尿动力学检查在合并急性尿潴留的前列腺增生患者中的应用

THE CLINICAL SIGNIFICANCE OF URODYNAMIC STUDIES IN PATIENTS OF BENIGN PROSTAT- IC HYPERPLASIA WITH ACUTE URINARY RETENTION

目的评价尿动力学检查在合并急性尿潴留的前列腺增生患者中的临床应用价值。方法我们随机选择43例合并急性尿潴留的良性前列腺增生患者行尿动力学检查，分析留置尿管时间、逼尿肌收缩力、逼尿肌不稳定、逼尿肌不稳定幅度、梗阻程度之间的相关性。结果43例患者平均年龄为65．6（52～78）岁。43例患者中，发生逼尿肌不稳定者29例（67．4％），逼尿肌不稳定幅度5～164（97±35）cmH2O；有随意性逼尿肌收缩者36例（83．7％），明确诊断为膀胱出口梗阻者32例（74．4％）；逼尿肌收缩力与留置尿管时间无相关性（P〉0．05），与逼尿肌不稳定、逼尿肌不稳定幅度、梗阻程度有相关性（P分别为〈0.05、〈0.01、〈0.01）；逼尿肌不稳定与梗阻程度无相关性（P〉0．05），逼尿肌不稳定幅度与梗阻程度呈显著性正相关（P〈0．01）。结论合并急性尿潴留的良性前列腺增生患者尿动力学检查前无需留置尿管2～3周以上；有逼尿肌不稳定者的逼尿肌收缩力强于无逼尿肌不稳定者；膀胱出口梗阻越严重，逼尿肌不稳定幅度越大，逼尿肌收缩力越强。

Objective To evaluate the usefulness of urodynamie study in patients with benign prostatic hyperplasia with acute urinary retention. Methods A total of 43 patients of benign prostatic hyperpla- sia with acute urinary retention were selected randomly and underwent urodynamic study. The correla- tions among the lasting time of indwelling catheter, detrusor contractility, detrusor instability（DI）, the amplitude of DI and obstruction grades were also analyzed. Results Mean age of patients was 65.6 years （52 - 78）. Among the 43 patients of benign prostatic hyperplasia with acute urinary retention, D1 was found in 29 cases（67.4% ）, the amplitude of D1 was （97 ± 35） （5 - 164）cm H2O;voluntary detrusor contractions were seen in 36 cases （83.7%） ;bladder outlet obstruction was diagnosed definitely in 32 eases（74. 4 %）. There was no correlation between detrusor contractility and the lasting time of indwelling catheter（P〉0.05）. The detrusor contractility was correlated with DI, the ampli- tude of DI and the grade of bladder outlet obstruction （P〈0. 05,0. 01 and 0.01, respectively）. No correlation between DI and the grade of bladder outlet obstruction was indicated（P〉0.05）, but the correlation between the amplitude of DI and the grade of bladder outlet obstruction was found（P 0.01）. Conclusions In patients who present with BPH and resultant AUR,it is not necessary to indwell catheter 2 - 3 weeks before uradynamic examination. The contractility of detrusor muscle is stronger in patients with DI than those without DI. The results show that the more serious the grade of bladder outlet obstruction and the higher amplitude of DI, the stronger the contractility of detrusor.