Department of Urology, University of Crete Medical School, Heraklion, Crete, Greece.
World J Urol. 2011 Apr;29(2):199-204. doi: 10.1007/s00345-010-0612-9. Epub 2010 Nov 16.
The aim of this retrospective study was to evaluate in a historical series of patients whether morphological changes of the urinary tract imaged on intravenous urography (IVU) are associated with clinical or urodynamic data.
During a 1-year period, every man 45 years or older with lower urinary tract symptoms suggestive of benign prostatic hyperplasia was systematically evaluated with multi-channel computer-urodynamic investigation and IVU. Men with urinary retention, known bladder stones or diverticula, severely impaired renal function, or allergy to iodine contrast media were excluded. Structural alterations of the urinary tract were correlated with clinical and urodynamic data using logistic regression analysis.
Data on 203 consecutive patients were available for analysis. Multivariate analysis demonstrated that the "fish-hook" configuration of the distal ureter (also known as "hockey-stick", or "J-shaped" ureter) was the only sign significantly associated with benign prostatic obstruction (BPO) (odds-ratio 3.64; 95% confidence interval 1.69-7.83; P < 0.001). The sensitivity, specificity, positive and negative predictive values of the "fish-hook" ureter configuration sign to detect BPO was 53, 76, 61 and 70%, respectively. Bladder trabeculation, upper urinary tract dilatation, or bladder base elevation were not associated with BPO, detrusor overactivity, detrusor underactivity, bladder low-compliance or any clinical data.
The "fish-hook" shape of the distal ureter(s) indicates BPO and may be a result of prostate median lobe enlargement.
本回顾性研究旨在评估静脉尿路造影（IVU）上尿路形态变化是否与临床或尿动力学数据相关。
在为期 1 年的时间内，对每一位有下尿路症状（提示良性前列腺增生）的 45 岁以上男性，均进行多通道计算机尿动力学检查和 IVU 检查。排除有尿潴留、已知膀胱结石或憩室、严重肾功能不全或对碘造影剂过敏的患者。使用逻辑回归分析将尿路结构改变与临床和尿动力学数据相关联。
共分析了 203 例连续患者的数据。多变量分析表明，输尿管远端的“鱼钩”状（也称为“曲棍球棒”或“J 形”输尿管）是与良性前列腺梗阻（BPO）唯一显著相关的征象（比值比 3.64；95%置信区间 1.69-7.83；P<0.001）。“鱼钩”状输尿管形态的敏感性、特异性、阳性预测值和阴性预测值分别为 53%、76%、61%和 70%。膀胱小梁化、上尿路扩张或膀胱底抬高与 BPO、逼尿肌过度活动、逼尿肌活动不足、膀胱顺应性低或任何临床数据均无关。
输尿管下段的“鱼钩”形状提示 BPO，可能是前列腺中叶增大的结果。
