Sharma Adittya K, Poonawala Ali, Girish G N, Kamath A J, Keshavmurthy R, Nagaraja N H, Venkatesh G K, Ratkal C S
Institute of Nephro-Urology, Victoria Hospital Campus, Bangalore, Karnataka, India.
Arab J Urol. 2013 Dec;11(4):340-3. doi: 10.1016/j.aju.2013.06.004. Epub 2013 Jul 27.
To assess the effect of the urodynamic catheter on the urinary flow rate and residual volume in various urodynamic diagnoses, and compare the outcome when using a smaller catheter, as the effect of this catheter on free uroflow variables is mostly studied in patients with bladder outlet obstruction (BOO) and little is known about its effect in other urodynamic diagnoses.
In all, 319 men undergoing a pressure-flow study (PFS) with a 5 F filling and 5 F measuring bladder catheter were subdivided into three groups based on a urodynamic diagnosis, i.e. normal PFS (group 1), BOO (group 2) and detrusor underactivity (DU, group 3). Another group (4) comprised 61 patients who had a PFS with the filling catheter removed before the voiding phase. The effect of the catheters on the maximum urinary flow rate (Qmax) and the postvoid residual volume (PVR) was analysed statistically and compared among the groups. We also compared the free-flow variables with the clinical and urodynamic variables.
Groups 1-3 (with two catheters) had a significantly lower Qmax and higher PVR than those voiding with one catheter (group 4). The reduction in Qmax was highest in group 3 (41.9%) and least in group 2 (21%). Group 4 showed no significant change in Qmax in cases with BOO and a normal PFS but a significant decline in those with DU (19.6%). The PVR was positively associated with the bladder capacity and negatively with detrusor contractility, but no association with a urodynamic diagnosis of BOO or any specific symptom.
Detrusor contractility was the strongest predictor of the obstructive effect caused by the catheter. This study justifies the use of a single 5 F catheter at the time of voiding, although that can also cause a reduction in flow in patients with DU.
评估尿动力学导管对各种尿动力学诊断中尿流率和残余尿量的影响，并比较使用较细导管时的结果，因为该导管对自由尿流变量的影响大多是在膀胱出口梗阻（BOO）患者中进行研究的，而其在其他尿动力学诊断中的影响知之甚少。
总共319名男性接受了压力-流率研究（PFS），使用5F充盈和5F测量膀胱导管，根据尿动力学诊断分为三组，即正常PFS（第1组）、BOO（第2组）和逼尿肌活动低下（DU，第3组）。另一组（第4组）由61名患者组成，他们在排尿期前移除了充盈导管进行PFS。对导管对最大尿流率（Qmax）和排尿后残余尿量（PVR）的影响进行统计学分析并在组间进行比较。我们还将自由流变量与临床和尿动力学变量进行了比较。
第1 - 3组（使用两根导管）的Qmax显著低于使用一根导管排尿的组（第4组），PVR则更高。Qmax降低幅度在第3组最高（41.9%），在第2组最低（21%）。第4组中，BOO和正常PFS的患者Qmax无显著变化，但DU患者的Qmax显著下降（19.6%）。PVR与膀胱容量呈正相关，与逼尿肌收缩力呈负相关，但与BOO的尿动力学诊断或任何特定症状无关。
逼尿肌收缩力是导管引起梗阻效应的最强预测因素。本研究证明了排尿时使用单根5F导管的合理性，尽管这也可能导致DU患者的尿流减少。
