Effect of doxazosin on rabbit bladder compliance after partial bladder outlet obstruction

Objective To explore the effect of doxazosin on rabbit bladder compliance after partial bladder outlet ob- struction. Methods A total of 40 male New Zealand white rabbits were randomized into 4 groups,with 10 rabbits in each group. Partial bladder outlet

Is there a correlation between the outcome of transurethral resection of prostate and preoperative degree of bladder outlet obstruction？

To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.

Expression of Large Conductance, Voltage- and Ca²⁺-Activated K⁺(BK) Channels in Human Urinary Bladder: Alteration of Subunit Expression Profile in Association with Bladder Outlet Obstruction

Purpose: Large conductance, voltage- and Ca2+-activated K+ (BK) channel is thought to have a central role to regulate urinary bladder smooth muscle functions, and its dysfunction may lead to increase of urination frequency and overactive bladder. The present study aims to investigate the expression pattern of BK channel subunits in the human urinary bladder, and how it changes in association with bladder outlet obstruction (BOO). Materials and Methods: Human bladders were obtained from 7 controls without prostatic enlargement and lower urinary tract symptoms and 4 BPH patients with clinically diagnosed overactive bladder who were verified by the International Prostate Symptom Score (IPSS) and prostate volume. The expression and location of BK channel protein complex was examined using immunohistochemistry with affinity-purified anti-BKα antibodies. A real-time RT-PCR was used to quantify the expression of each BK channel subunit (α and β1 - 4) gene in the mucosal and muscle layers of human urinary bladder. Results: Immunohistochemical staining for BK-α protein complex was localized in the muscle and submucosal regions of urinary bladder. RT-PCR analysis revealed the presence of α-, β1-, and β4-subunit genes of BK channel in the mucosal layer, α- and β1-subunit in the muscle layer. The expressions of α- and β1-subunit genes in the muscle (α: p = 0.0003, β1: p = 0.0003) and mucosal (α: p = 0.03, β1: p = 0.02) layers significantly decreased in BOO bladders compared with controls. The expression levels of α- and β1-subunit in mucosal layer were statistically correlated with storage score of IPSS (α;r = 0.84, p = 0.002, β1;r = 0.84, p = 0.002), and so were in muscle layer (α;r = 0.934, p 0.0001, β1;r = 0.917, p = 0.00018). Conclusions: BK channels, which are mainly composed of α- and β1-subunits, are expressed in both the mucosal and muscle layers of human urinary bladder. Decreased expression of BK channel in BOO might be implicated in the mechanisms underlying the development of overactive bladder.

Comparison of Combination Treatments of Distigmine and either Mirabegron or Solifenacin for Rats with Partial Bladder Outlet Obstruction

Objective: Detrusor hyperactivity with impaired contractility (DHIC) is not an uncommon bladder disorder, and is often difficult to treat. Therefore, using a rat model featuring both urinary frequency and residual urine, we investigated whether an anticholinergic agent (solifenacin) or a β3-agonist (mirabegron) is more suitable to combine with distigmine to treat DHIC. Methods: The partial bladder outlet obstruction (BOO) rat model was used. Rats were treated for 2 weeks: BOO/Solifenacin group was treated with 0.1 mg/kg solifenacin (n = 8), BOO/Mirabegron group was treated with 1 mg/kg mirabegron (n = 8), BOO/- group was not drug-treated but was given distilled water (n = 8), and the control group was also given distilled water (n = 8). Then the urethral ligature was removed under urethane anesthesia, and continuous cystometry was performed to evaluate bladder function. Baseline measurements were taken, then distigmine was administered to all groups, and cystometry was performed again to measure changes in bladder function. Results: Residual volumes increased in the BOO/- group, and the detrusor contractions were more frequent than that of the control group. Solifenacin treatment did not influence changes, except for threshold pressure, to any cystometric measurements. However, mirabegron treatment decreased the residual volume and residual volume rate;it also decreased detrusor contraction frequency similar to measurements obtained from the control group. Distigmine treatment enhanced detrusor contractions, which resulted in less residual volume, and decreased detrusor contraction frequency in the BOO model. Conclusions: The combination of distigmine and mirabegron was determined to be a better treatment than the combination of distigmine and solifenacin for DHIC.

