攝護腺段尿道長度和角度是否為男性下泌尿道症狀的影響因子？
許自翔1、林志杰1,2,3、林登龍1,2,3
1臺北榮民總醫院 泌尿部
2國立陽明大學 醫學院 泌尿學科；3書田泌尿科學研究中心
Are Prostatic Urethral Length and Angle Influencing Factors for Male LUTS?
Tzu-Hsiang Hsu1, Chih-Chieh Lin1,2,3, Alex T.L. Lin1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, and 3Shu-Tien Urological Science Research Center, National Yang-Ming University
Purpose:
Lower urinary tract symptoms (LUTS) are the most frequently complaints among aged men. They usually result from benign prostatic hyperplasia (BPH). The prostate volume does not correlate well with the severity of symptoms. Several studies have reported the structural variations of the prostatic urethra may affect the symptoms. This study aimed to evaluate the effects of prostatic urethral angle and length on urodynamic study parameters in men with LUTS and/or BPH.
Materials and Methods:
A prospective study was conducted of 20 men with BPH/LUTS from July to October in 2017. Body height, body weight, body mass index (BMI), prostatic specific antigen (PSA) and three questionnaires including international prostate symptom score (IPSS), urogenital distress inventory (UDI-6) and overactive bladder symptom Scores (OABSS) were obtained for each patients. The urodynamic studies including uroflowmetry, cystometrogram (CMG), pressure flow studies, external sphincter electromyogram (EMG) and urethral pressure profile were performed to access the complaints of patient objectively. Prostate volume, transitional zone volume, transitional zone-to-total volume ratio, prostatic urethral length (PUL), prostatic urethral angle (PUA) and PUL-to-volume ratio (rPUL) were measured by transrectal ultrasonography (TRUS). The correlations between prostate-related variables and LUTS parameters were then investigated.
Results:
The mean age was 63.3±11.5 years. The serum PSA level was 1.2±1.0 ng/ml. The mean prostate volume was 28.6±11.1 ml (range, 14.3 to 50.2 ml) and the transitional zone volume was 8.6±6.3 ml. The mean PUA and PUL were 40.2±23.4° (range, 4.3 to 73.7°) and 39.8±7.82 mm (range, 28.6 to 53.4 mm), respectively. The mean IPSS was 20.6±6.3 and Qmax was 12.5±5.3 ml/s. The PUA had a significant negative correlation with Qmax (p=0.05). In addition, strong positive correlation was noted between PUA and PUL (p=0.001). No statistically significant correlation was found between PUA/PUL and IPSS or other urodynamic study parameters.
Conclusions:
The results of our study showed that the PUA is significantly associated with Qmax. This finding suggested PUA should be considered as an influencing factor for male LUTS with prostate volume < 50 ml.