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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 鍾旭東 | 男性膀胱過動正與前列腺之向膀胱內膨出之相關 | 2011/4/27 下午 05:23:59 | 0 |
| 原 文 | 題 目 | Correlation of Male Overactive Bladder with Intravesical Prostatic Protrusion |
| 作 者 | Ki Hong Kim and Young Sig Kim | |
| 出 處 | KOREAN JOURNALOF UROLOGY | |
| 出版日期 | 2010 December; 51(12): 843–846. | |
| 評 論 |
男性下泌尿道症狀在過去著名歐洲五國調查之European Prospective Investigation into Cancer and Nutrition (EPIC) 研究指出，為相當常見且嚴重影響生活品質之疾患。其中膀胱過動症狀(包括急尿或是急尿性失禁)，根據於男性過去的研究結果，可能因為解剖位置上膀胱出口的前列腺造成阻塞以及尿道壓力上升所致，近年來的研究已經發現男性下泌尿道症狀也可能肇因於膀胱及逼尿肌的病變。舉例來說有接近一半的男性下泌尿道症狀的病人並無膀胱出口阻塞的情況。因為經直腸前列腺超音波的快速進展及機器解析度的提升，有相當多的研究在超音波協助下，探討前列腺的形狀以及前列腺向膀胱內膨出（Intravesical prostatic protrusion, IPP) 對於病患林床上症狀之影響。已經有研究提與膀胱出口阻塞以及發生尿㶆留有相關。 這篇來自韓國的文章主要是來探討前列腺向膀胱內膨出與男性膀胱過動之症狀的相關性，為期參年的研究經由排除貳拾參位患有泌尿道感染.前列腺惡性腫瘤.尿道及膀胱結石.尿道狹窄.神經性膀胱以及陸位有泌尿道手術病史的病人後，總共收集了壹百柒拾玖人的臨床資料，包括國際前列腺症狀評分.血清中前列腺特異抗原.經直腸超音波之表現.尿流速以及餘尿量。其中經直腸超音波之表現根據前列腺向膀胱內膨出的嚴重程度分為三類：第一群為小於伍毫米有壹百壹拾伍人;第二群為介於伍與拾毫米間有叁拾捌位;第三群為大於拾毫米有貳拾柒位。結果發現經過多重線性迴歸分析，前列腺向膀胱內膨出與臨床上之膀胱過動症狀有顯著相關性。綜合來說此研究不只非常有趣，有很直接的臨床應用性且執行容易。其隱含的意義即為當前列腺增生有明顯侵犯膀胱頸或是往膀胱內突出，可能代表嚴重之膀胱出口阻塞，久而造成逼尿肌之肥厚，導致膀胱上皮感覺異常以及逼尿肌過度活性;亦可假設當前列腺的實質(stroma)過度生長時對於膀胱頸或是前列腺尿道區的交感神經造成一定之生理及功能性的變化，進一步使膀胱儲存的功能降低，也可在臨床上觀察到急尿或是尿失禁癥狀。 |
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| abstract |
Purpose: Male overactive bladder (OAB) may be caused by prostatic pathologies such as bladder outlet obstruction (BOO). Intravesical prostatic protrusion (IPP) has been found to correlate with BOO and acute urinary retention. We investigated the interrelation between male OAB symptoms and IPP for estimating anatomical changes to the prostate. Materials and Methods: We assessed 179 consecutive men aged >40 years who presented with lower urinary tract symptoms. The initial evaluation included International Prostate Symptom Score (IPSS) and quality of life assessments, transrectal ultrasonography (TRUS), uroflowmetry, and postvoid residual urine volume. The degree of IPP was determined by the distance from the tip of the protrusion to the circumference of the bladder at the base of the prostate gland. Patients with IPP <0.5 cm were defined as group A (n=114), and patients having 0.5 cm≤IPP<1 cm were defined as group B (n=38). The others were defined as group C (n=27). Results: A total of 51 patients complained of urgency in group A, 38 patients in group B, and 27 patients in group C. Likewise, 14 patients had a history of acute urinary retention in group A, 8 patients in group B, and 16 patients in group C. IPP grade had a statistically significant relation with both OAB and a history of acute urinary retention. Conclusions: The results of our study have shown that male OAB is correlated with IPP. However, larger scale studies are needed to confirm these results. |
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