替勃龙对卵巢切除大鼠膀胱功能及结构的影响

目的:通过比较正常、卵巢切除及卵巢切除后补充替勃龙大鼠的膀胱功能和组织形态,探讨替勃龙对膀胱的影响及其作用机制。方法:30只雌性成年SD大鼠分为3组:正常对照组、切除双侧卵巢组(OVX组)、切除双侧卵巢后补充替勃龙组(OVX+Tib组)。用药12周后测定膀胱压力容积,Masson染色膀胱石蜡切片分析胶原纤维(CF)和平滑肌(SM)的面密度及二者比值。结果:(1)OVX组膀胱最大容量(0.32±0.20m l)、顺应性(0.012±0.006m l/cmH2O)和最大收缩力(1.4±0.4cmH2O)相对于正常对照组(分别为1.11±0.09m l、0.026±0.003m l/cmH2O和4.4±0.3cmH2O)明显减少,有统计学差异(P<0.01)。OVX+Tib组膀胱顺应性(0.022±0.003m l/cmH2O)与正常对照组比较无统计学差异(P>0.05),膀胱最大容量(0.87±0.26m l)及最大收缩力(3.3±1.0cmH2O)比正常对照组减少(P<0.05),但比OVX组增加(P<0.01);(2)CF面密度、CF面密度与SM面密度比值:OVX组(0.2180±0.0407和0.5396±0.0837)比正常对照组(0.1598±0.0387、0.3199±0.0860)增加,有统计学差异(P<0.01)。OVX+Tib组此两值(0.1893±0.0251、0.4249±0.0646)介于OVX组与正常对照组之间。结论:大鼠切除双侧卵巢后膀胱功能降低,补充替勃龙在一定程度上改善了膀胱功能,这可能是与它对胶原的抑制有关。     

雷洛昔芬和依普黄酮对去卵巢大鼠骨干力学的影响

目的:研究雷洛昔芬和依普黄酮对切除成熟卵巢大鼠骨干生物力学性能的影响,探讨此两种药物治疗绝经后骨质疏松症的疗效。方法:选用6月龄未交配健康雌性Sprague-Dawley大鼠50只,随机分为5组,每组10只:(1)假手术组(sham);(2)骨质疏松组(OVX);(3)OVX加戊酸雌二醇组(Valerate Estriol,E_2;0．8mg·kg~(-1)·d~(-1));(4)OVX加雷洛昔芬组(Raloxifene,RLX;5mg·kg~(-1)·d~(-1));(5)OVX加依普黄酮组(Ipriflavone,IPR; 100mg·kg~(-1)·d~(-1));于去势手术3周后开始按分组设计喂药(灌胃),治疗3个月后处死。取大鼠右股骨及第三腰椎测定骨密度;然后对右股骨中段进行三点弯曲试验,测定多个股骨干生物力学指标。结果:(1)骨密度:OVX组椎骨及股骨干骺端密度明显下降,使用E_2和RLX能够显著提升骨密度;但股骨干密度各组间差异无统计学意义;(2)骨干生物力学性能:三点弯曲实验结果显示,OVX组股骨干生物力学指标较sham组明显下降,用RLX和IPR治疗与E_2一样可阻止这种变化(P＜0．05)。结论:雷洛昔芬和依普黄酮能阻止卵巢切除所致的成熟雌性大鼠股骨干(皮质骨)生物力学性能受损。     

