膀胱出口阻塞症狀（ＢＯＯ）是一種常見的老年疾病，而現今在臨床上的診斷依據卻又都是用非侵入式的檢測方式，這不僅影響病人的身心健康，還會有感染傳染病的危險。因此，本文的目的是希望能夠利用數值方法發展一套非侵入式的診斷方法來協助醫師診斷膀胱出口阻塞症狀。
本文的研究方法，著重在找出尿道流場中影響壓力損失的最主要因素，我們先建立起尿道的計算網格，利用計算流體力學算出尿道內的流場，壓力分布，在配以實驗驗證我們的數值結果，最後利用這些結果找出一個無因次參數圖來診斷膀胱出口阻塞症狀。

在數值方法上，我們是採用三維的非正交（non-orthogonal）非交錯的網格來處理複雜的幾何外型，並且採用Hybrid的方法來解我們的流場，在壓力修正項方面，我們是採用Simple的方法來避開棋盤狀的速度場和壓力場，另外再以 紊流模式配合壁面函數做為紊流流場的計算。

實驗上，我們模擬了一個五倍大的尿道模型，並配以不同阻塞程度，阻塞外型來做實驗，並以計算流體力學驗證之。

根據我們計算和實驗的結果，我們得知在沒有阻塞的尿道流場內，摩擦損失（Major loss）是影響壓力損失最主要的因素；而在輕微阻塞的尿道流場內，磨差損失（Major loss）及阻塞段幾何外型改變，面積改變的能量損失（Minor loss）都影響很大；而在較為嚴重的阻塞情況下，阻塞段的外型，最小截面積等影響能量損失甚為巨大，另外我們根據計算的結果發展出一個無因次參數圖，我們選用了Reynolds number和 來做參數，結果發現這樣不僅可以把阻塞和未阻塞的病例分清，甚至能判斷逼尿肌無力等症狀。

In the present study, the aim is to develop a non-invasive measurement technique to diagnose patients having Bladder Outlet Obstruction(BOO). This is achieved by identifying major causes of the pressure loss in the lower urinary system by experimental and CFD methods. Computational fluid dynamics is used to compute the pressure distribution within the urinary system to determine the bladder pressure. This will help to diagnose the symptom of BOO.
It is found that the pressure loss in the unobstructed case is due to the presence of friction. For slightly obstructed cases, the pressure losses are due to both the major (frictional) loss and the minor loss due to the change of geometry in the obstructed zone. As for the highly obstructed cases, the large proportion of the pressure loss is the minor loss resulting from the change of the geometry in the obstructed zone. A new set of dimensionless nomogram characterized by two parameters and Reynolds number is used to improve the deficiency of the AG number. Based on the newly proposed nomograph, patients both with obstructed and unobstructed cases can be diagnosed accurately. Also, those patients with weak detrusor, where the bladder can not provide enough power to micturate regularly, can also be identified with this new nomograph, which again can not be diagnosed with the Abrams-Griffiths nomogram.

