药物治疗后仍有持续性储尿期下尿路症状的男性下尿路功能障碍的影像尿动力学检查结果

Videourodynamic findings of lower urinary tract dysfunctions in men with persistent storage lower urinary tract symptoms after medical treatment.

作者信息

Jiang Yuan-Hong, Wang Chung-Cheng, Kuo Hann-Chorng

机构信息

Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.

Department of Urology, En Chu Kong Hospital, College of Medicine, National Taiwan University, New Taipei, Taiwan.

出版信息

PLoS One. 2018 Feb 20;13(2):e0190704. doi: 10.1371/journal.pone.0190704. eCollection 2018.

DOI:10.1371/journal.pone.0190704

PMID:29462145

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5819762/

Abstract

OBJECTIVE

To analyze the underlying lower urinary tract dysfunctions by video-urodynamic studies in men who have persistent storage symptoms after initial drug therapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

METHODS

The medical records of 614 men ≥40 years of age with LUTS and an International Prostate Symptom Score of ≥8 were retrospectively analyzed. All patients had persistent storage symptoms after medical treatment for at least 6 months. A video-urodynamic study was done to investigate the underlying bladder or bladder outlet dysfunction. Predictors of bladder outlet obstruction (BOO) by baseline urine flow metrics and prostate parameters were investigated.

RESULTS

The final results revealed bladder neck dysfunction (BND) in 137/614 (22.3%), benign prostatic obstruction (BPO) in 246/614 (40.1%), detrusor overactivity (DO) in 193/614 (31.4%), and DO with detrusor underactivity (DO+DU) in 38/614 (6.2%) patients. Among the patients, 221/281 (78.6%) with a total prostatic volume (TPV) ≥40 ml had BOO, including 43/281 (15.3%) with BND and 178/281 (63.3%) with BPO. If we combined TPV ≥40 ml and Qmax <12 ml/s as predictors of BOO, BOO was found in 176/215 (81.8%) patients including 34/215 (15.8%) with BND and 142/215 (66.0%) with BPO. BOO was also found in 48.8% of men with a TPV <40ml, and in 36.3% of men with TPV< 40 ml and Qmax ≥ 12 ml/s. In 102 men with TPV <40 ml and Qmax ≥12 ml/s, 64 (62.7%) had DO.

CONCLUSION

BOO, including BND and BPO, comprise 62.4% (383/614) of men with persistent storage symptoms after initial medical treatment for LUTS/BPH. In men who have persistent storage symptoms after medical treatment for LUTS/BPH, BOO should be carefully investigated and appropriate management being given to improve LUTS.

摘要

目的

通过视频尿动力学研究，分析在接受针对提示良性前列腺增生（BPH）的下尿路症状（LUTS）的初始药物治疗后仍有持续性储尿期症状的男性潜在的下尿路功能障碍。

方法

回顾性分析614名年龄≥40岁、国际前列腺症状评分≥8分且有LUTS的男性的病历。所有患者在接受药物治疗至少6个月后仍有持续性储尿期症状。进行视频尿动力学研究以调查潜在的膀胱或膀胱出口功能障碍。研究通过基线尿流指标和前列腺参数预测膀胱出口梗阻（BOO）的因素。

结果

最终结果显示，614例患者中137例（22.3%）存在膀胱颈功能障碍（BND），246例（40.1%）存在良性前列腺梗阻（BPO），193例（31.4%）存在逼尿肌过度活动（DO），38例（6.2%）存在逼尿肌过度活动伴逼尿肌活动减退（DO+DU）。在这些患者中，281例前列腺总体积（TPV）≥40 ml的患者中有221例（78.6%）存在BOO，其中43例（15.3%）为BND，178例（63.3%）为BPO。如果将TPV≥40 ml和最大尿流率（Qmax）<12 ml/s作为BOO的预测指标，则215例患者中有176例（81.8%）存在BOO，其中34例（15.8%）为BND，142例（66.0%）为BPO。TPV<40ml的男性中48.8%存在BOO，TPV<40 ml且Qmax≥12 ml/s的男性中36.3%存在BOO。在102例TPV<40 ml且Qmax≥12 ml/s的男性中，64例（62.7%）存在DO。