一种用于雌性大鼠尿动力学研究的新方法

目的 建立一种适用于雌性大鼠尿动力学研究的新检测方法,应用该方法测定成年雌性大鼠尿动力学各项参数正常范围.方法 33只成年雌性大鼠乌拉坦腹腔麻醉,尿道内置入2根3 F输尿管导管,分别连接尿动力学检查仪压力传感器及微量注射泵,同时由肛门置入直肠测压气囊管与腹压传感器连接.应用尿动力学检查仪测定大鼠充盈期膀胱压力变化和静态尿道压力图的各项参数.结果 正常成年雌性大鼠尿动力学参数测定值如下:(1)充盈期膀胱压力参数:腹压漏尿点压(ALPP)、喷嚏漏尿点压(SLPP)、排尿压(VP)及膀胱最大容量(MBV)分别为(28.06±5.85)、(23.00±5.96)、(25.39±6.23)cm H2O及(1.21±0.52)ml;(2)静态尿道压力图参数:最大尿道压(MUP)、最大尿道闭合压(MUCP)及功能性尿道长度(FUL)分别为(17.13±4.55)、(14.87±3.77)cm H2O及(14.23±2.64)mm.结论 这种新方法可方便地应用于雌性大鼠的尿动力学研究,更为接近临床所用的方法,因此更具可比性.     

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。     

自体干细胞注射治疗女性压力性尿失禁的实验研究

目的 探讨自体肌肉干细胞注射治疗女性压力性尿失禁的可行性.方法 采用双侧卵巢切除和反复阴道扩张的方法,构建雌性SD大鼠压力性尿失禁动物模型.45只大鼠分3组,正常对照组15只,尿失禁模型30只,其中模型对照组15只,细胞注射治疗组15只.细胞注射治疗组建立模型后第2个月末接受自体肌肉干细胞尿道周围注射治疗.注射治疗组治疗1个月后,测定3组大鼠腹压漏尿点压,同时取近段尿道组织,HE染色观察形态学变化.结果 尿失禁模型组腹压漏尿点压(n=12)(26.4±2.7)cm H2O、正常对照组(n=14)(78.4±3.1)cm H2O、细胞注射治疗组(n=11)(58.8±2.4)cm H2O.3组间两两比较差异均有统计学意义.细胞注射后局部尿道壁肌层增厚、肌纤维增强.结论 自体肌肉干细胞注射治疗能明显提高压力性尿失禁动物模型的腹压漏尿点压,并使注射位点尿道壁肌层得到增强.注射细胞数量和注射后对膀胱功能的远期影响需进一步研究.     

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。     

三种压力性尿失禁大鼠模型的比较研究

目的：通过比较明确三种压力性尿失禁大鼠模型在建模成功率及模型相关尿流动力学方面的差异.方法：60只健康雌性SD大鼠,完全随机分为A、B、C、D四个组各15只大鼠.A组大鼠作为对照组不做建模处理;B组大鼠行全尿道游离;C组大鼠行阴道扩张并双侧卵巢切除;D组大鼠仅行阴道扩张.术后1个月,全部大鼠均行耻骨上膀胱置管,测定腹压漏尿点压（ALPP）及最大膀胱容量（MBC）,并用喷嚏实验检测模型是否漏尿,恒定模型的成功率.结果：尿流动力学（ALPP、MBC）：实验组B、C、D组较对照组A组均明显降低了,差异有统计学意义（P〈0.001）.其中实验组中B组最低,C组次之,D较高,它们之间差异均有统计学意义（P〈0.001）,但C、D组ALPP除外（P=0.082）;喷嚏试验：四组大鼠喷嚏试验阳性率分别为0、85.71%、64.29%、40.00%.喷嚏试验阳性率,实验组B、C、D组较对照组A组差异有统计学意义（P〈0.05）.其中B组最高、C组次之,D组最低.B、C及C、D组间差异无统计学意义（P〉0.05）,B、D组间差异有统计学意义（P=0.031）.结论：三种方法（游离尿道、阴道扩张并双侧卵巢切除及单纯阴道扩张）都可以成功建立压力性尿失禁大鼠模型,且它们在建模成功率及模型尿动力学参数方面存在具有统计学意义的差异.     

