良性前列腺增生并发急性尿潴留患者的逼尿肌收缩功能

doi:10.6040/j.issn.1671-7554.0.2017.1183

摘要/Abstract

摘要： 目的研究良性前列腺增生(BPH)并发急性尿潴留(AUR)患者的尿流动力学特征及临床意义,特别探讨AUR患者的逼尿肌收缩功能。方法回顾性分析2014年8月至2017年3月间264例BPH患者的尿流动力学特征及临床资料;根据有无AUR史将其分为AUR组(n=99)及非AUR组(n=165); AUR组患者插尿管后7~10 d行尿流动力学检查,比较两组患者的年龄、前列腺特异抗原(PSA)水平、前列腺体积(PV)等临床资料以及尿流动力学参数。结果 AUR组患者年龄及PSA水平高于非AUR组(P<0.05)。AUR组患者最大自由尿流率、排尿量、强烈排尿感、急迫排尿感时的膀胱容积及膀胱顺应性较非AUR组患者显著降低(P<0.05)。AUR组患者具有IV级以上梗阻患者的比例高于非AUR组(P<0.05);两组患者中,衡量逼尿肌收缩功能的膀胱收缩指数(BCI)及最大瓦特指数(W_max)都随梗阻程度的增加而增大,但无论是总体比较,还是同一梗阻程度内的比较,W_max两组差别均无统计学意义(P>0.05)。多因素Logistic回归分析显示,梗阻程度III、V及VI是患者发生AUR的显著危险因素。结论 BPH患者并发AUR主要与梗阻程度加重有关,而膀胱逼尿肌收缩功能无明显受损。

关键词: 良性前列腺增生, 急性尿潴留, 尿流动力学, 前列腺特异抗原, 膀胱收缩指数, 瓦特因子

Abstract: Objective To elucidate the urodynamic and clinical characteristics of benign prostate hyperplasia(BPH)patients complicated by acute urinary retention(AUR), specially focusing on their detrusor contraction function. Methods The urodynamic parameters and clinical characteristics of 264 BPH patients from Aug. 2014 to Mar. 2017 were analyzed retrospectively. The patients were divided into AUR group(n=99)and non-AUR group(n=165). Urodynamic study was performed 7-10 days after the urinary catherization for AUR patients. Age, prostate-specific antige(PSA)level, prostate volume(PV), and urodynamic parameters in the two groups were compared. Results Age and PSA level of AUR patients were significantly higher than those of non-AUR patients(P<0.05). Maximum flow rate, voided volume, bladder volume at first desire and strong desire, and bladder compliance were decreased in AUR patients than those in non-AUR patients(all P<0.05). The percentage of patients with Schaefer obstruction grade IV or higher was greater in AUR group than that in non-AUR group(P<0.05). In both groups, bladder contraction index(BCI)and maximum Watts factor(W_max)were increased with the rising of obstruction grade; however, there was no significantly statistical difference for these two indexes. Multivariate Logistic regression analysis showed that obstruction 山东大学学报 (医学版)56卷3期 -王文振,等. 良性前列腺增生并发急性尿潴留患者的逼尿肌收缩功能 \=-grades III, IV and VI were risk factors for predicting the development of AUR. Conclusion Obstruction severity rather than the impairment of detrusor contractility is closely related with the occurrence of AUR in BPH patients.

Key words: Benign prostate hyperplasia, Acute urinary retention, Urodynamics, Prostate-specific antigen, Bladder contraction index, Watts factor

中图分类号:

R443+.8

王文振,刘玉强,俎树禄,张秀琳,张婵娟,邵光锋,于阳,王绍勇. 良性前列腺增生并发急性尿潴留患者的逼尿肌收缩功能[J]. 山东大学学报 (医学版), 2018, 56(3): 66-71.

WANG Wenzhen, LIU Yuqiang, ZU Shulu, ZHANG Xiulin, ZHANG Chanjuan, SHAO Guangfeng, YU Yang, WANG Shaoyong. Detrusor contractility in patients with benign prostate hyperplasia combined with acute urinary retention[J]. Journal of Shandong University (Health Sciences), 2018, 56(3): 66-71.

