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。     

全雄激素阻断治疗晚期前列腺癌

目的　观察诺雷德和康士德治疗晚期前列腺癌的临床疗效,分析影响疗效的有关因素。方法　对1999年 8月至 2004年 8月收治的 33例晚期前列腺癌患者,给予以诺雷德和康士德为主治疗,并对其疼痛缓解程度、身体功能状况、肿瘤消退情况及血象、肝肾功能等进行观察分析。结果 33例中 25例缓解,有效率为 75. 8%,无明显不良反应。临床治疗效果与患者身体功能状况、既往治疗、转移部位及PSA改变等因素有关。结论　全雄激素阻断治疗晚期前列腺癌,疗效肯定,不良反应轻微,对初治和睾丸切除术后复发的前列腺癌均有治疗作用,初治较复治效果好。     

全雄激素阻断治疗晚期前列腺癌的护理

目的观察和讨论全雄激素阻断治疗晚期前列腺癌的护理效果.方法通过对45例晚期前列腺癌患全雄激素阻断治疗的观察和护理,总结护理要点.结果患者治疗后的生活质量和生存率得到了提高.结论通过全激素阻断治疗前列腺癌患者的护理,提高了患者的生存质量和生存率.     

成年男性下尿路症状与尿流率和前列腺体积的相关性研究

目的 :了解下尿路症状与前列腺体积和尿流率之间的相关性。方法 :采用国际前列腺症状评分 (IPSS)调查问卷评价下尿路症状 ,经腹B超测量前列腺体积 ,尿动力学检测仪检测尿流率。结果 :IPSS评分与最大尿流率呈负中度相关 (r =- 0 .6 4 ,P <0 .0 0 1) ,IPSS评分与前列腺体积呈弱相关 (r=0 .36 ,P <0 .0 0 1) ,前列腺体积与最大尿流率呈负弱相关 (r=- 0 .4 3,P <0 .0 0 1)。按单个症状与最大尿流率的相关系数的大小排列 ,尿细弱与最大尿流率呈中度相关 (r =- 0 .74 ,P <0 .0 0 1)。尿中断、尿等待、尿不尽、夜尿、尿急与最大尿流率呈弱相关 (P <0 .0 0 1) ;尿频与最大尿流率呈弱相关 (P =0 .0 1)。按单个症状与前列腺体积相关系数的大小排列 ,夜尿、尿细弱、尿急、尿不尽与前列腺大小呈弱相关 (P <0 .0 0 1) ;尿等待、尿中断、尿频与前列腺体积无相关性 (P >0 .0 5 )。结论 :下尿路症状越严重 ,最大尿流率越小。尿细弱与最大尿流率相关性最强。IPSS评分与前列腺体积呈弱相关 ,前列腺体积与最大尿流率呈负弱相关。     

雄激素全阻断在前列腺癌治疗中的应用

目的了解雄激素全阻断方法在前列腺癌治疗中的作用。方法睾丸切除加氟他胺治疗C、D期前列腺癌患者29例,应用(LHRH-A)加氟他胺治疗3例。结果雄激素全阻断疗法在降低PSA及缩小前列腺体积上有显著疗效。结论在前列腺癌的治疗中,雄激素全阻断治疗疗效好。     

绿激光前列腺汽化术联合雄激素全阻断治疗前列腺癌的近期疗效观察

目的探讨绿激光前列腺汽化术(PVP)加雄激素全阻断(maxjmal androgen blockade,MAB)治疗晚期前列腺癌(prostate cancer,PCa)合并膀胱出口梗阻(bladder outlet obstruction,BOO)的近期疗效。方法应用绿激光前列腺汽化术加雄激素全阻断对28例晚期前列腺癌患者进行治疗,观察患者手术前后前列腺症状评分(IPSS)、生活质量评分(QOL)、剩余尿量(RUV)、最大尿流率(MFR)及前列腺特异性抗原(PSA)变化情况。结果所有患者手术均获成功,无严重并发症发生,术后全部患者尿路梗阻情况均得到缓解。与手术前比较,患者PISS评分及QOL评分均明显下降,MFR明显升高,RUV及PSA明显降低,差异均具有统计学意义(P<0.05)。结论绿激光前列腺汽化术加雄激素全阻断治疗晚期前列腺癌患者能显著解除下尿路梗阻,提高患者生活质量,安全性高,近期疗效较满意。     

