静态尿道压力测定和应力性尿道压力测定在女性真性压力性尿失禁诊断中的应用

目的探讨静态尿道压力测定(RUPP)和应力性尿道压力测定(SUPP)在女性真性压力性尿失禁(GSI)诊断中的应用价值。方法对30例临床诊断为GSI的患者进行RUPP及SUPP测定,比较其结果,以15例正常女性作为对照。结果静态尿道压力测定,SCI组的最大尿道关闭压和控制带长度较正常对照组小。应力性尿道压力测定中,患者压力传导率(PTR)及尿道关闭压(UCP)以多次咳嗽的平均值计算,GSI组PTR及UCP各为(0.63±0.24)、(-26.58±21.43cmH2O),而正常组PTR及UCP各为(1.78±0.12)与(83.42±37.23cmH2O)。两组间上述指标的差异均有显著性意义(p<0.01)。结论SUPP和RUPP在GSI的诊断中均具有一定意义,对于症状较轻的尿失禁患者的诊断,两者联合应用可以提高GSI的诊断水平。     

The physical finding of stress urinary incontinenceamong African women in Ghana

The aim of this study is to determine the proportion of women with the physical sign of stress urinary incontinence in a sample of Ghanaian women. Two hundred randomly selected women from attendants at a convenience selected ultrasound clinic were interviewed about symptoms of urinary incontinence. A paper towel test was performed to objectively demonstrate the physical sign of stress urinary incontinence as leakage on coughing. Forty-two percent of the women had a positive paper towel test. The two major symptoms reported by the women with positive paper towel test were (1) loss of urine while waiting to use the toilet (48.2%) and (2) loss of urine on coughing (43.4%) in daily life. The physical sign of stress urinary incontinence could be present in up to 42% of Ghanaian women.     

TVT-O治疗女性压力性尿失禁的疗效观察

目的 探讨评价经闭孔无张力尿道中段悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的临床疗效.方法 回顾性分析2008年9月至2011年9月采用TVT-O治疗SUI18例进行疗效观察.结果 手术时间15 ～45min,平均25 min,术中出血20 ～ 60ml,平均40ml.拔管后尿失禁消失15例,增加腹压后偶有尿液溢出3例.随访3～l2个月,平均6个月,无一例复发.结论 TVT-O治疗SUI操作简单安全,创伤小,并发症少,疗效可靠,是一种理想治疗方法.     

The association between diabetes mellitus and urinary incontinence in adult women

Introduction and hypothesis  The purpose of the study was to investigate the relationship of diabetes mellitus and urinary incontinence in adult women. Methods  We conducted a cross-sectional, comparative study with a case-control design. One thousand three hundred eighty-one women (aged 20–87 years) attending six Primary Healthcare Centers in Turkey were enrolled in this study, after giving their informed consent. Subjects were dichotomized into cases and controls according to presence of diabetes mellitus (DM) and were matched for the confounding factors age, body mass index (BMI), and reproductive history. Results  Nine hundred ten women were included: 273 diabetics and 637 non-diabetics. Diabetes was shown to be associated with a 2.5-fold risk increase for urinary incontinence (UI), and age and BMI were weakly associated with UI. UI was significantly more prevalent in diabetic women: 41% diabetic and 22.1% non-diabetic women reported UI (p < 0.001). Age, BMI, and DM were revealed as independent determinants of UI in adult women. Urge incontinence was more prevalent in non-diabetic women, whereas stress and mixed incontinence were more prevalent among diabetic women. Conclusions  DM is the most important independent determinant of UI.     

Treatment-seeking behavior in Hong Kong Chinese women with urinary symptoms

 A pan-territory telephone survey was conducted in Hong Kong of Chinese women concerning urinary symptoms and their treatment preferences; 1500 women replied. One hundred and ninety-four (13%) of the 1500 subjects had urinary symptoms. Of these 194, 155 (10.3%) had stress incontinence, 64 (4.3%) had urgency, 10 (0.7%) had urge incontinence, 63 (4.2%) had frequency of urination, 64 (4.3%) had nocturia, 2 (0.1%) had enuresis, and 20 (1.3%) had incomplete emptying. Sixty-eight (35.1%) of the 194 symptomatic subjects sought medical advice (group 1) and 126 (64.9%) did not (group 2). In group 1, 28 (41.2%) sought medical advice from general practitioners, 26 (38.2%) from private specialists, 2 (2.9%) from Chinese herbalists and 12 (17.6%) from public hospitals. In group 2, 4 (3.2%) claimed they had no time, 119 (94.4%) did not think their symptoms were serious, and 11 (8.7%) did not know help was available. None of the subjects felt too embarrassed to seek medical advice, or felt that they could not afford medical attention. The strongest predictor for treatment-seeking behavior was the symptom of incomplete emptying (logistic regression, P=0.004). A substantial proportion of Hong Kong Chinese women with urinary symptoms seek medical advice for their symptoms. The symptom of incomplete emptying appears to be the strongest reason for them to do so. Received: 5 February 2002 / Accepted: 24 June 2002 Acknowledgment The research project was supported by the Health Services Research Committee/Health Care and Promotion Fund (HSRC number 531010).     

