上海市中老年男性下尿路症状的流行病学调查

目的 了解上海市市区中老年男性人群下尿路症状(LUTS)的患病率及对生活质量的影响.方法 运用描述性流行病学的多阶段抽样方法,在上海市市区一般人群中抽取40岁以上男性居民1 583名,通过国际前列腺症状评分(IPSS)和生活质量(QoL)评分等方法调查该人群中LUTS的患病率及对生活质量的影响.结果 在40～49岁、50～59岁、60～69岁和70岁年龄组中,中、重度LUTS(IPSSI≥8)患病率分别为8.7%、19.4%、32.3%和40.2%,呈现随年龄增长患病率上升趋势;随着LUTS严重程度的增加,患者的QoL评分也显著上升,轻、中、重度LUTS三组间QoL评分有显著差异(P＜0.01).结论 上海市市区男性LUTS患病率已接近欧美国家且严重影响生活质量.     

社区老年女性下尿路症状调查

目的 了解社区老年女性的下尿路症状(LUTS)的发生情况及膀胱功能状况.方法 采用问卷调查方式,包括下尿路症状(LUTS)描述、国际前列腺症状(IPSS)评分和生活质量(QoL)评分;同时对被调查者进行尿流率和残余尿量测定.结果 调查总人数为359人.根据IPSS评分,中、重度LUTS(IPSS≥8)的总发生率39.0%;三年龄段(50～59、60～69、≥70岁)的发生率分别为35.1%、46.2%和54.8%(P=0.034).以刺激症状为主者占73.8%.各年龄段最大尿流率(Qmax)分别为(24.5±11.5)mL/s、(22.7±11.0)mL/s和(14.5±8.2)mL/s(P＜0.001).刺激症状、梗阻症状和残余尿量与QoL评分呈正相关(r=0.59,r=0.40,r=0.32;P＜0.001);Qmax与QoL评分无明显相关性.结论 社区老年女性人群中的LUTS发生率很高,并随着年龄的增加而上升;Qmax则随着年龄的增加而降低.老年女性LUTS以刺激症状为主,且对生活质量的影响最大.     

社区老年女性下尿路症状调查

目的了解社区老年女性的下尿路症状(LUTS)的发生情况及膀胱功能状况。方法采用问卷调查方式,包括下尿路症状(LUTS)描述、国际前列腺症状(IPSS)评分和生活质量(QoL)评分;同时对被调查者进行尿流率和残余尿量测定。结果调查总人数为359人。根据IPSS评分,中、重度LUTS(IPSS≥8)的总发生率39.0%;三年龄段(50~59、60~69、≥70岁)的发生率分别为35.1%、46.2%和54.8%(P=0.034)。以刺激症状为主者占73.8%。各年龄段最大尿流率(Qm ax)分别为(24.5±11.5)mL/s、(22.7±11.0)mL/s和(14.5±8.2)mL/s(P<0.001)。刺激症状、梗阻症状和残余尿量与QoL评分呈正相关(r=0.59,r=0.40,r=0.32;P<0.001);Qm ax与QoL评分无明显相关性。结论社区老年女性人群中的LUTS发生率很高,并随着年龄的增加而上升;Qm ax则随着年龄的增加而降低。老年女性LUTS以刺激症状为主,且对生活质量的影响最大。     

广西防城港地区3423位男性下尿路症状的患病情况及影响因素分析

目的探讨男性中重度下尿路症状(LUTS)的患病率以及影响因素。方法采用国际前列腺症状评分表(IPSS)和自行设计的问卷,对防城港市体检人群进行患病率及相关因素调查,以及对血脂、血糖等进行检测。采用Logistic回归分析中重度LUTS的影响因素。结果不同年龄、运动频率、体重指数、吸烟状况、受教育程度及是否患高血压的人群在不同程度LUTS中的分布差异有统计学意义(P<0.05或P<0.001);不同饮酒频率、是否患糖尿病及血脂障碍的人群在不同程度LUTS中的分布差异无统计学意义(P>0.05)。年龄、体重指数与中重度LUTS的发生有一定的关系。结论在该地区人群中,LUTS是一种高发病率的疾病,且随着年龄的增加呈明显的上升趋势,此外,肥胖亦是影响其患病的一个重要危险因素。     

