α受体激动剂盐酸米多君治疗女性压力性尿失禁的临床研究

目的　评价盐酸米多君 (管通 )治疗女性压力性尿失禁的有效性和安全性。　方法　采用多中心、随机、双盲、安慰剂平行对照方法对 136例女性压力性尿失禁患者进行管通与安慰剂的对比研究。试验组 6 8例 ,服管通 2 .5mg/次 ,3次 /d ,疗程 4周 ;对照组 6 8例 ,以安慰剂替代管通。 　结果　完成试验 12 9例 ,,管通组 (6 6例 )平均尿失禁量减少 9.9g ,安慰剂组 (6 3例 )减少 3.1g ;管通组尿失禁等级评分减少 1.0 2分 ,安慰剂组减少 0 .35分 ;管通组的客观有效率和主观有效率分别为 6 6 .7%和 80 .3% ,安慰剂组分别为 31.7%和 33.3% ,两组比较 ,差异均有显著性意义 (P均 <0 .0 0 1)。管通组患者副作用发生率 15 .0 % ,安慰剂组 17.1% ,两组间差异无显著性意义 (P >0 .0 5 )。　结论　盐酸米多君治疗女性压力性尿失禁疗效明显 ,优于安慰剂 ,安全性和耐受性与安慰剂相似。     

无张力吊带术治疗女性压力性尿失禁和术后尿动力学评估

目的:探讨无张力尿道吊带术(TVT)治疗女性压力性尿失禁(SUI)的效果和术后尿动力学测值的变化。方法:27例女性SUI患者接受TVT手术治疗,其中9例术后复查尿动力学检查。根据症状评定手术效果,同时比较手术对最大平均尿流率、膀胱容量、最大逼尿肌张力、最大尿道压和最大尿道关闭压(MUCP)的影响。结果:术后23例治愈,3例改善,1例无效,手术有效率为96.3%。手术前后对比显示MUCP显著升高(P=0.027),平均尿流率显著下降(P=0.039),最大尿流率等其他尿动力学指标无显著变化。结论:TVT是治疗女性SUI的有效微创手术,它很可能是通过加强尿道下方的支撑力量来增加MUCP,从而达到控尿目的。手术时必须保证吊带对尿道无张力以防止排尿困难。     

漏尿点压力测定诊断压力性尿失禁

目的 进一步明确漏尿点压力（ＬＰＰ）测定对女性压力性尿失禁（ＳＵＩ）的诊断意义。方法 对１９例女性ＳＵＩ进行详细的尿动力学检查及统一方法的ＬＰＰＩ民其它检测结果进行对比分析。结果 １９例病人中Ⅲ型ＳＵＩ６例，其ＬＰＰ均〈６０ｃｍＨ２Ｏ；Ⅱ／Ⅲ型４例，３例ＬＰＰ６０￣９０ｃｍＨ２Ｏ；Ⅱ型３例，ＬＰＰ９０￣１２９ｃｍＨ２Ｏ；Ⅰ型６例，５例ＬＰＰ〉１２０ｃｍＨ２Ｏ。结论ＬＰＰＩ地ＳＵＩ患者能够进行比较正     

女性不同类型尿失禁临床及尿动力学特点

目的 探讨女性不同类型尿失禁临床及尿动力学特点，提高临床诊治水平。方法 对76例女性患者常规行尿动力学检查，包括尿流率、压力流率研究、尿道压力测定、漏尿点压测定。结果 76例患者中，压力性尿失禁30例，运动紧迫性尿失禁15例，反射性尿失禁19例，混合型压力性／紧迫性尿失禁2例，不稳定尿道3例，假性尿失禁7例。运动紧迫性尿失禁中，DLPP≥40cmH2O者14例，均有不同程度双肾积水。结论 腹压漏尿点压测定可以协助确定压力性尿失禁的手术方式。神经性膀胱尿道功能障碍和膀胱出口梗阻均可能出现膀胱顺应性下降，逼尿肌漏尿点压可以帮助决定膀胱顺应性下降时手术治疗时机。当逼尿肌漏尿点压≥40cmH2O，或者膀胱充盈200ml时逼尿肌压力≥40cmH2O时，必须进行治疗，否则会导致上尿路损害。     

