莫沙必利联合胰激肽原酶治疗糖尿病神经源性膀胱疗效观察

目的探讨莫沙必利联合胰激肽原酶治疗糖尿病神经源性膀胱（DNB）的疗效及其安全性。方法将80例DNB患者随机分为观察组和对照组各40例,两组均采用基础治疗包括降糖、降压、营养神经、改善微循环及调节血脂等,观察组在基础治疗上加用莫沙必利和胰激肽原酶治疗,治疗21d后观察两组的血糖、血脂、血压和膀胱残余尿量改善情况。结果观察组治疗后总有效率明显高于对照组（P〈0．05）;两组治疗前后血糖、血压及血脂组间相比无明显差异（P〉0．05）,两组治疗后膀胱残余尿量明显少于治疗前（P〈0．05）,观察组治疗后膀胱残余尿量明显少于对照组（P〈0．05）;两组均未出现不良反应。结论莫沙必利联合胰激肽原酶治疗DNB能有效缓解患者的症状、体征,减少膀胱残余尿量,临床应用安全有效。     

女性压力性尿失禁严重程度与尿动力学参数的相关性分析

目的 探讨女性真性压力性尿失禁（GSⅠ）患者临床表现严重程度与尿动力学参数的相关性。方法 50例GSⅠ患者安排填写国际尿失禁咨询委员会尿失禁问卷简表（ⅠCⅠ-Q-SF）,依据其评分分为三组,Ⅰ组问卷表评分≤7分。Ⅰ组7分〈评分〈14分,Ⅰ组14分≤评分≤21分。分别记录三组排尿日记并测定其尿动力学参数。结果 功能性膀胱容量和valsalva漏尿点压在Ⅰ、Ⅰ、Ⅲ组之间逐渐降低,具显著性差异（P〈0．05）。Ⅰ组最大尿道压、最大尿道闭合压、最大尿流率时逼尿肌压力和最大逼尿肌压力均显著高于Ⅰ、Ⅲ组（P〈0．05）。三组总排尿量、总排尿次数、最大尿流率、膀胱顺应性、最大膀胱压测定容量和功能性尿道长度无显著性差异（P〉0．05）。结论 有选择地应用排尿日记指标和尿动力学参数可有效地评估女性尿失禁患者的严重程度。     

综合康复治疗糖尿病神经源性膀胱的临床研究

采用随机分组的方法,将90例病人,分为综合康复组45例,给予针灸治疗、膀胱控制训练、膀胱区按摩以及清洁导尿等方法;对照组45例,给予针灸治疗及清洁导尿等方法;观察并记录2组患者尿流率、排尿后B超测定残余尿量。结果：综合康复组患者在尿流率、排尿后B超测定残余尿量等方面均优于对照组（P〈0．05）。结论：综合康复训练可有效促进糖尿病神经源性膀胱功能恢复。     

老年前列腺增生症患者逼尿肌功能变化的尿动力学检测意义

目的探讨前列腺增生症（ＢＰＨ）患者逼尿肌功能变化的尿动力学特点及其临床意义。方法应用尿动力学技术，检查３５例ＢＰＨ患者的尿流率、膀胱充盈期和排尿期压力、膀胱感觉，观察膀胱容量－压力相关关系，测定剩余尿量，评估膀胱的稳定性、顺应性及逼尿肌受损程度。结果逼尿肌不稳定２２例（６２．９％），逼尿肌收缩功能受损８例（２２．９％），膀胱顺应性改变５例（１４．２％），表明ＢＰＨ可引起逼尿肌功能变化。结论尿动力学对判断逼尿肌功能状态、确定排尿功能障碍原因、选择药物治疗或手术适应证有重要意义。     

