女性膀胱颈部梗阻的诊断与治疗

为探讨女性膀胱颈部梗阻的病因、诊断及治疗方法。总结１９８１年５月～１９９６年６月收治女性膀胱颈部梗阻病例３２例。２９例经手术治疗，其中２例行膀胱颈ＹＶ成形术，２７例经尿道膀胱颈部后唇切除术，效果满意。结果认为，女性膀胱颈部梗阻病因为纤维组织增生和慢性炎症所致；尿流率检查是客观评价排尿状况的指标；膀胱镜检查为可靠的诊断手段；经尿道膀胱颈部后唇切除为有效的治疗方法。     

女性膀胱颈梗阻的诊断与治疗

目的：探讨女性膀胱颈阻的诊断和治疗方法。方法;对２７例女性膀胱颈梗阻患者行尿流动力学检查和膀胱检查,对其中２２例行经光颈电切术（ＴＵＲＢｎ）５例行非选手治疗。结果：２２例行ＴＵＲＢＮ治疗者术后无明显乘余尿,２０例临床症状消失;５例非手术治疗者经定期饔主药物治疗,效果满意。结论：女性膀胱颈梗阻的尿流动客观评价排尿状况的有效指标;ＴＵＴＢＮ是治疗女性膀胱劲梗阻的首选方法,具有手术小和住院时间短等优点。     

女性膀胱颈梗阻的诊治体会

目的　提高女性膀胱颈梗阻的诊治水平。　方法　对 1 5例女性膀胱颈梗阻患者的诊治情况进行回顾性分析。　结果　 6例行膀胱颈Y V成形术 ,9例行经尿道膀胱颈后唇电切术 ,效果满意 ,无尿失禁及尿瘘发生。　结论　膀胱尿道镜结合压力 流率测定是该病可靠的诊断手段 ,经尿道膀胱颈部后唇切除是最佳治疗方法。     

The suspensory apparatus of the female bladder neck.

Lateral cystourethrograms have shown a forwards-downwards displacement of the bladder neck in bladder base insufficiency, a type of stress incontinence. In search for the structure which in normal subjects prevents this displacement, a series of 10 dissections of the female pelvic floor was undertaken. The formerly described structures: The pubo-vesical ligaments and the precervical arc are shown. As a new finding it is demonstrated how these structures are dependent on an upwards-backwards suspension by a strong ligament in the fascia over the levator muscle.     

经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察

目的:评估经尿道膀胱颈内切开术治疗女性原发性膀胱颈梗阻(PBNO)的长期疗效。方法:56例女性患者通过排泄性膀胱尿道造影及尿动力学检查确诊为PBNO,在膀胱颈上选取2点及10点位置,所有患者行经尿道膀胱颈内切开术。结果:术后随访6~72个月(平均26.2个月)。56例接受手术的患者中47例(83.9%)术后恢复良好,未见严重并发症。随访过程中,平均国际前列腺症状评分(IPSS)由21.2降至7.6(P<0.05),生活质量评分(QOL)由4.2降至2.3(P<0.05),最大尿流率(Q_max)由8.63ml/s增至17.36ml/s(P<0.05),残余尿量(PVR)由106.32ml降至21.46ml(P<0.05),最大尿流率时逼尿肌压力(Pdet at Q_max)由68.42cmH_2O降至19.86cmH_2O(1cmH_2O=0.098kPa,P<0.05)。术后出现的并发症有血尿、二次行膀胱颈内切开术、压力性尿失禁、尿道狭窄。所有这些并发症按Clavien分类评估为Ⅲa级。3例(5.3%)术后出现出血,经延长尿管留置时间、膀胱冲洗治愈,均未输血治疗;4例(7.1%)出现压力性尿失禁,行经阴道无张力尿道中段吊带术后恢复;4例(7.1%)出现尿道狭窄,间断尿道扩张后好转。结论:PBNO不常见,排泄性膀胱尿道造影及尿动力学检查可确诊,通过经尿道膀胱颈内切开术治疗安全有效。在膀胱颈的2点和10点方向仔细地、足够深度地行颈内切开可以保证手术的成功。     

Transurethral electroincision of bladder neck in female patients with neurogenic bladder.

Transurethral electroincision of the bladder neck in female patients with neurogenic bladders has not been widely reported. We have performed this operation on 21 patients who have failed to achieve balanced bladder function through other treatment modalities and who have presented with recurrent urinary tract infections, high postvoid residual urine, and evidence of upper urinary tract deterioration. Eighty-five per cent of female patients treated in this fashion have demonstrated significant improvement in bladder emptying. The rate of complication has been low, and no cases of persistent incontinence have occurred. We recommend this operation in difficult cases of neurogenic bladder in females.     

Ultrasonographic changes of the female bladder neck during development.

BACKGROUND: Our previous study showed that the anteroposterior vesical wall angle (APVA) at the bladder neck on transabdominal ultrasonography varied widely between women. The present study examines whether the APVA changes during development in girls with a normal bladder. METHODS: Seventy-four females aged 0-29 years with normal bladders were examined by transabdominal ultrasonography. They were divided into six age groups and their APVA was measured in the supine position by sagittal ultrasonography. Intravenous urography was conducted to examine bladder neck descent and bladder neck opening. RESULTS: The APVA ranged from 85 to 200 degrees. The mean APVA in girls aged 0-4 years was 129 +/- 30 degrees (+/-SD) and the mean APVA in girls aged 5-9 years was 135 +/- 25 degrees. The mean APVA at ages 10-14 years was 161 +/- 26 degrees; at 15-19 years, 164 +/- 33 degrees; at 20-24 years, 164 +/- 18 degrees; and at 25-29 years, 163 +/- 16 degrees. The APVA values of these four groups were significantly larger (P < 0.05) than those of the two younger groups. No bladder abnormalities were found on intravenous urography. CONCLUSION: The APVA was small in some girls under 10 years of age, but the APVA of girls aged over 10 years was similar to that in young adults. The APVA may reflect bladder base plate tone and be partially related to hormonal changes in females during development.     

