排尿期尿道压力测定在膀胱出口梗阻疾病诊断中的应用

目的　研究排尿期尿道压力测定 (MUPP)在膀胱出口梗阻 (BOO)疾病诊断中的应用。方法　下尿路梗阻患者 4 5例 ,其中良性前列腺增生 (BPH) 38例 ,前尿道狭窄 3例 ,女性尿道狭窄 4例。对照组为健康志愿者 4例。按常规方法行压力 流率测定 ,静态尿道压力测定 (UPP)及MUPP。以压力下降梯度计算梗阻程度。数据分析采用t检验。研究不同疾病梗阻患者尿道压力下降点及下降梯度 ,MUPP对梗阻部位的诊断价值 ,MUPP与压力 流率研究对可疑梗阻诊断的比较 ,MUPP与压力 流率研究判断梗阻程度的比较。　结果　对照组 2例男性 ,外括约肌以上尿道内压与膀胱内压力相等 ,尿道压在外括约肌处快速下降 ;2例女性 ,膀胱压与全部尿道压几乎相等 ,尿道末端 1cm处尿道压下降。 38例BPH患者最大排尿压增高 ,平均为 (99.33± 4 1.0 9)cmH2 O(1cmH2 O =0 .0 98kPa) ,尿道压力在膀胱颈或前列腺尖部下降。 3例前尿道狭窄患者后尿道近端压力与膀胱压相等 ,球部及远端尿道压力下降。 4例女性远端尿道狭窄患者尿道压力在狭窄远端区域下降。BPH、前尿道狭窄、女性远端尿道狭窄平均MUPP压力下降梯度分别为 (71.6 3± 37.4 1)cmH2 O、(43.5 1± 15 .71)cmH2 O、(41.4 8± 17.34)cmH2 O ,与正常对照组的 (2 4 .2 5± 2 .99)cmH2 O相比 ,差别有

Micturitional urethral pressure profilometry in bladder outlet obstruction

Objective To study micturitional urethral pressure profilometry (MUPP) in bladder outlet obstruction. Methods 45 cases of bladder outlet obstruction underwent urodynamic voiding investigation including pressure flow studies,urethral pressure profilometry (UPP) and MUPP. Results In asymptomatic males with normal urinary flow rates, the supramembranous urethral and intravesical pressure are isobaric. The urethral pressure drops precipitously across the membranous bulbous urethral region. In normal women, the bladder and nearly the entire urethra are isobaric up to the terminal 1 cm of the distal urethra where a physiologic pressure drop occurs. In patients with benign prostatic hypertrophy (BPH), the pressure disparity between the bladder and the urethra may occur proximal to the anatomic bladder neck in those with significant intravesical prostatic enlargement. Alternatively, in patients with prostatic enlargement spanning from the bladder neck to prostatic apex, the pressure drop occurs in the prostatic apex. In anterior urethral stricture, the pressure drops in the distal urethral at the site of the stricture. In women with distal urethral obstructions, the drop pressure occurs in proximal to the distal urethral of obstruction. Conclusions MUPP is highly reproducible, accurate, and clinically useful not only in diagnosing the presence of outlet obstruction but also in identifying its location and assessing its severity.