河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (12): 1479-1484.doi: 10.3969/j.issn.1007-3205.2022.12.022

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后尿道弯曲角度对尿流率的影响及预测下尿路症状患者膀胱出口梗阻的意义

  

  1. 1.首都医科大学附属天坛医院超声科，北京 100069；2.河北医科大学第二医院泌尿外科，河北 石家庄 050000

  • 出版日期:2022-12-25 发布日期:2023-01-11
  • 作者简介:贾旭东（1986-），男，河北石家庄人，首都医科大学附属天坛医院主治医师，医学学士，从事医学影像学研究。
  • 基金资助:
    北京青年科技课题（20200964）

Effect of posterior urethral curvature angle on urine flow rate and its significance in predicting bladder outlet obstruction in patients with lower urinary tract symptoms

  1. 1.Department of Ultrasonography, Tiantan Hosptial Affiliated to Capital Medical University, 
    Beijing 100069, China; 2.Department of Urology, the Second Hospital of 
    Hebei Medical University, Shijiazhuang 050000, China
  • Online:2022-12-25 Published:2023-01-11

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摘要： 目的 研究利用后尿道弯曲角度（posterior urethral curvatyre,PUC）评估良性前列腺增生（benign prostatic hyperplasia，BPH）所致膀胱出口梗阻（bladder outlet obstruction，BOO）的临床价值。
方法 纳入于河北医科大学第二医院泌尿外科的男性患者253例。根据患者是否合并下尿路症状（lower urinary tract symptoms,LUTS），将其分为LUTS组（193例）和对照组（60例）。经盆底超声采集所有入组人群的PUC。收集的资料包括前列腺总体积（total prostate volume，TPV）、移行区体积（transition zone volume，TZV）、移行区指数（transition zone index，TZI）、前列腺突出膀胱程度（intravesical prostatic protrusion，IPP）、前列腺尿道角（Prostatic urethral angle，PUA）、前列腺特异性抗原（prostatic specific antigen，PSA）、前列腺症状评分（international prostate symptom score，IPSS）及尿道长度（Urethral length，UL）。利用尿动力学检测仪采集最大尿流率Qmax及膀胱出口梗阻指数（bladder outflow obstruction Index，BOOI）。通过ROC曲线进一步分析应用PUC来预测BOOI的敏感度、特异度及分界点。利用多元线性回归分析TPV、TZV、TZI 、IPP、PUA、PUC、UL、PSA、Qmax、IPSS等因素对BOOI的影响。
结果 数学模拟显示，当后尿道弯曲角从0 °增加到90 °时，尿流率下降约50.9%；当后尿道角从30 °增加到90 °时，尿流率下降超过27%。PUC诊断BOO的曲线下面积为0.867，诊断BOO的最佳PUC值为48 °，敏感度为88.1%，特异度为75.8%。对比PUC≤48 °组与PUC＞48 °组，PUC大的患者，TPV、TZV、TZI、IPP、PUA、IPSS更大，Qmax更低（P＜0.05）。PUC与TPV（r=0.268，P＜0.001）、TZV（r=0.257，P＜0.001）、TZI（r=0.241，P＜0.001）、IPP（r=0.305，P＜0.001）、PUA（r=0.335，P＜0.001）、IPSS（r=0.357，P＜0.001）、BOOI（r=0.154，P=0.014）显著相关。PUC与Qmax（r=-0.358，P＜0.001）显著负相关。多元线性回归分析表明TPV、TZV、Qmax、PUA、PUC是BOOI的主要影响因素。
结论 在该理论模型中， PUC与尿流率呈负相关。PUC与TPV、TZV、TZI、IPP、PUA、IPSS呈正相关，与Qmax呈负相关，这可能使PUC成为评估LUTS的新指标。


关键词: 膀胱颈梗阻, 超声检查, 后尿道弯曲角

Abstract: Objective To study the clinical value of posterior urethral curvature (PUC) in evaluating bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH). 
Methods A total of 253 male patients treated in the Department of Urology,the Second Hospital of Hebei Medical University were enrolled in this study. According to presence or absence of lower urinary tract symptoms (LUTS), the patients were divided into LUTS group (n=193) and control group (n=60). The PUC of all enrolled people was collected by pelvic floor ultrasound. The data collected included total prostate volume (TPV), transition zone volume (TZV), transition zone index (TZI), degree of intravesical prostatic protrusion (IPP), prostate urethral angle (PUA), prostatic specific antigen (PSA), international prostate symptom score (IPSS) and urethral length (UL). The maximum urinary flow rate (Qmax) and bladder outlet obstruction index (BOOI) were collected with the urodynamic detector. The sensitivity, specificity and cut-off point of PUC in predicting BOOI were further analyzed by receiver operating characteristic (ROC) curve. Multiple linear regression was used to analyze the impact of TPV, TZV, TZI, IPP, PUA, PUC, UL, PSA, Qmax and IPSS on BOOI. 
Results The mathematical simulation showed that when the PUC angle increased from 0 °to 90 °, the urinary flow rate decreased by 50.9%. When the PUC angle increased from 30 ° to 90 °, the urinary flow rate decreased by 27%. The area under the ROC curve of PUC in diagnosing BOOI was 0.867. The optimal PUC value for diagnosing BOO was 48 °, the sensitivity was 88.1%, and the specificity was 75.8%. Based on comparison between PUC ≤48 ° group and PUC ＞48 ° group, patients with large PUC had larger TPV, TZV, TZI, IPP, PUA, IPSS and lower Qmax (P＜0.05). PUC was significantly correlated with TPV (r=0.268, P＜0.001), TZV (r=0.257, P＜0.001), TZI (r=0.241, P＜0.001), IPP (r=0.305, P＜0.001), PUA (r=0.335, P＜0.001), IPSS (r=0.357, P＜0.001), and BOOI (r=0.154, P=0.014). PUC was negatively correlated with Qmax (r=-0.358, P＜0.001). Multiple linear regression analysis showed that TPV, TZV, Qmax, PUA and PUC were the major influencing factors of BOOI. 
Conclusion In this theoretical model, PUC is negatively correlated with urinary flow rate. PUC is positively correlated with TPV, TZV, TZI, IPP, PUA, IPSS, and negatively correlated with Qmax, which may make PUC a new indicator for evaluating LUTS.


Key words: urinary bladder neck obstruction, ultrasonography, posterior urethral curvatyre

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