动物模型在下尿路功能障碍中的应用进展

目的:如今,下尿路功能障碍,如膀胱过度活动症、膀胱流出道梗阻、压力性尿失禁、膀胱疼痛综合征等的发病率逐年升高.如何建立这些疾病的动物模型,对发现这些疾病的病因、探讨其病理生理及寻求其治疗的机制显得尤为重要.本文着重对下尿路动物模型的应用作一综述,旨在为下尿路疾病发病机制的研究及其治疗的探讨奠定理论基础.     

良性前列腺增生患者压力-流率测定中尿道内置测压管对尿流率的影响

目的:探讨压力-流率测定过程中尿道内测压管对尿流率的影响。方法:对39例BPH患者行自由尿流率及压力-流率检测;行压力-流率检测时尿道内留置8F测压管,记录尿流率、膀胱压及逼尿肌压力等参数值,并对最大自由尿流率与最大置管尿流率变化进行统计分析。结果:39例患者置管前后的尿量分别为(209.23±56.56)ml和(210.33±62.02)ml,无统计学差异(P>0.05);最大自由尿流率为(8.61±2.80)ml/s,最大置管尿流率为(7.39±3.01)ml/s,两者间有统计学差异(P<0.05)。以Schafer列线图法对膀胱出口梗阻(BOO)分级后,0～Ⅰ级最大自由尿流率为(12.56±1.57)ml/s,最大带管尿流率为(10.95±2.51)ml/s,两者间无统计学差异(P>0.05);Ⅱ级最大自由尿流率为(9.35±0.76)ml/s,最大带管尿流率为(8.41±1.23)ml/s,两者间无统计学差异(P>0.05);Ⅲ级最大自由尿流率为(7.88±1.21)ml/s,最大带管尿流率为(6.37±0.59)ml/s,两者间有统计学差异(P<0.05);Ⅳ级最大自由尿流率为(6.54±1.93)ml/s,最大带管尿流率为(5.55±2.48)ml/s,两者间有统计学差异(P<0.05);Ⅴ～Ⅵ级最大自由尿流率为(6.01±2.10)ml/s,最大带管尿流率为(4.84±2.89)ml/s,两者间有统计学差异(P<0.05)。结论:行压力-流率测定时,尿道内置8F测压管能够影响最大尿流率的测定结果。     

动物模型在下尿路功台甚障碍中的应用进展

目的：如今，下尿路功能障碍，如膀胱过度活动症、膀胱流出道梗阻、压力性尿失禁、膀胱疼痛综合征等的发病率逐年升高。如何建立这些疾病的动物模型，对发现这些疾病的病因、探讨其病理生理及寻求其治疗的机制显得尤为重要。本文着重对下尿路动物模型的应用作一综述，旨在为下尿路疾病发病机制的研究及其治疗的探讨奠定理论基础。     

骶神经刺激/调节在下尿路功能障碍的应用

慢性排尿功能障碍临床十分常见,主要包括急迫性尿失禁、尿频尿急综合征、慢性尿潴留和慢性盆腔疼痛综合征.目前临床中,药物和其他保守治疗方法效果不确切,外科手术因创伤大,患者不易接受,因此此类排尿障碍成为当前泌尿外科临床实践的难题之一.20世纪90年代以来,排尿反射的神经调节概念越来越被人们重视,功能性神经电刺激治疗慢性排尿功能障碍得到应用.近年来出现并不断应用于临床的骶神经刺激(sacral nerve stimulation,SNS)和骶神经调节(sacral neuromodulation)为治疗排尿功能障碍患者提供了一种新途径.本文就有关骶神经调控技术(Interstim)的原理、适应证、临床操作技术及相关进展作一简介.     

尿道内置7F三腔测压管对压力-流率测定时尿流率的影响

目的:探讨尿道内置7F三腔测压管对压力-流率测定（pressure-flow study, PFS）时尿流率的影响。方法:回顾性分析2011年9月—2016年4月在华中科技大学同济医学院附属同济医院行尿动力学检查的患者资料,筛选出女性压力性尿失禁（stress urinary incontinence, SUI）、逼尿肌活动低下（detrusor underactivity, DU）、膀胱出口梗阻（bladder outlet obstruction, BOO）、逼尿肌过度活动（detrusor overactivity, DO）患者,共计875例。剔除置管前后尿流量相差超过20%的患者,最终406例患者被纳入研究。PFS采用7F三腔测压管,对比自由尿流率（free flow, FF）和PFS时的参数：最大尿流率(maximum flow rate, Q_max),尿流时间（flow time, FT）,尿流量（voided volume, VV）以及尿流曲线形态变化。结果:各组的Q_max-PFSmax-FF且F...     

