夫妻的萬年課題: 老公應該坐著尿還是站著尿?
童綜合醫院 泌尿外科 呂謹亨 醫師
一篇PTT的文章: [求助] 大家都如何說服老公坐著尿
引發了網友熱烈討論，(先自首一下，在下也是在結婚後，被老婆馴化成坐著尿的案例之一…)
記得從前老師有教，結婚守則有三條: “ 1. 老婆永遠是對的. 2. 千錯萬錯都是先生的錯. 3.如果第一條違反第一條，那以第一條為準。” 所以在發這篇文章時，就算有實證醫學支持，回到家，還是得乖乖坐著小便….
查閱了新聞，在日本，越來越多已婚男性，怕站著小便尿液濺起或尿不準污染馬桶及廁所(X) [老婆要求(O)]，採取坐著小便的方式。那究竟，在實證醫學上有沒有證據支持呢?
身為男性，我們先來為先生們發聲:
反方論點: 不支持坐著尿
如果說達爾文的進化論是真的，就演化的觀點來說，男性之所以需要站著排尿，是因為爬行動物進化成直立行走的人類，得以解放了雙手，看得更遠，創造文明，而負責保衛警戒狩獵的男性因為站立排尿的便捷優點得以存活下來。進化成S形的男性尿道，可以在站立時，讓尿液因為重力的牽引自然流出。同時，站立的姿勢排尿有助於演少腹部器官壓力對盆腔的壓迫，減少攝護腺的充血腫脹。因此站立排尿，能緩解久坐導致的盆腔與攝護腺充血發炎風險。有效的減少患攝護腺炎及下尿路症狀的風險。
(專家意見等級)
而且，根據研究，在健康且無攝護腺肥大的病人，站著小便與坐著小便在尿流速、解尿後殘尿量及解尿時間上是沒有統計差異的! [1]
正方論點: 支持坐著尿
無法拒絕的理由: 太太要求!
實證醫學理由: 根據2014年de Jong Y et.al. 統合了 11篇研究，總計800位病人，分析了尿路動力學的檢查，針對最大尿流速、解尿後殘尿量及解尿時間作分析，發現對於有下泌尿道症狀的病人，坐著小便對解尿後殘尿量有顯著減少，且可以達到跟吃攝護腺肥大藥物一樣的療效! 對於最大尿流速及解尿時間來說，雖然有改善的趨勢但是沒有達到顯著差異。但是文獻同時也說，對於健康的男性，如果沒有解尿症狀，坐著小便與站著小便對於尿路動力學來說，並沒有顯著差異。[1]
所以對於攝護腺肥大或有解尿症狀的的病人，坐著小便，更可以使尿液充分排出!大大減少患攝護腺炎及下尿路阻塞的風險!
男性從40歲開始，就逐漸步入攝護腺肥大一途，一般來說50歲左右就有將近5成的人有此困擾，70歲就有7成、80歲就有8成、90歲就幾乎達到9成。只是每個人的速度不同。所以如果已經40歲的男性，就跟另一半妥協吧! 而年輕的健康男性，雖然可以掙扎一下，但為了婚姻的和諧，有時只能說顧全大局，吃虧就是占便宜，祝大家婚後幸福美滿，每天都有乾淨的馬桶廁所可以用XD
[1] 文獻證據: de Jong Y, Pinckaers JHFM, ten Brinck RM, Lycklama à Nijeholt AAB, Dekkers OM (2014) Urinating Standing versus Sitting: Position Is of Influence in Men with Prostate Enlargement. A Systematic Review and Meta-Analysis. PLoS ONE 9(7): e101320. doi:10.1371/journal.pone.0101320
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