经闭孔经阴道无张力尿道中段悬吊术治疗压力性尿失禁的护理

压力性尿失禁(stress urinary incontinence,SUI)是指腹内压突然增加导致尿液不自主地从膀胱、尿道外溢[1,2].据报道,北京地区女性尿失禁总患病率为38.5%,SUI占49%,是尿失禁主要的患病类型[3].     

盆底肌训练配合针灸治疗女性压力性尿失禁的临床研究

女性压力性尿失禁(stress urinary incontinence,SUI)是指腹内压的突然增加导致尿液不自主流出,其特点是正常状态下无遗尿,而腹内压突然增高时尿液自动流出。因咳嗽、喷嚏、大笑、站起、走动等动作或身体活动使得腹压急剧上升而导致膀胱内压升高,超过尿道内压而引起的尿失禁[1,2]。我科对90例确认为轻中度SUI病人分别采用盆底肌训练、针灸、盆底肌锻炼配合针灸3种方法治疗SUI,现报告如下。     

干细胞治疗压力性尿失禁的进展

压力性尿失禁(stress urinary incontinence,SUI)是指在逼尿肌没有收缩的情况下,由于腹内压的骤然增加而引起的不自主排尿的现象。目前SUI的治疗方法有很多,本文回顾了SUI的治疗历程,重点对干细胞治疗SUI的进展进行综述。     

肥胖女性压力性尿失禁体质量管理中国专家共识(2020版)

正压力性尿失禁(stress urinary incontinence,SUI)是指喷嚏、咳嗽、大笑或运动时腹压增高后出现不自主的尿液自尿道口漏出。SUI限制了女性日常活动及运动,严重影响其生活质量,并导致巨大心理压力。SUI的危险因素有:年龄、遗传因素、雌激素水平降低、便秘、慢性咳嗽及肥胖等[1],其中肥胖是SUI的独立危险因素[2]。国际尿失禁专家咨询委员会(International Consultation on Incontinence,ICI)[3]及英国国家卫生和临床医疗优选研究所(National Institute for Health and Clinical Excellence,NICE)[4]建议对尿失禁患者首先进行非手术治疗,对于肥胖合并SUI的女性,减重是一线的治疗方式。因此,从体质量管理的角度进行临床干预对于完善SUI的整体治疗策略具有重要意义。专家组依据目前已有的循证医学证据,特制订此专家共识。本共识由妇科专家和营养学专家共同撰写。     

“疏”“堵”并举,系统治疗女性尿失禁

分析尿失禁的形成机制以及危险因素,为女性尿失禁防治提供理论研究方向。女性尿失禁的发生与盆底肌功能下降、尿路动力学改变相关。当基础腹内压与瞬间腹内压之和大于最大尿道闭合压时,就会发生尿失禁。通过降低基础腹内压来降低总腹内压,进而改善尿失禁,我们称之为"疏"。对患者采用"生活方式干预""生活方式干预联合药物治疗""生活方式干预联合手术治疗"的三阶梯治疗模式,可以降低手术率及术后并发症发生率,改善患者生活质量,降低医疗总费用。"疏堵理论"是对经典压力性尿失禁治疗方式的升华和完善,可以使女性尿失禁治疗手段更加系统化、个体化、精准化。     

女性压力性尿失禁盆底肌康复治疗和护理

尿失禁(UI)是我国已婚已育女性的常见病,我国各地报道女性患病率近18.1％～57.5％,其中压力性尿失禁(SUI)最常见,约占总发生率的一半.目前我国尿失禁患者各个年龄总计超过6 000万,其中轻度患者约占2/3,达4 000万.压力性尿失禁(SUI)是指腹压增加时,尿液不自主地自尿道流出,是一种影响妇女生活的常见疾病,严重影响女性的生活质量.     

女性压力性尿失禁治疗方法的研究进展

压力性尿失禁(stress urinary incontinence,SUI)是指当腹压增加时如咳嗽、大笑、提重物或体位改变等引起的不自主尿液漏出.压力性尿失禁在女性中比较常见,据调查结果显示,约近一半的老年女性患有压力性尿失禁;国际尿控协会(ICS)对压力性尿失禁的定义为存在腹压增加时出现不自主的尿道内尿液流出[1].     

手术护理配合在女性压力性尿失禁TVT-O术中的意义

<正>常见尿失禁包括压力性尿失禁(SUI)、急迫性尿失禁(UUI)及压力急迫混合性尿失禁(MUI)[1],压力性尿失禁(SUI)指当腹压突然增加时(如喷嚏、咳嗽、大笑、提重物、体位突然改变),尿液失去控制而不由自主地从尿道外口流出的现象,严重影响患者的生活质量[2]。TVT-O是目前治疗女性压力性尿失禁(SUI)最有效的方法之一。作为尿道中段悬吊术(TVT)的改良方     

经阴道闭孔无张力尿道中段悬吊术治疗压力性尿失禁

[目的]探讨经阴道-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)的临床疗效.[方法]回顾分析本院15例采用TVT-O术治疗女性SUI的临床资料.[结果]15例术后尿失禁得到控制,随访5～12个月无再次尿失禁发生.[结论]TVT-O治疗女性SUI疗效可靠,操作简单,手术创伤小,并发症低.     

