症状性BPH剩余尿及最大尿流率的临床价值再探讨

目的：探讨症状性BPH剩余尿（PVR）、最大尿流率（Qmax）在临床诊疗中的作用。方法：对173例BPH症患者进行IPSS、并测定Qmax、PVR及前列腺体积。应用相关分析评价各检变量间的相关性及其不同组间各指标的比较。结果：PVR与IPSS、前列腺移行带体积均呈正相关,与Qmax呈负相关。与年龄、前列总腺体积（P〉0．05）之间均无相关。PVR〈10ml组与10-30ml组在年龄、IPSS、前列腺移行带体积和Qmax比较差异均无统计学意义。PVR10-30ml组与≥30ml组在年龄、前列腺移行带体积比较差别均无统计学意义,而IPSS、Qmax比较差别有统计学意义。在Qmax〈10mL／s组,Qmax与年龄、IPSS、PVR、前列腺总体积和前列腺移行带体积均呈负相关;在Qmax〉10ml／s组,Qmax与上述指标均呈无相关（P〉0．05）;除年龄外,两组间上述指标均差异有统计学意义（P〈0．01）。结论：症状性BPH患者PVR≥30ml,Qmax〈10ml／s时,在排除其他因素引起逼尿肌损害所致的PVR增加及Qmax降低后,应及早解除膀胱出口梗阻。     

前列腺（厚径）^2／宽径计算值与高最大尿流率关系

本文分析８２例男性高最大尿流率与前列腺（厚径）＾２／宽径计算值、排尿前膀胱容积、残余尿及分布，年龄等相关因素，高最大尿流率与前列腺大小形态有关，与逼尿肌增生或膀胱内压升高相关更明显；其残余尿与尿流率大小无关，而残余尿分布与排尿前膀胱容积有关，出现在排尿前膀胱容积大者，年龄相对较小。最大尿流率随年龄增加而降低，但本组中已不再显示年龄均值差异。加之在最大尿流率诺模图标准差区间等综合分析，有助诊断与比较     

体位对BPH患者尿流率和剩余尿的影响

目的:研究体位对BPH患者尿流率测定和剩余尿的影响。方法:本研究选择45名有症状的BPH患者,分别于站立、坐位和卧位三种体位进行尿流率测定,每次排尿后的剩余尿通过腹部B超获得。比较三种体位最大尿流率(Qmax),平均尿流率(Qave),排尿量(VV)和剩余尿量(PVR)。结果:患者立位、坐位和卧位Qmax为(16.2±0.37)ml/s、(15.4±0.46)ml/s和(9.5±0.55)ml/s,Qave分别为(6.4±0.21)ml/s、(6.0±0.30)ml/s和(4.7±0.31)ml/s,VV分别为(267.6±10.14)ml、(251.3±12.53)ml和(181.1±8.17)ml,PVR为(63.2±12.17)ml、(67.5±10.36)ml和(101.2±16.42)ml。立位、坐位两种体位对最大尿流率、平均尿流率、排尿量和剩余尿均无影响,卧位时尿流率下降,剩余尿增加。结论:立位和坐位不影响BPH患者的尿流率和剩余尿,卧位时尿流率下降,剩余尿增加。     

前列腺(厚径)~2/宽径计算值与高最大尿流率关系

本文分析82例男性高最大尿流率与前列腺（厚径）2／宽径计算值、排尿前膀胱容积、残余尿及分布、年龄等相关因素。高最大尿流率与前列腺大小形态有关．与通尿肌增生或膀胱内压升高相关更明显；其残余尿与尿流率大小无关，而残余尿分布与排尿前膀胱容积有关，出现在排尿前膀胱容积大者，年龄相对较小、最大尿流率随年龄增加而降低，但本组中已不再显示年龄均值差异。加之在最大尿流率诺模图标准差区间等综合分析，有助诊断与比较。     

前列安栓对慢性前列腺炎和良性前列腺增生症患者尿流率的影响

慢性前列腺炎和良性前列腺增生症(BPH)是男性泌尿系统最常见的疾病,患者均可出现不同程度的排尿梗阻和下尿路刺激症状.尿流率的变化能反映出梗阻程度.我院2002年7～11月对78例慢性前列腺炎患者和50例(BPH)患者应用前列安栓(丽珠集团丽珠中药厂生产)治疗,比较治疗前后尿流率变化,报告如下.     

