良性前列腺增生患者逼尿肌功能的评估和治疗对策

目的　为了解良性前列腺增生（BPH）患者产生下尿路症状的成因，为正确诊治下尿路症状提供准确的证据。　方法　采用尿动力学方法分析无神经系统疾病的良性前列腺增生患者的膀胱尿道功能。　结果　164例良性前列腺增生患者，平均年龄67±7.04岁，膀胱出口梗阻者占61.6％（101/164），无梗阻者占38.4％（63/164）；逼尿肌收缩力正常者为83%（136/164），逼尿肌收缩力减弱者17％（28/164），以上各组之间I-PSS评分和年龄无显著性差异。膀胱出口无梗阻者中逼尿肌收缩力减弱者占44.4%（28/63），逼尿肌收缩力正常占55.6％（35/63）。在膀胱出口无梗阻者中，逼尿肌收缩力减弱合并不稳定膀胱患者为28.6％（8/28），而逼尿肌收缩力正常合并不稳定膀胱患者57.1％（20/35），膀胱出口无梗阻逼尿肌收缩力减弱合并不稳定膀胱患者明显少于膀胱出口无梗阻逼尿肌收缩力正常者（P＜0.02），两组患者I-PSS评分和膀胱顺应性均无明显差异。　结论　BPH患者下尿路症状的产生不仅与前列腺增生引起的膀胱出口梗阻有关，部分患者并不存在膀胱出口梗阻，其下尿路症状的成因为逼尿肌功能变化所致，尿动力学检查能为下尿路症状患者的诊治提供可靠的依据。

Evaluation of detrusor function with urodynamics and treatment choice

Objectives To understand the causes of lower urinary tractsymptoms(LUTS) of patients with benign prostate hiperplasia (BPH), and to provide more convinced evidences for treatment of those patients with LUTS. Methods Patients with BPH and without any other diseases which might affect detrusor function were evaluated with urodynamics. Results One hundred sixty-four patients with BPH were included in this study. 101 (61.6%) patients with BPH diagnosed routinely had bladder outlet obstruction(BOO) and 63 (38.4%) had no BOO. No statistically significant differences of I-PSS and age were observed between the two groups. 136 (83%) patients with BPH had normal detrusor contractility and 63 (17%) had decreased detrusor contractility; there was also no any significant differences of I-PSS and age between the two groups. In the 63 patients without BOO, 28 (44.4%) patients had decreased detrusor contractility and 35 (55.6%) had normal contractility. The incidence of bladder instability was 28.6% in non-BOO and decreased detrusor contractility patients. It was lower than 57.1% of those non-BOO and normal detrusor contractility patients(P＜0.02). There were no significant differences of I-PSS and bladder compliance between the two groups. Conclusions The causes of LUTS of patients with BPH are associated not only with BOO caused by BPH, but also with disarrangement of detrusor function for those BPH patients without BOO. Urodynamcs could provide more convinced evidences for treatment of patients with LUTS.