尿动力学检查对女性压力性尿失禁手术的意义

目的 探讨尿动力学检查对女性压力性尿失禁(SUI)手术治疗的指导价值。方法 16例SUI，尿失禁临床分度：Ⅱ度7例，Ⅲ度9例。根据尿动力学检查：Ⅲ型SUI6例，其中施行改良Gittes术2例，施行M—M—K术加阴道后壁修补1例，施行带涤纶片Sling术3例。混合型(Ⅲ型／Ⅱ型)SUI8例；Ⅱ型或Ⅰ型SUI2例，此10例皆行改良Gittes术。结果 全部病例皆得到随访，随访时间8～40个月，平均31个月。施行M—M—K术加阴道后壁修补1例和施行Sling手术者3例，无复发。施行改良Gittes术者12例，有3例(Ⅲ型1例，混合型2例)于1年左右复发(复发率为25％)，其余无复发。结论 尿动力学检查对SUI的诊断术式选择有指导意义。     

尿动力学联合膀胱尿道造影在女性压力性尿失禁诊断中的价值

目的探讨尿动力学检查联合排泄性膀胱尿道造影在女性压力性尿失禁诊断中的应用价值。方法回顾性分析56例临床诊断为女性压力性尿失禁（SUI）的患者,年龄（59．2±8．2）岁,每例均行尿动力学和排泄性膀胱尿道造影检查,评估膀胱顺应性、逼尿肌稳定性、尿道压、膀胱及尿道的形态。鳍杲尿动力学检查提示最大尿流率（33．6±7．7）mL／s,残余尿（17．8±14．7）mL,膀胱顺应性正常,膀胱容量（356．3±99．3）mL,33例测得腹压漏尿点压（49．8±17．6）cmH2O,最大尿道闭合压（47．4±10．5）cmH2O,功能性尿道长度（2．6±0．6）cm。相关性分析显示病程与腹压漏尿点压高度负相关（r=-0．816,P〈0．01）。排泄性膀胱尿道造影见膀胱颈及近端尿道下移34例,膀胱尿道后角变钝或消失44例,静息期膀胱颈和近端尿道呈漏斗形7例,咳嗽时47例见造影剂从尿道溢出。结论在无影像尿动力学设备的单位,尿动力学检查和排泄性膀胱尿道造影联合应用对SUI的诊断和术前评估具有重要的价值,比单用一种方法更具有临床意义。     

TVT-O治疗女性压力性尿失禁的远期疗效和尿动力学分析

目的 评估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)的远期疗效、并发症及尿动力学情况. 方法 回顾性分析2007年5月至2011年6月24例TVT-O治疗女性SUI患者的临床资料,术后远期随访尿动力学检查、生活质量评分和并发症情况. 结果 患者术后12 ～ 60个月回院完成远期随访.术后远期主观成功21例(87.5％),客观成功22例(91.7％),满意23例(95.8％),生活质量评分(20.0±2.4)分.术前腹压漏尿点压为(56.6±20.1)cm H2O(1 cm H2O=0.098 kPa),术后远期23例＞100 cm H2O,1例为66 cm H2O,其余尿动力学参数与术前比较差异无统计学意义(P＞0.05).远期并发症以排尿费力(8例)和外界反射性尿意(4例)多见.结论 TVT-O具有操作简便快捷、微创、安全、有效、并发症少的优点,长期随访对于全面评价TVT-O术式远期并发症和疗效持久性有重要意义,术后尿动力学检查对于评价手术疗效和并发症有较大价值.     

