良性前列腺增生膀胱出口梗阻评判指标分析

Analysis of the Diagnostic Criteria of Bladder Outlet Obstruction in Benign Prostatic Hyperplasia

目的 :探讨良性前列腺增生 (BPH)患者评判膀胱出口梗阻 (BOO)程度临床指标的应用价值。 方法 :35 8例BPH患者 ,根据膀胱镜下前列腺尿道梗阻的程度分为 3级 :1级为轻度梗阻 ;2级为中度梗阻 ;3级为重度梗阻 ;并根据Sch fer图定量划分梗阻程度 :0～Ⅵ级。结合相应的前列腺体积、最大尿流率、残余尿、国际前列腺症状评分(IPSS)以及膀胱的稳定性等项指标 ,进行单因素方差分析和相关分析 ,并计算相关指数。 结果 :按膀胱镜观测到的前列腺挤压尿道的程度将患者划分为 3级 :其中 1级 2 7例 ,2级 2 36例 ,3级 95例。前列腺体积为 16～ 14 5(4 7.0 4± 15 .6 1)ml。前列腺体积与前列腺挤压尿道的程度成正相关 (r =0 .2 9,R2 =0 .0 8) ,随着患者前列腺体积增大 ,前列腺挤压尿道的程度加重 (F =4 .2 16 ,P <0 .0 5 )。前列腺挤压尿道的程度与IPSS成正相关 (r =0 .35 ,R2 =0 .12 ) ,I PSS伴随着前列腺挤压尿道程度的增高而增高 (F =8.4 0 8,P <0 .0 0 1) ;生活质量评分随着前列腺挤压尿道程度的加重而增高 (F =10 .2 0 4 ,P <0 .0 0 1) ,两者成正相关 (r =0 .17,R2 =0 .0 3)。整个研究人群的平均最大尿流率为 (10 .0 2± 2 .12 )ml/min ,残余尿量为 (84 .0 6± 36 .5 0 )ml。最大自由率随着前列腺挤压尿道程度的加?

Objective: To analyze the value of the diagnostic criteria for bladder outlet obstruction in benign prostatic hyperplasia (BPH). Methods: A total of 358 patients with BPH were divided into 3 grades according to fibrous urethrocystoscopic information on the severity of obstructions, which were classified as Grade 1(slight), Grade 2 (moderate), and Grade 3(severe). By Schfer's graph they were divided into 7 grades, represented by 0 to Ⅵ. We analyzed the volume of prostate, maximum flow rate (Qmax),residual urine volume, International Prostatic Symptom Score (IPSS) and detrusor instability. Statistical analysis ANOVA (analysis of variance) was made, spearman correlation evaluated and the coefficient of determination measured. Results: Of all the patients, 27 were classified as Grade 1, 236 as Grade 2 and 95 as Grade 3. Eighty-four patients had detrusor instability. The volumes of the prostate ranged from 16 ml to 145 ml, averaging ( 47.04± 15.61) ml . The mean maximum flow rate was ( 10.02± 2.12) ml/min and the mean residual urine volume was (84.06±36.50) ml. With the increase of the severity of obstruction, the volume of the prostate increased (F= 4.216, P< 0.05), IPSS rose(F= 8.408,P< 0.001), the maximum flow rate decreased(F= 22.43,P< 0.001), the residual urine volume rose(F= 163.232, P< 0.001), the incidence of detrusor instability increased(F= 23.637, P< 0.001) and Schfer's grades were elevated(F= 202.897, P< 0.001). The volume of the prostate, the maximum flow rate (Qmax), residual urine volume, IPSS detrusor instability and Schfer's grades were all correlated significantly with the severity of the obstruction. The correlation index and coefficient of determination were r= 0.29, R 2= 0.08; r= 0.35, R 2= 0.12;r= -0.69, R 2= 0.47; r= 0.60, R 2= 0.36; r= 0.33,R 2= 0.11;r= 0.72, R 2= 0.52;respectively. The correlation between the urethrocystoscopic information and Schfer's graph on the severity of the obstruction were the best criteria of all. Conclusion: The severity of the obstruction at urethrocystoscopy correlates well with that at urodynamic investigation. Such criteria could improve the sensitivity and specificity of the diagnosis of bladder outlet obstruction.