好的尿流速在男性膀胱過度症是否為低殘尿保證？
林冠榮1、林志杰1,2,3、林登龍1,2,3、陳光國1,2,3
台北榮民總醫院泌尿部1; 陽明大學醫學系泌尿學科 2; 書田泌尿科學研究中心
Whether a Good Uroflow Rate Could Guarantee a Low Post-Void Residual Urine Volume in Men with Overactive Bladder?
Kuan-Jung Lin1, Chih-Chieh Lin 1,2,3, Alex Tong-Long Lin1,2,3, Kuang-Kuo Chen1,2,3
Department of Urology, Taipei Veterans General Hospital, Taipei , Taiwan 1; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan 2; Shu-Tien Urological Science Research Center , Taipei, Taiwan3
Purpose:
When considering antimuscarinics for patients with overactive bladder (OAB), post-void residual urine volume (PVR) is an important factor for decision-making. Using antimuscarinics in patients with a large amount PVR is not desirable. It is a reasonable inference that patients with good flow rates should be able to empty their bladders to achieve a low PVR. If this hypothesis is correct, then antimuscarinics can be used safely in OAB patients with good flow rate without the need to check PVR. This study tested this hypothesis by evaluating the correlation between uroflow rate and PVR in men with OAB symptom.
Materials and Methods:
We retrospectively recruited male OAB patients, who had urgency with or without urge incontinence, between Aug 2008 and July 2015. Exclusion criteria included urinary tract infection, prostate and bladder cancer. Patients with abdominal strain pattern or inadequate voided volume (less than 150ml) on uroflowmetry (UFR) were excluded. Patients were categorized into good Qmax and low Qmax groups by the cut-off value of 15ml/sec maximal flow rate (Qmax) in free uroflowmetry. All patients received pressure flow studies for evaluating bladder outlet obstruction (BOO) and transabdominal ultrasonography for evaluating the prostatic size, intra-vesical prostatic protrusion (IPP) and detrusor wall thickness (DWT). BOO was defined by BOOI>40. Amounts of residual urine were determined by post-void catheterization. International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) were collected for symptom evaluation.
Results:
A total of 136 male patients with OAB symptoms were enrolled. The patients’ demographic was showed in table 1. Patients with good Qmax group were significantly younger (table 1). Patients with good Qmax had lower scores in the total score of IPSS and voiding subscore(table 1). Nocturia as evaluated by IPSS and OABSS was more severe in patients with low Qmax group. PVR in good Qmax group was significantly less than that in low Qmax group (49.3±39.0 vs 82.7±79.6, p=0.04). However, in good Qmax group, 15.7% patients had PVR more than 100ml and 7.1% had PVR more than 200ml. More patients in low Qmax group had BOO than those in good Qmax group (48.6% vs 24.2%, p=0.03)
Conclusion:
Male OAB patients with maximal uroflow rate higher than 15ml/sec have lower PVR. Nevertheless, clinical significant high PVR might still present in patients with good flow rate. It is still necessary to measure PVR even in patients with a satisfactory uroflow rate.
Table 1 Comparison of subgroups between normal flow and low flow OAB
|
|
|
Good Qmax
|
Low Qmax
|
P value
|
|
Patient’s demographics
|
Patients(n)
|
70
|
66
|
|
|
Age(year)
|
64.7±12.7
|
72.7±8.8
|
<0.01
|
|
PSA(ng/ml)
|
2.2±1.6
|
2.7±1.9
|
0.36
|
|
Prostate size
|
39.4±18.0
|
43.6±15.4
|
0.36
|
|
Intravesical Prostate protrusion (cm)
|
0.6±0.4
|
0.7±0.4
|
0.09
|
|
Detrusor wall thickness(cm)
|
0.3±0.1
|
0.3±0.1
|
0.61
|
|
IPSS
|
Storage-subscore
|
8.2±3.1
|
9.0±3.2
|
0.25
|
|
Nocturia
|
2.5±1.3
|
3.3±1.1
|
<0.01
|
|
Voiding-subscore
|
4.8±4.5
|
7.0±4.6
|
0.01
|
|
Total
|
13.7±5.7
|
16.7±6.2
|
0.04
|
|
OABSS
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Frequency
|
1.0±0.4
|
1.0±0.4
|
0.65
|
|
Nocturia
|
2.1±0.9
|
2.6±0.6
|
<0.01
|
|
Urgency
|
3.4±1.2
|
3.7±1.1
|
0.30
|
|
Urge-incontinence
|
2.7±1.4
|
2.3±1.6
|
0.16
|
|
Total
|
9.2±2.8
|
9.5±2.5
|
0.55
|
|
Urodyanmic parameters
|
Free UFR volume(ml)
|
305.9±112.1
|
219.1±48.4
|
<0.01
|
|
Free UFR voided time
|
26.2±9.7
|
46.4±17.4
|
<0.01
|
|
PVR(ml)
|
49.3±39.0
|
82.7±79.6
|
0.04
|