膀胱逼尿肌無收縮的病人是否會在藥物或手術治療後恢復膀胱收縮力?
長期尿路動力學追蹤研究
陳聖復、郭漢崇
花蓮慈濟醫院暨慈濟大學 泌尿部
Will detrusor acontractile recover after medical or surgical treatment?A longitudinal long tern urodynamic follow-up
Sheng-Fu Chen , Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University Hualien, Taiwan
Objective: Underactive bladder (UAB) is a common urological clinical problem which the treatment is challenged, especially acontractile detrusor. However, in clinical practice, we found some patients may recover after treatment. This study investigated the treatment outcome of acontractile bladder.
Materials and Methods: We retrospective reviewed 37 acontractile detrusor patients, (including 27 women and 10 men with mean age 69.92±14.31) who were diagnosed by videourodynamic study (VUDS) (PdetQmax =0 mmH2O, and post void residual urine > 300ml). All patients received medical or surgical treatment and followed-up at single clinical center at least 3 months, and repeated VUDS was performed. When PdetQmax ≥ 10 mmH2O after treatment, we defined detrusor contractility recovery.
Results: The mean follow up duration was 1.66±1.74 (0.3-7.1) years. The follow-up VUDS showed 15 (40.5%) patients had detrusor function recovery. Patient received alpha blocker and clean intermittent catheterization (N=9) or surgical procedure if medication failed. Surgical treatments include transurethral incision of the bladder neck (TUI-BN, N=10), transurethral resection of prostate (TUR-P, N=3), urethral Botox injection (N=3), TUIBN+ urethral Botox injection (N=11), and cystocele correction (N=1). The aim of treatment was trying to improve voiding efficiency by decreasing bladder outlet resistance. 6 patients recovered within one year and 9 patients recovered later after one year. VUDS parameters between baseline and after at least 3 months follow up showed Pdet.Qmax, voided volume, PVR, maximum flow rate (Qmax) all showed significant improvement in both non-recovery and recovery group. But first sensation of filling (FSF), full sensation (FS), urge sensation (US) significant became significant earlier in recovery group. (table 1). We also noted after treatment, no matter detrusor recovery or not, both group showed improvement of voiding efficiency.
Conclusions: In this small series of acontractile bladder, 40.5% patients recovered after treatment. First sensation of filling at baseline is a predictor for bladder function recovery. Although surgical procedure for bladder outlet cannot help detrusor function recovery, but it may improve voiding efficiency and decrease post void residual.
Table 1. Urodynamic parameters of detrusor acontractile patiens at baseline and >3 months Follow-up (N=37)
Parameters
|
|
Detrusor non-recovery
N=22
|
Detrusor recovery
N=15
|
P
|
FSF (ml)
|
Baseline
|
217±113
|
248±87.4
|
0.263
|
>3months
|
188±63.0
|
176±6.5
|
|
P=0.275
|
*P=0.019
|
FS (ml)
|
Baseline
|
371±118
|
365±97.8
|
0.306
|
>3months
|
306±106
|
248±85.9
|
|
P=0.059
|
*P=0.008
|
US (ml)
|
Baseline
|
421±103
|
397±88.9
|
0.285
|
>3months
|
374±132
|
286±138
|
|
P=0.214
|
*P=0.031
|
CBC (ml)
|
Baseline
|
430±102
|
397±88.6
|
0.563
|
>3months
|
376±131
|
309±128
|
|
P=0.169
|
P=0.080
|
Compliance
|
Baseline
|
86.4±57.2
|
103±113
|
0.641
|
>3months
|
87.7±71.2
|
128±140
|
|
P=0.933
|
P=0.608
|
PdetQmax
(cmH2O)
|
Baseline
|
0±0
|
0±0
|
**0.000
|
>3months
|
3.91±6.09
|
23.8±16.1
|
|
*P=0.049
|
*P=0.000
|
Qmax (ml/sec)
|
Baseline
|
0.27±0.77
|
0.13±0.52
|
0.883
|
>3months
|
6.59±7.41
|
6.80±6.93
|
|
*P=0.000
|
*P=0.002
|
Vol (ml)
|
Baseline
|
7.81±21.0
|
2.47±9.56
|
0.764
|
>3months
|
178±228
|
152±161
|
|
*P=0.002
|
*P=0.003
|
PVR (ml)
|
Baseline
|
511±164
|
515±80.1
|
0.585
|
>3months
|
292±173
|
253±184
|
|
*P=0.001
|
*P=0.000
|
* P-value <0.05 comparison with baseline and >3 months.
** P-value <0.05 comparison with Detrusor non-recovery and recovery group.
FSF: first sensation of filling, FS: full sensation, US: urge sensation, Pdet: detrusor pressure, Qmax: maximum flow rate, Vol: voided volume, PVR: post-void residual, CBC: cystometric bladder capacity,