良性前列腺增生患者术前压力-流率测定的局限性

目的评估良性前列腺增生(BPH)患者术前行压力一流率测定的应用价值。方法BPH患者69例,根据尿动力学检查直线被动尿道阻力关系(PURR)图结果分为膀胱出口梗阻(BOO)组50例,无或可疑BOO组19例,术前行剩余尿、尿流率、膀胱有效容量和压力-流率测定,国际前列腺症状评分(IPSS)、生活质量评分(QOL)。术后3个月复查比较尿动力学指标变化。结果无或可疑BOO组和有BOO组平均Qmax分别为12.8 ml/s和7.6 ml/s,差异有统计学意义(P<0.01),2组年龄、膀胱最大容量、剩余尿、膀胱有效容量、IPSS和QOL等参数差异无统计学意义(P>0.05)。术后2组平均Qmax分别提高了7.2 ml/s和10.8 ml/s,BOO组Qmax提高幅度与无或可疑BOO组比较差异有统计学意义(P<0.05);2组IPSS和QOL与术前比较差异有统计学意义(P<0.05),IPSS和QOL的改善幅度2组间差异无统计学意义(P>0.05)。BOO组术前逼尿肌活动过度21例(42%),无或可疑BOO例组逼尿肌活动过度7例(37%)。BOO组和无或可疑BOO组术后3个月IPSS和QOL等参数改善不明显分别有15例(30%)和6例(32%)。结论压力-流率测定有无BOO,对大部分BPH患者仍有预测疗效的作用;但术前膀胱有效容量大小以及逼尿肌活动过度等因素影响了手术疗效。部分伴严重下尿路症状(LUTS)的BPH患者无BOO,手术疗效满意。术前BPH患者压力-流率测定应有选择应用,结果分析个体化。     

良性前列腺增生症患者尿动力学特点

目的 :探讨良性前列腺增生 (BPH)患者尿动力学特点。方法 :就 474例 BPH患者的尿动力学资料 ,分析 BPH患者膀胱出口梗阻 (BOO)比例及其与最大尿流率 (Qmax)、排尿后剩余尿量 (PVRV)的关系 ;BOO(+)、BOO(- )和 BOO(± )患者间以及不同梗阻程度患者间的膀胱功能变化特点。结果 :75 .11%的 BPH患者存在BOO;BOO(+)组 Qmax明显低于其余两组 (P <0 .0 1) ,其 PVRV明显高于另两组 ;BOO (+)组的逼尿肌痉挛发生率显著高于其余两组 (P <0 .0 1) ,但不同梗阻程度患者间差异无显著性意义 (P >0 .0 5 ) ;逼尿肌顺应性降低和逼尿肌亢进在 BOO(+)组的发生率高于其余两组 (P <0 .0 5 ) ,且随梗阻程度加重 ,其发生率明显升高 (P <0 .0 0 5 ) ;逼尿肌收缩力减弱在 BOO(- )组的发生率显著高于另两组 (P<0 .0 0 5 )。结论 :Qmax和 PVRV的变化除受到 BOO的影响外 ,可能与逼尿肌功能状况有更直接的关系 ;逼尿肌痉挛、逼尿肌顺应性降低及逼尿肌亢进的发生率与 BOO的存在及其程度有正相关性     

良性前列腺增生症尿动力学检查的意义

目的:探讨尿动力学检查对良性前列腺增生症（BPH）治疗的意义。方法：通过对48例BPH患者的尿动力学检查,发现3例无膀胱出口梗阻（BOO）,6例可疑BOO,39例有不同程度的BOO,并发逼尿肌不稳定（DI）9例,逼尿肌收缩无力（逼尿肌收缩为W－以下）5例,高顺应性膀胱2例,低顺应性膀胱6例。结果：根据检查结果分别采用TURP或耻骨后前列腺开放切除术、耻骨上膀胱穿刺造瘘加药物治疗一段时间后再手术、药物治疗三种方法,取得较好的效果。结论：尿动力学检查是判定BPH患者是否需要手术治疗的客观量化指标,引流尿液及使用新斯的明和加兰他敏是治疗逼尿肌收缩无力的有效方法。     

