尿动力学检查在经尿道前列腺四区分割剜切术治疗BPH中的意义

目的探讨并评估经尿道低压灌注下四区分割法等离子体前列腺剜切术（FPKRP）患者术前选择性实施尿动力学检查的临床意义。方法选择拟手术前列腺增生（BPH）患者31例，平均年龄69．5岁，平均病程5a。31例患者术前进行尿动力学检查，截石位插管测定膀胱最大容量、膀胱稳定性和顺应性、逼尿肌压力等。按四区分割法实施前列腺剜切术，术后加强盆底肌功能锻炼，低顺应性膀胱术后加强膀胱容量训练，高顺应性膀胱加用α受体阻滞剂。结果术前27例I、Ⅱ度增生和4例III度增生患者尿动力学检查提示中、重度膀胱出口梗阻（BOO），最大尿流率（Qmax）均〈15（11±3．6）mL／s，平均尿量〉160mL，平均尿流率〈10mL／s。不稳定膀胱（DI）7例（23％），低顺应性膀胱4例（13％），高顺应性膀胱2例（7％），无明显逼尿肌异常18例。术后随访3～12个月，平均Qmax达17．3mL／s。6例膀胱测压未达到40cm H2O，且充盈过程中无DI发生，保留膀胱造瘘出院，半年后再次尿动力学检查，其中4例膀胱逼尿肌收缩部分恢复，2例功能无改善，则长期留置造瘘管。结论尿动力学检查具有直观、准确、量化、比较值高等优点，对BPH的手术方案、治疗时机选择和疗效预测评估具有重要的指导作用。

Significance of Urine dynamics test in four area segmentation of transurethral prostate for the treatment of BPH

Objective To explore and assess the clinical significance of the selective urodynamic examination for ＂FPKRP＂ patients. Methods 38 cases of BPH patients, an average age 69.5 years old and average dis- ease duration 5 years, were selected to be received urodynamic examination for observing their bladders＇ maximum capacity, stability, compliance and pressure of bladder detrusor with the method of lithotomy position intubation. Having received pluck resection of prostate with ＂four-region segmentation method＂, indwelling catheter after surgery, bladder fistula 48h extraction and 3--5 day pulling out catheters, they should be strengthened the pelvic floor muscle exercise, the bladder capacity training enhanced after sur- gery of low compliant bladder, bladder and a receptor blockers in high compliance. Results In 27 cases I , preoperative Ⅱ degree of hyperplasia and 4 patients with hyperplasia of ]I degree prompt and severe BOO, maximum urinary flow rate （Qmax） 〈15 mL/s （11＋3.6）, average urine volume 〉160 mL, aver-age urine flow rate ~10 mL/s. In 38 cases of the implementation of ＂four areas＂ surgery and 31 cases of urinary dynamics test, unstable bladder （DI） took up 7 cases （23%）; Low compliance bladder 4 cases （13%）and high compliance of the bladder in 2 cases, accounting for 7% no obvious abnormal detrusor 18 cases. In postoperative follow-up after 3--12 months, the average Qmax had reached 14.3 ml/S, bladder pressure of 6 cases was under 40 cmH20. Besides, without occurrence of DI in the process of fill- ing, they went back home retaining the bladder fistula. Half a year later, urine dynamics test would be given again, 4 cases are found that their bladder detrusorrs contraction section had partly recovered and 2 cases showd no improvement in function, with the fistula installed for a long term. Conclusion Urine dy- namics test, explicit, accurate, quantitative and with a comparative value, plays an important guiding role in the operation scheme for BPH, selection of treatment timing and prediction of a curative effect.