nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2005-9-2-112-116nefr-769Research ArticleЖУРНАЛ В ЖУРНАЛЕ. АКТУАЛЬНЫЕ ПРОБЛЕМЫ УРОЛОГИИJOURNAL IN THE JOURNAL. ACTUAL PROBLEMS OF UROLOGYОПРЕДЕЛЕНИЕ ИНФРАВЕЗИКАЛЬНОЙ ОБСТРУКЦИИ ПРИ КОМПЛЕКСНОЙ ОЦЕНКЕ РЕЗУЛЬТАТОВ ОБСЛЕДОВАНИЯ У БОЛЬНЫХ ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИЕЙ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫDETERMINATION OF INFRAVESICAL OBSTRUCTION IN COMPLEX ASSESSMENT OF RESULTS OF EXAMINATION IN PATIENTS WITH BENIGN HYPERPLASIA OF THE PROSTATEАмдийР. Э.AmdyR. E.

Кафедра урологии

Санкт-Петербургский государственный медицинский университет им. акад. И. П. ПавловаRussian Federation20051002200592112116Copyright © Амдий Р.Э., 20052005Амдий 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/769

ЦЕЛЬ ИССЛЕДОВАНИЯ. Повышение надежности оценки наличия и степени инфравезикальной обструкции (ИВО) у больных доброкачественной гиперплазией предстательной железы (ДГПЖ) на основе общепринятых методик урологи ческого обследования. ПАЦИЕНТЫ И МЕТОДЫ. 80 больным ДГПЖ, средний возраст 58,2±2,1 лет, было проведено обследование, включавшее оценку жалоб по шкале IPSS, ультразвуковое исследование с определением размеров простаты и количества остаточной мочи и уродинамическое исследования, включавшее проведение урофлоуметрии и микционной цистометрии (исследование «давлениепоток»). РЕЗУЛЬТАТЫ. На основании оценки симптомов ДГПЖ, размеров предстательной железы, количества остаточной мочи и максимальной объемной скорости мочеиспускания не всегда можно судить об особенностях нарушения функции нижних мочевых путей у больных ДГПЖ, в т.ч. и о наличии и степени ИВО. В связи с чем была разработана формула для комплексной оценки клинических показателей для более точного и надежного определения наличия ИВО: D1=0,818×SMAX+0,0006×SMIN+0,215×QMAX0,478×QAVER , где D1– дискриминантная функция; SMAX–максимальный линейный размер предстательной железы; SMIN– минимальный линейный размер предстательной железы; QMAX– максимальная объемная скорость мочеиспускания; QAVER– средняя объемная скорость мочеиспускания. При значении D1 ≥ 2,85 определяется ИВО, при D1 <2,85 более вероятно отсутствие ИВО. ЗАКЛЮЧЕНИЕ. Разработанная нами формула позволяет с более высокой точностью и надежностью по сравнению с изолированной оценкой клинических показателей диагностировать ИВО у больных ДГПЖ.

THE AIM of the investigation was to increase reliability of the assessment of the presence and degree of infravesical obstruction (IVO) in patients with benign hyperplasia of the prostate (BHP) on the basis of common methods of urologic examination. PATIENTS AND METHODS. Eighty BHP patients, mean age 58.2±2.1 years, were examined. The examination included the assessment of complains by the IPSS score, ultrasonic investigation with determination of the prostate size and amount of the residual urine and urodynamic investigation including uroflowmetry and miction cystometry («pressureflow» investigation). RESUILTS. The assessment of BHP symptoms, the prostate size, quantity of residual urine and maximal volume rate of urination can not always speak of peculiarities of the disturbances of functions of the lower urinary pathways in BHP patients, the presence and degree of IVO included. So, a formula was developed for a complex estimation of clinical indices for more exact and reliable determination of the IVO presence: D1 =0.818× Smax +0.0006×Smin+0.215× Qmax 0.478× Qaver , where D1 is the discriminant function; Smax is the maximal linear size of the prostate; Qmax  is the maximal volume rate of urination and Qaver is the average rate of urination.In D1 ≥2.85 IVO can be determined, in D1<2.85 IVO is more likely to be absent. CONCLUSION. The developed formula allows a more exact and reliable diagnosis of IVO in BHP patients as compared to the isolated assessment of clinical indices.

