Video-urodynamics study on female patients with bladder neck obstruction

Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruction （BOO） is not clear so far. Video-urodynamic study （VUDS） would provide more information to define the female BOO, but it is not used commonly due to the limitation of video-urodynamic equipment in China. We attempted to find a better way for diagnosis of female BOO by performing VUDS. Methods VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital. Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck, voiding pressure greater than 20 cmH2O and maximum flow rate （Qmax） less than 12 ml/s. Transurethral incision of bladder neck was then performed on those patients. Follow-up examination （Qmax and residual urine） was recorded 3 months after operation. Results The mean time from its onset to diagnosis was （18.1±9.1） months in 38 patients. Average patient age was 36.1 years （range from 19 to 79 years）. The mean Qrnax was （10.6±4.7） ml/s and residual urine was （81.5±42.4） ml. Three out of 38 patients had obvious distal urethral stricture, eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination. For the 35 patients without urethral stricture, the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination. With video-urodynamics definition, 32 patients were diagnosed as bladder neck obstruction with mean Qmax of （10.8±3.7） ml/s, residual urine of （76.9±32.7） ml and detrusor pressure at maximum flow （Pdet Qmax） of （50.7±19.1） cmH20. Other three patients were suffered from detrusor hypocontractility. All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision. The symptom of difficult voiding was relieved. The postoperative follow-up showed that Qrnax was （21.7±7.6） ml/s （P 〈0.01） and the residual urine was （23.2±17.6） ml （P 〈0.01）. Conclusions The real cause of the obstruction for female patient with difficult voiding might be various. A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction.

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.

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。

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。

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.

Work Capacity of the Bladder During Voiding： A Novel Method to Evaluate Bladder Contractile Function and Bladder Outlet Obstruction

Background： Work in voiding （WIV） of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of its calculations. We have developed a method of calculating work capacity of the bladder while voiding and analyzed the associations of bladder work parameters with bladder contractile function and bladder outlet obstruction （BOO）. Methods： The study retrospectively evaluated 160 men and 23 women, aged 〉40 years and with a detrusor pressure at maximal flow rate （PdetQmax） of ≥40 cmH2O in men, who underwent urodynamic testing. The bladder power integration method was used to calculate WIV; WIV per second （WIV/t） and WIV per liter of urine voided （WIV/v） were also calculated. In men, the relationships between these work capacity parameters and PdetQmax and Abrams-Griffiths （AG） number were determined using linear-by-linear association tests, and relationships between work capacity parameters and BOO grade were investigated using Spearman＇s association test. Results： The mean WIV was 1.15 ± 0.78 J and 1.30 ± 0.88 J, mean WIV/t was 22.95 ± 14,45 mW and 23.78 ± 17.02 mW, and mean WIV/v was 5.59 ± 2.32 J/L and 2.83 ± 1.87 J/L in men and women, respectively. In men, WIV/v showed significant positive associations with PdetQmax （r = 0.845, P = 0.000）, AG number （r = 0.814, P = 0.000）, and Schafer class （r = 0.726, P = 0.000）. Conversely, WIV and WIV/t showed no associations with PdetQmax or AG number. In patients with BOO （Schafer class 〉 II）, WIV/v correlated positively with increasing BOO grade. Conclusions： WIV can be calculated from simple urodynamic parameters using the bladder power integration method. WIV/v may be a marker of BOO grade, and the bladder contractile function can be evaluated by WIV and WIV/t.

术前尿流动力学检查在良性前列腺增生症手术疗效预测中的应用进展

良性前列腺增生症(BPH)是老年男性常见病,许多患者最终需接受手术治疗。尿流动力学检查对预测术后疗效、查明手术疗效不佳的原因有着重要作用。用于评价手术疗效的尿流动力学指标主要有:尿流率测定、膀胱出口梗阻指数、膀胱收缩力指数、逼尿肌过度活动、膀胱顺应性、膀胱残余尿、最大膀胱容量。

