尿流动力学检查在女性压力性尿失禁诊断和治疗中的意义

女性压力性尿失禁诊治过程中是否需要常规行尿流动力学检查值得注意,重要的是理解该症可能出现哪些膀胱尿道功能障碍,因此应该对以下问题有所了解。一、发病学压力性尿失禁是中老年女性的常见病,其主要的病理生理学改变是尿道过度移动和内源性括约肌功能缺陷,或者两者兼而有之,此分析为病因学分析。尿道过度活动是主要改变,内源性括约肌功能缺陷在次。经受压力时尿道解剖位置发生改变令尿道不足以抵御膀胱内压的升高,乃发生尿外渗,此即吊床或尿道中段松动理论,尿道耻骨韧带是尿道中段的吊床,其过分松动影响尿道关闭功能。经典的女性尿道分为…     

尿道周围注射脂肪或胶原治疗尿道固有括约肌薄弱所致压力性尿失禁的体会

尿道周围注射脂肪或胶原治疗尿道固有括约肌薄弱所致压力性尿失禁的体会［ＨａａｂＦ，ｅｔａｌ．ＪＵｒｏｌ，１９９７，１５７∶１２８３］为比较尿道周围注射自体脂肪或胶原治疗由尿道固有括约肌薄弱所致压力性尿失禁的疗效，作者对６７例压力性尿失禁女性患者做了前瞻...     

真性尿失禁的手术治疗进展

根据国际尿控协会(ICS)的定义,尿失禁指尿液自尿道不自主的流出[1].临床上尿失禁主要表现为压力性尿失禁(SUI),急迫性尿失禁(UUI)及混合性尿失禁(MUI). 真性尿失禁(GSI)在临床上属于压力性尿失禁范畴,又称真性压力性尿失禁(GSUI).当用力、咳嗽、打喷嚏等动作导致腹压增加时,腹压传入膀胱使膀胱内压升高而逼尿肌并无收缩,当膀胱内压大于尿道压,出现尿液不自主流出,称为GSUI.膀胱颈部及尿道过度移动、尿道括约肌功能不足,均可导致GSI.男女均存在GSI,不过女性GSI患者远多于男性.女性GSI常是由于盆底支撑组织功能不全所引起,男性GSI常继发于前列腺疾病手术所导致的尿道括约肌功能损害.随着老年男性人口的增加,手术治疗前列腺疾患的数量也相应增多,男性GSI的比例也相应增加.     

排尿期尿道测压的临床应用

目的：确定下尿路梗阻及其梗阻部位。方法：对４１例有下尿路梗阻症状患者进行了排尿期尿道测压（ＭＵＰＰ）,其中包括前列腺增生症（ＢＰＨ）２９例,男性尿道狭窄３例,逼尿肌－外括约肌协同失调３例,女性压力性尿失禁４例,女性尿道末端缩窄综合征１例,前例腺炎１例。结果：２９例ＢＰＨ患者中,２６例有梗阻,其中梗阻位于膀胱颈部２０例;３例逼尿肌－外括约肌协同失调患者表现为外括约肌部压力下降;４例女性压力性尿失禁患     

肌瓣转移治疗女性压力性尿失禁：附13例报告

为探讨女性压力性尿失禁患者的治疗效果，对１３例女性压力性尿失禁病人使用股薄肌肌瓣翻转移位包围尿道、加强尿道括约肌功能，同时游离尿道并给以延长。结果１３例病人手术治疗后随访６～２４个月，１０例病人排尿通畅，３例病人有尿线变细，经过尿道扩张后排尿正常。本术式方法易掌握，取材方便，成功率高，并发症少，是一种治疗女性压力性尿失禁较理想的手术方法。     

经耻骨上膀胱尿道悬吊带治疗女性压力性尿失禁(附8例报告)

目的:探讨尿道悬吊带(SPARC)治疗女性压力性尿失禁的疗效.方法:局麻下对8例女性压力性尿失禁患者施行经耻骨上膀胱尿道悬吊带手术治疗.结果:平均手术时间45 min(30～70 min),平均住院2天(1～3天).术后留置导尿管24 h.8例患者术后尿失禁症状均消失,无并发症.结论:SPARC尿道悬吊带治疗女性压力性尿失禁疗效确切,操作简便,对患者损伤少,并发症发生率低,是一种治疗女性压力性尿失禁的有效方法.     

