男性膀胱过度活动症的尿动力学分型及临床疗效随访

doi:10.19723/j.issn.1671-167X.2019.06.012

摘要/Abstract

摘要：

目的介绍男性膀胱过度活动症(overactive bladder,OAB)的尿动学分型并探究其临床疗效的差异。方法收集2015年1月至2017年1月北京大学人民医院泌尿外科诊断为OAB并且接受尿动力学检查的男性患者共126例,根据患者的主诉(是否可感知尿急)及尿动力学检查结果(是否有逼尿肌过度活动和终止不自主收缩的能力)将膀胱过度活动症分为四型,分析患者的基本信息、伴随疾病情况、治疗前后的OAB症状评分表(OAB symptom score,OABSS)以及国际前列腺症状评分(international prostate symptom score,IPSS)是否存在差异。结果根据分型方法,Ⅰ型32例(25.40%),Ⅱ型27例(21.43%),Ⅲ型59例(46.83%),Ⅳ型8例(6.35%),四型患者的身高差异无统计学意义(P>0.05),Ⅳ型患者的年龄、体质量、伴随疾病数目显著大于其余三型,差异有统计学意义(P<0.05),Ⅰ、Ⅱ、Ⅲ型患者的年龄、体质量、伴随疾病数目的差异无统计学意义(P>0.05),Ⅳ型患者治疗前后OABSS和IPSS量表差值显著小于其余三型,差异有统计学意义(P<0.05),Ⅲ型患者治疗前后OABSS和IPSS量表差值显著大于其余三型,差异有统计学意义(P<0.05),Ⅰ型和Ⅱ型患者治疗前后OABSS和IPSS量表差值的差异无统计学意义(P>0.05)。结论在四型男性OAB患者中,Ⅲ型治疗效果最好,Ⅳ型治疗效果最差,此分型方法对男性OAB的个体化诊疗以及指导预后具有重要意义。

关键词: 男性, 膀胱过度活动症, 排尿障碍, 尿动力学

Abstract:

Objective: To introduce a urodynamic classification of male patients with symptoms of overactive bladder (OAB) and discuss its clinical significance in practice.Methods: From January 2015 to January 2017, there were 181 male patients from Peking University People’s Hospital who were diagnosed clinically with OAB and underwent preoperative urodynamic test. Finally 126 male patients were enrolled in the research. Male OAB patients could be stratified into four groups based on the chief complaints (whether or not presenting urgency) and the results of urodynamic test (whether or not presenting detrusor overactivity and the ability to stop the involuntary contraction). The contents of this follow-up study included the basic information, the preoperative and postoperative scores of the OAB symptom score (OABSS), the preoperative and postoperative scores of the international prostate symptom score (IPSS), and the amount of the concomitant diseases.Results: According to the classification, the amounts of the four types of OAB patients were 32 (25.40%) for type Ⅰ, 27 (21.43%) for type Ⅱ, 59 (46.83%) for type Ⅲ, and 8 (6.35%) for type Ⅳ, respectively. The data of their heights showed no statistical significance (P>0.05). The ages, weights and the amount of the concomitant diseases of type Ⅳ were obviously higher than those of the other three types (P<0.05). And the ages, weights and the amount of the concomitant diseases of the other three types had shown no statistical significance (P>0.05). The improvement of the OABSS and IPSS scores of the type Ⅳ were obviously inferior to the other three types (P<0.05). The improvements of the OABSS and IPSS scores of type Ⅲ were obviously higher than those of the other three (P<0.05). The discrepancy of the OABSS and IPSS scores of type Ⅰ and type Ⅱ had shown no statistical significance (P>0.05).Conclusion: Type Ⅳ has the worst outcome and type Ⅲ has the best among the four types of OAB. And this classification system will certainly have a profound significance in guiding and directing our clinical diagnosis and treatments, and evaluating the prognosis of the patients with OAB.

Key words: Male, Overactive bladder, Urination disorders, Urodynamics

中图分类号:

R694

王涛,许克新,张维宇,胡浩,张晓威,王焕瑞,刘献辉,陈京文,张晓鹏. 男性膀胱过度活动症的尿动力学分型及临床疗效随访[J]. 北京大学学报（医学版）, 2019, 51(6): 1048-1051.

Tao WANG,Ke-xin XU,Wei-yu ZHANG,Hao HU,Xiao-wei ZHANG,Huan-rui WANG,Xian-hui LIU,Jing-wen CHEN,Xiao-peng ZHANG. Urodynamic classification of male patients with symptoms of overactive bladder and the outcome classification[J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1048-1051.

图/表 4

表1

图1

表2

四型膀胱过度活动症男性患者相关信息的单因素分析"

Variables	Type Ⅰ	Type Ⅱ	Type Ⅲ	Type Ⅳ	Univariate analysis (P values)
Age/years, $x ?$ ±s	69.50±13.92	69.51±8.05	68.75±9.29	78.50±9.20	0.033
Height/cm, $x ?$ ±s	171.38±5.98	171.70±6.00	171.22±5.54	173.63±4.94	0.125
Weight/kg, $x ?$ ±s	69.30±6.19	68.43±5.68	68.93±8.83	73.50±7.52	0.030
OABSS^*, $x ?$ ±s	4.62±2.23	4.18±2.45	6.07±3.33	2.75±1.77	<0.001
IPSS^*, $x ?$ ±s	14.72±6.71	14.26±8.00	16.13±8.25	7.45±4.70	0.036
Concomitant disease, $x ?$ ±s	2.25±1.11	2.22±1.09	2.16±1.15	4.25±2.60	<0.001

表2

表3

参考文献 15

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Types	Symptoms	Urodynamic test
Type Ⅰ	Urgency, no incontinence	No DO, no incontinence
Type Ⅱ	Urgency, no incontinence	DO, no incontinence
Type Ⅲ	Urgency, incontinence	DO, incontinence
Type Ⅳ	No urgency, incontinence	DO, incontinence

Variables	OR	95%CI	P values
Age	1.76	1.10-4.21	0.036
Weight	1.99	1.21-3.09	0.039
OABSS^*	3.55	1.57-8.23	0.014
IPSS^*	1.37	1.04-4.25	0.045
Concomitant disease	2.98	2.01-7.36	0.016