【1】 Lim CS, Abrams P., “The Abrams-Griffiths Nomogram”. World Journal of Urology, vol.13, pp.34-39, 1995.
【2】 Scott J.E. S., Clayton C.B., Dee P.M. and Simpson W., “A study of the female urethra. Experiments with models”, Journal of Urology, vol.96, pp.763-769, 1966.
【3】 Spangerg A., Terio H., Anders E. and Ask P.,”Quantification of urethral function based on Griffiths’ model of flow through elastic tubes”, Neurourol Urodynamics, vol.8, pp.29-52, 1989.
【4】 Brown M, Wickham JEA (1969). The urethral pressure profile. Br J Urol, vol.41, pp.211-217.
【5】 Blaivas J.G., “Multichannel urodynamics studies in men with benign prostatic hyperplasia”, Indications and interpretation. Urol Clin North Am 17, pp.543-552, 1990.
【6】 Abrams P, Bruskewitz R, De la Rosette J, et al, “The diagnosis of bladder outlet obstruction”, Urodynamics. In Cockett ATK, Khoury S, Aso Y, et al(eds): Proceedings, the 3rd International Consultation on BPH. Geneva, World Health Organization, pp.299-367, 1995.
【7】 McGuire E.J., “Urodynamic studies in prostatic obstruction”, In Fitzpatrick J.M., Krane R.J. (eds): The Prostate. New York, Churchill Livingstone, pp.103-109, 1989.
【8】 Bruskewitz R, Jensen KM-E, Ivversen P, et al, ”The relevance of minimum urethral resistance in prostation”, Journal of Urology vol.129, pp.769-771, 1983.
【9】 Schäfer W., “Detrusor as the energy source of micturition”, In Hinman F Jr, Boyarsky S (eds): Benign Prostatic Hypertrophy. New York, Springer Verlag, pp.450-469, 1983.
【10】 Schäfer W., “The contribution of the bladder outlet to the relation between pressure and flow rate during micturition”, In Hinman F Jr, Boyarsky S (eds): Benign Prostatic Hypertrophy. New York, Springer Verlag, pp.470-496, 1983.
【11】 Spangerg, A., Terio H., Engberg A., and Ask P., ”Estimation of elastic properties in the urethral flow controlling zone by singnal analysis of urodynamic pressure/flow data”, Med. and Biol.Eng and Computing, vol.27 ,pp.314-321,1989.
【12】 James S. Walter, John S. Wheeler, Jr., Paul Zaszczurynski, and Michael Plishka, ”Urodynamic measure of urethral cross-sectional area: application for obstructive uropathy”, Neurourology and Urodynamics, vol.13, pp.571-586, 1994.
【13】 Hideo Ozawa, Hiromi Kumon, Teruhiko Yokoyama, Toyohiko Watanabe and Michael B. Chancellor, “Develop of noninvasive velocity flow video urodynamics using Doppler sonography. PARTII: Clinical application in bladder outlet obstruction”, Journal of Urology, vol.160, p1792-1796, 1998.
【14】 Ozawa, Hideo; Chancellor, Michael B.; Ding, Yew Yoong; Nasu, Yasutomo; Yokoyama, Teruhiko; Kumon, Hiromi, “Noninvasive urodynamic evaluation of bladder outlet obstruction using Doppler ultrasonography”, Urology, Vol.56, issue 3, pp.408-412, 2000.
【15】 Siroky M.B., Olsson C.A., Krane R.J., “The flow rate nomogram: I. Development”, Journal of Urology, vol.122, pp.665-668, 1979.
【16】 Haylen B.T., Parys B.T., Anyaebunam W.I., et al, “Urine flow rates in male and female urodynamics patient compared with the Liverpool nomograms”, Br Journal of Urology, vol.65, pp.483-487, 1990.
【17】 Harish S. Lecamwasam, Maryrose P. Subbarao V. Yalla, and Ernest G. Cravalho, “The flow regimes and the pressure-flow relationship in the canine urethra”, Neurourology and Urodynamics, vol.18, pp.521-541, 1999.
【18】 Comiter, Craig V.; Sullivan, Maryrose P.; Schacterle, Richard S.; Yalla, Subbarao V., “Prediction of prostatic obstruction with a combination of isometric detrusor contraction pressure and maximum urinary flow rate.”, Urology, vol.48, issue: 5, pp.723-730, 1996.
【19】 Patrick C.Walsh, M.D., Ruben F. Gittes, M.D., Alan D. Perlmutter, M.D., Thomas A. Stamey, M.D., “Urology”, W.B. Saunders Company, 1986.
【20】 Victor W. Nitti, M.D., ”Practical Urodynamics”, W.B. Saunders Company, 1998.
【21】 M. Peric, “A finite-volume method for the prediction of three-dimensional fluid flow in complex ducts”, Ph.D thesis, University of London, 1985.
【22】 林登龍, 陳明村, 張心湜, ”Urodynamics of Lower Urinary Tract”, 九州圖書文物, 1989.
【23】 黃仁政, “計算流體力學運用於泌尿系統臨床檢查可行性之研究”, 國立清華大學碩士論文, 1999.
【24】 楊子慶, “泌尿系統內部壓力分佈研究”, 國立清華大學碩士論文,2000
【25】 James M.Cummings, M.D., Raul O. Parra, M.D., F.A.C.S., John A. Boullier, M.D., Ph. D. “Laser prostatectomy: initial experience and urodynamic follow-up”, Urology, vol.45, pp.414-420, 1995.
【26】 Craig V. Comiter, Maryrose P. Sullivan, Richard S. Schacterle, and Subbarao V. Yalla, “Prediction of prostatic obstruction with a combination of isometeric detrusor contraction pressure and maximum urinary flow rate”, Urology, vol.48, pp.723-730, 1996.
【27】 Wim P. J. Witjes, Peter F. W. M. Rosier, Christine T.M. Caris, Frans M. J. Debruyne, and Jean J. M. C. H. de la Rosette, “Urodynamic and clinical effects of terazosin therapy in symptomatic patients with and without bladder outlet obstruction: a stratified analysis”, Urology, vol.49, pp.197-206, 1997.
【28】 Wim P. J. Witjes, Andrew Robertson, Peter F. W. M. Rosier, David E. Neal, Frans M. J. Debruyne, and Jean J. M. C. H. de la Rosette, “Urodynamic and clinical effects of noninvasive and minimally invasive treatments in elderly men with lower urinary tract symptoms stratified accorging to the grade of obstruction”, Urology, vol.50, pp.55-61, 1997.
【29】 Osamu Ichiyanagi, Isoji Sasagawa, YasuhiIro Suzuki, Manabu Ishigooka, and Teruhiro Nakada, “Relation between urethral elasticity and bladder outlet obstruction and histologic composition of the prostate in patients with benign prostatic hyerplasia”, Urology, vol.53, pp.1149-1153, 1999.
【30】 W. Scha ¨ Fer, T. L. J. Tammela, D. M. Barrett, P. Abrams, H. Hedlund, H. J. Rollema, J. Nordling, J. T. Andersen, T. Hald, A. Matos-Ferriera, R. Bruskewitz, P. Miller, S. Mustonen, A. Cannon, Marie-Pierre Malice, Carol A. Jacobsen, Mark A. Bach, and the Finasteride Urodynamic Study Group, “Continued improvement in pressure-flow parameters in men receiving finasteride for 2 years”, Urology, vol.54, pp.278-283, 1999.
【31】 M. Gotoh, Y. Yoshikawa, A. Kondo Y. Ono, S. Ohshima, “Prognostic value of pressure-flow study in surgical treatment of benign prostatic obstruction”, World Journal of Urology, vol.17, pp.274-278, 1999.
【32】 E.P. Arnold, “Tamsulosin in men with confirmed bladder outlet obstruction: a clinical and urodynamic analysis from the single centre in New Zealand”, BJU International (2001), vol.87, pp.24-31.