多沙唑嗪的血药浓度和最大尿流率改善的临床关系

为了探讨多沙唑嗪剂量、血药浓度和治疗BPH的临床疗效之间关系，Fawzy Ahmed等进行了一项为期16周、安慰剂对照的双盲试验。入选了248名合并高血压的良性前列腺增生（BPH）患者。经过2周的安慰剂导入期，患者被随机分人多沙唑嗪组（每日2、4、8或12mg）或安慰剂组。在6、10和14周后，测定多沙唑嗪用药后2～6h（峰值）和约24h（谷值）的血药浓度。同时测定最大尿流率（Qmax）与基线水平的变化。患者每日记录症状并在2、8和16周完成调查表评价前列腺梗阻和刺激症状。此外研究者每次随访时评估前列腺症状。结果显示，治疗6周，多沙唑嗪达到稳态峰值和谷值血药浓度，并维持6到14周。每日一次服用多沙唑嗪，从2到12mg剂量范围内峰值和谷值血药浓度呈线形升高，并与Qmax的改善成正相关（分别为P=0．001和P=0．008）。多沙唑嗪峰值浓度在60到80ng／ml，谷值浓度在25ng／ml能维持临床疗效。与安慰剂组相比，多沙唑嗪4mg和8mg能明显改善梗阻性前列腺症状。由此得出结论，BPH的患者多沙唑嗪用量在每日2到8mg，血药浓度和Qmax改善随着剂量增大呈线性提高。多沙唑嗪用于BPH患者的最大治疗剂量为8mg。需要进一步的研究支持这些发现。     

良性前列腺增生患者压力-流率测定中尿道内置测压管对尿流率的影响

目的:探讨压力-流率测定过程中尿道内测压管对尿流率的影响。方法:对39例BPH患者行自由尿流率及压力-流率检测;行压力-流率检测时尿道内留置8F测压管,记录尿流率、膀胱压及逼尿肌压力等参数值,并对最大自由尿流率与最大置管尿流率变化进行统计分析。结果:39例患者置管前后的尿量分别为(209.23±56.56)ml和(210.33±62.02)ml,无统计学差异(P>0.05);最大自由尿流率为(8.61±2.80)ml/s,最大置管尿流率为(7.39±3.01)ml/s,两者间有统计学差异(P<0.05)。以Schafer列线图法对膀胱出口梗阻(BOO)分级后,0～Ⅰ级最大自由尿流率为(12.56±1.57)ml/s,最大带管尿流率为(10.95±2.51)ml/s,两者间无统计学差异(P>0.05);Ⅱ级最大自由尿流率为(9.35±0.76)ml/s,最大带管尿流率为(8.41±1.23)ml/s,两者间无统计学差异(P>0.05);Ⅲ级最大自由尿流率为(7.88±1.21)ml/s,最大带管尿流率为(6.37±0.59)ml/s,两者间有统计学差异(P<0.05);Ⅳ级最大自由尿流率为(6.54±1.93)ml/s,最大带管尿流率为(5.55±2.48)ml/s,两者间有统计学差异(P<0.05);Ⅴ～Ⅵ级最大自由尿流率为(6.01±2.10)ml/s,最大带管尿流率为(4.84±2.89)ml/s,两者间有统计学差异(P<0.05)。结论:行压力-流率测定时,尿道内置8F测压管能够影响最大尿流率的测定结果。     

前列腺增生症病人的逼尿肌收缩力减弱与剩余尿

应用压力流率测定技术，经Ｓｃｈ¨ａｆｅｒ列线图和直线被动尿道阻力关系（ＬｉｎＰＵＲＲ）定量分析９５例前列腺增生症病人的逼尿肌收缩强度。逼尿肌收缩强度分为四级：很弱（ＶＷ）、弱（Ｗ）、正常（Ｎ）和强（ＳＴ）。导管法结合压力流率测定时膀胱灌注量与排出量之差确定剩余尿。结果表明，逼尿肌收缩力很弱和弱与收缩力正常和强的病人之间存在显著性差异（Ｐ＜０．００１）。剩余尿量随逼尿肌收缩力减弱而增加。逼尿肌收缩力很弱的病人术后剩余尿量未改善；逼尿肌收缩力弱的病人术后逼尿肌收缩力可能改善，剩余尿减少；逼尿肌收缩力正常或强的病人术后剩余尿明显减少。     

前列腺移行区指数与压力—流率同步尿动力学检查的临床研究

目的：探讨前列腺移行区指数与压力－流率尿动力学检查的关系。方法：选择82例前列腺增生（BPH）患者行经直肠前列B超及尿动力学压力－流率同步检查,观察前列腺移行区体积及前列腺移行区指数（TZI）、最大尿流率（Qmax)和最大尿流率时膀胱收缩压力（PdetQmax)等指标,并将结果进行统计学相关分析。结果：TZI与Qmax及PdetQmax相关系数（r)分别为－0.346和0．261,P＜0．05和＞0．05。结论：TZI与Qmax呈显著负相关,与PdetQmax关系不肯定。     