促性腺激素释放激素激动剂对化疗损伤卵巢功能保护作用的实验研究

目的研究促性腺激素释放激素激动剂(GnRHa)对注射环磷酰胺(CTX)大鼠的卵巢功能的保护作用。方法80只Fischer344大鼠分为4组,即空白对照组、GnRHa组、CTX组及联合治疗组,每组20只,分别接受生理盐水、CTX、GnRHa和CTX+GnRHα注射,采用酶联免疫吸附实验和化学发光法测定各组大鼠卵泡刺激素(FSH)和雌二醇浓度的变化,在实验开始后第60、90天,各组分别处死一半大鼠,观察卵巢重量、卵泡数量及卵泡直径的变化。结果实验第90天,CTX组大鼠血清雌二醇和FSH浓度分别为(148·3±16·5)pmol/L和(16·90±1·90)U/L,明显高于联合治疗组的(91·8±9·9)pmol/L和(7·60±0·30)U/L,两组分别比较,差异有统计学意义(P<0·05);CTX组大鼠卵巢重量为(37·0±3·0)mg,低于联合治疗组的(71·0±5·0)mg,两组比较,差异有统计学意义(P<0·05);CTX组大鼠卵泡总数为(550±50)个,而联合治疗组为(1250±160)个,两组比较,差异有统计学意义(P<0·05)。结论GnRHa能够降低CTX对大鼠卵巢功能的损伤,从而保护大鼠卵巢储备功能。     

初产妇与经产妇分娩后一周内尿动力学表现分析

目的探讨初产妇与经产妇分娩后1周内的尿动力学表现。方法按照国际尿控协会推荐的方法对36例初产妇志愿者（初产妇组）和12例经产妇志愿者（经产妇组）分娩后1周内（产后2-7d）的尿动力学变化进行检查。14例因上尿路疾病而下尿路功能正常的已婚未育妇女作为对照组。结果初产妇组与经产妇组妇女分娩后功能性膀胱容量（FBV）分别为（310±154）、（243±141）ml,正常尿意膀胱压测定容量（NDCC）分别为（215±90）、（225±115）ml,均低于对照组的（437±193）ml和（338±120）ml,分别比较,差异均有统计学意义（P〈0．05）;但初产妇组与经产妇组间FBV和NDCC比较,差异无统计学意义（P〉0．05）。初产妇组与经产妇组妇女最大静态尿道压（MUP）和最大尿道闭合压（MCUP）也均显著高于对照组,差异有统计学意义（P〈0．05）;但初产妇组MUP和MCUP与经产妇组比较,差异无统计学意义（P〉0．05）。功能尿道长度（FUL）初产妇组妇女为（31±6）mm,经产妇组妇女为（27±5）mm,对照组妇女为（30±3）mm,初产妇、经产妇组分别与对照组比较,差异均无统计学意义（P〉0．05）,但初产妇组FUL显著长于经产妇组,差异有统计学意义（P〈0．05）。初产妇组、经产妇组及对照组的Abrams-Griffiths（AG）值分别为-35±28、-26±26和-11±17,两产妇组分别与对照组比较,差异有统计学意义（P〈0．05）;初产妇组、经产妇组及对照组尿道阻力因子（URA）分别为（8±4）、（9±3）和（11±3）cmH20（1cmH2O：0.098kPa）,3组比较,差异均无统计学意义（P〉0．05）。初产妇组和经产妇组腹压漏尿点压（VLPP）测定各有1例漏尿发生,ⅥPP分别为50cmH2O和67cmH2O。结论初产妇和经产妇分娩后1周内均表现为膀胱容量减少,尿道静态阻力增加,但膀胱排空能力正常。     

吗啡对雌性大鼠性腺轴和骨组织的影响

目的:研究吗啡对雌性大鼠性腺轴和骨组织的影响。方法:选取3月龄雌性大鼠45只,随机分为吗啡组30只和对照组15只。吗啡组采用剂量递增法皮下注射盐酸吗啡12周,对照组注射同等体积的生理盐水12周。放射免疫法测定血清FSH、LH、E2、P;免疫组织化学检测下丘脑、垂体、卵巢雌激素受体(ER)和β-内啡肽(β-EP)的表达;原位杂交方法测定下丘脑、垂体和卵巢的μ-阿片受体mRNA的表达;双能X线骨密度测量仪测量不同部位的骨密度值;测量骨代谢生化指标;对骨组织切片进行形态计量分析;并用RT-PCR方法检测骨组织中雌激素受体(ER)mRNA的变化。结果:(1)吗啡组FSH、LH、E2、P基础分泌较对照组降低(P<0·01,P<0·05,P<0·01,P<0·05);(2)吗啡组大鼠性腺轴各组织中ER平均光密度值均显著降低(P均<0·01);(3)吗啡组大鼠下丘脑、垂体β-内啡肽的含量下降,而μ-阿片受体mRNA表达增强;(4)吗啡组大鼠股骨远侧干骺端和胫骨近侧干骺端骨密度以及骨组织中ERmRNA表达均较对照组显著下降(P<0·05),组织切片观察显示,吗啡组大鼠骨小梁纤细、断裂、形态结构完整性差,骨髓腔大小不一,对照组大鼠骨小梁粗壮、饱满、形态结构完整,骨髓腔相对较小,计量分析显示,吗啡组骨小梁面积明显低于对照组(P<0·05);骨代谢生化指标结果显示,吗啡组大鼠血清钙和尿钙以及TRAP、HOP较对照组增加显著(P<0·05)。结论:长期使用吗啡对下丘脑-垂体-卵巢轴及骨组织会有不同程度的损伤。     

