【摘要翻译】对下尿路症状伴有良性前列腺增生的老年人用非侵袭的方法评估前列腺梗阻

[文题]Noninvasive assessment of prostatic obstruction in elderly men with lower urinary tract symptoms associated with benign prostatic hyperplasia
对下尿路症状伴有良性前列腺增生的老年人用非侵袭的方法评估前列腺梗阻
[来源] Urology.
[年、卷、期、页]2004. 63(3):476-480
[作者]Ger E. P. M. van Venrooij ;Mardy D. Eckhardt;Tom A. Boon
[原文摘要]
Abstract
Objectives
To investigate what combination of easily available parameters allows the noninvasive prediction of infravesical obstruction in optimal agreement with urodynamic classification. Urodynamically, men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia are classified as nonobstructed or obstructed.

Methods
Mandatory and recommended tests were performed in 160 consecutive men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. The classification of the International Continence Society, the group-specific urethral resistance factor, and Schäfer's obstruction grade were estimated from urodynamic studies. The frequency-volume charts were analyzed. A separate group of 173 consecutive men was used for validation.

Results
The formula, prostate volume (in cubic centimeters) − 3 × maximal urinary free flow rate (in milliliters per second) − 0.2 × mean voided volume (in milliliters; as estimated from frequency-volume charts), was optimal in the classification compared with the urodynamic classification. Extension of this formula to more than three parameters did not result in better selection. As estimated from receiver operating characteristic curves, the accuracy of the formula appeared to be good. The method of quantifying urethral resistance minimally affected the classification that resulted from the combination. From the results, a diagram was created presenting the probability of an individual to have infravesical obstruction. The validation results were satisfactory.

Conclusions
The prediction of the probability of a man with lower urinary tract symptoms suggestive of benign prostatic hyperplasia to have infravesical obstruction can be deduced from a diagram based on a formula composed of three readily available parameters: prostate volume, maximal urinary free flow rate, and mean voided volume.
中文翻译
目的:探讨如何联合临床易测的非侵袭指标来评估膀胱出口梗阻,并与尿动力学检查的分类达最佳的吻合.BPH患者下尿路症状尿动力学检查分为:膀胱出口无梗阻或梗阻.
方法:选择163例下尿路症状的BPH患者,行必须和推荐的检查.依据尿动力学检查,按照国际尿控协会分类来分析组间特异性尿道阻力和Schafer的梗阻等级.分析患者排尿频率表.173例确诊患者作为对照组.
结果:与尿动力学检查分类比较,前列腺体积(cm3)-3最大自由尿流率(ml/s)-1/5平均排尿量,这一公式对膀胱出口梗阻的诊断达到最佳.此公式多于三个参数可能导致不佳的选择.从受试者工作曲线上分析可知这公式的精确度似乎好.定量的尿道阻力方法很少会影响各参数组合判断膀胱出口有无梗阻的分类.从这个结果中,可创建一个特异性判断膀胱出口梗阻的图形,能获得满意的结果.
结论:由前列腺体积、最大自由尿流率、平均排尿量，这三个参数构成的公式可预测前列腺增生的下尿路症状患者膀胱出口梗阻。
目前BPH患者诊断膀胱出口梗阻的金标准是行尿动力学检查，但尿动力学检查有其缺点，插导管可能损伤尿道及可能诱发尿路感染，一些患者行尿动力学检查后因插尿管可能会不舒服。因此，国内外许多学者积极探讨一些无创伤的诊断BPH患者膀胱出口梗阻的方法。而前列腺体积、最大自由尿流率、剩余尿量是临床常用来评估膀胱出口梗阻的无创辅助检查，故三者结合来诊断BPH患者膀胱出口有无梗阻有重要的临床意义。

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