剩余尿量作为良性前列腺增生手术指征标准的初步探讨

目的　探讨以剩余尿 (PVR)量作为良性前列腺增生手术指征标准的可能性。　方法　将不同剩余尿量的 10 3例BPH患者分为 3组 ,A组无PVR ,B组PVR <60ml,C组PVR >60ml。分别进行尿动力学检查。　结果　 3组间膀胱测压容积、逼尿肌等容收缩压 (Piso)和高顺应性膀胱、低顺应性膀胱、逼尿肌反射亢进、逼尿肌反射减弱的相互比较差异无显著性意义 (P >0 .0 5 ) ;B、C组不稳定性膀胱 (DI)、最大尿流率 (Qmax)、Griffiths组间特异性尿道阻力因子 (URA)及逼尿肌储能 (DR)相互比较差异无显著性意义 (P >0 .0 5 ) ,但与A组相比较差异有显著性意义 (P <0 .0 5 )。　结论　PVR≥ 60ml并非是BPH患者接受手术治疗的绝对量化指征 ,当BPH引起膀胱出口梗阻 (BOO)及排尿功能受到损害出现PVR时 ,在排除其他因素引起逼尿肌无力所致的PVR后 ,应及早接受手术治疗     

良性前列腺增生患者膀胱出口梗阻和逼尿肌功能的分析

目的：探讨尿动力学检查对BPH患者膀胱出口梗阻（BOO）和逼尿肌功能的诊断意义.方法：对95例BPH患者进行压力-容积和压力-流率测定.结果：95例BPH患者中BOO 57例,无BOO23例,其余15例为可疑或分析困难.BOO组前列腺体积大于无BOO组（62.4±16.1）cm^3 vs（41.0±7.1）cm^3（P＜0.05）,最大尿流率（Qmax）小于无BOO组（5.4±1.9）ml/s vs（12.4±5.0）ml/s（P＜0.05）,两组IPSS评分无差别（23.7±4.4）分vs（25.2±4.9）分（P＞0.05）.BOO组有逼尿肌不稳定收缩（DD34例,无BOO组D119例.结论：尿动力学检查有助于判断有无BOO存在,了解BPH患者的逼尿肌功能.IPSS不能判断患者的下尿路症状（LUTS）是否因BOO导致.BPH患者前列腺体积不足很大,但LUTS明显时,应行尿动力学检查.自由尿流率测定对BOO诊断有一定帮助.DI是无BOO患者发生LUTS的重要因素.     

良性前列腺增生患者膀胱出口梗阻及逼尿肌收缩强度对剩余尿的影响

目的　探讨良性前列腺增生 (BPH)患者膀胱出口梗阻 (BOO)及逼尿肌收缩强度与剩余尿的关系。　方法　应用尿动力学方法检测 181例BPH患者BOO情况和逼尿肌收缩强度 ,以导管法结合膀胱灌注量与排出量之差确定剩余尿 ,对相互关系进行统计学分析。　结果　 181例患者剩余尿量 0～ 2 0 0ml。逼尿肌收缩强度减弱 ,剩余尿量增多 (F =12 .14 3,P =0 .0 0 1) ;BOO加重 ,剩余尿量无明显改变 (F =2 .386 ,P =0 .0 71)。 2 5例 (13.8% )患者逼尿肌收缩强度减弱或正常时仍有较多剩余尿(>10 0ml)。　结论　剩余尿增多主要由逼尿肌收缩强度减弱所致 ,而随着BOO加重 ,剩余尿量无明显变化     

