Rademakers Kevin L J, van Koeveringe Gommert A, Oelke Matthias
aDepartment of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands bDepartment of Urology, Hannover Medical School, Hannover, Germany.
Curr Opin Urol. 2016 Jan;26(1):3-10. doi: 10.1097/MOU.0000000000000246.
Detrusor underactivity is a highly prevalent type of voiding dysfunction in men and responsible for residual urine and decreased voiding efficiency. Patients with detrusor underactivity have an unfavorable outcome after prostatic surgery and do not have better long-term results than untreated detrusor underactivity patients. Therefore, differentiation between detrusor underactivity and bladder outlet obstruction (BOO) is crucial for the prediction of the outcome of prostatic surgery.
Patients with detrusor underactivity report more frequently about decreased/interrupted urinary flow, hesitancy, feeling of incomplete bladder emptying and/or decreased bladder sensation compared with men with normal pressure-flow studies. Determination of and differentiation between detrusor underactivity and BOO is only possible by pressure-flow studies. Threshold values for the diagnosis of detrusor underactivity have to be adjusted to the BOO-grade. A nomogram using BOO-index and maximum Watts factor is currently the most advanced tool to diagnose detrusor underactivity and/or BOO; values below the 25th percentile line indicate detrusor underactivity. It is desirable to establish tests to noninvasively diagnose detrusor underactivity. The combination of ultrasound detrusor wall thickness and bladder capacity can safely detect detrusor underactivity.
Careful assessment of voiding dysfunction to discriminate between detrusor underactivity and BOO should be done with pressure-flow studies, can avoid unsuccessful prostate surgery and helps in counselling patients.
逼尿肌收缩功能减退是男性中一种非常普遍的排尿功能障碍类型,可导致残余尿量增多和排尿效率降低。逼尿肌收缩功能减退的患者在前列腺手术后预后不佳,与未经治疗的逼尿肌收缩功能减退患者相比,长期效果并无改善。因此,区分逼尿肌收缩功能减退和膀胱出口梗阻(BOO)对于预测前列腺手术的结果至关重要。
与压力 - 流率研究正常的男性相比,逼尿肌收缩功能减退的患者更频繁地报告尿流减少/中断、排尿犹豫、膀胱排空不全感和/或膀胱感觉减退。只有通过压力 - 流率研究才能确定和区分逼尿肌收缩功能减退与BOO。诊断逼尿肌收缩功能减退的阈值必须根据BOO分级进行调整。使用BOO指数和最大瓦茨因子的列线图是目前诊断逼尿肌收缩功能减退和/或BOO的最先进工具;低于第25百分位线的值表明逼尿肌收缩功能减退。建立非侵入性诊断逼尿肌收缩功能减退的检测方法是很有必要的。超声测量逼尿肌壁厚度和膀胱容量相结合可以安全地检测出逼尿肌收缩功能减退。
应通过压力 - 流率研究仔细评估排尿功能障碍,以区分逼尿肌收缩功能减退和BOO,这样可以避免前列腺手术失败,并有助于为患者提供咨询。