良性前列腺增生患者膀胱内前列腺突人程度的超声测定

目的 探讨良性前列腺增生(BPH)患者膀胱内前列腺突入程度(IPP)测定对膀胱出口梗阻及膀胱功能的预测与评价. 方法 BPH患者206例,年龄55～84岁,均为首次就诊,有不同程度的尿频、尿急等下尿路症状.行经腹B超测定IPP并根据程度分2组:研究组78例(IPP>10mm)和对照组128例(IPP≤10 mm),分析2组患者临床资料及尿动力学检查结果 间的关系. 结果 研究组和对照组前列腺体积(73.7±35.9)、(62.8±36.5)ml]、前列腺特异性抗原(1.81±0.67)、(1.64±0.36)ng/ml]、残余尿量(290.2±217.2)、(228.2±167.9)ml]、急性尿潴留发生率(33.3%、18.0%)及膀胱小梁化发生率(23.1%、11.7%)比较差异均有统计学意义(P<0.05).IPP与前列腺体积、残余尿量呈正相关(r分别为0.401,0.342).2组患者排尿期最大尿流率(7.6±4.1)、(9.1±3.6)ml/s]、膀胱过度活动症发生率(82.1%,17.2%)、膀胱顺应性降低率(35.9%,12.5%)、最大逼尿肌压力(109.8±84.9)、(84.9±44.1)cm H2O,1 cm H2O=0.098 kPa]及膀胱出口梗阻指数(75.2±27.1、65.9±34.6)比较差异均有统计学意义(P<0.05); IPP与最大尿流率呈负相关(r=-0.284),与最大逼尿肌压力及膀胱出口梗阻指数呈正相关(r分别为0.252,0.456).经保守治疗后,2组患者急性尿潴留复发率分别为64.3%(9/14)和23.5%(4/17)(P<0.05). 结论 IPP可以作为初步预测及评价膀胱出口梗阻程度和膀胱功能的指标之一;前列腺突入膀胱的BPH患者膀胱出口梗阻及膀胱功能受损程度明显高于无突入患者,对于前列腺突入膀胱的BPH患者.尤其是合并急性尿潴留患者应及早采取外科手术治疗.

Ultrasonic measurement of intravesical prostatic protrusion in benign prostatic hyperplasia patients

Objective To study a noninvasive method in evaluating the bladder outlet obstruc-tion (BOO) and bladder function in patients with benign prostatic hyperplasia (BPH) based on the transabdominal ultrasonic measurement of intravesical prostatic protrusion (IPP). Methods The da-ta of 206 first visit BPH patients with lower urinary tract symptoms (LUTS) were retrospectively re-viewed. Patients were divided into 2 groups based on the degree of IPP: the research group with IPP greater than 10 mm(n=78) and control group with IPP 10 mm or less(n=128). Clinical data and uro-dynamic findings of the 2 groups were analyzed to find the clinical significance of IPP. Resells In-creased prostate volume(73.7±35.9 ml vs 62.8±36.5 ml), serum prostate specific antigen(1.81± 0.67 ng/ml vs 1. 64±0.36 ng/ml), post-voiding residual urine volume (PVR)(290.2±217.2 ml vs 228.2±167.9 ml), incidence of acute urine retention(33.3% vs 18.0%)and bladder trabeculation (23.1% vs 11.7%)had signicant differences between the 2 groups (P<0.05). Positive correlation was found between IPP and prostate volume as well as PVR (r=0.401 and 0.342, respectively). In the urodynamic study, significantly lower peak flow rate (Qmax) (7.6±4.1 ml/s vs 9.1±3.6 ml/s), higher incidence of detrusor overactivity (82.1% vs 17.2%) and low bladder compliance (35.9% vs 12.5%)were found in research group (P<0.01). In addition, maximum detrusor pressure(109.8± 84.9 cm H2O vs 84.9±44.1 cm H2O) and BOO index (BOOI) (75.2±27.1 vs 65.9±34.6) were significantly higher in the research group (p<0.05). The correlation study showed that r between IPP and Qmax, Pdet. max and BOOI was-0.284, 0.252 and 0.456, respectively. The incidence of acute urinary intention recurrence was higher in research group than in control group (64.3% vs 23.5%) (P<0.05). Conclusions IPP is a useful predictor in evaluating BOO and detrusor function. BOO and impaired detrusor function in obvious IPP patients are more severe. The obvious IPP pa-tients, especially those presenting with acute urine retention, may benefit more from early surgical in-tervention.