盐酸米多君防治透析低血压疗效观察

低血压是血液透析中最常见的并发症之一,不仅严重影响患者的生活质量,而且是导致死亡危险的一个原因.国外报道其发生率为25%～50%[1],其发病原因与患者自身因素(如自主神经紊乱、血管反应性低下)、内分泌因素、细胞因素[2]、心脏因素、透析相关因素(如透析膜的生物相容性差,有效循环血量减少,透析液及其温度)及其他因素(如镇静或降压药物、严重贫血、低蛋白血症、感染、出血、糖尿病、老龄等)有关,针对可能引起透析低血压的各个环节,临床上采取了多种措施以降低透析中低血压的发生,但都有局限性.我们对透析中反复出现低血压的病人采用口服盐酸米多君的方法防治透析低血压,取得了较好的效果.     

超声尿动力学检查对女性压力性尿失禁行TVT-O手术的指导价值

目的 探讨超声尿动力学检查对女性压力性尿失禁(SUI)的诊断价值及其对经闭孔阴道无张力吊带术(TVT-O)手术的指导价值.方法 对41例SUI患者行超声尿动力学检查,重点了解膀胱尿道连接部活动度( UVJ-M)及腹压漏尿点压力(ALPP),并据此对SUI进行分型,再结合尿失禁临床分度以决定行TVT-O手术.结果 A型,UVJ-M≤l.5cm,ALPP ＞55cmH2O,7例;B型,UVJ-M＞1.5cm,ALPP＞55 cmH2O,11例;C型,UVJ-M≤1.5cm,ALPP≤55cmH2O,10例;D型,UVJ-M＞1.5cm,ALPP≤55cmH2O,13例;其中B型中的Ⅱ度、C型和D型患者共26例行TVT-O手术治疗.术后随访时间3～ 29个月,平均11个月.拔管后除2例重度咳嗽时有漏尿现象外,其余皆尿失禁消失,无一例复发.结论 超声尿动力学检查对SUI患者选择TVT-O手术有客观的针对性,具有重要的指导价值.     

尿动力学检查诊断女性压力性尿失禁(附24例报告)

2003年12月～2005年1月,我们对24例女性压力性尿失禁(SUI)患者行系统的尿动力学检查,以探讨尿动力学检查在SUI诊断中的作用.现报告如下.     

Sequential assessment of urodynamic findings before and after transobturator tape procedure for female urodynamic stress incontinence

The objective of this study was to sequentially compare the urodynamic findings of patients with urodynamic stress incontinence before and after transobturator tape procedure. Between May 2004 and December 2005, 26 of 34 consecutive patients with urodynamic stress incontinence who underwent transobturator tape procedure were enrolled. The sequential urodynamic findings of each case were compared and analyzed. Based on pad test, the cure and improvement rates were 69.2 and 30.8%, respectively. A significant increase in pressure transmission ratio at maximal urethral pressure at 1 year postoperatively (p = 0.005) was observed after surgery. The improvement group (n = 8) had significantly lower preoperative maximal urethral closure pressure (45.4 vs 68.2 mmHg, p = 0.036) than did the cure group (n = 18). The postoperatively increased pressure transmission ratio at maximal urethral pressure appears to contribute to its cure for urodynamic stress incontinence.     

Perineal pad testing in the quantitation of urinary incontinence

Thirty-seven women with urodynamically proved genuine stress incontinence underwent 2 hours of perineal pad-weighing and answered a series of questions regarding perception of their incontinence. It was found that 22% of patients had a pad weight of 1.0 g after the first hour, compared with 8% for the second hour, and 3% for both hours combined. No association was found between pad weight gain and clinical incontinence severity score. In contrast, answers to simple questions about frequency of leaking episodes and pad use were significantly associated with incontinence severity. Our results indicate that pad-testing is a poor predictor of incontinence severity and provides no improvement in its prediction over answers to simple questions about frequency of leaking episodes and pad use. The high false-negative rate of the 1-hour pad test precludes its use in differentiating continent from incontinent women.     

