The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction
The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction
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DOI：
10.1016/s0022-5347(05)63949-3
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发表时间：
2003-02-01
影响因子：
6.6
通讯作者：
Laurenti, C
中科院分区：
文献类型：
--
作者：
de Nunzio, C;Franco, G;Laurenti, C
目的：分析膀胱出口梗阻患者经内科治疗、手术治疗和警惕等待后逼尿肌过度活动的演变。材料与方法：255例有症状的良性前列腺增生症患者，完成国际前列腺症状评分并进行尿流动力学检查，161例出现膀胱出口梗阻。在161名男性中，101人在观察等待后1-5年(平均2年)重新评估了101人，36人接受了内科治疗(阿夫唑嗪20和非那雄胺16)，45人接受了手术(经尿道前列腺切开术13人，前列腺切除术32人)。为了进行统计学分析，Wilcoxon匹配配对数据，并适当使用Kruskal Wallis检验。结果：基线时有53名患者(52%)存在逼尿肌过度活动，随访时有41名患者(40%)。观察等待组有9例(45%)和随访时有11例(55%)逼尿肌过度活动(p=0.17)；阿夫唑嗪组基线时有7例(35%)和随访时有6例(30%)(p=0.37)；非那雄胺组有10例(62.5%)基线和随访时有10例(62.5%)；经尿道前列腺切开组有6例(46%)和4例(30%)在随访时(p=0.48)；前列腺摘除组术前21例(68%)，随访时10例(31%)(p=0.02)。结论：逼尿肌功能亢进在膀胱出口梗阻患者中非常普遍(52%)，且在梗阻不加治疗或仅用药物治疗时可持续较长时间。然而，膀胱出口梗阻的外科治疗，特别是前列腺切除术，显著减少了逼尿肌过度活动的发生率，并减少了长达5年的膀胱出口梗阻重新出现的机会。
Purpose: We analyzed the evolution of detrusor overactivity in patients with bladder outlet obstruction treated with either medical or surgical therapy or watchful waiting.Materials and Methods: Of 255 patients with symptomatic benign prostatic enlargement who completed the International Prostate Symptom Score and underwent full urodynamic investigation 161 presented with bladder outlet obstruction. Of the 161 men 101 were reevaluated with a second clinical evaluation and urodynamics 1 to 5 years (mean 2) after watchful waiting in 20, medical treatment (alfuzosin 20 and finasteride 16) in 36 and surgery (transurethral incision of the prostate 13 and prostatectomy 32) in 45. For statistical analysis Wilcoxon matched paired data and Kruskal Wallis tests were used as appropriate.Results: Overall detrusor overactivity was present in 53 patients (52%) at baseline and 41 (40%) at followup. Detrusor overactivity was present in 9 patients (45%) at baseline and 11 (55%) at followup in the watchful waiting group (p = 0.17); 7 (35%) at baseline and 6 (30%) at followup in the alfuzosin group (p = 0.37); 10 (62.5%) at baseline and 10 at followup in the finasteride group (p = 1); 6 (46%) at baseline and 4 (30%) at followup in the transurethral prostate incision group (p = 0.48); and 21 (68%) at baseline and 10 (31%) at followup in the prostatectomy group (p = 0.02).Conclusions: Detrusor overactivity is highly prevalent (52%) in patients with bladder outlet obstruction, and appears to persist for long periods when obstruction is left untreated or treated only with medical therapy. However, surgical treatment of bladder outlet obstruction, prostatectomy in particular, significantly reduces the incidence of detrusor overactivity and lessens the chance of its de novo appearance for up to 5 years.