影像尿动力检查在下尿路排尿障碍疾病诊断中的作用

目的 探讨影像尿动力检查在下尿路排尿障碍疾病中的应用价值.方法 2008年12月至2010年3月对115例下尿路排尿障碍患者行影像尿动力检查,确定排尿障碍类型,分析各类疾病的影像尿动力特点.结果 神经原性膀胱患者37例,男性25例,女性12例.其中逼尿肌无反射(DA)18例,膀胱过度活动(OAB)2例,低顺应性膀胱伴肾积水10例,逼尿肌-外括约肌协同失调7例.非神经原性排尿障碍患者59例,男性34例,女性25例;其中膀胱出口梗阻40例,DA 15例,单纯OAB 4例.膀胱扩大术后复查患者7例,男性4例,女性3例.可控回肠膀胱术后男性患者1例.输尿管再植术后男性患者1例.影像尿动力检查显示膀胱尿道功能基本正常者10例,男性6例,女性4例.结论 影像尿动力检查通过压力-流率曲线与实时影像结合分析,可为各类下尿路排尿障碍疾病提供准确的诊断及治疗依据.     

影像尿动力学在下尿路排尿功能障碍中的应用进展

正影像尿动力学检查(video urodynamic study,VUDS)是在普通尿动力学测定膀胱压力和记录尿动力学参数的基础上,同时显示膀胱和尿道的X线形态变化,为临床诊断和治疗提供依据。对于复杂膀胱尿道功能障碍、下尿路梗阻及压力性尿失禁等疾病,特别是当患者合并解剖异常时,影像尿动力学检查可更准确的反映下尿路潜在的病理     

女性膀胱流出道梗阻的影像尿动力学检查特点分析

目的 探讨女性膀胱出口梗阻(BOO)患者影像尿动力学检查特点及意义.方法 女性BOO患者42例,根据梗阻部位分为膀胱颈梗阻(7例)、中段尿道梗阻(13例)、远端尿道梗阻(15例)、尿道外口梗阻(3例)、盆腔器官重度脱垂(4例)5组.患者术前均行影像尿动力学检查,比较5组病例Qmax、最大膀胱容量、Pdet atQmax、残余尿、逼尿肌无抑制收缩、双侧肾积水等指标.结果 42例患者中以尿频、尿急等储尿症状为主者17例(40.5%),以排尿困难等为主者4例(9.5%),混合症状者21例(50.0%).42例Qmax(10.9±5.6)ml/s、最大膀胱容量(253±140.7)ml、Pdet atQmax(53.3±25.7)cm H2O、残余尿量(76.2±70.3)ml,逼尿肌无抑制收缩者21例(50.0%);5组患者比较:最大膀胱容量差异无统计学意义;膀胱颈梗阻组Pdet atQmax最高、残余尿量最多、Qmax最低、肾积水比例最高,与其他各组比较差异有统计学意义(P<0.05);逼尿肌无抑制收缩在外括约肌部梗阻患者中10例(76.9%),与其他各组比较差异有统计学意义(P<0.05).结论 影像尿动力学检查能有效评估女性BOO下尿路功能,提示梗阻部位并指导临床治疗.女性BOO患者中膀胱颈梗阻程度是影响上尿路损害的主要因素.     

尿动力学检查在糖尿病患者膀胱功能评定中的意义

目的探讨尿动力学检查在糖尿病患者膀胱功能障碍诊断中的意义。方法伴有下尿路症状(LUTS)的糖尿病患者42例，年龄38～78岁，男24例，女18例。糖尿病发病1个月一25年。结果42例患者完成尿动力学全项检查41例，尿动力学表现异常者38例(93％)，尿动力学表现正常3例(7％)；膀胱逼尿肌收缩减低14例(34％)；膀胱逼尿肌反射消失10例(24％)；膀胱出口梗阻13例(32％，13／41)；女性压力性尿失禁1例。结论伴有LUTS的糖尿病患者膀胱功能异常发生率高，尿动力学检查可以明确膀胱逼尿肌功能，对合并糖尿病的LUTS患者正确诊断和治疗具有重要意义．糖尿病患者行膀胱尿道手术前进行尿动力学检查可提高手术成功率。     

