Ho C C K, Ngoo K S, Hamzaini A H, Rizal A M M, Zulkifli M Z
Urology Unit, Departments of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
Urology Unit, Departments of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
Clin Ter. 2014;165(2):75-81. doi: 10.7471/CT.2014.1680.
To determine the clinical utility of urinary bladder and prostate characteristics measured by ultrasound scan in predicting acute urinary retention (AUR) for men with bladder outlet obstruction with an underlying benign prostate hyperplasia (BPH).
Consecutive men aged ≥50 years presenting with lower urinary tract symptoms (LUTS) or AUR were prospectively recruited in this cross-sectional study. International prostatic symptom score (IPSS) and serum prostate-specific antigen (PSA) were recorded. High-resolution ultrasound was used to measure bladder detrusor thickness (DT, mm), prostatic volume (PV, cm3), intravesical prostatic protrusion (IPP, mm), bladder wall thickness (BWT,mm), intravesical volume and bladder radius. The latter two parameters were used to estimate bladder weight (UEBW, g), assuming a spherical bladder.
Among selected patients, thirty had AUR while 32 men presented with LUTS only. There were significant differences between those with and without AUR in their age (70.5 vs 66.0, p=0.017), IPSS (24.0 vs 18.5, p=0.009), serum PSA (6.18 vs 1.77, p=0.002), PV (56.7 vs 32.4, p=0.006), BWT (5.0 vs 4.4, p=0.034) and UEBW (39.1 vs 25.0, p=0.0003). Multivariate analysis revealed high IPSS and UEBW to be predictors for AUR. UEBW was the strongest predictor of AUR: area under ROC curve was 0.767, with sensitivity and specificity of 63.3% and 87.5%, respectively, at cut-off point of 35 g. The likelihood ratio for AUR was also best with UEBW≥35 g.
Combined with IPSS, ultrasound determined bladder characteristic, particularly UEBW, is a useful tool in predicting AUR in men with BPH.
确定通过超声扫描测量膀胱和前列腺特征在预测患有良性前列腺增生（BPH）导致膀胱出口梗阻的男性急性尿潴留（AUR）方面的临床效用。
在这项横断面研究中，前瞻性招募了年龄≥50岁且出现下尿路症状（LUTS）或AUR的连续男性患者。记录国际前列腺症状评分（IPSS）和血清前列腺特异性抗原（PSA）。使用高分辨率超声测量膀胱逼尿肌厚度（DT，mm）、前列腺体积（PV，cm³）、膀胱内前列腺突出（IPP，mm）、膀胱壁厚度（BWT，mm）、膀胱内体积和膀胱半径。假设膀胱为球形，后两个参数用于估计膀胱重量（UEBW，g）。
在选定的患者中，30例患有AUR，而32例男性仅表现为LUTS。患有和未患有AUR的患者在年龄（70.5对66.0，p = 0.017）、IPSS（24.0对18.5，p = 0.009）、血清PSA（6.18对1.77，p = 0.002）、PV（56.7对32.4，p = 0.006）、BWT（5.0对4.4，p = 0.034）和UEBW（39.1对25.0，p = 0.0003）方面存在显著差异。多变量分析显示高IPSS和UEBW是AUR的预测因素。UEBW是AUR的最强预测因素：ROC曲线下面积为0.767，在截断点为35 g时，敏感性和特异性分别为63.3%和87.5%。当UEBW≥35 g时，AUR的似然比也最佳。
结合IPSS，超声测定的膀胱特征，特别是UEBW，是预测BPH男性患者AUR的有用工具。
