尿动力学检查在耻骨上前列腺切除术后尿失禁诊断中的应用

目的:探讨尿动力学检查在耻骨上前列腺切除术后尿失禁诊断中的应用价值。方法:对23例耻骨上前列腺切除术后尿失禁患者进行尿动力学检查,包括膀胱压力容积测定、Valsalva漏尿点压力测定、压力-流率测定、静态尿道压力测定。结果:11例诊断为运动急迫性尿失禁,2例诊断为感觉急迫性尿失禁,5例诊断为压力性尿失禁,3例诊断为混合性尿失禁,2例诊断为充盈性尿失禁。结论:尿动力学检查能准确判断耻骨上前列腺切除术后尿失禁的类型,为治疗提供客观依据。     

术前尿流动力学检查对TURP术后疗效预测的研究

目的: 探讨经尿道前列腺电切术(TURP)术前尿流动力学检查对术后疗效预测的价值。　方法: 对 160例良性前列腺增生(BPH)患者TURP术前、术后 8~11个月尿流动力学检查的参数及国际前列腺症状评分(IPSS)、生活质量评估(QOL)等进行统计学分析。　结果: TURP术后尿流动力学检查的参数(最大尿流率、最大尿流率时逼尿肌压力、Schafer分级、A G值、尿道阻力因子、最大膀胱容量、有效膀胱容量)、IPSS及QOL均明显得到改善 (P<0. 001)。术后IPSS、QOL分别与最大尿流率、最大尿流时逼尿肌压力、Schafer分级、A G值、尿道阻力因子、最大膀胱容量、有效膀胱容量等呈极显著相关或显著相关。　结论: TURP术前尿流动力学检查有助于把握TURP手术指征、能预测术后患者症状改善的程度;TURP术前尿流动力学检查应列为重要检查项目,以杜绝手术的盲目性及预测术后疗效。     

尿流动力学检查在经尿道前列腺电切术术前的应用

目的探讨尿流动力学检查在经尿道前列腺电切术（TURP）术前的应用,对提高术前诊断水平及对手术指征、手术方法、手术时机选择的价值。方法回顾分析186例前列腺增生症患者在TURP术前尿流动力学检查的临床资料。结果186例前列腺增生症患者经尿流动力学检查,140例有不同程度的膀胱出口梗阻,且与其他动力学异常同时存在;140例患者行TURP手术治疗,8例行膀胱造瘘术,38例行药物保守治疗。结论TURP术前尿流动力学检查可提供前列腺增生疗患者膀胱尿道功能状况,对治疗方案及手术时机的选择以及术后疗效评估提供量化参数。     

人工尿道括约肌植入术治疗骶髓损伤后压力性尿失禁

目的评价人工尿道括约肌植入术(AUS)治疗骶髓损伤后压力性尿失禁的临床效果。方法 2010年3月至2012年10月,广州军区广州总医院泌尿外科全军泌尿外科中心收治了2例男性骶髓损伤后压力性尿失禁患者,术前采用影像尿流动力学检查、自由尿流率、脊髓磁共振、静脉肾盂造影检查、中段尿细菌培养、尿常规进行评估。行经会阴尿道球部人工尿道括约肌(AMS 800)植入术,并从术前开始口服抗胆碱能药物;术后第3、6个月行尿常规、超声、残余尿和尿流率检查。结果 2例患者随访9~12个月,术后完全控尿,未出现感染、侵蚀、尿道萎缩、装置机械故障等并发症。结论 AUS治疗骶髓损伤后压力性尿失禁,需要精确评估其膀胱及尿道功能,严格选择手术适应证,术后可获得满意控尿效果,同时需要长期密切随访。     

直肠癌根治术后并发神经源性膀胱的诊断和处理

目的　提高直肠癌术后神经源性膀胱的诊断和治疗水平。方法　 2 3例直肠癌术后并发神经源性膀胱的患者行尿流动力学检查 ,明确诊断 ,并给予相应治疗 ,观察疗效。结果　 2 2例患者经治疗后恢复正常的排尿 ,1例尿失禁患者在随访 6个月后仍未恢复正常。结论　直肠癌术后并发神经源性膀胱的患者应早期行尿动力学检查 ,并根据尿流动力学检查的结果采取相应的治疗     