经尿道手术治疗神经性排尿功能障碍

目的 总结经尿道手术治疗神经性排尿障碍的疗效及适应证.方法 神经性排尿功能障碍患者41例.男13例,女28例.年龄12～43岁,平均27岁.其中骶椎裂36例、骶脊膜膨出术后2例、骶神经瘤切除术后1例、腰椎外伤术后2例.临床表现为排尿困难、尿线细.B超检查提示膀胱残余尿及双肾输尿管积水,尿动力学检查提示神经原性膀胱.手术采用局麻,女性患者在5、6、7点电切膀胱颈至环状纤维;男性患者在11、1点垂直部分切断外括约肌.结果 41例均获随访,平均随访85(2～252)个月.手术成功36例(88%),患者排尿通畅,尿流率增加>10 ml/s,肾输尿管积水减少或消失.无效5例(12%).结论 经尿道电切治疗骶神经损伤所致下尿路排尿功能障碍方法简便易行、费用低、效果好.     

逼尿肌漏尿点压在神经原性排尿功能障碍上尿路损害评估中的意义

目的　探讨逼尿肌漏尿点压检测神经原性排尿功能障碍患者上尿路损害功能评估中的诊断价值。　方法　 38例神经原性排尿功能障碍患者行尿动力学检查 ,重点进行逼尿肌漏尿点压测定。　结果　以逼尿肌漏尿点压 4 .0kPa(1kPa=10 .2 0cmH2 O)为界将 38例患者分为高压 (n =2 6 )及低压 (n =12 )两组 ,高压组膀胱容量为 (42 2 .95± 183.2 7)ml,低压组为 (46 4 .83± 10 6 .4 3)ml,高压组逼尿肌顺应性较低压组低 ,逼尿肌尿道括约肌协同失调 (DSD)增高。B超、IVU、血尿素氮及血肌酐检查等临床指标检测显示逼尿肌漏尿点压高者上尿路损害机会较低压组显著增高。　结论　逼尿肌漏尿点压测定对神经原性排尿功能障碍患者上尿路损害状态的评估有较大价值。     

青年男性下尿路排尿功能障碍影像尿动力特点分析

目的 探讨青年男性人群中下尿路排尿障碍影像尿流动力学检查结果、特点及对临床诊治的价值。方法 收集2016年1月—2021年9月因下尿路排尿障碍就诊于甘肃省人民医院泌尿外科行影像尿动力的106例青年男性(18～45岁)患者的临床资料，分析其临床特点及影像尿动力特点。结果 106例患者中，有明确的神经系统病变导致神经源性下尿路功能障碍患者55例(52.44%),非神经源性下尿路功能障碍患者51例(48%)。神经源性下尿路功能障碍患者中排尿困难是最常见的症状，占76.74%;腰骶部病变为主要原因(76.36%);影像尿动力主要诊断为逼尿肌肌力不同程度的减弱。非神经源性下尿路功能障碍患者中主要症状为尿频(48.72%)、排尿困难(48.72%),存在2个及2个以上下尿路症状的患者约58.97%,主要诊断为逼尿肌无力(35.90%)。结论 青年男性神经源性下尿路功能障碍多为逼尿肌肌力不同程度的减弱、逼尿肌括约肌协调失调及膀胱顺应性降低；非神经源性多为逼尿肌过度活动(DO)及逼尿肌无力。     

