Department of Urology, Stanford University School of Medicine, Stanford, California.
Department of Urology, Stony Brook University Hospital, Stony Brook, New York.
Neurourol Urodyn. 2019 Nov;38(8):2224-2232. doi: 10.1002/nau.24122. Epub 2019 Aug 20.
To identify clinical and urodynamic factors leading to spontaneous voiding in men with detrusor underactivity (DU) and suspected bladder outlet obstruction who underwent an outlet de-obstruction procedure.
We identified 614 men who underwent an outlet procedure at our institution from 2005 to 2014. Men were stratified by bladder contractility index (BCI). The primary outcome was spontaneous voiding after surgery. Data were analyzed in Statistical analysis system software.
Of the 131 men who underwent preoperative urodynamics, 122 (mean age 68 years) had tracings available for review. DU (BCI < 100) was identified in 54% (66 of 122), of whom only 68% (45 of 66) voided spontaneously before surgery, compared with 82% (46 of 56) of men with BCI ≥ 100. At a mean follow-up of 6.4 months postoperatively, 79% (52 of 66) of men with DU were able to void spontaneously, compared with 96% (54 of 56) of men with BCI ≥ 100. In men with a BCI < 100 unable to void before surgery, 57% (12 of 21) recovered spontaneous voiding after surgery. On logistic regression for the outcome postoperative spontaneous voiding, significant preoperative characteristics, and urodynamic factors included preoperative spontaneous voiding (odds ratio [OR] = 9.460; 95% confidence interval [CI] = 2.955-30.289), increased maximum flow rate (Qmax; OR = 1.184; 95% CI = 1.014-1.382), increased detrusor pressure at maximum flow (Pdet@Qmax; OR = 1.032; 95% CI = 1.012-1.052), DU with BCI < 100 (OR = 0.138; 95% CI = 0.030-0.635), and obstruction with bladder outlet obstruction index > 40 (OR = 5.595; 95% CI = 1.685-18.575).
Outlet de-obstruction improves spontaneous voiding in men with DU and may benefit men who do not meet the urodynamic threshold for obstruction.
确定导致逼尿肌活动低下(DU)且疑似膀胱出口梗阻的男性在接受出口解除梗阻手术后自行排尿的临床和尿动力学因素。
我们从 2005 年至 2014 年在我院确定了 614 名接受出口手术的男性。根据膀胱收缩指数(BCI)对男性进行分层。主要结果是术后自行排尿。数据在统计分析系统软件中进行分析。
在接受术前尿动力学检查的 131 名男性中,122 名(平均年龄 68 岁)的检测结果可供回顾。54%(66/122)的男性被诊断为 DU(BCI<100),其中仅 68%(66/122)在术前自行排尿,而 BCI≥100 的男性为 82%(46/56)。术后平均随访 6.4 个月时,57%(66/122)的 DU 男性能够自行排尿,而 BCI≥100 的男性为 96%(56/56)。在术前无法自行排尿的 BCI<100 的男性中,57%(21/37)术后恢复了自行排尿。对于术后自发性排尿的结局,有意义的术前特征和尿动力学因素包括术前自发性排尿(优势比[OR] = 9.460;95%置信区间[CI] = 2.955-30.289)、最大流量(Qmax)增加(OR = 1.184;95%CI = 1.014-1.382)、最大流量时逼尿肌压力增加(Pdet@Qmax;OR = 1.032;95%CI = 1.012-1.052)、BCI<100 的 DU(OR = 0.138;95%CI = 0.030-0.635)和膀胱出口梗阻指数>40 的梗阻(OR = 5.595;95%CI = 1.685-18.575)。
出口解除梗阻可改善逼尿肌活动低下男性的自主排尿能力,可能使不符合梗阻尿动力学标准的男性受益。