前列腺增生致膀胱逼尿肌收缩无力的临床研究

Clinical Study of Detrusor Underactivity with Impaired Contractile Function on Voiding Function in Benign Prostatic Hyperplasia

目的:探讨膀胱过度充盈所致逼尿肌损伤,引起膀胱逼尿肌收缩无力良性前列腺增生患者的诊断及治疗方法。方法:分析膀胱过度充盈所致逼尿肌损伤,引起膀胱逼尿肌收缩无力良性前列腺增生48例患者的临床资料,包括诊断,尿动力学检查,治疗及随访结果。结果:37例经尿流动力学检查,诱发存在逼尿肌不稳定,伴膀胱内压达40 cmH_2 O以上,采取TURP,术后留置膀胱造瘘管(1～8)周后全部拔除,排尿通畅。11膀胱内压始终未达到40 cmH_2O,且在膀胱注水充盈过程中无逼尿肌不稳定出现,行膀胱造瘘后出院,(1～3)个月后经尿动力学检查复查膀胱逼尿肌收缩力,其中7例膀胱逼尿肌收缩功能有恢复,行经尿道前列腺汽化电切术治愈;剩余4例膀胱逼尿肌收缩功能几乎无任何改善。长期留置膀胱造瘘治疗。结论:良性前列腺增生(BPH)导致膀胱过度充盈所致逼尿肌损伤,引起膀胱逼尿肌收缩无力患者,术前应用尿流动力学检查对膀胱逼尿肌损伤程度进行认真分析,可进行有针对性的治疗。

Objective： To investigate diagnosis and treatment choice of detrusor hypoactivity with impaired contractile function （DHIC） on voiding function in benign prostatic hyperplasia （BPH）.Methods：The clinical date of 48 BPH patients with DHIC were analyzed,including clinical diagnosis,urodynamic parameters,treatment and follow-ups.Results：37 patients with detrusor instability（DI） and over 40 cmH2O bladder pressure were treated successfully by TURP.The time of indwelling suprapubic punctural cystostomy cathter was（1-8）weeks.11cases without DI and under 40 cmH2O bladder pressure were treated by suprapubic punctural cystostomy,accepted the test of urodynamics after（1-3）months.7 cases with DI were treated successfully by TURP,4 cases without DI were indwelled suprapubic punctural cystostomy cathter all life.Conclusion：DHIC worsens the voiding function of the patients with BPH,and the test of urodynamic is helpful to diagnose and could provide more convinced evidences for treatment of patients.