伴有难治性储尿期LUTS女性膀胱黏膜白斑患者的影像尿动力学变化及手术疗效研究

目的:探讨伴有难治性储尿期下尿路症状(LUTS)女性膀胱黏膜白斑患者影像尿动力学变化及手术疗效。方法:选取49例伴有非神经源性难治性储尿期LUTS并确诊为膀胱黏膜白斑的女性患者为病例组,行经尿道膀胱黏膜病变电切术,术前行影像尿动力学检查,记录排尿日记、生活质量评分(QOL);术后3个月门诊随访排尿日记、QOL等并评估手术疗效。同时选取15例仅存在上尿路疾患而下尿路功能正常的女性患者为对照组,记录排尿日记,行影像尿动力学检查。结果:病例组术前充盈期膀胱呈卵圆形或圆形,壁光滑,未见膀胱颈口开放和明显漏尿;排尿期膀胱颈口开放良好、尿道显影正常,未见逼尿肌括约肌协同失调和膀胱输尿管反流等。病例组术前正常尿意容量(VND)、功能性膀胱容量(FBC)、最大膀胱测压容量(MCC)均显著低于对照组[分别为(242±46)ml vs.(344±55)ml、(298±53)ml vs.(450±51)ml、(456±59)ml vs.(524±54)ml,P0.01]。病例组术后的24小时排尿次数和QOL均显著低于术前[分别为(10±1)次/d vs.(14±2)次/d,(3±1)分vs.(5±1)分,P0.01)];术后FBC显著高于术前[(447±56)ml vs.(298±53)ml,P0.01)],与对照组FBC相比差异无统计学意义[(447±56)ml vs.(450±51)ml,P0.05)]。病例组术后的总体手术有效率为85.7%。结论:伴有难治性储尿期LUTS女性膀胱黏膜白斑患者多伴有膀胱感觉敏感,尿动力学检查可为其诊疗提供客观依据。部分患者行经尿道膀胱黏膜病变电切术可获得满意疗效。     

良性前列腺梗阻患者尿动力学分型及经尿道前列腺切除术的疗效

目的:建立中老年良性前列腺梗阻(BPO)患者的尿动力学分型,探讨经尿道前列腺切除术(TURP)治疗各型患者的疗效。方法:回顾性分析2010年1月至2018年12月北京大学人民医院793例行尿动力学检查的中老年男性非神经源性下尿路症状(LUTS)患者的病例资料。尿动力学检查提示逼尿肌无收缩者经膀胱镜检查诊断为BPO。尿动...     

神经源性膀胱尿道功能障碍患者的影像尿动力学研究

目的 探讨各类神经源性膀胱患者的影像尿动力学特点.方法 2002年12月至2008年6月间,我们对1800例神经源性膀胱患者进行了影像尿动力学检查,分析不同神经病变所致膀胱尿道功能障碍的影像学特点.结果 脑卒中患者均未发现上尿路改变和反流,71% 为逼尿肌过度活动(DO),60% 伴括约肌无抑制性松弛,29% 为逼尿肌无反射(DA).脑外伤患者中70% 为DO不伴协同失调.7例帕金森病患者均表现为DO.1170例骶上损伤患者91% 为DO,83% 伴逼尿肌括约肌协同失调(DSD),223例骶髓及以下损伤患者73% 为DA.共有12% 的创伤性脊髓损伤患者出现上尿路积水改变,4% 表现为膀胱输尿管反流.脊髓发育不良患者81% 表现为逼尿肌无反射,86% 膀胱顺应性下降,55% 有上尿路积水改变,31% 出现膀胱输尿管反流.腰椎间盘突出患者92% 为逼尿肌无反射,88% 膀胱顺应性基本正常.糖尿病膀胱患者81% 膀胱感觉减退,76% 排尿期逼尿肌收缩力低下.结论 不同神经病变所致神经源性膀胱尿道功能障碍的特点不同,应根据影像尿动力学检查结果 选择合适的临床治疗方案.     

Managing voiding dysfunction in young men

Voiding dysfunction is an uncommon condition in young men. With increased understanding of the etiology of chronic lower urinary tract dysfunction, there has been significant improvement in the management of the condition. We have reviewed the current literature and make suggestions about diagnosis, treatment, and further research on this topic. We searched the PubMed database for the management of voiding dysfunction in young men using the following terms: voiding dysfunction, lower urinary tract symptoms, young men, risk factor, urodynamics study, uroflowmetry, magnetic resonance imaging, primary bladder neck obstruction/bladder neck dysfunction, dysfunctional voiding/pseudodyssynergia, impaired detrusor contractility/detrusor underactivity, adrenergic antagonist, transurethral incision, urotherapy, baclofen, and botulinum toxin. Uroflowmetry is an important noninvasive examination for screening young men for possible voiding dysfunction. A videourodynamic study is recommended for patients with low urine flow. Primary bladder neck obstruction and dysfunctional voiding are the two most common diagnoses. α-Adrenergic antagonists and urotherapy are widely used for treating bladder neck obstruction and dysfunctional voiding, respectively. Botulinum toxin A may become a potential therapeutic option in the future. Although the published reports usually included a small number of patients and lacked randomization and a placebo-controlled group, these clinical studies still provide great advances in managing voiding dysfunction in young men. Further well-designed studies are warranted to support optimal management of these conditions.     