尿动力学检查在下尿路症状及良性前列腺增生诊治中的作用

尿动力学对评估前列腺增大 (ＢＰＥ)及下尿路症状 (ＬＵＴＳ)的作用至今尚不清楚。多数学者认为 ,虽然良性前列腺增生 (ＢＰＨ)的症状、尿动力学、病理学及病理生理学之间的关系极为复杂 ,但有证据证明 ,尿流率及压力 /流率测试对膀胱出口梗阻 (ＢＯＯ)的诊断和疗效评估有帮助。临床医师常常对ＬＵＴＳ患者作出最初诊断后 ,就按ＢＰＨ治疗。因此 ,从尿动力学角度探讨ＬＵＴＳ及ＢＰＨ对临床有实际指导意义。一、对单纯尿流率测定的认识尿流率测定不能区分ＢＯＯ及逼尿肌反应 ,但它是最常用的尿动力学检查。第五届国际ＢＰＨ咨询委员会建议Ｂ…     

影像尿动力学在下尿路排尿功能障碍中的应用进展

正影像尿动力学检查(video urodynamic study,VUDS)是在普通尿动力学测定膀胱压力和记录尿动力学参数的基础上,同时显示膀胱和尿道的X线形态变化,为临床诊断和治疗提供依据。对于复杂膀胱尿道功能障碍、下尿路梗阻及压力性尿失禁等疾病,特别是当患者合并解剖异常时,影像尿动力学检查可更准确的反映下尿路潜在的病理     

压力-流率测定在诊断老年男性排尿困难中的意义

目的探讨压力-流率测定在老年男性排尿困难诊断中的意义.方法老年男性排尿困难伴前列腺增大者125例,年龄56～83岁,平均68岁,均行尿动力学全项检查,对成功排尿并获得满意尿流率曲线者行压力-流率测定,结果分为膀胱出口梗阻(BOO)、可疑梗阻、无梗阻3类,并将逼尿肌收缩功能分为很弱、弱、正常、强烈4级.结果125例患者中87例获满意压力-流率测定结果,其中BOO 39例,可疑梗阻18例,无梗阻30例.BOO组、可疑梗阻组和无梗阻组的最大尿流率逼尿肌压分别为(99.2±34.3)cmH2O(1 cmH2O=0.098 kPa)、(46.9±9.9)cmH2O和(30.8±10.0)cmH2O,膀胱开口压分别为(99.4±39.6)cmH2O、(43.7±9.9)cmH2O和(29.9±9.7)cmH2O,排尿期最小逼尿肌压分别为(61.3±27.5)cmH2O、(33.9±14.1)cmH2O和(22.1±12.5)cmH2O,最大逼尿肌压分别为(113.0±42.1)cmH2O、(55.8±14.9)cmH2O和(38.4±11.3)cmH2O,BOO组与无BOO组和可疑BOO组差异均有极显著性意义(P均＜0.001).BOO组、可疑梗阻组和无梗阻组逼尿肌收缩功能正常级以上者分别占74.4%(29/39)、27.8%(5/18)和26.7%(8/30),BOO组与另两组比较差异均有极显著性意义(P均＜0.001).结论压力-流率测定是目前诊断BOO的惟一方法和金标准,对老年男性BOO的诊断和治疗有重要意义.     

连续测定的压力-流率分析

目的 通过一组混合疾病的随机病例的回顾分析，探讨用不同方法对于同一病人的膀胱流出道梗阻(BOO)分级和膀胱收缩能力评价的可重复性。方法 连续2次测定22例的结果进行配对比较研究，按线性被动尿道阻力关系(linPURR)和膀胱流出道梗阻指数(BOOI)对每次测定作出BOO分级，用Schafer列线图和膀胱收缩能力指数(BCI)对膀胱收缩能力进行分级，比较四个参数前后两次分析结果的差异。结果 对于BOO以linPURR和BOOI分级P值分别为0．00l和0．057；对于膀胱收缩能力以Sehafer列线图和BCI分级P值分别为0．033和0．325。结论 linPURR对BOO分级的可重复性较差，而按公式计算BOOI方法简便，重复性好。     

女性逼尿肌活动低下患者自由尿流率曲线形态分析及其临床意义

目的:探讨女性逼尿肌活动低下(DU)患者自由尿流率曲线形态特点及其临床意义。方法:回顾性分析2014年6月至2016年6月因下尿路症状(LUTS)于华中科技大学同济医学院附属同济医院行尿动力学检查的275例女性患者的临床资料。年龄(48.0±13.0)岁;症状主要为尿频、尿急、尿不尽感、排尿费力、尿失禁等。根据尿动力学...     