晚期妊娠妇女下泌尿道尿控的特点

目的探讨晚期妊娠妇女下泌尿道尿控的特点。方法选择47例志愿接受尿动力学检查的晚期妊娠妇女作为研究组,另选取同期27例已婚未孕且下泌尿道功能正常的志愿者作为对照组,分别对两组进行自由尿流率、膀胱压力容积-尿流率测定及静态尿道压力描记检查等尿动力学检查。结果研究组最大尿流率较对照组显著降低[分别为(20±13)、(32±7)ml/s,P<0·05];研究组排尿量以及正常尿意膀胱容量[分别为(163±13)、(226±85)ml],与对照组[分别为(436±19)、(338±56)ml]比较,差异均有统计学意义(P<0·05);研究组最大尿道压、最大尿道闭合压、功能性尿道长度均较对照组明显增加(P<0·05)。研究组中仅有7例患者排尿后测出残余尿,但均<10ml。结论晚期妊娠妇女静态尿道压力的增高,弥补了增大的子宫压迫周围器官所致膀胱压的增高,有利于保持孕期的尿控。     

血小板活化因子和卵巢过度刺激综合症发病的关系

目的 :建立过度刺激卵巢模型 ,探讨血小板活化因子 ( PAF)在卵巢过度刺激综合症( OHSS)发病中的变化。方法 :未成年 Wistar雌鼠 ,连续 4d皮下注射 PMSG1 0 IU,d5注射 h CG 3 0 IU,48h后取腹腔灌洗液 ,用分光光度计测腹腔和卵巢的血管通透性。取尾静脉血测 PAF含量、血浆血小板活化因子乙酰水解酶 ( PAF-AH)活性及血小板聚合功能。另设生理盐水对照组。结果 :PMSG+h CG组腹腔灌洗液中美兰的含量为 5.6 1 8±1 .1 3 3μg/1 0 0 g体重 ,显著高于对照组的 0 .976± 0 .2 2μg/1 0 0 g体重 ( P<0 .0 1 )。卵巢PAF含量 PMSG+h CG组为 1 1 .3 51± 0 .46 9pmol/卵巢 ,显著高于对照组的 1 .0 0 0±0 .1 0 8pmol/卵巢 ( P<0 .0 1 )。PAF-AH活性 :PMSG+h CG组 d5和 d7分别为 40 .0 2 7±1 3 .791 pmol/min· ml和 1 8.90 9± 9.783 pmol/min· ml,显著低于对照组的 57.875±1 4 .2 2 8pmol/min· ml和 53 .82 1± 1 6 .71 4 pmol/min· ml( P<0 .0 1和 P<0 .0 0 1 )。结论 :注射 PMSG和 h CG后 ,雌鼠卵巢 PAF含量增高 ,并使腹腔和卵巢血管通透性增高 ,导致 OHSS。血浆 PAF-AH在 OHSS发病中可能通过调节 PAF的水平而发挥作用。     