Vesicoureteral reflux and lower urinary tract dysfunction: evidence for 2 different reflux/dysfunction complexes

We examined retrospectively 458 children 2 to 15 years old without neuropathic conditions or a gross anatomical abnormality to determine whether there was an association between lower urinary tract dysfunction and vesicoureteral reflux. We identified 2 different types of reflux/dysfunction complexes with contrasting urodynamic characteristics. One type included bladder instability with powerful voiding contractions of the bladder and reflux that frequently occurred on 1 side only. Reflux nephropathy or the presence of an upper urinary tract abnormality is rare. In the other type the bladder contracted poorly during voiding and overactivity of the urethral closure mechanism often was observed. The bladder usually was stable and the reflux occurred frequently on both sides. Reflux nephropathy or the presence of an upper urinary tract abnormality is relatively common. Direct videourodynamic observations of reflux in a second group of children confirmed the existence of these 2 types of reflux/dysfunction complexes.     

Correlation of bladder base elevation with pelvic floor hypertonicity in women with lower urinary tract symptoms

AIMS: To determine whether the bladder base elevation as revealed by cystogram under fluoroscopy is associated with pelvic floor hypertonicity or bladder outlet obstruction (BOO) in women. METHODS: Sixty-two women who were referred to our videourodynamic laboratory for assessment of lower urinary tract symptoms (LUTS) were included in this retrospective analysis. Thirty-one of these women with bladder base elevation-revealed by cystogram under fluoroscopy during videourodynamic study-served as the experimental group, and another group of 31 women without bladder base elevation served as control. None of the patients had neuropathy, previous pelvic surgery or chronic urinary retention. The clinical symptoms, urodynamic diagnosis, and parameters were compared between the two groups. RESULTS: The mean voiding pressure (Pdet.Qmax) and postvoid residual (PVR) were significantly greater, and maximum flow rate (Qmax) and voided volume were significantly lower in the bladder base elevation group. When a Pdet.Qmax of >or=35 cmH2O combined with a Qmax of 相似文献   

Investigation of dysfunctional voiding in children with urgency frequency syndrome and urinary incontinence

PURPOSES: Dysfunctional voiding may result in lower urinary tract symptoms (LUTS) in children and is associated with urinary tract infection and vesicoureteral reflux (VUR). This study analyzed the videourodynamic investigations in children with urgency frequency syndrome and/or urinary incontinence. METHODS: Forty children, 1-13 years old, with urgency frequency syndrome and/or incontinence were investigated to determine their LUTS or for the assessment of VUR. Videourodynamic study was performed in all patients and the results were analyzed with clinical characteristics and underlying pathophysiology. RESULTS: Dysfunctional voiding was present in 75.7% of the children with detrusor overactivity, in 73.3% of the children with VUR, in 63% of the children with urinary incontinence, in 77% of the children with episodic urinary tract infection, and in all of the children with diurnal enuresis. Compared to children without dysfunctional voiding, the voiding pressure was significantly higher in children with dysfunctional voiding (with VUR, 61.1 +/- 29.8 vs. 24.8 +/- 15.8 cm H(2)O, p = 0.004; without VUR, 53.4 +/- 24.1 vs. 24.8 +/- 15.8 cm H(2)O, p = 0.010). Biofeedback pelvic floor muscle training and treatment with antimuscarinic agent effectively decreased detrusor pressure, increased bladder capacity and maximum flow rate, and reduced the grade of VUR in 5 children who had post-treatment urodynamic studies. CONCLUSIONS: This study has shown that dysfunctional voiding is highly prevalent in children with symptoms of urgency frequency and incontinence. Biofeedback pelvic floor muscle training is effective in treatment of dysfunctional voiding in children.     