下尿路排尿功能障碍患者的影像尿动力学评估

目的:研究影像尿动力学检查在下尿路排尿功能障碍患者诊断和治疗中的价值。方法:应用影像尿动力学仪检查64例下尿路排尿功能障碍患者的排尿功能情况。结果:神经原性膀胱(Neurogenic bladder,NB)28例(43.75%),女性压力性尿失禁(Stress urinary incontinence,SUI)15例(23.43%),BPH 12例(18.75%),前列腺切除术(TURP)后排尿障碍4例(6.25%),女性排尿困难5例(7.82%)。发现膀胱输尿管反流5例,膀胱小梁或憩室25例,逼尿肌尿道括约肌协同失调8例,尿道远端狭窄1例。结论:影像尿动力学检查通过同时评估膀胱尿道的功能和形态,为复杂性下尿路排尿功能障碍性疾病的临床诊断和治疗提供可靠的依据。     

应用避孕隔膜治疗压力性尿失禁

压力性尿失禁(stress urinary incontinence,SUI)是由于腹部压力增加导致膀胱内压力大于尿道压力所致。女性SUI的正规治疗包括各种外科治疗或药物治疗。本文报告作者用阴道避孕隔膜治疗女性SUI的经验。材料和方法本组12例,均进行病史、体格检查、尿液分析、尿流动学检查、膀胱镜检查及Marshall-Marchetti试验。SUI的诊断依据:临床尿失禁病史、尿流动力学及膀胱镜检查正常、尿液分析正常、Marshall-Marchetti试验阳性。每例均接受正常放置和取出阴道隔膜的方法,2周后再询问病史、体检、尿液分析及尿流动力学检查,之后每月检查1次,询问有无不适证状,排尿梗阻及尿失禁。     

良性前列腺增生相关的膀胱痉挛病因分析及治疗

目的:探讨与良性前列腺增生(BPH)有关的膀胱痉挛的发生原因,寻找有效的防治方法。方法:102例BPH患者术前均行尿流动力学检查;应用t检验及χ2检验分析BPH患者的国际前列腺症状评分(IPSS)、前列腺体积(Vp)、生活质量评分(QOL)、手术方式及尿流动力学各项指标与膀胱痉挛发生的相关性。结果:在102例患者尿流动力学检查结果的分类中,低顺应性膀胱和不稳定膀胱的膀胱痉挛发生率为32.1%(9/28例)和42.5%(13/20例)。开放式手术和经尿道前列腺电切术(TURP)后膀胱痉挛发生率分别是50.9%(26/51例)、23.3%(12/51例),两者相比差异有显著性(P<0.05)。结论:低顺应性膀胱、不稳定膀胱及开放手术易产生膀胱痉挛。TURP可以降低BPH术后的膀胱痉挛发生率。     

女性膀胱颈梗阻的诊断与治疗

目的 探讨女性膀胱颈梗阻的临床诊断和治疗方法。方法 对36例女性膀胱颈梗阻患者行超声、膀胱尿道镜检查及尿流动力学检查，8例行保守治疗，28例行经尿道膀胱颈电切术（transurethral resection of bladder neck，TURBn）。结果36例经治疗后排尿通畅，尿流率增大，症状改善，无尿失禁及尿瘘发生。结论超声、膀胱尿道镜检查结合尿流动力学检查是女性膀胱颈梗阻的可靠诊断手段，TURBn是治疗症状严重、剩余尿多的女性膀胱颈梗阻的首选方法，具疗效稳定、安全性高、患者恢复快及术后并发症少等优点，但手术适应证及范围应严格控制。     

女性压力性尿失禁的微创治疗

目的探讨女性压力性尿失禁的发病机制和微创治疗方法。方法女性压力性尿失禁患者25例,经临床、尿动力学检查或膀胱尿道造影确诊,均为稳定性膀胱,无膀胱出口梗阻。采用无张力阴道吊带术(TVT),将吊带无张力置于尿道中段。结果手术时间平均(40±5)min;术中出血量平均(43±10)mL;术后平均留置导尿1.5 d;术后平均住院3 d。23例患者术后尿失禁症状均消失,其中2例患者术后出现尿潴留,留置导尿1周后好转,尿潴留症状消失,尿失禁未复发;2例尿失禁症状显著改善。结论TVT等微创术式因简单、微创、疗效好、并发症少等,目前是女性压力性尿失禁外科手术治疗的发展方向。     

