前列腺增生症患者的尿动力学诊断价值评估

The evaluation on diagnosis value of urodynamics in patients with benign prostate hypertrophy

目的 评估尿流动力学检查在前列腺增生症患者所致的下尿路症候群中的诊断价值。方法 采用自制半卧位床 ,常规行尿流率、压力 流率测定及尿道测压 ,并同步测定尿道外括约肌肌电图及残余尿量 ;并记录膀胱逼尿肌受损情况、膀胱顺应性和尿道外括约肌协调情况。联合应用A G图、P Q图及DS诊断BOO(膀胱出口梗阻 ) ,结果进行统计处理。结果 本组患者 338例 ,312例诊断为BOO ,71例可疑 ,5例无BOO。其中伴膀胱低顺应性 12 3例 ,膀胱逼尿肌功能受损 10 8例 ,尿道外括约肌功能失调 15 7例 ,不稳定膀胱 134例。随着BOO程度加重 ,Pdet Qmax、Popen、DS、IPSS积分及前列腺体积呈升高趋势 ,膀胱顺应性、Qmax呈下降趋势。结论 前列腺增生症患者排尿障碍的机制是排尿过程中机械因素和动力学因素共同作用的结果 ,尿流动力学检查在其诊断评估中扮演着一个极其重要的角色。BOO程度与Pdet Qmax、Popen、DS、IPSS积分及前列腺体积呈正相关 ,与膀胱顺应性。

Objective To further research the mechanism of voiding disorder and to evaluate the diagnosis value of urodynamics in patients with benign prostate hypertrophy (BPH).Methods With domestic-made semi-supine bed and Dantec Mannuet V4.11 urodynamic device,the full set of urodynamic exam were administrated in 388 patients with BPH,and the extra-sphincter urethral myogram was monitored simultaneously in pressure-flow studies (PFS).The bladder outflow obstruction were diagnosed by combined with A?G nomogram,P?Q plot and DS;the degree of BOO was quantitated by LPURR(Linear passive urethral resistance relation).The IPSS score and prostate volume were also acquired.Results The diagnostic rate of BOO is 81.7%,concomitantly detrusor muscle impair in 108 cases (28.19%),bladder compliance decreased in 123 cases ( 32.11 %),urethral sphincter dyssynegia in 157 cases (40.99%),and unstable bladder in 134 cases ( 34.98 %).The degree of BOO show an increasing tendency with urodynamic finding such as P det-Qmax ,P open ,DS and IPSS score and prostatic volume respectively,but a decreasing tendency with Q max and bladder compliance.Conclusions Both the dynamic and mechanical factors are attributed to the voiding disorder in patients with BPH.The urodynamic exam plays an important role in diagnosis of BOO.There is a positive relation among degree of BOO with urodynamic finding such as P det-Qmax ,P open ,DS and IPSS score and prostatic volume,however,negative relation with Q max and bladder compliance respectively.