Primary Presentation of Ovarian Cancer with Bladder Outlet Obstruction/Chronic Urinary Retention in a 12-Year Old Female

Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old female student. She presented with progressive weight loss, worsening lower urinary tract symptoms with distended lower abdomen of 10 weeks duration. Physical examination revealed a mobile tender firm pelvic mass, 18 centimeters (cm) × 16 cm in size. Laboratory and imaging studies showed obstructive nephropathy and uropathy respectively. She was worked up and had uneventful exploratory laparotomy with right salpingo-oophorectomy, urinary bladder diverticulectomy and pelvic lymphadenectomy. Histopathology of the pelvic mass showed ovarian dysgerminoma with lymph node metastasis. She responded very well to chemotherapy and resumed her school activities. Bladder outlet obstruction is relatively rare in females and in the index patient, ovarian dysgerminoma is the cause leading to obstructive nephropathy and uropathy.

Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation

AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.

Development and validation of a clinical nomogram predicting bladder outlet obstruction via routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms

We aimed to develop and validate a clinical nomogram predicting bladder outlet obstruction(BOO)solely using routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms(LUTS).A total of 750 eligible patient ≥50 years of age who had previously not responded(International Prostate Symptom Score[IPSS]improvement<4 points)to at least three different kinds of LUTS medications(including a-blocker)for the last 6 months were evaluated as subcohorts for nomogram development(n=570)and for split-sample validation(n=180).BOO was defined as Abrams-Griffiths number^40,or 20-39.9 with a slope of linear passive urethral resistance ratio>2 cmH20 ml^-1 s^-1.A stepwise multivariable logistic regression analysis was conducted to determine the predictors of BOO,and^-coefficients of the final model were selected to create a clinical nomogram.The final multivariable logistic regression model showed that age,IPSS,maximum urinary flow rate,postvoid residual volume,total prostate volume,and transitional zone index were significant for predicting BOO;these candidates were used to develop the final nomogram.The discrimination performance of the nomogram was 88.3%(95%Cl:82.7%-93.0%,P<0.001),and the nomogram was reasonably we 11-fitted to the ideal line of the calibration plot.Independe nt split-sample validation revealed 80.9%(95%Cl:75.5%-84.4%,P<0.001)accuracy.The proposed BOO nomogram based solely on routine clinical parameters was accurate and validated properly.This nomogram may be useful in determining further treatment,primarily focused on prostatic surgery for BOO,without impeding the detection of possible BOO in men with LUTS that is refractory to empirical medications.

Efficacy of Bladder Neck Incision (BNI) Versus Transurethral Resection of Prostate (TURP) in Management of Benign Prostatic Hyperplasia (BPH) Causing Obstruction: A Randomised Controlled Study

Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.

电针通过调节膀胱及尿道平滑肌中的血清素受体表达改善骶上脊髓损伤大鼠的排尿功能

目的观察电针治疗后骶上脊髓损伤(suprasacral cord injury,SSCI)大鼠的膀胱最大容量(maximum cystometric capacity,MCC)、漏尿点压力(leakage point pressure,LPP),结合分析逼尿肌、内尿道括约肌(internal urethral sphincter,IUS)中血清素(5-hydroxytryptamine,5-HT)不同亚型受体的表达,探讨电针治疗通过突触后5-HT受体调节逼尿肌-尿道括约肌协同失调(detrusor sphincter dyssynergia,DSD)大鼠排尿功能的效应机制。方法36只SD雌性大鼠,随机抽取12只作为空白组,剩余24只采用改良Hassan Shaker脊髓横断法在T10脊髓节段全横断制作SSCI大鼠模型,成模后随机分为模型组和电针组,每组12只。电针组取次髎、中极、三阴交穴予持续电针刺激40 min,1次/d,连续治疗7 d;空白组与模型组只捆绑不治疗。采用膀胱造瘘法进行尿流动力学检测;处死大鼠后取逼尿肌和近端尿道组织,采用Western blot法检测5-HT受体含量。结果模型组大鼠MCC、LPP显著高于空白组(P<0.01);电针组MCC显著低于模型组且高于空白组(P<0.01),LPP显著低于模型组(P<0.01)。与空白组比较,5-HT1A受体在模型组大鼠逼尿肌中表达显著降低(P<0.01),IUS中显著增高(P<0.01);电针组大鼠逼尿肌中5-HT1A受体显著高于模型组(P<0.01),IUS中5-HT1A受体低于模型组(P<0.05),但仍显著高于空白组(P<0.01)。模型组大鼠逼尿肌中5-HT2B受体表达高于空白组(P<0.05);电针组大鼠逼尿肌中5-HT2B受体表达低于模型组和空白组(P<0.05)。与空白组比较,5-HT7受体在模型组大鼠逼尿肌中表达显著降低(P<0.01),IUS中表达显著增高(P<0.01);电针组大鼠逼尿肌和IUS中5-HT7受体的表达均低于模型组(P<0.05)。结论电针刺激SSCI后DSD大鼠次髎、三阴交、中极穴引起膀胱及尿道平滑肌中5-HT受体表达变化,5-HT1A和5-HT2B受体可能通过Ca^(2+)流入使平滑肌产生相性和/或强直性收缩,5-HT7受体可能通过环磷酸腺苷(cyclic adenosine monophosphate,cAMP)途径影响大电导Ca^(2+)激活K^(+)(big-conductance Ca^(2+)-activated K^(+),BK)通道活性介导平滑肌松弛,电针治疗由此抑制逼尿肌过度活动、增加其收缩能力并协调尿道阻力以改善SSCI后DSD大鼠下尿路功能。

