女性压力性尿失禁评估问卷的研究进展

压力性尿失禁作为困扰女性身心健康的卫生问题,近年来引起了越来越多研究者的关注。本文从诊断评估、症状与生活质量评估、性功能影响评估三个方面总结了女性压力性尿失禁的评估问卷,从内容、用时、应用情况等角度进行列表对比,以期为流行病学及临床研究者进行女性压力性尿失禁的评估提供参考依据。     

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…     

尿动力学检查在女性压力性尿失禁诊治中的价值(附20例报告)

目的 探讨尿动力学检查对女性压力性尿失禁(SUI)诊断中的价值。方法 对20例SUI，进行全面的尿动力学检查(包括应力性漏尿点压力测定)。20例中不稳定膀胱者6例(30％)。Ⅲ型7例，混合型(Ⅲ型／Ⅱ型)10例，Ⅱ型3例。16例行手术治疗，其中改良Gittes术12例，带涤纶片吊带术3例，MMK术加阴道后壁修补1例。结果 16例手术患者随访8～40个月，平均31个月。MMK术加阴道后壁修补1例和吊带手术者3例均无复发。改良Gittes术12例中3例(Ⅲ型1例，混合型2例)于1年左右复发。结论 尿动力学检查有助于SUI的诊断和鉴别诊断，对SUI的术式选择有指导意义。     

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.     

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。     

尿动力学检查在女性压力性尿失禁诊治中的应用

目的探讨尿动力学检查在女性压力性尿失禁（SUI）诊治中的应用价值。方法对38例SUI的患者进行尿动力学检查，并根据漏尿点压测定（ALPP）对29例真性压力性尿失禁（GSUI）进行分型，对其中21例患者行经闭孔无张力阴道吊带（TVT-O）术，并对TVT-O术后10例治愈者手术前后的尿动力学指标进行分析。结果38例SUI患者经尿动力学分析，诊断GSUI29例，对其中ALPP分型为Ⅱ型、Ⅱ／Ⅲ型及Ⅲ型的21例患者行TVT-O术，18例治愈，2例好转，1例无效。对术后10例治愈者进行尿动力学测定，结果最大尿道关闭压（MUCP）较术前明显升高（P〈0．05）。结论尿动力学检查在尿失禁的病因鉴别诊断上有重要意义。ALPP对GSUI的诊断、分型、手术方式的选择有参考价值。TVT-O术具有简单、微创、安全、疗效可靠的优点，其机制可能与增加最大尿道闭合压有关。     

压力性尿失禁合并糖尿病患者的尿动力学研究

目的 探讨尿动力学检查在压力性尿失禁合并糖尿病中的诊断意义。方法 采用德国Ellipse尿动力检测仪对58例女性压力性尿失禁合并糖尿病患者及40例单纯压力性尿失禁患者进行尿动力学检测,参照不同的糖尿病病程,明确不同时期尿动力学的特征性改变。结果 实验组与对照组相比,两组中以McGuire法分型的各型腹压漏尿点所占百分比具有明显差异;糖尿病病程大于2年患者的尿动力学参数与单纯SUI间差异具有统计学意义(P<0.05),最大尿流率、最大尿流率时逼尿肌压力随病程的增加而降低,而强烈排尿感容量、剩余尿量、最大膀胱测压容量及初始尿意容量均随病程的增加而增加。结论 尿动力学检查的各项指标结合糖尿病病程临床资料,有助于判断压力性尿失禁伴有何种膀胱功能的改变,对正确的诊断及后续治疗具有重要意义。     

女性压力性尿失禁的治疗进展

女性压力性尿失禁(SUI)是指在咳嗽、大笑等腹部压力增加时而膀胱逼尿肌未收缩的情况下出现的不自主溢尿。SUI在中年女性中的发病率为10%～40%,明显影响女性的身心健康。伴随着我国人口老龄化的发展以及人们对生活品质要求的不断提高,SUI的治疗显得尤为重要,本文即对SUI的相关治疗方法进行总结及概述。     

