Kuo H C
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Urology. 1999 Jul;54(1):90-6. doi: 10.1016/s0090-4295(99)00092-8.
To establish a clinical prostate score based on the parameters of uroflowmetry and prostate measurements to provide a better prediction of benign prostatic obstruction (BPO) in men with lower urinary tract symptoms (LUTS) and small prostate volume.
From October 1997 to September 1998, a prospective study of 324 consecutive men with LUTS was conducted in a community hospital in Taiwan. All patients were first evaluated by uroflowmetry and transrectal sonography of the prostate, and a videourodynamic study (VUDS) was performed before any medication was given. Patients were grouped as obstructed or unobstructed according to the results of the VUDS. Parameters from uroflowmetry and prostate measurements were evaluated for their sensitivity in predicting BPO. A clinical prostate score was established by summing scores on seven prostatic and uroflowmetric items: maximal flow rate (Qmax), flow pattern, voided volume, residual urine amount, total prostate volume (TPV), transition zone index (TZI), and prostatic configuration. Each of these items had a score representing the grade of sensitivity of BPO.
Among the 324 men examined, only 65.4% were found to have obstruction by VUDS. A value of Qmax 10 mL/s or less had a sensitivity of only 75.4% and specificity of only 63.7% for BPO. A constrictive flow pattern had 87.2% sensitivity, residual urine 100 mL or greater had 86.1%, TPV 40 mL or greater had 94.6%, TZI 0.5 or greater had 87.8%, and the presence of a median lobe had 87.1% sensitivity; the presence of any of these factors added 2 points to the score. The other parameters were scored as 1, 0, and -1, representing their sensitivity as slightly superior or inferior to that of LUTS. A prostate score of 3 or greater had a sensitivity of 87.2% and a specificity of 60.8% for BPO. On the basis of this prostate score, 148 patients (46%) would have been treated for BPO without the need for further investigation, of whom 19 (5.9%) would have been misdiagnosed. The remaining 176 patients (54%) would have undergone a VUDS and 93 of these patients (28.7%) were unobstructed.
By combining uroflowmetry and transrectal sonography of the prostate, patients with LUTS can be diagnosed with a good sensitivity and specificity. Using the parameters in the uroflow and prostate measurements, a prostate score could be established and used as an indicator of BPO for selecting patients with LUTS who require further treatment or invasive VUDS.
基于尿流率测定和前列腺测量参数建立临床前列腺评分，以更好地预测下尿路症状（LUTS）且前列腺体积较小男性的良性前列腺梗阻（BPO）。
1997年10月至1998年9月，在台湾一家社区医院对324例连续的LUTS男性进行了前瞻性研究。所有患者首先接受尿流率测定和经直肠前列腺超声检查，并在给予任何药物治疗前进行了视频尿动力学研究（VUDS）。根据VUDS结果将患者分为梗阻组或非梗阻组。评估尿流率测定和前列腺测量参数对预测BPO的敏感性。通过对七个前列腺和尿流率测定项目的得分求和来建立临床前列腺评分：最大尿流率（Qmax）、尿流模式、排尿量、残余尿量、前列腺总体积（TPV）、移行区指数（TZI）和前列腺形态。这些项目中的每一项都有一个代表BPO敏感性等级的分数。
在检查的324名男性中，仅65.4%经VUDS发现有梗阻。Qmax值为10 mL/s或更低时，对BPO的敏感性仅为75.4%，特异性仅为63.7%。收缩性尿流模式的敏感性为87.2%，残余尿量100 mL或更多时为86.1%，TPV 40 mL或更多时为94.6%，TZI 0.5或更高时为87.8%，中叶存在时敏感性为87.1%；这些因素中的任何一个存在都会使分数增加2分。其他参数分别评分为1、0和 -1，代表其敏感性略高于或低于LUTS。前列腺评分为3或更高时，对BPO的敏感性为87.2%，特异性为60.8%。基于该前列腺评分，148例患者（46%）本可接受BPO治疗而无需进一步检查，其中19例（5.9%）会被误诊。其余176例患者（54%）本会接受VUDS检查，其中93例患者（28.7%）无梗阻。
通过结合尿流率测定和经直肠前列腺超声检查，LUTS患者可获得良好的敏感性和特异性诊断。利用尿流和前列腺测量中的参数，可以建立前列腺评分并用作BPO的指标，以选择需要进一步治疗或侵入性VUDS的LUTS患者。
