Sajeel Mustafa, Harding Christopher, Robson Wendy, Drinnan Michael, Griffiths Clive, Pickard Robert
Department of Urology, Newcastle upon Tyne, United Kingdom.
J Urol. 2007 Sep;178(3 Pt 1):996-1000; discussion 1000-1. doi: 10.1016/j.juro.2007.05.050. Epub 2007 Jul 16.
We determined whether categorizing men with lower urinary tract symptoms using a noninvasive pressure flow nomogram is sensitive to change following the removal of obstruction.
A prospective cohort of men undergoing transurethral prostate resection was recruited, of whom 143 (69%) underwent noninvasive pressure flow study using the penile cuff technique before and 4 months following surgery. Cuff pressure required to interrupt voiding, estimated isovolumetric bladder pressure and maximum flow rate were recorded during a single void. Values were plotted on a nomogram categorizing cases as obstructed (upper left quadrant), not obstructed (lower right quadrant) or diagnosis uncertain (upper right and lower left quadrants). Changes in maximum flow rate, cuff pressure required to interrupt voiding and nomogram position following transurethral prostate resection were then analyzed.
Transurethral prostate resection resulted in an improved flow rate for all diagnostic groups, which was highest for obstructed cases with a mean +/- SD increase of 11 +/- 6 ml second(-1) (p <0.01). Men categorized with obstruction and those placed in the upper right quadrant showed significant decreases in cuff pressure required to interrupt voiding following transurethral prostate resection with a mean decrease of -45 +/- 35 and -48 +/- 32 cm H(2)O, respectively (p <0.01). The number of cases classified as not obstructed increased from 28 (19%) preoperatively to 114 (80%) after transurethral prostate resection.
Sensitivity to change following the removal of obstruction further validates the usefulness of noninvasive measurement of bladder pressure by the penile cuff test and the categorization of obstruction by the noninvasive nomogram. Decreased isovolumetric bladder pressure following transurethral prostate resection may reflect a return to normal detrusor contraction strength.
我们确定使用无创压力流列线图对下尿路症状男性进行分类，在解除梗阻后对变化是否敏感。
招募了一组接受经尿道前列腺切除术的男性前瞻性队列，其中143例（69%）在手术前和术后4个月使用阴茎袖带技术进行了无创压力流研究。在单次排尿期间记录中断排尿所需的袖带压力、估计的等容膀胱压力和最大流速。将这些值绘制在列线图上，将病例分类为梗阻（左上象限）、无梗阻（右下象限）或诊断不确定（右上和左下象限）。然后分析经尿道前列腺切除术后最大流速、中断排尿所需袖带压力和列线图位置的变化。
经尿道前列腺切除术使所有诊断组的流速均有所改善，梗阻病例改善最为明显，平均增加±标准差为11±6 ml·s⁻¹（p<0.01）。分类为梗阻的男性和位于右上象限的男性在经尿道前列腺切除术后中断排尿所需的袖带压力显著降低，平均降低分别为-45±35和-48±32 cm H₂O（p<0.01）。分类为无梗阻的病例数从术前的28例（19%）增加到经尿道前列腺切除术后的114例（80%）。
解除梗阻后对变化的敏感性进一步证实了阴茎袖带试验无创测量膀胱压力及无创列线图对梗阻分类的有用性。经尿道前列腺切除术后等容膀胱压力降低可能反映逼尿肌收缩力恢复正常。
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