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.

Analysis on impacts of detrusor instability and lower urinary tract obstruction on urodynamics of male patients with lower urinary tract symptoms

Objective To investigate the impacts of detrusor instability （DI） and lower urinary tract obstruction（LUTO） on the nrodynamic indexes of male patients with lower urinary tract symptoms （LUTS）. Methods Urodynamic data of 81 patients who diagnosed as benign prostatic hyperplasia （BPH） with LUTS during July 2012 to June 2013 were retrospectively analyzed. Patients were classified into three groups, 11 patients had LUTS with DI, 41 patients had LUTS with LUTO and 29 patients had LUTS with LUTO and DI. Urodynamic indexes of three groups were statistical analyzed. Results Compared the urodynamic indexes of three groups, there were significant difference among three groups for residual urine, maximum flow rate and maximum detrusor pressure （P 〈 0. 05 ）, there were highly significant difference among three groups for bladder volume of first sensation and bladder volume of strong sensation （P 〈 0. 01 ）, age and initial detrusor pressure had no difference among the groups （P 〉 0.05）. Compared the urinary storage indexes to group of LUTS with DI, patients of LUTS with LUTO and DI had higher maximum DI detrusor pressure and amplitude of DI （ P 〈 0. 05 ）. Conclusions The changes of urodynamic indexes caused by DI are lower residual urine, lower maximum cystometrie capacity and hyperaesthesia of bladder. Patients of LUTO with DI have higher maximum DI detrusor pressure and amplitude of DI. The examination of maximum flow rate is beneficial to the diagnosis of LUTO. Invasive urodynamics can diagnose DI and LUTO exactly and direct the diagnosis and treatment of LUTS patients.