Kaplan S A, Te A E, Jacobs B Z
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
J Urol. 1994 Dec;152(6 Pt 1):2063-5. doi: 10.1016/s0022-5347(17)32309-1.
Many patients are misdiagnosed as having refractory chronic nonbacterial prostatitis, and are treated with antibiotics and/or alpha-blockers with variable success. This study was designed to ascertain the potential diagnostic role of synchronous video-pressure-flow urodynamics and the therapeutic role of transurethral incision of the bladder neck in 34 consecutive men (age 26 to 51 years) with a minimum of 2 years of misdiagnosis. Duration of symptoms ranged from 25 to 126 months (mean 38.3). The average number of previous antibiotic days ranged from 42 to 136 (mean 54.3). In addition, 24 men were given empiric trials of alpha-blockers, all unsuccessful. Patients with evidence of bacterial infection or excessive leukocytes in expressed prostatic secretions were excluded from the study. Of these 34 patients 31 had urodynamic evidence of bladder outlet obstruction localized fluoroscopically to the vesical neck, while the remaining 3 had normal studies. The mean pretreatment maximum urine flow was 9.2 ml. per second and the mean maximal detrusor pressure was 76.3 cm. water. In 31 patients the bladder neck was incised at the 5 o'clock position from the bladder neck to the verumontanum with the patient under caudal (22) or spinal (9) anesthesia. Of these 31 patients 30 had marked subjective improvement in symptoms with an increase in maximal urine flow to 16.4 and 15.7 ml. per second at 3 and 6 months, respectively. The remaining patient noticed continued symptoms despite urine flow improvement. All 31 patients reported postoperative antegrade ejaculation. These results indicate that many men who are categorized as having and empirically treated for chronic nonbacterial prostatitis are misdiagnosed and, in fact, have bladder outlet obstruction. Urodynamics are helpful in diagnosing and predicting success in these patients. Furthermore, transurethral incision of the bladder neck is an effective and safe therapeutic modality in this group.
许多患者被误诊为难治性慢性非细菌性前列腺炎，并接受了抗生素和/或α受体阻滞剂治疗，疗效不一。本研究旨在确定同步视频压力-流率尿动力学检查的潜在诊断作用，以及经尿道膀胱颈切开术对34例连续男性患者（年龄26至51岁）的治疗作用，这些患者至少误诊2年。症状持续时间为25至126个月（平均38.3个月）。既往使用抗生素的天数平均为42至136天（平均54.3天）。此外，24名男性患者接受了α受体阻滞剂的经验性试验，但均未成功。有细菌感染证据或前列腺液中白细胞过多的患者被排除在研究之外。这34例患者中，31例尿动力学检查显示膀胱出口梗阻，荧光镜检查定位在膀胱颈，其余3例检查正常。术前最大尿流率平均为9.2毫升/秒，最大逼尿肌压力平均为76.3厘米水柱。31例患者在骶管麻醉（22例）或脊髓麻醉（9例）下，于膀胱颈5点位置从膀胱颈至精阜切开膀胱颈。这31例患者中，30例症状有明显主观改善，3个月和6个月时最大尿流率分别增至16.4毫升/秒和15.7毫升/秒。其余1例患者尽管尿流有所改善，但仍有持续症状。所有31例患者均报告术后出现顺行射精。这些结果表明，许多被归类为慢性非细菌性前列腺炎并接受经验性治疗的男性患者被误诊，实际上患有膀胱出口梗阻。尿动力学检查有助于诊断这些患者并预测治疗效果。此外，经尿道膀胱颈切开术对该组患者是一种有效且安全的治疗方式。