前列腺增生症患者膀胱逼尿肌超微结构的研究

目的：探讨前列腺增生症(BPFI)患者(BPH组)膀胱逼尿肌超微结构的改变。方法：对15例BPH患者和6例无膀胱颈梗阻老年人(无BOO组)膀胱逼尿肌进行透射电镜观察。结果：无BOO组膀胱逼尿肌呈退行性变，肌细胞间隙增宽，细胞中间连接减少，细胞间隙中有胶原纤维分布。BPH组逼尿肌细胞外形肥大，扭曲变形，胞浆内空泡形成，密体明显减少，细胞中间连接减少甚至消失，细胞间隙明显增宽，内含较多的胶原及弹性蛋白。尤其慢性尿潴留患者改变更为显著。结论：逼尿肌超微结构的改变导致BPH患者膀胱排空障碍，对BPH患者的预后评估具有一定的意义。     

良性前列腺增生手术前后尿动力学检查及其临床价值

目的 探讨尿动力学检查在良性前列腺增生症(BPH)诊治中的价值.方法 回顾性分析72例良性前列腺增生症患者手术前后尿动力学检查结果 .结果 72例均有膀胱出口梗阻(BOO),其中40例伴有不稳定膀胱(DI),占55%.66例膀胱逼尿肌收缩正常或增强,6例膀胱逼尿肌收缩减弱.65例尿流率(UFR)低平,7例正常.手术后3个月,66例症状消失,2例出现并发症经再次处理治愈,不稳定膀胱15例,占21%,包括5例低顺应性膀胱.结论 通过对良性前列腺增生症患者术前术后详细的尿动力学检查,可明确患者有无下尿路梗阻、膀胱逼尿肌顺应性和收缩功能及尿道括约肌功能.这对于合理选择病人及术后疗效判定有重要的指导意义.     

良性前列腺增生患者残余尿量与膀胱出口梗阻和逼尿肌收缩力的相关性研究

目的:探讨良性前列腺增生(BPH)患者残余尿量(VRU)与膀胱出口梗阻(BOO)程度和逼尿肌收缩力的相关性。方法:临床诊断为BPH的患者152例,均行B超检查测量前列腺体积(PV)和膀胱VRU,自由尿流率检测,全套尿动力学检查评估BOO程度和逼尿肌收缩力。采用SPSS 20.0统计软件,对B超和尿动力学参数行相关性分析,两样本均数比较采用t检验,定义P0.05有统计学意义。结果:PV与BOO程度和逼尿肌收缩力有正相关性(相关系数r=0.432和r=0.343,P0.01)。最大尿流率(Qmax)与BOO程度负相关(r=-0.327,P0.01),而与逼尿肌收缩力无显著相关性(r=0.123,P0.05)。VRU≤150 ml时,VRU与逼尿肌收缩力间无显著相关性(r=0.041,P0.05);当VRU150 ml时,VRU与逼尿肌收缩力有显著负相关性(r=-0.490,P0.01);VRU300 ml时,该相关性尤为明显(r=-0.717,P0.01)。结论:VRU对逼尿肌功能有一定预测价值。VRU150 ml者应重视逼尿肌功能的评估,尤其是VRU300 ml时,建议行尿动力学检查以正确评估BOO程度和逼尿肌收缩力。     

BPH手术前后尿动力学检查及其临床价值

目的：评价尿动力学检查在BPH诊治中的意义。方法：对80例BPH患者进行详细的手术前后尿动力学检查。结果：80例均有膀胱出口梗阻，其中41例伴有不稳定性膀胱，占52％；78例逼尿肌压力正常或增强；72例尿流率降低，8例正常；手术后3个月，76例症状消失，2例出现并发症经再次处理治愈，不稳定性膀胱24例，占30％，包括6例低顺应性膀胱(术前为低顺应性膀胱)，2例逼尿肌无力(术前为高顺应性膀胱)。与术前相比，膀胱顺应性升高，而膀胱压及尿道降落压降低。结论：本研究表明，详细的、规范的尿动力学检查，可明确BPH患者有无BOO、逼尿肌顺应性和收缩功能及尿道压力。这对于合理选择术式和提高手术疗效有重要的临床意义。     

