尿动力学在下尿路症状诊治中的应用观察

目的:研究尿动力学在临床诊断下尿路症状中的效果.方法:对2010-03 ～2014-03我院就诊的162例下尿路功能障碍患者进行尿动力学检查,通过检查结果对患者进行有针对性的治疗.结果:膀胱出口梗阻、逼尿肌受损、逼尿肌-括约肌失协调、不稳定膀胱以及膀胱容量减少是尿动力学方法检测出的五种能够提示下尿路病症的主要症状.针对该原因给患者制定治疗方案,能够取得良好的临床效果.结论:尿动力学检查能够详细的了解下尿路功能状况,该方法能够帮助对患者制定有针对性的治疗方案,应该在临床上得到推广.     

尿动力学在下尿路症状诊治中的应用体会

为了说明尿动力学在临床诊断下尿路症状（LUTS）中的作用,以利于提出针对性治疗建议,总结我科2005年3月～2009年3月对324例以LUTS为主诉就诊者进行的尿动力学检查结果,并根据结果进行针对性治疗。结果表明,尿动力学结果提示LUTS病因有5种：膀胱出口梗阻、逼尿肌受损、逼尿肌-括约肌失协调、不稳定膀胱、膀胱容量减少。针对以上原因,制定相应治疗方案,取得良好临床效果。结论：尿动力学检查可以充分了解下尿路功能状态,明确引发LUTS的真正原因,有利于针对性指导治疗。     

前列腺增生患者下尿路症状评估及治疗

目的探讨前列腺增生患者下尿路症状的原因及尿动力学检查在治疗方法选择中的意义。方法对162例有下尿路症状的前列腺增生患者进行尿动力学检查,根据检查结果选择治疗方法,并对治疗效果进行分析。结果膀胱出口梗阻和逼尿肌不稳定为主要表现,分别为77.2%(125/162)及64.2%(104/162),膀胱顺应性减低及逼尿肌收缩无力亦有表现。治疗方法包括药物治疗、留置尿管、膀胱穿刺造瘘及前列腺切除。结论前列腺增生患者下尿路症状的主要病因为膀胱出口梗阻及其引起的逼尿肌功能障碍,尿动力学检查可准确区分梗阻与非梗阻,判断逼尿肌功能状态,为合理选择治疗方案提供可靠依据。     

坦索罗辛治疗女性顽固性下尿路症状

目的评价坦索罗辛(哈乐)片剂口服治疗女性顽固性下尿路症状的临床效果及安全性。方法选择尿道综合征32例,尿道损伤(因手术插尿管所致)18例,尿路感染28例。病程2周~8年。消炎解痉药治疗1周/3个月,尿培养均为阴性,排尿15m in至2h 1次。用坦索罗辛片0.2m g口服早、晚各1次,连续5~7d。结果总有效率达84.61%,其中痊愈51.28%,显效33.33%。结论坦索罗辛对女性顽固性下尿路症状也有明显疗效,对血压无明显影响,安全可靠。     

年轻女性28例下尿路症状与尿动力学的临床分析

<正>年轻女性的慢性下尿路症状往往误诊为慢性尿路感染或尿道综合征,给治疗上带来困难,为此我站对28例具体慢性下尿路症状的女性患者进行尿动力学检查。1膀胱贮尿功能相关生理[1]①贮、尿功能是膀胱最重要的两大功能;②贮存功能依靠逼尿肌的伸展性、粘弹性构成一个容器,以及一个高效、精确的"闸门"     

尿动力仪检查在下尿路疾病中的应用

１９９５年９月引进ＮＤＹ－０１型尿动力仪以来，在４２例患有不同下尿路疾患的病人中进行检查。结果异常者３５例，占８３．３％；正常７例，占１６．７％，临床应用效果满意。本文就尿动力仪检查在下尿路疾病中应用的意义及其应用范围进行讨论。     

女性尿道综合征的尿流动力学分析

对女性尿道综合征２０例行尿动力学检查，除２例正常外其余病例均有膀胱尿道功能异常，表现为两种异常类型。通过尿动力学检查提供了临床治疗的依据，减少了盲目性，提高了治疗效果。     

