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目的 分析良性前列腺增生 (BPH)患者出现肾积水的尿动力学机制。 方法 116例膀胱出口梗阻≥Ⅲ度的BPH患者分为 2组 ,无肾积水者 98例为甲组 ,行普通尿动力学检查 ;有肾积水者 18例为乙组 ,行影像尿动力学检查。对两组检查结果进行比较分析。 结果 甲乙两组的年龄分别为 (6 8.3± 6 .8)岁和 (70 .4± 7.8)岁。甲组梗阻度为Ⅲ、Ⅳ、Ⅴ、Ⅵ度者分别为 2 6、2 9、2 1、2 2例 ,乙组分别为 3、4、4、7例 ;两组的剩余尿量分别为 (10 1± 143)ml和 (2 43± 2 14)ml;不稳定性膀胱患者甲组为 34例 (35 % ) ,乙组为 8例 (4 4% ) ;顺应性差者甲组为 11例 (11% ) ,乙组为 16例 (89% )。所有 18例有肾积水的患者行影像尿动力学检查 ,无 1例出现膀胱输尿管返流。Logistic逐步回归统计发现 ,膀胱顺应性下降为唯一筛选出的危险因素 (P <0 .0 0 1)。 结论 BPH患者膀胱顺应性下降是导致肾积水的最重要危险因素 ,而患者的年龄、梗阻程度、剩余尿量、是否合并有不稳定膀胱以及有无膀胱输尿管返流与肾积水的出现无密切关系。
Objective To analyze the urodynamic mechanism of hydronephrosis in patients with benign prostatic hyperplasia (BPH). Methods One hundred and sixty-six BPH patients with bladder outlet obstruction ≥Ⅲdegree were divided into two groups. 98 patients without hydronephrosis were Group A, who underwent routine urodynamic examination. Eighteen patients with hydronephrosis were Group B with imaging urodynamics School inspection. The two groups of test results for comparative analysis. Results The age groups A and B were (6 8.3 ± 6.8) years old and (70.4 ± 7.8) years old respectively. A group of obstruction Ⅲ, Ⅳ, Ⅴ, Ⅵ degrees were 26,29,2 1,2 2 cases, respectively, 3,4,4,7 cases in group B; two groups of residual urine were (10 1 ± 143) ml and (2 43 ± 2 14) ml in group A, 34 cases (35%) in group A, 8 cases (4 4%) in group B, Cases (11%), Group B was 16 cases (89%). All 18 patients with hydronephrosis were examined by imaging urodynamics, and none of the patients had vesicoureteral reflux. Logistic regression analysis showed that bladder compliance decreased as the only risk factor for screening (P <0.01). Conclusions The decrease of bladder compliance is the most important risk factor of hydronephrosis in patients with BPH. The patients’ age, degree of obstruction, residual urine volume, presence of unstable bladder and the presence of vesicoureteral reflux and hydronephrosis close relationship.