中老年男性逼尿肌活动低下及合并膀胱出口梗阻的尿动力学特点

目的探讨中老年男性逼尿肌活动低下(DU)及合并膀胱出口梗阻(BOO)的尿动力学特点。方法对郑州大学第一附属医院尿动力学中心2020年11月至2023年6月尿动力学资料完整的50岁以上男性患者317例进行回顾性分析,通过压力流率Schaefer列线图将患者分为DU组、BOO组、DU+BOO组和对照组。对组间尿动力学参数进行比较。结果DU组67例,BOO组144例,DU+BOO组70例,对照组36例,4组患者年龄差异无统计学意义(P>0.05)。DU组较对照组初始排尿感容量、残余尿量和最大尿流率时腹压增高(P<0.05),而最大尿流率、最大尿流率时逼尿肌压力、膀胱排空率和逼尿肌收缩力因子降低(P<0.05);DU组较BOO组初始排尿感容量、最大膀胱测压容量和最大尿流率时腹压增高(P<0.05),而最大尿流率时逼尿肌压力、逼尿肌过度活动比率、膀胱出口梗阻因子(BOOI)和逼尿肌收缩力因子降低(P<0.05);DU组较DU+BOO组初始排尿感容量、最大尿流率和最大尿流率时腹压增高(P<0.05),而最大尿流率时逼尿肌压力、逼尿肌过度活动比率、BOOI和逼尿肌收缩力因子降低(P<0.05)。结论中老年DU男性主要尿动力学特点为充盈期膀胱感觉降低,逼尿肌过度活动比率低和排尿时腹压增高,合并BOO者则残余尿量增多,BOOI和逼尿肌收缩力因子高,而最大尿流率和膀胱排空率低,应及时给予治疗。

盆底四维超声量化评估后盆腔异常在女性出口梗阻型便秘诊断中的价值

目的 探讨盆底四维超声测量肛直角(ARA)大小及肛提肌裂孔面积(LH)量化评估后盆腔异常在女性出口梗阻型便秘(OOC)诊断中的应用价值。方法 前瞻性选取宝鸡市中心医院消化内科及肛肠外科因便秘就诊,盆底四维超声诊断为后盆腔异常且符合出口梗阻型便秘的女性患者142例为研究组,68名健康体检者为对照组,应用盆底四维超声在静息状态和Vasvala状态下分别测量ARA大小;观察直肠壶腹在静息状态及Vasvala状态的位置变化;并在Vasvala状态测量最大LH面积,将2组的测量数据进行对比分析。结果 静息状态时研究组中ARA大小为(116±10)°,对照组ARA大小为(107±11)°,差异有统计学意义(t=5.37,P<0.05)。Valsalva动作时,研究组ARA大小为(107±10)°,较静息状态变小;对照组ARA大小为(119±11)°,较静息状态增大,差异有统计学意义(t=-7.92,P<0.05);Valsalva动作时研究组最大LH面积为(31.5±6.1)cm^(2),对照组为(20.0±2.4)cm^(2),研究组大于对照组,2组比较差异无统计学意义(t=18.97,P<0.05)。研究组分型中,静息状态下直肠前突者ARA大小为(116±10)°,会阴体过度运动者ARA大小为(116±10)°,2组比较差异无统计学意义(t=-0.034,P>0.05);Valsalva动作下直肠前突者ARA大小为(105±11)°,较静息状态减小;会阴体过度运动者ARA大小为(108±9)°,较静息状态减小。Valsalva动作下直肠前突者的ARA略小于会阴体过度运动者,二者差异有统计学意义(t=-1.32,P<0.10);Valsalva动作下直肠前突者LH最大面积(32.4±6.2)cm^(2),会阴体过度运动者LH最大面积(30.7±5.8)cm^(2),Valsalva动作下直肠前突者的LH最大面积略大于会阴体过度运动者,二者差异有统计学意义(t=1.63,P<0.10)。结论 盆底四维超声通过测量ARA大小、Valsalva状态LH最大面积量化评估后盆腔异常在诊断女性OOC与其具体分型中有一定的参考价值。