深圳某社区青年女性下尿路症状的问卷调查研究

目的:分析青年女性人群下尿路症状(LUTS)的发病率和相关影响因素.方法:对广东省深圳市某社区青年女性人群进行随机抽样问卷调查[问卷设计参考女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUT)、国际前列腺状问卷(IPSS)布里斯托女性下尿路症状(BFLUTS)问卷及生活质量(QoL)等],根据具体情况进行调整.问卷由被调查者独立填写.结果:调查共发出问卷1 500份,回收有效问卷1 387份.储尿症状总患病率为91.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P＜0.01),与年龄和分娩方式有关;排尿症状总患病率为65.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P＜0.01),与生育情况、分娩方式以及文化水平有关.受调查者以刺激症状和梗阻症状的生活质量进行评分,分别为(2.87±1.32)分和(2.23±1.05)分;刺激症状和梗阻症状与生活质量评分的关联系数分别为0.51和0.23.结论:青年女性人群中的LUTS患病率很高,且不同程度影响青年女性的生活质量.     

深圳某社区青年女性下尿路症状的问卷调查研究

目的:分析青年女性人群下尿路症状(LUTS)的发病率和相关影响因素。方法:对广东省深圳市某社区青年女性人群进行随机抽样问卷调查〔问卷设计参考女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUT)、国际前列腺状问卷(IPSS)布里斯托女性下尿路症状(BFLUTS)问卷及生活质量(QoL)等〕,根据具体情况进行调整。问卷由被调查者独立填写。结果:调查共发出问卷1 500份,回收有效问卷1 387份。储尿症状总患病率为91.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P<0.01),与年龄和分娩方式有关;排尿症状总患病率为65.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P<0.01),与生育情况、分娩方式以及文化水平有关。受调查者以刺激症状和梗阻症状的生活质量进行评分,分别为(2.87±1.32)分和(2.23±1.05)分;刺激症状和梗阻症状与生活质量评分的关联系数分别为0.51和0.23。结论:青年女性人群中的LUTS患病率很高,且不同程度影响青年女性的生活质量。     

尿流动力学检查在男性下尿路症状诊治中的临床应用

目的 评价尿流动力学检查在男性下尿路症状（LUTS）临床诊治中的作用.方法 采用Laborie尿流动力学分析仪对385例合并下尿路症状的男性患者进行检查,检测其各项尿流动力学指标,参考国际尿控学会（ICS）标准判断其膀胱尿道功能并进行分型,并根据其分型进行针对性治疗.结果 尿流动力学检查结果发现,385例男性LUTS患者中,膀胱出口梗阻（BOO） 283例,其中合并膀胱过度活动（OAB） 96例,合并逼尿肌无力38例;单纯OAB 64例;神经原性膀胱25例,尿流动力学检查正常13例.根据其尿流动力学检查结果分别进行治疗,有效率93％,疗效满意.结论 尿流动力学检查对于男性LUTS患者的诊断、治疗具有重要意义.     

妇科下尿路功能障碍141例尿动力学分析

目的探讨尿动力学在妇科下尿路功能障碍检查中的应用价值。方法对2009年1月至2010年9月我院141例下尿路功能障碍的妇科患者进行尿动力学检查,其中尿失禁106例,排尿困难14例,尿频21例。结果 106例尿失禁患者中,10例膀胱过度活动,42例未诱导出漏尿,22例膀胱流出道Linp-URR图示梗阻;14例排尿困难的患者中,1例膀胱过度活动,2例逼尿肌收缩乏力,5例检出漏尿,7例膀胱流出道Linp-URR图示无梗阻;21例尿频患者中,6例膀胱过度活动,4例顺应性欠佳,8例漏尿,无逼尿肌收缩乏力病例,5例膀胱流出道Linp-URR图示梗阻。尿失禁组患者的膀胱容量和最大尿流率明显高于排尿困难组和尿频组(P<0.05)。结论根据尿动力学检查结果有助于诊断并明确妇科下尿路功能障碍产生的原因。     

输尿管镜下钬激光治疗尿道狭窄合并尿道结石

目的总结尿道狭窄合并尿道结石钬激光治疗的疗效和经验。方法回顾性分析15例尿道狭窄合并尿道结石患者采用输尿管镜下钬激光术治疗,观察其疗效。结果 15例患者均一次手术成功,后续随访1年,15例患者无排尿障碍、尿道狭窄并发症。结论输尿管镜下钬激光治疗尿道狭窄合并后尿道结石安全高效、创伤小、恢复快、手术易掌握、值得首选。     

Managing lower urinary tract symptoms in men

Over one-quarter of men aged 40 years or over in the UK have lower urinary tract symptoms. These symptoms, which may seriously disrupt day-to-day activity, include frequency, urgency, hesitancy, reduced flow, dribbling, nocturia, incontinence and incomplete emptying of the bladder. Here, we review non-surgical measures that may help men with such symptoms.     

