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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 彭崇信 | 使用陰莖袖套測試診斷男性膀胱出口阻塞 | 2018/1/31 上午 11:22:41 | 0 |
| 原 文 | 題 目 | Diagnosing bladder outlet obstruction using the penile cuff test in men with lower urinary tract symptoms |
| 作 者 | Kwang Jin Ko, Yoon Seok Suh, Tae Heon Kim, Hyun Hwan Sung, Gyu Ha Ryu and Kyu-Sung Lee | |
| 出 處 | Neurourology and Urodynamics, 2017 Sep;36(7):1884-1889 | |
| 出版日期 | September, 2017 | |
| 評 論 | 陰莖袖套測試(penile cuff test)，是一種非侵入式的檢查。受試者自行膀胱脹尿，於陰莖包圍一個類似量血壓的袖套，排尿開始後自動充氣加壓，導致尿流中斷，隨即迅速放氣，使尿流恢復，如此重複操作直到排尿結束為止。這種中斷尿流的袖套壓代表等容膀胱壓（isovolumetric bladder pressure），而量測及記錄每個袖套壓及尿流速，可用以診斷男性膀胱出口阻塞（bladder outlet obstruction, BOO）。本研究共納入146名男性，病人的國際前列腺症狀分數（International Prostate Symptom Score）大於12分且下尿路症狀（lower urinary tract symptoms）超過6個月，都接受了penile cuff test和壓力尿流研究(pressure-flow study)兩項檢查以評估是否有BOO。與pressure-flow study相比較，penile cuff test的敏感性(sensitivity)為89.7％，陽性預測值(positive predictive value)為54.2％，特異性(specificity)為71.8％，而陰性預測值(negative predictive value)為94.9％。檢查疼痛程度(visual analog scale)分別為pressure-flow study (5.04±2.17)及penile cuff test (1.83±1.98)（P <0.0001）。檢查時間分別為pressure-flow study（23.3±2.2 min）及penile cuff test （6.3±0.6 min）（P <0.0001）。Penile cuff test沒有發生不良副作用。研究結果顯示，penile cuff test診斷男性BOO時，有很高的陰性預測值，以及檢查耗時短且疼痛較少的優點。目前BOO的標準診斷方式仍然是侵入性的pressure-flow study。近十多年來有不少非侵入性的方式被提出，包括penile cuff test，condom-catheter method，doppler ultrasonography urodynamics，detrusor wall thickness，intravesical prostatic protrusion，及near-infrared spectroscopy等。雖然多數文獻的證據程度較低，有些在男性BOO的診斷上有不錯的敏感性及特異性。如果只想得到關於BOO的資訊而無需完整的尿路動力學數據，這些檢查未來也許可以作為pressure-flow study的替代方法。 | |
| abstract |
摘要： METHODS: A total of 146 consecutive men with an International Prostate Symptom Score (IPSS) >12 and lower urinary tract symptoms (LUTS) for >6 months were included in this single-institution, prospective, diagnostic study. The primary outcome was to evaluate the diagnostic accuracy of PCT. Secondary outcomes included pain severity measured on a visual analog scale (VAS), procedure time, and adverse events. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated. RESULTS: Based on the PFS results, the sensitivity of PCT was 89.7%, the PPV 54.2%, the specificity 71.8%, and the NPV 94.9%. The mean pain VAS for the PFS and PCT were 5.04 ± 2.17 and 1.83 ± 1.98, respectively (P < 0.0001). The mean procedure time for PCT (6.3 ± 0.6 min) was shorter than that of PFS (23.3 ± 2.2 min) (P < 0.0001). There were no adverse events reported during PCT. CONCLUSIONS: Given its high NPV, PCT may be an efficient screening test for BOO in men. In addition, PCT is advantageous over PFS with regard to its short procedure time and acceptable tolerability. |
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