Are urodynamic tests useful tools for the initial conservative management of non-neurogenic urinary incontinence? A review of the literature

OBJECTIVES: To summarise the evidence for the role of urodynamic tests in the diagnosis and classification of urinary incontinence. METHODS: Reference lists in relevant papers were reviewed and MEDLINE searches conducted. RESULTS: The mean sensitivity (specificity) of clinical history versus urodynamic tests was 0.82 (0.57) for stress incontinence, 0.69 (0.60) for urge incontinence/overactive bladder, and 0.51 (0.66) for patients with mixed incontinence. The proportion of women with a clinical diagnosis of urinary incontinence but with normal findings from urodynamic tests ranged from 3 to 8%. Overall sensitivity of urodynamic tests was about 85-90% in the diagnosis of urodynamic stress incontinence, but generally lower following diagnosis of urge and mixed incontinence. No relationship emerged between urodynamic test results and response to medical treatment. CONCLUSIONS: This literature review shows that the sensitivity of clinical history versus urodynamic tests was 0.82, 0.69 and 0.51 respectively for stress, urge and mixed urinary incontinence. It also suggests that urodynamic diagnosis does not predict response to treatment. These data add to the ongoing 'urodynamics or no urodynamics' debate in the evaluation of urinary incontinence and show that urodynamic testing may not be helpful for patients receiving initial non-invasive therapy. These data are in line with the conclusions of the 1st and 2nd International Consultations on incontinence.     

Development of de novo urge incontinence in women post sling: the role of preoperative urodynamics in assessing the risk

AIMS: The study was undertaken to investigate if there are specific identifiable risk factors on the preoperative history or urodynamics testing associated with an increased risk for the development of symptoms of de novo urge urinary incontinence after a minimally invasive sling procedure. METHODS: Two hundred eighty-one women who had undergone minimally invasive sling surgery for stress urinary incontinence between January 2000 and December 2003 were identified. The records of 92 patients were included in this review. RESULTS: Twenty-five patients (27%) reported urge urinary incontinence on postoperative questioning. Clinical and urodynamic parameters were correlated with the development of de novo urge urinary incontinence. Preoperative history parameters were not predictive of the increased risk of de novo urge urinary incontinence, with the exception of increased preoperative daytime frequency (OR 3.3 (1.2, 9.1)). Of 16 women whose detrusor pressure during the filling phase of cystometry exceeded 15 cm H(2)O, de novo urge urinary incontinence developed in 9 (56%) vs. 16 (21%) of 76 women, whose detrusor pressure was < or = 15 cm H(2)O (OR 4.6 (1.4, 15.0)). CONCLUSIONS: Directed patient history is only minimally helpful in the identification of women at increased risk for the development of de novo urge urinary incontinence, with the exception of the complaint of increased daytime frequency. Women with elevated detrusor pressure during the filling phase of cystometry were more likely to develop urge urinary incontinence postoperatively. Therefore, we suggest that preoperative urodynamic evaluation, and specifically detrusor pressure > 15 cm H(2)O may help identify patients at increased risk of developing de novo urge urinary incontinence following the minimally invasive sling procedure.     

Effect of functional continuous magnetic stimulation for urinary incontinence

PURPOSE: We evaluated the therapeutic efficacy of continuous magnetic stimulation on urinary incontinence by studying the urodynamic effect on urethral closure and bladder inhibition. MATERIALS AND METHODS: A total of 11 patients with stress incontinence and 12 with urge incontinence (7 males and 16 females, mean age 55.8 years) were evaluated. In the pilot study urethral pressure profile was performed before and after 20 Hz. 15-minute (with 1-minute on/30-second off cycles) stimulation, and maximum intraurethral pressure was recorded during stimulation in stress incontinence cases. Cystometry was performed before and during 15-minute stimulation at 10 Hz. in urge incontinence cases. In the therapeutic study 8 females with stress incontinence, and 3 males and 5 females with urge incontinence were treated with magnetic stimulation twice a week for 5 weeks. RESULTS: In the pilot study maximum intraurethral pressure increased by 34% during stimulation and maximum urethral closure pressure increased by 20.9% (p = 0.0409) after stimulation in stress incontinence cases. In urge incontinence cases significant increases in bladder capacities at first and maximum desire to void during stimulation were noted (p = 0.0164 and 0.0208, respectively). In the therapeutic study 86% of 7 patients with stress incontinence and 75% of 8 with urge incontinence were improved, and 1 dropped out of the study. CONCLUSIONS: Continuous magnetic stimulation was effective on urethral closure and bladder inhibition, and as treatment of urinary incontinence.     