膳食脂肪对妊娠期糖尿病孕妇发病的影响

目的探讨膳食脂肪对妊娠期糖尿病(GDM)发病的影响。方法选择GDM孕妇85例(GDM组),及正常孕妇159例(正常妊娠组)为调查对象。饮食治疗前对GDM组孕妇和正常妊娠组孕妇进行膳食调查。比较两组孕妇膳食结构中三大营养素供能百分比,特别是膳食脂肪、脂肪酸类型等。结果(1)GDM组孕妇每日摄入总热卡为(8970±2115)kJ,正常妊娠组为(8799±1785)kJ,两组比较,差异无统计学意义(P>0·05)。(2)GDM组孕妇碳水化合物、蛋白质和脂肪供能百分比分别为(51·9±7·2)%、(17·5±0·9)%和(30·6±1·3)%,正常妊娠组分别为(53·6±8·1)%、(18·3±1·1)%和(28·1±2·3)%。GDM组脂肪供能百分比高于正常妊娠组,两组比较,差异有统计学意义(P<0·05);两组碳水化合物和蛋白质供能百分比比较,差异无统计学意义(P>0·05)。(3)GDM组孕妇饱和脂肪酸、多不饱和脂肪酸和单不饱和脂肪酸供能百分比分别为(15·2±0·4)%、(8·3±0·5)%和(7·1±0·5)%,正常妊娠组饱和脂肪酸、多不饱和脂肪酸和单不饱和脂肪酸供能百分比分别为(11·7±0·6)%、(10·1±0·4)%和(6·3±0·3)%。GDM组饱和脂肪酸供能百分比高于正常妊娠组,两组比较,差异有统计学意义(P<0·05);GDM组多不饱和脂肪酸供能百分比低于正常妊娠组,两组比较,差异有统计学意义(P<0·05);两组单不饱和脂肪酸供能百分比比较,差异无统计学意义(P>0·05)。结论孕妇高脂肪、高饱和脂肪酸和低多不饱和脂肪酸饮食可能是GDM发病的外部原因之一。     

卵巢上皮性癌组织中KiSS-1基因及其受体GPR54 mRNA的表达及其意义

目的探讨肿瘤转移抑制基因KiSS-1及其受体GPR54mRNA在卵巢上皮性癌组织中的表达及其意义。方法采用RT-PCR技术检测37例卵巢上皮性癌、15例卵巢交界性上皮性肿瘤、15例卵巢良性上皮性肿瘤及11例正常卵巢组织中KiSS-1基因及其受体GPR54mRNA的表达,并分析其与各临床病理指标的相关性。结果KiSS-1mRNA在卵巢上皮性癌及卵巢交界性上皮性肿瘤组织中的阳性表达率(分别为68%、60%)及表达水平(分别为0·82±0·09、0·80±0·10)均显著高于卵巢良性上皮性肿瘤及正常卵巢组织(分别为20%、18%和0·65±0·10、0·66±0·06;P均<0·05);且KiSS-1mRNA在卵巢上皮性癌组织中的阳性表达率和表达水平均与手术病理分期和淋巴结转移有明显相关性(P<0·05)。GPR54mRNA在卵巢上皮性癌、卵巢交界性上皮性肿瘤、卵巢良性上皮性肿瘤及正常卵巢组织中的阳性表达率(分别为70%、67%、60%和45%)及表达水平(分别为0·79±0·07、0·76±0·10、0·73±0·07和0·78±0·08)分别比较,差异均无统计学意义(P>0·05);GPR54mRNA在卵巢上皮性癌组织中的阳性表达率和表达水平与手术病理分期、病理分级、病理类型、淋巴结转移及腹水生成均无相关性(P>0·05)。结论KiSS-1基因及其受体GPR54可能在抑制卵巢上皮性癌浸润和转移的过程中起重要作用。     

