Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
Tzu Chi University, Hualien, Taiwan.
Sci Rep. 2022 Jan 10;12(1):362. doi: 10.1038/s41598-021-04237-0.
Detrusor underactivity (DU) could be resulted from many different etiologies. Patients with DU might have reduced bladder sensation, low detrusor contractility, and large post-void residual volume. This study analyzed therapeutic outcome of active management for male DU patients, based on clinical and urodynamic characteristics. Male DU patients aged > 18 years old were retrospectively reviewed from the videourodynamic study (VUDS) records in recent 10 years. The patients' demographics, VUDS results, treatment modalities, and treatment outcome were analyzed. The treatment outcomes were compared among patients with different DU subgroups, clinical diagnosis and treatment modalities. Patients with voiding efficiency of > 66.7% were considered having a successful treatment outcome. For comparison, 30 men with normal VUDS finding served as the control arm. Most of the DU patients had reduced bladder sensation. The reduced bladder sensation is closely associated with low detrusor contractility. After active treatment, a successful outcome was achieved in 68.4% of patients after bladder outlet surgery, 59.1% after urethral botulinum toxin A injection, and 57.6% after medical treatment, but only 18.2% after conservative treatment. A successful treatment outcome was achieved in patients with an intact detrusor contractility, either low (69.2%) or normal voiding pressure (81.8%), and in patients with a normal or increased bladder sensation (78.1%). However, patients with detrusor acontractile (41.3%) or absent bladder sensation (17.9%) had less favorable treatment outcome after any kind of urological management. This study revealed that active management can effectively improve voiding efficiency in patients with DU. The normal bladder sensation, presence of adequate detrusor contractility, and bladder outlet narrowing during VUDS provide effective treatment strategy for DU patients. Among all management, BOO surgery provides the best treatment outcome.
逼尿肌活动低下（DU）可能由多种不同病因引起。DU 患者可能会出现膀胱感觉减退、逼尿肌收缩力降低和较大的残余尿量。本研究基于临床和尿动力学特征，分析了主动管理对男性 DU 患者的治疗效果。回顾性分析了近 10 年来视频尿动力学检查（VUDS）记录中的年龄大于 18 岁的男性 DU 患者。分析了患者的人口统计学特征、VUDS 结果、治疗方式以及治疗效果。比较了不同 DU 亚组、临床诊断和治疗方式患者的治疗效果。将排尿效率大于 66.7%的患者视为治疗成功。为了进行比较，将 30 名 VUDS 检查正常的男性作为对照组。大多数 DU 患者存在膀胱感觉减退。膀胱感觉减退与逼尿肌收缩力降低密切相关。经过积极治疗，膀胱出口手术后 68.4%、尿道肉毒素 A 注射后 59.1%、药物治疗后 57.6%的患者获得了成功的治疗效果，而仅 18.2%的保守治疗患者获得了成功。逼尿肌收缩力完整（无论是低的还是正常的）、排尿压正常或升高的患者（分别为 69.2%和 81.8%）以及膀胱感觉正常或升高的患者（78.1%），治疗效果较好。然而，任何类型的泌尿外科管理后，逼尿肌无收缩（41.3%）或膀胱感觉缺失（17.9%）的患者治疗效果较差。本研究表明，积极治疗可以有效提高 DU 患者的排尿效率。正常的膀胱感觉、足够的逼尿肌收缩力以及 VUDS 时的膀胱出口狭窄为 DU 患者提供了有效的治疗策略。在所有治疗方式中，膀胱出口梗阻手术的治疗效果最好。