An assessment of the importance of pad testing in stress urinary incontinence and the effects of incontinence on the life quality of women

Our objectives in this study were to determine the severity of incontinence using pad testing and the effects of incontinence on the life quality of women with stress incontinence. Fifty women with a diagnosis of stress urinary incontinence were selected for the study. The Symptom Severity Index (SSI) and Symptom Impact Index (SII) were used to determine the severity and impact of incontinence. Afterwards the women were given a 1-h pad test. According to the pad tests 38% of women suffered severe to very severe incontinence. Women who showed severe incontinence on pad testing scored high in the SSI; on the other hand, no relationship was found between SII and pad test indicators. It was also observed that both SSI and SII scores increased with increasing age of the women (SSI: r=0.29, P<0.05; SII: r=0.30 P<0.05). It may therefore be concluded that the severity of incontinence makes no difference in the effects of incontinence on the life quality of women. Abbreviations SSI Symptom Severity Index - SII Symptom Impact IndexEditorial Comment: The authors have used the pad test as an objective measure of the severity of incontinence. The Symptom Severity Index (SSI) and Symptom Impact Index (SII) were used to look at the impact of the incontinence on lifestyle and compare this to the severity. The severity of incontinence made no difference to the quality of life of the women assessed.     

The diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth

The clinical impact of incontinence in pregnancy and after childbirth is growing because some studies report the efficacy of physiotherapy in pregnancy and because obstetric choices are supposed to have significant impact on post-reproductive urinary function (Goldberg et al. in Am J Obstet Gynecol 188:1447–1450, 2003). Thus, the need for objective measurement of urinary incontinence in pregnancy is growing. Data on pad testing in pregnancy are lacking. We assessed the clinical relevance of the 24-h pad test during pregnancy and after childbirth, compared with data on self-reported symptoms of urinary incontinence and visual analogue score. According to the receiver operating characteristic curve, the diagnostic value of pad testing for measuring (severity of) self-reported incontinence during pregnancy is not of clinical relevance. However, for the purposes of research, pad tests, combined with subjective/qualitative considerations, play a critical role in allowing comparisons across studies, quantifying the amount of urine loss and establishing a measure of severity.     

女性尿失禁患者尿动力学检查的意义

对６８例女性尿失禁的临床诊断和尿动力学检查结果进行了比较研究。根据病史、主诉、体查和辅助检查而做出的诊断，各型尿失禁之间有１５．０％到２７．８％与尿动力学检查不一致。详细的病史、体检、辅助检查与尿动力学检查结果相结合，才能对尿失禁做出正确的诊断。尿动力学检查对于拟手术的患者或基于临床诊断治疗失败的患者具有重要意义。     

女性盆底器官脱垂伴尿失禁患者的尿动力学特征

目的 探讨女性盆底器官脱垂伴尿失禁患者膀胱储尿期和排尿期的尿动力学参数变化. 方法对182例女性尿失禁和盆底器官脱垂患者进行尿动力学检查,其中尿失禁140例,尿失禁伴盆底器官脱垂42例.在统一标准下行尿动力学检查测定膀胱灌注量、排尿量、膀胱顺应性、最大尿流率、最大尿流率逼尿肌压、最小尿流率逼尿肌压、尿道阻力因子(URA)、膀胱梗阻指数(OBI)以及归-化逼尿肌收缩力,评价女性尿失禁患者盆底器官脱垂对膀胱储尿功能和排尿功能的影响. 结果 尿失禁组与尿失禁伴盆底器官脱垂组患者尿失禁病程[(58.1±75.4)与(41.9±55.4)个月]、膀胱灌注量[(295.3±95.8)与(276.5±80.8)ml]、膀胱顺应性[(77.7±122.1)与(51.5±61.9)ml/cm H2O]、最大尿流率[(15.8±12.5)与(14.7±13.9)ml/s]、最小尿流率逼尿肌压[(3.2±5.8)与(2.8±5.5)ml/cm H2O]、归-化逼尿肌收缩力[(7.5±12.8)与(8.2±13.8)cm H2O]相比差异均无统计学意义(P>0.05);而年龄[(58.7±12.2)与(67.1±8.3)岁]、排尿量[(269.2±145.2)与(248.9±135.1)ml]、最大尿流率逼尿肌压[(20.4±16.2)与(25.7±21.3)cm H2O]、URA[(11.3±9.5与(14.8±12.6)cm H2O]、OBI[(15.6±14.5)与(21.7±20.1)cm H2O]2组相比差异有统计学意义(P<0.05).结论高龄女性尿失禁患者更可能伴有盆底器官脱垂,而盆底器官脱垂对膀胱储尿功能无影响,但可影响排尿期相关参数,增加膀胱出口阻力和膀胱残余尿量.     

