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

An urodynamic study of detrusor function in BPH patients with bladder outlet obstruction

BPH patients with bladder outlet obstruction were evaluated with uroflowmentry,postvoid residual measurement,cystometry,isometric test,urethral closure pressure profilometry and micturitional urethral pressure profilometry (MUPP).Subjective symptoms were assessed with international prostatic symptom score (IPSS).The isometric test was performed by occluding the bladder outlet before the onset of a detrusor contraction.The results revealed that the maximum isometric contraction pressure (Piso) correlated well with the detrusor contraction velocity ( r =0.7167, P <0.001).As the bladder was filled so that the patient experienced a strong desire to void,the value of Piso was significantly decreased ( P <0.001).A significant correlation ( r =0.6781, P <0.001) was found between Piso and the severity of bladder outlet obstrution as determined by the voiding profilometry gradient.When the postvoid residual urine volume was more than or equal to 100ml,the potential of detrusor was significantly decreased ( P <0.001).37(63%) of the 59 presented detrusor instability.Patients with detrusor instability tended to have a higher valus of IPSS,an acceleration of flow rate and a higher Piso than those with stable bladders,but the bladder capacity and urine volume required to evoke a first desire to void was significantly decreased.It was believed that detrusor isometric contraction test is an effective alternative method of assessing detrusor contractibility by which the pathophysiologic changes in bladder outlet obstruction caused by BPH could be understood better.