尿流动力学检查参数与前列腺增生患者发生膀胱出口梗阻严重程度相关性分析

目的:探讨尿流动力学检查参数最大尿流率(Qura of maximum,Qmax)、残余尿量(Postvoid residual volume,PVR)、膀胱最大储尿量(Volume cystometric capacity,VMCC)与拟行膀胱造瘘术及经尿道前列腺电切术(Transurethral resection of the prostate,TURP)的前列腺增生患者发生膀胱出口梗阻(Bladder outlet obstruction,BOO)严重程度的相关性。方法:选取2019年8月~2021年6月于我院就诊的158例拟行膀胱造瘘术及TURP术的前列腺增生患者作为研究对象,所有患者均接受经膀胱造瘘术及尿流动力学检查,根据是否发生BOO分为BOO发生组(n=124)和BOO未发生组(n=34)。比较BOO发生组、BOO未发生组,以及BOO发生组中不同梗阻程度患者尿流动力学检查参数(Qmax、PVR、VMCC),分析Qmax、PVR、VMCC与前列腺增生患者发生BOO梗阻严重程度的相关性,并比较BOO不同预后患者的Qmax、PVR、VMCC。结果:BOO发生组Qmax、VMCC水平低于BOO未发生组,PVR水平高于BOO未发生组(P<0.05);BOO发生组不同严重程度患者的Qmax、VMCC水平比较:轻度梗阻>中度梗阻>重度梗阻(P<0.05);PVR水平比较:轻度梗阻<中度梗阻<重度梗阻(P<0.05)。Qmax、VMCC水平与是否发生BOO,及梗阻严重程度呈负相关(P<0.05),PVR水平与是否发生BOO,及梗阻严重程度呈正相关(P<0.05)。结论:尿流动力学检查参数Qmax、PVR、VMCC与行膀胱造瘘术的前列腺增生患者是否发生BOO及梗阻严重程度密切相关,临床可通过检测患者Qmax、PVR、VMCC水平,辅助临床判断BOO严重程度,为临床制定相应的治疗方案提供依据。

良性前列腺增生膀胱出口梗阻评判指标分析

目的 :探讨良性前列腺增生 (BPH)患者评判膀胱出口梗阻 (BOO)程度临床指标的应用价值。 方法 :35 8例BPH患者 ,根据膀胱镜下前列腺尿道梗阻的程度分为 3级 :1级为轻度梗阻 ;2级为中度梗阻 ;3级为重度梗阻 ;并根据Sch fer图定量划分梗阻程度 :0～Ⅵ级。结合相应的前列腺体积、最大尿流率、残余尿、国际前列腺症状评分(IPSS)以及膀胱的稳定性等项指标 ,进行单因素方差分析和相关分析 ,并计算相关指数。 结果 :按膀胱镜观测到的前列腺挤压尿道的程度将患者划分为 3级 :其中 1级 2 7例 ,2级 2 36例 ,3级 95例。前列腺体积为 16～ 14 5(4 7.0 4± 15 .6 1)ml。前列腺体积与前列腺挤压尿道的程度成正相关 (r =0 .2 9,R2 =0 .0 8) ,随着患者前列腺体积增大 ,前列腺挤压尿道的程度加重 (F =4 .2 16 ,P <0 .0 5 )。前列腺挤压尿道的程度与IPSS成正相关 (r =0 .35 ,R2 =0 .12 ) ,I PSS伴随着前列腺挤压尿道程度的增高而增高 (F =8.4 0 8,P <0 .0 0 1) ;生活质量评分随着前列腺挤压尿道程度的加重而增高 (F =10 .2 0 4 ,P <0 .0 0 1) ,两者成正相关 (r =0 .17,R2 =0 .0 3)。整个研究人群的平均最大尿流率为 (10 .0 2± 2 .12 )ml/min ,残余尿量为 (84 .0 6± 36 .5 0 )ml。最大自由率随着前列腺挤压尿道程度的加?