Stress incontinence and cystoceles

We studied prospectively 62 women with cystoceles by video-urodynamics before and after operative repair. Of 29 women with grades 1 and 2 cystoceles 8 had residual urine, 14 had urge incontinence and 24 had symptoms of stress urinary incontinence. Of these women 23 had urodynamic evidence of stress incontinence, as did 3 of 5 without stress incontinence symptoms. Of 33 women with large cystoceles 22 had symptoms of stress urinary incontinence but 10 more had urodynamic evidence of stress urinary incontinence. Of these 33 women 18 had significant residual urine and 24 had urge incontinence. Operative repair resolved stress incontinence in 51 of 54 women, urge incontinence in 33 of 38 and residual urine in 24 of 26. Cystoceles recurred in 3 patients, and enteroceles developed in 3 and recurred in 2. These findings indicate that cystoceles may cause voiding dysfunction and lack of symptoms of stress incontinence is unreliable in patients with cystoceles. In addition, cystoceles are associated with other symptoms, most of which actually resolve after operative repair.     

Extracorporeal magnetic innervation treatment for urinary incontinence

BACKGROUND: Extracorporeal magnetic innervation (ExMI) is a new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We explored whether this new technology is effective for patients with urge incontinence, as well as those with stress urinary incontinence. METHODS: We studied 20 patients with urge incontinence and 17 patients with stress urinary incontinence. The Neocontrol system (Neotonus Inc., Marietta, GA) was used. Treatment sessions were for 20 min, twice a week for 8 weeks. Evaluations were performed by bladder diaries, one-hour pad weight testing, quality-of-life surveys and urodynamic studies. RESULTS: Of the urge incontinence cases, five patients were cured (25.0%), 12 patients improved (60.0%) and three patients did not show any improvement (15.0%). Leak episodes per day reduced from 5.6 times to 1.9 times at 8 weeks (P < 0.05). Eight patients with urge incontinence recurred within 24 weeks after the last treatment (47.1%). Of the stress incontinence cases, nine patients were cured (52.9%), seven patients improved (41.1%) and one patient did not show any improvement (6%). In one-hour pad weight testing, the mean pad weight reduced from 7.9 g to 1.9 g at 8 weeks (P < 0.05). Three patients returned to the baseline values within 24 weeks after the last treatment (17.6%). No side-effects were experienced by any of the patients. CONCLUSION: Although the results for urge incontinence were less effective than for stress urinary incontinence, ExMI therapy offers a new option for urge incontinence as well as stress urinary incontinence.     

Mixed urinary symptoms: What are the urodynamic findings?

AIM: To define the urodynamic diagnoses of women with mixed urinary incontinence (MUI) symptoms. MATERIALS AND METHODS: Women with MUI symptoms were studied. They were divided into stress predominant MUI; urge predominant MUI; or equal severity of stress and urge MUI on the basis of the most severe symptom scored on the King's Health Questionnaire. The frequency of different urodynamic diagnoses for the all women with MUI and in each of the above groups was calculated. RESULTS: Overall 3,338 women were studied. Of these 49% (1,626/3,338) reported MUI symptoms and were included. In this group 29% (464/1,626) had stress predominant MUI, 15% (248/1,626) had urge predominant MUI and 56% (912/1,626) had equal severity of urge and stress MUI. On urodynamics 42% (665/1,626) had pure urodynamic stress incontinence, 25% (414/1,626) had pure detrusor overactivity, 18% (299/1,626) had both detrusor overactivity and urodynamic stress incontinence and 15% (248/1,626) had normal urodynamic studies. In those with stress predominant MUI, 82% had urodynamic stress incontinence; in those with urge predominant MUI, 64% had detrusor overactivity. The urodynamic diagnoses were significantly different for the different balance of symptoms (P < 0.05, Chi-Square test). In women with equal severity of urge and stress incontinence, 46% had detrusor overactivity while 54% had urodynamic stress incontinence. CONCLUSIONS: The relative severity of MUI symptoms from a symptom questionnaire significantly distinguishes between different urodynamic diagnoses. Women with urge predominant MUI are more likely to have detrusor overactivity while those with stress predominant MUI are more likely to have urodynamic stress incontinence.     

