周明智高育琳Yu-Lin醫學研究所2026-10-289999-12-31https://handle.ncl.edu.tw/11296/9s6u57https://scholars.csmu.edu.tw/handle/123456789/35197研究背景：當病患的膀胱功能不良，或先天下泌尿道異常，在腎臟移植前的評估，就應包括尿路動力學檢查。腎臟移植後的膀胱不一定能正常地恢復功能，此時它可能合併發生尿失禁、頻尿、排尿困難，甚至腎水腫，造成移植腎損傷。本研究是要探討腎臟移植病患合併下尿路症狀時的尿路動力學發現。研究方法: 共有66個腎臟移植病患（男=37，女=29）發生下尿路症狀，完成國際前列腺症狀積分評量及接受尿路動力學檢查，其包括尿流速、膀胱容積壓力檢查、外括約肌肌電圖及壓力-流速檢查。結果: 頻尿是最常抱怨的下尿路症狀。國際前列腺症狀積分在男女的積分是不分上下，只有排尿症狀積分（男=9.8 vs. 女=7.1，p=0.01）是有明顯差異。尿路動力學的變項若依男女別作比較，只有最大尿流速（p=0.007）及餘尿量（p=0.04）統計上有明顯差異。若將男性腎臟移植病患依國際前列腺症狀積分大於7分及小於等於7分作比較，則最大尿流速（p=0.009），解尿量（p=0.02），最初脹尿感容積（p=0.04）及最大膀胱容積（p=0.01）在統計上有明顯差異。至於女性腎臟移植病患，依前述之國際前列腺症狀積分作比較，則所有之尿路動力學之變項皆無統計上顯著差異。結論: 合併下尿路症狀的腎臟移植病患，雖然膀胱容量及膀胱的順應性皆下降，但是仍保有可接受的最大尿流速及餘尿量。國際前列腺症狀積分對女性腎臟移植病患之下尿路症狀嚴重度而言，並不是一個好的評量表。對我們年紀稍高的腎臟移植病患群而言，膀胱出口阻塞的發生率的增高是可預期的。至於腎臟移植病患的膀胱順應性低下，對移植腎的影響及膀胱順應性本身的發展仍需要更多的觀察及研究來證實。Introduction: The indication for a pre-transplantation urodynamic study (UDS) is well-documented including defunctionalized bladders, and complex urologic histories. The resumption of bladder function after renal transplantation does not always go smoothly and it may complicate as incontinence, frequency, dysuria, or hydronephrosis. This study aims to present the urodynamic characteristics of renal transplant recipients with lower urinary tract symptoms (LUTS). Methods: A total of 66 transplant recipients with LUTS completed the International Prostate Symptom Score (I-PSS) and underwent a detailed urodynamic investigation, including uroflow, cystometry, electromyography and pressure-flow study. Patients were stratified by sexes and subgrouped by IPSS to compare the UDS parameters.Results: Frequency was the chief complaint of renal transplant recipients with LUTS. IPSS were similar in the men and women except for voiding symptoms (9.8 for men vs. 7.1 for women, p=0.01). When urodynamic parameters were compared according to sexes, maximal uroflow (p=0.007) and residual urine (p=0.04) were significantly different. When the urodynamic parameters were compared according to IPSS in men and women, respectively, maximal uroflow (p=0.009), voiding volume (p=0.02), first sensation of bladder capacity (p=0.04), and maximal bladder capacity (p=0.01) were significant for men with an IPSS>7 and for men with an IPSS≦7. However, all the comparative urodynamic parameters were insignificant for women with an IPSS>7 and for women with an IPSS≦7.Conclusions: Although Renal transplant recipients with LUTS have decreased bladder capacity and compromised bladder compliance, they still have acceptable uroflow and minimal residual urine. IPSS is not a good tool to define the severity of bladder function in female renal transplant recipients with LUTS. The incidence of bladder outlet obstruction was relatively high in our aged transplant patient pool. The fate of compromised bladder compliance in aged patients needs time to validate.thesis