铒激光技术治疗压力性尿失禁

正女性尿失禁是女性常见的储尿期功能障碍性疾病,据全球统计其罹患率高达50%,其中大约有一半为压力性尿失禁(stress urinary incontinence,SUI),对女性的健康状态和生活质量造成严重影响[1-2]。SUI是指喷嚏、咳嗽或运动等腹压增高的情况下尿液不自主地自尿道外口流出[3]。通常认为造成女性SUI的病理生理机制主要有以下几个因素:膀胱颈及近端尿道下移;尿道黏膜封闭功能减退;尿道固有括约肌功能下降以及支配控尿组织结构     

女性压力性尿失禁治疗方案的选择和指征

引起女性压力性尿失禁的病因如尿道括约肌功能障碍的诊断可由尿流动力学决定,同时必须注意逼尿肌不稳定和排尿困难的诊断。本文复习了保守治疗的指征及方案;外科手术的指征和手术方法,以及复发性尿失禁的治疗措施。     

女性压力性尿失禁

女性压力性尿失禁的诊疗效果一直不够理想，本文综述了这方面的进展，认为注意尿道内括约肌功能的诊断，并针对不同的病因选择不同治疗方法。     

干细胞治疗压力性尿失禁进展

压力性尿失禁（stress urinary incontinence,SUI）是泌尿系统的常见病、多发病,其中老年妇女的发病率高达50%以上。目前治疗尿道固有括约肌缺陷（intrinsic sphincter deficiency,ISD）导致的SUI的方法主要是尿道周围注射的方法,治疗解剖型SUI的主要手术方式是尿道中段悬吊术。但传统材料由于自身的物理化学性质及受体组织的相容性等使其有效性和稳定性受到很大影响。随着胚胎干细胞、神经干细胞等研究的不断深入,有关干细胞在压力性尿失禁的研究已逐渐成为一个热点。本文对多种干细胞治疗压力性尿失禁的动物研究和临床研究进展进行综述。     

Neurophysiology and therapeutic receptor targets for stress urinary incontinence

Stress urinary incontinence is the most common type of urinary incontinence in women. Stress urinary incontinence involves involuntary leakage of urine in response to abdominal pressure caused by activities, such as sneezing and coughing. The condition affects millions of women worldwide, causing physical discomfort as well as social distress and even social isolation. This type of incontinence is often seen in women after middle age and it can be caused by impaired closure mechanisms of the urethra as a result of a weak pelvic floor or poorly supported urethral sphincter (urethral hypermobility) and/or a damaged urethral sphincter system (intrinsic sphincter deficiency). Until recently, stress urinary incontinence has been approached by clinicians as a purely anatomic problem as a result of urethral hypermobility requiring behavioral or surgical therapy. However, intrinsic sphincter deficiency has been reported to be more significantly associated with stress urinary incontinence than urethral hypermobility. Extensive basic and clinical research has enhanced our understanding of the complex neural circuitry regulating normal function of the lower urinary tract, as well as the pathophysiological mechanisms that might underlie the development of stress urinary incontinence and lead to the development of potential novel strategies for pharmacotherapy of stress urinary incontinence. Therapeutic targets include adrenergic and serotonergic receptors in the spinal cord, and adrenergic receptors at the urethral sphincter, which can enhance urethral reflex activity during stress conditions and increase baseline urethral pressure, respectively. This article therefore reviews the recent advances in stress urinary incontinence research and discusses the neurophysiology of urethral continence reflexes, the etiology of stress urinary incontinence and potential targets for pharmacotherapy of stress urinary incontinence.     

Artificial urinary sphincter for recurrent female urinary incontinence: indications and results

A retrospective review of our experience with the artificial urinary sphincter in 32 women is presented. All patients had a history of recurrent urinary incontinence after failed bladder suspension procedures. Of 32 devices 31 were functioning, with an average followup of 2.5 years, and 91 per cent of the patients were dry without pads. Mechanical complications requiring surgical repair occurred in 21 per cent of the patients. Indications for artificial urinary sphincter implantation in the female patient and technical aspects of the procedure are discussed. The artificial urinary sphincter appears to be an acceptable treatment modality for urethral sphincter deficiency resulting in recurrent urinary stress incontinence in female patients.     

