【作者】 何乐业；

【导师】 蒋先镇；

【作者基本信息】 中南大学 ， 泌尿外科， 2010， 博士

【摘要】 研究目的：了解成年男性下尿路症状(LUTS)的发生情况、年龄分布与变化规律,为进一步了解BPH有关LUTS的临床特点、影响因素、产生机理及治疗策略提供一些新的启发。研究方法：采用国际前列腺症状评分问卷(IPSS)表调查前来我院进行健康体检的成年男性1048人,年龄30岁-80岁,以10岁为一年龄段,分为5个年龄段,评估被调查者的LUTS发生情况。结果：各组LUTS发生的情况为：30岁年龄段347人,平均IPSS评分2.48±0.38；40岁年龄段311人,平均IPSS评分3.80±0.53；50岁年龄段114人,平均IPSS评分4.78±1.07；60岁年龄段207人,平均IPSS评分5.33±0.68；70岁年龄段69人,平均IPSS评分6.80±1.66。其中各年龄组储尿期症状平均评分分别为：1.20,1.66,2.24,2.57,3.20；排尿期症状平均评分分别为：1.28,2.14,2.54,2.76,3.59；生活质量平均评分为：1.78±1.42,1.84±0.30,1.89±1.04,2.03±1.08,2.07±1.92。不同年龄组男性LUTS发生率与年龄相关(χ2=70.46,P<0.005)。IPSS总评分、排尿期症状评分及储尿期症状评分与生活质量评分呈正相关,其中储尿期症状比排尿期症状对生活质量影响更大些(储尿期评分、排尿期评分与QoL评分相关系数分别为：r=0.966(P<0.05),r=0.931(P<0.05))。结论：LUTS症状在成年健康男性中较普遍存在,发病率随年龄增大而增加。LUTS症状越重,对生活质量影响越大,而储尿期症状较排尿期症状对生活质量影响更大些。目的：探讨前列腺增生症(BPH)患者出现下尿路症状(LUTS)的临床特点及其对患者生活质量的影响。方法：对2003年7月至2009年10月收治的548例前列腺增生症患者的资料进行回顾性研究。分析患者住院时填写的国际前列腺症状问卷调查表(IPSS)/自行设计的夜尿症状评分表及性功能问卷调查表(MSF-4)上的数据,并对这些数据进行统计学分析。结果：548例患者LUTS中,中度(8-19分)占24.8%,重度(20-35分)占75.2%。LUTS及其中各单个症状均与年龄存在正相关但相关性较小。LUTS及其中各单个症状与QoL正相关,症状评分越高,QoL评分也高。其中夜尿增多(NQ7)与QoL相关性最大,其次是排尿不尽(NQ1)、排尿无力(NQ5)。28.6%(157／548)的患者认为夜尿增多对自己影响最大,主要影响患者的睡眠(NQ5),其次是引起患者次日疲倦、注意力下降(NQ1)及担心影响家人或伴侣的睡眠(NQ6)。经Spearman等级相关分析发现IPSS评分与MSF-4评分存在正相关(P<0.0001),其中夜尿增多、排尿困难及尿频是影响患者性功能最大的三个尿路症状(r为0.20648、020635、0.18861)。结论：LUTS严重地影响BPH患者的生活质量,并影响患者的性功能。应重视对BPH患者夜尿增多的研究及其对患者睡眠及生活质量的影响。目的：探讨不同的临床因素与前列腺增生症(BPH)相关下尿路症状(LUTS)之间的关系,了解影响BPH有关LUTS的危险因素。方法：对2003年7月至2009年10月收治的548例前列腺增生症患者的资料进行回顾性研究。分析不同年龄、病史、最大尿流率、前列腺总体积、移行区体积、移行区指数、总PSA、游总比(f/tPSA)、组织炎症对IPSS值的影响,并进行多元线性回归分析。结果：年龄、移行带体积、Qmax、PSA及前列腺组织炎症对IPSS评分影响显著。随着年龄增大和移行带体积的增加,IPSS值变大；随着最大尿流率的减少,IPSS值显著增加(P<0.05)。当PSA≥4ng/ml时,IPSS值要显著大于<4ng/ml组的IPSS值(P<0.05),但是介于4-10ng/ml组和≥10ng/ml组的IPSS评分并无差异(P<0.05)。合并前列腺组织炎症患者的IPSS值要显著高于非炎症组(P<0.05)。进一步通过多元线性回归分析,发现所有可能影响IPSS评分的因素中,Qmax和前列腺组织炎症与IPSS评分密切相关(p=-0.807,5.736；P<0.001)。结论：前列腺组织炎症和Qmax对下尿路症状的影响最显著。其他的临床因素如患者年龄、移行带体积和PSA值对BPH患者的下尿路症状影响有限,经过多因素回归分析发现并无显著性。目的：急性尿储留(AUR)是一种常见的泌尿外科需要急诊处理的情况。前列腺增生症(BPH)是老年男性的一种常见疾病,是引起AUR最常见的原因之一。本研究试图探讨BPH患者发生AUR的危险因素,以便在治疗BPH患者时采取合理的预防措施。方法：对2003年7月至2009年12月收治的548例前列腺增生症患者的资料进行回顾性研究。对患者的年龄、病程、IPSS评分、Qmax、残余尿量、前列腺体积、移行区体积、移行区指数、tPSA、fPSA、游总比及PSAD等数据进行统计学分析。结果：548例参与调查的BPH患者中,合并AUR的患者为164例(29.9%),不伴有AUR的患者为384例(70.1%)。两组患者的年龄、IPSS评分、Qmax、残余尿量、前列腺体积、移行区体积、tPSA、fPSA、游总比及PSAD有显著差异(P<0.05),而两组间的病程和移行区指数无显著性差异。进一步多因素Logistic回归分析显示,IPSS、残余尿量、tPSA及Qmax是AUR发生最相关的因素。结论：BPH患者的年龄、IPSS评分、Qmax、残余尿量、前列腺体积、移行区体积、tPSA、fPSA及PSAD均可能会增加AUR发生的风险,其中症状严重程度、Qmax、残余尿量及总PSA与AUR具有高度相关性。目的：分析合并前列腺组织炎症的前列腺增生症的临床特点,探讨炎症与前列腺增生有关LUTS的相关性及其在前列腺增生症病程中可能起的作用。方法：对2003年7月至2009年10月间的548例良性前列腺增生症患者的资料进行回顾分析,内容包括年龄、病史、国际前列腺症状评分(IPSS)、生活质量评分(QoL)、前列腺体积、前列腺特异性抗原(PSA)、最大尿流率、急性尿潴留和治疗方式。结果：合并前列腺组织炎症的患者504例(91.97%),该组病史(62.10±45.21月)延长,IPSS/QoL (26.07±7.13/4.7±0.5)评分明显增加、前列腺体积(63.37±40.81cm3)和移行区体积(32.77±25.69cm3)显著增大,最大尿流率(5.75±5.37ml／s)减小,发生急性尿潴留的几率增高,接受外科治疗的比例也较大。但是,年龄和PSA相关值(tPSA、fPSA、f/tPSA、PSAD)无明显差异。结论：前列腺炎症在前列腺增生组织中非常普遍。炎症存在可能会加重良性前列腺增生症患者的下尿路症状,增加急性尿潴留发生及前列腺增生症相关手术的风险。炎症可能是促进前列腺增生症发生及进展一个重要因素。