经尿道前列腺电切术加全雄激素阻断治疗47例前列腺癌

目的探讨前列腺癌的治疗方法。方法经尿道前列腺电切术加全雄激素阻断治疗前列腺癌。结果47例经尿道前列腺电切术加全雄激素阻断治疗,41例随访,疗效满意,2例死亡。前列腺特异抗原(PSA)由术前的2.6~76.6ng/mL,平均12.8ng/mL,下降为术后1个月1.12~7.66ng/mL,平均2.84ng/mL,3个月后下降至1.10~5.36ng/mL,平均2.44ng/mL。结论经尿道前列腺电切术加全雄激素阻断治疗前列腺癌,对中高分化前列腺,特别是偶发前列腺癌,是一种较好的治疗方法。     

经尿道前列腺电汽化切除加全雄激素阻断治疗晚期前列腺癌

对13例晚期前列腺癌采用经尿道前列腺电汽化切除及行睾丸切除术后3－5d加服缓退瘤做全雄激素阻断治疗。结果，随访6－34个月均健在，4例骨痛患者治疗后疼痛消失。前列腺特异性抗原（PSA）术前为75．37ng/ml，1个月后下降到1.34ng/ml，3个月后为0.27ng/ml。B超、胸片、骨扫描未新的转移。结果表明，经尿道前列腺癌电汽化切除加全雄激素阻断治疗晚期前列腺癌具有较好的临床疗效，值得进一步观察。     

最大雄激素阻断治疗前列腺癌的进展

雄激素阻断疗法已被普通用于前列腺癌的治疗中，其中联合应用非类固醇类抗雄激素的最大雄激素阻断治疗（MAB or CAB)是比单一去势治疗更具优势的治疗。间歇性雄激素阻断治疗可减少非雄激素依赖性前列腺癌细胞的出现而提高CAB疗效。     

TUVP联合激素全阻断治疗晚期前列腺癌PSA分析

目的探讨TUVP联合雄激素全阻断（MAB）治疗晚期前列腺癌的有效方法以及血PSA水平变化。方法应用经尿道前列腺电汽化术（TUVP）治疗合并膀胱出口梗阻（BOO）前列腺癌患者68例，结合MAB治疗。结果68例患者手术成功，疗效满意，无并发症，术后分别随访3个月-3年。国际前列腺症状评分（IPSS）由术前的（27．6&#177;3．8）分下降到术后2个月（9．4&#177;2．1）分（P〈O．05）；PSA由术前（67．2&#177;5．3）μg／L、术后30min（65．8&#177;6．4）μg／L下降到术后2个月的（5．6&#177;1．8）μg／L（P〈O．05）。结论应用TUVP联合MAB是治疗Pca合并BOO有效方法。但TUVP治疗晚期前列腺癌是否引起癌转移须进一步研究。     

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.     

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.     

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。     

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。     

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.     

间歇性雄激素阻断与晚期前列腺癌患者胰岛素抵抗的关系

目的探讨间歇性雄激素阻断与晚期前列腺癌患者胰岛素抵抗的相关性。方法将72例晚期前列腺癌患者根据BMI分为超重组（32例）和非超重组（40例）,两组患者均采用间歇性雄激素阻断方法治疗又称之为去势治疗。分别测定两组患者治疗前及治疗后6、12个月时的空腹血糖（FPG）、空腹胰岛素水平（FNS）,并计算胰岛素抵抗指数（IRI）,然后作组间比较及相关分析。结果去势后6个月两组患者FNS水平均较治疗前显著升高（均P〈0．01）;去势后12个月超重组患者FNS水平仍较治疗前明显升高（均P〈0．05）,但较去势后6个月显著下降（P〈0．01）,非超重组患者FNS水平较去势后6个月显著下降（P〈0．01）。两组患者去势后6个月IRI均显著升高（P〈0．01）;去势后12个月超重组患者IRI仍较去势前明显升高（P〈005）,但去势后6个月显著下降（P〈0．01）,非超重组患者IRI较去势后6个月显著下降（P〈0．01）。结论间歇性雄激素阻断会促使晚期前列腺癌患者发生胰岛素抵抗,但进入治疗间歇期后胰岛素抵抗又可逐渐恢复正常。     

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.