Outcome of the artificial urinary sphincter in female patients

PURPOSE: We reviewed the outcome in female patients at our unit in whom an artificial urinary sphincter was inserted. MATERIALS AND METHODS: We reviewed notes on 68 patients and mailed a questionnaire to those without recent followup. RESULTS: Median time since insertion was 12 years. Overall 25 patients (37%) had the original artificial urinary sphincter in situ and were dry at a median followup of 7 years. The artificial urinary sphincter was replaced for loss of function in 12 patients, of whom 11 were dry with the replaced device. The device was removed for erosion or infection in 31 patients, of whom 19 underwent successful replacement or were continent after removal. Overall 55 of 68 patients (81%) were continent. Those with neuropathic bladder dysfunction achieved a continence rate of greater than 90%, although half required sphincter removal initially. When the indication for insertion was stress incontinence, 70% of the patients had the original or a replaced artificial urinary sphincter in situ and 82% were continent. All patients with previous pelvic irradiation had the sphincter removed and urinary diversion was done. CONCLUSIONS: The overall continence rate in female patients after insertion of an artificial urinary sphincter is satisfactory. A satisfactory outcome was achieved in terms of stress incontinence and we would recommend an artificial urinary sphincter after an adequate anti-stress incontinence operation fails. Continence in patients with neuropathic bladder dysfunction is excellent and the artificial urinary sphincter should be considered first line treatment in this group, although the risk of revision surgery is high. Pelvic irradiation is a contraindication to the artificial urinary sphincter in female patients.     

Management of type III stress urinary incontinence using artificial urinary sphincter.

Type III stress urinary incontinence due to severe intrinsic urethral weakness without significant urethrovesical descensus may be treated by periurethral injection, sling cystourethropexy, bladder neck reconstruction, or artificial urinary sphincter implantation. The rationale for procedure selection depends on a number of patient factors and the surgeon's experience. We herein report on 25 women who were identified as having such incontinence by evaluation which included videourodynamic study and lateral voiding cystography and who were managed by the implantation of an artificial urinary sphincter. The etiology of the severe intrinsic urethral weakness in most patients was multiple prior failed cystourethropexies. Postoperatively, 1 patient died of a cerebral vascular accident. The remaining 24 women had significantly improved continence and were completely satisfied at latest follow-up. No revisions have been required for patients receiving an artificial sphincter after 1983. No sphincter erosions or infections have occurred. Our experience and review of the literature shows that the artificial sphincter provides an excellent first option for women with type III urinary stress incontinence due to intrinsic urethral weakness of various etiologies.     

Management of male incontinence following artificial urinary sphincter failure

PURPOSE OF REVIEW: The artificial urinary sphincter has been used successfully for the treatment of stress urinary incontinence in both male and female patients. Its most common use, however, is in men suffering from postprostatectomy incontinence. RECENT FINDINGS: The success rates, long-term durability, and patient satisfaction for the artificial urinary sphincter are high. The incidence of complications and adverse events remains low although they are sometimes unavoidable. SUMMARY: We believe that continence can be salvaged in the majority of men in whom the device fails or requires explantation and we present the logical analysis for device revision and relocation in this review.     

The artificial urinary sphincter AMS 800 in the treatment of complex female urinary incontinence: indications, results, complications and risk factors

Summary Indications, results and complications of 144 women who have undergone implantation of the current model AMS 800 since 1983 and remained in continuous follow-up in our department are presented. Included are 70 patients suffering from stress urinary incontinence (SUI) type III after 208 previously unsuccessful incontinence procedures, 54 patients with incontinence due to neurogenic bladder dysfunction (NBD) and 20 patients with congenital or acquired internal sphincter weakness of other causes. In the NBD group, apart from sphincter implantation a total of 113 additional operations were necessary due to complex malfunctions of the urinary tract: augmentation ileocystoplasty in 51 patients, ureterocystoneostomy in 23 patients and 43 operations at the bladder neck. One hundred and twenty-six patients (86 %) achieved total continence and 5 patients (3 %) were significantly improved. In 9 females (6 %) incontinence persisted, and 4 patients ultimately underwent urinary diversion into a Kock pouch. With the implanted artificial sphincter 116 patients (81 %) are able to empty their bladder spontaneously, without residual urine and without the necessity of intermittent self catheterisation. Under the aforementioned conditions implantation of the artificial urinary sphincter AMS 800 is the most effective therapy for complex female incontinence.      

Pharmacotherapy of urinary incontinence

The pathophysiology of urinary incontinence (UI) involves an overactive detrusor (DOA) or an incompetent urethral sphincter. Therefore, the three most common types of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI), or a combination of stress and urge known as mixed urinary incontinence (MUI). Pharmacotherapy represents a recognized option for the treatment of different types of UI. A literature search of Medline publications on pharmacological treatment of urinary incontinence until 2008 was performed. Relevant data from recently published literature were included. Anticholinergics are the cornerstone of UUI treatment, whereas serotonin and norepinephrine re-uptake inhibitors represent an option for SUI treatment. A significant percentage of patients with UI, mainly those with UUI and MUI, can be treated successfully with pharmacotherapy.     

