慢性前列腺炎患者的尿动力学分析

目的探讨Ⅲ型慢性前列腺炎患者存在的下尿路症状,结合尿动力学检查分析其原因。方法对30例Ⅲ型慢性前列腺炎患者行尿动力学检查,测量其尿流率、充盈性膀胱测压、压力-流率测定、尿道括约肌肌电图同步检测、尿道测压。结果最大尿流率降低18例（60．0％）,前列腺压增高5例（16．7％）,逼尿肌过度活动11例（36．7％）,膀胱出口处梗阻9例（30％）,膀胱感觉过敏5例（16．7％）,低顺应性膀胱4例（13．3％）,逼尿肌收缩无力4例（13．3％）,逼尿肌外括约肌不同程度协同失调14例（46．7％）。结论Ⅲ型慢性前列腺炎患者出现不同程度的下尿路症状与前列腺或盆腔局部因素诱发的逼尿肌过度活动、膀胱出口梗阻和逼尿肌-外括约肌协同失调有关。认识并解除这些相关因素有助于提高慢性前列腺炎的治疗效果。     

前列腺增生症疗效不佳者尿流动力学原因分析

为分析良性前列腺增生症（ＢＰＨ）疗效不佳的原因，对５８例曾接受经膀胱及Ｍａｄｉｇａｎ前列腺摘除术，经尿道前列腺切除术、经尿道激光治疗、微波及射频热疗等不同方法治疗并诉疗效不满意的ＢＰＨ患者进行尿流动力学测定，项目为充盈膀胱测压、压力－流率测定、ＥＭＧ测定、静态及加压尿道压力测定。测定结果出口梗阻（ＢＯＯ）占４８．３％、副尿肌收缩无力（ＤＤＣ）占１７．２％、逼尿肌不稳定（ＤＩＳ）占２０．７％、压力性     

前列腺增生症患者的尿动力学诊断价值评估

目的　评估尿流动力学检查在前列腺增生症患者所致的下尿路症候群中的诊断价值。方法　采用自制半卧位床 ,常规行尿流率、压力 流率测定及尿道测压 ,并同步测定尿道外括约肌肌电图及残余尿量 ;并记录膀胱逼尿肌受损情况、膀胱顺应性和尿道外括约肌协调情况。联合应用A G图、P Q图及DS诊断BOO(膀胱出口梗阻 ) ,结果进行统计处理。结果　本组患者 338例 ,312例诊断为BOO ,71例可疑 ,5例无BOO。其中伴膀胱低顺应性 12 3例 ,膀胱逼尿肌功能受损 10 8例 ,尿道外括约肌功能失调 15 7例 ,不稳定膀胱 134例。随着BOO程度加重 ,Pdet Qmax、Popen、DS、IPSS积分及前列腺体积呈升高趋势 ,膀胱顺应性、Qmax呈下降趋势。结论　前列腺增生症患者排尿障碍的机制是排尿过程中机械因素和动力学因素共同作用的结果 ,尿流动力学检查在其诊断评估中扮演着一个极其重要的角色。BOO程度与Pdet Qmax、Popen、DS、IPSS积分及前列腺体积呈正相关 ,与膀胱顺应性、Qmax呈负相关     

尿动力学检查在处理前列腺增生症中的意义

为评价尿动力学检查（ＵＤＳ）在良性前列腺增生症（ＢＰＨ）诊治中的意义，对９４例ＢＰＨ病人进行了详细尿动力学检查。发现９４例均有膀胱出口梗阻（ＢＯＯ）；逼尿肌收缩正常或增强９２例，乏力２例；逼尿肌不稳定（ＤＩ）４０例；尿流率（ＵＦＲ）低平８６例，正常８例。手术治疗６０例，术后症状消失５８例，２例出现并发症经再次处理治愈；ＵＦＲ形态恢复正常５８例，２例低平为逼尿肌收缩乏力者。无ＤＩ者症状在术后２～６周消失，ＤＩ较轻和顺应性降低不明显者术后恢复与非ＤＩ者无区别，ＤＩ严重和顺应性严重降低者术后需６～１２周，个别需６～１２个月才能恢复。本研究表明ＵＤＳ能明确ＢＰＨ有无ＢＯＯ、逼尿肌顺应性和收缩功能，以及尿道括约肌功能状态，对术前合理选择病例和提高手术疗效具有重要意义。     

