Leriche A
Service d'urologie Hospices civils de Lyon, Hôpital Henry-Gabrielle, Saint-Genis-Laval.
Rev Prat. 1995 Feb 1;45(3):299-304.
The uroflowmetry is still the only criteria to show and analyse a dysuria unknown by the patient two times out of three. This analysis will allow us to appreciate the follow-up of the desobstruction regarding the therapeutic which has been chosen. The ultrasonography (renal ultrasonography and prostate) can easily detect bladder and renal failures. It provides good information on anatomical and shape of the prostate but less information on urethral obstruction because dynamic ultrasonography is carried out in a few cases. The intravenous pyelography seems to be out of date but it will give the most important parameters to appreciate the urinary problems allowing the analysis of the physiological micturation by voiding urethrography. The retrograd urethrography provides good imaging diagnosis but gives a better image of urethral stenosis in a very important dysuria. It is not appropriate to say that it is an invasive procedure. The endoscopy is very convenient. It could be used during an examination and need no anesthetic to be performed with an optical fibroscope. The urodynamic examination is needed only in a major dysuria without real obstruction or detrusor instability. First the obstruction has to be evaluated by the previous examinations. It could point out that some bladders are hypocontractile and in these cases, surgery will be inappropriate. Also it allows us to test the effectiveness of external sphincter pressure to determine the prognostic of continence and even to treat the incontinence by biofeedback.
尿流率测定仍是用以显示和分析排尿困难的唯一标准，在三分之二的情况下患者对此排尿困难并不知晓。该分析将使我们能够根据所选择的治疗方法来评估解除梗阻的后续情况。超声检查（肾脏超声和前列腺超声）能够轻易检测出膀胱和肾脏功能衰竭。它能提供有关前列腺解剖结构和形态的良好信息，但关于尿道梗阻的信息较少，因为只有少数情况下会进行动态超声检查。静脉肾盂造影似乎已过时，但它能给出评估泌尿系统问题的最重要参数，通过排尿尿道造影可分析生理性排尿情况。逆行尿道造影能提供良好的影像诊断，但在严重排尿困难时能更好地显示尿道狭窄情况。不宜说它是一种侵入性检查。内镜检查非常方便。在检查过程中即可使用，使用光学纤维镜进行操作时无需麻醉。尿动力学检查仅在严重排尿困难但无真正梗阻或逼尿肌不稳定的情况下才需要。首先必须通过先前的检查来评估梗阻情况。它可能会指出某些膀胱收缩功能减退，在这些情况下，手术将不合适。此外，它还能让我们测试外括约肌压力的有效性，以确定控尿的预后情况，甚至通过生物反馈来治疗尿失禁。