新型射频治疗女性压力性尿失禁的疗效分析

目的 研究新型射频治疗女性轻、中度压力性尿失禁的疗效分析.方法 回顾性分析本院2019年10月-12月门诊就诊的SUI女性患者42例行新型射频治疗女性轻、中度压力性尿失禁的临床资料.其中轻度尿失禁32例,中度尿失禁10例,年龄(48.51±4.13)岁,且均已生育,治疗前行国际尿失禁咨询委员会尿失禁问卷(ICI-Q-S...     

Chirurgie de l’incontinence urinaire à l’effort chez la femme obèse

Obesity is an established risk factor for SUI. Among overweight women, a weight loss program improves urinary incontinence with a reduction in the frequency of self-reported urinary incontinence episodes and may be suggested as a first-line therapy. Success rates after TVT are similar among obese patients and normal-weight patients, and TVT is the prime procedure to treat SUI in obese patients. Obesity does not appear as a risk factor for intra- and postoperative complications.     

Stress urinary incontinence in active elderly women

Urinary incontinence in the elderly is a significant health problem fraught with isolation, depression, and an increased risk of institutionalization and medical complications. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most common type of urinary incontinence. SUI can seriously degrade the quality of life for many active seniors, and has become an economic challenge for society. With the rapid increase in the active elderly worldwide, SUI is becoming a significant global problem. However, since only a fraction of women with SUI have consulted a physician, the clinical extent and public health impact of SUI are probably underestimated. The mounting social, medical, and economic problem of SUI in active elderly women as a rapidly growing segment of the population worldwide is reviewed. We evaluate the age-related changes of the lower urinary tract, examine risk factors, and suggest different treatment options shown to be effective in reducing SUI in this population.     

Managing stress urinary incontinence -- a primary care issue

Stress urinary incontinence (SUI) is a common condition in women, caused by anatomical problems related to factors such as age, parity, menopause and obesity. Depending on the clinical findings and on the severity of symptoms, SUI can be managed with conservative methods including pelvic floor exercises, vaginal cones and general lifestyle modification advice; or, it can be treated surgically with procedures such as Burch colposuspension, vaginal slings or tension-free tapes and injection of bulking agents alongside the urethra. SUI is greatly underdiagnosed, because many women are reluctant to consult their doctors about their condition. Department of Health guidelines are placing greater emphasis on primary care management of the condition and Primary Care Trusts (PCTs) to provide consistent, integrated continence care services. The availability of new, non-invasive treatment options, such as duloxetine, are likely to have a positive impact on the future of SUI management.     

超声和临床诊断女性压力性尿失禁进展

压力性尿失禁（SUI）是影响中老年妇女健康的常见疾病,其给患者造成的身体损伤和心理压力逐渐受到重视。对SUI可在早期进行药物及康复治疗,后期常需进行手术干预。超声、尿动力学检查及尿垫试验是临床诊断SUI的常用方法。本文对超声和临床诊断SUI的研究现状和进展进行综述。     

女性盆底肌锻炼的超声尿动力学实时观察

目的：应用超声尿动力学对女性压力性尿失禁盆底肌锻炼进行监测。方法：对30例压力性尿失禁患者盆底肌收缩与松弛动作进行观察，对照组为20例正常妇女。比较两组下尿路形态与盆底功能参数的差异。结果：盆底肌收缩较之松驰时，膀胱尿道连接部向前向上运动，尿道轴向上向前旋转，尿道最大关闭压、阴道压明显提高。病例组盆底肌收缩力度明显低于正常组。结论：超声尿动力学方法可以实时反映盆底肌运动时下尿路的解剖与盆底功能的改变，有利于对压力性尿失禁盆底肌的锻炼进行监测。     

The integrated continence system: a manual therapy approach to the treatment of stress urinary incontinence

Stress urinary incontinence (SUI) constitutes a large-scale public health concern. The integrated continence system (ICS) developed by the authors is an evidence-based model that demonstrates how urinary incontinence is maintained through the interaction of three structural systems (intrinsic urethral closure, urethral support and lumbopelvic stability) and three modifiable factors (motor control, musculoskeletal and behavioural). The purpose of the ICS is first, to demonstrate the important role that manual physiotherapists can play in the treatment of SUI and second, to guide clinical practice decisions in order to improve clinical outcomes among women with SUI.     