折叠缝合TOT吊带治疗复发性女性压力性尿失禁1例

<正>患者,女,72岁。行经闭孔阴道尿道中段无张力悬吊带术(TOT)后1年,再发漏尿3个月,于2013年5月入院。入院后查尿常规阴性,尿培养阴性,咳嗽试验阳性,加压试验阳性,指压试验阳性,Q-Tip试验45°,尿道长度3.1cm,膀胱镜检查未见吊带腐蚀入尿道和膀胱。尿动力学检查:腹压漏尿点压(ALPP)60cmH2O(1cmH2O=0.098     

女性压力性尿失禁的诊治进展

女性压力性尿失禁(SUI)指喷嚏、咳嗽等腹压增高时出现不自主的尿液从尿道外口漏出。体征是在腹压增加时观察到尿液不自主地从尿道流出,且腹压下降时漏尿自动停止。其尿动力学检查表现为充盈性膀胱测压时,在腹压增高且无逼尿肌收缩的情况下出现不自主漏尿。目前临床应用最广泛的治疗是经阴道无张力中段尿道吊带术(MUS)。规范化SUI的诊疗流程具有非常重要的意义,更微创有效地预防和治疗方法有待进一步探索。     

大鼠逼尿肌不稳定模型的建立及评估

目的建立大鼠逼尿肌不稳定（detrusor instability,DI）模型并进行效果评估。方法选取雌性Wistar大鼠25只,随机分为实验组15只和对照组10只。实验组大鼠行膀胱出口部分结扎术建立模型,对照组在相同部位行相同操作但不结扎尿道。术后6周对两组大鼠进行经尿道插管充盈性膀胱测压并评估尿动力学检测结果。结果实验组术后死亡2只,余13只大鼠于术后第6周行充盈性膀胱测压,结果9只（69.2%）出现DI表现,2只逼尿肌稳定,2只膀胱测压未见明显收缩波。DI组大鼠的膀胱容量、排尿量、残余尿量及最大逼尿肌压与对照组比较均显著增加（P〈0.05）。结论对大鼠膀胱出口进行部分结扎建立DI模型方法简便,可重复性强;在术后6周左右麻醉下行插管测压评估DI效果最为适宜。     

遗尿症患者的尿动力学改变

目的探讨遗尿症患者的尿动力学变化。方法对１５例遗尿症患者行尿流率,充盈期膀胱压,压力流率及静态尿道压测定。结果功能性膀胱容量减少者４例,不稳定膀胱者８例,膀胱顺应性下降者９例,尿道压力升高者６例,尿道压力降低者２例。结论尿动力学紊乱是遗尿症的原因之一,尿动力学检查对遗尿症的临床治疗有指导意义。     

女性压力性尿失禁患者在不同膀胱容量下漏尿点压的对照研究

目的:探讨女性压力性尿失禁患者在不同膀胱灌注量下漏尿点压的差异。方法:回顾性分析2016年1月至2018年12月本院收治的12例女性压力性尿失禁患者,在术前行尿动力检查时分别给予膀胱灌注200、250、300、350 mL时,测出腹压漏尿点压及咳嗽漏尿点压并分别进行比较。结果:不同膀胱容量下同时测得的腹压漏尿点压及咳嗽...     

脊髓损伤并发上尿路扩张的危险因素分析

目的探讨脊髓损伤患者并发上尿路扩张的尿动力学危险因素。方法随机抽取唐山地震脊髓损伤患者96例,经B超检查并发上尿路扩张16例为A组,无上尿路扩张80例为对照组B组,分别进行尿动力学测定。而后对两组患者间性别、年龄和尿动力学等参数进行单因素和多因素分析。结果男性上尿路扩张发生率明显高于女性,A组残余尿量、最大膀胱容量、逼尿肌漏点压和膀胱低顺应性发生率明显高于B组,而两组年龄、逼尿肌反射亢进发生率、相对安全容量、逼尿肌括约肌协同失调发生率、最大尿流率和最大尿道关闭压差异无统计学意义。Logistic回归分析结果显示,膀胱低顺应性是筛选出的惟一危险因素。结论对脊髓损伤患者及时进行尿动力学检查,阻止或减缓膀胱顺应性的改变,可防止上尿路扩张的发生。     

