Welk Blayne, McGarry Patrick, Baverstock Richard, Carlson Kevin, Hickling Duane
Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Department of Surgery, Western University, London, Ontario, Canada.
Urology. 2018 Jul;117:120-125. doi: 10.1016/j.urology.2018.04.010. Epub 2018 Apr 25.
To determine if urodynamic findings other than high-pressure voiding influence the decision to perform a transurethral resection of prostate (TURP).
Four clinical scenarios were created featuring a healthy 65-year-old man. An electronic survey was distributed to members of the International Continence Society and the Society for Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.
Eighty-six urologists responded (median age was 45-54 years, 62% described their practice as academic). Scenario 1: an incidental residual urine >1 L with detrusor underactivity. The majority (76%) would offer a TURP; however, the estimated chance that the residual volume would improve was only 57%. Scenario 2: retention with detrusor overactivity but no voluntary voiding contraction. The majority (72%) would offer a TURP; however, the average chance quoted that he would void was only 48%. Scenario 3: catheter-dependent retention and an underactive detrusor. The majority (89%) would offer a TURP; however, the average chance quoted that he would void was only 53%. Scenario 4: a man with only frequency and urgency, but urodynamic bladder outlet obstruction. The majority (90%) would offer him a TURP; however, the average chance that his frequency and urgency would improve was only 64%, and the average estimated postoperative risk of urgency incontinence was 33%. Willingness to offer TURP did not correlate with physician characteristics.
Urodynamic findings other than bladder outlet obstruction were associated with modest perceived outcomes after TURP; however, despite this, urologists are still willing to offer this intervention.
确定除高压排尿外的尿动力学检查结果是否会影响经尿道前列腺切除术（TURP）的决策。
创建了以一名健康的65岁男性为主角的四种临床场景。向国际尿失禁学会以及尿动力学、女性盆底医学与泌尿生殖重建学会的成员发放了电子调查问卷。
86位泌尿科医生做出了回应（中位年龄为45 - 54岁，62%称其执业机构为学术性）。场景1：偶然发现残余尿量>1升且逼尿肌活动不足。大多数人（76%）会建议进行TURP；然而，残余尿量改善的预估概率仅为57%。场景2：伴有逼尿肌活动亢进但无自主排尿收缩的尿潴留。大多数人（72%）会建议进行TURP；然而，预估他能够自主排尿的平均概率仅为48%。场景3：依赖导尿管的尿潴留且逼尿肌活动不足。大多数人（89%）会建议进行TURP；然而，预估他能够自主排尿的平均概率仅为53%。场景4：仅有尿频和尿急症状但尿动力学检查显示膀胱出口梗阻的男性。大多数人（90%）会建议他进行TURP；然而，其尿频和尿急症状改善的平均概率仅为64%，且急迫性尿失禁的术后平均预估风险为33%。建议进行TURP的意愿与医生的特征无关。
除膀胱出口梗阻外的尿动力学检查结果与TURP后适度的预期结果相关；然而，尽管如此，泌尿科医生仍愿意提供这种干预措施。
