Robertson A S, Griffiths C, Neal D E
Department of Urology, Freeman Road Hospital, Newcastle Upon Tyne, England.
J Urol. 1996 Feb;155(2):506-11.
We determined whether ambulatory urodynamics and new objective methods of defining bladder outflow obstruction might improve the classification of bladder outflow obstruction over conventional urodynamics (cystometrography), and whether such measures might improve prediction of the outcome of prostatectomy.
A prospective study was performed of 122 men undergoing prostatectomy for symptoms and low flow rates. Cystometrography and ambulatory urodynamics were performed before and 6 months after prostatectomy but did not influence selection for operation. Methods of classifying obstruction included the Abrams-Griffiths nomogram, Schäfer linear passive urethral resistance relation and Griffiths urethral resistance factor.
The proportion of cases defined as obstructed did not differ on ambulatory urodynamics or cystometrography or when the Abrams-Griffiths nomogram was compared to the linear passive urethral resistance relation or urethral resistance factor. Significant improvements after prostatectomy were noted in flow rates (p < 0.001), residual urine (p < 0.001), voiding pressure (p < 0.001) and symptom scores (p < 0.001). Ambulatory urodynamics were more sensitive than cystometrography in detection of detrusor instability but detrusor instability did not correlate with outcome. Voiding pressures were greater during ambulatory urodynamics (p < 0.02). The outcome of obstructed cases (on Abrams-Griffiths nomogram during ambulatory urodynamics) was better (79% good outcome) than that of nonobstructed or equivocally obstructed cases (55% good symptomatic outcome, p < 0.05).
Men proved to have obstruction on the basis of pressure and flow measurements applied to a nomogram have better outcomes after transurethral resection of the prostate but sophisticated or computer derived methods of classification of obstruction did not improve prediction.
我们确定动态尿动力学以及定义膀胱出口梗阻的新客观方法是否比传统尿动力学（膀胱压力描记法）能更好地对膀胱出口梗阻进行分类，以及这些措施是否能改善前列腺切除术预后的预测。
对122例因症状和低尿流率而接受前列腺切除术的男性进行了一项前瞻性研究。在前列腺切除术前及术后6个月进行膀胱压力描记法和动态尿动力学检查，但这些检查不影响手术选择。梗阻分类方法包括艾布拉姆斯 - 格里菲思列线图、舍费尔线性被动尿道阻力关系和格里菲思尿道阻力因子。
在动态尿动力学、膀胱压力描记法中，或者将艾布拉姆斯 - 格里菲思列线图与线性被动尿道阻力关系或尿道阻力因子进行比较时，定义为梗阻的病例比例没有差异。前列腺切除术后，尿流率（p < 0.001）、残余尿量（p < 0.001）、排尿压力（p < 0.001）和症状评分（p < 0.001）均有显著改善。动态尿动力学在检测逼尿肌不稳定方面比膀胱压力描记法更敏感，但逼尿肌不稳定与预后无关。动态尿动力学期间的排尿压力更高（p < 0.02）。在动态尿动力学中根据艾布拉姆斯 - 格里菲思列线图判定为梗阻的病例预后（79%预后良好）优于非梗阻或可疑梗阻病例（55%症状改善良好，p < 0.05）。
根据应用于列线图的压力和流量测量结果被证明存在梗阻的男性，经尿道前列腺切除术后预后更好，但复杂的或计算机衍生的梗阻分类方法并不能改善预测。