前列腺增生症与下尿路症状的临床研究

目的探讨前列腺增生（BPH）患者出现下尿路症状(LUTS)的临床特点，和对生活质量的影响。方法分析我院2006年1月—2009年10月住院的400例前列腺增生患者的临床资料，并根据国际前列腺症状评分问卷（IPSS）对患者进行问卷回答评分。结果400前列腺增生患者中，LUTS中度（6—18分）占33.8%，重度（22—36分）占66.2%。结论LUTS症状在男性中较普遍存在,发病率随年龄增大而增加，LUTS严重地影响BPH患者的生活质量，并影响患者的性功能。应重视对BPH患者LUTS的研究及其对患者睡眠及生活质量的影响。     

腰椎间盘突出患者的下尿路症状分析

目的 探讨腰椎间盘突出引起的下尿路症状的特点和临床意义.方法 2000年2月至2010年4月北京积水潭医院住院的80例男性腰椎间盘突出患者进行尿动力学检查并分为膀胱功能正常组(A组)、早期膀胱功能障碍组(B组)和晚期膀胱功能障碍组(C组).全部患者均进行国际前列腺症状评分(IPSS)和生活质量(QOL)问卷调查,比较各组间的评分情况.结果 A组(30例)、B组(22例)和C组(28例)的IPSS总分分别为9.4±4.6、11.3±3.3和15.0±3.4,QOL评分分别为2.1±1.1、2.2±1.0和3.4±1.3,排尿期症状总分分别为3.8 ±2.7、6.2±2.6和10.4±3.1,3组间差异均有统计学意义(均P＜0.05);储尿期症状总分分别为5.6±3.4、5.1±2.9和4.6±2.3,3组间差异无统计学意义(P＞0.05).A、B两组之间排尿期症状总分差异有统计学意义(P＜0.01),但IPSS总分、QOL评分差异无统计学意义(均P＞0.05);B、C两组之间IPSS总分、QOL评分和排尿期症状总分差异均有统计学意义(均P＜0.05).结论 腰椎间盘突出引起的下尿路症状主要出现在膀胱功能障碍晚期.排尿期症状为典型表现,有助于早期诊断.

Abstract：

Objective To evaluate the characteristic and clinical significance of lower urinary tract symptoms (LUTS) caused by lumbar disk herniation. Methods A total of 80 male patients from February 2000 to April 2010 in our hospital with lumbar disk herniation underwent an urodynamic test. And they were divided into the normal bladder function group ( Group A), the early-stage of bladder dysfunction group ( Group B) and the late-stage of bladder dysfunction group (Group C) according to the urodynamic results.LUTS in these patients were assessed by the international prostate symptom score (IPSS) and quality of life (QOL) questionnaire. The results were analyzed statistically among these three groups. Results In Groups A ( n = 30), B ( n = 22) and C ( n = 28 ), the total IPSS scores were 9. 4 ± 4. 6, 11.3 ± 3. 3 and 15.0 ±3.4 while the QOL scores 2. 1 ± 1.1, 2. 2 ± 1.0 and 3.4 ± 1.3 respectively. The total voiding symptom scores were 3. 8 ± 2. 7, 6. 2 ± 2. 6 and 10. 4 ± 3. 1 respectively and the differences were significant ( all P ＜0. 05 ). The total storage symptom scores were 5. 6 ± 3.4, 5. 1 ± 2. 9 and 4. 6 ± 2. 3 in 3 groups respectively and the difference was insignificant (P ＞0. 05). Between Groups A and B, the differences of total voiding symptom score were significant ( P ＜ 0. 01 ) while those of the total IPSS and QOL score were insignificant (both P＞0. 05). Between Groups B and C, the differences of the total IPSS, QOL score and total voiding symptom score were significant ( all P ＜ 0. 05 ). Conclusions The LUTS caused by lumbar disk herniation are notable during the late stage of bladder dysfunction. As one typical early manifestation, the voiding symptom may aid an early diagnosis of the disease.     