The impact of multichannel urodynamics upon treatment recommendations for female urinary incontinence

The aim of this study was to evaluate whether multichannel urodynamic testing changes a physician's treatment recommendations when managing women with urinary incontinence. In this prospective reader study, four fellowship-trained urogynecologists reviewed 39 abstracted cases of urinary incontinence on two occasions: first without and subsequently with urodynamic data. Treatment recommendations were made for each case after each review. The probability of urodynamic data modifying treatment recommendations was estimated for each reader and for the population of readers using a random effects logistic regression to account for reader variability. The overall probability that urodynamic data would change treatment was 26.9% (95% confidence interval (CI), 18.6%, 37.2%) for medical treatments and 45.5% (95% CI, 37.8%, 53.4%) for surgical treatments. Reader-to-reader differences accounted for 3% and <1% of the total variance for medical and surgical treatments, respectively. Multichannel urodynamic evaluations are significantly associated with changes in medical and surgical treatment recommendations in a referral population.     

Removal of transurethral catheter during urodynamics may unmask stress urinary incontinence

PURPOSE: The measurement of Valsalva leak point pressure may have an important role in the treatment algorithm of women with stress urinary incontinence. However, some patients with stress urinary incontinence may not have leakage during standard urodynamic studies and, thus, the Valsalva leak point pressure cannot be determined. We hypothesized that the transurethral catheter may inhibit leakage during urodynamics. MATERIALS AND METHODS: We evaluated 21 consecutive women presenting with complaints of stress urinary incontinence who failed to have leakage on urodynamic studies. Bedside cystometry was performed, followed by urodynamics using a 6Fr transurethral catheter. When stress urinary incontinence was not noted, the catheter was removed and the Valsalva leak point pressure was measured using the intraabdominal pressure catheter. RESULTS: No woman had leakage on urodynamic studies with the catheter in place, although 11 of 21 had leakage after the catheter was removed and 15 had leakage on bedside cystometry. All 11 patients with leakage at catheter removal showed leakage on bedside stress testing. Mean Valsalva leak point pressure in those with leakage was 67 cm. water. CONCLUSIONS: Patients with a history of stress urinary incontinence and those with a positive bedside stress test who do not have leakage during a Valsalva maneuver on urodynamic studies should repeat the Valsalva maneuver with the catheter out. This technique may unmask stress urinary incontinence and allow the measurement of Valsalva leak point pressure.     

Ambulatory urodynamics in urge incontinence evaluation

The identification of bladder instability is essential for the appropriate treatment of incontinent women. In-office stationary urodynamics may miss up to 50% of unstable bladder diagnoses. Multichannel microtip transducer ambulatory urodynamics were performed on 27 women with urgency-associated urinary incontinence, utilizing two commercially produced systems. All the women had previously undergone inoffice multichannel testing. An additional 12 cases of bladder instability were identified. Three cases of bladder instability were confirmed. Satisfactory monitoring was performed for a period of up to 8 hours. Problems with catheter migration/expulsion and timer correlation led to diagnostic difficulties, especially as related to urethral pressure tracings. Essentially a bladder holter monitor, ambulatory monitoring can augment the diagnostic accuracy of cystometric testing. This technique should reach widespread acceptance as a useful complement to current diagnostic tools.     

压力性尿失禁患者的尿流动力学研究

目的　了解压力性尿失禁患者的尿流动力学特点,为明确诊断及合理治疗提供参考。方法　对临床诊断为压力性尿失禁的30例患者进行系统尿流动力学研究,并与正常对照组(30 例)比较。结果　两组最大尿流率分别为(30.12±9.81)mL/s、(18.70±8.31)mL/s,平均尿流率分别为(15. 18±7. 22) mL/s、(12. 30±7. 21) mL/s,初感容量分别为(175. 20±57. 34) mL、(165.70±40.65)mL,强烈尿感容量分别为(354.83±52.83)mL、(339.20±50.84)mL,最大尿道闭合压分别为(84.93 ±45.81)cm H2O、(110.23±32.26)cm H2O,压力性尿失禁组测得Valsalva漏尿点压力(73.70±22.61) cm H2O,出现异常尿流曲线7例(23.3%),残余尿 10 例(33. 3%),合并逼尿肌不稳定性收缩 3 例(10%),肌电图协同失调 5 例(16. 7%),正常对照组均无。结论　压力性尿失禁患者是一个复杂的群体,尿流动力学检查对于明确其诊断,选择正确的治疗方法,提高治疗效果有着重要意义。     