女性糖尿病患者膀胱功能障碍的尿流动力学表现及意义

目的 观察糖尿病膀胱功能障碍患者的尿流动力学表现,探讨糖尿病对膀胱功能的影响.方法 分析28例女性糖尿病患者(观察组)的尿流动力学检查资料,对其最大尿流率(Qmax)、残余尿量(PVR)、初始尿意膀胱容量(FDV)、最大尿流率时逼尿肌压力(Pdet at Qmax)、最大膀胱容量(MCC)等进行统计,并与28例因其他原因行尿动力检查且结果正常的女性患者(对照组)进行比较.结果 观察组的最大尿流率为(10.4±7.6) mL/s,明显低于对照组的(21.4±4.1)mL/s(P ＜0.01);残余尿量为(223.8±247.8) mL,明显高于对照组的(19.0±11.3)mL(P ＜0.01);初始尿意容量为(286.1±157.9)mL,明显高于对照组的(195.6±71.4) mL(P ＜0.05).最大尿流率时逼尿肌压力为(20.6±19.1) cmH20,明显低于对照组的(30.8±11.1)cmH2O(P ＜0.05);最大膀胱容量为(514.3±163.2) mL,明显高于对照组的(320.9±90.3)mL(P ＜0.05).观察组发生糖尿病膀胱病(DC) 16例(57.1％)、逼尿肌过度活动(DO)5例(17.9％),膀胱出口梗阻(BOO)3例(10.7％),4例(14.3％)逼尿肌肌力正常.对照组逼尿肌肌力均正常.结论 糖尿病显著影响女性患者的膀胱感觉功能和逼尿肌功能收缩功能,导致尿流率降低,膀胱容量增大,残余尿量增多.DC是糖尿病膀胱功能障碍(DBD)最主要的表现形式,部分患者可出现DO和BOO症状.     

TURP同期膀胱造瘘术治疗合并逼尿肌收缩力减弱的良性前列腺增生症

目的观察经尿道前列腺电切（TURP）同期膀胱造瘘术治疗合并逼尿肌收缩力减弱良性前列腺增生（BPH）的疗效。方法 60例合并逼尿肌收缩力减弱的BPH患者,按膀胱逼尿肌受损程度分为A组[30 cmH2O≤排尿期膀胱逼尿肌压力（Pdet）30-40 cmH2O]、B组（Pdet 20-30 cmH2O）和C组（Pdet 10-20 cmH2O）,均同期行TURP膀胱造瘘术,术后1 a随访最大尿流率、残余尿量、国际前列腺症状评分（IPSS）和生活质量评分（QOL）。结果 A组24例术后2周均拔除造瘘管,排尿通畅,总有效率100%;B组21例中19例先后拔除造瘘管,排尿良好,2例终生保留造瘘管,总有效率90.5%;C组15例中6例先后拔除造瘘管,排尿良好,9例终生保留造瘘管,总有效率40%。结论 BPH患者,由于单纯膀胱出口梗阻引起逼尿肌收缩力减弱时,如逼尿肌轻度受损或中、重度受损而腹压较高者,可行TURP同期膀胱造瘘术;逼尿肌重度受损且腹压低者,宜行单纯膀胱造瘘术,3个月后如逼尿肌功能明显改善,可行TURP。     

无创尿动力学检测在糖尿病性膀胱病早期诊断中的价值

目的 探讨应用无创尿动力学检测早期发现糖尿病性膀胱病(DCP).方法 对70例2型糖尿病患者和30例非糖尿病者进行尿动力学检测,并以糖尿病病程5年为界限将70例患者分为2组,分别应用无创尿动力学方法进行最大尿流率、平均排尿率、初尿意膀胱容量及残尿量测定.结果 70例糖尿病患者中膀胱有残余尿者34例,即DCP组,平均残尿量7～139(30.1±27.1)ml,DCP检出率48.6%,无残余尿者36例,即非DCP糖尿病组.正常对照组30例均无残余尿量.与正常对照组相比,DCP组及非DCP糖尿病组最大尿流率、平均尿流率均明显降低(P<0.01).糖尿病病程≥5年组最大尿流率、平均尿流率均低于病程<5年组,但差异无统计学意义(P>0.05).结论 无创尿动力学检查提示最大尿流率降低和出现膀胱残余尿可作为早期发现和诊断DCP的筛查指标.     