多囊卵巢综合征患者血清脂联素水平与胰岛素抵抗关系的研究

目的探讨多囊卵巢综合征(PCOS)患者血清脂联素(APN)水平与胰岛素抵抗的关系。方法采用酶联免疫吸附法(ELISA)测定40例PCOS患者[PCOS组,根据体重指数(BMI)分为肥胖者(BMI≥25kg/m2)19例,非肥胖者(BMI<25kg/m2)21例]及15例健康志愿者和10例非PCOS不孕患者(对照组,其中肥胖者9例,非肥胖者16例)的APN水平,化学发光法、葡萄糖氧化酶法、放射免疫法分别测定空腹胰岛素、空腹血糖、肿瘤坏死因子α(TNF-α)水平。计算两组患者胰岛素敏感指数(ISI),评价胰岛素抵抗程度。结果(1)PCOS组肥胖者APN水平为(1·6±0·5)mg/L,PCOS组非肥胖者为(3·0±0·6)mg/L,对照组肥胖者为(3·2±0·3)mg/L,非肥胖者为(4·9±0·5)mg/L,两组分别比较,差异均有统计学意义(P<0·05)。(2)PCOS组肥胖者胰岛素水平为(17±6)mU/L,非肥胖者为(14±6)mU/L,对照组肥胖者为(10±3)mU/L,非肥胖者为(7±3)mU/L,两组分别比较,差异有统计学意义(P<0·05)。(3)PCOS组肥胖者空腹血糖为(5·2±0·7)mmol/L,非肥胖者为(5·1±0·6)mmol/L,对照组肥胖者为(5·4±0·5)mmol/L,非肥胖者为(4·8±0·6)mmol/L,两组分别比较,差异无统计学意义(P>0·05)。(4)PCOS组肥胖者TNF-α水平为(1·32±0·14)μg/L,非肥胖者为(1·02±0·12)μg/L,对照组肥胖者为(0·93±0·15)μg/L,非肥胖者为(0·63±0·18)μg/L,两组分别比较,差异有统计学意义(P<0·05)。(5)PCOS组肥胖者ISI为-4·5±0·3,非肥胖者为-4·1±0·4,对照组肥胖者为-3·6±0·3,非肥胖者为-3·1±0·4,两组分别比较,差异也有统计学意义(P<0·05)。PCOS组患者APN水平与BMI呈显著负相关关系(r=-0·56,P<0·05),与ISI呈显著正相关关系(r=0·49,P<0·05)。结论PCOS患者APN水平降低,并以PCOS肥胖者降低更明显;PCOS患者APN水平下降与胰岛素敏感性及胰岛素抵抗相关。     

子宫颈癌患者广泛性子宫切除术后下泌尿道的尿动力学特点

目的 探讨宫颈癌患者在广泛性子宫切除手术前后下泌尿道的尿动力学特点.方法 选择Ⅰ b～Ⅱa期宫颈癌患者46例,分别于广泛性子宫切除术前及术后进行尿动力学检查.结果 26例(57%)患者术前排尿模式正常但术后需借助于腹压排尿;排尿后残余尿量明显增加,术后为(205±201)ml,而术前为(5±3)ml,两者比较,差异有统计学意义(P＜0.01).术后正常尿意膀胱容量较术前显著增加,分别为(365±108)、(286±84)ml,两者比较,差异有统计学意义(P=0.01);最大膀胱容量较术前显著增加,分别为(670±174)、(402±124)ml,两者比较,差异有统计学意义(P=0.05);膀胱顺应性显著下降[分别为(15±5)、(102±64)ml/cm H2O(1 cm H2O=0.098 kPa),P＜0.01];最大逼尿肌收缩压显著下降[分别为(11±5)、(39±14)cm H2O,P＜0.01];功能性尿道长度缩短[分别为(31±7)、(39±7)mm,P＜0.01].结论 广泛性子宫切除术后下泌尿道功能障碍,其尿动力学特点表现为膀胱感觉功能减退,逼尿肌功能受损,而尿动力学检查有助于早期诊断.     

