动态尿动力学监测在男性前列腺增生诊治中的应用价值

Application of ambulatory urodynamic monitoring in the diagnosis and treatment of male prostatic hyperplasia

关键词:  尿动力学  动态尿动力学监测  男性前列腺增生

Key words:  urodynamic  ambulatory urodynamic  benign prostatic hperplasia

摘要:

目的　探讨动态尿动力学监测(ambulatory urodynamics monitoring，AUM)在男性前列腺增生（benign prostatic hyperplasia,BPH）诊断、评估膀胱功能、选择有效治疗方法中的价值。方法　收集70例BPH患者，按国际前列腺症状评分（IPSS）包含轻度11例、中度37例、重度22例。分为AUM组和传统尿动力学检查(conventional urodynamics，CUD)组，各35例，分别行AUM和CUD检查，比较两组尿动力学检查的差异。结果　AUM组患者均检测出膀胱出口梗阻（bladder outlet obstruction，BOO），其中2例IPSS评分为重度症状者评价为中度BOO,CUD组33例患者检测出BOO，2例IPSS评分为轻度症状者评价为可疑BOO，1例IPSS评分为中度症状者评价为重度BOO。两组差异无统计学意义（P＞0.05）。两组在最大尿流率（maximum flow rate,Qmax）、平均尿流率（average flow rate,AFR）及排尿量（voided volume,VV）方面差异均无统计学意义（P＞0.05）。AUM组检测出逼尿肌不稳定(detrusor overactivity，DO）8例，CUD组检测出DO 4例，但差异无统计学意义（P＞0.05），AUM组最大尿流率时Pdet（PdetQmax）及尿流中最大Pdet（Pdetmax）均高于CUD组（P＜0.05），而残余尿（residual volume,RV）在AUM组明显低于CUD组（P＜0.05）。结论　AUM可以诊断BPH患者是否有BOO，评估逼尿肌受损程度，选择治疗方案更为精准。尤其是CUD检查结果不理想的患者可用AUM补充检查，进行疾病评估。

Abstract:

Objective To evaluate the value of ambulatory urodynamics (AUM) in the diagnosis of bladder outflow obstruction (BOO) in patients with benign prostatic hyperplasia (BPH)．Methods We prospectively enrolled 70 men with BPH and performed conventional urodynamic（CUD）and ambulatory urodynamic (AUM) after they completed the IPSS questionnaire．During AUM, one micturition cycle was recorded．According to IPSS，patients were divided into three groups of mild（n=11），moderate （n=37）and severe（n=22）．Half patients of each group were performed conventional urodynamic，and the other half were performed AUM．Results BOO was detected in all AUM group of patients, including 2 patients with severe IPSS score and an evaluation of moderate BOO. BOO was detected in 33 CUD group of patients, including 2 patients with mild IPSS score and an evaluation of suspected BOO and 1 patient with moderate IPSS score and an evaluation of severe BOO (P＞0.05). The Qmax, AFR, VV and DO had no significant differences between the two groups (P＞0.05). The PdetQmax and Pdetmax in AUM group were higher than those in CUD group (P＜0.05). However, the RV in AUM group was more than that in CUD group (P＜0.05). Conclusions AUM is effective in the diagnosis of BOO. It can evaluate the function of detrusor and predict the curative effects of surgery. AUM can also provide complementary data to CUD and may be helpful in the clinical management of patients.