老年良性前列腺增生合并糖尿病患者的尿流动力学检测

目的通过尿流动力学检测评估良性前列腺增生合并糖尿病患者的下尿路症状,探讨糖尿病对良性前列腺增生患者逼尿肌功能改变的影响。方法 80例良性前列腺增生患者,分成2组,36例为伴发糖尿病的良性前列腺增生患者(糖尿病组),44例为单纯良性前列腺增生患者(对照组),对比分析两组患者的尿流动力学结果。结果两组患者在膀胱初始尿意容量,膀胱最大容量,残余尿量,最大尿流率,最大尿流时逼尿肌压力,膀胱顺应性增高,逼尿肌不稳定及膀胱出口梗阻发生率等方面,差异均有统计学意义(P0.05)。结论糖尿病加重了良性前列腺增生患者的膀胱功能障碍,尿动力学检查对于良性前列腺增生合并糖尿病患者是否行手术治疗及预测术后效果具有重要的临床参考价值。     

术前膀胱逼尿肌收缩力对BPH患者TURP后膀胱功能恢复的影响

目的观察术前膀胱逼尿肌收缩力情况对良性前列腺增生症（BPH）患者经尿道前列腺切除术（TURP）后膀胱功能恢复的影响。方法 106例BPH患者中,术前逼尿肌收缩力增强34例（A组）、收缩力低下30例（B组）、收力缩正常42例（C组）,均行常规TURP治疗,术后行尿动力学检查观察膀胱功能恢复情况。结果三组患者最大尿流率（Qmax）较术前均增加（P均〈0.01）,剩余尿量（PVR）减少（P均〈0.01）。与术前相比,A组逼尿肌最大收缩力（Pdet）降低,B组Pdet增加（P均〈0.01）。A组术后Qmax、PVR与C组比较,C组与B组比较,P均〈0.01。结论术前逼尿肌收缩力正常及增强的BPH患者较收缩力低下者,TURP术后膀胱功能恢复好。     

高龄良性前列腺增生中小体积前列腺伴膀胱出口梗阻患者的尿动力学特点

目的探讨高龄良性前列腺增生(BPH)中小体积前列腺伴膀胱出口梗阻(BOO)患者的尿动力学特点。方法年龄>70岁的高龄BPH中有BOO的患者115例,根据前列腺体积分为前列腺体积≤30 ml组45例,>30 ml组70例,比较两组年龄、血清前列腺特异性抗原(TPSA)水平、残余尿量、最大尿流率(Qmax)、平均尿流率、排尿量、排尿时间、膀胱顺应性、Qmax时膀胱压力、逼尿肌收缩能力。结果前列腺体积≤30 ml组年龄、Qmax时膀胱压力及Qmax时逼尿肌压力均明显低于前列腺体积>30 ml组,而残余尿量明显高于前列腺体积>30 ml组(P<0.05);前列腺体积≤30 ml组逼尿肌收缩乏力发生率明显高于前列腺体积>30 ml组(χ~2=3.86,P=0.049)。结论小体积前列腺的BPH,在经尿动力学检查判断为BOO时,合并发生膀胱排空障碍及逼尿肌收缩能力降低的可能性更大。     

Repeated injection of botulinum toxin a in patients with neurogenic bladder: our experience