中西医治疗出口梗阻型便秘的现状

出口梗阻型便秘(OOC)作为功能性便秘的主要类型之一,因其发病机制较为复杂,临床治疗存在一定难度。随着饮食、生活习惯等变化,该病的发病率逐年上升,严重影响患者生活。为了解中西医治疗OOC的效果和进一步完善中西医治疗手段,此文从病因、发病机制、治疗方式等角度出发,查阅国内外相关文献,综述OOC的中西医治疗现状,为临床提供相关参考。

比卡鲁胺联合TURP术治疗晚期前列腺癌合并膀胱出口梗阻的效果及预后观察

目的探讨比卡鲁胺联合经尿道前列腺切除术(TURP)治疗晚期前列腺癌合并膀胱出口梗阻(BOO)的效果及预后。方法前瞻性选取2018年7月至2021年11月海南省肿瘤医院收治的70例晚期前列腺癌合并BOO患者作为研究对象。按照随机数字表法将其分为观察组(n=35)及对照组(n=35)。对照组采用TURP治疗,观察组采用比卡鲁胺联合TURP治疗。比较两组治疗前、治疗3个月后症状改善情况[采用国际前列腺症状评分(IPSS)评估],比较两组治疗前、治疗3个月后尿动力学[平均尿流率(Qave)、残余尿量、最大尿流率(Qmax)]、免疫功能(CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+))、肿瘤标志物[血管内皮生长因子(VEGF)、前列腺特异性抗原(PSA)]及预后。结果观察组治疗3个月后梗阻症状评分、刺激症状评分、IPSS总分分别为(3.95±0.62)、(5.01±1.24)、(8.96±1.73)分,均低于对照组[(5.74±0.96)、(7.28±1.56)、(13.02±2.59)分],差异均有统计学意义(P<0.05)。观察组治疗3个月后Qave、Qmax分别为(8.75±1.92)mL/s、(11.17±2.52)mL/s,均高于对照组[(6.48±1.65)mL/s、(8.96±1.93)mL/s],残余尿量为(37.81±4.63)mL,低于对照组[(49.75±6.94)mL],差异均有统计学意义(P<0.05)。观察组治疗3个月后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)分别为(63.06±7.28)%、(42.79±4.35)%、1.63±0.29,均高于对照组[(59.25±6.64)%、(39.81±4.02)%、1.39±0.24],差异均有统计学意义(P<0.05)。观察组治疗3个月后的血清VEGF、PSA水平分别为(76.89±12.34)pg/mL、(6.93±1.06)ng/mL,均低于对照组[(94.67±15.63)pg/mL、(8.32±1.57)ng/mL],差异均有统计学意义(P<0.05)。观察组治疗后12个月生存率为97.14%,高于对照组(82.86%),差异有统计学意义(P<0.05)。结论比卡鲁胺联合TURP术治疗晚期前列腺癌合并BOO的疗效确切,能缓解患者前列腺症状,促进尿动力学恢复,提高免疫功能,调节肿瘤标志物水平,改善预后,值得临床推广应用。

腹腔镜下前列腺癌根治术对非神经源性逼尿肌活动低下的局限性前列腺癌患者术后尿控的影响

目的 探讨腹腔镜下前列腺癌根治术(LRP)对非神经源性逼尿肌活动低下(DU)的局限性前列腺癌患者术后尿控的影响。方法 选取2020年1月—2023年1月接受LRP的患者75例,包括腹腔镜下筋膜外入路前列腺癌根治术(LERP)25例,腹腔镜下筋膜内入路前列腺癌根治术(LIRP)50例。其中DU患者28例,非DU患者47例。根据基线尿动力学检查结果将患者分为4组:对照组(n=28)、膀胱出口梗阻(BOO)组(n=19)、DU组(n=14)和BOO+DU组(n=14)。记录患者基线特征。评估术后下尿路症状,包括国际前列腺症状评分(IPSS)、生存质量评分(QOL),以及尿动力学检查指标,包括最大尿流率(Qmax)、残余尿量(PVR)。记录患者术后尿失禁情况,比较尿控率。结果 与非DU患者相比,DU患者年龄更大,IPSS评分更高,QOL评分更高,Qmax更低,差异有统计学意义(P<0.05)。与术前相比,DU患者和非DU患者术后12个月Qmax均显著升高、QOL评分均下降,非DU患者IPSS评分和PVR显著下降,差异有统计学意义(P<0.05)。DU患者术后12个月尿失禁情况明显改善,而非DU患者LIRP术后3个月和LERP术后6个月尿失禁情况显著改善。分层分析显示,对照组和BOO组术后3个月尿失禁情况开始改善。DU组和BOO+DU组在LRP术后尿失禁情况严重,术后12个月尿失禁情况有所改善。结论 LRP术后DU患者的尿控恢复需至术后12个月,较非DU患者尿控恢复时间延长6个月以上。

