青春期慢性前列腺炎伴膀胱逼尿肌括约肌协同失调的临床分析

Chronic prostatitis during puberty with detrusor sphincter dyssyergia

目的探讨青春期慢性前列腺炎伴膀胱逼尿肌括约肌协同失调（DSD）的临床特点及治疗效果。方法青春期慢性前列腺炎患者43例，均行慢性前列腺炎（CP）症状评分（NIH-CPSI）评估，尿常规、细菌培养，前列腺按摩液常规检查、细菌培养及泌尿系B超检查，行NIH分型。Ⅲ型CP患者组均行尿动力学检查，分析尿流曲线，记录最大尿流率（Qmax）、DSD、残余尿（PVR）、最大尿流逼尿肌压（Pdet max）、最大尿道压（MUP）和最大尿道闭合压（MUCP）等参数。Ⅲ型CP伴DSD患者行生物反馈治疗，或辅以抗生素、α-受体阻滞剂治疗。12周后行NIH-CPSI评分及尿流动力学检查评估疗效。结果43例青春期CP患者中，Ⅱ型4例（9．30％），ⅢA型7例（16．28％），ⅢB型30例（69．77％），Ⅳ型2例（4．65％）；其中伴DSD患者28例（65．12％），其中ⅢA型2例，ⅢB型26例。28例Ⅲ型伴DSD患者治疗12周后，疗效评估显示NIH-CPSI总评分较治疗前显著降低，治疗前后分别为（27．24±12．41）分和（6．75±2．13）分，差异具统计学意义（P〈0．05）；尿流动力学指标Qmax治疗前后分别为（9．64±4．52）ml／s和（16．16±7．28）ml／s，Pdetmax治疗前后分别为（126．74±43．58）cmH2O和（74．57±11．80）cmH2O，MUP治疗前后分别为（112．45±22．73）cmH2O和（66．82±13．92）cmH2O，MUCP治疗前后分别为（96．54±13．60）cmH2O和（51．36±9．74）cmH2O，DSD发生例数治疗前后分别为28例和3例，差异均具统计学意义（P〈0．05），仅PVR治疗前后无变化，治疗前后分别为（8．23±3．79）ml和（7．16±4．02）ml，差异无统计学意义（P〉0．05）。结论青春期CP患者多伴DSD发生，临床表现除下尿路症状外，还出现尿流动力学改变；尿流动力学检查是诊断该疾病并拟定治疗方案的重要指标；盆底生物反馈治疗是该类型CP的主要治疗方法，短期疗效确切。

Objective To evaluate the clinical feature and treatment efficacy of chronic prostatitis during puberty （CPP） with detrusor sphincter dyssyergia （DSD）. Methods Forty-three cases of CPP were tested with the NIH-CPSI score, urine analysis ,bacterial culture, and expressed prostatic secretion （EPS）. ⅢCP cases were investigated with the urodynamic test, and analyzed with Qmax, DSD, PVR, Pdetmax, MUP and MUCP. Ⅲ CPP with DSD was treated with the pelvic floor biofeedback therapy, afflicted with antibacterial or a -ARI. Twelve weeks later, the NIH-CPSI score and urodynamic test were performed. Results Of 43 cases, 4 cases were of the Ⅱ type （9.30%）, 7 cases of the ⅢA （16.28%）, 30 cases of the Ⅲ B（69.77%） and 2 cases of the 11/（4.65%）; There were 28 cases of Ⅲ CPP with DSD including 2 ⅢA and 26 Ⅲ B. After 12-week treatment, the NIH-CPSI scores of 28 Ⅲ CPP patients with DSD were significantly decreased （27.24±12.41 VS 6.75±2.13, P〈0.05）, whereas Qmax （9.64±4.52 ml/s VS 16.16 ±7.28 ml/s） wasimproved significantly. Other indexes like Pmax （126.74±43.58 cmH2O VS 74.57±11.80 cmH2O）, MUP （ 112.45 ± 22.73 cmH2O VS 66.82 ±13.92 cmH2O）, MUCP （96.54±13.60 cmH2O VS 51.36±9.74 cmH2O） and ocurrence of DSD （28 cases VS 3 cases） were all decreased obviously （P〈0.05）. No difference was found in PVR （8.23 ±3.79 ml VS 7.16±4.02 ml, P〉 0.05）. Conelusion CPP is often complicated with DSD. It has urodynamic alteration besides LUTS. The urodynamic test is an important index for diagnosis and treatment of CPP with DSD. The pelvic floor biofeedback therapy is an effective treatment.