Madersbacher S, Pycha A, Klingler C H, Mian C, Djavan B, Stulnig T, Marberger M
Department of Urology, University of Vienna, Austria.
Neurourol Urodyn. 1999;18(1):3-15. doi: 10.1002/(sici)1520-6777(1999)18:1<3::aid-nau2>3.0.co;2-4.
Data on the interrelationships of bladder compliance (BC), detrusor instability (DI), and bladder outflow obstruction (BOO) in elderly men with lower urinary tract symptoms (LUTS) are scarce and were therefore assessed in this study. Principle inclusion criteria for this study were men aged > or = 50 years suffering from LUTS as defined by an International Prostate Symptoms Score (IPSS) of > or = 7 and a peak flow rate (Qmax) of < or = 15 ml/sec. Patients with previous surgery of the bladder, prostate, or urethra as well as a pathological neurourological status were excluded from this study. The following parameters were studied in all patients: IPSS, prostate volume calculated by transrectal ultrasonography, free uroflow study, post-void residual volume determined by transurethral catheterization, and a multichannel pressure flow study (pQS). A group of 170 men were included in the analysis. The mean BC in the overall group was 32 +/- 2 ml/cm H2O (mean +/- standard error of the mean [SEM]; range, 4-100 ml/cm H2O). In 36.5% of patients, BC was significantly reduced (< or = 20 ml/cm H2O), and in a further 37.1%, it ranged from 20 to 40 ml/cm H2O. BC decreased statistically significantly (p < 0.05) in patients with advanced age, lower Qmax, higher voiding pressures, and larger prostates. In men with DI (n = 61), mean BC was significantly lower (22 +/- 3 ml/cm H2O) compared to those without (37 +/- 3 ml/cm H2O; p = 0.001; n = 109). Patients with severe BOO as defined by a linear passive urethral resistance relationship of > or = 3 (n = 109), had a significantly lower BC (23 +/- 2 ml/cm H2O) compared to those without or minimal obstruction only (39 +/- 3 ml/cm H2O; p = 0.0002; n = 61). Stepwise logistic regression analysis revealed that DI, a low bladder capacity, and a high maximum detrusor pressure were independent predictors of markedly reduced BC (< 20 ml/cm H2O). BC is decreased in elderly men with high voiding pressures, BOO, and DI. The mechanism leading to the reduction of BC under these circumstances is largely unknown and could result from cytostructural alterations of the detrusor and changes in detrusor innervation.
关于老年男性下尿路症状（LUTS）患者膀胱顺应性（BC）、逼尿肌不稳定（DI）和膀胱出口梗阻（BOO）之间相互关系的数据稀缺，因此本研究对其进行了评估。本研究的主要纳入标准为年龄≥50岁、国际前列腺症状评分（IPSS）≥7且最大尿流率（Qmax）≤15 ml/秒的LUTS男性患者。既往有膀胱、前列腺或尿道手术史以及神经泌尿病理状态的患者被排除在本研究之外。对所有患者研究了以下参数：IPSS、经直肠超声计算的前列腺体积、自由尿流率测定、经尿道插管测定的排尿后残余尿量以及多通道压力流率研究（pQS）。170名男性纳入分析。总体组的平均BC为32±2 ml/cm H2O（平均值±平均标准误差[SEM]；范围为4 - 100 ml/cm H2O）。36.5%的患者BC显著降低（≤20 ml/cm H2O），另有37.1%的患者BC在20至40 ml/cm H2O之间。高龄、低Qmax、高排尿压力和前列腺较大的患者BC在统计学上显著降低（p < 0.05）。DI患者（n = 61）的平均BC（22±3 ml/cm H2O）显著低于无DI患者（37±3 ml/cm H2O；p = 0.001；n = 109）。线性被动尿道阻力关系≥3定义的严重BOO患者（n = 109）的BC（23±2 ml/cm H2O）显著低于无梗阻或仅有轻微梗阻的患者（39±3 ml/cm H O；p = 0.0002；n = 61）。逐步逻辑回归分析显示，DI、低膀胱容量和高最大逼尿肌压力是BC显著降低（< 20 ml/cm H2O）的独立预测因素。高排尿压力、BOO和DI的老年男性BC降低。在这些情况下导致BC降低的机制很大程度上未知，可能是由于逼尿肌的细胞结构改变和逼尿肌神经支配的变化所致。
