慢性前列腺炎伴非神经源性膀胱外括约肌协同失调的诊治(附21例报告)  

Chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia:Diagnosis and treatment

作　　者：祖雄兵[1] 叶章群[2] 周四维[2] 齐琳[1] 杨中青[1] 

机构地区：[1]中南大学湘雅医院泌尿外科,湖南长沙410008 [2]华中科技大学附属同济医院泌尿外科,湖北武汉430030

出　　处：《中华男科学杂志》2010年第2期146-149,共4页National Journal of Andrology

摘　　要：目的:研究表现为非神经源性膀胱外括约肌协同失调(NNDSD)的慢性前列腺炎(CP)的特点及其生物反馈治疗疗效。方法:CP患者113例,诊断标准为有尿频、尿急、尿痛、排尿不尽、排尿困难等CP的典型症状大于3个月,且NIH-CPSI评分中第一和第二项评分≥1。经相关检查,排除尿道炎、间质性膀胱炎、尿道狭窄和神经源性膀胱等情况。113例均行尿动力学检查,分析尿流曲线,记录最大尿流率(Qmax)、最大逼尿肌排尿压(Pdet.max)、最大尿道压(MUP)和最大尿道闭合压(MUCP)等参数。对尿流动力学结果表现为NNDSD的患者行生物反馈治疗,10周后评估疗效。结果:CP患者113例中尿流动力学表现为NNDSD的21例(21/113,18.6%)。NNDSD患者治疗前后Qmax[(8.2±4.1)ml/s vs(15.1±7.3)ml/s]、Pdet.max[(125.1±75.3)cmH_2O vs(86.3±54.2)cmH_2O]、MUP[(124.3±23.3)cmH_2O vs(65.4±23.0)cmH_2O]和MUCP[(101.5±43.6)cmH_2O vs(43.5±16.7)cmH_2O]差异有统计学意义(P<0.05);生物反馈治疗前后NIH-CPSI疼痛评分[(4.0±2.0)分vs(2.2±1.7)分]、排尿评分[(7.9±2.1)分vs(2.2±1.9)分]、生活影响评分[(9.6±2.7)分vs(2.9±2.6)分]和总分[(21.7±4.8)分vs(8.4±4.6)分]差异有统计学意义(P<0.05)。结论:有下尿路症状的CP患者可能存在NNDSD,尿动力学主要表现为尿流率下降,排尿期膀胱内压力升高和部分患者尿道压力升高,尿动力学检查可以明确诊断及选择正确的治疗方法;盆底肌生物反馈治疗此类患者的近期疗效确切。Objective：To investigate the features of chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia （NNDSD） and the effects of pelvic floor biofeedback in the treatment of the disease.Methods：We included in this study 113 male patients,aged 15-48（mean 36） years and diagnosed as having chronic prostatitis for 1-2（mean 1.2） years based on such typical symptoms as frequent micturition,urgent micturition,voiding pain,difficult void,etc,that lasted over 3 months,and the score≧1 on the first and second parts of NIH-CPSI.Urethritis,interstitial cystitis,urethral stricture and neurogenic bladder were excluded.All the patients underwent urodynamic examinations for the uroflow curve,Qmax,Pdet.max and MUCP.Biofeedback was carried out for those with non-neurogenic detrusor sphincter dyssynergia,and the effects were evaluated at 10 weeks.Results：Twenty-one （18.6%） of the 113 cases were found to be NNDSD.Biofeedback treatment achieved obvious decreases in Qmax（8.2±4.1）, Pdet.max（125.1±75.3）,MUP（124.3±23.3） and MUCP（101.5±43.6）,as compared with 15.1±7.3,86.3±54.2, 65.4±23.0 and 43.5±16.7 before the treatment（P〈0.05）.Statistically significant differences were observed between pre-and post-treatment scores on voiding pain（4.0±2.0 vs 2.2±1.7）,urination（7.9±2.1 vs 2.2±1.9）,life impact（9.6±2.7 vs 2.9±2.6） and total scores（21.7±4.8 vs 8.4±4.6）（P〈0.05）.Conclusion：Chronic prostatitis patients with LUTS may have NNDSD,which is urodynamically characterized by low Qmax,high intra-bladder pressure and increased urethral pressure in some patients.Urodynamic examinations may contribute to definite diagnosis and appropriate choice of treatment.Pelvic floor biofeedback has satisfactory short-term effects in the treatment of these patients.

关 键 词：慢性前列腺炎 非神经源性膀胱外括约肌协同失调 尿动力学 生物反馈 

分 类 号：R697.3[医药卫生—泌尿科学] R694[医药卫生—外科学]