妊娠末期女性下尿路症状调查分析

目的调查妊娠妇女最末1个月下尿路症状发病情况。方法采用女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUTS),于产后3d详细询问产妇的一般情况和孕前、孕期尿失禁发病情况和妊娠期最末1个月的下尿路症状。结果456名正常怀孕妇女参加这项研究。其中最常见的下尿路症状是夜尿(79.2%)和压力性尿失禁(30.5%),其次是尿急(27.4%),尿频(25.0%),排尿中断(16.2%),排尿延迟(11.0%),排尿时需要用力(4.2%),混合型尿失禁(4.1%),排尿疼痛(2.2%),急迫性尿失禁(0.9%)。结论夜尿、压力性尿失禁是最常见下尿路症状,夜尿对孕妇的生活质量影响最大。     

膀胱出口梗阻对逼尿肌功能的影响

良性前列腺增生（benign prostatic hyperplasia,BPH）是泌尿外科常见疾病之一。60岁以后,大约70％的男性存在前列腺增生,其中85％～95％出现下尿路功能异常症状,10％～20％需行前列腺切除。BPH致膀胱出口梗阻（BOO）,继而引起的逼尿肌功能改变主要有两种类型：逼尿肌收缩功能受损及逼尿肌不稳定,是引起老年男性下尿路症状（LUTS）的主要原因。目前认为LUTS的内容主要包括贮尿期和排尿期症状,前者如尿频、尿急、夜尿增多及尿失禁等,逼尿肌不稳定是主要原因;后者如尿线细、射程短、排尿中断、排尿后尿滴沥及尿潴留等,其主要原因在于逼尿肌收缩功能受损。本文阐述前列腺增生症引起的膀胱出口处梗阻对逼尿肌功能的影响。     

深圳某社区青年女性下尿路症状的问卷调查研究

目的:分析青年女性人群下尿路症状(LUTS)的发病率和相关影响因素。方法:对广东省深圳市某社区青年女性人群进行随机抽样问卷调查〔问卷设计参考女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUT)、国际前列腺状问卷(IPSS)布里斯托女性下尿路症状(BFLUTS)问卷及生活质量(QoL)等〕,根据具体情况进行调整。问卷由被调查者独立填写。结果:调查共发出问卷1 500份,回收有效问卷1 387份。储尿症状总患病率为91.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P<0.01),与年龄和分娩方式有关;排尿症状总患病率为65.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P<0.01),与生育情况、分娩方式以及文化水平有关。受调查者以刺激症状和梗阻症状的生活质量进行评分,分别为(2.87±1.32)分和(2.23±1.05)分;刺激症状和梗阻症状与生活质量评分的关联系数分别为0.51和0.23。结论:青年女性人群中的LUTS患病率很高,且不同程度影响青年女性的生活质量。     

深圳某社区青年女性下尿路症状的问卷调查研究

目的:分析青年女性人群下尿路症状(LUTS)的发病率和相关影响因素.方法:对广东省深圳市某社区青年女性人群进行随机抽样问卷调查[问卷设计参考女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUT)、国际前列腺状问卷(IPSS)布里斯托女性下尿路症状(BFLUTS)问卷及生活质量(QoL)等],根据具体情况进行调整.问卷由被调查者独立填写.结果:调查共发出问卷1 500份,回收有效问卷1 387份.储尿症状总患病率为91.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P＜0.01),与年龄和分娩方式有关;排尿症状总患病率为65.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P＜0.01),与生育情况、分娩方式以及文化水平有关.受调查者以刺激症状和梗阻症状的生活质量进行评分,分别为(2.87±1.32)分和(2.23±1.05)分;刺激症状和梗阻症状与生活质量评分的关联系数分别为0.51和0.23.结论:青年女性人群中的LUTS患病率很高,且不同程度影响青年女性的生活质量.     

尿流动力学检查对神经源性下尿路功能障碍的临床意义

目的 评估尿流动力学检查对神经源性下尿路功熊障碍的临床意义.方法 回顾性收集我院2012年2月至2014年4月34例神经源性下尿路功能障碍患者的尿流动力学检查资料,按临床症状分储尿期症状组、排尿期症状组及储尿期与排尿期症状混合组,分析总结各组患者的尿动力特点.结果 以储尿期症状为主的患者全部都有膀胱感觉过敏及逼尿肌过度活动;以排尿期症状为主的患者90％(18例)逼尿肌无自主收缩,60％(12例)膀胱感觉减退;同时有储尿期及排尿期症状的患者55.5％(5例)逼尿肌无自主收缩,33.3％(3例)逼尿肌-括约肌协同失调,33.3％(3例)膀胱感觉过敏,33.3％(3例)膀胱顺应性降低.结论 尿流动力学检查能明确神经损害后下尿路功能障碍的模式,尤其是能够检查出膀胱顺应性是否降低,有利于指导临床制定治疗方案,更好地保护上尿路功能.尿流动力学检查在神经源性下尿路功能障碍的临床应用中是可靠及必要的.     