老年男性下尿路症状病因的尿动力学研究进展

下尿路症状（lowerurinarytractsymptoms，LUTS）是排尿障碍的总称，由wein等提出的一组症候群，是老年男性中最常见的症状之一。基于统计数据和各国老龄人口的增加，LUTS在未来社会中将不可避免的成为一种普遍的疾病，并成为专业人员面对的主要问题之一。随着尿动力学研究的进展，对LUTS的病因及常见疾病有了较深入的了解与认识，从而对LUTS的治疗起到了指导作用。     

老年男性下尿路症状病因的尿动力学分析研究

目的探讨老年男性下尿路症状（LUTS）病因的尿流动力学改变,为指导临床诊治提供帮助。方法 311例有下尿路症状的患者行尿动力检查与其病因结合,全面认识下尿路症状病因。结果①老年LUTS中87.5%（272/311）尿流率降低与70.7%（220/311）残余尿增加,与膀胱出口梗阻72.3%（225/311）造成的结果基本吻合;20-30%LUTS由逼尿肌不稳定（21.5%）造成,符合临床实际情况;②引起老年LUTS最常见的原因以前列腺疾病（71.4%）最多见,其中前列腺增生占67.5%（210/311）;③神经系统疾病,包括糖尿病引起的老年LUTS占22.8%（71/311）;④精神障碍性疾病也可引起LUTS。结论唯一明确可以区分导致LUTS的不同原因的方法是尿动力学检查;在诊治伴有LUTS的老年男性患者时,依据尿流动力学检测结果进行是有效而安全的。     

老年男性下尿路症状病因的悄尿动力学分析

下尿路症状（ＬＵＩＳ）是临床一常见症状群。包括储尿期症状,如尿频、尿急、夜尿增多、急迫性尿失禁等,及排尿期症状,如尿线变细、射程短、排尿中断、排尿后滴沥及尿潴留等。老年男性下尿路症状是一较特殊年龄组［１］,其常见病因以良性前列腺增生多见。仅仅通过病史。体检,一般影像学检查,对该类疾病的诊治结果常不尽人意。尿动力学检查对临床进一步诊治该类患者开辟了新途径。１　临床资料及方法 收集１９９８年１０月～１９９９年１０月我科门诊及住院８４例有较全面的临床病史、检查及尿动力学资料的病例总结如下：１．１　一般…     

老年男性下尿路症状与2型糖尿病的相关性

目的探究老年男性2型糖尿病患者与下尿路症状(LUTS)之间的相关性及2型糖尿病对LUTS的影响因素.方法选取2014年1月至2016年1月到延安医院就诊的92例老年男性2型糖尿病患者为研究对象,其中发生下尿路症状的34例患者作为观察组,其余58例患者作为对照组.检测2组患者空腹血糖、餐后2 h血糖、空腹胰岛素、C肽、糖化血红蛋白、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、前列腺特异性抗原,前列腺体积大小并加以比较;比较2组患者糖尿病病程;对2组患者比较有统计学意义的数据进行logistics多因素回归分析,研究下尿路症状发生的危险因素.结果对血糖指标进行检测:对照组患者空腹血糖,餐后2 h血糖,空腹胰岛素,空腹C肽,糖化血红蛋白较观察组患者的相同指标降低.血脂指标检测结果发现2组患者总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白以及载脂蛋白的含量差异无统计学意义(P>0.05),前列腺特异性抗原(PSA)比较无统计学意义(P>0.05).前列腺体积增大差异有统计学意义(P<0.05).对照组平均糖尿病病程较观察组平均糖尿病病程... 更多     

应激诱导炎症反应与下尿路症状的研究进展

下尿路症状（LUTS）是一组包括储存、排尿及排尿后不适的非特异性泌尿系统症状,发病率较高,且病因和发病机制较复杂。应激作为导致LUTS的独立危险因素,通过诱导全身炎症反应在局部膀胱和排尿中枢中发挥作用,参与LUTS的发生发展。该文围绕应激诱导炎症反应与LUTS的发病机制展开综述。     

Association between the presence of bacteria in prostate tissue and histopathology in biopsies from men not complaining of lower urinary tract symptoms