漏尿点压力测定诊断压力性尿失禁(附19例报告)

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ＬＰＰ 测定。将测定结果与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＜ ６０ｃｍ Ｈ２Ｏ（１ｃｍ Ｈ２Ｏ＝ ０ ．０９８ｋＰａ） ;Ⅱ／ Ⅲ型４ 例,３ 例ＬＰＰ６０ ～９０ｃｍ Ｈ２Ｏ;Ⅱ型３ 例,ＬＰＰ９０ ～１２０ｃｍ Ｈ２Ｏ;Ⅰ型６ 例,５ 例ＬＰＰ＞１２０ｃｍ Ｈ２Ｏ。　结论　ＬＰＰ 测定对ＳＵＩ患者能够进行比较正确的诊断和分型,方法简单,有一定的临床应用价值     

Comparison of video urodynamic results after the pubovaginal sling procedure using rectus fascia and polypropylene mesh for stress urinary incontinence

PURPOSE: Video urodynamic changes were compared after the pubovaginal sling procedure using rectus fascia or polypropylene mesh in women with stress urinary incontinence. MATERIALS AND METHODS: A total of 50 women with various types of stress urinary incontinence were treated with the pubovaginal sling procedure using randomly abdominal rectus fascia in 24 or polypropylene mesh in 26. The sling was placed at the level of the bladder neck and tied with sufficient tension to prevent urinary leakage without obstructing the bladder outlet. Video urodynamics were performed preoperatively, and 7 to 14 days and 3 to 6 months postoperatively in all cases. Surgical results and urodynamic changes after the pubovaginal sling procedure were compared in the 2 groups. Long-term results were evaluated at a mean followup of 2 years. RESULTS: Complete continence was achieved in 23 patients (95.8%) in the rectus fascia group and 26 (100%) in the polypropylene mesh group, including 1 initial failure with reoperation, at a median followup of 24 and 23 months, respectively. The subjective success rate was 91.6% for rectus fascia and 92.3% for polypropylene mesh. The main cause of dissatisfaction was persistent urge incontinence and dysuria in 2 cases each. In each group video urodynamics revealed a mild but nonsignificant decrease in maximum urinary flow and a significant increase in bladder neck opening time at 7 to 14 days versus baseline. However, these parameters returned to baseline within 3 to 6 months postoperatively. Voiding pressure, cystometric capacity and post-void residual urine also showed no significant change in either group after the pubovaginal sling procedure. Patients treated with a polypropylene mesh sling had a shorter operative time and hospital stay, a higher spontaneous voiding rate after catheter removal and a lower incidence of wound pain after surgery. One patient treated with polypropylene mesh had sling margin extrusion. The incidence of new onset detrusor instability and persistent dysuria was similar in the 2 groups. Transrectal sonography of the sling showed that it was located beneath the bladder neck and proximal urethra in all patients in each group. CONCLUSIONS: The results of this study show that the pubovaginal sling procedure using rectus fascia or polypropylene mesh as the sling material had similar effectiveness for treating female stress incontinence but the polypropylene group had more rapid recovery. Postoperatively video urodynamics demonstrated that the pubovaginal sling using either sling material did not cause bladder outlet obstruction with proper surgical technique.     

