DHIC和DHIC合并BOO患者在尿动力学检查的差异及抗胆碱能药物治疗的效果

Differences of urodynamic tests between patients of detrusor hyperactivity with impaired contractility with and without bladder outlet obstruction and effect of anticholinergic medications in these patients

目的探讨逼尿肌过度活动伴收缩功能受损（DHIC）患者和DHIC合并膀胱出口梗阻（BOO）患者在尿动力学、下尿路症状的差异，以及抗胆碱能药物治疗的效果和风险。方法回顾性分析2000年2月至2011年2月确诊的56例DHIC患者，其中单纯DHIC患者37例，DHIC合并BOO患者19例，对比两组患者尿动力学检查及下尿路症状评分。27例患者接受抗胆碱能药物治疗，其中单纯DHIC患者16例，DHIC合并BOO患者11例，对比治疗2个月后的症状评分变化以及尿潴留发生情况。结果尿动力学检查结果显示，DHIC合并BOO患者的中位残余尿量明显高于单纯DHIC患者[70（23—106）ml比20（10-81）ml，P=0．02]。DHIC合并BOO患者的国际前列腺症状评分（IPSS）、排尿期症状总分均明显高于单纯DHIC患者（25．6±3．9比22．1±4．1，15．3．±2．9比11．8±3．3，均P=0．00）。DHIC合并BOO患者在接受抗胆碱能药物治疗前的IPSS总分为25．7±4．6，治疗后为23．6±4．9；单纯DHIC患者治疗前IPSS总分为22．8±4．7，治疗后为21．4±4．6，均有明显降低（均P=0．01）。接受抗胆碱能药物治疗后11例DHIC合并BOO患者中2例出现尿潴留，单纯DHIC患者中无一例发生。结论DHIC合并BOO患者的膀胱排空更为恶化，排尿期的下尿路症状更为严重。抗胆碱能药物可改善DHIC患者下尿路症状，但对DHIC合并BOO患者易造成尿潴留。

Objective To explore the differences of urodynamic parameters and lower urinary symptoms between detrusor hyperactivity with impaired contractility （DHIC） patients and DHIC patients with bladder outlet obstruction （BOO） and evaluate the effects and risks of anticholinergic medications in these patients. Methods A retrospective analysis was performed in 56 DHIC patients at our hospital between February 2000 to February 2011. Among them, 19 patients were complicated with BOO. Urodynamic studies were conducted and lower urinary symptoms assessed in all patients. Then the urodynamic parameters and lower urinary symptoms scores were compared between the DHIC and DHIC plus BOO patients. Among them, 27 received anticholinergic medications and there were 11 BOO patients. After 2-month anticholinergic medications, the differences of lower urinary symptom score were analyzed and anticholinergic-induced retention was also investigated. Results As compared with the DHIC patients, the DHIC plus BOO patients had a higher post-voiding residual urine （70 （23-106）vs 20 （10-81） ml, P = 0. 02）, higher total international prognostic scoring system （IPSS） score （25.6 ± 3. 9 vs 22. 1 ± 4. 1, P = 0. 00）and higher total voiding symptom score （15.3 ± 2. 9 vs 11.8 ± 3. 3, P = 0. 00）. After 2-month anticholinergic medications, the IPSS score of DHIC plus BOO patients decreased from 25.7 ± 4. 6 to 23.6± 4. 9（P =0. 01 ）, 2/11 patients developed urinary retention. The IPSS scores of DHIC patients decreased from 22. 8 ± 4. 7 to 21.4 ±4. 6 （ P = 0. 01 ） and none had urinary retention. Conclusions The DHIC plus BOO patients have more aggravated bladder empting and more severe lower urinary symptoms especially during voiding phase. Anticholinergic medications may alleviate the lower urinary symptoms in DHIC and DHIC plus BOO patients. But anticholinergic-induced retention is common among the DHIC plus BOO patients.