Pathophysiology of lower urinary tract symptoms in aged men without bladder outlet obstruction

OBJECTIVE: To assess the pathophysiology of lower urinary tract symptoms (LUTS) in aged men without bladder outlet obstruction in a videourodynamic study. METHODS: In a videourodynamic study of 324 consecutive men with moderate to severe LUTS suggestive for bladder outlet obstruction, 112 were found to be urodynamically nonobstructed. International prostatic symptom score (IPSS), uroflowmetry and transrectal sonography of the prostate were assessed before videourodynamic study. The pressure flow expression and the obstructive parameters were compared between the 212 obstructed and 112 nonobstructed men. RESULTS: Of the 112 nonobstructed men investigated, 25 had a normal bladder and urethral trace (22.3%), 5 had detrusor instability (4.5%), 17 had a hypersensitive bladder and a normal urethra (15.2%), 3 had detrusor underactivity and a normal urethra (2.7%), while 61 were found to have a poorly relaxed external sphincter and low detrusor contractility (54.5%). Most of the patients in the normal and hypersensitive groups had normal voiding pressure and high flow (NPHF) tracings, whereas men with detrusor underactivity or a poorly relaxed external sphincter had normal voiding pressure and low flow (NPLF) tracings. Only the maximal flow rate and voided volume were significantly higher in patients with NPHF than in patients with NPLF tracings. However, both groups showed a significantly lower IPSS, less residual urine, and a smaller transition zone index than the obstructive group. After medical treatment, 78 patients (69.6%) had satisfactorily improved, 31 patients (27.6%) remained stationary, while 3 (2.7%) worsened. CONCLUSION: Nonobstructed men with LUTS have various pathophysiologies other than benign prostatic obstruction. In this study 54.5% of these patients had poorly relaxed external sphincter on videourodynamic study. Identification of the underlying pathology can not only prevent unnecessary prostate surgery but can also enable proper medical treatment to be selected.     

Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults

Data concerning learned voiding dysfunction (Hinman syndrome; non-neurogenic, neurogenic bladder) in adults are scarce. The present study was conducted to assess the pre-valence and clinical characteristics of this dysfunction among adults referred for evaluation of lower urinary tract symptoms. Learned voiding dysfunction was suggested by a characteristic clinical history and intermittent "free" uroflow pattern and by the absence of any detectable neurological abnormality or anatomic urethral obstruction. A definitive diagnosis was made by the demonstration of typical external urethral sphincter contractions during micturition by EMG or fluoroscopy. A urodynamic database of 1,015 consecutive adults was reviewed. Twenty-one (2%) patients (age, 24-76 years) met our strict criteria of learned voiding dysfunction. Obstructive symptoms were the most common presenting symptoms, followed by frequency, nocturia, and urgency. Eight (35%) patients had recurrent urinary tract infections, seven of these being women. None of the patients had any clinically significant upper urinary tract damage. First sensation volume was significantly lower in women than in men. Both detrusor pressure at maximum flow and maximum detrusor pressure during voiding were found to be significantly higher in men than in women. Further differentiation between adult women and men failed to reveal any other clinically significant differences. In conclusion, by strict video-urodynamic criteria, 2% of our patients had learned voiding dysfunction. Other patients, with presumed learned voiding dysfunction, who did not undergo video-urodynamics were not included in the present series. Thus, the prevalence of learned voiding dysfunction among adults referred for evaluation of lower urinary tract symptoms is likely to be even higher.     

International prostate symptom score for assessing lower urinary tract dysfunction in women

Introduction and hypothesis

Some lower urinary tract dysfunction (LUTD) subtypes may have similar symptoms. This study aimed to investigate the feasibility of using the International Prostate Symptom Score (IPSS) to evaluate lower urinary tract symptoms (LUTS) in women.

Methods

All consecutive women with non-stress urinary incontinence LUTS who visited the urologic clinics for treatment were prospectively enrolled. LUTS include urinary storage, voiding, and post-micturition symptoms. All enrolled patients were requested to complete the Overactive Bladder Symptom Score (OABSS) and the modified Indevus Urgency Severity Scale (IUSS) questionnaires as well undergo uroflowmetry and post-void residual testing. A videourodynamic study was also performed, if indicated, for LUTD.

