Lukacs B, Doizi S, Cornu J-N
Department of urology, Tenon university hospital, Assistance publique-Hopitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
Department of urology, Tenon university hospital, Assistance publique-Hopitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
Prog Urol. 2019 Apr;29(5):288-292. doi: 10.1016/j.purol.2018.10.007. Epub 2019 Apr 6.
To assess the feasibility of voiding urethrocystoscopy (VUC) in males and describe the characteristics of dynamic movements of the prostatic lobes during micturition.
Patients scheduled for benign prostatic obstruction relief in a tertiary reference center were included in this prospective evaluation. During urethrocystoscopy with a small diameter flexible endoscope, the bladder was filled until desire to void. The patient was asked to void with endoscope in place facing the veru montanum. Movements of the prostatic lobes during micturition were characterized, video-recorded, and categorized based on the dynamics of the lateral lobes, the posterior lobe and the bladder neck.
In all, 192 evaluations were conducted. In 161 cases (84%), the patient was able to void. Among these patients, 126 cases were stated as "closed" (coalescent), without opening of the initial part of the urethra and the bladder neck. In 38 cases, there was no opening of the lateral lobes (type 1A), and in 47 cases a partial opening of the distal parts of the lateral lobes was seen (type 1B). In 31 cases, a fixed posterior bladder neck was seen (type 2A) and in 10 cases a mobile median lobe, with a rolling ball effect, was seen (type 2B). In 25 cases, the lumen was completely open and equivocal in 10 cases.
This study demonstrates the feasibility of VUC and describes for the first time the dynamics of prostatic lobes during micturition. This evaluation may lead to a new approach for understanding the mechanical aspects of benign prostatic obstruction.
评估男性排尿期尿道膀胱镜检查（VUC）的可行性，并描述排尿过程中前列腺叶动态运动的特征。
本前瞻性评估纳入了在三级转诊中心计划进行良性前列腺梗阻缓解治疗的患者。使用小直径软性内窥镜进行尿道膀胱镜检查时，将膀胱充盈至有排尿欲望。要求患者在尿道膀胱镜就位且朝向精阜的情况下排尿。对排尿过程中前列腺叶的运动进行特征描述、视频记录，并根据侧叶、后叶和膀胱颈的动态进行分类。
共进行了192次评估。161例（84%）患者能够排尿。在这些患者中，126例被判定为“闭合”（融合），尿道起始部和膀胱颈未开放。38例侧叶未开放（1A型），47例侧叶远端部分出现部分开放（1B型）。31例可见固定的膀胱后颈（2A型），10例可见有滚球效应的可移动中叶（2B型）。25例管腔完全开放，10例情况不明确。
本研究证明了VUC的可行性，并首次描述了排尿过程中前列腺叶的动态变化。该评估可能会为理解良性前列腺梗阻的机械方面带来一种新方法。
3级。
