Liu Ning, He Feng, Man Li-bo, Huang Guang-lin, Wang Hai-dong, Wang Hai, Li Gui-zhong, Wang Jian-wei
Department of Urology, Beijing Jishuitan Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2012 Jul 10;92(26):1824-7.
To explore the differences of urodynamic parameters and lower urinary symptoms between detrusor hyperactivity with impaired contractility (DHIC) patients and DHIC patients with bladder outlet obstruction (BOO) and evaluate the effects and risks of anticholinergic medications in these patients.
A retrospective analysis was performed in 56 DHIC patients at our hospital between February 2000 to February 2011. Among them, 19 patients were complicated with BOO. Urodynamic studies were conducted and lower urinary symptoms assessed in all patients. Then the urodynamic parameters and lower urinary symptoms scores were compared between the DHIC and DHIC plus BOO patients. Among them, 27 received anticholinergic medications and there were 11 BOO patients. After 2-month anticholinergic medications, the differences of lower urinary symptom score were analyzed and anticholinergic-induced retention was also investigated.
As compared with the DHIC patients, the DHIC plus BOO patients had a higher post-voiding residual urine (70 (23 - 106) vs 20 (10 - 81) ml, P = 0.02), higher total international prognostic scoring system (IPSS) score (25.6 ± 3.9 vs 22.1 ± 4.1, P = 0.00) and higher total voiding symptom score (15.3 ± 2.9 vs 11.8 ± 3.3, P = 0.00). After 2-month anticholinergic medications, the IPSS score of DHIC plus BOO patients decreased from 25.7 ± 4.6 to 23.6 ± 4.9 (P = 0.01), 2/11 patients developed urinary retention. The IPSS scores of DHIC patients decreased from 22.8 ± 4.7 to 21.4 ± 4.6 (P = 0.01) and none had urinary retention.
The DHIC plus BOO patients have more aggravated bladder empting and more severe lower urinary symptoms especially during voiding phase. Anticholinergic medications may alleviate the lower urinary symptoms in DHIC and DHIC plus BOO patients. But anticholinergic-induced retention is common among the DHIC plus BOO patients.
探讨逼尿肌收缩力受损伴逼尿肌活动亢进（DHIC）患者与合并膀胱出口梗阻（BOO）的DHIC患者尿动力学参数及下尿路症状的差异，并评估抗胆碱能药物在这些患者中的疗效和风险。
对2000年2月至2011年2月我院收治的56例DHIC患者进行回顾性分析。其中，19例患者合并BOO。对所有患者进行尿动力学研究并评估下尿路症状。然后比较DHIC患者与合并BOO的DHIC患者的尿动力学参数及下尿路症状评分。其中，27例接受抗胆碱能药物治疗，其中11例为BOO患者。抗胆碱能药物治疗2个月后，分析下尿路症状评分的差异，并调查抗胆碱能药物引起的尿潴留情况。
与DHIC患者相比，合并BOO的DHIC患者排尿后残余尿量更高（70（23 - 106）ml对20（10 - 81）ml，P = 0.02），国际前列腺症状评分（IPSS）总分更高（25.6±3.9对22.1±4.1，P = 0.00），排尿症状总分更高（15.3±2.9对11.8±3.3，P = 0.00）。抗胆碱能药物治疗2个月后，合并BOO的DHIC患者的IPSS评分从25.7±4.6降至23.6±4.9（P = 0.01），2/11例患者出现尿潴留。DHIC患者的IPSS评分从22.8±4.7降至21.4±4.6（P = 0.01），无患者出现尿潴留。
合并BOO的DHIC患者膀胱排空障碍更严重，下尿路症状更严重，尤其是在排尿期。抗胆碱能药物可缓解DHIC患者及合并BOO的DHIC患者的下尿路症状。但抗胆碱能药物引起的尿潴留在合并BOO的DHIC患者中较为常见。
