Eri Lars M, Wessel Nicolai, Tysland Ole, Berge Viktor
Department of Urology, Ullevaal University Hospital, Oslo, Norway.
Neurourol Urodyn. 2002;21(3):186-93. doi: 10.1002/nau.10018.
Methods for quantification of bladder outlet obstruction (BOO) are still controversial. Parameters such as detrusor opening pressure (p(det.open)), maximum detrusor pressure (p(det.max)), minimum voiding pressure (p(det.min.void)), and detrusor pressure at maximum flow rate (P(det.Qmax)) separate obstructed from nonobstructed patients to some extent, but two nomograms, the Abrams-Griffiths nomogram and the linearized passive urethral resistance relation (LinPURR), are more accepted for this purpose, along with the urethral resistance algorithm. In this retrospective, methodologic study, we evaluated the properties of these parameters with regard to test-retest reproducibility and ability to detect a moderate (pharmacologic) and a pronounced (surgical) relief of bladder outlet obstruction. We studied the pressure-flow charts of 42 patients who underwent 24 weeks of androgen suppressive therapy, 42 corresponding patients who received placebo, and 30 patients who had prostate surgery. The patients performed repeat void pressure-flow examinations before and after treatment or placebo. The various parameters were compared. Among the bladder pressure parameters, P(det.Qmax) seemed to have some advantages, supporting the belief that it is the most relevant detrusor pressure parameter to include in nomograms to quantify BOO. In assessment of a large decrease in urethral resistance, such as after TURp, resistance parameters that are based on maximum flow rate as well as detrusor pressure are preferable.
膀胱出口梗阻（BOO）的量化方法仍存在争议。诸如逼尿肌开放压（p(det.open)）、最大逼尿肌压（p(det.max)）、最小排尿压（p(det.min.void)）以及最大尿流率时的逼尿肌压（P(det.Qmax)）等参数在一定程度上可区分梗阻患者与非梗阻患者，但为此目的，艾布拉姆斯 - 格里菲思列线图和线性化被动尿道阻力关系（LinPURR）这两种列线图以及尿道阻力算法更被认可。在这项回顾性方法学研究中，我们评估了这些参数在重测可重复性以及检测膀胱出口梗阻中度（药物治疗）和显著（手术治疗）缓解能力方面的特性。我们研究了42例接受24周雄激素抑制治疗的患者、42例接受安慰剂的相应患者以及30例接受前列腺手术的患者的压力 - 流率图。患者在治疗或服用安慰剂前后进行了重复的排尿压力 - 流率检查。对各种参数进行了比较。在膀胱压力参数中，P(det.Qmax)似乎具有一些优势，这支持了一种观点，即它是列线图中用于量化BOO的最相关的逼尿肌压力参数。在评估尿道阻力大幅下降时，例如经尿道前列腺电切术后，基于最大尿流率以及逼尿肌压力的阻力参数更为可取。
