The Influence Of 45 Degree Semi-reclining Position In The Cystometry In Patients With Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is a disease with high morbidity in men of middle and old age.Urodynamics can help with the clinical diagnose and treatment significantly. Position is one of the most important factors. Correlation between position and Detrusor Overactivity have been reported by researchers at home and abroad .The International Continence Society suggest using supine position in Cystometry, however, position have to be changed in Pressure-Flow Study(standing for men, sitting for women).This change could not only cause to result deviation ,but also be harmful to clinical operation . 45 degree semi-reclining position is a position between supine and sitting .Using this"one-step"position can not only avoid position changing but also readjusting of transducer ,so that we can reduce confounding factor, shorten procedure and time. The guideline of urodynamics at home have mention the use of 45 degree semi-reclining position in Cystometry ,however there is no systematic research about the influence to the reliability of Cystometry result at home and abroad .Objective: To investigate the influence of 45 degree semi-reclining position in Cystometry in patients with benign prostatic hyperplasia.Methods: Patients with benign prostatic hyperplasia were enrolled according to the inclusion and exclusion criteria. Patients enrolled were divided into two groups (A and B) randomly by Two Stage Cross-Over Design. Each patient continuously underwent CMG twice. The group A took the 45 degree semi-reclining position firstly then changed to the supine position, while the group B took the examinations contrarily.We analyze the initial Resting values for intravesical pressure,Volume Of First Sensation,Volume Of First Urge,Maximum Cystometric Capacity,Detrusor Overactivity. Questionnaire about the preference was finish. All The results were analyzed using Analysis Of Variance With Two Stage Cross-Over Design Data or Spearman's correlation coefficient by SPSS 17.0 software. Statistical significance was taken at the 5% level.Results: From Oct.2009 to Apr. 2010,43 consecutive BPH patients were enrolled from Guangzhou First Municipal Hospital Affiliated Guangzhou Medical College.21 patients were randomized to group A,22 group B. Mean age was 70.02±8.54y(47-86y),mean prostate volume was 57.29±23.07ml(22.71-126.47ml),mean total IPSS was 19.98±3.00,mean total score of storage symptoms was 9.74±1.84,mean QOL was 4.19±0.66.The results of CMG:①There was statistical difference in Initial Resting Values For Intravesical Pressure between two position(45 degree semi-reclining position 11.92±5.05cmH2O(6.00-22.00 cmH2O)vs. supine 6.33±3.03 cmH2O(2.00～14.00 cmH2O),P=0.000)②There was no statistical difference in FS between two position(45 degree semi-reclining position 106.65±50.09ml(30.00-297.00ml)vs. supine 111.49±46.08ml(27.00-223.00ml),P=0.363)③There was no statistical difference in FU between two position ( 45 degree semi-reclining position 159.65±74.69 m l(40.00-349.00ml)vs. supine 169.56±67.25ml(44.00-305.00ml),P=0.252)④There was no statistical difference in MCC between two position ( 45 degree semi-reclining position 200.44±91.83 m l(44.00-396.00ml)vs. supine 211.84±80.24ml(50.00-350.00ml),P=0.111)⑤There was statistical difference in BC between two position (45 degree semi-reclining position 85.83±41.70 ml/cmH2O(37.00-176.00 ml/cmH2O)vs. supine 99.65±49.00 ml/cmH2O(88.00-224.00 ml/cmH2O),P= 0.041)⑥There was statistical difference in DO detection between two position (45 degree semi-reclining position 37.21%vs. supine 11.63%,P=0.006).The correlation between CMG parameters and total score of storage symptoms show:①There was no significant correlation between Initial Resting Values For Intravesical Pressure and total score of storage symptoms (45 degree semi-reclining position r=0.079(P=0.614)vs. supine r=0.061(P=0.699))②There was negative significant correlation between FS and total score of storage symptoms(45 degree semi-reclining position r=-0.531(P=0.000)vs. supine r=-0.386(P=0.011))③There was negative significant correlation between FU and total score of storage symptoms(45 degree semi-reclining position r=-0.489(P=0.001)vs. supine r=-0.511(P=0.000))④There was negative significant correlation between MCC and total score of storage symptoms(45 degree semi-reclining position r=-0.617(P=0.000)vs. supine r=-0.519(P=0.000)⑤There was no significant correlation between BC and total score of storage symptoms( 45 degree semi-reclining position r=-0.164(P=0.294)vs. supine r=-0.237(P=0.125). F S,F U,M C C have negative significant correlation with total score of storage symptoms in 45 degree semi-reclining position,which is the same with supine. From the result of questionnaire, 19 patients prefer to 45 degree semi-reclining position, 14 patients prefer tosupine,6patients founded both position preferable , and 4 patients express no preference, and there is statistical difference(P=0.000).Conclusions: 45 degree semi-reclining position can influence Initial Resting Values For Intravesical Pressure,DO,BC, but have no effect on FS,FU,MCC.And FS,FU,MCC have negative significant correlation with total score of storage symptoms in 45 degree semi-reclining position , which is the same with supine. 45 degree semi-reclining position can be used as a substitution for supine in CMG. It can not only improve the detection of DO, but also be good for the operation. We suggest using 45 degree semi-reclining position in CMG.