Mayo M E, Ross S O, Krieger J N
Department of Urology, University of Washington, School of Medicine, Seattle, USA.
Urology. 1998 Sep;52(3):417-21. doi: 10.1016/s0090-4295(98)00202-7.
A high prevalence of significant bladder outlet obstruction has been reported among men diagnosed as having "chronic prostatitis." To evaluate the possibility that case selection may determine this high prevalence, we compared findings in patients referred directly to our Urodynamic Unit with that of patients evaluated in our Prostatitis Clinic.
The videourodynamics records of 201 men aged 18 to 50 years who presented to the Urodynamic Unit with any lower tract symptoms (irritative and/or obstructive with or without pain) were compared with the findings in 123 Prostatitis Clinic patients. The latter were evaluated for obstruction with flow rates and, if abnormal, by retrograde urethrograms and videourodynamics.
Only 37 (18%) of 201 patients referred to the Urodynamic Unit had pain as a significant symptom and might have been diagnosed as having chronic prostatitis. Of these 37 patients, 4 (11%) had definite obstruction, 6 (16%) were equivocal, 6 (16%) were hypocontractile, 1 (3%) had pseudodyssynergia, and 7 (19%) had normal findings. The remainder had abnormalities of bladder filling (hypersensitivity in 11 [30%] and detrusor instability in 2 [5%]). Fewer of the 123 patients with prostatitis had obstruction (definite in 2 [1.6%] and equivocal in 1 [0.8%]) (P = 0.03), 2 (1.6%) had hypocontractile detrusors, and 2 had urethral strictures.
Patients referred to the Urodynamic Unit with lower urinary tract symptoms and pain rarely have bladder outlet obstruction. However, they are significantly more likely to have bladder outlet obstruction than patients referred to the Prostatitis Clinic who can be screened for obstruction by history, flow rate, postvoid residual, and retrograde urethrogram.
据报道，在被诊断为“慢性前列腺炎”的男性中，严重膀胱出口梗阻的患病率较高。为评估病例选择是否可能导致这一高患病率，我们将直接转诊至我们尿动力学科室的患者的检查结果与在我们前列腺炎诊所接受评估的患者的结果进行了比较。
将201名年龄在18至50岁之间、因任何下尿路症状（刺激性和/或梗阻性，伴或不伴疼痛）就诊于尿动力学科室的男性的视频尿动力学记录，与123名前列腺炎诊所患者的检查结果进行比较。后者通过尿流率评估梗阻情况，若异常，则通过逆行尿道造影和视频尿动力学进一步评估。
转诊至尿动力学科室的201名患者中，只有37名（18%）以疼痛为主要症状，可能被诊断为慢性前列腺炎。在这37名患者中，4名（11%）有明确梗阻，6名（16%）不明确，6名（16%）收缩功能减退，1名（3%）有假性协同失调，7名（19%）检查结果正常。其余患者存在膀胱充盈异常（11名[30%]膀胱过敏，2名[5%]逼尿肌不稳定）。123名前列腺炎患者中梗阻的较少（明确梗阻2名[1.6%]，不明确梗阻1名[0.8%]）（P = 0.03），2名（1.6%）逼尿肌收缩功能减退，2名有尿道狭窄。
因下尿路症状和疼痛转诊至尿动力学科室的患者很少有膀胱出口梗阻。然而，与转诊至前列腺炎诊所、可通过病史、尿流率、排尿后残余尿量和逆行尿道造影筛查梗阻的患者相比，他们有膀胱出口梗阻的可能性显著更高。
