小体积良性前列腺增生治疗方式的选择

目的：寻找治疗小体积良性前列腺增生（ＢＰＨ）患者的最佳治疗方式。方法：对４２例小体积ＢＰＨ患者采用直肠Ｂ超及尿动力学检查相结合方法进行综合分析，如移行区指数（ＴＺＩ）〉０．４且存在膀胱颈梗阻者，采用ＴＵＲＰ治疗；如ＴＺＩ≤０．４且存在膀胱颈梗阻者，则行药物治疗，结果：ＴＺＩ〉０．４者ＴＵＲＰ治疗效果好（９３．３％），药物治疗效果较差（５０．０Ａ％０；ＴＺＩ≤０．４者药物治疗优于ＴＵＲＰ治疗：ＴＺＩ≤０．４而无膀胱颈梗阻者手术及药物治疗均无效。结论：治疗小体积ＢＰＨ患者的原则是尿动力学检查有膀胱颈梗阻存在，如ＴＺＩ〉）．４，宜行ＴＵＲＰ治疗；如ＴＺＩ〉０．４，则行药物治疗，如尿动力学检查无膀胱颈梗阻存在，则应继续寻找病因。     

残余尿在前列腺增生症所致膀胱出口梗阻中的临床意义

作者应用压力－流率测定法确定前列腺增生症（ＢＰＨ）患者有无膀胱出口梗阻（ＢＯＯ），并经导管法测定其残余尿，分析５１例有或无膀胱出口梗阻的前列腺增生症患者的残余尿状况。ＢＯＯ组和无ＢＯＯ组分别为３１例和２０例；残余尿分别为３２．８±３５．９ｍｌ和２５．２±２２．７ｍｌ，范围分别为６～２１０ｍｌ和３～８８ｍｌ。两组间残余尿量无显著性差异（Ｐ＞０．０５）；其余指标均存在显著性差异（Ｐ＜０．０１）。作者认为以残余尿作为选择ＢＰＨ患者手术的重要指标并不可靠，ＢＯＯ不是产生残余尿的唯一原因。ＢＯＯ患者可无明显残余尿，无明显残余尿的ＢＰＨ患者不能除外ＢＯＯ。     

BPH梗阻致膀胱功能改变的尿动力学研究

为探讨前列腺增生症（ＢＰＨ）梗阻致膀胱功能改变的临床意义，对５９例ＢＰＨ病人进行全面尿动力学检查。结果：（１）最大逼尿肌等容收缩压（Ｐｉｓｏ）与逼尿肌收缩速度呈正相关（ｒ＝０．７１６７，Ｐ＜０００１）。（２）Ｐｉｓｏ随膀胱充盈量增加而显著下降（Ｐ＜０００１）。（３）Ｐｉｓｏ与ＢＰＨ梗阻程度呈正相关性（ｒ＝０．６７８１，Ｐ＜０００１）。（４）当剩余尿量≥１００ｍｌ，逼尿肌储能显著下降（Ｐ＜０００１）。（５）不稳定膀胱组的Ｐｉｓｏ显著高于稳定膀胱组。结果认为：不稳定膀胱是引起ＢＰＨ病人临床症状的主要因素之一，膀胱等容收缩试验应用于ＢＰＨ病人有重要的临床价值     

残余尿在前列腺增生所致膀胱出口梗阻中的临床意义

作应用压力－流率测定法确定前列腺增生症（ＢＰＨ）患有无膀胱出口梗阻（ＢＯＯ），并经导管法测定其残余尿，分析５１例有或无膀胱出口梗阻的前列腺增生症患的残余尿状况。ＢＯＯ组和无ＢＯＯ组分别为３１例和２０例，残余尿分别为３２．８±３５．９ｍｌ和２５．２±２２．７ｍｌ，范围分别为６～２１０ｍｌ和３～８８ｍｌ，两缚间残余尿量无显性差异（Ｐ〉０．０５）；其余指标均存在显性差异（Ｐ〈０．０１）。作认     

