in the BOO-only group were significantly better than in the DO group (all p < 0.05). In conclusion, early surgical management for men with severe LUTS and associated BPH before secondary degeneration occurs may be beneficial for preserving detrusor function and yield better treatment outcomes.