女性膀胱颈梗阻的诊断

目的：探讨女性膀胱颈梗阻的诊断方法,提高女性膀胱颈梗阻的诊治水平。方法：对42例女性膀胱颈梗阻患者的临床资料和腔内治疗情况进行回顾性分析。结果：诊断的42例患者行经尿道膀胱颈电切术,效果满意,无尿失禁及尿瘘发生。结论：临床症状结合膀胱尿道镜检查和压力-尿流率测定是该病可靠的诊断手段,经尿道膀胱颈电切术是治疗女性膀胱颈梗阻的首选方法。     

经尿道电切术治疗女性膀胱颈梗阻12例

目的探讨经尿道电切治疗女性膀胱颈梗阻的疗效。方法对12例女性膀胱梗阻患者行径尿道膀胱颈电切术治疗,年龄51±13岁,病程3个月-5年,尿流率3.8±11.4ml／s,残余尿200-800ml术后随诊6个月以上。结果手术均获成功,手术时间15-50min,平均25min,术中出血〈20ml。12例患者排尿症状评分,最大尿流率平均18ml／s,残余尿均〈50ml。最大尿流率、残余尿量等均较术前显著改善,随访无尿失禁、尿瘘发生。结论经尿道电切术治疗女性膀胱颈梗阻疗效显著,并发症少。     

The treatment of female bladder outlet obstruction

Authors from the USA present a review of the treatment of BOO in the female. This topic is important, which should be of considerable help to the reader. It is covered systematically, dealing with anatomy and then therapy. There is also a meta‐analysis comparing industry‐ and non‐industry funded trials of antimuscarinic medication. This careful study shows no difference in outcomes between them, but suggests there are some shortcomings that need to be overcome.     

Cost-effective treatment of female stress urinary incontinence: Modified pereyra bladder neck suspension

We herein report on the cost effectiveness of the modified Pereyra bladder neck suspension (MPBNS) compared with the Marshall-Marchetti-Krantz (MMK) retropubic suspension procedure. A total of 82 cases was reviewed retrospectively. The MPBNS was found to provide a 41 per cent cost savings with significantly shorter duration of intravenous fluid administration, shorter duration of postoperative indwelling catheter drainage, shorter operative time, and significantly shorter postoperative hospitalization. Early postoperative intermittent catheterization was a major factor in facilitating early discharge after MPBNS.     

Transurethral resection of bladder neck in female patients with neurogenic bladder

Transurethral resection of the bladder neck was performed in 6 female patients with neurogenic bladders who presented with a large volume of residual urine and bladder neck obstruction on voiding cystourethrography without detrusor hyperreflexia on cystometry. In 4 of the patients, transurethral sphincterotomy was performed concomitantly. Five of the patients demonstrated significant improvement in bladder emptying and 4 did not need self-catheterization. No complications of the operation were observed.     

Unilateral bladder neck incision: endoscopic treatment of bladder neck obstruction. Results in 100 patients

Endoscopic diathermy unilateral incision of the bladder neck was carried out in 100 consecutive male patients. This procedure was performed for bladder neck obstruction and small benign prostate. The operative details of this technique are given. Follow-up after 2 months revealed excellent symptomatic and urodynamic results. Morbidity was low. Results remain stable after 13 +/- 9 months. One patient needed a transurethral resection of the prostate. Retrograde ejaculation occurred in 5% of the patients. Unilateral bladder neck incision is a simple procedure safe, and easy to learn, with a low risk of retrograde ejaculation. It is the operation of choice for small benign prostate, bladder neck obstruction and young patients.     

女性膀胱颈梗阻的诊治体会

目的：提高女性膀胱颈梗阻的诊治水平。方法：通过对26例女性膀胱颈梗阻患者经膀胱颈梗阻电切术,对其诊断和治疗进行回顾性分析。结果：26例膀胱颈梗阻患者(其中例合并腺性膀胱炎)全部进行电切术,术后疗效满意,无1例术后并发症。结论：膀胱镜检可明确诊断膀胱颈梗阻,膀胱颈梗阻部分电切术是治疗本病的最佳方法。     

Needle bladder neck suspension for female stress incontinence

A highly successful transvaginal bladder neck suspension for female stress urinary incontinence is described and illustrated. Precise lateral placement of sutures, maximum mobilization of the anterior vaginal wall and bladder neck, and ease of approach are keys to the technique. The procedure can be utilized in any setting with minimal complications and with neither obesity nor multiple previous surgeries as contraindications.     

The treatment of incomplete bladder emptying in females by bladder neck incision

Thirty females suffering from incomplete bladder emptying underwent bladder neck incision. All patients had undergone some form of therapy earlier without success. The bladder neck incision was often an alternative to repeated catheterizations or an indwelling catheter. In 7 patients (23%) the result was excellent, 12 other patients (40%) benefited from the operation. The role of this operation and possible complications is discussed.