Anticholinergic therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia

Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic hyperplasia (BPH). The LUTS-BPH complex consists of both voiding and storage symptoms that may overlap with overactive bladder symptoms. Drug therapy for men with LUTS may include alpha1-antagonists, 5-alpha-reductase inhibitors, combination therapy, and over-the-counter phytotherapy. Anticholinergic agents are effective in relieving overactive bladder symptoms in patients without bladder outlet obstruction. However, anticholinergic therapy has historically been contraindicated in patients with LUTS associated with BPH because of concerns for developing acute urinary retention. To assess the safety and efficacy of anticholinergic therapies for LUTS associated with BPH, a MEDLINE search and a bibliographic search of the English-language literature were conducted. Two nonrandomized, open-label studies; two randomized trials that assessed anticholinergic therapy alone; and eight trials that assessed anticholinergic therapy in combination with an alpha1-antagonist were identified. Trials were of short duration (6-12 wks) and included only men with low postvoid residual volumes at baseline. Small nonsignificant changes were seen in objective measures of urinary function. Several trials demonstrated an increase in postvoid residual with anticholinergic therapy, which was statistically significant in two trials. Despite the increase in postvoid residual, rates of acute urinary retention were low and the drugs were well tolerated. Of the five trials that used a validated symptom scoring scale, two demonstrated subjective improvement in urinary function. Men with symptomatic overactive bladder and BPH who are not adequately relieved with alpha1-antagonists may benefit from the addition of an anticholinergic agent. Before starting therapy, however, a postvoid residual volume should be measured to measure to rule out baseline urinary retention.     

Current pharmacological treatment options for male lower urinary tract symptoms

Introduction: Benign prostatic hyperplasia (BPH) is a highly prevalent disease in the aging male and significantly impairs quality of life. Men with BPH present with lower urinary tract symptoms (LUTS), which include storage and voiding disorders. Medical therapy is the first option in patients with mild to moderate symptoms.

Areas covered: α₁-adrenoceptor antagonists, 5α-reductase inhibitors or the combination of both have been considered gold standard for pharmacological treatment over the last decade in this patient cohort. Recently, a variety of novel substances have been tested which include Phosphodiesterase Typ 5 inhibitors (PDE5i), anti-cholinergic agents and β-3-agonists. This article highlights the key studies with regard to each drug class and discusses current pharmacotherapy and possible future treatment options.

Expert opinion: In patients with small prostates, α₁-adrenoceptor antagonists represent the gold standard in the medical treatment of mild LUTS. For men with large prostate glands and mild to moderate LUTS, recent data support the combination of α₁-adrenoceptor antagonists and 5α-reductase inhibitors. PDE5i may be useful in men with LUTS and concomitant erectile dysfunction, while anti-cholinergics have been shown to be beneficial in patients with predominant storage disorders. Future studies have to elucidate the role of β-3-agonists in men with BPH and LUTS.     

盆底脏器脱垂患者与下尿路功能障碍关系的探讨

目的探讨盆底脏器脱垂患者与下尿路功能障碍之间的关系。方法于2009年7月-2010年11月对54例诊断为盆腔脏器脱垂的住院患者进行病史采集、妇科检查、POP—Q评分及尿动力学检查,探讨盆腔脏器脱垂与下尿路功能障碍的关系。结果54例POP患者中,出现下尿路主观症状44例,其中尿失禁症状27例（压力性24例,急迫性1例,混合性2例）,尿急和／或尿频27例,排尿功能障碍16例。尿动力学检查结果显示：压力性尿失禁28例,急迫性尿失禁2例,混合性尿失禁2例,伴膀胱顺应性降低1例,腹压排尿3例。腹部漏尿点压力（ALPP）〈60cmH2O有10例,60～90cmH2O13例,〉90cmH2O7例。与尿失禁主观症状的符合率为70％（19／27）;隐匿性尿失禁的发生率为41％（11／27）,均为重度阴道前壁脱垂的患者。结论POP患者术前在减轻脱垂程度情况下行尿动力学检查可更客观地评价下尿路功能障碍,POP患者术前应了解膀胱及尿道括约肌功能,注意排除隐匿性尿失禁。     

