Biardeau Xavier, Elkoushy Mohamed A, Aharony Shachar, Elhilali Mostafa, Corcos Jacques
Department of Urology, Jewish General Hospital, McGill University, 3755 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
McGill University Health Center, McGill University, Montreal, QC, Canada.
World J Urol. 2016 Apr;34(4):463-9. doi: 10.1007/s00345-015-1647-8. Epub 2015 Jul 28.
Lower urinary tract symptoms (LUTS) are common in middle-aged men and could be consequences of multiple etiologies responsible for bladder outlet obstruction (BOO), detrusor underactivity (DUA) and/or overactive bladder. When LUTS are suggestive of BOO secondary to benign prostatic hyperplasia, a surgical treatment can sometimes be consider. Even if multichannel urodynamic study (UDS) is currently the gold standard to properly assess LUTS, its use in non-neurogenic men is still a matter of controversy. Here, we aim to explore the evidence supporting or not the use of systematic multichannel UDS before considering an invasive treatment in men LUTS.
The debate was presented with a "pro and con" structure. The "pro" side supported the systematic use of a multichannel UDS before considering a surgical treatment in men LUTS. The "con" side successively refuted the "pro" side arguments.
The "pro" side mainly based their argumentation on the poor correlation of LUTS and office-based tests with BOO or DUA. Furthermore, since a multichannel UDS could allow selecting men that will most benefit of a surgical procedure, they hypothesized that such an approach could reduce the overall morbidity rate and cost associated with. The "con" side considered that, in most cases, medical history and symptoms were reliable enough to consider surgery. Finally, they underlined the UDS limitations and the frequent lack of alternative to surgery in this context.
Randomized clinical trials are being conducted to compare these two approaches. Their results would help the urological community to override this debate.
下尿路症状（LUTS）在中年男性中很常见，可能是由多种病因导致膀胱出口梗阻（BOO）、逼尿肌活动低下（DUA）和/或膀胱过度活动症引起的。当LUTS提示继发于良性前列腺增生的BOO时，有时可以考虑手术治疗。即使多通道尿动力学研究（UDS）目前是正确评估LUTS的金标准，但其在非神经源性男性中的应用仍存在争议。在此，我们旨在探讨在考虑对男性LUTS进行侵入性治疗之前，支持或不支持使用系统性多通道UDS的证据。
辩论采用“赞成与反对”的结构。“赞成”方支持在考虑对男性LUTS进行手术治疗之前系统性地使用多通道UDS。“反对”方则依次反驳“赞成”方的论点。
“赞成”方主要依据LUTS及门诊检查与BOO或DUA的相关性较差进行论证。此外，由于多通道UDS可以筛选出最能从手术中获益的男性，他们推测这种方法可以降低总体发病率和相关成本。“反对”方认为，在大多数情况下，病史和症状足以可靠地判断是否需要手术。最后，他们强调了UDS的局限性以及在这种情况下手术替代方案的匮乏。
目前正在进行随机临床试验以比较这两种方法。其结果将有助于泌尿外科界解决这一争议。