The prevalence of urinary incontinence in a randomized population of 5247 adult finnish women

A randomized study of the prevalence of urinary incontinence was performed among adult Finnish females. In 1986, 5247 women (aged 25–55 years) who participated voluntarily in a gynecological health study, anonymously completed a questionnaire concerning subjective symptoms and experiences with urinary incontinence. One-fifth of the studied population (20.1%) reported that they were handicapped by incontinence. The number of incontinent women increased significantly with increasing age up to 45 years. Stress urinary incontinence alone was reported by 73% of the women experiencing incontinence. Surprisingly, only one-third of the women stated that they needed treatment, and less than one-fifth of all had sought help for this disorder.     

The treatment of urinary incontinence in 1814

 A selection from a little-known medical treatise of the early 19th century is presented which describes the condition of urinary stress incontinence and its treatment by means of pessaries, mechanical occlusive devices and electrical stimulation therapy. The author provides a foreshadowing of therapies that would come into more common use 150 years later. Received: 19 June 2002 / Accepted: 21 July 2002     

Prevalence of urinary incontinence in Korean women: results of a National Health Interview Survey

Objectives We determined the prevalence and types of urinary incontinence (UI) in Korean women and analyzed their attitude toward treatment. Methods This national survey was conducted as part of the Korean National Health Interview Survey to evaluate the prevalence of UI in Korean women between April and June 2005. In 13,345 Korean households, 13,484 women aged 19 years or older were interviewed by census takers. The subjects were asked about the type of UI that they had experienced and their treatment. UI was classified as “stress,” “urge,” “mixed” (stress and urge), or “other.” Results The overall prevalence of UI in the subjects was 24.4%. Of those women, 48.8% reported stress UI only; 7.7%, urge UI only; 41.6%, mixed UI; and 1.9%, other type of UI. The prevalence of UI increased with age. Only 12.6% of the women with UI had sought medical care, and only 0.8% had undergone surgery for UI. Self-reported depression was higher in women with UI than in those without that disorder, and UI was more prevalent in women who were married, unemployed, and undereducated. According to national population data estimated by weighted UI numbers, about 4.2 million Korean women aged 19 years or older have experienced UI. Conclusions The prevalence of UI among women aged 19 years or older in Korea was 24.4%, and stress UI was the most prevalent type. Many women with UI did not seek medical treatment for that condition.     

Ultrasonography in stress urinary incontinence

Evaluation of the urethrovesical junction in stress urinary incontinence is essential. For this reason the Q-tip test, a clinical test with debatable specificity; lateral cystourethrography, a conventional method; and videourethrocystography, a sophisticated method, have been in use. Because ultrasonography is inexpensive, reliable, easy to apply and free of any contrast material and X-ray exposure, it has practically replaced all the former methods in the evaluation of the urethrovesical junction in stress urinary incontinence patients within the last decade.     

The influence of obesity, constitution and physical work on the phenomenon of urinary incontinence in women

Urinary incontinence in women is a common and complex problem which can be defined and classified as stress, urge and mixed incontinence. Three of the eight most common risk factors are obesity, constitution and physical work, in addition to age, length of menstrual cycle, number of pregnancies, education and level of health awareness. Women with the diagnosis of urinary incontinence were invited to respond to questionnaires on a voluntary basis. The three factors found to be associated with urinary incontinence are increased body weight, strong osteomuscular structure and hard physical work. These indicate that the work of a health team must take a holistic approach to women even before the phenomenon of urinary incontinence occurs.Editorial Comment: This study is a statistical analysis of the risk factors for urinary incontinence in women. The authors find that obesity, hard physical work and strong osteomuscular structure are linked to the development of incontinence. Limitations to the study design and results include the absence of an appropriate control group and potential selection bias. Nevertheless, few investigators have attempted to study the impact of the type of daily workload on the development of urinary incontinence and, vice versa, the impact of urinary incontinence on a patient's employment and social life. These are important issues which deserve further investigation.     

