Adot Zurbano José María, Salinas Casado Jesús, Dambros Miriam, Virseda Chamorro Miguel, Ramírez Fernández Juan Carlos, Silmi Moyano Angel, Marcos Díaz José
Servicios de Urología: Hospital General Yagüe, Burgos, España.
Arch Esp Urol. 2005 Sep;58(7):641-9. doi: 10.4321/s0004-06142005000700008.
To evaluate the clinical and urodynamic characteristics of a series of adult males with BPH and bladder diverticula, and to analyze the changes in urodynamics in patients undergoing lower urinary tract surgery to relieve obstruction, with or without associated diverticulectomy.
We studied 91 patients in two groups: Group 1- BPH: 67 cases (73.6%) and Group 2-BPH + diverticulum: 24 cases (25%). Mean age was 65.04 years. All patients underwent urological physical examination and complete urodynamic study including cystogram. In addition, we studied 19 patients with BPH and bladder diverticula (mean age 64.58 years) who underwent either endoscopic surgery (1 I cases; 57.9%) or endoscopic surgery plus diverticulectomy (8 cases, 42. 1%). Complete clinical study and urodynamics (including cystogram) were performed preoperative and three months after surgery. Statistical significance was established at 0.05.
Comparative study between group 1 (BPH) and group 2 (BPH with diverticulum): there were significant differences in clinical data: acute urinary retention (6.1% vs. 25%;p<0.01), and urinary tract infection (3.1% vs. 21.7%;p=0,004). All evaluated cases had single diverticula (8 cases). Urodynamic studies showed: 1) Post-void residual after free flowmetry: 45.9 ml vs. 221.4 ml, p = 0.008. 2) Bladder capacity on cystometrogram: 211.2 ml vs. 350.8 ml, p = 0.024. 3) Voiding pressure/flow study: a) Voiding with abdominal press 23.9% vs. 50%, p = 0.02. b) URA 36.5 cm H2O vs. 48.5 cm H2O, p= 0.04, c) post void residual 70.7ml vs. 210.3 ml, p= 0.004. d) Bladder contractility measurements (Wmax- isometric contractility- and W80, W20- isotonic contractility) did not show significant differences between groups. Bladder contractility duration was significantly decreased in group 2. In the analysis of patients undergoing surgery to relieve obstruction (Group A- Surgery without diverticulectomy; Group B Surgery with diverticulectomy) there were not differences between groups in clinical data. Urethral resistance parameters (URA) decreased in both groups. Group A: from 43 cm H20 to 26.3 cm H2O. Group B: from 60.6 cm H2O to 48 cm H2O. This decrease was similar after either TURP or myocapsulotomy. Post void residual diminished in both groups. There were no statistical differences between groups in Wmax, W 80-20, or volume, number and site of the diverticula. On the contrary, bladder contractility duration diminished after diverticulectomy.
Bladder diverticula appear in the cases with highest ureteral resistance values (lower urinary tract obstruction). Standard bladder contractility parameters were not diminished. Duration of detrusor contraction was the only contractility parameter significantly affected in cases of bladder diverticula and presented a significant association with the use of abdominal press while voiding. Diverticulectomy showed an improvement of bladder contractility with longer detrusor contraction duration, which supports its use in cases of BPH-associated diverticula. Both TURP and transurethral incision of the prostate diminished urethral resistance in a similar way, so that they may be considered alternative options. Our data should be confirmed with a bigger sample size.
评估一系列患有良性前列腺增生（BPH）和膀胱憩室的成年男性的临床和尿动力学特征，并分析接受下尿路手术以解除梗阻（无论是否联合憩室切除术）的患者的尿动力学变化。
我们将91例患者分为两组：第1组-BPH：67例（73.6%），第2组-BPH+憩室：24例（25%）。平均年龄为65.04岁。所有患者均接受了泌尿外科体格检查和包括膀胱造影在内的完整尿动力学研究。此外，我们研究了19例患有BPH和膀胱憩室的患者（平均年龄64.58岁），他们接受了内镜手术（11例；57.9%）或内镜手术加憩室切除术（8例，42.1%）。在术前和术后三个月进行了完整的临床研究和尿动力学检查（包括膀胱造影）。统计学显著性设定为0.05。
第1组（BPH）和第2组（伴有憩室的BPH）之间的比较研究：临床数据存在显著差异：急性尿潴留（6.1%对25%；p<0.01）和尿路感染（3.1%对21.7%；p=0.004）。所有评估病例均为单个憩室（8例）。尿动力学研究显示：1）自由尿流率后的残余尿量：45.9ml对221.4ml，p=0.008。2）膀胱容量测定图上的膀胱容量：211.2ml对350.8ml，p=0.024。3）排尿压力/流率研究：a）腹压排尿23.9%对50%，p=0.02。b）尿道阻力（URA）36.5cmH₂O对48.5cmH₂O，p=0.04，c）排尿后残余尿量70.7ml对210.3ml，p=0.004。d）膀胱收缩力测量值（Wmax-等长收缩力-以及W80、W20-等张收缩力）在两组之间未显示出显著差异。第2组膀胱收缩持续时间显著缩短。在对接受解除梗阻手术的患者（A组-未行憩室切除术的手术；B组-行憩室切除术的手术）的分析中，两组临床数据无差异。两组尿道阻力参数（URA）均降低。A组：从43cmH₂O降至26.3cmH₂O。B组：从60.6cmH₂O降至48cmH₂O。经尿道前列腺切除术（TURP）或前列腺包膜切开术后这种降低相似。两组排尿后残余尿量均减少。两组在Wmax、W80-20或憩室的体积、数量和位置方面无统计学差异。相反，憩室切除术后膀胱收缩持续时间缩短。
膀胱憩室出现在输尿管阻力值最高的病例中（下尿路梗阻）。标准膀胱收缩力参数未降低。逼尿肌收缩持续时间是膀胱憩室病例中唯一受显著影响的收缩力参数，并且与排尿时使用腹压显著相关。憩室切除术显示膀胱收缩力有所改善，逼尿肌收缩持续时间延长，这支持在BPH相关憩室病例中使用该手术。TURP和经尿道前列腺切开术均以相似方式降低尿道阻力，因此它们可被视为替代选择。我们的数据应以更大样本量进行验证。