前列腺增生患者膀胱出口梗阻程度对尿动力学指标的影响

目的探讨前列腺增生患者膀胱出口梗阻程度对尿动力学指标的影响及临床意义。方法分析113例前列腺增生患者的尿动力学资料,根据膀胱出口有无梗阻分为梗阻组和非梗阻组,梗阻组又根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级四组。结果梗阻组的最大尿流率、膀胱顺应性值和逼尿肌收缩力减弱发生率明显低于非梗阻组,逼尿肌不稳定和急性尿潴留发生率明显高于非梗阻组。梗阻组内各梗阻级别之间在顺应性值、逼尿肌不稳定和急性尿潴留的发生率上无显著性差异,随梗阻级别增加尿流率和逼尿肌收缩功能受损发生率下降。结论一些反映排尿异常和逼尿肌功能的尿动力学指标受膀胱出口梗阻程度影响,在无法进行压力/流率分析时综合分析这些指标有助于判断出口梗阻及其程度。     

前列腺增生症疗效不佳者尿流动力学原因分析

为分析良性前列腺增生症（ＢＰＨ）疗效不佳的原因，对５８例曾接受经膀胱及Ｍａｄｉｇａｎ前列腺摘除术，经尿道前列腺切除术、经尿道激光治疗、微波及射频热疗等不同方法治疗并诉疗效不满意的ＢＰＨ患者进行尿流动力学测定，项目为充盈膀胱测压、压力－流率测定、ＥＭＧ测定、静态及加压尿道压力测定。测定结果出口梗阻（ＢＯＯ）占４８．３％、副尿肌收缩无力（ＤＤＣ）占１７．２％、逼尿肌不稳定（ＤＩＳ）占２０．７％、压力性     

Evaluation for Madigan＇s prostatectomy in patients with benign prostatic hyperplasia

Aim: To comparatively evaluate the efficacy and post-operative complications of the Madigan‘s prostatectomy (MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasia were divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symptom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The International Continence Society (ICS) nomogram, Abrams-Gfiffiths (AG) number and linear passive urethral resistance relation analysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamic parameters before and after operation, as well as the advantages and post-operative complications were recorded and compared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urodynamic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantages of the absence of postoperative hematuria and post-catheter stricture, a shorter period of hospitalization, and lower incidence of retrograde ejaculation and erectile dysfunction. Conclusion: Both MPC and SPPC can effectively relieve BOO. MPC has certain advantages and a lower incidence of complications as compared with SPPC.     

压力-流率测定与BPH术后症状改善的关系

目的：搪塞术前测定压力－流率是否能预测前列腺增生症（ＢＰＨ）前列切除术的手术效果。方法：对有完整压力－流率测定资料的５２名ＢＰＨ患者术前及术后５￣１１个月的有列腺症状评分和生活质量评分进行了分析。结果：根据压力－流率测定值将患者分为重度梗阻、中度梗阻、可疑或无梗阻３个组，各组手术满意率分别为８９．５％、８１．８％和５４．５％。结论：压力－流率测定诊断存在膀胱出口梗阻（ＢＯＯ）者手术治疗可以满意效果     

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。     

Analysis of the pathophysiology of lower urinary tract symptoms in patients after prostatectomy