前列腺突入膀胱程度及尿TIMP-2水平与前列腺增生患者膀胱出口梗阻严重程度的相关性分析

目的研究前列腺突入膀胱程度(Intravesical prostatic protrusion,IPP)及尿金属蛋白酶组织抑制剂-2(Tissue inhibitor of metalloproteinase-2,TIMP-2)与前列腺增生患者膀胱出口梗阻(Bladder outlet obstruction,BOO)严重程度的相关性。方法收集99例良性前列腺增生(Benign prostatic hyperplasia,BPH)患者纳入本研究,收集患者临床资料,检测患者IPP及尿TIMP-2,对患者进行尿动力学检测。根据国际前列腺症状评分(International prostate symptom score,IPSS)将患者分为3组,0~7评分为轻度组,共42例,8~19分为中度组,共25例,20~35分为重度组,共32例。采用Logistic回归分析3组患者的临床资料、IPP、尿TIMP-2、膀胱出口梗阻指数(Bladder outlet obstruction,BOOI)的相关性。采用受试者工作特征曲线(Receiver operating characteristic,ROC)分析IPP、TIMP-2检测预测BOO的敏感性。结果使用单因素方差分析法分析3组患者的临床指标,随着患病程度加重,年龄、TPV、IPSS、IPP、尿TIMP-2水平均有增加趋势,尿动力学指标中Qmax下降,Pdet.Qmax、BOOI、PVR均升高,且差异具有统计学意义(P均<0.05)。相关性分析结果显示,3组患者BOOI与年龄、BMI、TPV、PVR无显著相关性(P均>0.05)。轻度组、中度组和重度组患者BOOI与IPP、尿TIMP-2以及IPSS均呈正相关(P均<0.05)。ROC曲线分析显示IPP与尿TIMP-2单独预测BOO均具有较强敏感性,IPP联合尿TIMP-2检测敏感性更高(P均<0.05)。结论IPP、尿TIMP-2与前列腺增生患者BOO严重程度具有相关性,且IPP联合尿TIMP-2预测BOO具有较高敏感性。

后尿道超声形态改变与良性前列腺增生致下尿路症状发生的相关性

目的探讨与分析后尿道超声形态改变与良性前列腺增生致下尿路症状发生的相关性。方法选择2020年月—2023年5月在商洛市商州区人民医院诊治的92例良性前列腺增生男性患者作为病例组,92名体检健康男性为对照组。检测病例组与对照组的后尿道超声形态的改变情况,同时对下尿路症状进行记录,并采用Spearman分析分析尿道超声形态改变与良性前列腺增生致下尿路症状的相关性。结果病例组的后尿道超声形态异常率为53.26%,对照组为5.43%,病例组的后尿道超声形态异常率显著高于对照组,差异有统计学意义(P<0.05)。病例组的膀胱出口梗阻指数、残余尿量都显著高于对照组,差异有统计学意义(P<0.05)。病例组最大尿流率明显低于对照组,差异有统计学意义(P<0.05)。在病例组中,Spearman分析显示后尿道超声形态异常与膀胱出口梗阻指数、残余尿量、最大尿流率等都存在相关性(P<0.05)。多因素logistic回归分析显示,良性前列腺增生患者后尿道超声形态异常为影响膀胱出口梗阻指数、残余尿量、最大尿流率的重要因素(P<0.05)。结论良性前列腺增生患者多表现为后尿道超声形态异常,伴随有膀胱出口梗阻指数、残余尿量、最大尿流率异常,后尿道超声形态改变与良性前列腺增生致下尿路症状的发生存在相关性。

Underactive bladder:Pathophysiology and clinical significance

Underactive bladder(UAB)is a voiding disorder which generates disabling lower urinary tract symptoms(LUTS)due to the inability to produce an effective voiding contraction sufficient to empty the bladder.The underlying abnormality,that is usually appreciated when performing urodynamic studies,has been defined by the International Continence Society(ICS)as detrusor underactivity(DUA).DUA is a common yet under-researched bladder dysfunction.The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated.Currently there is no effective therapeutic approach to treat this condition.An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment.The purpose of this review is to discuss the epidemiology,pathophysiology,common causes and risk factors potentially leading to DUA;to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.

