膀胱小梁形成作为BPH外科干预指征的初步探讨

Preliminary study on bladder trabeculation formation as a surgery indication for BPH patients

目的研究B超发现有膀胱小梁形成BPH患者临床及尿流动力学特点,探讨其作为BPH外科干预指征的意义.方法比较B超显示有膀胱小梁形成BPH患者与无膀胱小梁形成BPH患者的临床资料及尿流动力学检查结果.结果56例B超发现有膀胱小梁形成BPH患者与106例无膀胱小梁形成BPH患者比较,平均年龄分别为（72.9±11.2）岁和（68.2±6.4）岁,国际前列腺症状评分（international prostate symptom score, IPSS）分别为（23.8±6.4）分和（22.5±7.9）分,均无明显差别（P〉0.05）.有小梁形成患者和无小梁形成患者,最大尿流率时逼尿肌压力分别为（134.6±59.2）cmH2O（1 cmH2O=0.098kPa）和（93.3±45.4） cmH2O,线性被动尿道阻力关系（linearized passive urethral resistance relation,LinPURR）梗阻程度分级分别为（4.6±1.3）和（3.6±1.6）,差异有统计学意义（P〈0.05）.有小梁形成组逼尿肌过度活动（detrusor overactive, DO）患者所占比例为73.2%,无小梁形成组为56.6%（P=0.038）;小梁形成组71.4%的患者膀胱顺应性减低,16.1%出现肾积水,无小梁形成组分别为44.7%、4.7%（P值分别为0.001和0.014）.肾积水患者均存在肾功能不全,平均肌酐水平149μmol/L.结论膀胱小梁形成是膀胱代偿功能的一种表现;其中多数患者处于由代偿期向失代偿期过渡的阶段;有膀胱小梁形成的BPH患者上尿路积水风险明显升高;以B超发现膀胱小梁形成作为BPH患者外科干预指征,有利于膀胱功能恢复,降低上尿路积水及肾功能损害风险.

Objective To investigate the clinical and urodynamic characters of benign prostatic hyperplasia（BPH） patients with bladder trabeculation formation and evaluate if it can be as a surgery indication for BPH patients. Methods：Clinical and urodynamic characters of BPH patients with or without bladder trabeculation formation were comparatively analyzed, retrospectively. Results Total of 56 BPH patients with bladder trabeculation and 106 BPH patients without it were comparatively analzyed. The mean age was（72.9±11.2） years old and （68.2±6.4）years old , IPSS was （23.8±6.4）and （22.5±7.9） respectively, in which no significant differences were found（P〉0.05）. The detrusor pressure at the maximum flow rate was （134.6±59.2） cmH2O and （93.3±45.4） cmH2O and linearized passive urethral resistance relation （LinPURR） was （4.6±1.3） and （3.6±1.6）, in which significant differences were found （P〈0.05）. The incidence of DO in trabeculation positive and negative group was 73.2%and 56.6%respectively （ P=0.038）. 71.4%of the patients with bladder trabeculation had a low compliance bladder, 16.1%had hydronephrosis and the proportion of the patients without trabeculation was 44.7%and 4.7%respectively （P=0.001 and 0.014）. All of the patients with hydronephrosis had renal insufficiency. Conclusion Bladder trabeculation was the manifestation of compensation of BOO. Most of the patients with trabeculaiton were in the transition period and had higher risk for hydronephrosis. Bladder trabeculation formation as a surgery indication might be important for protecting bladder function and reducing the risk of renal insufficiency for BPH patients.