Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Urology, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea.
Biomed Res Int. 2020 Aug 10;2020:4605683. doi: 10.1155/2020/4605683. eCollection 2020.
We investigated which benign prostatic hyperplasia-related lower urinary parameters are related to upper urinary tract obstruction and whether transurethral prostatectomy could improve upper urinary tract obstruction.
Patients with prostate size over 30 g and urodynamically proven bladder outlet obstruction were enrolled in this prospective observational study. Bladder wall thickness and prostate size were measured by ultrasonography. A urodynamic study with laboratory tests including serum creatinine, prostate-specific antigen, and urinalysis was performed. Finally, a diuretic scintigraphy using mercaptoacetyltriglycine was performed. Tests except the urodynamic evaluation were repeated after transurethral prostatectomy.
In total, 24 patients were enrolled, and 19 patients completed the present study. The mean values of age (yrs), prostate size (mL), bladder thickness (mm), bladder compliance (mL/pr), and the bladder outlet obstruction index were 68.42 ± 8.25, 72.29 ± 32.78, 4.42 ± 1.14, 50.17 ± 32.15, and 82.11 ± 34.68, respectively. The mean T (min) was 17.51 ± 16.34 on the left side and 15.30 ± 11.96 on the right side. Statistical analysis showed that bladder compliance and bladder thickness were preoperatively related to upper urinary tract obstruction ( = 0.001 and = 0.007, respectively). Diuretic mercaptoacetyltriglycine scan in 19 patients showed improvement 6 months after prostate surgery. Clinically significant proteinuria was associated with upper urinary tract obstruction, and proteinuria was also improved after prostate surgery.
Storage-phase bladder dysfunction could be a reliable urodynamic factor for the indication of upper urinary tract obstruction in patients with benign prostatic hyperplasia, and upper urinary tract obstruction with subsequent kidney damage could be improved by surgical decompression of benign prostatic obstruction.
我们研究了哪些良性前列腺增生相关的下尿路参数与上尿路梗阻有关，以及经尿道前列腺切除术是否可以改善上尿路梗阻。
本前瞻性观察研究纳入前列腺体积>30g 且尿动力学证实膀胱出口梗阻的患者。通过超声测量膀胱壁厚度和前列腺体积。进行尿动力学研究，包括实验室检查，包括血清肌酐、前列腺特异性抗原和尿液分析。最后，使用巯基乙酰三甘氨酸进行利尿剂闪烁显像。除尿动力学评估外，所有检查在经尿道前列腺切除术后均重复进行。
共纳入 24 例患者，19 例完成本研究。年龄（岁）、前列腺体积（mL）、膀胱壁厚度（mm）、膀胱顺应性（mL/pr）和膀胱出口梗阻指数的平均值分别为 68.42±8.25、72.29±32.78、4.42±1.14、50.17±32.15 和 82.11±34.68。左侧 T（min）平均值为 17.51±16.34，右侧为 15.30±11.96。统计学分析显示，术前膀胱顺应性和膀胱厚度与上尿路梗阻相关（=0.001 和=0.007）。19 例利尿剂巯基乙酰三甘氨酸扫描显示，前列腺手术后 6 个月梗阻改善。临床显著蛋白尿与上尿路梗阻相关，前列腺手术后蛋白尿也得到改善。
储存期膀胱功能障碍可能是良性前列腺增生患者上尿路梗阻的可靠尿动力学因素，通过手术解除良性前列腺梗阻可以改善上尿路梗阻及随后的肾损伤。