Reliability of the 24-h sensation-related bladder diary in women with urinary incontinence

Increased bladder sensation is the most troublesome symptom of overactive bladder. In clinical practice, reliable noninvasive evaluation of bladder sensation is needed. This study was designed to determine the reliability of a 24-h sensation-related bladder diary (SR-BD) in women with urinary incontinence including clinically relevant information regarding the bladder sensation. A total of 246 women with urinary incontinence filled out a SR-BD for 3 days. They graded the perception of bladder sensation at each micturition and measured the volume voided. The reliability of the 24-h SR-BD method is preserved, when taking into account the grade of bladder sensation. The 24-h SR-BD, which incorporates bladder sensation at each micturition, not only gives information on sensation-related micturition behavior but also shows good reliability. Grading of bladder sensation does not jeopardize this methodology but on the contrary provides added value, which is clinically relevant.     

脑血管意外尿失禁的机制探讨

目的探讨脑血管意外引起尿失禁的可能机制。方法对42例诊断为脑血管意外伴有尿失禁的患者进行尿动力学检查(包括静止期尿道压测定、充盈期及排尿期膀胱尿道功能测定)并按Burney分类进行分析,同时研究病变部位、脑血管意外性质和病变半球侧与尿动力学的关系。结果42例脑血管意外患者中,表现为逼尿肌反射亢进者31例(73.8%):其中外括约肌无抑制性松弛19例(45.2%),逼尿肌-外括约肌不协调3例(7.1%),逼尿肌-外括约肌协调9例(21.4%);逼尿肌反射减低,外括约肌协调者11例(26.2%);无逼尿肌功能正常者。发生膀胱顺应性减低5例(11.9%),发生尿感缺失者11例(26.2%)。初感尿容量(140.00±46.97)ml;膀胱最大容量(293.20±60.71)ml;最大尿道闭合压(65.14±19.83)cmH2O。逼尿肌最大收缩力(Pdetmax)为(60.98±31.11)cmH2O;最大尿流率时逼尿肌压力(Pdet-Qmax)为(35.98±17.46)cmH2O;逼尿肌收缩时间(Tcon)为(86.07±36.09)sec;最大流量(Qmax)为(9.02±5.62)ml/s。中风后尿失禁患者其发病部位多见于基底节、皮层多灶以及额顶叶,脑出血与脑梗塞患者的尿动力学表现无明显差异,左右半球病变对尿动力学也无明显差异。结论脑血管意外后尿失禁的尿动力学异常主要为逼尿肌反射亢进,部分出现逼尿肌反射减弱,但感觉正常,感觉缺失者较少见;外括约肌功能以无抑制性松弛为主,其次为逼尿肌-外括约肌协调,少数出现不协调;较少出现膀胱顺应性降低。     

女性压力性尿失禁患者在不同膀胱容量下漏尿点压的对照研究

目的:探讨女性压力性尿失禁患者在不同膀胱灌注量下漏尿点压的差异。方法:回顾性分析2016年1月至2018年12月本院收治的12例女性压力性尿失禁患者,在术前行尿动力检查时分别给予膀胱灌注200、250、300、350 mL时,测出腹压漏尿点压及咳嗽漏尿点压并分别进行比较。结果:不同膀胱容量下同时测得的腹压漏尿点压及咳嗽...     

Acute urinary retention in females

Twenty-six hospitalized females were evaluated prospectively for acute urinary retention. They could be divided into three etiologic groups: 1) transient; 2) neuropathic; and 3) pelvic causes. An initial division into the first two categories could be obtained in 21 patients by the history, physical examination and urine cultures, sparing further unnecessary testing. The rest were evaluated by pelvic sonogram, and unexpected potentially life-threatening pathology was found in 4 patients. An algorithm for the evaluation and treatment of acute urinary retention in females is presented.     

Chronic urinary retention after radical cystectomy and orthotopic neobladder in women: Risk factors and relation to time

Purpose

To investigate the long-term cumulative incidence of chronic urinary retention (CUR) after radical cystectomy (RC) and orthotopic neobladder (ONB) in women and the possible risk factors.

