Persistent detrusor overactivity after transurethral resection of the prostate is associated with reduced perfusion of the urinary bladder
Persistent detrusor overactivity after transurethral resection of the prostate is associated with reduced perfusion of the urinary bladder
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DOI：
10.1111/j.1464-410x.2006.06735.x
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发表时间：
2007-04-01
影响因子：
4.5
通讯作者：
Pinggera, Germar-Michael
中科院分区：
文献类型：
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作者：
Mitterberger, Michael;Pallwein, Leo;Pinggera, Germar-Michael
目的 阐明良性前列腺增生 (BPH) 患者经尿道前列腺切除术 (TURP) 后持续逼尿肌过度活动 (DOA) 的频率以及下尿路灌注是否影响术后结果。 患者和方法 50 名经尿动力学证实因 BPH 导致 DOA 和膀胱出口梗阻的男性接受了 TURP。在 TURP 之前和之后 1 年，评估了国际前列腺症状评分 (IPSS)、生活质量 (QoL) 评分、前列腺特异性抗原 (PSA) 水平和前列腺总体积 (TPV)。此外，还使用压力流量研究和经直肠彩色多普勒超声检查来评估下尿路，以评估作为下尿路灌注变量的血管阻力指数（RI）。 结果 TURP 后，IPSS、QoL 评分、PSA 水平和 TPV 下降。膀胱测压测量显示 15 名 (30%) 患者在 TURP 后 DOA 持续存在。平均（SD）最大尿流率从9.20（4.03）增加到15.98（4.62）mL/s，排尿后残余尿量从109.38（73.71）减少到29.24（45.00）mL。当将持续 DOA 的男性（15 名患者；第 1 组）与 TURP 后无 DOA 的男性（35 名；第 2 组）进行比较时，第 1 组膀胱血管的 RI 显着升高，为 0.86 (0.068)，而第 2 组为 0.68 (0.055) (P < 0.001)。 结论 TURP 后男性持续 DOA 似乎与增加有关膀胱血管阻力 随后血管灌注减少和缺氧。
OBJECTIVES To elucidate, in patients with benign prostatic hyperplasia (BPH), how often detrusor overactivity (DOA) is persistent after transurethral resection of the prostate (TURP) and if perfusion of the lower urinary tract influences postoperative outcomes.PATIENTS AND METHODS Fifty men with urodynamically confirmed DOA and bladder outlet obstruction due to BPH had a TURP. Before and 1 year after TURP the International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA) level and total prostatic volume (TPV) were evaluated. Also, the lower urinary tract was evaluated using pressure-flow studies and transrectal colour Doppler ultrasonography to assess the vascular resistive index (RI) as a variable of the perfusion of the lower urinary tract.RESULTS After TURP the IPSS, QoL score, PSA level and TPV decreased. Cystometric measurements showed that in 15 (30%) patients DOA was persistent after TURP. The mean (SD) maximum urinary flow rate increased from 9.20 (4.03) to 15.98 (4.62) mL/s and postvoiding residual urine volumes decreased from 109.38 (73.71) to 29.24 (45.00) mL. When men with persistent DOA (15 patients; group 1) were compared with those with no DOA after TURP (35; group 2) there was a statistically significantly higher RI of the bladder vessels in group 1, at 0.86 (0.068) than in group 2, at 0.68 (0.055) (P < 0.001).CONCLUSIONS Persistent DOA in men after TURP seems to be associated with increased vascular resistance of the bladder vessels with subsequent reduced perfusion and hypoxia.