Pathophysiologie von Drang-, Belastungs- und Mischinkontinenz

According to the new ICS classification, urinary incontinence is subdivided by symptomatic, clinical, and urodynamic criteria. Understanding the pathophysiological interactions is important to find the correct diagnosis. Disturbances in bladder storage include urge incontinence due to neurogenic or non-neurogenic (idiopathic) detrusor hyperactivity as well as stress urinary incontinence caused by an insufficient urethral closure mechanism due to reduced pressure transmission (active-passive), hypotonic urethra, hyporeactivity of sphincter musculature, or involuntary relaxation of the urethra. Stress and urge incontinence can occur in combination and then be defined as mixed incontinence.     

Changes in urodynamic measurements after successful anal electrostimulation in female urinary incontinence

Fifty-five of 71 women with stress, motor urge and mixed stress and motor urge urinary incontinence were treated successfully with a new integrated electrostimulation device (Incontan) used anally. Changes in urodynamic measurements were evaluated when the patients themselves reported cure or significant improvement. The duration of the treatment was 9 to 20 h/day for at least 2 months (mean 9 months). According to the patients' subjective evaluation, 71% were cured of their incontinence and 29% were markedly improved. In motor urge and mixed incontinence a significant increase in bladder volume at first sensation and at maximum cystometric capacity was found, and 45% of these patients had a normal, stable bladder after treatment. A significant increase in functional urethral length was observed in patients who had had stress incontinence, but the measured increase in maximum urethral pressure was not significant. Of the 16 patients with stress and mixed incontinence who reported cure, 15 had a positive urethral closure pressure during coughing after treatment. Urodynamic analysis confirmed the positive clinical effect observed after electrostimulation therapy. It is recommended as primary therapy in stress, motor urge and mixed stress and motor urge incontinence in women.     

THE ETIOLOGY OF POST-RADICAL PROSTATECTOMY INCONTINENCE AND CORRELATION OF SYMPTOMS WITH URODYNAMIC FINDINGS

Purpose

We evaluated men with post-radical prostatectomy incontinence to determine the incidence of intrinsic sphincter deficiency and bladder dysfunction, and the contribution of each to incontinence. In addition, we determined if subjective symptoms of stress urinary incontinence and urge incontinence correlated with urodynamic findings of intrinsic sphincter deficiency and bladder dysfunction, respectively.

Materials and Methods

A total of 60 consecutive patients (mean age 64.8 years) were prospectively evaluated with multichannel video urodynamics. All patients were evaluated at least 6 months postoperatively and had achieved a stable level of continence. Patients characterized incontinence as stress or urge related, and stress urinary incontinence was graded from 0 to 3. Intrinsic sphincter deficiency was defined as incontinence associated with increased intra-abdominal pressure and was further assessed by Valsalva's leak point pressure. Bladder dysfunction included urodynamic findings of detrusor instability or decreased compliance.

Results

Intrinsic sphincter deficiency was demonstrated in 54 patients (90%). Some component of bladder dysfunction was seen in 27 patients (45%), including detrusor instability in 24 and decreased compliance in 3, but incontinence was actually a result of bladder dysfunction in only 16 (27%). Incontinence was due to intrinsic sphincter deficiency alone in 40 patients (67%), intrinsic sphincter deficiency and bladder dysfunction in 14 (23%), and bladder dysfunction alone in only 2 (3%). Incontinence was not demonstrated on video urodynamics in 4 patients (7%). Of the 57 men who complained of stress urinary incontinence 54 demonstrated intrinsic sphincter deficiency for a positive predictive value of 95%. The 3 patients without stress urinary incontinence did not demonstrate intrinsic sphincter deficiency for a negative predictive value of 100%. Positive and negative predictive values for urge incontinence were 44 and 81%, respectively.

Conclusions

Incontinence after radical prostatectomy is associated with intrinsic sphincter deficiency in the overwhelming majority of patients. Bladder dysfunction rarely is an isolated cause. When present on urodynamic tests bladder dysfunction may not always be a significant contributor to incontinence. The symptom of stress urinary incontinence (or its absence) accurately predicts the finding (or absence) of intrinsic sphincter deficiency on urodynamics. Urge incontinence is not as reliable in predicting incontinence due to bladder dysfunction.