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。     

剩余尿量作为良性前列腺增生手术指征标准的初步探讨

目的　探讨以剩余尿 (PVR)量作为良性前列腺增生手术指征标准的可能性。　方法　将不同剩余尿量的 10 3例BPH患者分为 3组 ,A组无PVR ,B组PVR <60ml,C组PVR >60ml。分别进行尿动力学检查。　结果　 3组间膀胱测压容积、逼尿肌等容收缩压 (Piso)和高顺应性膀胱、低顺应性膀胱、逼尿肌反射亢进、逼尿肌反射减弱的相互比较差异无显著性意义 (P >0 .0 5 ) ;B、C组不稳定性膀胱 (DI)、最大尿流率 (Qmax)、Griffiths组间特异性尿道阻力因子 (URA)及逼尿肌储能 (DR)相互比较差异无显著性意义 (P >0 .0 5 ) ,但与A组相比较差异有显著性意义 (P <0 .0 5 )。　结论　PVR≥ 60ml并非是BPH患者接受手术治疗的绝对量化指征 ,当BPH引起膀胱出口梗阻 (BOO)及排尿功能受到损害出现PVR时 ,在排除其他因素引起逼尿肌无力所致的PVR后 ,应及早接受手术治疗     

Association between chronic kidney disease and small residual urine volumes in patients with benign prostatic hyperplasia

Aim: It has been well described that large residual urine volumes (≥300 mL) affect renal function in advanced benign prostatic hyperplasia (BPH). However, it is not clear whether small residual urine volumes (<100 mL) are related to renal function. The present study was performed to examine the association between chronic kidney disease (CKD) and the post‐void residual urine volume (PVR) in BPH patients. Methods: A cross‐sectional study was performed in 160 consecutive BPH patients with PVR of less than 100 mL. We first determined the stage of CKD and compared the PVR in subjects with/without CKD. Next, we divided the subjects into three groups according to the extent of PVR (PVR < 12 mL, 12 mL ≤ PVR < 50 mL, 50 mL ≤ PVR < 100 mL) and compared the estimated glomerular filtration rate (eGFR) among these groups. Moreover, risk factors associated with CKD, including the presence of post‐void residual urine, were explored by multiple logistic regression analysis. Results: The PVR of the patients with CKD was significantly greater than that of the patients without CKD. The group with the normal PVR (group PVR < 12 mL) had a significantly higher eGFR compared with the other two groups. Multivariate analysis demonstrated that the presence of post‐void residual urine (PVR ≥12 mL) was a significant and independent risk factor associated with the presence of CKD. Conclusion: In BPH patients, the PVR of the patients with CKD was significantly greater than that of the patients without CKD and the presence of post‐void residual urine (PVR ≥12 mL) was independently associated with CKD, indicating a close association between CKD and small residual urine volumes.     

前列腺增生症患者剩余尿与膀胱出口梗阻逼尿肌收缩力的相关性研究

目的 :探讨前列腺增生症 (BPH)患者剩余尿 (RUV )与膀胱出口梗阻 (BOO)、逼尿肌收缩力相关性。方法 :对 42例 BPH患者进行尿动力学检查。结果 :RUV与 BOO呈正相关 (r =0 .716 0 ,P <0 .0 1) ,与逼尿肌等容收缩压 (Piso)呈负相关 (r =- 0 .5 718,P <0 .0 1)。术前和术后的 RU V、尿道阻力因子 (URA )的差异有显著性意义 (P<0 .0 5 ) ,而术前和术后的 Piso差异无显著性意义 (P>0 .0 5 )。结论 :BPH患者 RUV的产生及增多是由于 BOO的加重和逼尿肌功能受损的共同结果 ,在病程的不同阶段 ,BOO和逼尿肌收缩力对 RUV的产生、增多及减少具有不同的作用和意义。     

症状性良性前列腺增生患者生活质量分析

目的了解伴下尿路症状（LUTS）的良性前列腺增生（BPH）患者的生活质量.方法88例具有典型LUTS的BPH患者,平均年龄68岁.患者治疗前均行国际前列腺症状评分（IPSS）、勃起功能国际问卷（IIEF-5）、简明性功能问卷（BSFI）、焦虑自评量表、老年抑郁量表和BPH影响指数问卷（BII）调查,同时检测尿流率、前列腺体积和血清睾酮.应用多元逐步回归分析方法和一元相关回归分析方法评价各检测变量间的相关性.结果统计学分析显示：年龄与BSFI中勃起功能和IIEF-5有显著相关性（r=-0.552和r=-0.567,P=0.000）,IPSS评分与年龄有显著相关性（r=0.213,P=0.047）,BII与年龄无明显相关性.IPSS评分与BSFI中勃起功能和满意度有显著相关性（r=-0.332,P=0.002;r=0.302,P=0.005）,IPSS与BII间有显著相关性（r=0.420,P=0.000）.BII与抑郁评分间有显著相关性（r=0.426,P=0.002）.最大尿流率、前列腺体积和睾酮与BII评分间无明显相关性.结论LUTS对BPH患者的日常生活、性功能和心理有明显影响,BPH治疗前需重视老年患者的心理和生活质量.     

