nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2006-10-4-87-92nefr-705Research ArticleЖУРНАЛ В ЖУРНАЛЕ. АКТУАЛЬНЫЕ ПРОБЛЕМЫ УРОЛОГИИJOURNAL IN THE JOURNAL. ACTUAL PROBLEMS OF UROLOGYСОКРАТИМОСТЬ МОЧЕВОГО ПУЗЫРЯ У БОЛЬНЫХ ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИЕЙ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫCONTRACTILITY OF THE BLADDER IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIAАмдийР. Э.AmdyR. E.

кафедра урологии

Санкт-Петербургский государственный медицинский университет им. акад. И. П. ПавловаRussian Federation2006100420061048792Copyright © Амдий Р.Э., 20062006Амдий Р.Э.Amdy R.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/705

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценка сократимости детрузора у больных доброкачественной гиперплазией предстательной железы (ДГПЖ). ПАЦИЕНТЫ И МЕТОДЫ. Для определения сократимости детрузора, 540 больным ДГПЖ, средний возраст 64,1±0,7 лет, было проведено комплексное урологическое обследование, включавшее уродинамическое исследование с выполнением урофлоуметрии и микционной цистометрии (исследование «давление-поток»). Интерпретацию результатов микционной цистометрии проводили по номограмме W. Shafer, также был определен индекс опорожнения мочевого пузыря как процентное отношение объема мочеиспускания к максимальной цистометрической емкости мочевого пузыря. РЕЗУЛЬТАТЫ. Снижение сократимости детрузора было выявлено у 61,7% обследованных больных ДГПЖ. Результаты определения сократимости мочевого пузыря по номограмме Шафера зависят от степени инфравезикальной обструкции (ИВО). Индекс опорожнения мочевого пузыря не зависит от наличия и степени ИВО и характеризует как степень опорожнения мочевого пузыря так и длительность сокращения. Наличие такой сопутствующей патологии, как остеохондроз поясничного отдела позвоночника и сахарный диабет, ухудшают опорожнение мочевого пузыря. Оценка сократимости достоверно может быть проведена только на основе уродинамического исследования, т.к. при оценке сократимости детрузора результаты общепринятого обследования больных ДГПЖ малоинформативны. ЗАКЛЮЧЕНИЕ. У значительного количества больных ДГПЖ нарушение функции нижних мочевых путей обусловлено не наличием инфравезикальной обструкции, а снижением сократимости мочевого пузыря, что следует учитывать при определении тактики лечения.

THE AIM of the investigation was to assess the detrusor contractility in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS. Complex urological examination was performed in 540 BPH patients (mean age 64.1±0.7 years) in order to determine the detrusor contractility. It included urodynamic investigation with uroflowmetry and urination cystometry (investigation «pressure-flow»). Interpretation of the results of urination cystometry was made by the W.Shafer nomogram, the index of the bladder emptying was determined as a percent ratio of the urination volume to maximal cytometric bladder capacity. RESULTS. Decreased detrusor contractility was detected in 61.7% of BPH patients examined. Results of the determination of bladder contractility by W.Shafer nomogram depend on the degree of infravesical obstruction (IVO). The bladder emptying index does not depend on IVO or its degree and characterize both the bladder emptying degree and the duration of contraction. Such coexisting pathologies as ostechondrosis of the lumbar part of the spine and diabetes mellitus make the bladder emptying worse. The contractility can be reliably estimated but on the basis of a urodynamic investigation because the results of the generally used examination of BPH patients for the estimation of detrusor contractility are insufficiently informative. CONCLUSION. In a considerable number of BPH patients the impaired function of the lower urinary tracts is dependent on decreased contractility of the bladder rather than on infravesical obstruction, that must be taken into account in the decision on the treatment strategy.

