【摘要翻译】男性下尿路功能障碍的自然史

[文题]The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up
男性下尿路功能障碍的自然史:至少10年的尿动力学检查随访逼尿肌活动低下对经尿道电切前列腺(TURP)的影响
[来源]British Journal of Urology.
[年、卷、期、页]2004. 93(6):745-750
[作者]THOMAS, A. W.; CANNON, A.; BARTLETT, E.; ELLIS-JONES, J.; ABRAMS, P.
[原文摘要]
OBJECTIVES: To assess the long-term outcome of the efficacy of transurethral resection of the prostate (TURP) in men with detrusor underactivity (DUA), a cause of lower urinary tract symptoms (LUTS) in a significant minority of men.

PATIENTS AND METHODS: Neurologically intact men with LUTS, who were investigated in our department between 1972 and 1986, diagnosed with DUA and who underwent surgical intervention, were invited for a repeat symptomatic and urodynamic assessment. Identical methods were used, allowing direct comparison of the results.

RESULTS: In all, 224 men were initially diagnosed with DUA; 87 (39%) of these died in the interim and 22 followed had a TURP, with a mean follow-up since surgery of 11.3 years. There were no significantly sustained reductions in any symptoms. There was a small but significant reduction of questionable clinical significance in the bladder outlet obstruction index, but this did not translate into an improved flow rate. Comparison with 58 age-matched patients with DUA who remained untreated showed no significant advantage of surgical intervention in the long-term; on the contrary, there was more chronic retention in those who had had surgery.

CONCLUSIONS: There are no long-term symptomatic or urodynamic gains from TURP in men shown to have DUA. The results of TURP in men with DUA are important, as urologists who surgically treat patients based on the symptoms and uroflowmetry alone will do so in a significant minority of men with DUA. These results strengthen the argument for a routine preoperative urodynamic assessment.
中文翻译:
目的:评估行了TURP手术的逼尿肌活动低下(一种少数人产生下尿路症状的原因)的患者长期的手术疗效.
患者和方法:从1972-1986年,诊断为逼尿肌活动低下(DUA),并行了手术治疗的神经系统正常的下尿路症状患者,这些患者有复发的下尿路症状,且行了尿动力学检查.与对照组使用相同的评估方法,给予直接的对比结果.
结果:共有224例DUA患者,其中87例(39%)陆续死亡,22例行了TURP手术的患者进行了随访,术后平均随访是11.3年.行TURP手术的DUA患者下尿路症状无明显的持续下降.膀胱出口梗阻指数有少的下降,但可疑的临床意义显著下降.此外,下降的膀胱出口梗阻指数不能转化为提高尿流率.与58例年龄相仿无TURP手术的DUA患者比较,行TURP手术的DUA患者无明显的手术疗效;相反,行TURP手术的DUA患者有更多发生的慢性尿潴留.
结论:DUA患者行TURP手术无长期的症状缓解和尿动力学参数的改善.泌尿科医生仅根据下尿路症状和尿流率,就为极少数DUA患者行TURP手术治疗时,TURP手术结果对他们是非常重要.此研究结果进一步说明对下尿路症状患者行TURP手术时要常规行尿动力学检查.

个人短评:
临床医生若只依据前列腺症状评分(IPSS)和尿流率,对患者行手术可能是不科学的.因为IPSS和尿流率不能判断下尿路症状患者膀胱出口有无梗阻及膀胱功能怎样.要判断下尿路症状患者的膀胱出口有无梗阻和膀胱功能,只能依据尿动力学检查.若下尿路症状患者膀胱出口梗阻,膀胱功能良好,应行手术治疗;若下尿路症状患者膀胱出口无梗阻,应采取其它的治疗方法.