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。     

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…     

前列腺增生症尿流动力学分析

目的：研究前列腺增生症（ＢＰＨ）患者尿流动力学状况。方法：对２０例正常成人和３５例ＢＰＨ患者进行尿流动力学研究。结果：ＢＰＨ患者与正常成人各项检测指标有极显著性差异（Ｐ〈０．０１）。在３０例ＢＰＨ患者中随机抽样１０例进行了尿流动力学各项指标的直线相关分析,其相关系数最大尿流率与膀胱顺应性有显著性意义（Ｐ〈０．０５）,膀胱顺应性与膀胱颈压有显著性意义（Ｐ〈０．０５）,膀胱颈压与前列腺体积有显著性意义     

良性前列腺增生患者膀胱顺应性的临床研究

目的：探讨良性前列腺增生（ＢＰＨ）患者膀胱顺应性与流出道梗阻及逼尿肌稳定性之间的关系。方法：分析１２１例ＢＰＨ患者尿动力学检测结果的有关资料。结果：年龄、逼尿肌压梗阻程度与顺应性呈正相关，尿流率则与顺应性呈负相关。结论：ＢＰＨ患者膀胱顺应性的减低程度与逼尿肌不稳定和梗阻程度密切相关。     

BPH患者逼尿肌不稳定与M受体密度的关系

目的探讨逼尿肌胆碱能受体（Ｍ受体）在前列腺增生（ＢＰＨ）梗阻性逼尿肌不稳定中的作用。方法根据尿动力学结果,应用３ＨＱＭＢ结合分析法测定７例ＢＰＨ梗阻稳定和１２例梗阻不稳定及８例无梗阻的膀胱肿瘤患者膀胱顶部逼尿肌Ｍ受体密度Ｂｍａｘ。结果梗阻性逼尿肌不稳定组较正常对照组和梗阻稳定组Ｍ受体密度（Ｂｍａｘ）明显降低（Ｐ＜０．０５）,三者分别为（１６６．８７±２９．９１）ｆｍｏｌ／ｍｇ蛋白、（１７３．８４±３２．１４）ｆｍｏｌ／ｍｇ蛋白和（１２０．２１±３２．２０）ｆｍｏｌ／ｍｇ蛋白,而正常对照组和梗阻稳定组之间差异无显著性（Ｐ＞０．０５）。三组之间平衡解离常数Ｋｄ差异无显著性（Ｐ＞０．０５）。结论逼尿肌Ｍ受体密度变化没有参与梗阻性逼尿肌不稳定的产生,逼尿肌不稳定中Ｍ受体下调可能是一种降低逼尿肌不稳定的自身调节。     

前列腺增生梗阻性逼尿肌不稳定对逼尿肌胆碱能神经的影响

目的探讨前列腺增生（ＢＰＨ）梗阻性逼尿肌不稳定与乙酰胆碱能神经的关系。方法根据尿动力学，将研究对象分为ＢＰＨ梗阻逼尿肌稳定和梗阻逼尿肌不稳定组，并设无梗阻的膀胱肿瘤患者作为对照。取膀胱顶部逼尿肌作ＨＥ、Ｋａｒｎｏｖｓｋｙ－Ｒｏｏｔ直接法染色，乙酰胆碱脂酶（ＡｃｈＥ）结合镀银法染色、电镜观察和图像分析，通过形态测定检测了逼尿肌ＡｃｈＥ阳性神经密度。结果梗阻不稳定组和稳定组ＡｃｈＥ阳性神经密度较正常对照明显降低（Ｐ＜０．０１），且不稳定组ＡｃｈＥ阳性神经密度较稳定组也明显减低（Ｐ＜０．０５）。结论ＢＰＨ梗阻性逼尿肌不稳定与逼尿肌胆碱能神经密度降低（去神经）程度有关。     

Predictability of Conventional Tests for the Assessment of Bladder Outlet Obstruction in Benign Prostatic Hyperplasia

Background The degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) is most accurately quantified by pressure flow studies (PFS), although these studies are more invasive and complicated than conventional tests. We examined how precisely conventional tests predicted the PFS-assessed degree of BOO.
Methods The study population consisted of 232 BPH patients who had undergone routine conventional tests and PFS. Correlation of the conventional test results with the degree of BOO assessed by PFS was examined by Spearman's correlation coefficients. Regression and subgroup analyses were performed to predict the degree of BOO using the conventional test results as the explanatory variables.
Results The degree of BOO correlated with prostate volume, the degree of endoscopic obstruction, and to a lesser extent, with the maximum flow rate ( Q _max) and age. The predictability of conventional tests alone, or in combination, for BOO, was approximately 60% to 70%, which is not acceptable for investigational use. However, almost all patients with a prostate volume larger than 30 mL, or with severe obstruction on urethroscopic findings, had an obstructed bladder outlet.
Conclusion PFS is mandatory when the precise evaluation of the degree of BOO is required, and patients are highly likely to have an outlet obstruction when they have a prostate larger than 30 mL, or severely obstructed posterior urethra on endoscopy.     