膀胱出口梗阻指数在良性前列腺增生诊断中的临床价值

目的:评估膀胱出口梗阻指数(BOOI)在BPH诊断中的临床应用价值。方法:回顾性收集分析2016年7月至2018年9月收治并诊断为BPH的199例患者的尿动力学检查结果并计算BOOI,根据BOOI结果分为BOO组、可疑BOO组以及无BOO组,比较3组患者前列腺体积(PV)、国际前列腺症状评分(IPSS)、排尿期IPSS(IPSS-VS)、生活质量(QOL)评分、最大尿流率(Qmax)以及残余尿量(PVR)。使用Pearson直线相关性分析判断BOOI与PV、IPSS、IPSS-VS、QOL、Qmax、PVR之间的相关性。结果:3组之间年龄(P=0.195)、PSA(P=0.380)、IPSS(P=0.380)、IPSS-VS(P=0.380)、QOL(P=0.380)、Qmax(P=0.380)、PVR(P=0.912)均无统计学差异,但BOO组PV[(58.8±30.0)ml]明显大于可疑BOO组[(49.8±33.9)ml]和无BOO组[(45.5±26.0)ml](P=0.031)。Pearson直线相关性分析发现BOOI与IPSS(r=-0.020,P=0.778)、IPSS-VS(r=-0.013,P=0.853)、QOL(r=-0.107,P=0.132)、Qmax(r=-0.130,P=0.066)、PVR(r=-0.056,P=0.433)均无显著相关性,而对于PV,尽管P=0.012,但|r|=0.178<0.4,因此认为BOOI与PV亦无明显相关性。结论:BOOI与PV、IPSS、IPSS-VS、QOL、Qmax以及PVR均无显著相关,单以BOOI结果诊断BOO并不可靠,BOO的诊断需要同时结合临床实际才能做出。

尿动力学参数多元分析对良性前列腺增生所致膀胱出口梗阻的诊断价值

目的:探索用于诊断良性前列腺增生患者合并膀胱出口梗阻(BOO)的函数模型,绘制能用于判断不同的逼尿肌收缩力状况下尤其是逼尿肌收缩力减弱时BOO情况的曲线。方法:回顾性分析131例患者尿动力学的检查结果和临床资料,通过多因素Logistic回归分析的方法,建立函数模型,根据此模型绘制BOO情况判断的曲线。采用ROC曲线分析的方法,确定我们的函数模型和相应曲线诊断BOO的界值。结果:建立的函数模型为BOO指数(BOO I)=5.03×剩余分数+0.04×最大尿流率时的逼尿肌压力-0.20×最大尿流率-0.91+α(当压力流率曲线为低压低流型时α=0;为高压低流型时α=1.42;为高压高流型时α=-7.30)。确定的BOO I诊断BOO的界值为0.36。验证该界值时灵敏度、特异度、阳性预测价值、阴性预测价值分别为85.7%、91.7%、96%、73.3%。结论:我们建立的函数模型BOO I计算公式较为简单,可推测出患者出现BOO概率的大小。诊断标准具有良好的灵敏度和特异度。我们绘制的诊断曲线能够把表现为低压低流型患者中有BOO的患者鉴别出来使之从解除梗阻的手术中获得益处。

前列腺中叶增生与膀胱出口梗阻程度的相关性分析(附131例报告)

目的：分析良性前列腺增生（BPH）患者中叶增生大小与膀胱出口梗阻（BOO）程度之间的相关性。方法：对2008年5月~2010年6月因排尿困难就诊的BPH患者131例,通过经腹超声测定前列腺三径和前列腺突入膀胱的距离（IPP）,尿动力学检查测定最大尿流率（Qm ax）、最大尿流率时的逼尿肌压力（Pdet@Qm ax）,利用L in-PURR图判断梗阻级别和逼尿肌收缩力,并计算出AG值（AG=Pdet@Qm ax-2Qm ax）。不同IPP梗阻程度的比较采用方差分析,并对前列腺体积（PV）、IPP与AG值进行相关性分析。结果：当IPP〉10 mm时,IPP与BOO高度正相关（相关系数r=0.821,P〈0.01）。PV与BOO相关度较低（r=0.475,P〈0.01）。IPP与Pdet@Qm ax高度正相关（r=0.865,P〈0.01）。结论：前列腺中叶增生与BOO存在高度相关性,超声测定中叶突入膀胱的距离是判断BOO程度较为可靠的方法。

