老年男性脑卒中患者排尿功能障碍的尿动力学评估

目的:存在阻塞性尿路疾患的老年男性在发生脑血管意外后,是否可通过早期症状或排尿症状类型(梗阻性还是刺激性)来预判排尿功能障碍的病因。方法:选择57例脑卒中后主诉排尿障碍的老年男性患者,所有患者均有继发于良性前列腺增生(BPH)的膀胱出口梗阻(BOO)症状。采集病史并行体检,57位患者均实行尿动力学检查,检查结果行A-G图分析并分类为:有梗阻,无梗阻及可疑梗阻。结果:患者平均年龄70岁(54-87),按排尿障碍的主诉类型分组(纯刺激症状42%,纯梗阻症状34%,两者混合24%),其中51例(89%)在脑卒中发生后即出现排尿症状,47(82%)例患者出现逼尿肌反射亢进(DH),在三组患者中无显著统计学差异。压力流率分析显示,36(63%)位患者有出口梗阻,无梗阻14(24%)例,可疑梗阻7(13%)例。在3组患者中亦无显著统计学差异。结论:所有老年男性患者呈现的症状不能预测膀胱出口梗阻或逼尿肌反射亢进的尿动力学结果。中风发生后排尿功能障碍症状的发生率明显升高,表明由脑血管意外引起的排尿功能障碍合并前期具有膀胱出口梗阻疾病时,可能会使后者的症状恶化,反之亦然。

Urodynamic Evaluation of Stroke in Patients with Voiding Dysfunction in Older Men

Objective: Older men with obstructive urinary tract disorders in the event of a cerebral vascular accident,whether through the early symptoms or type of urinary symptoms(obstructive or irritating) to predict the cause of voiding dysfunction.Methods: 57 cases of stroke emperor complained of voiding dysfunction in elderly male patients,all patients were bladder outlet obstruction(BOO) symptoms secondary to benign prostatic hyperplasia(BPH).After a comprehensive history and physical examination,all patients underwent urodynamic studies.Findings were classified by the Abrams-Griffiths nomogram as obstruction,no obstruction or equivocal.Results: The average age of the patients was 70 years old(54-87).Patients were grouped according to the presenting voiding complaints(purely irrita-tive in 42 percent,purely obstructive in 34 percent or mixed in 24 percent).In 51 patients(89 percent) the onset of symptoms paralleled the occurrence of the cerebrovascular accident.Detrusor hyperreflexia was noted in 82 percent of the patients.There was no statistically significant difference in the occurrence of detrusor hyperreflexia among the 3 symptom groups.Pressure-flow analysis clearly showed ob-struction in 24 patients(63 percent),no obstruction in 9(24 percent) and equivocal results in 5(13 percent) according to the A-G nomo-gram.There was no statistically significant difference in the incidence of obstruction among the 3 symptom groups.Conclusions: Elderly male patients presented symptoms can not predict bladder outlet obstruction or detrusor hyperreflexia,After stroke,the incidence of void-ing dysfunction symptoms significantly increase,which suggests that the cerebrovascular accident induced voiding dysfunction in the face of preexisting bladder outlet obstruction may exacerbate the symptoms of the latter condition or vice versa.