Correlation Between the International Prostatic Symptom Score and a Pressure-Flow Study in the Evaluation of Symptomatic Benign Prostatic Hyperplasia

Purpose

We examined the relationship between the International Prostatic Symptom Score (I-PSS) and the occurrence of bladder outlet obstruction caused by benign prostatic hyperplasia (BPH).

Materials and Methods

The American Urological Association developed a questionnaire to quantify the severity of symptoms resulting from BPH. A further question relating the impact of BPH to the quality of life was subsequently added. This questionnaire has been adopted by the World Health Organization and is known as the I-PSS. There are 4 questions related to obstructive symptoms and 3 related to irritative symptoms. Scores of 0 to 7, 8 to 19 and 20 to 35 represent mild, moderate and severe symptoms, respectively. During an 18-month interval the I-PSS questionnaire was administered to 258 patients 50 to 81 years old (mean age 63 years) with BPH. A pressure-flow study was used to determine the presence of bladder outlet obstruction in 227 patients. Based on the scores, the patients were divided into 31 with mild, 116 with moderate and 111 with severe obstruction. The pressure-flow study was not conducted on patients with a mild symptom score.

Results

Of the patients with a severe symptom score 92 (82.9 percent) had bladder outlet obstruction, compared to 62 (53.4 percent) with a moderate symptom score. Statistical analysis (Pearson chi-square test) showed that there was a significant positive correlation between the symptoms and the presence of bladder outlet obstruction. Thus, when the I-PSS was greater than 28, the probability of bladder outlet obstruction was more than 0.91. Stratification of the results according to the obstructive (0 to 20) and irritative (0 to 15) symptoms of the I-PSS yielded a significant positive correlation between obstructive symptoms and the presence of bladder outlet obstruction. Thus, when the obstructive symptom score was greater than 15, the probability of bladder outlet obstruction was greater than 0.91.

Conclusions

When the total I-PSS is greater than 28 or the obstructive symptom score is greater than 15, a pressure-flow study must be avoided.     

Relation between urethral elasticity and bladder outlet obstruction and histologic composition of the prostate in patients with benign prostatic hyperplasia

Objectives. In benign prostatic hyperplasia (BPH), bladder outlet obstruction is caused by mechanical blockage resulting from an enlarged prostate, and by the increased tone of prostatic smooth muscle. In patients with obstructive BPH, the prostatic urethra urodynamically corresponds to the flow-controlling zone (FCZ). We sought to investigate the relation between the obstruction and elastic properties of the FCZ and the histologic composition of the prostate in symptomatic patients with BPH.Methods. The grade of infravesical obstruction was classified according to preoperative pressure-flow data from 30 men with symptomatic BPH, and the elastic properties of the FCZ were evaluated as the mean elastance, which was calculated using the three-parameter model. The area densities of smooth muscle, fibrous tissue, epithelium, and lumen were determined by quantitative morphometry, using BPH tissue obtained by transurethral resection.Results. The area density of smooth muscle had a negative correlation with mean elastance (ρ = −0.50, P <0.01), the linear passive urethral resistance relation (ρ = −0.43, P<0.05), and the group-specific urethral resistance factor (ρ = −0.39, P <0.05). No other histologic element was correlated with these variables.Conclusions. Our results suggest that urethral elasticity and bladder outlet obstruction grade are influenced by the relative content of smooth muscle within the prostate in patients with BPH.     