Quality of life in women with stress urinary incontinence

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity. Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from the National Institute of Child Health and Human Development and the Office of Research on Women’s Health, National Institutes of Health.     

Where should bulking agents for female urodynamic stress incontinence be injected?

For bulking agents used for female stress urinary incontinence, the recommendation for the anatomical placement varies as some injectables are to be placed close to the bladder neck and others midurethrally. Aim of the study was to determine if there are differences concerning the outcome after transurethral collagen injections depending on the anatomical placement midurethrally or at the bladder neck. We randomly assigned 30 elderly female patients with urodynamic stress incontinence to either transurethral collagen injection midurethrally or to the bladder neck. Prior to injection and at ten month follow-up, maximum urethral closure pressure (MUCP), functional urethral length (FUL), maximum flow rate and cough test were performed and the patient was asked to estimate her bladder condition using a visual analogue scale. Postoperative contentness was 8 (median, 95% confidence interval 5–9) in the midurethral group and 8 (median, 95% confidence interval 7–10) in the bladder neck group with a p value of 0.012, 95% confidence interval –2.464 to –0.2859, in favour to midurethral injections. MUCP and FUL increased significantly in both groups and flow rate decreased in both groups. Continence was 66.6% in the midurethral group and 60% for the bladder neck group respectively. Both midurethral and bladder neck collagen injections improve patients’ satisfaction almost equally with a small advantage for midurethral injections.     

Difference in quality of life in women with urge urinary incontinence compared to women with stress urinary incontinence

Introduction  We evaluated whether women with urge urinary incontinence (UUI) have lower quality of life (QOL) than women with other forms of urinary incontinence. Methods  Patients completed three validated questionnaires when presenting for evaluation at a urogynecology practice and were divided into four groups based on their responses: those with symptoms of stress urinary incontinence (SUI), UUI, both SUI and UUI (mixed UI), and neither SUI nor UUI (controls). Results  A total of 465 women were included: 53 women with UUI (11.4%), 101 with SUI (21.7%), 200 with mixed UI (43%), and 111 controls (23.9%). Overall, there was a significant difference (p < 0.001) in PFIQ bladder scale scores as a function of UI group, with individual mean PFIQ scores of 17.1 for controls, 22.3 for SUI, 32.7 for UUI, and 36.8 for mixed UI. Individually, all seven questions in the PFIQ bladder domain were significantly different by group (p ≤ 0.001). Conclusions  Women with UUI and mixed UI have lower QOL scores than women without incontinence or with only SUI. The project was approved by the IRB at Hartford Hospital.     

Analysis of risk factors associated with surgical failure of inside-out transobturator vaginal tape for treating urodynamic stress incontinence

The goals of this study were to assess the efficacy of inside-out transobturator vaginal tape (TVT-O) as a treatment of urodynamic stress incontinence (USI) and to explore the possible factors determining surgical success and failure. Each woman had a 20-min pad test and urodynamic study including uroflowmetry, cystometry, and stress urethral pressure profile before and after treatment. Forty-six of the 54 women (85%) were cured of the disease, and two (4%) showed clinical improvement; TVT-O had failed to treat USI in six patients (11%) during the 9-month follow-up period. We assessed the relationship between clinical features, urodynamic parameters, and treatment outcome. Of these, only age and previous anti-incontinence surgery were significant risk factors for surgical failure. The success rate during the 9-month follow-up period decreased significantly in women ≧60 years and in women with previous anti-incontinence surgery. Women with USI can be treated by the TVT-O procedure.