雌激素、三苯氧胺与氟化物配伍预防去势大鼠骨丢失的研究

目的　比较三苯氧胺与雌激素对骨代谢的影响 ,及两者与氟化物配伍后是否产生协同效果。方法　将 142只 6月龄雌性SD大鼠行去势手术或假手术后随机分为 7组 (每组 19～ 2 1只 ) :(1)假手术组 ;(2 )去势组 ;(3)雌激素组 ;(4 )氟化物组 ;(5 )雌激素 +氟化物组 ;(6 )三苯氧胺组 ;(7)三苯氧胺 +氟化物组。治疗 12个月 ,行骨密度、腰椎骨组织形态计量学参数 (不脱钙骨切片 )、右股骨中段三点弯曲试验观察 ,并行子宫病理及血脂检查。结果　 (1)术后 12个月时 ,全身骨密度去势组为2 79mg/cm2 、治疗组为 2 86～ 2 98mg/cm2 ,腰椎骨密度分别为 2 32mg/cm2 、2 5 1～ 2 6 6mg/cm2 (P均<0 0 5 ) ;股骨中段骨密度 ,雌激素组 2 16mg/cm2 ,明显高于三苯氧胺组 195mg/cm2 (P <0 0 5 ) ;配伍治疗组与单药治疗组无明显差异 (P >0 0 5 )。 (2 )术后 4个月 ,两个配伍治疗组最大载荷 (均为 145牛顿 )与去势组 [(118± 2 4)牛顿 ]有显著差异 (P <0 0 5 ) ;术后 12个月各治疗组最大载荷为 132～ 15 5牛顿 ,均明显高于去势组 (10 8± 13)牛顿 (P <0 0 5 ) ,雌激素组最大载荷、弹性载荷均明显高于三苯氧胺组 (P <0 0 5 )。 (3)各组骨组织形态计量学检查未发现骨矿化不良现象。结论　雌激素在维持骨量、骨强度方面优于三苯     

妊娠晚期初产妇下泌尿道尿控功能的变化

目的 探讨妊娠晚期初产妇下泌尿道尿控功能的变化及特点.方法应用会阴超声尿动力学检测方法,检测2003年1月至2005年12月在上海交通大学附属第六人民医院产科接受系统产前检查的初产妇共83例(研究组,孕36～40周,胎儿先露未衔接),及同期无分娩史、非妊娠、认知能力正常的育龄女性28例(对照组,排卵期)的下泌尿道尿控功能.下泌尿道尿控功能指标包括:最大尿道关闭压(MUCP)、最大静态尿道压(MUP)、功能尿道长度(FUL)、腹压漏尿点压(VLPP)、残余尿量(PVRBV)、膀胱初始尿意感容量(VFDV).结果 研究组产妇分娩的新生儿平均出生体重为(3504±404)g,MUP为(110±22)cm H2O(1 cm H2O=0.098 kPa),MUCP为(96±22)cm H2O,FUL为(44±9)mm,对照组MUP为(98±20)cm H2O,MUCP为(79±8)cm H2O,FUL为(37±4)mm,两组各指标比较,差异均有统计学意义(P＜0.01);研究组VFDV为(141±44)ml,PVRBV为(6.2±2.7)ml,对照组为(149±41)ml,PVRBV为(5.7±1.8)ml,两组比较,差异无统计学意义(P＞0.05).研究组有33例于孕24～38周出现漏尿症状,其中14例表现为VLPP＜90 cm H2O.研究组中VLPP≥90 cm H2O和＜90 cm H2O者MUP、MUCP和FUL比较,差异均无统计学意义(P＞0.05);研究组中有漏尿症状和无漏尿症状者除MUCP明显降低外,MUP、FUL比较,差异均无统计学意义(P＞0.05).结论 初产妇妊娠晚期的静态尿道关闭功能明显增强;而动态尿道关闭功能明显降低,并与漏尿症状相关;VFDV无明显变化.     