доброкачественная гиперплазия предстательной железыуродинамические исследованиясократимость детрузораbenign prostatic hyperplasiaurodynamic investigationsdetrusor contractilityReferencesThomas AW, Cannon A, Bartlett E et al. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with minimum 10-year urodynamic follow-up. BJU International 2004; 93:745-750Thomas AW, Cannon A, Bartlett E et al. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with minimum 10-year urodynamic follow-up. BJU International 2004; 93:745-750Abrams P, Cardozo L, Fall M et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodynam 2002; 21 (2): 167-178Abrams P, Cardozo L, Fall M et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodynam 2002; 21 (2): 167-178Shafer W. Basic principles and clinical application of advanced analysis of bladder voiding function. Urol Clin North Am 1990; 17 (2): 553-566Shafer W. Basic principles and clinical application of advanced analysis of bladder voiding function. Urol Clin North Am 1990; 17 (2): 553-566Abrams P. Bladder outlet obstruction index, blader contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU International 1999; 84: 745-750Abrams P. Bladder outlet obstruction index, blader contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU International 1999; 84: 745-750Schafer W, Abrams P, Liao L et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 2002; 21(3): 261-74Schafer W, Abrams P, Liao L et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 2002; 21(3): 261-74Kaplan SA, Te AE, Blaivas JG. Urodynamic findings in patients with diabetic cystopathy. J Urol 1995; 153: 342–344Kaplan SA, Te AE, Blaivas JG. Urodynamic findings in patients with diabetic cystopathy. J Urol 1995; 153: 342–344Yamamoto T, Sakakibara R, Uchiyama T et al. Neurological diseases that cause detrusor hyperactivity with impaired contractile function. Neurourol Urodyn 2006; 25 (2): 119-123Yamamoto T, Sakakibara R, Uchiyama T et al. Neurological diseases that cause detrusor hyperactivity with impaired contractile function. Neurourol Urodyn 2006; 25 (2): 119-123Chancellor MB, Rivas DA, Keeley F et al. Similarity of the American Urological Association symptom index among men with benign prostatic hyperplasia, urethral obstruction not due to BPH and detrusor instability without bladder outlet obstruction. Br J Urol 1994; 74 (2): 200-203Chancellor MB, Rivas DA, Keeley F et al. Similarity of the American Urological Association symptom index among men with benign prostatic hyperplasia, urethral obstruction not due to BPH and detrusor instability without bladder outlet obstruction. Br J Urol 1994; 74 (2): 200-203Hindley RG, Brierly RD, McLarty E et al. A qualitative ultrastructural study of the hypocontractile detrusor. J Urol 2002;168(1): 126-131Hindley RG, Brierly RD, McLarty E et al. A qualitative ultrastructural study of the hypocontractile detrusor. J Urol 2002;168(1): 126-131Steele GS, Sullivan MP, Sleep DJ, Yalla SV. Combination of symptom score, flow rate and prostate volume for predicting bladder outflow obstruction in men with lower urinary tract symptoms. J Urol 2000; 164 (2): 344-348Steele GS, Sullivan MP, Sleep DJ, Yalla SV. Combination of symptom score, flow rate and prostate volume for predicting bladder outflow obstruction in men with lower urinary tract symptoms. J Urol 2000; 164 (2): 344-348Chancellor MB, Blaivas JG, Kaplan SA, Axelrod S. Bladder outlet obstruction versus impaired detrusor contractility: the role of outflow. J Urol 1991; 145(4): 810-812Chancellor MB, Blaivas JG, Kaplan SA, Axelrod S. Bladder outlet obstruction versus impaired detrusor contractility: the role of outflow. J Urol 1991; 145(4): 810-812Van Venrooij GE, Eckhardt MD, Boon TA. Data from frequency-volume charts versus maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility grade in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Neurourol Urodyn 2002; 21(5): 450-456Van Venrooij GE, Eckhardt MD, Boon TA. Data from frequency-volume charts versus maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility grade in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Neurourol Urodyn 2002; 21(5): 450-456

The authors declare that there are no conflicts of interest present.