目的：比较经尿道前列腺等离子双极电切术(PKRP)和经尿道前列腺汽化电切术(TUVRP)的手术疗效及安全性,为前列腺增生症(BPH)有关LUTS的治疗提供最佳选择。研究方法：回顾性分析2003年7月至2009年10月在我院行TUVRP和PKRP治疗341例BPH患者的临床资料,比较两者之间的手术时间、术中出血及输血量、术后冲洗及导尿管拔管时间、IPSS、QoL及Qmax。结果：所有患者手术顺利,未发生明显的术中并发症。TUVRP组(193例)手术时间96.60±52.05min及术后冲洗时间2.62±0.99天,均长于PKRP组(148例)的84.96±28.93min和2.32±1.33天(P<0.05)。在术中出血量、输血量、导尿管拔除时间、住院时间方面,TUVRP组和PKRP组无显著性差异(P>0.05)。出院时,TUVRP组的IPSS、QoL、Qmax分别为8.38±5.86分、1.87±1.46分、17.98±7.33ml/s, PKRP组分别为7.86±5.87分、2.09±2.12分,16.77±9.69ml／s,两组指标均较术前有明显改善,(P<0.05)。IPSS分类症状评分中,TUVRP组和PKRP组的储尿期症状评分和排尿期症状评分分别为4.99±3.10、3.44±3.80,5.00±2.96分、2.26±2.98分,两组指标均较术前有明显改善(P<0.05)。两组间比较,TUVRP组IPSS、储尿期症状评分、排尿期症状评分、QoL评分和Qmax的改善较PKRP组无明显差异(P>0.05)。结论：TUVRP和PKRP的手术效果与术前比较均有明显差异,都是治疗BPH有关LUTS安全、有效的方法。PKRP组在手术时间、术后冲洗时间等方面均优于TUVRP组,而在术中出血量及输血量、导尿管拔除时间、住院时间、IPSS、QoL、Qmax等方面无显著差异。PKRP似乎较TUVRP的切割效率更高,但在改善LUTS等短期疗效方面,两者并无明显差别。更多还原

【Abstract】 Objective:To assess the prevalence, age distribution and presentation of low urinary tract symptoms (LUTS) in adult men.Methods:A random sample was obtained from men coming to our hospital for healthy physical examination during the period of 2008. By completion of the IPSS questionnaire and general health information, 1048 men aged 30-80 years old were assigned into five groups according to 10-year age stratum.The occurrence of symptoms and severity of discomfort from the respondents were assessed.Results:The occurrence of LUTS for each group was as follow. The average IPSS score was 2.48±0.38,3.80±0.53,4.78±1.07,5.33±0.68, 6.80±1.66 in 347 men in 30-39,311 men in 40-49,114 men in 50-59,207 men in 60-69,69 men in 70-79 years of age group respectively. And the average score of storage urinary symptoms in each group was 1.20,1.66,2.24,2.57,3.20; average score of voiding symptoms was 1.28,2.14,2.54,2.76,3.59; average score of the quality of life (QoL) was 1.78±1.42,1.84±0.30,1.89±1.04,2.03±1.08,2.07±1.92 respectively. The incidence of LUTS in different age groups was correlated with age (x2=70.46, P<0.005). IPSS total score, voiding symptom score and storage symptoms score were positively correlated with QoL score, in which storage symptoms had a more impact on the quality of life than voiding symptoms.Conclusions:LUTS are relatively widespread in adult healthy males more than 30 years of age. The incidence of LUTS and symptom scores increase with age. The more severe symptoms of LUTS, the greater impact on QoL, in which storage symptoms have a greater impact on QoL than voiding symptoms (The correlation coefficient between the storage symptom score, voiding symptom score and QoL are r=0.966(P<0.05), r=0.931(P<0.05), respectively)Objective:To explore the clinical characteristics of LUTS suggestive of BPH and their impact on patients’quality of life(QoL).Methods:548 patients with BPH were enrolled from July 2003 to October 2009 and their clinical data were studied retrospectively. Data on International Prostate Symptom Questionnaire Score (IPSS), a self-designed nocturia symptom score sheet and sexual function