良性前列腺增生症患者膀胱小梁化与逼尿肌压力的相关性研究

Relationship between the bladder trabeculation grades and pressure of detrusor in benign prostatic hyperplasia

目的分析良性前列腺增生病人由膀胱内窥镜观测到的膀胱小梁化程度和尿动力学检查测定的逼尿肌压力的联系。方法298例BPH病人,按照膀胱镜下的膀胱小梁化的严重程度分为4级。0级:无小梁化;1级:轻度到中度小梁化;2级:重度小梁化;3级:重度小梁化伴有假性憩室形成。结合相应的最大自由尿流率、最大尿流率逼尿肌压、排尿期最小逼尿肌压和最大逼尿肌压等项指标,进行方差分析和相关检验分析。结果膀胱小梁化0级34例、1级91例、2级117例、3级56例。随着膀胱小梁化程度的加重最大自由尿流率呈现明显降低趋势;最大尿流率逼尿肌压、排尿期最小逼尿肌压和最大逼尿肌压呈现增高趋势。最大尿流率逼尿肌压、排尿期最小逼尿肌压和最大逼尿肌压变化与膀胱小梁化分级成正相关。结论膀胱小梁化改变作为一种形态学变化与尿动力学的逼尿肌功能改变间有良好的关联。

【Objective】To analyze the relationship between the bladder trabeculation grade and the pressure of detrusor （Pdet） in patients with benign prostatic hyperplasia （BPH）.【Methods】 A total of 298 patients with BPH. They were divided into 4 grades by the bladder trabeculation,Grade 0-none bladder trabeculation, Grade 1-slight to moderate, Grade 2-severe and Grade 3-severe with formation of （pseudo）diverticula. We analysed the relationship between the bladder trabeculation found by fibrous urethrocystoscopy and the investigations on urodynamic such as maximum flow rate （Qmax）, pressure of detrusor in maximal urine flow rate （Pdet,Qmax）, minimum pressure of detrusor in voiding （Pdet,min,void）、maximal pressure of detrusor（Pdet,max）. For statistical analysis ANOVA （analysis of variance） and spearman correlation were used. 【Result】Of the 34 patients were classified as Grade 0, 91 were classified as Grade 1,117 were classified as Grade 2 and 56 were classified as Grade 3. A significant correlation was found between bladder trabeculation and the change of Pdet on urodynamic. While the degree of bladder trabeculation evaluation had increased, the Qmax had decreased; the Pdet in Qmax had increased , the minimum pressure of detrusor in voiding（Pdet,min,void）had increased, and the maximal pressure of detruso（rPdet, max）had increased too. We also found that pressure of detrusor in maximal urine flow rate （Pdet,Qmax）, minimum pressure of detrusor in voiding （Pdet,min,void） and maximal pressure of detruso（rPdet,max）correlated significantly with severity of the bladder trabeculation. 【Conclusion】The bladder trabeculation as a kind of morphology change has matched well with the detrusor fuction change in BPH patients＇bladder.