Effect of abdominal versus pelvic floor muscle exercises in obese Egyptian women with mild stress urinary incontinence: A randomised controlled trial

The aim of this study was to compare the benefits of a 12-week abdominal and pelvic floor muscle strength training programme for the treatment of mild stress urinary incontinence (SUI) in obese women. Thirty obese female patients with mild SUI were randomly divided into two groups: the abdominal exercise (ABD) group and the pelvic floor exercise (PF) group. The participants were evaluated for vaginal pressure, leak point pressure (LPP) and waist–hip ratio (WHR) before, immediately after and at a 12-week follow-up after the termination of treatment. The ABD group showed a significant increase in vaginal pressure immediately after the intervention and at follow-up (p < 0.001), while the PF group showed no significant change in this variable. The ABD group also showed a significant increase in LPP after 12 weeks of treatment (p = 0.008), while the PF group demonstrated no significant change in the same variable (p = 0.030). At 24 weeks, the LPP remained significantly different from the baseline only for the ABD group (p = 0.005). The results showed that the 12-week abdominal muscle strength training programme is superior to pelvic floor strength training for the treatment of mild SUI in obese patients.     

无张力阴道吊带术微创治疗女性压力性尿失禁

目的:评价无张力阴道吊带术(TVT)治疗女性压力性尿失禁的疗效。方法:对21例压力性尿失禁或混合性尿失禁的女性患者进行了TVT手术治疗。结果:平均手术时间38min(35～45min),术后平均住院天数3.5d(2～5d)。18例单纯性SUI患者治愈17例,治愈率94.4%,显效1例(5.6%);3例混合性尿失禁患者中治愈2例,显效1例。膀胱穿孔1例,经积极处理后痊愈。21例随访均无SUI复发。结论:TVT手术因其简单、微创、疗效好、并发症少,目前可作为女性压力性尿失禁手术治疗的首选术式。     

Impact of urinary and climacteric symptoms on social and sexual life after surgical treatment of stress urinary incontinence in women: a long-term outcome

AIM: The aim of the present study was to evaluate the long-term results of surgical treatment of stress urinary incontinence (SUI) using both subjective and objective methods. BACKGROUND: Few studies have focused on the influence of biological and social changes in a woman's life on the long-term outcome of surgical treatment of stress urinary incontinence. METHODS: The study included 45 women with genuine SUI treated with either retropubic urethrocystopexy (n=30) or puboccocygeal repair (n=15). The assessment included interviews, questionnaires, urinary diary, pad test, continence test and urodynamic investigation. RESULTS: The results were evaluated at intervals of 3 months, 1 year and 5--7 years after the treatment. One year after the surgical treatment 71% of the women in the urethrocystopexy group and 80% in the pubococcygeal repair group were subjectively cured, while 5--7 years after surgery the corresponding values were 43% vs. 60%. However, according to pad test a 67% of the women in the urethrocystopexy group and 47% in the pubococcygeal repair group had ceased to leak urine 1 year after the operation whereas at the long-term follow-up the corresponding values were 64% vs. 71%. According to the questionnaire at the long-term follow-up only 35% of the women in the whole group had genuine SUI whereas 21% had urge-incontinence. Moreover, 37% experienced sweating, 23% flushing and 44% vaginal dryness. The number of women with adiposity had increased significantly (P < 0.001) at the long-term follow-up. Twenty-eight per cent of the women decreased their activities whereas the majority experienced no impediment. Seventy-nine per cent reported that they were sexually active and the majority reported satisfaction with their sexual lives. CONCLUSIONS: Accurate assessment of postoperative results of SUI demands rigorous recording of subjective and objective data taking into consideration psychological and social factors, otherwise there is a high risk of bias in the interpretation of the results of the treatment for SUI. This study indicates that, in order to give women with SUI adequate treatment the nursing care should comprehend the women's divergent experiences of urinary incontinence and its impact on social and sexual life.     

Treatment options for female urinary incontinence

Contrary to the belief of some patients and physicians, urinary incontinence in women should not be accepted as a natural and inevitable part of aging. Indeed, it is a costly problem, psychologically, physically, and economically, and can have a considerable impact on a woman's quality of life. Accurate diagnosis of the type of incontinence is important to implement appropriate and successful treatment. In general, a focused medical and symptom-oriented history and physical examination is all that is needed to establish the correct diagnosis. UI, SUI, and mixed incontinence are the most common types seen in women. Most patients with urge incontinence respond to behavioral treatments, PFEs, medication, or some combination thereof. Recalcitrant cases should be referred to a specialist. Patients with SUI may respond to PFEs, but many require surgical intervention for a satisfactory outcome. The successful treatment of urinary incontinence in a woman can lead to a substantial improvement in her overall quality of life, and for the physician, can be as professionally rewarding as the successful management of various other chronic disease states.