经尿道前列腺汽化术治疗高危前列腺增生症42例

采用经尿道前列腺汽化术(TUVP)治疗前列腺增生伴急、慢性尿潴留患者42例。平均年龄80岁。均伴有其它系统严重并发症。经尿道改道和充分术前准备后,采用TUVP安全有效地解除前列腺尿道的梗阻,排尿功能恢复良好、肾功能损害者有显著改善,随访3～6个月无复发。结论:TUVP损伤小,安全性高,疗效确切且并发症少,适用于有严重并发症的高危患者的治疗。     

Autonomic receptors in human prostate adenomas.

Radioligand receptor binding techniques were used to characterize alpha 1 adrenergic, alpha 2 adrenergic and muscarinic cholinergic (MCh) binding sites in human prostate adenomas obtained from men with symptomatic and asymptomatic benign prostatic hyperplasia (BPH). Prostate adenoma specimens were obtained from nine men with asymptomatic BPH undergoing cystoprostatectomy, 11 men with symptomatic BPH undergoing open prostatectomy, and 11 men with symptomatic BPH undergoing transurethral resection of the prostate (TURP). A quantitative symptoms score analysis and urinary flow rate determinations documented the absence of bladder outlet obstruction in men undergoing cystoprostatectomy and confirmed the presence of bladder outlet obstruction in men undergoing prostatectomy. The mean equilibrium dissociation constants (Kd) and the mean densities of 125I-Heat (alpha 1 adrenergic) and 3H-NMS (MCh) binding sites were similar in tissue homogenates obtained from men with asymptomatic and symptomatic BPH. The mean Kd of 3H-Rauwolscine (3H-Ra) was significantly greater in the prostatectomy specimens obtained from men with symptomatic BPH compared to the specimens obtained from men with asymptomatic BPH (p less than 0.05). The density of 3H-Ra (alpha 2 adrenergic) binding sites was significantly greater in the prostate adenomas obtained from men with symptomatic BPH compared to the prostate adenomas obtained from men with asymptomatic BPH (p less than 0.05). The difference in alpha 2 adrenoceptor density was accounted for by an increased receptor density in the open prostatectomy specimens. There was no significant correlation between alpha 2 adrenergic, alpha 1 adrenergic, and MCh receptor densities and prostate weight or patient age. This study indicates that the development of infravesical obstruction in men with BPH is not related to upregulation or altered binding affinity of alpha 1 adrenergic or MCh receptor binding sites. The significance of the observed upregulation of alpha 2 adrenoreceptors in the prostate adenomas obtained from men undergoing open prostatectomy is unknown, and requires further investigation.     

前列腺增生手术前后膀胱重量变化的研究

目的 探讨良性前列腺增生（BPH）经尿道前列腺切除术（TURP）手术前后膀胱重量的变化及临床意义。方法 BPH患者63例,其中术后随访资料完整者21例,以相同年龄段无下尿路症状30例男性作为对照组。经腹B超测量膀胱壁厚度并结合膀胱容量按照球形体积公式估算膀胱重量。以尿动力学检查评价膀胱出口梗阻（BOO）和膀胱功能。63例BPH患者术前膀胱重量（97±54）g,对照组为（41±14）g,膀胱重量与梗阻分级（LinPURR）呈正相关（R=0．47）,与最大尿流率（Qmax）呈负相关（R=-0．52）,与残余尿量呈正相关（R=0．48）,差异均有统计学意义（P〈0．01）,与逼尿肌收缩强度（WF）呈负相关（R=-0．40,P〈0．05）。21例患者术前B超估测膀胱重量（UEBW）（99±50）g。结果 21例患者术后UEBW为（56±21）g,与术前比较差异有统计学意义（P〈0．01）。术后UEBW平均下降43．68％,国际前列腺症状评分（IPSS）下降16．81分,Qmax平均增加8．38ml／8。结论 膀胱重量作为一项无创性检查方法,对前列腺增生症进展的监测、术前评估和术后疗效的评价具有临床应用价值。     

Contractile properties of human prostate adenomas and the development of infravesical obstruction

