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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 王炯珵 | 超音波測量膀胱壁厚度可區分各種排尿障礙嗎？ | 2008/7/10 上午 10:29:03 | 0 |
| 原 文 | 題 目 | Ultrasound measurement of bladder wall thickness in the assessment of voiding dysfunction. |
| 作 者 | Blatt AH, Titus J, Chan L. | |
| 出 處 | J Urol | |
| 出版日期 | 2008 Jun;179(6):2275-8; discussion 2278-9. Epub 2008 Apr 18 | |
| 評 論 |
多年來許多研究者都想嘗試用非侵入性的方式來診斷排尿障礙的原因，以取代侵入式的尿路動力學檢查，超音波測量膀胱壁厚度就是一個方法，一般而言，膀胱壁可分為三層，外層是高回音的漿膜層，中間是低回音的肌肉層，內層是高回音的黏膜層，厚度就是測中間的低回音肌肉層。 先直接講本篇結論好了，超音波無法區分正常膀胱、膀胱出口阻塞、逼尿肌過動和敏感性膀胱，這四組厚度大約都在0.2公分左右，男性比女性有稍微厚一點〈0.21公分 VS 0.19公分〉，年紀和膀胱無關。 不過本篇的結論和過去發現並不大相同，審稿委員Dr. Yalla認為，基於科學的常識，平滑肌當需要做功時〈如BOO或DO〉，就會增厚，在動物的模型上，也可以看到類似的發現，至於人類尚為何有不同的發現，這和檢查的是否標準化，測量的方法和位置都有相關性的。 以上看來，這個話題還有得爭論一番，也或許不久的將來，逐漸會有個標準化的方法，讓這爭議有一個大家所能接受的答案。 |
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| abstract |
PURPOSE: Ultrasound measurement of bladder wall thickness has been proposed as a useful diagnostic parameter in patients with bladder outlet obstruction and other voiding dysfunctions. We assessed bladder wall thickness measurement as a noninvasive test in patients with suspected bladder outlet obstruction or overactive bladder syndrome. MATERIALS AND METHODS: Transabdominal ultrasound measurement of bladder wall thickness was performed during urodynamic study in 180 patients with nonneurogenic voiding dysfunction. Two measurements of anterior bladder wall thickness, 1 cm apart in the midline and averaged, were obtained at 200 ml filling. Bladder wall thickness findings were correlated with urodynamic diagnoses. RESULTS: A total of 180 patients with an average age of 62 years (range 20 to 94) were recruited, comprising 73 males and 107 females. Of the patients 69 had normal urodynamics, 39 had bladder outlet obstruction, 38 had increased bladder sensation on cystometry and 34 had detrusor overactivity. Bladder wall thickness was 1.1 to 4.5 mm in all groups. Males had a slightly thicker bladder wall than females (mean 2.1 vs 1.9 mm, p = 0.064). Mean bladder wall thickness in patients with normal urodynamics, bladder outlet obstruction, detrusor overactivity and increased bladder sensation was 2.0, 2.1, 1.9 and 1.8 mm, respectively. No significant difference was found between the groups (ANOVA p = 0.064, not significant). In particular there was no difference in bladder wall thickness between patients with normal urodynamics, and those with bladder outlet obstruction (p = 0.31) or detrusor overactivity (p = 0.309). CONCLUSIONS: Bladder wall thickness is remarkably uniform in patients with nonneurogenic voiding dysfunction. Therefore, it cannot reliably predict bladder outlet obstruction or detrusor overactivity. Bladder wall thickness measurement does not provide an alternative to urodynamic studies for diagnosing voiding dysfunction. |
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