Relationship between urodynamic patterns and lower urinary tract symptoms in Chinese women with a non-neurogenic bladder

Objective:To investigate the urodynamic study(UDS)patterns,obstruction status,continence status,and their correlations among neurologically intact women with lower urinary tract symptoms(LUTS)through an epidemiological and logistic regression analyses.Methods:We retrospectively analyzed the UDS data of 3265 neurologically intact women with LUTS(2002e2014).Five UDS patterns were identified:normo-active detrusor/sphincter(NA,or DSI,detrusor/sphincter intact),idiopathic detrusor overactivity(IDO),idiopathic sphincter overactivity(ISO),IDO+ISO,and detrusor underactivity(DUA).Analyses of UDS pattern distribution and stratification were performed(based on a modification of the European Urological Association-Madersbacher classification system),and their correlations with bladder outlet obstruction(BOO)and stress urinary incontinence(SUI)status were evaluated via logistic regression analysis.Results:NA,IDO,IDO+ISO,ISO,and DUA were noted in 927(28.4%),678(20.8%),320(9.8%),689(21.1%),and 651(19.9%)cases,respectively.Moreover,storage,storage+voiding,and voiding symptoms were noted in 62.4%,21.1%,and 16.5% cases,respectively,whereas BOO and SUI were observed in 12.1%and 29.0%cases,respectively.The risk factors for BOO included NA,IDO,ISO,and IDO+ISO,whereas the protective factors against BOO included storage symptoms,SUI,storage+voiding symptoms,and complaint duration within 1e12 months.NA was the only risk factor for SUI,whereas BOO,storage+voiding symptoms,IDO,and storage symptoms were protective factors for SUI.Conclusion:Five UDS patterns were identified among neurologically intact women with LUTS.Functional abnormalities of the detrusor and/or sphincter were the main causes of LUTS,and were correlated with the BOO or SUI status.Thus,the UDS pattern can provide additional information regarding the risk factors for BOO or SUI status,as compared to symptomatic typing.

Correlation between bladder compliance and the content of detrusor collagen fibers

Objective： To explore the possible correlation between bladder compliance （BC） and the changes in detrusor collagen fiber content after bladder outlet obstruction （BOO）. Methods： Ninety healthy female Sprague-Dawley （SD） rats were enrolled in this experiment and divided into an experimental group and a control group randomly, using the randomizing table method, with 70 rats in the experimental group and 20 rats in the control group. Six weeks after BOO modeling was established, BC was evaluated through bladder testing. Bladder tissues were then fixed and embedded in paraffin. The tissues were cut into thin slices, followed by Masson staining and observation under a microscope. Results： Compared with the control group, the BC of the experimental group rats increased, and the difference had statistical significance （P 〈 0.05）; the content of detrusor collagen fibers of the rats in the experimental group increased significantly compared to the control group. Conclusions： The content of detrusor collagen fibers increased significantly after BOO, and BC was higher.

直肠前突导致的排便障碍综合征的诊疗进展

直肠前突是临床上较难处理的疾病之一,易导致排便障碍综合征;且最佳诊治手段无统一结论。回顾近年来文献发现:在诊断及评估中,超声等检查与直肠前突的临床症状严重程度并无实质的联系,因此更须重视查体的作用;近年来发现呼吸中甲烷水平也可作为直肠前突的评估指标,希望进一步运用到临床工作中;直肠前突外科治疗,经肛门入路仍被认为是安全有效的手段之一,单环形吻合器及Khubchandani联合吻合器直肠后壁切除等术式均被报道有效;经会阴入路,一些生物补片的使用并不会增加其并发症;对于高位直肠前突或伴有盆腔脏器脱垂的疾病,经腹直肠固定术能达到良好的解剖学效果,但对便秘改善的持续性一般;序贯缝合固定术、骶尾部固定联合直肠前突进行后路修复术丰富了术式;而生物补片、阴道支架等一些新材料、新技术的运用,为将来直肠前突的诊治提供了新的机遇和挑战。