Hyman M J, Groutz A, Blaivas J G
Weill Medical College, Cornell University, New York, New York, USA.
J Urol. 2001 Aug;166(2):550-2; discussion 553. doi: 10.1016/s0022-5347(05)65982-4.
We evaluated the correlation of lower urinary tract symptoms suggestive of detrusor instability with urodynamic findings in men.
Enrolled in our prospective study were 160 consecutive neurologically intact men referred for urodynamic evaluation of persistent lower urinary tract symptoms. All patients had storage symptoms suggestive of detrusor instability. Patients were further clinically categorized according to the chief complaint of urge incontinence, frequency and urgency, nocturia or difficult voiding. The clinical and urodynamic diagnosis in all patients as well as specific urodynamic characteristics of those with detrusor instability were analyzed according to the these 4 clinical categories.
Mean patient age was 61 +/- 15 years. The chief complaint was urge incontinence in 28 cases (17%), frequency and urgency in 57 (36%), nocturia in 30 (19%) and difficult voiding in 45 (28%). Detrusor instability was diagnosed in 68 cases (43%). A higher incidence of detrusor instability was associated with urge incontinence than with the other clinical categories (75% versus 36%, p <0.01). Of the patients 109 (68%) had bladder outlet obstruction, including 50 (46%) with concomitant detrusor instability. The prevalence of bladder outlet obstruction was similar in all patients regardless of the chief complaint. All other urodynamic diagnoses were also similar in the 4 clinical categories. The mean bladder volume at which involuntary detrusor contractions occurred were lower in patients with urge incontinence and frequency and urgency than in those with nocturia and difficult voiding (277.1 +/- 149.4 and 267.7 +/- 221.7 versus 346.7 +/- 204.6 and 306.2 +/- 192.1 ml., respectively, not statistically significant, p = 0.07).
Detrusor instability and bladder outlet obstruction are common in men with lower urinary tract symptoms. The symptom of urge incontinence strongly correlated with detrusor instability. Other lower urinary tract symptoms did not correlate well with any urodynamic findings. Therefore, we believe that an accurate urodynamic diagnosis may enable focused and more efficient management of lower urinary tract symptoms in men.
我们评估了提示逼尿肌不稳定的下尿路症状与男性尿动力学检查结果之间的相关性。
160例连续的神经系统正常的男性纳入我们的前瞻性研究，他们因持续性下尿路症状接受尿动力学评估。所有患者均有提示逼尿肌不稳定的储尿期症状。患者根据尿急失禁、尿频和尿急、夜尿或排尿困难的主要症状进一步进行临床分类。根据这4种临床分类分析了所有患者的临床和尿动力学诊断以及逼尿肌不稳定患者的特定尿动力学特征。
患者平均年龄为61±15岁。主要症状为尿急失禁28例（17%），尿频和尿急57例（36%），夜尿30例（19%），排尿困难45例（28%）。68例（43%）诊断为逼尿肌不稳定。与其他临床分类相比，尿急失禁患者逼尿肌不稳定的发生率更高（75%对36%，p<0.01）。109例（68%）患者存在膀胱出口梗阻，其中50例（46%）合并逼尿肌不稳定。无论主要症状如何，所有患者膀胱出口梗阻的患病率相似。4种临床分类中所有其他尿动力学诊断也相似。尿急失禁和尿频尿急患者出现非自主性逼尿肌收缩时的平均膀胱容量低于夜尿和排尿困难患者（分别为277.1±149.4和267.7±221.7ml对346.7±204.6和306.2±192.1ml，无统计学意义，p = 0.07）。
逼尿肌不稳定和膀胱出口梗阻在有下尿路症状的男性中很常见。尿急失禁症状与逼尿肌不稳定密切相关。其他下尿路症状与任何尿动力学检查结果均无良好相关性。因此，我们认为准确的尿动力学诊断可能有助于对男性下尿路症状进行有针对性和更有效的管理。