Background: In literature, the majority of data about treatment with botulinum toxin A are based on the results of a single treatment. We evaluate the safety and effectiveness in the medium term of the use of botulinum toxin type A in patients with neurogenic bladder, taking into consideration the clinical and urodynamic parameters, particularly in cases with repeated injections. Methods: 25 patients were divided into 2 groups: a first group of patients with detrusor overactivity, and a second with overactive sphincter. We performed 20-30 injections (Dysport), at a dose ranging between 500 and 1000 U. The first group was treated with infiltration in the detrusor and in the detrusor and trigone. The second group received injections in the perisphinteric zone, and in the?perisphinteric zone and bladder neck. Of the 25 patients, 12 received a retreatment: the first group of patients kept a daily voiding diary to record the number of bladder emptying, incontinence episodes, nycturia and urgency of urination. The urodynamic parameters and symptoms pre-treatment and 4 months after the treatment were compared in both groups. Results: In the first group there were significant changes in the cystometric capacity, maximum detrusor pressure, and in the post-void residual urine 4 months after treatment. These patients were satisfied with the treatment because of the improvement of incontinence and episodes of urgency. In 9 out of 15 retreated patients, the therapeutic results were similar to the first treatment. The second group reported significant improvements in maximum urinary flow rate, post-void residual urine and maximum detrusor pressure. 3 out of 10 patients were retreated even in this group; the new therapeutic results were similar to the first treatment. Conclusions: Our results in 25 patients with neurogenic bladder showed a concordance with the literature data. The treatment of detrusor and sphincter neurogenic overactivity with botulinum toxin A is effective and safe. Also in the 12 patients with repeated injection treatment, it has been proven safe and effective.     

糖尿病神经源性膀胱患者血清铁蛋白水平的改变及其临床意义

目的 探讨糖尿病神经源性膀胱（DNB）患者血清铁蛋白（SF）水平变化及两者的相关性.方法 选取单纯T2DM患者（T2DM组）,DNB患者（DNB组）和正常对照（NC组）者,各30例,采用化学发光法测定SF水平. 结果 DNB组和T2DM组SF水平均高于NC组,且DNB组高于T2DM组[（689.75±67.31）vs（498.98±49.76）vs（278.15±38.65） ng/ml,P＜0.01].SF水平与TC、TG、HbA1 c水平均呈正相关（r=0.48、0.42、0.57,P均＜0.01）.非条件Logistic回归分析显示,DNB与病程、年龄、SBP、HbA1 c、FIns、TC及SF呈正相关（P＜0.05或P＜0.01）. 结论 SF的升高与DNB的发生发展密切相关,可作为DNB的检测指标之一,为临床干预治疗提供理论依据.     

大鼠膀胱逼尿肌过度活动与内脏高敏感的关系

目的 探讨大鼠膀胱逼尿肌过度活动（DO）与内脏高敏感（VH）的关系.方法 将36只雌性Wistar大鼠随机分为VH组和对照组,各18只.WH组采用腹腔注射卵清白蛋白方法建立VH模型,对照组注射等量无菌生理盐水.2周后行腹部撤回反射（AWR）评分检测是否造模成功.对两组大鼠行尿流动力学检测明确是否有DO发生.结果 VH组12只（67％）大鼠出现DO,对照组未见DO.VH组大鼠DO发生率明显高于对照组（P＜0.05）.VH合并DO大鼠、对照组大鼠膀胱容量分别为（0.621 ±0.185）、（0.265±0.052） mL,排尿反射压分别为（50.4±7.0）、（43.6±5.5） cmH2O,膀胱重量分别为（0.181 ±0.034）、（0.112 ±0.021）g.与对照组相比,VH合并DO大鼠膀胱容量、排尿反射压和膀胱重量均明显增加（P均＜0.05）.结论 VH参与了DO的发生.     