Long-term subjective continence status and use of alternative treatments by women with stress urinary incontinence after collagen injection therapy

This study examined subjective continence status and use of subsequent alternative therapeutic procedures at long-term follow-up after collagen injection for stress incontinence (SI) in women. Seventy women who underwent collagen injection for SI were identified by retrospective chart review and surveyed by mail questionnaire for subjective continence status, daily pad usage pre- and post-treatment, and use of anticholinergics and alternative procedures. Questionnaire responders’ versus non-responders’ mean age, follow-up, and pad usage were compared. Thirty-three women (47%) responded on questionnaires. Of the 33, 50% were dry or subjectively improved at long-term follow-up and 91% had not chosen an alternative invasive treatment after collagen injection. Chart review showed responders were not significantly different from non-responders in mean age (65.9 vs. 69.2 years), pad usage (0.6 vs. 0.8 pads/day), or follow-up (4.5 vs. 4.3 years). Collagen injection, a minimally invasive treatment for SI, appears to benefit a significant number of women.     

Reasons why women with long-term urinary incontinence do not seek professional help: a cross-sectional population-based cohort study

The aims of this study were to investigate the reasons why some women with long-term urinary incontinence (UI) seek professional help whereas others do not, their experiences and satisfactions with the healthcare services, and how women deal with their incontinence. In total, 95 women aged 23–51 years with persistent UI (median 10 years, range 6–20 years) were included in this telephone interview survey. Seventy-four percent of the women with long-term UI had not sought help. The most common reason given was that the disorder was considered a minor problem, which they felt they could cope with on their own. When women did consult professional help they did so because they were afraid of the odor of urine and that they perceived the leakage as shameful and embarrassing. These women felt that the healthcare service offered appropriate care for their condition. Pelvic floor exercises were the most commonly used management methods for all participants. Abbreviations - UI Urinary incontinenceEditorial Comment: In this survey of 78 women aged 23–51 with reported urinary incontinence, only 20 (26%) sought professional help for this problem. Although the majority of women in this younger sample deemed their problem to be minor, increasing urinary leakage, embarrassment and fear of odor were the most frequent reasons given for seeking help. This study highlights the taboo regarding urinary incontinence.     

Changing prevalence and knowledge of urinary incontinence among Hong Kong Chinese women

A territory-wide telephone survey was conducted in Hong Kong to assess the prevalence, knowledge, and treatment-seeking behaviour of Chinese women with urinary incontinence, using validated Chinese version of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Women, 540, aged between 17 to 77 years were interviewed. Of the respondents, 40.8% reported stress urinary incontinence, 20.4% had urge incontinence and 15.9% had mixed incontinence. Among these, 16.0% reported quality of life impairment; 9.3% felt frustrated with low morale, and 15.2% had nervous and anxiety problems. However, as many as 78.3% of the respondents did not know that stress urinary incontinence is a disease entity, and 60.6% thought that leakage of urine was a normal aging process. For those respondents having stress urinary incontinence, the first treatment of choice was physiotherapy. The second choice was medication, and surgical treatment was the last option. Respondents with stress urinary incontinence showed higher education level.     

Prevalence of anorectal dysfunction in women attending health care services

The aim of this study was to assess the prevalence of different bowel symptoms (constipation, faecal incontinence and faecal evacuation dysfunction) and associated urinary symptoms in women attending health care services. All women attending colposcopy clinics and general gynaecology clinics in a district general hospital in the southwest of England were invited to participate in the study. In addition, women attending the local family planning clinic were also recruited. Women attending these clinics routinely completed a history sheet and were asked to complete the Birmingham Bowel and Urinary Symptoms Questionnaire. Two hundred women participated in the study: 116 (64.4%) had at least one bowel symptom from the list in the questionnaire and 57 (31.6%) of women thought they had a bowel problem but only 26 (14.4%) consulted their family doctor regarding the problem while four (2.2%) were referred for specialist opinion. Six were unsure about their bowel symptoms. There were 46 (25.5%) of women who had constipation, 99 (55%) had faecal incontinence and 97 (53.8%) complained of faecal evacuation dysfunction. Only 48 (26.6%) of women were free of any bowel complaint. One patient with faecal incontinence discussed her problem with her midwife but no further action was taken as she was too embarrassed to discuss it with her doctor. Seventy-eight (43.3%) of patients had urinary symptoms. Fifty-five (30.5%) thought they had a urinary problem but only 29 (16.1%) consulted their doctor and 17 (9.4%) were referred for specialist opinion. Sixty-one (33.8%) of those who admitted to have urinary incontinence also had faecal incontinence. Forty-nine (27.2%) of the patients were free of all symptoms. The mode of delivery as well as previous surgery did not have any influence on urinary incontinence nor on anal incontinence. This study has demonstrated a high prevalence of bowel symptoms in women attending health care services.