доброкачественная гиперплазия предстательной железыуродинамические исследованияинфравезикальная обструкцияbenign prostate hyperplasiaurodynamic investigationsinfravesical obstructionReferencesHomma Y. Pressureflow studies in benign prostatic hyperplasia: to do or not to do for the patient? Br J Urol Int 2001; 87 (1): 1923Homma Y. Pressureflow studies in benign prostatic hyperplasia: to do or not to do for the patient? Br J Urol Int 2001; 87 (1): 1923Mashino R, Kakizaki H, Ameda K et al. Detrusor instability with equivocal obstruction: A predictor of unforable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodynam 2002; 21 (5): 444449Mashino R, Kakizaki H, Ameda K et al. Detrusor instability with equivocal obstruction: A predictor of unforable symptomatic outcomes after transurethral prostatectomy. Neurourol Urodynam 2002; 21 (5): 444449Hakenberg OW, Pinnock CB, Marshall VR. Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy : analysis of variables relevant for outcome. Br J Urol Int 2003; 91 (4): 375 379Hakenberg OW, Pinnock CB, Marshall VR. Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy : analysis of variables relevant for outcome. Br J Urol Int 2003; 91 (4): 375 379Porru D, Jallous H, Cavalli V et al. Prognostic value of a combination of IPSS, flow rate and residual urine volume compared to pressureflow studies in the preoperative evaluation of symptomatic BPH. Eur Urol 2002; 41 (3): 246 249Porru D, Jallous H, Cavalli V et al. Prognostic value of a combination of IPSS, flow rate and residual urine volume compared to pressureflow studies in the preoperative evaluation of symptomatic BPH. Eur Urol 2002; 41 (3): 246 249Rodrigues P, Lucon AM, Campos Freire G, Arap S. Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection. J Urol 2001; 165 (2): 499502Rodrigues P, Lucon AM, Campos Freire G, Arap S. Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection. J Urol 2001; 165 (2): 499502Blaivas JG, Appel RA, Leach G et al. Definition and classification of urinary incontinence : recommendations of the Urodynamic Society. Neurourol Urodynam 1997; 16 (3): 149151Blaivas JG, Appel RA, Leach G et al. Definition and classification of urinary incontinence : recommendations of the Urodynamic Society. Neurourol Urodynam 1997; 16 (3): 149151Shafer W. Basic principles and clinical application of advanced analysis of bladder voiding function. Urol Clin North Am 1990; 17 (2): 553566Shafer W. Basic principles and clinical application of advanced analysis of bladder voiding function. Urol Clin North Am 1990; 17 (2): 553566Abrams P. In support of pressure flow studies for evaluating men with lower urinary tract symptoms. Urol 1994; 44 (2): 153158Abrams P. In support of pressure flow studies for evaluating men with lower urinary tract symptoms. Urol 1994; 44 (2): 153158Chancellor MB, Rivas DA, Keeley FX 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): 200203Chancellor MB, Rivas DA, Keeley FX 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): 200203Rosier P, de la Rosette J. Is there correlation between prostate size and bladder outlet obstruction. World J Urol 1995; 13 (1): 913Rosier P, de la Rosette J. Is there correlation between prostate size and bladder outlet obstruction. World J Urol 1995; 13 (1): 913Steele 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 348Zhang P, Wu Z, Gao J. Influence of bladder outlet obstruction and detrusor contractility on residual urine in patients with benign prostatic hyperplasia. Chin Med J 2003; 116 (10): 15081510Zhang P, Wu Z, Gao J. Influence of bladder outlet obstruction and detrusor contractility on residual urine in patients with benign prostatic hyperplasia. Chin Med J 2003; 116 (10): 15081510Grino PB et al. Maximum urinary flow rate by uroflowmetry: automatic or visual interpretation. J Urol 1993; 149 (2): 339341Grino PB et al. Maximum urinary flow rate by uroflowmetry: automatic or visual interpretation. J Urol 1993; 149 (2): 339341АльШукри СХ, Амдий РЭ, Горбачев АГ, Кузьмин ИВ. Оценка результатов урофлоуметрии. IX Всерос. съезд урологов. Материалы. М., 1997: 2425АльШукри СХ, Амдий РЭ, Горбачев АГ, Кузьмин ИВ. Оценка результатов урофлоуметрии. IX Всерос. съезд урологов. Материалы. М., 1997: 2425Абоян ИА, Головко СЮ, Хитарьян АГ и др. Шкала диагностики инфравезикальной обструкции у больных с доброкачественной гиперплазией простаты. Урол и нефрол 1998; (6): 32 37Абоян ИА, Головко СЮ, Хитарьян АГ и др. Шкала диагностики инфравезикальной обструкции у больных с доброкачественной гиперплазией простаты. Урол и нефрол 1998; (6): 32 37Van Venrooij GE, Boon TA. The value of symptom score, quality of life score, maximal urinary flow rate, residual volume and prostate size for diagnosis of obstructive benign prostatic hyperplasia: a urodynamic analysis. J Urol 1996; 155 (6): 20142018Van Venrooij GE, Boon TA. The value of symptom score, quality of life score, maximal urinary flow rate, residual volume and prostate size for diagnosis of obstructive benign prostatic hyperplasia: a urodynamic analysis. J Urol 1996; 155 (6): 20142018Madersbacher S, Klinger HC, Djavan B et al. Is obstruction predictable by clinical evaluation in patients with lower urinary tract symptoms? Br J Urol 1997; 80 (1): 7277Madersbacher S, Klinger HC, Djavan B et al. Is obstruction predictable by clinical evaluation in patients with lower urinary tract symptoms? Br J Urol 1997; 80 (1): 7277Kuo HC. Clinical prostate score for diagnosis of bladder outlet obstruction by prostate measurements and uroflowmetry. Urol 1999; 54 (1): 9096Kuo HC. Clinical prostate score for diagnosis of bladder outlet obstruction by prostate measurements and uroflowmetry. Urol 1999; 54 (1): 9096

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