Tammela T L, Hellström P A, Kontturi M J
Division of Urology, Oulu University Central Hospital, Finland.
Br J Urol. 1992 Oct;70(4):404-7. doi: 10.1111/j.1464-410x.1992.tb15797.x.
A series of 73 patients with bladder outflow obstruction caused by benign prostatic hyperplasia underwent urodynamic investigation, including the cold water test. The presence of detrusor instability was associated with a higher urethral opening pressure, maximum detrusor pressure and detrusor pressure at maximum flow. Instability was more common and more pronounced in patients with a lack of cold sensation, but there were some patients who, whilst lacking cold sensation, still possessed the cold reflex. This suggests partial denervation of the bladder or some form of altered modulation of sensory activity within the spinal cord or central nervous system. On the other hand, some of the patients lacked cold sensation but showed a stable detrusor and a high maximum cystometric capacity. This leads to the conclusion that there are different mechanisms by which the bladder reacts to outflow obstruction.
73例因良性前列腺增生导致膀胱流出道梗阻的患者接受了尿动力学检查，包括冷水试验。逼尿肌不稳定的存在与较高的尿道开口压力、最大逼尿肌压力和最大尿流率时的逼尿肌压力相关。不稳定在缺乏冷觉的患者中更常见且更明显，但也有一些患者虽然缺乏冷觉，但仍有冷反射。这提示膀胱存在部分去神经支配，或脊髓或中枢神经系统内感觉活动存在某种形式的调节改变。另一方面，一些患者缺乏冷觉，但逼尿肌稳定且膀胱测压最大容量较高。由此得出结论，膀胱对流出道梗阻的反应存在不同机制。