膀胱水扩术在大鼠氯胺酮性膀胱炎治疗中的应用效果观察

目的 观察膀胱水扩术联合药物膀胱灌注对氯胺酮性膀胱炎大鼠的治疗效果.方法 将20只氯胺酮性膀胱炎模型大鼠随机分为水扩组与灌注组各10只,水扩组行膀胱水扩术联合膀胱灌注药物（碱性利多卡因与地塞米松）治疗;灌注组行单纯膀胱内灌注药物治疗;另取10只正常大鼠作对照组.行尿流动力学检测,观察三组大鼠储尿期和排尿期膀胱功能改变.结果 与灌注组比较,水扩组最大膀胱容量（MBC）显著增大（F=77.575,P=0.000）,排尿间隔显著缩短（F=71.922,P=0.000）,储尿期逼尿肌不稳定收缩频率显著降低（F =24.934,P=0.000）.结论 膀胱水扩术能扩大大鼠膀胱容量,增加排尿间隔时间,改善氯胺酮性膀胱炎大鼠的膀胱功能.     

黄葵胶囊联合氯沙坦治疗老年糖尿病肾病的临床疗效观察

目的观察氯沙坦联合黄葵胶囊治疗老年糖尿病肾病的临床疗效。方法将50例老年糖尿病肾病患者按随机数字表法分为两组：氯沙坦组、氯沙坦与黄葵胶囊联合用药组,每组25例,氯沙坦组患者接受氯沙坦治疗,氯沙坦与黄葵胶囊联合用药组患者在使用氯沙坦的基础上加用黄葵胶囊治疗。观察两组患者治疗前、治疗12w后24h尿蛋白定量、尿-乙酰-β-D氨基葡萄糖苷酶（尿NAG）、尿β2微球蛋白（β2-MG）及血肌酐水平的变化情况。结果联合用药组患者治疗12w后24h尿蛋白定量、尿NAG、尿β2-MG水平与氯沙坦组比较差异均有统计学意义（P〈0．05）,而12w后血肌酐水平与氯沙坦组比较差异无统计学意义（P〉0．05）;两组各自治疗前后比较发现氯沙坦组仅24h尿蛋白定量显著下降（P〈0．05）,联合用药组则24h尿蛋白定量、尿NAG、尿β2-MG均显著降低（P〈0．05）。结论氯沙坦联合黄葵胶囊治疗糖尿病肾病能显著降低蛋白尿,改善肾小管功能。     

Critical review of the uroflowmetry

Uroflowmetry is the measurement of a urinary flow rate by using the flow meter. A urine flow rate is the volume of urine (millilitres) expelled from the bladder via the urethra per unit of time (second). It is expressed in ml/s.(1) Urine flow curve is the plot of velocity of the voided urine against time. The urine stream is affected by voiding pressure (detrusor power) and bladder outlet resistance. Therefore, uroflowmetry evaluates the interaction of the urinary bladder expelling strength and bladder outlet resistance. This is the initial, non-invasive urodynamic investigation for evaluation of patients with lower urinary tract symptoms (LUTS). Although, it is very simple and widely used urodynamic test, the results are nonspecific and required caution interpretations. In the next few pages we will review some aspects of this test, i.e. brief history, equipment, indications, procedure itself and interpretation of the results.     

Update on detrusor hyperactivity with impaired contractility

Detrusor hyperactivity with impaired contractile function (DHIC) is a complex voiding dysfunction that is often misdiagnosed as incontinence resulting from benign prostatic hyperplasia with outlet obstruction, underactive detrusor with chronic retention, and stress urinary incontinence due to sphincter incompetence, particularly in women. Urodynamic assessments have shown that these subjects exhibit low pressure and almost unrecognizable involuntary detrusor contractions associated with reflex urethral relaxation accompanied with inefficient bladder emptying. These patients therefore tend to develop high residual volumes with a tendency towards chronic urinary retention. DHIC is a major cause of urinary incontinence in institutionalized elderly women. Accurate diagnosis requires awareness of this condition, careful video-urodynamic evaluation, and elimination of other disorders such as outlet obstruction and neurogenic bladder that confound DHIC. The exact causes are unclear, although some studies indicate that this entity may be a coincidental association of two separate etiologies, with each one independently contributing to the two different components of DHIC. Alternately, impaired detrusor function could emerge as a long-term sequelae of detrusor overactivity. Recent ultrastructural studies of the bladder in those with DHIC show distinct morphological patterns characteristic of both detrusor overactivity and impaired contractility. Management of this condition requires knowing that the condition potentially causes incontinence in women and lower urinary tract symptoms in men. Failure to diagnose DHIC in symptomatic patients may lead to inappropriate therapies including morbidity-prone surgical misadventures.     

