Mauroy B
Service Universitaire d'Urologie Hôpital Victor Provo, Roubaix, France.
Eur Urol. 1997;32 Suppl 1:3-8.
The development of new imaging techniques has improved our knowledge of the cross-sectional anatomy of the pelvis and thereby our understanding of the bladder's response to prostatic obstruction. It is now known that changes in the bladder are intimately linked to the development of irritative and obstructive symptoms of BPH. This paper illustrates the anatomical changes within the pelvic region that can develop as a consequence of prostatic enlargement. The anatomical position of the prostate is such that its enlargement inevitably affects neighbouring organs. Enlargement of the median lobe can cause irritation of the trigone and the physical trapping of urine behind the lobe. The urethra may also become mechanically obstructed leading to an increase in the detrusor muscle mass as it struggles to overcome the restriction of the bladder outlet. In time, a change in the collagen to muscle ration in favour of collagen may develop, with the consequence that bladder compliance is reduced and the ability to increase volume without increasing pressure is diminished. Thereafter one of two scenarios may develop: the 'high pressure conflict' bladder or the 'distended low pressure' bladder. Urinary disturbance in BPH therefore results from an inadequate balance between bladder contractility and urethral resistance.
新成像技术的发展增进了我们对骨盆横断面解剖结构的了解，从而也加深了我们对膀胱对前列腺梗阻反应的认识。现在已知膀胱的变化与良性前列腺增生（BPH）的刺激性和梗阻性症状的发展密切相关。本文阐述了由于前列腺增大可能导致的盆腔区域内的解剖学变化。前列腺的解剖位置使其增大不可避免地会影响邻近器官。中叶增大可刺激膀胱三角区，并在中叶后方形成尿液潴留。尿道也可能受到机械性梗阻，导致逼尿肌质量增加，因为它要努力克服膀胱出口的阻力。随着时间的推移，胶原与肌肉的比例可能会朝着有利于胶原的方向变化，结果是膀胱顺应性降低，在不增加压力的情况下增加容量的能力减弱。此后可能会出现两种情况之一：“高压冲突”膀胱或“扩张低压”膀胱。因此，BPH中的尿路紊乱是由膀胱收缩力和尿道阻力之间的平衡不足所致。