尿动力学因素对子宫颈癌广泛性子宫切除术后尿潴留的影响

目的 探讨尿动力学因素对宫颈癌广泛性子宫切除术后尿潴留的影响.方法 对2006年6月-2009年8月间福建省妇幼保健院收治的72例术前尿动力学检查正常的宫颈癌Ⅰb1～Ⅱa期患者,根据术后是否存在尿潴留分为尿潴留组和非尿潴留组,对两组患者进行术后尿动力学检查,并通过logistic回归模型分析尿动力学因素对宫颈癌广泛性子宫切除术后尿潴留的影响.结果 72例患者中,21例患者发生术后尿潴留,发生率为29%.尿潴留组和非尿潴留组患者术后膀胱初感容量分别为(171±61)和(134±39)ml,均高于术前[分别为(126±28)和(119±17)ml],分别比较,差异均有统计学意义(P＜0.05);而术后膀胱最大容量[分别为(337±66)和(300±66)ml]、顺应性[分别为(31±25)和(29±18)ml/cm H2O(1 cm H2O=0.098 kPa)]、最大尿流率[分别为(10±4)和(12±5)ml/s]及最大尿流率时逼尿肌压力[分别为(27±9)和(32±8)cm H2O],均低于术前,分别比较,差异均有统计学意义(P＜0.05);且尿潴留组术后的尿动力学改变较非尿潴留组明显(P＜0.05).单因素分析显示,术后逼尿肌受损(OR=8.20,95%CI:2.62～25.66,P＜0.01)和膀胱感觉缺失(OR=6.90,95%CI:1.95～24.43,P＜0.01)与术后尿潴留有明显相关性,而术后低顺应性膀胱(OR=1.99,95%CI:0.70～5.63,P=0.195)、逼尿肌过度活动(OR=2.51,95%CI:0.73～8.67,P=0.144)、膀胱流出道梗阻(OR=3.77,95%CI:0.76～18.57,P=0.104)和逼尿肌外括约肌协同失调(OR=2.67,95%CI:0.49～14.45,P=0.255)与术后尿潴留无明显相关性;逼尿肌过度活动与逼尿肌受损间具有明显的拮抗作用(OR=7.60,95%CI:1.43～40.39,P=0.017).多因素分析显示,逼尿肌受损(OR=7.01,P＜0.01)和膀胱感觉缺失(OR=5.45,P=0.018)是影响术后尿潴留的独立危险因素.结论 宫颈癌广泛性子宫切除术后患者尿动力学改变明显,逼尿肌受损与膀胱感觉缺失是影响术后尿潴留的独立危险因素,而逼尿肌过度活动可能对术后逼尿肌受损具有一定的代偿性保护作用.尿动力学检查对术后尿潴留的病因分析及治疗指导具有重要意义.     

Radical hysterectomy: An anatomic evaluation of parametrial dissection

OBJECTIVES: This study was designed to demonstrate a reduction in the amount of blood loss for vesicouterine ligament dissection and to investigate the intrapelvic autonomic nerve pathway and its preservation by means of anatomic analysis. METHODS: The anchoring mechanism of the pelvic viscera to the pelvic wall was divided into a supporting system facing laterally and a suspensory system facing dorsoventrally. An operative procedure was designed in which both systems were separated and dissected independently. RESULTS: Between the two systems, an artificial space was developed, which required a new dissection method for the parametrium and revealed a new anatomic pathway for the ureter and autonomic nerve. The amount of blood loss (mean +/- SD) during dissection of the vesicouterine ligament was ultimately 260.1 +/- 114.8 ml. Postoperatively, the maximum capacity of the bladder was 393.9 +/- 40.4 ml, maximum detrusor pressure 6.3 +/- 4.1 cm H(2)O, mean compliance >10 ml/cm H(2)O, residual urine 23.8 +/- 9.4 ml, and maximum flow rate 25. +/- 8 2.2 ml/s, respectively. CONCLUSION: A new classification for the parametrium and its dissection method have been established. Development of this new operative procedure has also contributed to a decrease in blood loss and preservation of bladder function.     

Urethral sphincter morphology in women with detrusor instability.

OBJECTIVE: To determine whether sonographic urethral sphincter morphology is different in patients with detrusor instability than in those with normal urodynamic testing. METHODS: Patients from a population of women presenting for evaluation of urinary incontinence or pelvic organ prolapse underwent intraurethral ultrasonography before multichannel urodynamic testing. Maximal rhabdosphincter thickness, total urethral diameter, total urethral circumference, and longitudinal smooth muscle thickness, diameter, and circumference were measured. For patients with detrusor instability, the strength of the involuntary detrusor contraction and the bladder volume at its onset were recorded. These data were compared with information from history questionnaires and urodynamic evaluations. RESULTS: The 17 patients with detrusor instability and 16 patients with normal urodynamic testing did not differ with respect to age, vaginal parity, race, weight, body mass index, prior continence surgery, or maximal total urethral closure pressure. Patients with detrusor instability, had decreased urethral longitudinal smooth muscle thickness (3.0 +/- 0.9 mm vs 4.1 +/- 0.7 mm, P =.001), total urethral diameter (18.0 +/- 1.6 mm vs 19.4 +/- 1.4 mm, P =.01), and total urethral circumference (5.65 +/- 0.5 cm vs 6.1 +/- 0.4 cm, P =.012) compared with those with normal urodynamic tests. A linear relationship between rhabdosphincter thickness and strength of involuntary detrusor contraction was observed (r =.686, P =.002). CONCLUSION: Urethral sphincter morphology is different in patients with detrusor instability compared with those who have normal urodynamic tests. These findings provide an anatomic basis for the physiologic findings in patients with "urethrogenic" detrusor instability.     

