Urodynamic characterization of nonobstructive voiding dysfunction in symptomatic elderly men
Urodynamic characterization of nonobstructive voiding dysfunction in symptomatic elderly men
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DOI：
10.1097/00005392-199907000-00035
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发表时间：
1999-07-01
影响因子：
6.6
通讯作者：
Yalla, SV
中科院分区：
文献类型：
--
作者：
Ameda, K;Sullivan, MP;Yalla, SV
目的：无膀胱出口梗阻的男性下尿路症状的发病机制尚未得到很好的表征。因此，我们定义了与症状性非梗阻性排尿功能障碍相关的尿动力学异常，并确定了年龄和类型之间的关系。正常膀胱出口的标准是前列腺尿道的压力梯度为5 cm。在没有远端狭窄的情况下，水或更少。最大等长收缩压力小于60 cm。水被认为。逼尿肌收缩力受损逼尿肌不稳定是指逼尿肌在充盈过程中不自主收缩或在开始流动后无法抑制逼尿肌收缩。根据尿动力学结果将患者分为4组。193个男人（平均年龄69.6 ± 10.5岁）40.9%有逼尿肌不稳定（组1），31.1%有收缩力受损（组2），10.8%有逼尿肌不稳定和收缩力受损（第3组），17.1%尿动力学正常。（第4组）。第4组患者的平均年龄显著低于所有其他组。第1组膀胱容量最低，第3组排尿效率最低。最大尿流率、膀胱顺应性和症状评分在4组间无差异。逼尿肌不稳定伴或不伴收缩力受损的患病率增加，而无尿动力学异常的患者比例随年龄增长而下降。膀胱收缩力与年龄无关。结论：非梗阻性患者人群包括几个功能不同而功能相似的组。因此，根据症状治疗非梗阻性病例可能导致不适当的药物治疗和不成功的临床结局。
Purpose: The pathogenesis of lower urinary tract symptoms in men without bladder outlet obstruction has not been well characterized. Therefore, we defined the urodynamic abnormalities associated with symptomatic nonobstructive voiding dysfunction, and determined the relationship between age and type of dysfunction.Materials and Methods: Video urodynamic studies of symptomatic men without outlet obstruction were examined. The criterion for a normal bladder outlet-was a pressure gradient across the prostatic urethra, of 5 cm. water or less in the absence of distal stricture. A maximum isometric contraction pressure less than 60 cm. water was regarded. as impaired detrusor contractility. Detrusor instability was defined as involuntary detrusor contractions during filling or the inability to suppress a detrusor contraction after initiation of flow, Patients were categorized into 4 groups based on the urodynamic findings.Results: Of 193 men (mean age 69.6 +/- 10.5 years) 40.9% had detrusor instability (group 1), 31.1% had impaired contractility (group 2), 10.8% had detrusor instability and impaired contractility (group 3), and 17.1% were urodynamically normal. (group 4). Average patient age was significantly lower in group 4 than all other groups. Bladder capacity was lowest in group 1, and group 3 had the lowest voiding efficiency. Maximum flow rate, bladder compliance and symptom scores were not different among the 4 groups. The prevalence of detrusor instability with and without impaired contractility increased, while the proportion of patients without urodynamic abnormalities decreased with age. Bladder contractility did not correlate with age.Conclusions: The nonobstructed patient population comprises several groups that are functionally distinct while symptomatically similar. Thus, treatment of nonobstructed cases based on symptoms may lead to inappropriate pharmacological therapy and unsuccessful clinical outcomes.