上海市虹桥商务区楼宇职业女性心理健康状况分析

目的:对上海市虹桥商务区楼宇职业女性心理健康状况进行调查分析,为制定职业女性的心理健康干预政策提供参考.方法:于2020年9—12月将在上海市虹桥商务区楼宇工作的839名职业女性作为调查对象纳入调查,通过调查负责人将电子问卷链接发给被调查者,由被调查者独立完成问卷后提交.调查共收到862份问卷,回收有效问卷839份,问...     

脊髓损伤患者不同导尿方式对尿路感染和尿道功能影响的研究

目的研究Crede法排尿、间隙导尿与持续导尿对继发尿路感染和远期尿道功能的影响。方法113例神经源性膀胱功能障碍者分别采用Crede法排尿、间隙导尿和留置导尿,定期尿液培养进行尿路感染率比较：导尿时间达4～6个月后配合膀胱尿路造影（VCUG）及尿流动力学检查观测尿液返流情况、膀胱颈形态变化和尿道功能指标。结果Crede法排尿组、间隙导尿组和留置导尿组其尿路感染率分别为16．6％、29．7％、和35．1％,尿液返流率分剐为17．9％、32．4％和40．5％,差异有显著性意义（P〈0．05）：VCUG及尿流动力学检查提示持续导尿较Crede法排尿及间隙自家导尿明显损害膀胱颈形态和远期尿道功能。结论对丧失自主排尿功能但无严重意识障碍者尽可能减少留置导尿的应用范围和时间,间隙导尿尚不能有效防止尿液返流,采用Crede法排尿对控制尿路感染、维护和促进排尿功能恢复均具有重要意义。     

留置输尿管内支架后的症状调查

目的了解留置输尿管内支架后患者有何症状,症状与留置的时间是否有关,耐受性如何。方法调查问卷法,对排除下尿路病变．留有输尿管内支架的183例患者,于术后派发调杏表进行调查。结果留置输尿管内支架后最常见的症状为尿频（66％）、尿急（59％）、腰痛（66％）、排尿疼痛（尤以终末时为甚）（57％）及血尿（61％）。结论多数患者的症状不随时间的延长而加重;大多数患者留置内支架后,耐受良好,对生活质量仅有轻中度影响。     

女性下尿路症状的影像尿动力学评价

目的探讨女性下尿路症状患者的影像尿动力学异常表现及临床意义。方法选择38例门诊主诉持续下尿路症状就诊的女性患者，采用15％泛影葡胺溶液为膀胱灌注液。根据膀胱测压、压力-流率、盆底肌电图以及X线影像等对患者下尿路症状进行诊断，并比较尿动力学正常和异常患者的I-PSS评分。结果38例中影像尿动力学异常23例，占60．5％，其中感觉性尿急迫6例，不稳定膀胱（DI）5例，假性逼尿肌一括约肌协同障碍（PDS）4例，PDS＋DI2例，尿道外口狭窄2例，DI＋急迫尿失禁、低顺应性膀胱、膀胱颈后唇增生以及近端尿道憩室各1例。结论影像尿动力学检查不仅可以了解女性下尿路症状患者的下尿路功能和形态变化，且有助于不同病变类型的诊断和治疗。     

腹针联合中药治疗夜尿频数临床观察

夜尿频数是指夜间排尿在3次以上,大于4次者称为重度夜尿增多,为老年常见的下尿路症状之一。夜尿频数不仅影响睡眠,还增加老年患者心脑血管急症发生及外伤机率。对夜尿频数的治疗,目前西医药物治疗方法疗效欠佳。笔者采用腹针联合中药方法治疗夜尿频数,效果满意,报告如下。     

Managing lower urinary tract symptoms in men

Over one-quarter of men aged 40 years or over in the UK have lower urinary tract symptoms. These symptoms, which may seriously disrupt day-to-day activity, include frequency, urgency, hesitancy, reduced flow, dribbling, nocturia, incontinence and incomplete emptying of the bladder. Here, we review non-surgical measures that may help men with such symptoms.     

