依據臨床診斷及錄影尿路動力學表現評估男性逼尿肌收縮力低下患者的治療成效

劉民慶¹、李政霖¹、張嘉峰¹、何翰蓁²、江元宏¹、許永祥³、郭漢崇¹

花蓮慈濟醫院 泌尿部；慈濟大學 解剖學科；花蓮慈濟醫院 病理部

Therapeutic Outcome of Active Management in Male Patients with Detrusor Underactivity Based on Clinical Diagnosis and Videourodynamic Classification

Min-Ching Liu, Cheng‑Ling Lee, Jia‑Fong Jhang, Han‑Chen Ho, Yuan‑Hong Jiang ,

Yuan‑Hsiang Hsu & Hann‑Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Hualien, Taiwan

Department of Anatomy, Tzu Chi University, Hualien, Taiwan

Department of Pathology, Hualien Tzu Chi Hospital, Hualien, Taiwan

Purpose: Treatment of voiding dysfunction due to detrusor underactivity (DU) remains challenging. This study aimed to investigate the videourodynamic study (VUDS) characteristics of male patients with DU and assess the treatment outcome based on different active managements and urodynamic findings, especially on the bladder sensation, detrusor contractility (detrusor acontractile, DA; low detrusor contractility, LDC, normal detrusor contractility, NDC) and VUDS characteristics.

Methods: A total of 298 male patients with VUDS-proven DU were recruited. According to the VUDS findings, conservative treatment (indwelling catheter, CIC, cystostomy voiding training), bladder outlet surgeries (TUI-BN, TUI-P, TURP, optic urethrotomy), urethral sphincter BoNT-A injection, or medical treatment were given to individual DU patients. Treatment outcomes were then analyzed by different VUDS characteristics.

Results: After active treatment, a successful outcome was achieved in 68.4% of patients after bladder outlet surgery, 59.1% after urethral botulinum toxin A injection, and 57.6% after medical treatment, but only 18.2% after conservative treatment. Compared with those in the controls (46.1 ± 15.4%), bladder sensations by ratio of FSF/CBC were significantly greater in patients with DA (63.2 ± 23.3%, p < 0.001), LDC (55.5 ± 18.4%), and NDC (57.70 ± 19.5%); whereas the Pdet was significantly lower in patients with DA (1.31 ± 2.07 cmH₂O) and LDC (15.0 ± 6.34 cmH₂O), but not NDC (33.9 ± 3.98 cmH₂O). In patients with DU, the Pdet was positively correlated with Qmax (r = 0.539, p = 0.000) and negatively correlated with PVR (r =− 0.397, p = 0.000), FSF (r = − 0.233, p = 0.000) and FS (r = − 0.148, p = 0.006). The BCI and VE were all significantly lower in patients with DA (6.98 ± 14.3, 9.79 ± 23.1), LDC (31.3 ± 20.1, 27.2 ± 32.2), and NDC (52.7 ± 15.9, 30.8 ± 28.5) compared with the controls (133.1 ± 22.8, 96.7 ± 4.56), all with significantly elevated PVR.

Conclusion: This study revealed that active management can effectively improve voiding efficiency in patients with DU. The normal bladder sensation, presence of adequate detrusor contractility, and bladder outlet narrowing during VUDS provide effective treatment strategy for DU patients. Among all management, BOO surgery provides the best treatment outcome.