下泌尿道症狀之非侵入式檢測

Abstract

下泌尿道症狀可分為膀胱儲存症狀及膀胱排空症狀。膀胱儲存症狀包含頻尿、急尿、夜尿；膀胱排空症狀則包含排尿遲緩、尿流細小、尿流間斷、及殘尿感。不只是中老年的男性才會患有此病症，許多兒童與婦女亦為此病所困擾。 下泌尿道症狀主要病因為良性攝護腺腫大及逼尿肌衰弱或不穩定。良性攝護腺腫大為一高流行率之男性疾病，主要是在老化過程中，攝護腺組織的良性增生，導致攝護腺日益肥大而逐漸壓迫到尿道，致使部分尿道截面積縮小，阻力增加，進而影響排尿的順暢。逼尿肌衰弱可能源於老化或其他相關症狀引起，導致膀胱收縮力不足而影響排尿。這兩項病因可能單獨或同時發生。為了診斷出正確的病因，醫生常常需要對病人進行壓力尿流研究。壓力尿流研究能夠直接量測出膀胱內壓力，再對照尿流速，便可判斷造成下泌尿道症狀之原因。但此研究中包含一些侵入性的檢測，除了過程帶來的不適，尿道內有插管時所量測到的膀胱壓力亦存在誤差的可能性，加上尿道感染的風險，往往使病人受測意願低落，使得醫生無法進行準確的判斷。 本研究旨在開發一舒適、非侵入式之量測裝置，提供下泌尿道症狀病患進行檢測並幫助醫生準確診斷。由於主要病因有兩個，本研究中以膀胱內壓力作為逼尿肌衰弱之代表參數，以攝護腺包圍之尿道段內徑作為攝護腺肥大之代表參數。主要開發方式為設計一動態式的裝置，於排尿時裝置於病患陰莖前端，透過適度裝置之變化，於排尿過程中改變病患排尿之流體力學特性，從而量測到兩項不同之尿流率，最後透過二元多次方程式之求解求出膀胱內壓力及攝護腺包圍之尿道段內徑。結果顯示裝置成功的於排尿過程中自動影響並改變尿流特性，裝置變化前後之尿流率亦如預期般量得。最後部分之膀胱內壓力與尿道內徑之推算尚在測試階段，需要更多臨床數據協助修正。

Lower urinary tract symptoms (LUTS) are a common disease which is used to be known as prostatism. Not only older men undergo these symptoms, some children and women also suffer the problem. Symptoms can be categorized into irritative symptoms (or storage symptoms) and obstructive symptoms (or voiding symptoms). Irritative symptoms include frequency, urgency, nocturia, and obstructive symptoms include hesitancy, small caliber of urine, intermittency, residual urine sensation. LUTS is majorly caused by prostate hyperplasia and weakening of the detrusor. Benign prostate hyperplasia (BPH) is a common disease which is highly prevalent in elderly male. During the aging process, benign hyperplasia of prostatic tissue creates additional pressure to the urethra which increases total resistance of voiding. Furthermore, serious prostatic hyperplasia will cause bladder outlet obstruction (BOO). Weakening of the detrusor can be reasoned by aging or some unknown detrusor diseases. Decreased bladder contractility provides lower pressure and causes poor urine flow. This two factors can occur simultaneous or independently. To ascertain the causes doctors need to perform a conventional treatment called pressure flow study (PFS) which including invasive treatment that may bring some side effects. The uncomfortableness and the risks of side effects considerably lower patients’ will to receive the treatment. This research aims to develop a comfortable, noninvasive measurement for patients who suffer LUTS. Consider two factors are to be determined, the main idea is to design a dynamic device to measure two different flow rates which provides data to calculate unknowns. Activation mechanism was applied to achieve the goal of changing flow characteristic of voiding process. Therefore, different flow rates can be measured in a single urine void. Results showed that the device successfully varied the fluid mechanics of voiding and two different flow rates were measured. Human experiments further proofed the efficacy of device. This measurement is non-invasive, comfortable, easy to operate and without any side effect. Future work includes calculation of bladder pressure and prostate characteristics. Clinical data are needed to demonstrate efficacy.