Objective: To investigate the presence of bacteria in prostate tissue, and relationships between the bacteria and histopathological findings. Methods: Samples were collected from prostate biopsy patients with no obvious lower urinary tract symptoms (LUTS). Detection and identification of bacterial species in the prostate tissues were performed with PCR for 16SrDNA and DNA sequencing. Histopathology was also evaluated. LUTS and lower urinary tract function were assessed by questionnaires, uroflowmetry, and ultrasonography. Results: DNA was extracted from 97 prostate biopsies, with 5 bacterial species detected among samples from 7 patients (7.2%). The stroma-to-gland ratio in the prostate tissues from patients with bacteria was lower than in those without bacteria (p < 0.01). Glandular epithelial hyperplasia was also identified in the prostates harboring bacteria. International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QOL), Overactive Bladder Symptom Score (OABSS), maximum flow rate, urine volume by uroflowmetry, and post-voided residual urine were not significantly different when comparing patients with and without bacteria in their prostate samples. Conclusions: The present study demonstrated that 7.2% of men without obvious LUTS had bacteria in their prostate tissues. The presence of such bacteria might induce glandular hyperplasia and contribute to pathological changes in the early stages of benign prostate enlargement before affecting LUTS.     

逼尿肌不稳定和下尿路梗阻对男性LUTS患者尿动力学影响分析

目的 探讨逼尿肌不稳定（DI）及下尿路梗阻（LUTO）对男性下尿路症状（LUTS）患者尿动力学指标的影响.方法 回顾性分析我院2012年7月至2013年6月住院的81例良性前列腺增生（BPH）伴LUTS患者的尿动力学资料,将其归类为三组,分别为LUTS伴DI组11例、LUTS合并LUTO组41例和LUTS合并LUTO伴DI组29例,对三组患者的尿动力学指标进行统计学分析.结果 三组患者尿动力学指标比较,残余尿、最大尿流率、最大逼尿肌压各组存在显著性差异（P＜0.05）,初感尿意容量、强烈尿意容量各组存在极显著性差异（P＜0.01）,年龄、初始逼尿肌压无差异（P＞0.05）.比较LUTS伴DI组和LUTS合并LUTO伴DI组的储尿期指标,LUTS合并LUTO伴DI组DI最大逼尿肌压更高、DI幅度增加（P＜0.05）.结论 DI患者残余尿及膀胱功能容量减少、膀胱感觉敏感,LUTO伴DI患者DI幅度增加,逼尿肌收缩力增强;最大尿流率对LUTO的诊断有一定的意义,侵入性尿动力学检查可准确诊断DI和LUTO,指导临床诊断和治疗.     

Relationship between lower urinary tract symptoms and objective measures of benign prostatic hyperplasia: a Chinese survey

Background The enlarged prostate leads to obstruction and lower urinary tract symptoms （LUTS）, which comprise frequency, urgency, weak stream, straining and nocturia. This study was conducted in a large series of patients to evaluate the relationship between LUTS as stipulated in the International Prostate Symptom Score （IPSS） and the objective parameters related to benign prostatic hyperplasia （BPH）.
Methods We enrolled 1295 BPH patients from seven centers. The patients were either at first diagnosis of BPH or had discontinued medical treatment for at least 3 months. Those with several other diseases that may be potential risk factors affecting urinary symptoms were excluded from the study. Age, IPSS, prostate volume, peak flow rate, urine volume and post-voiding residual urine volume were measured. The relationship between IPSS and objective parameters were quantified by means of Spearman correlation coefficients. The differences in these parameters between the groups with mild, moderate or severe symptoms were also evaluated.
Results Statistically significant correlations were found between IPSS and objective parameters by means of Spearman correlation coefficients. When the patients were divided into three groups with different severities of symptoms, there were significant differences in peak flow rate, urine volume, prostate volume, residue urine volume and quality of life, whereas average age and prostate-specific antigen levels were similar. However, there was evident overlap of these parameters between the groups. The same results were found when the irritative or obstructive subscore of IPSS was considered.
Conclusions The correlation between objective parameters of BPH and LUTS is significant. However, it is hard to predict the severity of symptoms by these parameters.     