尿流动力学测定对前列腺增生诊治的临床意义

作者对７４例前列腺增生患者进行了系统的尿流动力学检查，包括尿流率、膀肮测压、尿道分布压及括约肌肌电图。文中对前列腺体积（５７．３±６．３ｍｌ）、前列腺长（４．９４±１．２３ｃｍ）及逼尿肌收缩压（６．５４±４．７２ｋＰａ）三者的关系进行了分析，从动力学角度观察了前列腺增生对膀肮、尿道功能的影响，结果表明尿动力学检查对前列腺增生患者治疗方案的选择及术后疗效预测具有重要作用。尿流动力学检查显示膀胱功能处于失代偿期的患者宜先行膀胱造瘘；在判断尿路梗阻方面，尿道阻力测定的临床价值较尿流率测定更大。     

压力-流率测定在评估前列腺增生症手术适应证中的作用

对１２０例前列腺增生症（ＢＰＨ）患者进行了压力流率测定，以评估其在手术适应证中的作用。经Ｓｃｈｆｅｒ列线图和直线被动尿道阻力关系（ｌｉｎＰＵＲＲ）定量分析ＢＰＨ患者膀胱出口梗阻（ＢＯＯ）程度和逼尿肌收缩强度。结果表明：本组患者无ＢＯＯ和轻度ＢＯＯ者为２９．１％，逼尿肌收缩强度很弱者为７．５％，不适合前列腺手术者为３６．６％；ＢＯＯⅡ度者，ＩＰＳＳ＜７可等待性观察；ＢＯＯ＞Ⅲ度者，部分患者病情可进一步发展而需手术处理，尿流率和ＩＰＳＳ是有效的观察手段。逼尿肌收缩强度弱者，术后逼尿肌收缩功能可能改善；逼尿肌收缩强度很弱者，术后其功能难以改善     

BPH膀胱出口梗阻患者的逼尿肌功能状况评价

为了解前列腺增生症（ＢＰＨ）膀胱出口梗阻（ＢＯＯ）患者的逼尿肌功能状况，对６７例ＢＰＨ患者进行了尿动力学及直肠Ｂ超检查，结果发现逼尿肌痉挛、逼尿肌低顺应性，逼尿肌括约肌功能不协调及逼尿肌收缩力亢进在梗阻病人中的发生率分别为３４．３％，１７．９％，２５．４％，２６．９％；有前列腺突入膀胱的患者更易发生逼尿肌功能受损。对ＢＰＨ患者的逼尿肌功能作出准确评价，在手术时机的选择及预后判断方面具有十分重要的临床意义。     

影响前列腺手术疗效的逼尿肌因素

为探讨逼尿肌功能受损对前列腺手术疗效的影响 ,我们对 40例良性前列腺增生 (ＢＰＨ)患者手术前、后分别进行尿流动力学测定 ,报告如下。资料与方法　本组 40例。年龄 6 0～ 83岁 ,平均 6 9岁。 5例行耻骨上前列腺切除术 ,35例行经尿道前列腺电切术(ＴＵＲＰ)。 40例均排除神经系统疾病 ,肾功能正常 ,均行Ｂ超或ＣＴ检查并行国际前列腺症状评分 (ＩＰＳＳ)。手术前、后采用尿动力学分析仪测定充盈期膀胱压、压力流率、尿道压、膀胱等容收缩压。统计学方法采用ｔ检验。结　果　有逼尿肌功能受损 (Ａ组 )的 19例ＢＰＨ病人中 11例逼尿肌功能不…     

尿动力学检查在下尿路症状及良性前列腺增生诊治中的作用

尿动力学对评估前列腺增大 (ＢＰＥ)及下尿路症状 (ＬＵＴＳ)的作用至今尚不清楚。多数学者认为 ,虽然良性前列腺增生 (ＢＰＨ)的症状、尿动力学、病理学及病理生理学之间的关系极为复杂 ,但有证据证明 ,尿流率及压力 /流率测试对膀胱出口梗阻 (ＢＯＯ)的诊断和疗效评估有帮助。临床医师常常对ＬＵＴＳ患者作出最初诊断后 ,就按ＢＰＨ治疗。因此 ,从尿动力学角度探讨ＬＵＴＳ及ＢＰＨ对临床有实际指导意义。一、对单纯尿流率测定的认识尿流率测定不能区分ＢＯＯ及逼尿肌反应 ,但它是最常用的尿动力学检查。第五届国际ＢＰＨ咨询委员会建议Ｂ…     