The current role of the artificial urinary sphincter for the treatment of urinary incontinence

PURPOSE: The introduction of the artificial urinary sphincter (AUS) in 1972 was heralded as a revolution for the treatment of genuine stress incontinence. Initial enthusiasm was tempered by disappointment as complications occurred. The device has now been in routine clinical use for more than 30 years, and the indications and surgical principles involved in its use along with short-term and long-term outcomes are more clearly defined. Hence, we reviewed the literature to clarify the role of the AUS and offer a possible solution to its problems in the guise of a new sphincter. MATERIALS AND METHODS: A MEDLINE search was performed and all articles relating to the role of the AUS for the treatment of urinary incontinence were reviewed. RESULTS: The AMS 800 (American Medical Systems, Minnetonka, Minnesota) provides urinary continence in 73% of cases (range 61% to 96%) and it has a complication rate of 12% (range 3% to 33%) for mechanical failure, 4.5% to 67% for early infection/erosion, 15% for late erosion and 7% for delayed recurrent incontinence. The literature supports the role of the AUS as an important and reliable treatment modality for stress urinary incontinence and intrinsic sphincter deficiency. However, it is not suitable in all patients and its use for the management of hypermobility is controversial. Hence, careful patient selection according to indication is required with full preoperative counseling. CONCLUSIONS: Despite its reliability for achieving urinary continence the AMS 800 is not perfect. Newer devices, such as that being developed at our institution, may offer improved outcomes and decreased complication rates.     

Epidemiology and etiology of urinary incontinence in the elderly

Urinary incontinence is an important and common health problem, whose prevalence increases with age. Often quality of life is clearly affected for persons concerned. In the group of elderly individuals (> or =60 years of age) 19.3% of women and 10.4% of men report urinary incontinence. Women most frequently describe urinary stress incontinence followed by incontinence with urge symptoms (urge incontinence, mixed incontinence). In men urinary incontinence without any symptoms of stress or urge incontinence is most common followed by incontinence with urge symptoms and stress incontinence. Urinary incontinence in the elderly is rarely due to a single reason but rather due to multiple factors. In urinary stress incontinence, a differentiation can be made between mechanical and functional problems of the sphincter mechanism caused by myogenic, neurogenic, hormonal, or iatrogenic factors as well as changes in connective tissue. In urinary incontinence with urge symptoms, geriatric detrusor function is mostly affected by neurogenic, myogenic, or urothelial factors whereas the detrusor muscle shows characteristic ultrastructural changes. In chronic urinary retention with consecutive urinary incontinence, especially in men infravesical obstruction is more often the reason than a geriatric bladder dysfunction.     

Artificial urinary sphincter for post‐prostatectomy incontinence: A review

The artificial urinary sphincter remains the gold standard for treatment of post‐prostatectomy urinary incontinence. The AMS 800 (American Medical Systems, Minnetonka, MN, USA) is the most commonly implanted artificial urinary sphincter. Having been on the market for almost 40 years, there is an abundance of literature regarding its use, but no recent review has been published. We reviewed the current literature regarding the indications, surgical principles, outcomes and complications of artificial urinary sphincter implantation for stress urinary incontinence after prostatectomy. A PubMed search was carried out for articles on the artificial urinary sphincter from 1995 to present. The review was centered on articles related to the use of the AMS 800 for stress urinary incontinence in males after prostatectomy. Relevant articles were reviewed. The majority of patients will achieve social continence (1 pad per day) after artificial urinary sphincter implantation; however, rates of total continence (no pad usage) are significantly lower. Patient satisfaction outcomes average greater than 80% in most series. Potential complications requiring reoperation include infection (0.5–10.6%) and urethral erosion (2.9–12%). Revision surgeries are most commonly as a result of urethral atrophy, which ranges from 1.6 to 11.4%. The 5‐year Kaplan–Meier freedom from reoperation ranges from 50 to 79%, while the 10‐year Kaplan–Meier freedom from mechanical failure is 64%. The artificial urinary sphincter is a reliable device with good outcomes. As expected with any prosthetic device, complications including mechanical failure, infection, erosion and recurrent incontinence remain significant concerns. Despite known complications, the patient satisfaction rates after artificial urinary sphincter implantation remain high. Appropriate patient counseling and adherence to surgical principles are imperative.