尿动力学检查在女性尿道综合征的应用（附160例分析报告）

为探讨尿动力学检查(UDS)在女性尿道综合征(FUS)的临床价值,应用Laborie公司Encore 5.7尿动力分析仪检查FUS160例。结果发现剩余尿>50ml者占34.4％,初尿意尿量<60ml者28.1％,60～100ml者25.4％,由于有剩余尿和产生初尿意的尿量较少,产生初尿意的实际增加尿量更少,这些都可能是产生尿道综合征症状的部分原因。本组膀胱逼尿肌收缩无力或减弱55例,占34.4％,单纯使用平滑肌兴奋剂,如新斯的明和加兰他敏等提高了疗效。认为尿动力学检查女性尿道综合征患者,有助于了解其病因,分类治疗能提高疗效。     

神经源性夜遗尿与单症状性夜遗尿尿动力学表现

目的 :探讨神经源性夜遗尿与单症状性夜遗尿的尿动力学表现。方法 :对 36例神经源性夜遗尿患者和14例单症状性夜遗尿患者进行尿动力学测定。结果 :神经源性夜遗尿患者除表现为夜遗尿症状外 ,多伴有白天排尿异常。单症状性夜遗尿患者排尿后残余尿量、逼尿肌功能过度活跃发生率、逼尿肌收缩乏力发生率显著低于神经源性夜遗尿患者 (P <0 .0 5 ) ;单症状性夜遗尿患者膀胱顺应性、最大尿道压和最大尿道闭合压显著高于神经源性夜遗尿患者 (P <0 .0 5 )。结论 :对于夜遗尿患者应区分是否存在神经损害 ,并进行尿动力学检查 ,了解膀胱尿道的功能状态 ,从而进行针对性治疗     

Retrospective analysis in 46 women with vulvovaginal atrophy treated with ospemifene for 12 weeks: improvement in overactive bladder symptoms

Aims: The aim of this study was to assess the effectiveness and safety of ospemifene in the improvement of overactive bladder (OAB) symptoms in postmenopausal women affected by vulvovaginal atrophy (VVA).

Methods: Forty-six postmenopausal patients affected by VVA with OAB syndrome were enrolled for the study. All patients received Ospemifene 60?mg for 12?weeks. Clinical examination, 3-day voiding diary, urodynamic testing, ultrasound measurement of endometrial and bladder wall thickness (BWT) and the Vaginal Health Index (VHI) were performed at baseline and 12?weeks. Patients completed the OAB-Q SF and UDI-6.

Results: After 12-weeks, the number of patients with detrusor overactivity decreased from 39% to 13% (p?=?0.04). The reduction in the mean number in 24?h of voids (9.57?±?2.12 vs. 6.63?±?1.22, p?p?p?p?=?0.003) was observed. The UDI-6, OAB-Q symptoms, OAB-Q (HRQL) scores were 8.95?±?0.91 vs. 5.56?±?1.40, 62.60?±?14.70 vs. 20.08?±?10.83 and 18.71?±?7.41 vs. 79.45?±?14.47 (p?Conclusion: Ospemifene is an effective potential therapy for postmenopausal women with VVA improving OAB symptoms and quality of life.     

Ultrasonographic bladder measurements can replace urodynamic study for the diagnosis of non‐monosymptomatic nocturnal enuresis

Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b

OBJECTIVE

To compare urodynamic (UD) and ultrasonography (US)‐based measurements for the diagnosis and follow‐up of patients with non‐monosymptomatic primary nocturnal enuresis (NMPNE).

PATIENTS AND METHODS

The study included 455 enuretic children (282 boys and 173 girls, mean age 9.58 years) with daytime voiding symptoms and with more than one void per night. In healthy children the upper limits for US‐measured bladder wall thickness are 3 and 5 mm for a full or empty bladder, respectively. In 419 children the results showed urodynamic signs of an overactive bladder (OAB) and the US‐measured bladder wall was thickened. After 6 months of antimuscarinic treatment, we re‐assessed the children with US and UD; the relation between UD and US measurements was confirmed. After analysing these data, we considered the use of a new diagnostic assessment for patients with NMPNE. In children with a significant US measurement, i.e. a bladder wall with a thickness of >3 mm (full bladder) and >5 mm (empty bladder), the diagnostic assessment was concluded and therapy was started. We restricted the UD examination exclusively to those patients who either had severe intractable symptoms or did not respond to treatment. This new management was applied to 453 patients with NMPNE. After the first 6 months of therapy all the patients were assessed with a new US study.

RESULTS

In all, 343 patients (75.7%) were full‐responders, with a normal bladder wall thickness; 82 (18.1%) were partial responders but with no normalization of bladder wall thickness; only 28 (6.2%) were classified as nonresponders with a persistent thickened bladder wall.

CONCLUSIONS

We favour a more conservative management: the UD study should be limited to the very few patients who either have severe intractable symptoms or do not respond to treatment. In our experience, the US study, which is not invasive, is useful for the diagnosis and follow‐up of NMPNE and it is preferable to the UD study, which is invasive and often traumatic for children.     

尿流动力学在女性下尿路症候群诊治中的应用

目的评估尿流动力学在女性下尿路症候群（LUTS）分类和治疗中的作用。方法采用尿动力测定仪对127例女性下尿路症候群患者进行尿流动力学检查,并根据检查结果进行分类及相关治疗,治疗后观察临床症状变化并复查尿流动力学各项参数进行对照。结栗不稳定膀胱30例（26．8％）,低顺应性膀胱10例（8．9％）,逼尿肌无力12例（10．7％）,尿道压增高89例（79．5％）,尿动力学无明显异常15例（11．8％）。112例尿动力学异常患者经相应治疗后有效97例,有效率为86．6％。结论尿流动力学检查在女性LUTS的诊断分型及指导治疗上具有重要意义。     

持续质量改进在尿动力学检查护理配合中的应用

目的探讨持续质量改进(continues quality improvement,CQI)在尿动力学检查护理配合中的应用效果。方法回顾性分析2011年3-7月在浙江中医药大学附属第二医院泌尿外科行尿动力学检查的308例患者的临床资料,并针对影响尿动力学检查顺利完成的主要因素,从2011年8月开始运用CQI的方法,重建尿动力学检查护理配合流程,对实施CQI前后的尿动力学检查结果进行统计学分析。结果实施CQI前后,两组患者尿动力学检查一次性完成率分别为84.1%和91.6%,差异有统计学意义(P<0.05)。结论遵循护理CQI有助于实现护理质量的有效管理,改进后的尿动力学检查配合流程更科学、人性化,提高了尿动力学检查的成功率,为临床诊断提供了可靠的依据。