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。     

Urodynamic analysis in 245 patients with benign prostatic hypertrophy

To study the mechanism of voiding disorder and promote thediagnosic accuracy of bladder outlet obstruction (BOO), a full setof urodynamic examination were employed with self-made semi-supine bed and Manneu Danec Urodynamic device in 245 patients.The results showed definite BOO in 161 cases, doubtful BOO in 50cases, detrusor muscle dysfunction in 65 cases, depressed bladdercompliance in 70 cases, urethral sphincter dyssynergia in 114 cas-es , and unstable bladder in 59 cases. There is a close relationshipbetween the functional urethral length and the prostatic urethrallength as determined by B ultrasound. It suggests that both the dy-namic and mechanical factors are attributed to voiding disorder inpatients with BPH. The urodynamic examination plays an importantrole in the diagnosis of BOO. (Chin J Androl 2000; 4: 234 - 236)     

Utility of the American Urological Association symptom index in the diagnosis of women with voiding dysfunction

The objective of the study was to determine the applicability of the American Urological Association (AUA) symptom index to the assessment and treatment of women with voiding dysfunction while investigating the specificity of the index to men with benign prostatic hyperplasia (BPH).One hundred and two consecutive adult patients (45 females, 57 males) with symptoms of dysfunctional micturition were prospectively evaluated using both the AUA symptom index and videourodynamic studies. According to urodynamic criteria, the patients were placed into three groups: 45 women with stress incontinence and/or detrusor instability but without bladder outlet obstruction (BOO); 23 men with detrusor instability (DI) without BOO; and 34 men with BPH and BOO. Correlation between symptom index scores and patient characteristics were examined. The mean index score for the 45 women was 17.0 (range 4–33). In contrast, the men scored mean values of 18.9 (range 7–28) and 20.5 (range 12–27) for the BPH with BOO and DI without BOO groups, respectively. The total score was statistically correlated with age, duration of bladder symptoms, cystometric capacity and maximum urine flow rate.The quantification of voiding symptoms, using the AUA symptom index, yields strikingly similar results in both women and men with voiding dysfunction, despite vastly different bladder and urethral pathologies. The etiology of voiding symptoms, whether detrusor dysfunction or bladder outlet obstruction, cannot be determined by the AUA symptom index. The index should, however, prove to be useful in evaluating treatment outcome in both men and women with voiding dysfunction.     

膀胱出口梗阻

对主诉为排尿困难和(或)盆底部疼痛的病人510例行四导程尿流动力学检查。分析其临床表现及尿流动力学检查等结果,360例属膀胱出口梗阻(BOO),含神经源性功能性BOO 77例,非神经源性BOO 283例,其中机械性梗阻239例(BPH 189例,膀胱颈梗阻即BNO 45例。远端尿道缩窄即DUS5例),功能性梗阻44例(外括约肌痉挛症24例,特发性非神经源性尿道内括约肌痉挛症即MNISS 20例)。同时检出非梗阻性特发症MNISS13例,其尿道交感神经兴奋性增高是盆底内脏交感神经兴奋性增高的表现。     

尿动力学测定对前列腺增生患者逼尿肌不稳定的应用价值

为探讨膀胱出口梗阻患者逼尿肌不稳定的情况，对８３例存在膀胱出口梗阻的前列腺增生患者进行尿动力学测定。结果表明：４０例（４８．２％）患者出现逼尿肌不稳定，压力－流率测定发现该组病例排尿期逼尿肌各压力值均增高，尤以膀胱颈部开口压增高为显著，不稳定组为１３．２±３．４ｋｐａ，稳定组为８．２±２．４ｋＰａ，不稳定组开口压增高速率（０．９±０．１ｋＰａ／ｓ）明显大于逼尿肌稳定组（０．３±０．１ｋＰａ／ｓ）；随开口压增高，逼尿肌不稳定的发生率相应增高。长期高压力、高输出状态可能为逼尿肌无抑制性收缩的形成条件     

动态尿动力学监测

介绍一种接近生理状态下监测自然排尿过程的动态尿动力学监测方法，以精密换能传感器导管直接测定膀胱、逼尿肌、直肠和尿道外括约肌压力，用微机分析结果；该法对排尿生理 疾病的诊断具有重要意义。用本法对１１例有排尿异常的病例进行动态尿动力学监测，明确了诊断，为治疗提供了可靠的依据，动态尿动力学监测可作为常规尿动力学监测的补充。     

