Madersbacher S, Klingler H C, Djavan B, Stulnig T, Schatzl G, Schmidbauer C P, Marberger M
Department of Urology, University of Vienna, Austria.
Br J Urol. 1997 Jul;80(1):72-7. doi: 10.1046/j.1464-410x.1997.00220.x.
To determine whether it is possible to predict the presence of bladder outlet obstruction (BOO) by non-invasive clinical variables in patients with lower urinary tract symptoms (LUTS) suggestive of BOO.
Patients with LUTS suggestive of BOO were entered into a prospective protocol evaluating the International Prostate Symptom Score (IPSS), prostate size, non-invasive uroflow, post-void residual urine volume (PVR) and a pressure flow study. Only patients with a maximum flow rate (Qmax) of < or = 15 mL/s and an IPSS > or = 7 were included. The study comprised 253 patients; the degree of obstruction was correlated to several non-invasive clinical variables. Subsequently nomograms were developed by multiple logistic regression analysis to obtain the probability of BOO in patients with LUTS.
Prostate volume, Qmax, PVR and voided volume correlated significantly with the degree of BOO rated according to the linear passive urethral resistance relation (linPURR). In contrast, there was no such correlation for the IPSS and the quality-of-life question of the IPSS. The percentage of patients with BOO defined by a linPURR of 3-6 decreased from 85% in those with a Qmax of 0-5 mL/s to 60% (Qmax 6-10 mL/s) and 44% (Qmax 11-15 mL/s). In parallel, the percentage of patients with BOO increased from 53% of those with a prostate volume of < or = 50 mL, to 79% of those with prostates of 51-100 mL and 75% of those > 100 mL. Based on Qmax, PVR and prostate volume, nomograms were established by multiple logistic regression analysis for the probability of BOO in patients with LUTS.
The nomograms presented herein should help the clinician to identify patients with LUTS who should undergo pressure flow studies before surgical intervention to detect the presence of obstruction and in whom these studies can be safely spared.
确定对于有提示膀胱出口梗阻（BOO）的下尿路症状（LUTS）的患者，是否可以通过非侵入性临床变量预测BOO的存在。
有提示BOO的LUTS的患者进入一项前瞻性方案，评估国际前列腺症状评分（IPSS）、前列腺大小、非侵入性尿流率、排尿后残余尿量（PVR）以及压力流率研究。仅纳入最大尿流率（Qmax）≤15 mL/s且IPSS≥7的患者。该研究包括253例患者；梗阻程度与多个非侵入性临床变量相关。随后通过多因素逻辑回归分析绘制列线图，以获得LUTS患者发生BOO的概率。
根据线性被动尿道阻力关系（linPURR）评估，前列腺体积、Qmax、PVR和排尿量与BOO程度显著相关。相比之下，IPSS及其生活质量问题则无此类相关性。linPURR为3 - 6定义的BOO患者百分比，从Qmax为0 - 5 mL/s的患者中的85%，降至Qmax为6 - 10 mL/s的患者中的60%以及Qmax为11 - 15 mL/s的患者中的44%。同时，前列腺体积≤50 mL的患者中BOO患者百分比从53%，增至前列腺体积为51 - 100 mL的患者中的79%以及前列腺体积＞100 mL的患者中的75%。基于Qmax、PVR和前列腺体积，通过多因素逻辑回归分析建立了LUTS患者发生BOO概率的列线图。
本文呈现的列线图应有助于临床医生识别那些在手术干预前应进行压力流率研究以检测是否存在梗阻的LUTS患者，以及那些可以安全免做这些研究的患者。