Nocturia in Spanish patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH)

ABSTRACT

Objective: This study aimed to assess the prevalence of nocturia and its impact on quality of life (QoL) in Spanish patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).

Research design and methods: This was a Spanish, multicentre, cross-sectional study. Outpatients aged 60 years and over with LUTS/BPH, a prostate size ≥ 25?g, untreated for LUTS/BPH and responding to the International Prostate Symptom Score (I-PSS) were included. Nocturia was defined as ≥ 2 nocturnal voids/night. The Spanish version of the Nocturia-specific Quality of Life (N-QoL) questionnaire assessed the impact of nocturia on QoL, with a low score indicating a poor QoL due to nocturia.

Results: A total of 502 patients were included; mean age 68.1 ± 5.7 years, mean I-PSS 14.9 ± 7.1, mean prostate size 50.9 ± 20?g. The overall prevalence of nocturia was 83.1% (95% confidence interval [CI]: 79.8–86.4). Patients with nocturia had a lower score on the overall N-QoL questionnaire and the sleep/energy and bother/concern domains than those without nocturia (?p < 0.001); 42.9% of patients with nocturia stated that they had a good-very good QoL compared to 90.6% in those without nocturia (?p < 0.001).

Conclusion: This study shows a high prevalence of nocturia in Spanish LUTS/BPH patients. Nocturia negatively impacts on the QoL of LUTS/BPH patients, which is reflected in worse sleep, reduced energy levels and increased bother and concern. Therefore adequate treatment of this symptom is necessary.     

盆底脏器脱垂患者与下尿路功能障碍关系的探讨

目的探讨盆底脏器脱垂患者与下尿路功能障碍之间的关系。方法于2009年7月-2010年11月对54例诊断为盆腔脏器脱垂的住院患者进行病史采集、妇科检查、POP—Q评分及尿动力学检查,探讨盆腔脏器脱垂与下尿路功能障碍的关系。结果54例POP患者中,出现下尿路主观症状44例,其中尿失禁症状27例（压力性24例,急迫性1例,混合性2例）,尿急和／或尿频27例,排尿功能障碍16例。尿动力学检查结果显示：压力性尿失禁28例,急迫性尿失禁2例,混合性尿失禁2例,伴膀胱顺应性降低1例,腹压排尿3例。腹部漏尿点压力（ALPP）〈60cmH2O有10例,60～90cmH2O13例,〉90cmH2O7例。与尿失禁主观症状的符合率为70％（19／27）;隐匿性尿失禁的发生率为41％（11／27）,均为重度阴道前壁脱垂的患者。结论POP患者术前在减轻脱垂程度情况下行尿动力学检查可更客观地评价下尿路功能障碍,POP患者术前应了解膀胱及尿道括约肌功能,注意排除隐匿性尿失禁。     

不同气质类型官兵实弹训练期间心理状态特点

目的探讨军事应激条件下,官兵气质类型与实弹训练前后心理状况之间的关系。方法对参加实弹训练的装甲某部官兵119名,在训练前、训练后采用艾森克简式个性问卷(EPQ—RSC)和症状自评量表(SCL-90)评定,并对评定结果进行统计分析。结果SCL-90测试结果显示:在平时和实弹训练期间,属于胆汁质和抑郁质类型的官兵与属于多血质和黏液质官兵的得分存在显著差异;对实弹训练期间和平时的SCL-90结果进行配对t检验,结果发现胆汁质官兵的躯体化和焦虑因子均分较平时有所增高(P< 0．05),多血质官兵的躯体化和恐怖因子均分有所上升(P<0．05)。而黏液质和抑郁质官兵实弹训练前后的SCL-90结果并无明显差异(P>0．05)。结论在平时和实弹训练条件下,不同气质类型装甲某部官兵的心理状况有较大差异。     

Pharmacotherapeutic management of lower urinary tract symptoms in Multiple Sclerosis patients

ABSTRACT

Introduction

Multiple Sclerosis (MS) manifests with a plethora of signs and symptoms affecting brain structures and spinal pathways. The multitude of lesions in MS patients makes difficult to establish the relative role of each of them to lower urinary tract symptoms (LUTS). Generally, the subcortical white-matter lesions result in detrusor overactivity, whilst lesions of the spinal cord result in the combined occurrence of detrusor overactivity and detrusor-sphincter dyssynergia (DSD). It has been estimated that 80–90% of patients with MS will suffer from some form of LUTS over the course of the disease. Among LUTS, the most reported is detrusor overactivity which includes urinary urgency, frequent urination, nocturia, and urge urinary incontinence.     