前列腺增生患者膀胱出口梗阻程度对尿动力学指标的影响

目的探讨前列腺增生患者膀胱出口梗阻程度对尿动力学指标的影响及临床意义。方法分析113例前列腺增生患者的尿动力学资料,根据膀胱出口有无梗阻分为梗阻组和非梗阻组,梗阻组又根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级四组。结果梗阻组的最大尿流率、膀胱顺应性值和逼尿肌收缩力减弱发生率明显低于非梗阻组,逼尿肌不稳定和急性尿潴留发生率明显高于非梗阻组。梗阻组内各梗阻级别之间在顺应性值、逼尿肌不稳定和急性尿潴留的发生率上无显著性差异,随梗阻级别增加尿流率和逼尿肌收缩功能受损发生率下降。结论一些反映排尿异常和逼尿肌功能的尿动力学指标受膀胱出口梗阻程度影响,在无法进行压力/流率分析时综合分析这些指标有助于判断出口梗阻及其程度。     

尿动力学检查在糖尿病患者膀胱功能评定中的意义

目的探讨尿动力学检查在糖尿病患者膀胱功能障碍诊断中的意义。方法伴有下尿路症状(LUTS)的糖尿病患者42例，年龄38～78岁，男24例，女18例。糖尿病发病1个月一25年。结果42例患者完成尿动力学全项检查41例，尿动力学表现异常者38例(93％)，尿动力学表现正常3例(7％)；膀胱逼尿肌收缩减低14例(34％)；膀胱逼尿肌反射消失10例(24％)；膀胱出口梗阻13例(32％，13／41)；女性压力性尿失禁1例。结论伴有LUTS的糖尿病患者膀胱功能异常发生率高，尿动力学检查可以明确膀胱逼尿肌功能，对合并糖尿病的LUTS患者正确诊断和治疗具有重要意义．糖尿病患者行膀胱尿道手术前进行尿动力学检查可提高手术成功率。     

Diagnosing bladder outlet obstruction in women

PURPOSE: There are no universally accepted urodynamic criteria for diagnosing female bladder outlet obstruction. When accepted criteria for men are applied to women, the diagnosis of obstruction may often be missed, which is most likely due to differences in voiding dynamics. We propose video urodynamic criteria for diagnosing obstruction in women, and describe the urodynamic findings in those with and without obstruction. MATERIALS AND METHODS: We reviewed the charts of 331 women who underwent multichannel video urodynamics for nonneurogenic voiding dysfunction. Of these women 261 (mean age 55.8 years) had evaluable voiding pressure flow studies with simultaneous video fluoroscopy of the bladder outlet during voiding. At video urodynamics cases were classified as obstructed if there was radiographic evidence of obstruction between the bladder neck and distal urethra in the presence of a sustained detrusor contraction. Strict pressure flow criteria were not used. Maximum flow rate, detrusor pressure at maximum flow rate, post-void residual, bladder capacity and the incidence of detrusor instability were compared between obstructed and unobstructed cases. RESULTS: A total of 76 women met the criteria for obstruction (mean age 57.5 years), while 184 (mean age 55) did not. Causes of obstruction were dysfunctional voiding in 25 cases, cystocele in 21, primary bladder neck obstruction in 12, iatrogenic from incontinence surgery in 11, urethral stricture in 3, uterine prolapse in 2, urethral diverticulum in 1 and rectocele in 1. Obstructed cases had lower mean maximum flow rate (9 versus 20.2 ml. per second, p <0.0001), higher mean detrusor pressure at maximum flow rate (42.8 versus 22.1 cm. water, p <0.0001) and higher mean post-void residual (157 versus 33 ml., p <0.0001). There was no difference in bladder capacity (381 versus 347 ml.) or incidence of detrusor instability (45 versus 41%). CONCLUSIONS: Using the proposed video urodynamic criteria obstructed cases had significantly higher voiding pressures, lower flow rates and higher post-void residual than unobstructed cases, as expected. However, absolute values, especially for voiding pressure, are not as dramatic in women as in men. Pressure flow studies alone may fail to diagnose obstruction but simultaneous imaging of the bladder outlet during voiding greatly facilitates diagnosis.