Lower Urinary Tract Dysfunction as Persistent Complication of Radical Hysterectomy

Background This study was performed to evaluate late effects on the lower urinary tract after radical hysterectomy.
Methods We studied 9 women treated with radical hysterectomy for cervical cancer. All patients underwent surgery more than 10 years ago (range, 14 to 36 years). Six patients had urologic complications associated with lower urinary tract dysfunction. The remaining 3 were referred for urinary tract abnormalities detected by radiologic examinations. Lower urinary tract function was evaluated with thorough history taking, laboratory examinations, intravenous urography, and conventional urodynamic studies.
Results Obstructive voiding symptoms and/or urinary incontinence were observed in 7 patients. Uroflowmetry, which was assessable in 7 patients, revealed intermittent flow and a significant amount of residual urine in all patients. Cystometry revealed impaired bladder sensation, detrusor areflexia, straining on voiding, and probable impaired relaxation of the sphincter in all assessable patients. In addition, decreased bladder compliance was observed in 5 patients.
Conclusion All of the examined patients had severe and complicated urinary tract dysfunctions, even at more than 10 years after surgery. Careful follow-up may be mandatory for patients after radical hysterectomy, because compensating factors tend to mask their urologic symptoms.     

Erectile Dysfunction and Lower Urinary Tract Symptoms

Purpose of Review

In the past years, the relationship between lower urinary tract symptoms and erectile dysfunction has been widely explored. The aim of our systematic review is to summarize the published evidence over the past year on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).

Recent Findings

Recent data support the relationship between LUTS and ED in Eastern Europe and in Asia. The role of phosphodiesterase inhibitors alone or in combination with alpha blockers to treat LUTS and ED, especially in younger patients, is strongly supported by high level of evidence.

Summary

LUTS and ED are prevalent conditions in men over 50; epidemiologically, the relationship between both conditions has been confirmed all over the world. PDE5i alone or in combination with alpha blockers can be considered the gold standard for the treatment of young patients with storage symptoms and concomitant ED. In clinical research, a better understanding of the molecular pathways behind this association may also help to identify new possible targets and develop novel therapeutic approaches to manage both disorders; the identification of new biomarkers of both disorders is also compulsory in this area.

     

EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction

Context

Most patients with neurogenic lower urinary tract dysfunction (NLUTD) require life-long care to maintain their quality of life (QoL) and to maximise life expectancy.

Objective

To provide a summary of the 2008 version of the European Association of Urology (EAU) guidelines on NLUTD and to assess the effectiveness of currently available diagnostic tools, particularly ultrasound imaging and urodynamics.

Evidence acquisition

The recommendations provided in the 2008 EAU guidelines on NLUTD are based on a review of the literature, using online searches of Medline and other source documents published between 2004 and 2007. A level of evidence and/or a grade of recommendation have been assigned to the guidelines where possible.

Evidence synthesis

NLUTD encompasses a wide spectrum of pathologies, and patients often require life-long, intensive medical care to maximise their life-expectancy and to maintain their QoL. Treatment must be tailored to the needs of the individual patient and, in many cases, involves a multidisciplinary team of experts. Timely diagnosis and treatment are essential if irreversible deterioration of both the upper and lower urinary tracts are to be avoided. Therapeutic decisions are made on the basis of a comprehensive medical assessment, including urodynamics to identify the type of dysfunction. Advances in investigative technologies have facilitated the noninvasive and conservative management of patients who have NLUTD.

Conclusions

The diagnosis and treatment of NLUTD, which is a highly specialised and complex field involving both urology and medicine, requires up-to-date expert advice to be readily available. The current guidelines are designed to fulfil this need.     

下尿路症状与勃起功能障碍关系的研究进展

下尿路症状(LUTS)和勃起功能障碍(ED)均为老年男性的常见疾病,严重影响患者的生活质量。近年来许多流行病学调查对LUTS与ED的关联性进行研究分析,认为LUTS,尤其是其排尿症状、夜尿症状及个人困扰为ED的独立危险因素。LUTS与ED伴随发病可能主要涉及以下机制:①Rho-激酶表达/活性增强;②一氧化氮释放减少及内皮素-1的海绵体平滑肌收缩作用增强;③海绵体平滑肌肌球蛋白亚型组成改变;④自主神经兴奋性增强及海绵体平滑肌神经分布减少。LUTS与ED间关联性的研究为两者的临床诊疗提供了新的思路。现简要综述近年来LUTS与ED关系的研究进展。