超声测定逼尿肌厚度在无创诊断膀胱出口梗阻中的应用

目的探讨经超声逼尿肌厚度测定在无创诊断膀胱出口梗阻中的应用。方法 106例伴有下尿路症状的患者,在进行压力流率测定过程中,当膀胱容量为250ml时,应用7.5MHz高频线纵超声探头进行膀胱前壁逼尿肌厚度测定。通过A-G图进行膀胱出口梗阻的判定,将患者分为梗阻,可疑梗阻及非梗阻组,比较各组的逼尿肌厚度有无差异。应用相对工作特征曲线对逼尿肌厚度测定作为膀胱出口梗阻的诊断工具进行评价。结果梗阻组65例的逼尿肌厚度(2.6±0.5mm)明显高于可疑梗阻组(23例,2.0±0.4mm)及非梗阻组(18例,1.8±0.3mm)(P<0.01),可疑梗阻组及非梗阻组无显著性差异(P=0.16)。应用相对工作特征曲线,当临界值≥2.7mm时,特异度和阳性预测值均为100%,敏感度为39%,阴性预测值为51%。其曲线下面积为(0.88±0.03)。结论经超声逼尿肌厚度测定诊断膀胱出口梗阻,具有无创、方便、可靠的特点。当临界值≥2.7mm时,具有较高的特异度和阳性预测值,在一定程度上可取代压力流率测定诊断膀胱出口梗阻,但还需要进一步进行多中心、大样本的试验来证实临界值。

女性膀胱流出道梗阻的压力-流率测定的诊断价值

目的 探讨尿动力学检查中压力 -流率测定在女性膀胱流出道梗阻中的诊断价值。方法 使用压力 -流率测定中Schaefer列线图对 3 4例临床确诊为膀胱流出道梗阻的女性患者作回顾性分析 ,以确定压力 -流率测定在女性膀胱流出道梗阻中的诊断价值。结果 3 4患者中以 (Line Pasiveurethralresistancerelation ,PURR)诊断为 0、Ⅰ Ⅵ级的患者分别为 :0 %、14 .8%、2 3 .5 %、3 5 .3 %、2 0 .6%、2 .9%、2 .9%,其中按梗阻部位分类 ,膀胱颈梗阻 2 1例 ,远端尿道缩窄 13例 ,按压力 -流率图形分类 ,压迫型为 19例 ,狭窄型为 15例。结论 压力 -流率测定对女性膀胱流出道梗阻诊断有一定价值 ,对疾病分型也有一定意义 ,但以临床使用的现有参考值进行诊断会产生一定误差。

膀胱出口梗阻

对主诉为排尿困难和(或)盆底部疼痛的病人510例行四导程尿流动力学检查。分析其临床表现及尿流动力学检查等结果,360例属膀胱出口梗阻(BOO),含神经源性功能性BOO 77例,非神经源性BOO 283例,其中机械性梗阻239例(BPH 189例,膀胱颈梗阻即BNO 45例。远端尿道缩窄即DUS5例),功能性梗阻44例(外括约肌痉挛症24例,特发性非神经源性尿道内括约肌痉挛症即MNISS 20例)。同时检出非梗阻性特发症MNISS13例,其尿道交感神经兴奋性增高是盆底内脏交感神经兴奋性增高的表现。

前列腺增生致膀胱出口梗阻后逼尿肌功能改变对尿动力学参数的影响

目的探讨良性前列腺增生症(BPH)致膀胱出口梗阻(BOO)后逼尿肌功能改变对尿动力学参数的影响。方法 109例具有完整尿动力学结果的BPH患者根据有无BOO分为梗阻组和非梗阻组;梗阻组根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级4组;逼尿肌收缩力分为逼尿肌收缩力减弱(DCA)与收缩力正常组;逼尿肌不稳定(DI)分DI与非DI;膀胱顺应性(BC)分高、正常、低顺应性三组;28例患者行经尿道前列腺切除术(TURP)术前及术后尿动力参数对比。结果 BOO组的前列腺体积(PV)、国际前列腺症状评分(IPSS)、DI、急性尿潴留(AUR)发生率明显高于非BOO组(P<0.05);BOO组的最大尿流率(Qmax)、BC值、DCA发生率明显低于非BOO组(P<0.05);逼尿肌收缩力正常组的残余尿(RV)与BC值明显低于减弱组(P<0.05),而BOO和DI的发生率明显高于减弱组(P<0.01);DI组的年龄、BC值及DCA的发生率明显低于非DI组(P<0.05),而BOO级别和AUR的发生率明显高于非DI组(P<0.01);低BC组IPSS、BOO级别、AUR发生率明显高于正常及高BC组(P<0.05),而DCA发生率明显低于正常及高BC组(P<0.01);术后Qmax、BC值较术前明显升高(P<0.05),RV、IPSS、DI发生率较术前明显减小(P<0.01)。结论①BOO常与低顺应性膀胱、DI、AUR合并存在;②IPSS评分不能提示是否存在DI,DI的存在不影响IPSS评分;③TURP是治疗前列腺增生的金标准;④尿动力检查能全面了解有无BOO及BOO所致逼尿肌功能改变情况,对BPH的临床鉴别诊断、预后估计及选择恰当治疗方案都具有重要意义。