奥昔布宁对下尿路刺激症及急迫性尿失禁病人的疗效

目的：比较国产与进口奥昔布宁对下尿路刺激症及急迫性尿失禁病人的疗效。方法：２０３例下尿路刺激症及急迫性尿失禁病人（男性１３５例，女性６８例，年龄５２±ｓ１７ａ），随机分试验组１２３例与对照组８０例，试验组与对照组分别给国产与进口奥昔布宁片５ｍｇ，ｐｏ，ｔｉｄ，７～１４ｄ。儿童减半。结果：以总点数、尿流率及尿量评估２组皆有显著疗效（Ｐ＜０．０１），２组间疗效差别不显著（Ｐ＞０．０５）。不良反应轻微。结论：国产与进口奥昔布宁对治疗下尿路刺激症及急迫性尿失禁疗效相仿。     

高龄二孩再产妇下尿路症状的临床因素分析

目的　探讨高龄二孩产妇产后1年内下尿路症状发生的临床因素。方法　对2018年4月至2019年4月就诊于惠州市第二妇幼保健院的643例高龄二孩再产妇进行问卷调查,年龄（36.64±1.71）岁,采用logistic回归分析产后1年下尿路症状发生与临床各种因素的相关性。结果　在产后3个月,妊娠期下尿路病史、经常咳嗽便秘、年龄3个变量是储尿期下尿路症状的危险因素（OR=9.968、13.276、1.844）;在产后6个月,妊娠期下尿路病史、女性年龄是储尿期下尿路症状发生的危险因素（OR=2.228、2.254）;在产后9个月,胎儿体质量、女性年龄、会阴侧切顺产是储尿期下尿路症状发生的危险因素（OR=3.006、1.723、3.098）;在产后12个月,民族、胎儿体质量、女性年龄、会阴侧切顺产是储尿期下尿路症状发生的危险因素（OR=8.402、2.603、1.829、2.444）。剖宫产是避免高龄二孩产妇产后1年发生储尿期、排尿后症状发生的保护因素。结论　相对于会阴侧切、普通顺产分娩,剖宫产是避免高龄二孩再产妇产后1年内出现下尿路症状的显著保护因素,而女性年龄的增长和会阴侧切则明显增加高龄二孩再产妇产后1年内储尿期下尿路症状的发病风险。     

Interrelation of erectile dysfunction and lower urinary tract symptoms

The association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) has garnered attention as investigators have hypothesized a common pathophysiology to explain the assertion that they are causally linked. This relationship between LUTS and ED has received increased attention because both diseases are highly prevalent, frequently co-associate in the same aging male group, and significantly influence the overall quality of life. A causal association between LUTS and ED cannot be established on the basis of the ever-increasing number of epidemiological studies. Attempting to explain a causal relationship between ED and LUTS requires the use of Hill's criterion, which is used by many epidemiologists to separate causal from non-causal explanations. A review of the epidemiological evidence reveals a strong degree of association, internal consistency and dose response effects between ED and LUTS. The temporal relationships between the two remain unknown because of the strong cross-sectional flavor of the epidemiological studies. The issue of an "alternate explanation" to describe the LUTS-ED association appears to be accounted for in that several large studies have provided convincing multiple regression analyses in which the ED-LUTS relationship remains significant. Biologic plausibility is an important issue if the link between ED and LUTS is to have credence. There are four leading theories of how these diseases interrelate. These explanations have a variable amount of supporting data. These include: 1) autonomic hyperactivity effects on LUTS, prostate growth and ED; 2) nitric oxide synthase/nitric oxide levels decreased or altered in the prostate and penile smooth muscle; 3) prostate and penile ischemia; and 4) increased Rho-kinase activation/ endothelin activity. LUTS and sexual dysfunction are highly prevalent in aging men. Both conditions are also significant contributors to overall quality of life. New data has emerged to indicate potential links in epidemiological, physiologic, pathophysiologic and treatment aspects of these two diseases. Using Hill's causality method to separate causal from non-causal explanations linking ED with LUTS, it appears that most epidemiological components are fulfilled.