下尿路症状的电磁刺激治疗

电磁刺激治疗是一全新的无创治疗技术。电磁神经调控能够成为尿失禁和尿路刺激症状患者的一线治疗方法,特别是那些对药物治疗不耐受或无效的患者,以及不适于外科手术或不能应用电刺激治疗的患者。本文对应用电磁刺激治疗下尿路症状的技术方法和临床有效性、局限性等进行文献综述。     

SARS-CoV-2感染引发下尿路症状及机制研究进展

<正>自2019年末,新型冠状病毒感染(COVID-19)进入了全球大流行状态,虽然当前COVID-19在全球大多数地区已经得到一定程度的控制,但其蔓延的危险仍然没有消失。COVID-19的典型症状包括发烧、咳嗽、喉咙痛、乏力、咯痰、呼吸急促和头痛等^[1]。然而,已有许多研究报道COVID-19还有其他非呼吸系统的表现,这可能是新型冠状病毒(SARS-CoV-2)直接侵犯肺部以外器官的表现,     

糖尿病膀胱病变与下尿路症状

糖尿病的危害几乎都来自它的并发症，糖尿病膀胱病变（diabetic cystopathy，DCP）就是糖尿病在泌尿系统高发的并发症，在临床上可以产生下尿路症状（lower urinary tract symptoms，LUTS），对患者产生严重危害。     

脑卒中导致的下尿路功能障碍

脑卒中是指由血管事件导致的中枢神经系统功能障碍的急性阶段，最常见的原因有血栓形成（约占80％）、血栓栓塞和出血。卒中是影响中老年人健康的常见神经系统疾病，其发病率和死亡率有逐年上升的趋势。     

个体化健康管理对改善成年男性下尿路症状的效果评价

目的 探讨个体化健康管理对改善成年男性下尿路症状的效果.方法 对100例成年男性下尿路症状患者进行为期一年的个性化健康管理.结果 健康管理后患者的国际前列腺症状评分下降、生活质量评分提高,与管理前比较差异均具有统计学意义(P<0.01);健康管理后患者勃起功能国际问卷-5评分明显下降,与管理前比较差异具有统计学意义(P...     

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凋查（问卷设计参考女性下尿路症状国际尿失禁标准问卷（ICIQFLUT）、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1500份,回收有效问卷1387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。     

脑卒中康复期患者下尿路症状发生情况及危险因素分析

目的:观察脑卒中康复期下尿路症状(LUTS)发生情况,探讨影响其发生的危险因素,为其预防提供依据。方法:收集我科康复后出院1个月后的脑卒中患者121例,采取Danish前列腺症状评分问卷调查各类型LUTS发生情况。选取7个可能影响LUTS发生的因素,按有、无下尿路症状分两组进行logistic回归分析,确定与下尿路症状发生相关的危险因素。结果:121例患者LUTS发生率56%。各类型症状频度的前三位依次为:夜尿(42%)、尿急(39%)、日间尿频(34%)。各类型症状严重性依次为:尿急、夜尿、日间尿频。在至少有一个症状的患者中,LUTS困扰发生率为81%;使困扰发生的前三位症状依次为:夜尿(29%)、尿急(26%)、日间尿频(21%)。Logistic回归模型筛选后显示下肢Brunnstrom运动功能分期1—3期、卒中以来有留置导尿史、服用镇痛药物是发生LUTS的独立危险因素。结论:脑卒中康复期患者LUTS较为常见,以储尿期排尿障碍为主。可从促进分离运动、严格掌握留置导尿指征、早期积极进行膀胱功能训练、避免服用镇痛药物等方面进行干预来控制LUTS的发生率。     

