老年男性前列腺术后复杂下尿路症状患者的影像尿动力学特征及病因分型特点：单中心回顾性研究

Video urodynamic characteristics and etiological patterns in elderly male patients with complex lower urinary tract symptoms after prostatic surgery: a single-center retrospective study

摘要

目的 探讨老年前列腺疾病术后下尿路症状（LUTS）患者的影像尿动力学（VUDS）特征及病因分型特点。方法 回顾性分析2024年6月-2026年5月于中国康复研究中心北京博爱医院泌尿外科收治的因前列腺疾病术后复杂 LUTS接受 VUDS检查的男性患者的临床资料，包括年龄、原发前列腺疾病、既往手术方式及次数、术后症状发生特点、主诉、VUDS诊断及临床处理方式等，并进行描述性统计。结果 共纳入50例患者，平均年龄（66.3±9.0）岁;良性前列腺增生（BPH）34例（68%），前列腺癌（PCa）16例（32%）;既往手术共70次，40例（80%）既往接受1次手术，10例（20%）接受2次及以上手术。术后新发 LUTS 26例（52%），术前LUTS持续存在24例（48%）;单一症状与复合症状各25例（50%）;中位症状数量1.5（1.0，4.0）个，中位症状持续时间2.0（1.0，6.3）年;根据主诉分为排尿困难21例（42%）、尿失禁17例（34%）、尿频12例（24%）。50例患者中，共检出110项 VUDS异常，33例（66%）检出≥2项 VUDS异常，17例（34%）检出1项异常;主要异常包括逼尿肌收缩力低下（DU）24例（48%）、膀胱容积减少16例（32%）、膀胱感觉过敏14例（28%）、膀胱顺应性降低13例（26%）、逼尿肌过度活动（DO）和尿道括约肌功能缺陷（ISD）各12例（24%），膀胱出口梗阻（BOO）10例（20%）。进一步分析不同主诉患者的主导病因发现，排尿困难患者中 DU 主导型占66.7%（14/21），高于BOO 主导型（33.3%，7/21）;尿失禁患者中ISD 主导型占70.6%（12/17）;尿频患者中感觉异常主导型占50%（6/12），高于 DO 主导型（16.7%，2/12）。按原发疾病分层后，BPH 组以排尿困难为主要主诉（52.9%，18/34），其中 DU 主导型最常见（72.2%，13/18）;PCa组以尿失禁为主要主诉（75%，12/16），其中ISD 主导型最常见（75%，9/12）。结论 老年前列腺疾病术后复杂LUTS具有明显病因异质性，开展 VUDS有助于明确尿动力学异常及病因分型。

Abstract

Objective To investigate the video-urodynamic study（VUDS）characteristics and etiological patterns in elderly male patients with complex lower urinary tract symptoms（LUTS）after prostatic surgery. Methods A retrospective analysis was performed on the clinical data of male patients with complex LUTS after prostatic surgery who underwent VUDS at our center during Jun.2024 and May 2026. Data collected included age, primary prostatic disease, previous surgical procedures and number of surgeries, symptom onset characteristics, chief complaints, VUDS findings and subsequent clinical management. Descriptive statistics were performed. Results A total of 50 patients were included, with a mean age of（66.3±9.0）years. The primary diseases were benign prostatic hyperplasia（BPH）in 34 patients（68%）and prostate cancer（PCa）in 16（32%）. The patients had undergone a total of 70 previous surgical procedures; 40 patients（80%）had undergone one procedure, whereas 10（20%）had undergone two or more. Postoperative de novo LUTS occurred in 26 patients（52%）, while preoperative LUTS persisted in 24（48%）. Both single and multiple symptoms were reported in 25 patients（50%）. The median number of symptoms was 1.5（1.0, 4.0）, and the median symptom duration was 2.0（1.0, 6.3）years. According to the chief complaints, 21（42%）patients presented with voiding difficulty, 17（34%）with urinary incontinence, and 12（24%）with urinary frequency. A total of 110 VUDS abnormalities were identified, including 33 patients（66%）with two or more abnormalities, and 17（34%）with a single abnormality. The most common abnormalities were detrusor underactivity（DU）in 24 patients（48%）, reduced bladder capacity in 16（32%）, increased bladder sensation in 14（28%）, low bladder compliance in 13（26%）, detrusor overactivity（DO）and intrinsic sphincter deficiency（ISD）in 12（24%）, and bladder outlet obstruction（BOO）in 10（20%）. Among patients with voiding difficulty, DU-predominant dysfunction was more common than BOO-predominant dysfunction [66.7%（14/21）vs. 33.3%（7/21）]. ISD-predominant dysfunction was identified in 70.6%（12/17）of patients with urinary incontinence. Among patients with urinary frequency, sensory abnormality-predominant dysfunction was more common than DO-predominant dysfunction [50%（6/12）vs. 16.7%（2/12）]. After stratification by primary disease, voiding difficulty was the most common chief complaint in the BPH group[52.9% （18/34）], with DU-predominant dysfunction being the most frequent subtype[72.2% （13/18）]. Urinary incontinence was the most common chief complaint in the PCa group [75%（12/16）], with ISD-predominant dysfunction being the most frequent subtype[75% （9/12）]. Conclusion Complex LUTS after surgery for prostatic diseases in elderly men have markedly heterogeneous etiologies. VUDS can facilitate the identification of urodynamic abnormalities and etiologic classification.

关键词

老年 / 前列腺疾病术后 / 下尿路症状 / 影像尿动力学

Key words

elderly / post-prostatic surgery / lower urinary tract symptoms / video-urodynamics

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基金资助

中国康复研究中心课题(2025ZX-03)

国家重点研发计划项目(2023YFC3605300)

国家重点研发计划项目(2023YFC3605301)

中国康复科学所中央级公益性科研院所基本科研业务费项目(CRSI2025ZD-1-7)

中国康复科学所中央级公益性科研院所基本科研业务费项目(CRSI2026BKLNB-1)