Efficacy and safety of combined therapy with terazosin and tolteradine for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: a prospective study

Background The primary objectives of the treatment for the lower urinary tract symptoms （LUTS） associated with benign prostatic hyperplasia （BPH） are to produce rapid, sustained, and safe improvements in the symptoms that affect the quality of life in the majority of men over 50. In this study, we evaluated the efficacy and safety of the combined therapy with terazosin （α1-adrenergic receptor antagonist） and tolterodine （anticholinergic agent） for LUTS associated with BPH. Methods This combination study included 69 patients diagnosed with LUTS associated with BPH based on the International Prostate Symptom Scores （IPSS）, urinary flow rate, prostate volume, urinary residual, and their serum prostate-specific antigen levels. Initially, 191 patients were treated with terazosin 2 mg once daily for one week. Those patients with continued LUTS after the initial treatment were allocated randomly into two groups： terazosin group （n=-36） in which patients were treated with terazosin 2 mg once daily for six weeks, and combination group （n=33） in which patients were treated with both terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks. Results The IPSS were significantly improved in both groups after treatment, and the reduction of IPSS in the combination group was significantly greater than that in the terazosin group （P〈0.01）. A decrease in urgency, frequency and nocturia were the main contributory factors causing the reduction of IPSS in the combination group. The differences about the peak urinary flow rate and the residual urine from the baseline values were noted in both groups after treatment but were not significant between the two groups. The incidence of adverse effects in the combination group was higher than that in the terazosin group. As expected the most common adverse effect was mouth dryness which was associated with anticholinergic drugs such as tolterodine. Conclusions Patients with LUTS associated BPH appear the improved IPSS after combined therapy with terazosin and tolterodine. This study, although short term and limited numbers of patients, provides evidence that the combined therapy with terazosin plus tolterodine is a good approach for meeting the objectives of rapid, sustained, and safe improvements in the LUTS associated with BPH. And the profile of patients in this study might be used as the indication of such combined therapy for LUTS associated with BPH without urodynamic evaluation.     

糖尿病患者伴下尿路症状的尿动力学研究

目的探讨尿动力学检查在糖尿病患者排尿异常中的意义及膀胱尿动力学表现。方法选择伴有下尿路症状(LUTS)的糖尿病患者48例,病程入院初次发现-30年,全部患者均进行尿动力学全项检查。结果48例患者完成了尿动力学检查,尿动力学异常患者占68.8%,正常患者为31.2%,所有患者中膀胱感觉迟钝表现明显的占48%。在尿动力学异常患者中逼尿肌收缩减低及反射消失表现明显的占45%和18%。38例患者获得满意的压力-流率测定,在男性患者中确诊为膀胱出口梗阻者占男性患者的46.8%。结论尿动力学检查可对伴有下尿路症状的糖尿病患者膀胱功能进行客观评判,并及早选择适宜的治疗方案,对于患者的愈后及生活质量具有重要意义。     

临床良性前列腺增生患者下尿路症状严重程度分析

目的 调查临床良性前列腺增生(BPH)患者下尿路症状(LUTS)的特征及症状的严重程度.方法 对经临床确诊,满足BPH诊断标准的380例患者进行了问卷调查.内容包括:①年龄、民族、职业、文化程度、家 庭居住地及经济状况;②国际前列腺症状评分(IPSS);③根据IPSS评分,将患者分成轻度、中度及重度LUTS; ④根据症状表现进一步将其分成中～重度梗阻性症状和刺激性症状,评价患者LUTS的分布特点及症状的严 重程度.结果 ①380例BPH者中,369例(97.11%)患有中～重度LUTS.随着年龄的增高,LUTS患病率增加,尤其是中～重度患者的数目逐渐增多;②366例(96.32%)患有中～重度梗阻性症状;351例(92.37%)患有中～ 重度刺激性症状;具有梗阻性症状的比例高于刺激性症状.随着年龄的增加,具有中～重度梗阻性和刺激性症 状男性的数目增加;③IPSS评分的均值为(25.91±7.59).IPSS各项症状中,评分值最高的是夜尿增多(4.14± 1.33),而尿频的评分值最低(3.51±1.66).IPSS与年龄呈正相关(r＝0.145,P＝0.015).结论 LUTS的严重程度 包括梗阻性和刺激性症状,随年龄的增长呈明显升高.IPSS评分中,夜尿增多的症状评分最高,刺激性症状比 梗阻性症状更明显.