OBJECTIVES: To analyze the pathophysiology of persistent lower urinary tract symptoms (LUTS) in patients after transurethral prostatectomy (TURP). METHODS: A total of 185 patients who had persistent LUTS after TURP were enrolled into this study. All of these patients underwent multichannel videourodynamic studies and were classified into 6 groups according to the urodynamic results. Preoperative prostate volume, resected adenoma weight, and preoperative Q(max) were determined in each of the groups and the symptomatology and urodynamic findings were compared. RESULTS: A normal videourodynamic tracing was found in 17 patients (9.1%), pure detrusor instability in 18 (9.6%), low detrusor contractility in 35 (18.7%), detrusor instability and inadequate detrusor contractility (DHIC) in 27 (14.4%), poor relaxation of the urethral sphincter in 36 (19.3%), and bladder outlet obstruction (BOO) in 52 (27.8%). Incontinence was noted in 74 patients (40%), and 18 of them had BOO (24.3%). In urodynamic findings, Q(max) and residual urine showed no significant difference among patients with low contractility, poor relaxation of sphincter, DHIC and BOO. Concerning the preoperative prostatic volume, patients with low contractility, poor relaxation of urethral sphincter, and DHIC had a nonsignificantly smaller prostate volume and resected prostate weight than other groups. Preoperative Q(max) showed no significant difference among all groups. CONCLUSIONS: Symptoms alone are unreliable in predicting urodynamic findings with respect to obstruction and detrusor instability after TURP. Over half of the patients with persistent LUTS had a small prostate volume and small resected adenoma weight, indicating that some of these patients may not have had BOO. Videourodynamic study is helpful in making an accurate diagnosis for refractory LUTS after TURP.     

Utility of the American Urological Association symptom index in the diagnosis of women with voiding dysfunction

The objective of the study was to determine the applicability of the American Urological Association (AUA) symptom index to the assessment and treatment of women with voiding dysfunction while investigating the specificity of the index to men with benign prostatic hyperplasia (BPH).One hundred and two consecutive adult patients (45 females, 57 males) with symptoms of dysfunctional micturition were prospectively evaluated using both the AUA symptom index and videourodynamic studies. According to urodynamic criteria, the patients were placed into three groups: 45 women with stress incontinence and/or detrusor instability but without bladder outlet obstruction (BOO); 23 men with detrusor instability (DI) without BOO; and 34 men with BPH and BOO. Correlation between symptom index scores and patient characteristics were examined. The mean index score for the 45 women was 17.0 (range 4–33). In contrast, the men scored mean values of 18.9 (range 7–28) and 20.5 (range 12–27) for the BPH with BOO and DI without BOO groups, respectively. The total score was statistically correlated with age, duration of bladder symptoms, cystometric capacity and maximum urine flow rate.The quantification of voiding symptoms, using the AUA symptom index, yields strikingly similar results in both women and men with voiding dysfunction, despite vastly different bladder and urethral pathologies. The etiology of voiding symptoms, whether detrusor dysfunction or bladder outlet obstruction, cannot be determined by the AUA symptom index. The index should, however, prove to be useful in evaluating treatment outcome in both men and women with voiding dysfunction.     

245例前列腺增生患者尿流动力学的结果分析

本文采用自制半卧位尿动力测定床及Ｄａｎｅｃ尿动力仪器，常规行尿流率，压力－流率（同步测定尿道外括约肌肌电图），尿道测压。结果明确诊断ＢＯＯ１６１例，可疑５０例，合并逼尿肌功能受损６５例；膀胱顺应性降低７０例，外括约肌功能失调１１４例；逼尿肌不稳定５９例。最大尿流率受测压导管影响；功能尿道长度与经直肠Ｂ超测定的前列腺尿道长度相关联。结论：１、ＢＰＨ的排尿症状的机械因素与动力学因素共同作用的结果；尿动力学检查是诊断由ＢＰＨ所致ＢＯＯ的一个非常重要的手段，但分析结果时应考虑干扰因素的影响。２、功能性尿道长度与前列腺部尿道长度相关联。     

良性前列腺增生术后排尿困难的尿动力学分析

目的探讨尿动力学检查对良性前列腺增生(BPH)术后排尿困难患者的诊断价值。方法对32例BPH术后排尿困难患者行尿动力学检查,分析结果并探讨治疗方法。结果14例患者为膀胱出口梗阻,16例为逼尿肌收缩乏力,1例为假性排尿困难,1例为逼尿肌括约肌协同失调。结论BPH术后排尿困难患者进行尿动力学检查,对明确病因、指导治疗具有重要意义。