慢性前列腺炎伴非神经源性膀胱外括约肌协同失调的诊治(附21例报告)

目的:研究表现为非神经源性膀胱外括约肌协同失调(NNDSD)的慢性前列腺炎(CP)的特点及其生物反馈治疗疗效。方法:CP患者113例,诊断标准为有尿频、尿急、尿痛、排尿不尽、排尿困难等CP的典型症状大于3个月,且NIH-CPSI评分中第一和第二项评分≥1。经相关检查,排除尿道炎、间质性膀胱炎、尿道狭窄和神经源性膀胱等情况。113例均行尿动力学检查,分析尿流曲线,记录最大尿流率(Qmax)、最大逼尿肌排尿压(Pdet.max)、最大尿道压(MUP)和最大尿道闭合压(MUCP)等参数。对尿流动力学结果表现为NNDSD的患者行生物反馈治疗,10周后评估疗效。结果:CP患者113例中尿流动力学表现为NNDSD的21例(21/113,18.6%)。NNDSD患者治疗前后Qmax(8.2±4.1)ml/s vs(15.1±7.3)ml/s]、Pdet.max(125.1±75.3)cmH_2O vs(86.3±54.2)cmH_2O]、MUP(124.3±23.3)cmH_2O vs(65.4±23.0)cmH_2O]和MUCP(101.5±43.6)cmH_2O vs(43.5±16.7)cmH_2O]差异有统计学意义(P<0.05);生物反馈治疗前后NIH-CPSI疼痛评分(4.0±2.0)分vs(2.2±1.7)分]、排尿评分(7.9±2.1)分vs(2.2±1.9)分]、生活影响评分(9.6±2.7)分vs(2.9±2.6)分]和总分(21.7±4.8)分vs(8.4±4.6)分]差异有统计学意义(P<0.05)。结论:有下尿路症状的CP患者可能存在NNDSD,尿动力学主要表现为尿流率下降,排尿期膀胱内压力升高和部分患者尿道压力升高,尿动力学检查可以明确诊断及选择正确的治疗方法;盆底肌生物反馈治疗此类患者的近期疗效确切。

Chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia: Diagnosis and treatment

Objective: To investigate the features of chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia (NNDSD) and the effects of pelvic floor biofeedback in the treatment of the disease. Methods: We included in this study 113 male patients, aged 15-48 (mean 36) years and diagnosed as having chronic prostatitis for 1-2 (mean 1.2) years based on such typical symptoms as frequent micturition, urgent micturition, voiding pain, difficult void, etc, that lasted over 3 months, and the score ≥ 1 on the first and second parts of NIH-CPSI. Urethritis, interstitial cystitis, urethral stricture and neurogenic bladder were excluded. All the patients underwent urodynamic examinations for the uroflow curve, Qmax, Pdet. Max and MUCP. Biofeedback was carried out for those with non-neurogenic detrusor sphincter dyssynergia, and the effects were evaluated at 10 weeks. Results: Twenty-one(18.6%) of the 113 cases were found to be NNDSD. Biofeedback treatment achieved obvious decreases in Qmax (8.2±4.1),Pdet. Max (125.1±75.3), MUP (124.3±23.3) and MUCP (101.5±43.6), as compared with 15.1±7.3, 86.3±54.2,65.4±23.0 and 43.5±16.7 before the treatment (P < 0.05). Statistically significant differences were observed between pre-and post-treatment scores on voiding pain (4.0±2.0 vs 2.2±1.7), urination (7.9±2.1 vs 2.2±1.9), life impact (9.6±2.7vs 2.9±2.6) and total scores (21.7±4.8 vs 8.4±4.6) (P <0.05). Conclusion: Chronic prostatitis patients with LUTS may have NNDSD, which is urodynamicaUy characterized by low Qmax, high intra-bladder pressure and increased urethral pressure in some patients. Urodynamic examinations may contribute to definite diagnosis and appropriate choice of treatment. Pelvic floor biofeed-back has satisfactory short-term effects in the treatment of these patients.