questionnaire (MSF-4) filled out by patients when they hospitalized was anlyzed.Results:548 cases of patients with LUTS, moderate (8-19 points) accounted for 24.8% and severe (20-35 points) accounted for 75.2%. LUTS and its individual symptoms were positively associated with age, but less relevant, which were also positively correlated with QoL. Among the individual urinary symptoms, nocturnal score(Q7) correlated most with QoL, followed by dribbling urine (Q1), inability to urinate (Q5). 28.6%(157/548) of patients considered nocturnal as the greatest impact on their QoL, mainly affecting their sleep (NQ5), followed by fatigue and decreased attention in next day (NQ1),worring about the impact on family or partner’s sleep (NQ6). The Spearman rank correlation analysis showed that there was a positive correlation between IPSS and MSF-4 score (P<0.0001), in which nocturia, dysuria, and urinary frequency were the serious urinary symptoms that affected sexual function of patients (r=0.20648,020635,0.18861). Conclusion:LUTS seriously affect QoL of patients with BPH, including the impact on sexual function.More attention on the further study of BPH patients with nocturia should be paid in order to reduce its disturbance of patients’sleep and life.Objective:To explore the relationship between different clinical factors and lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (BPH), in order to understand the impact of the risk factors on BPH related LUTS.Methods:548 patients with BPH were enrolled from July 2003 to Octorber 2009 and their clinical data were studied retrospectively. The impact of various clinical factors such as age, medical history, maximum urinary flow rate (Qmax), total prostate volume, transition zone volume, transition zone index, total PSA, f/tPSA and prostatic inflammation on IPSS scores were analyzed, and multiple liner regression analysis was also conducted.Results:Among all the clinical factors mentioned above, age, transition zone volume, Qmax, PSA and prostatic inflammation had a significant impact on the IPSS score. IPSS scores increased significantly with the increase of age and transitional zone volume, while IPSS scores increased significantly with the reduction in Qmax (P<0.05). IPSS scores were significantly higher in the group of PSA≥4ng/ml than that of PSA<4ng/ml (P<0.05), however, there was no difference between the group of PSA range of 4-10ng/ml and that of PSA≥10ng/ml (P<0.05). Patients with prostate inflammation had much higher IPSS score than those patients without prostate inflammation (P<0.05). Further analysis by multiple liner regression found that Qmax and prostate tissue inflammation were closely correlated with the IPSS score among all the possible risk factors (β=-0.807,5.736;P<0.001).Conclusion:This study shows that prostate tissue inflammation and Qmax have a remarkable impact on the severity of LUTS, and other clinical factors such as patient’s age, transition zone volume and PSA value have a