The contractile response of human prostate adenomas to KCl, phenylephrine (alpha 1 adrenergic agonist), UK 14304 (alpha 2 adrenergic agonist), and carbachol (muscarinic cholinergic agonist) was evaluated in tissue specimens obtained from men with symptomatic and asymptomatic BPH. Prostate specimens were obtained from 5 men with asymptomatic BPH undergoing cystoprostatectomy, 11 men with symptomatic BPH undergoing open prostatectomy, and 11 men with symptomatic BPH undergoing transurethral resection of the prostate (TURP). Quantitative symptom score analysis and urinary flow rate determination documented the absence of bladder outlet obstruction in men undergoing cystoprostatectomy and confirmed the presence of bladder outlet obstruction in men undergoing prostatectomy. The magnitude of the contractile response (Emax) and the potency of phenylephrine-induced contractions (EC50) in prostatic preparations obtained from men with symptomatic and asymptomatic BPH were similar. The IC50 for the inhibition of phenylephrine-induced contractions by prazosin was 3.2 nM, confirming that phenylephrine-induced contraction in the human prostate is mediated by the alpha 1 adrenoceptor. The contractile responses of prostate adenomas to muscarinic cholinergic and alpha 2 agonists were negligible. This study demonstrates that the development of bladder outlet obstruction in men with BPH is not related to alterations in the functional response of the smooth muscle component of the prostate adenoma.     

The prediction of bladder outlet obstruction with prostate volume, maximum flow rate, residual urine and the international prostate symptom score in patients with lower urinary tract symptoms

We determined whether prostate volume (PV), maximum flow rate (Qmax), residual urine (RU) and the International Prostate Symptom Score (I-PSS) predicted bladder outlet obstruction in patients having lower urinary tract symptoms (LUTSs). The study consisted of 114 patients aged 50 years or older with LUTSs who had scores of 8 or more on the I-PSS and 2 or more for the quality of life index. All patients received transrectal ultrasonography for estimation of PV and pressure-flow study (PFS). When PFS showed an obstruction grade of 2 or more in Sch?fer's p/Q diagram, the result was defined as bladder outlet obstruction. When we examined which criteria indicated that 90% of patients had bladder outlet obstruction (positive predictive value: 90%), we found that PV of 35 ml or more, Qmax of 8 ml/sec or less, RU of 110 ml or more, and I-PSS of 30 or more did so. Fifty-nine percent of patients met at least one of these criteria. The results suggested that 59% of patients with LUTSs had bladder outlet obstruction with a 90% positive predictive value based on the value of PV, Qmax, RU or I-PSS.     

Interactions between prostate volume, filling cystometric estimated parameters, and data from pressure-flow studies in 565 men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

The aim of this study was to establish the characteristics and to investigate the interactions between prostate volume, degree of obstruction, bladder contractility, the prevalence of residual volume, bladder compliance, bladder capacities, and the prevalence of instability in a large, well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). The 565 consecutive men included in this study met the criteria of the International Consensus Committee on BPH and voided more than 150 mL during uroflowmetry. Their residual urine volume and prostate size were estimated, and filling cystometry and pressure-flow studies were performed. Fifty-three percent of the men appeared to have obstruction. We found a positive correlation between prostate volume and Sch?fer's obstruction grade, except that mean prostate volume decreased at Sch?fer's grades 5 and 6. Significant negative correlations existed between Sch?fer's grade and cystometric bladder capacity and effective capacity. Bladder outlet obstruction results in incomplete emptying. Of all men, 26% had a significant residual volume ( > 20% of cystometric capacity). Thirty-nine percent did not have residual volume. Of the 565 men, 46% had an unstable bladder. In particular, patients with an unstable bladder in the sitting and lying positions have a significantly higher Sch?fer's grade and contractility grade and a significantly lower cystometric and effective bladder capacity compared with patients without instability. Patients with a residual volume or instability were significantly older. We conclude that in men with LUTS suggestive of BPH, abnormalities of bladder and bladder outlet function vary greatly and have complex mutual interactions.     

相对膀胱出口梗阻的研究及临床意义

目的:研究相对膀胱出口梗阻参数与膀胱排空能力之间的关系,探讨其对于BPH患者的临床意义。方法:66名年龄在55岁以上并表现有下尿路症状的BPH患者被纳入本研究。所有患者均行尿动力学检查,对相对膀胱出口梗阻参数和排尿后剩余尿(PVR)之间的相关性进行研究。结果:相对膀胱出口梗阻参数(AG值/WFmax和URA/WFmax)与PVR之间的相关性强于AG值和URA。结论:相对膀胱出口梗阻参数能够更好地评价膀胱排空能力,有重要的临床指导意义。