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目的探讨经直肠三维超声测量膀胱逼尿肌厚度(detrusor wall thickness,DWT)对前列腺增生所致膀胱出口梗阻(bladder outlet obstruction,BOO)的临床意义。方法将有下尿路症状的良性前列腺增生患者分为膀胱出口梗阻组、非膀胱出口梗阻组和正常对照组,比较组间的DWT与年龄、最大尿流率、残余尿量、及其与国际前列腺症状评分的差异。结果膀胱出口梗阻组DWT(3.5±0.9)mm明显高于非梗阻组(1.8±0.4)mm和正常对照组(1.6±0.3)mm,P<0.01,有统计学意义。逼尿肌厚度与最大尿流率呈负相关(r=-0.71,P<0.01),与残余尿量正相关(r=0.60,P<0.01),与国际前列腺症状评分正相关(r=0.54,P<0.01)。以逼尿肌厚度≥2.9mm为标准诊断BOO的准确率为92.2%(83/90),假阳性率为3.3%(2/60),假阴性率为16.7%(5/30)。结论经直肠三维超声测量DWT可作为预测BOO的重要指征之一。
Objective To investigate the clinical significance of detrusor wall thickness (DWT) in the diagnosis of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia by transrectal three-dimensional ultrasonography. Methods Benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms were divided into bladder outlet obstruction group, non-bladder outlet obstruction group and normal control group. DWT and age, maximal uroflow rate and residual urine volume were compared between the two groups. Differences in prostate symptom scores. Results DWT (3.5 ± 0.9) mm in bladder outlet obstruction group was significantly higher than that in non-obstructive group (1.8 ± 0.4) mm and normal control group (1.6 ± 0.3) mm, P <0.01. The detrusor muscle thickness was negatively correlated with the maximal uroflow rate (r = -0.71, P <0.01), positively correlated with residual urine volume (r = 0.60, P <0.01) and positively correlated with the International Prostate Symptom Score , P <0.01). The diagnostic accuracy of BOO was 92.2% (83/90) with detrusor muscle thickness≥2.9mm, the false positive rate was 3.3% (2/60) and the false negative rate was 16.7% (5/30). Conclusion Transrectal three-dimensional ultrasound DWT can be used as one of the important indications for predicting BOO.