Exogenous testosterone and estrogen affect bladder tissue contractility and histomorphology differently in rat ovariectomy model

IntroductionChanges in sex hormone levels may play a role in the etiology of lower urinary tract dysfunction of aging women where the possible role of testosterone is overlooked.AimTo determine the effect of testosterone with/without estrogen replacement on histological and functional deterioration in ovariectomized rat bladder tissue.MethodsA total of 54 female Sprague Dawley rats were divided into 6 groups. Except sham operated (control group), all others underwent bilateral ovariectomy. No further treatment was given to the ovariectomy-only group (OVX group). At the third week of ovariectomy treatments were started; vehicle agent (VA group), estradiol (E2 group), testosterone undecanoate (T group), and estradiol + testosterone undecanoate combination (E2 + T group) in physiological doses. Nine weeks after ovariectomy, bladder strips were harvested for isometric tension and histopathological studies.Main Outcome MeasuresTo assess the effect of testosterone/estradiol on ovariectomized rat bladder tissue function and histomorphology.ResultsOVX and VA groups showed statistically significant histological changes such as urothelial damage, inflammatory cell infiltration, increase in collagen fibers and muscular atrophy compared with the control group. Both E2 and T reversed these changes but best histomorphological restoration was observed in E2 + T group. In isometric tension studies, ovariectomy tended to increase contractile responses which were normalized after E2 treatment. In contrary to E2, T significantly increased contractile responses that were normalized with combination treatment. During relaxation studies statistically significant higher relaxation responses were observed in ovariectomized rats. Although both exogenous testosterone and estradiol tended to reverse this effect, a statistically significant difference was found only after testosterone treatment.ConclusionEither estradiol or testosterone replacement alone or in combination prevents significant alterations in bladder tissue histology following ovariectomy whereas both affect the bladder tissue contractility. Thus, combination treatment appears to be the best method to restore both contractility and histomorphology of bladder tissue after ovariectomy. Tanidir Y, Ercan F, and Tarcan T. Exogenous testosterone and estrogen affect bladder tissue contractility and histomorphology differently in rat ovariectomy model.     

Effects of sex hormones on cell proliferation and apoptosis in the urinary bladder muscle of ovariectomized rat

ObjectiveTo reveal the exogenous effects of sex hormones on cell proliferation and apoptosis in the detrusor muscle of ovariectomized rat urinary bladder.Materials and MethodsProliferating cell nuclear antigen (PCNA) and in-situ apoptosis detection kit were used to evaluate cell proliferation and death in the detrusor muscle of castrated female rats after 1 day, 3 days, and 7 days of supplementary sex steroid hormone administration, including estrogen, progesterone, and testosterone. The percentage of cells positive for PCNA (proliferative index) and for apoptosis (apoptotic index) in various groups was calculated.ResultsWhen compared to the group of bilateral ovariectomy without hormonal supplementation, the groups given 3 days and 7 days of estrogen supplementation (p = 0.031 and p = 0.005, respectively) and the group given 7 days of combined supplementation with estrogen and progesterone (p = 0.044) had a significant increase in the proliferative indices. A significant decrease of apoptotic index was found in the group given 7 days of estrogen supplementation when compared to bilateral ovariectomy without hormonal supplementation (p = 0.035).ConclusionsExogenous estrogen supplementation stimulates proliferation and slows down apoptosis in the detrusor muscle of ovariectomized rat urinary bladder, an effect not counteracted by concomitant use of progesterone. Our results may have clinical implications for estrogen supplementation in offering benefits to menopausal women with lower urinary tract syndromes, based on evaluating the relationship between cell apoptosis and cell proliferation.