Results

A total of 222 women were enrolled, including 60 with overactive bladder (OAB) dry, 42 with OAB wet, 78 with bladder oversensitivity, and 42 with voiding dysfunction. A significantly higher IPSS voiding to storage subscore ratio (IPSS-V/S) and IPSS voiding score were found in the voiding dysfunction group. IPSS-V/S was found to have the highest area under the receiver-operating characteristic curve for predicting voiding LUTD than other noninvasive methods, and an IPSS-V/S of ≥1.33 had the best predictive value for female voiding LUTD with a high negative predictive value (97.4 %). In addition, significantly higher IPSS storage subscore (IPSS-S) values were found in the OAB wet subgroup, and the IPSS-S was well correlated with the OABSS and IUSS.

Conclusions

The IPSS can be used to evaluate female LUTD. IPSS-V/S may provide an initial guide for the treatment of voiding dysfunction in women. In addition, IPSS-S may be used for evaluating storage LUTD in women.

     

High-pressure bladder: an underlying factor mediating renal damage in the absence of reflux?

OBJECTIVE: To assess urodynamic studies of children with nonrefluxing pyelonephritis, investigate the possible connection between renal damage (as approximately 40% of children with febrile urinary tract infections and no evidence of vesico-ureteric reflux have irreversible renal cortical scarring) and lower urinary tract dysfunction, to test the hypothesis that bladders with high storage and voiding pressures may be the cause of renal damage in these patients. PATIENTS AND METHODS: The clinical records and urodynamic studies of 52 children (46 girls and six boys, mean age 6.6 years) with febrile urinary infections, no evidence of reflux and photopenic areas on renal scintigraphy were evaluated retrospectively. Each child was evaluated by urinary ultrasonography, a voiding cystogram, 99mTc-dimercaptosuccinic acid (DMSA) scan and urodynamic studies. The storage phase of the urodynamic study was divided into two equal segments to consider the filling variables of each. During the emptying phase, voiding pressures and voiding pressures with reference to peak detrusor contraction were evaluated. RESULTS: Despite no child having reflux, the DMSA scans showed bilateral renal scarring in 39 (75%) and unilateral scarring in the remaining children. Forty-eight (93%) children had abnormal urodynamic values: high filling pressures (34), high-pressure uninhibited contractions (32), high voiding pressures (31) and discoordinated voiding (28). The cystometric bladder capacity was lower than the expected bladder capacity (- 75 mL) in 82% of the patients; in only four patients were the urodynamics considered normal. CONCLUSIONS: Most children with renal scarring and no reflux had lower urinary tract dysfunction. Common findings include high storage and voiding pressures, and discoordinated voiding. These findings suggest that abnormal bladder dynamics play a role in the development of renal scars that occur in the absence of reflux.     

Behavioral and functional abnormalities linked with recurrent urinary tract infections in girls

BACKGROUND: Most girls with recurrent urinary tract infections do not have major urinary tract abnormalities. Recent studies focus on predisposing behavioral and functional abnormalities: infrequent voiding, inadequate fluid intake, stool retention, poor genital hygiene and voiding dysfunction. METHODS: Complete history, bladder and bowel questionnaire, physical examination, voiding-drinking diary, sonography and uroflowmetry were used to assess infrequent voiding, functional stool retention, poor fluid intake, inadequate hygiene, or voiding dysfunction in girls referred for evaluation of three or more symptomatic urinary tract infections (with a first infection at the age of more than 36 months). RESULTS: A total of 141 girls aged 3.9 to 18 years were evaluated between 1996 and 1999; 212 abnormalities were noted in 120 patients: infrequent voiding (isolated, 16; combined with other abnormalities, 47), poor fluid intake (isolated, 10; combined, 50), functional stool retention (isolated, 5; combined, 25), inadequate hygiene or toilet habits (isolated, 3; combined, 24), dysfunctional voiding (isolated, 15; combined, 10), bladder overactivity (isolated, 5; combined, 2). CONCLUSIONS: Most girls referred for evaluation of three or more urinary tract infections have host-mediated predisposing abnormalities: infrequent voiding, poor fluid intake, functional stool retention or voiding dysfunction. Poor genital hygiene and toilet habits were almost always combined with other abnormalities, suggesting that infections are not necessarily related to poor genital hygiene or toilet habits. Two or more indications of predisposing behavior often concur in the same patient.