Treatment of nocturia in the elderly

The aging process, behavioural habits and a multitude of pathological conditions are the main contributors to the development of nocturia in the elderly. Age-related physiological changes can alter the regular pattern of urine excretion and lead to increased nocturnal frequency of voiding. In addition, aging is associated with anatomical and physiological changes of the urinary tract itself that predispose to increased urinary frequency without affecting urine volume. Several urinary and extra-urinary tract conditions may have nocturia as a prominent symptom. These conditions can be grouped as those associated with bladder overactivity, bladder outlet obstruction, bladder hypotonicity and an increased urine volume. A detailed assessment that gathers clues from the medical history, physical examination and laboratory is of utmost importance in identifying the specific causes. Overactive bladder can be idiopathic or associated with different triggers such as UTI, bladder stones, bladder tumours and CNS diseases that disrupt the normal inhibitory signals to the bladder. It may be cured by the successful elimination of the trigger conditions. Therapeutic modalities include behavioural therapies with scheduled voiding, anticholinergic drugs and in women the use of transvaginal electrical stimulation. Benign prostatic hyperplasia is the most common cause of bladder outlet obstruction in men. Different drug classes (e.g. peripheral alpha-adrenoceptor blockers and 5 alpha-reductase inhibitors) are now available for the treatment of mild to moderate symptoms. Surgery is reserved for patients with severe symptoms or with complications, with new and less invasive surgical techniques being preferred. Bladder hypotonicity is usually caused by peripheral neuropathies, spinal cord lesions and the indiscriminate use of drugs with anticholinergic actions. Treatment involves discontinuation of implicated drugs, short term use of cholinergic drugs and urinary catheterisation. Increased urine volumes and nocturia are frequently seen in hyperosmolar and oedematous states. Excessive ingestion of fluids, caffeinated or alcoholic beverages are habits that commonly produce nocturia. Although more definitive studies are awaited, low dose loop diuretics given a few hours prior to bedtime and desmopressin nasal spray or tablets may be useful alternatives for the control of nocturic symptoms in elderly patients with nocturnal polyuria syndrome. Whenever nocturia is present, clinicians should try to identify its causes by means of a thorough history, physical examination and pertinent complimentary tests. Once the specific cause or causes are found, most cases can be satisfactorily managed with behavioural, pharmacological or surgical therapies.     

剖宫产术后静脉自控镇痛产妇最佳拔除尿管时间的探讨

目的探讨剖宫产术后硬膜外自控镇痛产妇留置尿管最佳拔管时间。方法300例产妇随机分成三组,12小时拔出尿管组、18小时拔出尿管组与24小时拔出尿管组各100人,比较三组拔出尿管后排尿情况、尿潴留、尿常规阳性以及泌尿系统症状的发生率。结果12小时拔出尿管泌尿系症状少,感染机会小,但尿潴留的发生率高。18小时拔出尿管泌尿系症状少,感染机会小,且尿潴留的发生率低。24小时拔出尿管泌尿系症状多,感染机会大,但尿潴留的发生率低。结论剖宫产术后自控镇痛产妇留置尿管最佳拔管时间为18小时。     

舟山地区部队官兵贫血的流行病学调查

目的了解舟山地区部队官兵贫血的检出情况。方法运用整群抽样方法,采集陆、海军男性官兵的静脉血2mL,检测血红蛋白（Hb）,并开展问卷调查。结果 444名受检官兵的Hb为（144.4±12.1）g/L,Hb〈120g/L的男性共5名,贫血检出率为1.1%,1例为中度贫血。问卷调查表中与血液系统疾病相关的10项自觉症状中,乏力、烦躁最多见;与消化系统疾病相关的10项自觉症状中,食欲不振最多见,且贫血官兵均有不同程度的不良饮食习惯。结论舟山地区部队官兵的贫血检出率较低,但中度贫血被检出;贫血官兵均有不同的不良饮食习惯;乏力、烦躁等自觉症状的发生,有助于贫血的早期诊断与治疗;消化系统自觉症状与贫血的相互关系值得进一步探讨。