452例前列腺增生患者尿动力学检查的应用

摘要

目的 分析良性前列腺增生(benign prostatic hyperplasia,BPH)患者的尿动力学数据,为治疗BPH提供依据.方法 选取BPH患者452例,均为男性,平均年龄(65.6±5.65)岁,对其进行尿动力学检查(urodynamics,UDS),根据结果对不同患者选择不同的治疗方法,并对术后效果进行评估.结果 所有患者中未出现膀胱出口梗阻(bladder outlet obstruction,BOO)15例,BOO患者430例,其中包括膀胱逼尿肌收缩乏力65例,膀胱逼尿肌不稳定(detrusor instability,DI)365例.剔除其中3例正常,4例膀胱逼尿肌收缩乏力.445例患者的平均最大尿流率为(8.32±3.15)ml/s,平均残余尿量(87.68±79.46)ml,平均最大尿流率时逼尿肌压(62.32±7.54)cm H2O,最大尿道闭合压为(86.43±18.35)cm H2O,其中19例患者不适合行手术治疗,最后对426例患者行手术治疗,术后随访3~18个月,国际前列腺症状评分 (international prostate symptom score,IPSS)0~5分,生活质量指数(quality of Life,QOL) 评分0~1分,最大尿流率为11~21ml/s,残余尿(45.6±36.2)ml.各项指标与术前比较,差异均有统计学意义(P<0.05).结论 尿动力学检查能指导前列腺增生患者的治疗,有利于掌握手术时机及判断预后.%Objective To analyze the urodynamic data of the patients with benign prostatic hyperplasia(BPH)and provide evidence for the therapy.Methods 452 patients with BPH were selected.The mean age was(65.6 ±5.65)years(51 to 89 years).All patients had intact history documents which included the results of cystoscopy,urodynamics,doppler,DRE and PSA.Results 15 cases were not diagnosed with BOO.430 cases were diagnosed with BOO,among them,65 cases of bladder detrusor muscle weakness,bladder detrusor instability(detrusor,DI,instability)in 365 cases,3 cases were normal,and the other 4 cases had detrusor atony.In 445 patients the mean maximum urinary flow rate(8.32±3.15)ml/s,the average residual urine volume(87.68±79.46)ml,the average maximum flow rate when the detrusor pressure(62.32±7.54)cm H2O,maximum urethral closure pressure was(86.43±18.35)cmH2O,among which 19 cases were not suitable for surgery.At the end of the 426 patients underwent surgical treatment,postoperative follow-up of 3 to 18 months,the International Prostate Symptom Score(IPSS)from 0 to 5,the quality of life index(QOL)score of 0 to 1,Qmax 11 to 21 ml /s,residual urine(45.6±36.2)ml.There were significant differences between the preoperative and postoperative indexes(P<0.05).Conclusion Urodynamic tests can avoid the blindness in the surgery treatment of BPH.