COMPARISON OF URODYNAMIC AND FREE VOIDING PATTERN IN INFANTS WITH DILATING REFLUX

PURPOSE: We compared simultaneous investigations of free voiding pattern and urodynamic assessment in infants with dilating reflux to obtain further information on previously suspected bladder dysfunction based on abnormal urodynamic findings. MATERIAL AND METHODS: A total of 33 male and 8 female infants with dilating reflux were included in the study. Free voiding pattern was determined by 4-hour voiding observation compared to previously described voiding pattern studies of healthy infants. Simultaneous invasive urodynamic assessments were performed. RESULTS: The patients were grouped according to urodynamic bladder capacity. Half of the male patients had low bladder capacity with high voiding pressure levels (hypercontractile) and the other half had either normal or high capacity bladders. The low capacity group had frequent small voids and a high rate of interrupted voiding, the high capacity group had infrequent voids of high volumes with high residual urine, and the pattern of the normal capacity group differed only from that of healthy infants by an increase in residual urine. All female infants had the typical characteristics of high capacity bladder on free voiding and urodynamic assessments. CONCLUSIONS: Infants with abnormal invasive urodynamic investigations, including those with a small capacity hypercontractile bladder and those with a high capacity bladder, could be identified on free voiding studies, indicating that an abnormal urodynamic pattern represents bladder dysfunction.     

Effect of time interval and overdistension on repeated urodynamic studies.

Repeated urodynamic testing of the lower urinary tract is often needed both clinically and experimentally. The objective of this study is to find out the time interval needed if repeated urodynamic tests are required even if overdistension occurs initially. Three hundred forty urodynamic studies were performed using five female rhesus monkeys (Macaca mulatta). Two groups of experiments (with or without bladder overdistension) were performed at the following time intervals: immediate, 15, 30 and 45 minutes after the initial urodynamic study. All urodynamic parameters (pressure, capacity, compliance and detrusor strength) were reproducible after a 30-minute waiting period. In case of overdistension, a 45-minute period is required.     

Urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder

Objectives: To investigate the urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder (OAB). Methods: A total of 52 untreated female patients with OAB symptoms were given 5 mg solifenacin once daily for 12 weeks. Before and after treatment, the frequency volume chart, overactive bladder symptom score (OABSS), postvoid residual volume, filling cystometry and adverse events were evaluated. Results: After solifenacin treatment, OAB symptoms were improved, voided volume was increased and voiding number was decreased. Bladder capacities at the first sensation of bladder filling, first desire to void and strong desire to void were significantly increased. Intravesical pressure at the first sensation of bladder filling was significantly decreased. Detrusor overactivity (DO) disappeared in five patients. For 28 patients with persisting DO after treatment, bladder capacity at DO was significantly increased. Both groups with and without DO at baseline had significant improvements of OAB symptoms. Conclusions: Solifenacin urodynamically increases bladder capacity in female patients with symptomatic OAB.     

压力性尿失禁动物模型的建立

目的 探讨压力性尿失禁(SUI)老鼠模型建立的有效方法,为深入研究SUI的发病机制提供有价值的研究对象.方法 50只Sprague-Dawley大鼠雌雄合笼(合笼比例4∶1),分娩后随机分成两组,即第一组(12只)和第二组(28只).第一组对其常规饲养,不做任何特殊处理.第二组对已育大鼠采用阴道球囊扩张4 h模拟难产,两周后重复一次,常规饲养1个月后切除双侧卵巢.8周后,两部分大鼠均行尿流动力学检查测膀胱最大容量(MBC)和腹部漏尿点压力(ALPP)及喷嚏实验,尿动力学检测完毕后从第二组随机筛选出压力性尿失禁成年已育雌性大鼠模型(12只).结果 对照组和实验组大鼠漏尿点压力值分别为(48.00±1.74)cmH2O和(32.94±1.63)cmH2O,差异有统计学意义(p＜0.05);最大膀胱容量为(2.02±0.19)ml和(1.29±0.16)ml,差异有统计学意义(p＜0.05);喷嚏实验见实验组有13只大鼠表现阳性(阳性率52%),对照组全部阴性.结论 阴道球囊扩张联合双侧卵巢切除可以成功建立压力性尿失禁大鼠模型.     

