Kageyama S, Watanabe T, Kurita Y, Ushiyama T, Suzuki K, Fujita K
Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Neurourol Urodyn. 2000;19(3):233-40. doi: 10.1002/(sici)1520-6777(2000)19:3<233::aid-nau4>3.0.co;2-m.
Detrusor hyperreflexia (DH) is frequently found in patients with benign prostatic hypertrophy (BPH) and persists in 30-50% of patients after successful removal of bladder neck obstruction by transurethral prostatectomy (TUR-P) or surgical enucleation of the prostate. It would be beneficial for surgeons to be able to identify patients who are at risk of persistent post-operative urinary irritation symptoms and DH. Twenty-three patients who showed DH pre-operatively were included in this study. Of these 23 patients, four had neurogenic bladder because of previous cerebrovascular disease. The other 19 patients were considered to have DH because of BPH. These 19 patients were classified according to their cystometry chart patterns. Pattern 1 was the continual sporadic onset and offset of DH, pattern 2 was a single episode of DH at a bladder volume of <160 mL, and pattern 3 was a single DH episode at a bladder volume >160 mL. Preoperative single-photon emission computed tomography (SPECT) was performed on 14 patients. Cystometric findings at 3 to 6 months after surgery were compared with the pre-operative findings. Four of the six patients with pattern 2 (67%) and all patients with pattern 3 (100%) showed an absence of DH after surgery. In contrast, all five patients with pattern 1 and all four patients with neurogenic bladder showed persistent DH. Compared with pattern 3 patients, pattern 1 patients more frequently complained of urgency before surgery, and their symptoms and uroflowmetry parameters did not improve afterward. Among 14 patients who had pre-operative SPECT, all eight patients with low cerebral blood flow in the frontal region showed persisting DH. Conversely, all six patients with normal SPECT results showed no DH after surgery. When DH occurs repeatedly (pattern 1) or occurs at a bladder volume of <160 mL (pattern 2), there is a greater risk of post-operative irritation symptoms. Abnormal SPECT findings can also predict the post-operative persistence of DH. Combing these two pre-operative examinations allows us to predict better post-operative DH in patients with BPH.
逼尿肌反射亢进（DH）常见于良性前列腺增生（BPH）患者，经尿道前列腺切除术（TUR-P）或前列腺手术摘除成功解除膀胱颈梗阻后，仍有30%-50%的患者存在该症状。对于外科医生而言，若能识别出术后有持续性尿路刺激症状和DH风险的患者将大有裨益。本研究纳入了23例术前表现为DH的患者。在这23例患者中，4例因既往脑血管疾病患有神经源性膀胱。另外19例患者被认为因BPH而患有DH。这19例患者根据其膀胱测压图模式进行分类。模式1为DH持续散在发作和缓解，模式2为膀胱容量<160 mL时出现单次DH发作，模式3为膀胱容量>160 mL时出现单次DH发作。14例患者术前行单光子发射计算机断层扫描（SPECT）。将术后3至6个月的膀胱测压结果与术前结果进行比较。模式2的6例患者中有4例（67%）和模式3的所有患者（100%）术后未出现DH。相比之下，模式1的所有5例患者和所有4例神经源性膀胱患者术后DH持续存在。与模式3患者相比，模式1患者术前更频繁地抱怨尿急，且术后其症状和尿流率参数并未改善。在14例术前行SPECT的患者中，额叶脑血流低的所有8例患者术后DH持续存在。相反，SPECT结果正常的所有6例患者术后未出现DH。当DH反复出现（模式1）或在膀胱容量<160 mL时出现（模式2），术后出现刺激症状的风险更高。SPECT检查结果异常也可预测术后DH的持续存在。结合这两项术前检查能够更好地预测BPH患者术后的DH情况。
