Prestatism이 있는 50세 이상의 남성에서 방광 수축력 저하의 빈도
Incidence of Detrusor Underactivity in Men with Prostatism Older than 50 years
박흠례, 심강수, 최종상,
소속 상세정보
박흠례 ( )
고려대학교 의과대학 비뇨기과학교실
심강수 ( )
고려대학교 의과대학 비뇨기과학교실
최종상 ( )
고려대학교 의과대학 비뇨기과학교실
KMID : 0358319990400030347
Abstract
결론
전립선증을 호소하는 96명의 남성에 대한 요역동학 검사 결과 37%에서 방광 수축력 저하
가 관찰되었으며 이들은 폐색이 확인된 환자군과 요역학검사를 제외한 다른 임상지표에서
큰 차이가 없었다. 따라서 전립선증을 호소하는 환자에서 통상적인 방법(증상점수, 요류측정
술, 전립선용적 등)으로는 방광 수축력 저하와의 감별이 어렵다고 본다. 방광출구폐색 환자
에 비해 방광 수축력 저하를 보이는 환자에서 TURP 후에도 증상의 호전이 저조한 사실을
고려할 때 침습적인 치료를 예정하거나 보존적인 방법으로 치료해도 배뇨증상의 호전이 없
을 경우 배뇨압-요류 동시측정에 의한 요역동학 검사가 필요할 것으로 본다.
Purpose: It has been well known that 70-80% of men with prostatism actually
manifest bladder outlet obstruction(BOO) and the rest have detrusor underactivity(DU)
or other abnormalities. Accordingly, the treatment of BPH by the results of symptom
score, or uroflow may be partly incorrect. It is also well known that the pressure-flow
study is the gold-standard to define the presence and degree of BOO. Therefore, we
investigated pressure-flow study to identify non-obstructed, underactive detrusor
function among the patients presented with prostatism.
Materials and Methods: This study included 96 patients older than 50 years (mean
69.6±5.8) with prostatism. All patients were assessed by history taking, symptom score,
digital rectal examination, uroflowmetry and pressure-flow study. Patients were divided
into irritative and obstructive symptom groups according to their chief complaints.
Urodynamic parameters between those two groups were analyzed and compared.
Results: Of the total 96 patients, detrusor instability was noted in 45(47%) at the
filling cystometry. Of the 53 patients presented with irritative symptoms, 33 showed
detrusor instability(62%); Of the 43 patients mainly presented with obstructive
symptoms, only 12(28%) showed detrusor instability Statistically significant correlation
was found between irritative symptoms and detrusor instability as well as obstructed
symptoms and BOO. In the total patients, BOO was found in 49(51%) and detrusor
underactivity(DU) was found in 36(37%) with equivocal cases in 11(12%). Of the 43
patients mainly presented with obstructive symptoms, BOO and DU was found in
23(53%) and 13(30%) respectively. Of the 53 patients presented with irritative symptoms,
BOO and DU was found in 26(49%) and 23(43%) respectively. There were no significant
differences between irritative and obstructive symptom group as well as BOO and DU
group in the clinical parameters as determined by symptom score, prostate size, and
uroflowmetry.
Conclusions: In this study, significant proportion(37%) of the whole patient population
was classified as detrusor underactivity as diagnosed by urodynamics to which
treatment for BPH may not be as effective as for those manifested with BOO. It is
suggested that pressure-flow study is to be considered to patients with prostatism who
didn't show any symptomatic improvement despite the treatment for BPH.
키워드
Benign prostatic hyperplasia; Detrusor underactivity; Pressure-flow study;
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