间质性膀胱炎/膀胱疼痛综合征尿动力学检查价值分析

目的:探讨间质性膀胱炎/膀胱疼痛综合征(interstitial cystitis/bladder pain syndrome,IC/BPS)尿动力学特征及鉴别诊断价值.方法:回顾性分析2019年06月-2019年12月就诊于我院40例女性IC/BPS患者与40例女性单纯压力性尿失禁(stress urinary in...     

脊髓损伤后膀胱尿流动力学检查及分类

目的：检测脊髓损伤患者膀胱功能并分类。探讨并发症与膀胱功能的关系。方法：采用尿流动力学四导程测压仪对３６例脊髓损伤患者进行下尿路功能分组检测。结果：各组患者因脊髓损伤节段及程度的不同，会有不同的尿流动力学表现及不同的膀胱功能，而且有相应的并发症发生，这之间有一定的规律及内在联系，并据此将膀胱分为三类。结论：根据尿流动力学表现对脊髓损伤后膀胱进行分类，对临床有一定的指导意义。     

膀胱出口梗阻大鼠膀胱过度活动的研究

目的:建立膀胱出口梗阻大鼠模型,诱发逼尿肌不稳定(DI),研究膀胱出口梗阻伴发膀胱过度活动的病理生理学特征。方法:选择38只成年SD雌性大鼠,随机分为模型组和对照组,结扎膀胱颈部建立膀胱出口梗阻模型。建模后3、6、9、12周采用BL-410生物机能实验系统测定膀胱压,以充盈期出现DI作为膀胱过度活动存在的标准,记录并计算DI阳性率和频率、最大排尿压(MVP)、最大膀胱容量(MCC)、膀胱顺应性(BC)和剩余尿量(PVR)。用光镜观察建模不同时期膀胱组织的病理学改变。结果:模型组大鼠3、6、9、12周DI阳性率分别为37.50%、75.00%、75.00%、62.50%。MVP、MCC、BC、PVR和DI频率较对照组增高(P<0.01),第9周大鼠PVR、MVP、MCC高于第3、6和12周。不同时期病理学改变呈现出膀胱容量增加、肌层逐渐增厚和纤维化的过程。结论:膀胱出口梗阻与逼尿肌不稳定的发生具有潜在的相关性,其病理学改变和尿流动力学参数反映了膀胱的病理生理学特点。     

Pharmacologic effect of thiphenamil HCl on lower urinary tract function of healthy asymptomatic volunteers.

The effect of thiphenamil HCl on the urodynamic parameters of bladder filling, voiding and isometric contraction was examined in controls. Data were obtained from 25 control female subjects with a mean age of 27.6 +/- 6.6 years. Three urodynamic studies were done on each subject on 3 different days. These studies were: (1) control study, (2) drug study with a single oral dose of 400 mg thiphenamil HCl and (3) another with 800 mg. Each urodynamic study involved filling and voiding cystometrograms to characterize stability, sensations of fullness and urgency, bladder capacity, urethral opening pressure, maximum flow rate, maximum detrusor pressure and residual urine. In addition, isometric detrusor pressure measurements were made at bladder volume increments of 100 ml. Each urodynamic study was done in the sitting position using medium fill water cystometry at 20 ml/min. Isometric pressures were made by catheterizing the subject with an 18-french three-way Foley catheter with a 30-ml balloon. One lumen was used to fill the bladder and the second to measure pressure. The results show that bladder capacity and the volume at which sensations of fullness and urgency are expressed are not significantly changed under the influence of thiphenamil HCl. Significant differences were seen in the maximum pressure generated by the detrusor during voiding and in the maximum urine flow rate. These differences were most pronounced at the 800-mg thiphenamil HCl dose. The isometric data show a highly significant increase in the maximum isometric pressure developed at the low bladder volumes.(ABSTRACT TRUNCATED AT 250 WORDS)