TUR术治疗女性膀胱颈梗阻分析

目的：探讨经尿道膀胱颈内切开治疗女性膀胱出口梗阻的手术经验。方法女性膀胱颈纤维化致膀胱出口梗阻病例28例,患者年龄52～73岁,患者均有不同程度的下尿路症状。术前评估包括尿动力学检查和膀胱镜检：最大尿流率为4.2～15.2 mL/ s,平均尿流率（7.5±3.1）mL/ s。所有病例均行经尿道膀胱颈内切开（截石位5～7点部位）。术后从尿动力学和临床症状两方面进行评价。结果26例患者拔管后下尿路症状明显改善,2例因长期尿潴留膀胱顺应性差延迟1个月拔管,拔管后排尿明显改善。术后1个月尿流率检查：最大尿流率为13.6～24.8 mL/ s,平均尿流率（14.3±4.1）mL/ s（P 〈0.01）,膀胱残余量为0～30 mL。未出现尿失禁及尿道阴道瘘,全部病例随访6个月～1年。结论经尿道膀胱颈内切开能有效地治疗因女性膀胱出口梗阻引起的下尿路症状。术前应当明确诊断,膀胱镜检及尿动力学评估是必要的。

前列腺增生患者膀胱出口梗阻程度对尿动力学指标的影响

目的探讨前列腺增生患者膀胱出口梗阻程度对尿动力学指标的影响及临床意义。方法分析113例前列腺增生患者的尿动力学资料,根据膀胱出口有无梗阻分为梗阻组和非梗阻组,梗阻组又根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级四组。结果梗阻组的最大尿流率、膀胱顺应性值和逼尿肌收缩力减弱发生率明显低于非梗阻组,逼尿肌不稳定和急性尿潴留发生率明显高于非梗阻组。梗阻组内各梗阻级别之间在顺应性值、逼尿肌不稳定和急性尿潴留的发生率上无显著性差异,随梗阻级别增加尿流率和逼尿肌收缩功能受损发生率下降。结论一些反映排尿异常和逼尿肌功能的尿动力学指标受膀胱出口梗阻程度影响,在无法进行压力/流率分析时综合分析这些指标有助于判断出口梗阻及其程度。

女性膀胱出口梗阻的诊断研究进展

女性膀胱出口梗阻病因复杂，大致可分为功能性梗阻和解剖性梗阻。诊断男性膀胱出口梗阻已有了“金标准”。如果在判断女性膀胱出口梗阻时，依然采用男性膀胱出口梗阻的诊断标准，有可能致漏诊、误诊率高。近年来学者们正在积极研究，希望能够制定出女性膀胱出口梗阻的诊断标准，本文主要就女性膀胱出口梗阻的诊断研究进展予以综述。

尿动力学检查在BPH患者诊治中的临床意义

目的:评价尿流动力学检查在良性前列腺增生症患者诊治中的意义。方法:对74例BPH患者治疗前后分别进行残余尿测定、国际前列腺症状评分(IPSS)和尿流动力学检查。结果:74例中有69例存在膀胱出口梗阻,3例可疑梗阻,2例无梗阻。逼尿肌压力正常或增强10例,逼尿肌收缩力减弱或无力8例(3例表现高顺应性膀胱),逼尿肌功能不稳定37例,19例伴有低顺应性膀胱。根据检测结果选择不同方法进行治疗,其中,经尿道前列腺电切(TURP)61例,行耻骨上经膀胱前列腺摘除术6例,Madigan前列腺摘除术2例,膀胱造瘘术3例,保守治疗2例。治疗后3个月复查,取得满意疗效。结论:BPH患者术前尿流动力学检测可以明确膀胱出口有无梗阻,了解逼尿肌顺应性和收缩功能,有助于临床鉴别诊断、估计预后,对选择合理的治疗方案、提高疗效具有重要的临床意义。