Division of Urology and Bioengineering, University of Campinas, Sao Paulo, Brazil.
Int Neurourol J. 2012 Sep;16(3):116-21. doi: 10.5213/inj.2012.16.3.116. Epub 2012 Sep 30.
The longevity of the world's population is increasing, and among male patients, complaints of lower urinary tract symptoms (LUTS) are growing. Testing to diagnose LUTS and to differentiate between the various causes should be quick, easy, cheap, specific, not too bothersome for the patient, and noninvasive or minimally so. Urodynamic evaluation is the gold standard for diagnosing bladder outlet obstruction (BOO) but presents some inconveniences such as embarrassment, pain, and dysuria; furthermore, 19% of cases experience urinary retention, macroscopic hematuria, or urinary tract infection. A greater number of resources in the diagnostic armamentarium could increase the opportunity for selecting less invasive tests. A number of groups have risen to this challenge and have formulated and developed ideas and technologies to improve noninvasive methods to diagnosis BOO. These techniques start with flowmetry, an increase in the interest of ultrasound, and finally the performance of urodynamic evaluation without a urethral catheter. Flowmetry is not sufficient for confirming a diagnosis of BOO. Ultrasound of the prostate and the bladder can help to assess BOO noninvasively in all men and can be useful for evaluating the value of BOO at assessment and during treatment of benign prostatic hyperplasia patients in the future. The great advantages of noninvasive urodynamics are as follows: minimal discomfort, minimal risk of urinary tract infection, and low cost. This method can be repeated many times, permitting the evaluation of obstruction during clinical treatment. A urethral connector should be used to diagnose BOO, in evaluation for surgery, and in screening for treatment. In the future, noninvasive urodynamics can be used to identify patients with BOO to initiate early medical treatment and evaluate the results. This approach permits the possibility of performing surgery before detrusor damage occurs.
随着世界人口寿命的延长,男性患者的下尿路症状(LUTS)抱怨也在增加。用于诊断 LUTS 并区分各种病因的检测应该快速、简单、廉价、具有特异性、对患者来说不太麻烦且非侵入性或微创。尿动力学评估是诊断膀胱出口梗阻(BOO)的金标准,但存在一些不便,如尴尬、疼痛和尿痛;此外,19%的病例会出现尿潴留、肉眼血尿或尿路感染。诊断工具中更多的资源可以增加选择非侵入性测试的机会。许多小组已经迎接了这一挑战,并提出了一些想法和技术,以改进诊断 BOO 的非侵入性方法。这些技术从流量测量开始,增加了对超声的兴趣,最后是在没有尿道导管的情况下进行尿动力学评估。流量测量不足以确认 BOO 的诊断。前列腺和膀胱的超声可以帮助所有男性无创性评估 BOO,并有助于评估 BOO 在良性前列腺增生患者评估和治疗中的价值。非侵入性尿动力学的主要优点如下:最小的不适、最小的尿路感染风险和低成本。这种方法可以多次重复,允许在临床治疗过程中评估梗阻。应使用尿道连接器来诊断 BOO,用于评估手术和筛查治疗。在未来,非侵入性尿动力学可以用于识别 BOO 患者,以启动早期药物治疗并评估结果。这种方法允许在逼尿肌损伤发生之前进行手术的可能性。