Influence of Preoperative Detrusor Underactivity on the Continence Rate and Satisfaction after Midurethral Sling Patient with Stress Urinary Incontinence

Objectives: We studied the influence of preoperative detrusor underactivity in patients with stress urinary incontinence on the postoperative continence rates and patient satisfaction. Methods: Medical records of 41 female patients who had detrusor underactivity and had undergone a midurethral sling procedure with a follow up of at least 12 months were reviewed. The preoperative evaluation included a history taking, physical examination, voiding diary for 3 days and an urodynamic study. Detrusor underactivity was defined at pressure flow study by a maximal flow rate (Q_max) less than 15 mL/sec and a detrusor pressure at maximal flow rate (P_detQ_max) less than 20 cmH₂O. The postoperative evaluation included a continence state, questionnaire regarding patient satisfaction (5: very satisfied, 1: very unsatisfied), uroflowmetry and residual urine volume. Results: The mean patient age was 52.9 (range 39–68) years. Preoperatively, mean Q_max was 12.6 ± 2.1 mL/sec, mean residual urine volume was 16.1 ± 32.3 mL and mean P_detQ_max was 13.1 ± 4.7 cmH₂O. Postoperative continence rate was 88% (36/41). Five patients experienced minimal incontinence when they coughed violently. The amount of patients satisfied with postoperative status was 71%. Postoperatively, three patients needed medication with alpha blocker because of voiding difficulty. There was significant differences between preoperative and postoperative Q_max (13.1 ± 0.9 mL/sec vs 17.1 ± 0.9 mL/sec, P < 0.05). In addition postoperative residual urine volume (26.1 ± 27.9 mL) was significantly increased compared to the preoperative residual urine volume (16.1 ± 32.3 mL) (P < 0.05). Conclusion: Midurethral sling can be done safely for the patients with stress urinary incontinence and detrusor underactivity. However, the evaluation of preoperative detrusor function is important since the therapeutic outcome and postoperative voiding pattern may be affected by detrusor underactivity.     

High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections

The aim of this study was to evaluate lower urinary tract dysfunction (LUTD) in women with recurrent urinary tract infections (UTIs). One hundred consecutive female patients with recurrent UTIs who underwent videourodynamic study (VUDS) were included. Another 25 women free from recurrent UTIs served as controls. All the underlying diseases, urine analysis and culture results, VUDS findings, and treatment outcomes of voiding dysfunction were carefully reviewed and analyzed. The mean age of the recurrent UTIs patients was 64.0 ± 16.0 years. Storage and voiding dysfunctions were found in 90 (90%) patients, including bladder neck dysfunction in 19 (19%), detrusor hyperactivity with impaired contractility in 6 (6%), detrusor overactivity in 5 (5%), detrusor underactivity in 10 (10%), dysfunctional voiding in 25 (25%), hypersensitive bladder in 6 (6%), and poor relaxation of the pelvic floor muscle in 20 (20%). Only 10 (10%) patients had normal urodynamic tracings. Compared with the controls, the recurrent UTI patients had significantly smaller cystometric bladder capacity, lower maximum flow rate, smaller voided volume, higher detrusor pressure, and larger PVR volume. However, only 6 (11.3%) patients with recurrent UTIs were free from subsequent UTIs following individualized treatment for their voiding dysfunction. A high incidence of vide urodynamic LUTD was identified in women with recurrent UTIs. Despite receiving individualized treatments based on their VUDS findings, only a small portion of these patients were subsequently free from UTIs.