Elevated postvoid residual in women with pelvic floor disorders: prevalence and associated risk factors

A retrospective case-control study was designed to assess risks for elevated post void residual (PVR) in women with pelvic floor disorders. The 1,399 women underwent evaluation including standardized questionnaire, examination, and catheterized PVR. Elevated PVR was defined as ≥100 ml and anterior and apical prolapse was defined as at or beyond the hymen. Overall, the prevalence of elevated PVR was 11%. After matching, the absence of stress incontinence symptoms (OR 0.55, CI 0.33–0.92), the symptoms of vaginal bulge (OR 2.19, CI 1.38–3.48), pelvic pressure (OR 1.79, CI 1.14–2.86), urinary splinting (OR 2.89, CI 1.24–6.74), and presence of prolapse (OR 2.60 CI 1.62–4.18) were significantly associated with an elevated PVR. Only prolapse (OR 1.96 CI 1.37–2.79) maintained a significant association after multivariate analysis. Symptoms alone do not predict which women may have an elevated PVR, but the finding of prolapse at or beyond the hymen is associated with incomplete emptying. Elevated post void residuals cannot be predicted based on symptoms alone; however, prolapse beyond the hymen may help identify women with incomplete bladder emptying. Presented at the annual Pacific Coast Obstetrics and Gynecology Society meeting, Phoenix, AZ, October 2004 and at the International Continence Society meeting, Montreal, CA, September 2005.     

Uroflowmetric assessment of acute effects of sildenafil on the voiding of men with erectile dysfunction and symptomatic benign prostatic hyperplasia

Purpose  To evaluate the acute effects of sildenafil (50 mg) on the micturation of men with erectile dysfunction (ED) and concomitant benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) using uroflowmetric parameters. Materials and methods  A total of 68 male patients randomized into two groups (36 treatment, 32 control groups) with International Prostate Symptom Score (IPSS) greater than 7 and International Index of Erectile Dysfunction-erectile function domain score lower than 26 were enrolled in the study. Patients in the treatment group received a single dose of 50 mg of oral sildenafil. Patients in the control group received no treatment. Prevoiding urine volumes determined ultrasonographically and voided urine volumes were also recorded. Statistical comparisons were made with the use of analysis of variance (ANOVA). Results  Mean ages were similar between treatment and control groups (60.4 ± 9.8 and 58.6 ± 8.3 years, respectively, P = 0.430). In the treatment group the maximum and average flow rates increased significantly (Q _max from 15.6 ± 6.8 cc/s to 19.3 ± 7.2 cc/s, P < 0.0001; Q _avg from 7.3 ± 3.0 cc/s to 9.1 ± 3.0 cc/s, P < 0.0001) with sildenafil administration, while other parameters studied remained unchanged. Conclusion  Despite the limitations of variations of uroflowmetry, this study showed that sildenafil improves Q _max and Q _avg in patients suffering from ED with concomitant BPH-LUTS. Long-term studies are needed to evaluate the effects on IPSS, side effects, and drug interactions.     

良性前列腺增生患者膀胱出口梗阻及逼尿肌收缩强度对剩余尿的影响

目的　探讨良性前列腺增生 (BPH)患者膀胱出口梗阻 (BOO)及逼尿肌收缩强度与剩余尿的关系。　方法　应用尿动力学方法检测 181例BPH患者BOO情况和逼尿肌收缩强度 ,以导管法结合膀胱灌注量与排出量之差确定剩余尿 ,对相互关系进行统计学分析。　结果　 181例患者剩余尿量 0～ 2 0 0ml。逼尿肌收缩强度减弱 ,剩余尿量增多 (F =12 .14 3,P =0 .0 0 1) ;BOO加重 ,剩余尿量无明显改变 (F =2 .386 ,P =0 .0 71)。 2 5例 (13.8% )患者逼尿肌收缩强度减弱或正常时仍有较多剩余尿(>10 0ml)。　结论　剩余尿增多主要由逼尿肌收缩强度减弱所致 ,而随着BOO加重 ,剩余尿量无明显变化