参考文献

[1] Berry SJ, Coffey DS, Walsh PC, et al. The development of human benign prostatic hyperplasia with age[J]. J Urol, 1984, 132(3):474-479.
[2] Garraway WM, Collins GN, Lee RJ. High prevalence of benign prostatic hypertrophy in the community[J]. Lancet, 1991, 338(8765):469-471.
[3] Powell PH, Smith PJ, Feneley RC. The identification of patients at risk from acute retention[J]. Br J Urol, 1980, 52(6): 520-522.
[4] Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Natural history of prostatism: risk factors for acute urinary retention[J]. J Urol, 1997, 158(2): 481-487.
[5] Tuncel A, Uzun B, Eruyar T, et al. Do prostatic infarction, prostatic inflammation and prostate morphology play a role in acute urinary retention[J]. Eur Urol, 2005, 48(2): 277-283, 283-284.
[6] 廖利民. 尿动力学技术规范——介绍国际尿控协会标准化报告[J].中国康复理论与实践, 2005,11(11): 875-878.
[7] 张一川,何乐业,龙智,等.前列腺增生症患者急性尿潴留发生的临床特点[J]. 中南大学学报(医学版), 2012, 37(3): 300-304. ZHANG Yichuan, HE Leye, LONG Zhi, et al. Clinical features of acute urine retention in patients with benign prostate hyperplasia[J]. J Cent South Univ(Med Sci), 2012, 37(3): 300-304.
[8] Roehrborn CG, Malice M, Cook TJ, et al. Clinical predictors of spontaneous acute urinary retention in men with LUTS and clinical BPH: a comprehensive analysis of the pooled placebo groups of several large clinical trials[J]. Urology, 2001, 58(2): 210-216.
[9] Roehrborn CG. The epidemiology of acute urinary retention in benign prostatic hyperplasia[J]. Rev Urol, 2001, 3(4): 187-192.
[10] Marberger MJ, Andersen JT, Nickel JC, et al. Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention. Combined experience from three large multinational placebo-controlled trials[J]. Eur Urol, 2000, 38(5): 563-568.
[11] 谢克基,廖土明,李涛,等.良性前列腺增生并急性尿潴留后的逼尿肌功能评估及其临床意义[J]. 中华泌尿外科杂志, 2006, 27(5): 311-313. XIE Keji, LIAO Tuming, LI Tao, et al. Evaluation of detrusor function and its clinical significance in patient with acute urinary retention secondary to benign prostatic hyperlasia[J]. Chin J Urol, 2006, 27(5): 311-313.
[12] Dubey D, Kumar A, Kapoor R, et al. Acute urinary retention: defining the need and timing for pressure-flow studies[J]. BJU Int, 2001, 88(3): 178-182.
[13] 谢涛,谢群,韩耕宇,等.前列腺增生并急性尿潴留行尿动力学检查时机的选择[J].医学临床研究, 2016, 33(7): 1379-1381.
[14] Roehrborn CG, Bruskewitz R, Nickel GC, et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Characterization of patients and ultimate outcomes. The PLESS Study Group[J]. Eur Urol, 2000, 37(5): 528-536.
[15] Miyashita H, Kojima M, Miki T. Ultrasonic measurement of bladder weight as a possible predictor of acute urinary retention in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia[J]. Ultrasound Med Biol, 2002, 28(8): 985-990.
[16] 卢根生,格次,宋波,等.不稳定膀胱逼尿肌兴奋性及收缩性改变的实验研究[J].第三军医大学学报, 2003, 25(24): 2229-2231. LU Gensheng, GE Ci, SONG Bo, et al. Changes of excitability and contractility in detrusor instability[J]. ACTA Academiae Medicinae Militaris Tertiae, 2003, 25(24): 2229-2231.
[17] CHS B, Ribeiro WO, Hemerly TS, et al. Increased detrusor collagen is associated with detrusor overactivity and decreased bladder compliance in men with benign prostatic obstruction[J]. Prostate Int, 2017, 5(2): 70-74.
[18] He LY, Zhang YC, He JL, et al. The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention[J]. Asian J Androl, 2016, 18(1): 134-139.
[19] Oelke M, Rademakers KL, van Koeveringe G A. Detrusor contraction power parameters(BCI and W_max)rise with increasing bladder outlet obstruction grade in men with lower urinary tract symptoms: results from a urodynamic database analysis[J]. World J Urol, 2014, 32(5): 1177-1183.
[20] Oelke M, Höfner K, Wiese B, et al. Increase in detrusor wall thickness indicates bladder outlet obstruction(BOO)in men[J]. World J Urol, 2002, 19(6): 443-452.
[21] Manieri C, Carter SS, Romano G, et al. The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness[J]. J Urol, 1998, 159(3): 761-765.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed