攝護腺尿道角度用於診斷具下尿路症狀及非攝護腺肥大之男性膀胱頸功能性異常之角色

張天霖、江元宏、郭漢崇

佛教花蓮慈濟醫院 泌尿部

The diagnostic rule of prostatic urethral angle in diagnosis of bladder neck dysfunction in men with lower urinary tract symptoms and small prostate volume

Tien-Lin Chang, Yuan-Hong Jiang, Hann-Chorng Kuo

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

Purpose: This cohort study uses video urodynamic study (VUDS) to investigate the relationship between the prostatic urethral angle (PUA) and bladder neck dysfunction (BND) in men with lower urinary tract symptoms (LUTS) and small prostate volume.

Materials and Methods: This is a single center study and retrospectively obtained the medical records of first-visit men with LUTS and total prostate volume lower than 30 ml from January 2019 to October 2022. A total of 158 men were enrolled. The TPV, transitional zone index (TZI), intravesical prostatic protrusion (IPP) and PUA were measured by transrectal ultrasonography. The International Prostate Symptom Score (IPSS) was accessed. Uroflowmetry and bladder sonography were also performed. VUDS was made to access BND, benign prostate obstruction (BPO) and dysfunctional voiding (DV).

Results: A total of 158 men (mean age, 66.7 ± 10.8 years) were enrolled. There are 46.8% of patients with BND, 10.1% having BPO and 19.6% having DV. The mean PUA was 17.7±17.6^ and mean IPP was 0.09±0.34 cm. The cQmax was significantly lower in patients with BND compare with patients without bladder outlet obstruction (BOO) (p=0.022). The Pdet and BOOI are higher in patients with BPO and BND (p<0.001 and p<0.001). In ROC analysis, the area under the curve using the IPP was 0.636, using 0.50 cm as the cut-off value for BPO. (sensitivity=0.188, specificity=0.923, 95% CI[0.544-0.728]); the area under the curve using the PUA was 0.605, using 30.0^ as the cut-off value for BND. (sensitivity=0.446, specificity=0.735 and 95% CI[0.515-0.695]). The diagnosis of BND using IPP lower than 0.50 cm and PUA >= 30.0^ is 55.8%.

Conclusion: The PUA may have a role in diagnosis of BND in men with LUTS and small prostate volume (TPV<=30), as well as providing a cut-off value, sensitivity and specificity. It may be an important clinical factor in male LUTS management and possible surgical intervention.