Correlation between urodynamics and perineal ultrasound in female patients with urinary incontinence

AIMS: We performed urodynamics and perineal ultrasound in female patients with urinary incontinence to assess morphology and function of the bladder base-urethra complex and of the detrusor muscle, and to find the correlation between these investigations in the diagnosis of (a) bladder neck and urethral hypermobility and (b) detrusor overactivity; we wanted to compare the tolerabililty of the urodynamic investigation and of the perineal ultrasound. METHODS: We considered 66 female patients referred to our outpatient clinic for urinary incontinence; we also studied 14 healthy control patients. After accurate case-history collection and physical examination, urodynamic investigation and perineal ultrasound were performed, with recording of parameters specific to both investigations. The statistical analysis was performed by ANOVA, Bonferroni post hoc test, and Spearman correlation test. The tolerability index between the diagnostic investigations performed was assessed by a 3-point scale suggested by the patient. RESULTS: In patients with stress incontinence the posterior urethro-vesical angle, the angle of urethral inclination, and the proximal pubo-urethral distance are significantly different under stress compared to the resting phase; in patients with urge incontinence, the detrusor wall is thicker and is accompanied by an increase in opening detrusor pressure and detrusor pressure at maximum flow; it is also accompanied by detrusor overactivity with increased urethral functional length. Increased urethral functional length is suggested on axial US images by alteration of its normal characteristic target-like appearance with four concentric rings of different echogenicity. In all cases the tolerability of perineal ultrasound has been higher than that of urodynamics. CONCLUSIONS: There is a good correlation between urodynamic and perineal ultrasound in the diagnosis of bladder neck and urethral hypermobility; perineal ultrasound can also be useful in the diagnosis of urge incontinence. Functional compressive urethral obstruction can be diagnosed on the basis of the ultrasound aspect of the urethral sphincter.     

MRI检查在女性压力性尿失禁临床诊断中的应用价值

目的 探讨MRI检查在女性压力性尿失禁(SUI)诊断中的应用价值. 方法 SUI患者16例,年龄48～66岁,中位年龄58岁;腹压下漏尿病史2～15年,中位数6年.患者术前均行MRI检查.均采用经闭孔尿道中段吊带术(transobturator tension-free tape,TOT)治疗.28例正常女性MRI检查作为对照组,年龄30～55岁,中位年龄45岁;无盆腔疾病史. 结果 对照组28例T1WI和T2WI上尿道支持韧带均表现为细条状偏低信号,尿道周围韧带显示率为89％(25例);尿道旁韧带双侧为75％(21例),单侧为25％(7例);耻骨尿道韧带近、中、远侧分别为100％(28例)、10％(3例)、7％(2例);尿道下韧带为100％.肛提肌在T1 WI、T2WI像上呈中等信号,显示率为100％(28例).16例SUI患者尿道支持韧带表现为松弛、断裂,发生在一组(4例)或多组(12例)韧带.松弛见于尿道周围韧带14例,尿道旁韧带2例,近侧耻骨尿道韧带10例;断裂见于尿道周围韧带2例,尿道旁韧带5例,近侧耻骨尿道韧带6例,尿道下韧带7例,其余呈正常表现或未显示.16例患者肛提肌均呈松弛改变,其中4例伴宫颈及阴道前、后壁膨出. 结论 MRI可以清晰显示女性SUI患者尿道支持结构的薄弱,同时显示宫颈及阴道的膨出,从而可为临床医生诊断与治疗提供影像学依据.     

Pressure transmission to the pre-urethral space in stress incontinence

Summary Pressure transmission from the abdomen to the pre-urethral space has been studied in stress-incontinent women and in some women following pubococcygeal repair for stress incontinence. Pressure was recorded at different levels of the pre-urethral space and simultaneously in the bladder. Simultaneous measurements inside and outside the urethra at different levels above the external urethral meatus showed that an intra-abdominal pressure rise was transmitted via the pre-urethral space to the urethra. Pressure was transmitted almost in full to the surroundings of the lower-most part of the bladder, but outside the functional urethra, transmission was successively more defective along the urethra towards the external meatus. Therefore, a short functional length and a distal maximal pressure plateau in the urethra, as in stress incontinence, is a disadvantage. Pressure losses amount to 1/3 or more. Pressure transmission could be improved to supranormal values by establishing firm support for the urethra, thereby allowing a minimum of rotational descent with stress and providing good counterpressure.