尿动力学检查对前列腺增生急性尿潴留术后疗效的预测

Urodynamic assessment for cases of benign prostatic hyperplasia associated with acute urinary retention

目的 :通过尿动力学检查及临床指标的观察 ,确定预测前列腺增生急性尿潴留患者术后疗效的指标。方法 :对 2 6例前列腺增生急性尿潴留患者进行国际前列腺症状评分、前列腺体积及术前后尿动力学检查 ,并在治疗成功组与失败组之间进行比较。结果 :2 4例 (92 .3 % )患者可见有逼尿肌主动收缩 ,最大逼尿肌排尿压为 (6 .62±3 .57)kPa ;5例 (1 9.2 % )患者术后不能排尿 ,需要留置导尿。患者年龄、手术前后排尿期膀胱逼尿肌最大压力、逼尿肌不稳定的发生率、逼尿肌的顺应性及测压容量在治疗成功组与失败组之间差异具有统计学意义 (P <0 .0 5)。结论 :前列腺增生急性尿潴留患者在急性尿潴留发作的晚期 (4周 )行尿动力学检查 ,可以预测术后的疗效。逼尿肌顺应性及膀胱测压容量异常增高、排尿期最大逼尿肌压力显著降低 (小于 1 .96kPa)。

Aim:Urodynamic and clinical parameters were analyzed in search of an outcome predictor after prostatectomy for cases of benign prostatic hyperplasia(BPH) associated with acute urinary retention (AUR). Methods: International Prostate Symptom Score, prostate volume, and urodynamic parameters were analyzed preoperatively and postoperatively in 26 cases of BPH associated with AUR. These parameters were compared between successful and failed treatment groups. Results: A voluntary detrusor contraction, with a mean maximal detrusor pressure of (6.62±3.57) kPa were noted in 24 patients. Five patients failed to void after transurethral vaporization of prostate (TUVP) and required catheterization. There were significant differences ( P <0.05) between 2 groups regarding age, maximal detrusor pressure, detrusor instability, detrusor compliance, and cystometric bladder capacity. Conclusion:For BPH patients with AUR, pressure flow studies undertaken within 4 weeks after retention are useful in predicting the surgical outcome. The increase of detrusor compliance and cystometric bladder capacity, absence of detrusor instability, and maximal detrusor pressure in the voiding phase lower than 1.96 kPa are possibly associated with a poor outcome after TUVP.