Seaman E K, Jacobs B Z, Blaivas J G, Kaplan S A
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
J Urol. 1994 Sep;152(3):935-7. doi: 10.1016/s0022-5347(17)32614-9.
Approximately 15 to 20% of patients who undergo transurethral resection of the prostate for benign prostatic hyperplasia have persistent or recurrent voiding symptoms requiring further therapy. To elucidate the etiology of these voiding abnormalities, the urodynamic findings of 129 consecutive men (mean age 72 years) with post-transurethral resection voiding symptoms were retrospectively analyzed with respect to symptoms, uroflowmetry and synchronous video pressure-flow cystometry. Our findings revealed obstruction in 38% of the patients, impaired contractility in 25% and intrinsic sphincter deficiency in 8%. Among 80 patients without neurological disorders involuntary bladder contractions were detected in 50%. However, in 49 patients with neurological disorders involuntary bladder contractions were detected in 76%. This difference was statistically significant. There were 15 patients who failed 2 or more transurethral resections of the prostate, and involuntary bladder contractions were detected in 80%, obstruction in 27%, impaired contractility in 27% and sphincteric incontinence in 20%. Our study reveals residual or recurrent obstruction to be a contributing factor in less than half of all patients who fail transurethral resection of the prostate. Furthermore, patients with a concomitant neurological disorder and those who have undergone more than 1 transurethral resection of the prostate have a significantly higher incidence of involuntary bladder contractions. These results underscore the importance of obtaining complete urodynamic assessment in patients with persistent or recurrent voiding symptoms following transurethral resection of the prostate to guide appropriate therapy.
因良性前列腺增生接受经尿道前列腺切除术的患者中，约15%至20%会出现持续或反复的排尿症状，需要进一步治疗。为阐明这些排尿异常的病因，我们回顾性分析了129例连续男性（平均年龄72岁）经尿道前列腺切除术后出现排尿症状的尿动力学检查结果，包括症状、尿流率以及同步视频压力 - 流率膀胱测压。我们的研究结果显示，38%的患者存在梗阻，25%的患者收缩功能受损，8%的患者存在固有括约肌功能不全。在80例无神经功能障碍的患者中，50%检测到膀胱不自主收缩。然而，在49例有神经功能障碍的患者中，76%检测到膀胱不自主收缩。这种差异具有统计学意义。有15例患者经两次或更多次经尿道前列腺切除术均失败，其中80%检测到膀胱不自主收缩，27%存在梗阻，27%收缩功能受损，20%存在括约肌失禁。我们的研究表明，残余或复发性梗阻在经尿道前列腺切除术失败的所有患者中，占比不到一半。此外，伴有神经功能障碍的患者以及接受过一次以上经尿道前列腺切除术的患者，膀胱不自主收缩的发生率显著更高。这些结果强调了对经尿道前列腺切除术后出现持续或反复排尿症状的患者进行全面尿动力学评估以指导适当治疗的重要性。