limited impact on the severity of LUTS suggestive of BPH as no significance is found after multiple liner regression analysis.Objective:Acute retention of urine (AUR) is a common urological condition that often needs an emergence management. One of the most common causes of acute urinary retention is benign prostatic hyperplasia (BPH) which is a common disease in aging male population. This study attempts to explore the risk factors of AUR ocurred in BPH patients, thus reasonable preventative measures are taken for the treatment of BPH patients.Methods:Total 548 patients with BPH were enrolled from Jul 2003 to Oct 2009 and their clinical data were studied retrospectively. Clinical data such as patient’s age, medical history, IPSS and QoL score, Qmax, residual urine volume, prostate volume, transition zone volume, transition zone index, tPSA and fPSA, and PSAD was analyzed statistically.Results:In 548 cases of BPH patients involved in the investigation, development of AUR was found in 164 cases (29.9%), not in 384 cases (70.1%). Patient’s age, IPSS score, Qmax, residual urine volume, prostate volume, transition zone volume, tPSA and fPSA including f/tPSA, and PSAD were significantly different in two groups (P<0.05), while there was no significant difference in the disease duration and transition zone index between the two groups. Further Multivariate Logistic regression analysis showed that symptom severity, residual urine volume, tPSA, and Qmax were the most risk factors for predicting the development of AUR.Conclusions:BPH patient’s age, IPSS score, Qmax, residual urine volume, prostate volume, transition zone volume, tPSA and fPSA, and PSAD are likely to increase the risk of AUR, in which symptom severity, Qmax, residual urine volume and total PSA are the most significant predictors for acute retention.Objective:To analyze the clinical characteristics of benign prostate hyperplasia (BPH) with prostate inflammation,and to investigate the relationship between inflammation and lower urinary tract symptoms (LUTS) suggestive of BPH and the possible role of inflammation in the progression of BPH.Methods:From July 2003 to Octorber 2009,548 patients diagnosed with BPH were enrolled in this study, and several items including age, history, IPSS, volume of prostate, prostatic-specific antigen (PSA) and related parameter, Qmax, acute urinary retention (AUR) and the way of treatment were analyzed.Results:504 cases (91.97%) were identified as prostatitis, and those patients’history (62.10±45.21) were longer and their scores of IPSS/QoL (26.07±7.1.3/4.7±0.5) were higher than that of patients without prostatitis. The total volume of prostate and transitional zone were 63.37±40.81cm3 and 32.77±25.69 cm3 respectively in patients with BPH combined with prostatitis, which were larger than those of the patients without prostatitis. Patients with prostatitis felt more uncomfortable about voiding symptoms than the other group.Their maximum flow rate (5.75±5.37ml/s) were decreased and risk of AUR were increased, and the proportion of BPH-related surgery were higher. On the other hand, there were no significant differences about patients’age, tPSA, fPSA, f/tPSA and PSAD between two groups.Conclusion:Prostatitis in benign prostatic hyperplasia is very common. LUTS may be aggravated by the existence of inflammation in benign prostatic hyperplasia, and the inflammation may increase the risk in occurrence of AUR and BPH-related surgery. Prostate inflammation may be an important factor in occurrence and progression of LUTS suggestive of BPH.Objective:To compare the surgical efficacy and safety of transurethral Plasma Kinetic Resection of the Prostate (PKRP) and transurethral vaporization resection of the prostate (TUVRP), so as to provide the best choice of the treatment for LUTS suggestive of benign prostatic hyperplasia (BPH).Methods:The clinical data of 341 patients with BPH treated by PKRP and TUVRP from July 2003 to October 2009 in our hospital was analyzed retrospectively, and the operative time, intraoperative blood loss and blood transfusion, post-operative bladder irrigation and catheter extubation time, IPSS, QoL, and Qmax between the two groups were compared.Result:The operations were completed successfully in all patients and no significant intraoperative complications occurred. The operation time (96.60±52.05min), post-operative washing time (2.62±0.99 days) of TUVRP group (193 cases) were longer than that (84.96±28.93min) (2.32±1.33 days) of PKRP group (148 cases) (P<0.05). No significant difference was found between two groups in the intraoperative blood loss, blood transfusion, catheter removal time, hospitalization time (P>0.05). IPSS, QoL, Qmax of TUVRP group were 8.38±5.86min,1.87±1.46min, 17.98±7.33ml/s, that of PKRP group were 7.86±5.87 min,2.09±2.12min, 16.77±9.69ml/s,these indicators of both groups improved significantly than that before surgery, (P<0.05). The storage and voiding symptom score of TUVRP group and PKRP group were 4.99±3.10,3.44±3.80 and 5.00±2.96min,2.26±2.98 points, which improved significantly than those before surgery (P<0.05). There was no significant difference existed between this two groups in parameters improvement of IPSS, including storage symptom score and voiding symptom score, QoL and Qmax (P>0.05).Conclusions:The post-operation results of TUVRP and PKRP improve remarkably compared with preoperation, and both are safe and effective methods for the treatment of LUTS suggestive of benign prostatic hyperplasia. PKRP is better on the operation time and the postoperative irrigating time than TUVRP in this study, however, there is no significant difference between the two groups in intraoperative blood loss and blood transfusion, catheter removal time, hospitalization time, IPSS and QoL score, Qmax. PKRP seems to be faster than TUVRP in cutting efficiency, but this two procedures have similar effects on the short term efficacy such as improving LUTS.更多还原