Horn Thomas, Kortmann Barbara B M, Holm Nina R, Smedts Frank, Nordling Jørgen, Kiemeney Lambertus A L M, de la Rosette Jean J M C H
Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
Urology. 2004 Mar;63(3):451-6. doi: 10.1016/j.urology.2003.10.061.
To establish whether routine evaluation of light microscopic changes in bladder biopsies in men with graded bladder outlet obstruction correlates with urodynamic parameters and to evaluate the performance of two pathologists in bladder biopsy interpretation.
In 63 consecutive patients presenting with lower urinary tract symptoms suggestive of bladder outlet obstruction, the workup included bladder biopsies, which were semiquantitatively and independently evaluated by two pathologists for fibrosis, elastosis, muscle cell degeneration, inflammation, and additional remarkable findings. Furthermore, as determined by their general impression, the pathologists gave a diagnosis of normal or graded abnormality. The pathologists' performance was compared and the clinical and urodynamic data were correlated to the consensus histologic diagnoses.
Fifty-four of 63 cases could be evaluated. The intraobserver and interobserver reproducibility were reasonable, with a kappa of 0.35 and 0.50, respectively. The consensus diagnosis of abnormal bladder biopsy correlated with impaired bladder compliance and capacity. However, no correlation was found between the presence and severity of histologic abnormalities and Schäfer class, urethral resistance factor, instability, postvoid residual urine volume, symptom score, and prostate volume.
Although abnormal bladder biopsies correlated significantly with impaired bladder capacity and compliance, routine evaluation of bladder biopsies is not indicated in the evaluation of bladder outlet obstruction.
确定在患有分级膀胱出口梗阻的男性中，膀胱活检光镜下变化的常规评估是否与尿动力学参数相关，并评估两名病理学家在膀胱活检解读中的表现。
在63例连续出现提示膀胱出口梗阻的下尿路症状的患者中，检查包括膀胱活检，两名病理学家对纤维化、弹性组织变性、肌细胞变性、炎症及其他显著发现进行半定量且独立的评估。此外，病理学家根据总体印象给出正常或分级异常的诊断。比较病理学家的表现，并将临床和尿动力学数据与一致的组织学诊断相关联。
63例中的54例可进行评估。观察者内和观察者间的可重复性合理，kappa值分别为0.35和0.50。膀胱活检异常的一致诊断与膀胱顺应性和容量受损相关。然而，组织学异常的存在和严重程度与施费尔分级、尿道阻力因子、不稳定性、排尿后残余尿量、症状评分及前列腺体积之间未发现相关性。
尽管膀胱活检异常与膀胱容量和顺应性受损显著相关，但在膀胱出口梗阻的评估中不建议进行膀胱活检的常规评估。
