Gerber G S, Kim J H, Contreras B A, Steinberg G D, Rukstalis D B
Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois, USA.
Urology. 1996 Jun;47(6):840-4. doi: 10.1016/S0090-4295(96)00040-4.
To assess the urodynamic changes in men with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction treated with doxazosin and to correlate these changes with voiding symptoms.
Fifty patients with LUTS were treated with doxazosin at a dose of 4 mg/day for 3 months. All men were initially evaluated by International Prostate Symptom Score (I-PSS) questionnaires, measurements of urinary flow rate, and complex urodynamic study. Those patients completing the 3-month study underwent repeat testing.
Forty-four (88%) men underwent initial and follow-up urodynamic evaluation. The mean I-PSS improved from 20.6 to 10.5 (P < 0.001), mean peak urinary flow rate increased for 11.7 to 13.2 cc/s (P = 0.20), mean detrusor pressure at peak flow decreased from 9 3.6 to 83.0 cm H20 (P = 0.15), and mean cystometric bladder capacity increased from 266 to 304 cc (P = 0.07). Using the Abrams-Griffiths nomogram and number, more than 58% of patients remained obstructed after treatment with doxazosin for 3 months. Men with and without objective evidence of bladder outlet obstruction at the outset of the study had similar improvement in voiding symptoms. Most patients elected to continue treatment with doxazosin at the completion of the study (41/44, 93%).
The majority of patients had objective evidence of persistent bladder outlet obstruction after treatment with doxazosin for 3 months despite significant benefit. The results of complex urodynamic evaluation did not predict treatment response in men with LUTS suggestive of bladder outlet obstruction. Urodynamic study does not appear to be helpful in the evaluation of patients with uncomplicated LUTS prior to treatment with doxazosin.
评估用多沙唑嗪治疗的、有提示膀胱出口梗阻的下尿路症状（LUTS）男性患者的尿动力学变化，并将这些变化与排尿症状相关联。
50例LUTS患者接受剂量为4mg/天的多沙唑嗪治疗，为期3个月。所有男性患者最初均通过国际前列腺症状评分（I-PSS）问卷、尿流率测量和复杂尿动力学研究进行评估。完成3个月研究的患者接受重复检测。
44例（88%）男性患者接受了初始和随访尿动力学评估。I-PSS平均值从20.6改善至10.5（P<0.001），平均最大尿流率从11.7增加至13.2cc/s（P=0.20），最大尿流时的平均逼尿肌压力从93.6降至83.0cmH₂O（P=0.15），平均膀胱容量从266增加至304cc（P=0.07）。使用Abrams-Griffiths列线图和数值，超过58%的患者在接受多沙唑嗪治疗3个月后仍存在梗阻。在研究开始时有无膀胱出口梗阻客观证据的男性患者在排尿症状方面有相似的改善。大多数患者在研究结束时选择继续使用多沙唑嗪治疗（41/44，93%）。
尽管有显著益处，但大多数患者在用多沙唑嗪治疗3个月后仍有持续膀胱出口梗阻的客观证据。复杂尿动力学评估结果不能预测有提示膀胱出口梗阻的LUTS男性患者的治疗反应。尿动力学研究似乎无助于在多沙唑嗪治疗前评估无并发症的LUTS患者。
