合并急性尿潴留的良性前列腺增生逼尿肌功能评估及术后疗效预测

目的评估幌并急性尿潴留(AUR)的良性前列腺增生(BPH)患者逼尿肌功能,预测术后疗效。方法对23例合并AUR的BPH患者术前后行尿动力学检查,评估逼尿肌功能(包括逼尿肌紊定性、顺应性、收缩功能),在治疗成功组与失败组之间进行比较。结果23例患者中,16例(70%)发生逼尿肌无抑制性收缩(DI),幅度5~168 cm H2O,平均(98±33)cm H2O(1cm H2O=0.098 kPa);20例(87%)可见有逼尿肌随意收缩;所有患者均明确诊断膀胱出口梗阻(BOO);4例(17%)患者术后不能排尿,需要留置导尿。手术前后患者年龄、DI的发生率、DI幅度、膀胱顺应性及测压容量、逼尿肌收缩力强弱在治疗成功组与失败组之间的差异具有统计学意义(P<0.05)。结论合并AUR的BPH患者留置尿管10 d后行尿动力学检查,可以预测术后疗效。术前尿动力学检查DI幅度越大,逼尿肌收缩力越强,术后疗效越好;术前膀胱顺应性及测压容量异常增高、无DI出现者术后疗效差。

Evaluation of detrusor function and predicting the surgical outcome for cases of benign prostatic hyperplasia associated with acute urinary retention

Objective To evaluate the detrusor function for cases of benign prostatic hyperplasia(BPH) associated with acute urinary retention(AUR),and to predict the surgical outcome.Methods Urodynamic parameters were analyzed preoperatively and postoperatively in 23 cases of BPH associated with AUR,evaluation of detrusor function(include detrusor stability,compliance,contractile function).These parameters were compared between successful and failed treatment groups.Results Among the 23 cases of BPH associated with AUR,detrusor insuability(DI) was found in 16 cases(69.6%),the amplitude of DI was(98±33)(5～168)cm H2O.Voluntary detrusor contractions were seen in 20 cases(87%).Bladder outlet obstruction(BOO) was diagnosed definitely in all cases.Four cases(17%) failed to void after operation and required catheterization.There were significant differences(P<0.05) between 2 groups regarding age,DI,detursor compliance,cystometric bladder capacity,and contractility of detrusor muscle.Conclusion For BPH patients with AUR,pressure-flow studies undertaken within 10 days after retention are useful in predicting the surgical outcome.The higher amplitude of DI,the stronger the contractility of the detrusor muscle and the better the postoperative results.The abnormal increase of detrusor compliance and cystometric bladder capacity and absence of DI are possibly associated with a poor outcome after operation.