Chen Jing-Liang, Jiang Yuan-Hong, Lee Cheng-Ling, Kuo Hann-Chorng
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2019 Aug 21;32(1):5-13. doi: 10.4103/tcmj.tcmj_107_19. eCollection 2020 Jan-Mar.
Male lower urinary tract symptoms (LUTSs) are highly prevalent in men and the incidence increases with aging. The pathophysiology of male LUTSs might be bladder outlet dysfunctions such as bladder neck (BN) dysfunction, benign prostatic obstruction, and poor relaxation of external sphincter and bladder dysfunctions such as detrusor overactivity (DO), detrusor underactivity, DO, and inadequate contractility. Male LUTSs include voiding and storage symptoms, and precision diagnosis should not be done based on the symptoms alone. Videourodynamic study provides a thorough look at the bladder and bladder outlet and can clearly demonstrate the underlying pathophysiology when the initial medication fails to relieve LUTS. Medical treatment should be given based on the underlying pathophysiology of LUTS, and surgical intervention to remove prostate should only be performed when a definite bladder outlet obstruction due to prostatic obstruction has been confirmed by invasive urodynamic study.
男性下尿路症状（LUTSs）在男性中非常普遍，且发病率随年龄增长而增加。男性LUTSs的病理生理学可能是膀胱出口功能障碍，如膀胱颈（BN）功能障碍、良性前列腺梗阻以及外括约肌松弛不良，还有膀胱功能障碍，如逼尿肌过度活动（DO）、逼尿肌活动不足、DO和收缩力不足。男性LUTSs包括排尿和储尿症状，不应仅基于症状进行精确诊断。影像尿动力学研究能全面观察膀胱和膀胱出口，当初始药物治疗无法缓解下尿路症状时，可清楚显示潜在的病理生理学。应根据下尿路症状的潜在病理生理学进行药物治疗，只有在侵入性尿动力学研究证实因前列腺梗阻导致明确的膀胱出口梗阻时，才应进行手术切除前列腺。