疑似慢性前列腺炎的青年男性伴下尿路症状患者的尿动力学分析

目的探讨尿动力学检查在疑似慢性前列腺炎的青年男性伴下尿路症状(LUTS)患者,评价中的临床应用价值。方法我们回顾性分析了85例18～40岁的临床疑似慢性前列腺炎的青年男性伴LUTS患者的尿动力学检查资料。排除有糖尿病史、神经源性疾病、泌尿系统外伤、手术史或急性尿路感染的患者。所有患者均接受多通道的尿动力学检查。对检查前后的诊断进行比较。结果 85例患者平均年龄为(27.3±4.3)岁;76.5%(65/85例)有储尿期症状,而68.2%(58/85例)有排尿期症状。72.9%(62/85例)例患者出现异常尿动力学检查结果,包括膀胱顺应性降低21.2%(18/85例)例、逼尿肌过度活动25.9%(22/85例)例、逼尿肌-外括约肌协同失调15.3%(13/85例)、膀胱出口梗阻31.8%(27/85例)例和逼尿肌活动低下/无收缩17.6%(15/85例)例。结论临床疑似慢性前列腺炎的青年男性伴LUTS患者的流行病学病因多种多样。临床诊断和治疗常依靠经验,并不准确。尿动力学检查在评价临床疑似慢性前列腺炎的青年男性伴LUTS患者中具有重要价值。     

尿动力学检查在青年男性下尿路症状患者中的应用

目的评价尿动力学检查在青年男性下尿路症状(LUTS)患者中的临床应用价值.方法 回顾性分析189例18~40岁的青年男性下尿路症状患者的尿动力学检查资料.排除有糖尿病史、退行性神经系统疾病、泌尿系统外伤、手术史或急性尿路感染的患者.所有患者均接受多通道的尿动力学检查并对检查前后的诊断进行比较.结果 189例患者平均年龄(29.1±5.6)岁,147例(78%)有潴尿期症状,而121例(64%)有排尿期症状.尿动力学检查前诊断主要有慢性前列腺炎/前列腺痛37例(20%)、神经源性膀胱46例(24%)、膀胱过度活动症63例(33%)和其他43例(23%).104例(65%)患者出现异常尿动力学检查结果,包括膀胱顺应性降低24例(13%),膀胱逼尿肌过度活动87例(46%),逼尿肌-外括约肌协同失调13例(7%),膀胱出口梗阻57例(30%)和逼尿肌活动低下/无收缩32例(17%).结论 青年男性LUTS患者的流行病学病因多种多样;临床诊断和治疗常依靠经验,并不准确;尿动力学检查在评价青年男性LUTS患者中具有重要价值.     

下尿路症状合并勃起功能障碍联合用药治疗的效果研究

选取我院2014年8月~2016年8月收治的100例下尿路症状合并勃起功能障碍患者。随机分为单药组和联合组各50例。单药组患者采取西地那非单药治疗,联合组则采取西地那非联合坦索罗辛治疗。观察对比两组患者治疗前后国际前列腺症状评分(IPSS)、勃起功能障碍国际指数(IIEF-5)及生活质量评分(QOL)评分,以及不良反应发生情况。结果两组患者治疗前IPSS评分、IIEF-5评分、QOL评分比较无明显差异(P>0.05),治疗后联合组各评分均明显优于单药组,差异有统计学意义(P<0.05);两组不良反应发生情况比较,差异无统计学意义(P>0.05)。下尿路症状合并勃起功能障碍采取西地那非联合坦索罗辛治疗,可以更好地改善前列腺症状与勃起功能,且安全性高。     

Toileting behaviours and lower urinary tract symptoms among female nurses: A cross-sectional questionnaire survey

BackgroundUnhealthy toileting behaviours exist among women, and lower urinary tract symptoms have a high prevalence and significant effects on quality of life. However, the relationship between toileting behaviours and lower urinary tract symptoms is unclear.ObjectivesThis study aimed to investigate the prevalence of lower urinary tract symptoms among female nurses, and the association between toileting behaviours and lower urinary tract symptoms.DesignA cross-sectional stratified cluster sampling study.ParticipantsA total of 636 female clinical nurses from tertiary hospitals in Jinan (the capital city of Shandong Province, China).MethodsThe Toileting Behaviour-Women’s Elimination Behaviours and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms scales were used to assess the participants’ toileting behaviours and lower urinary tract symptoms, respectively. Multiple linear regression analysis was used to evaluate the association between toileting behaviours and lower urinary tract symptoms.ResultsUnhealthy toileting behaviours were common among the female nurses, with delayed voiding being the unhealthiest toileting behaviour, which was followed by place and position preference for voiding. Nearly 68% of the female nurses had at least one lower urinary tract symptom, nearly 50% had incontinence symptoms, 40% had filling symptoms, and 18% had voiding symptoms. Unhealthy toileting behaviours (premature voiding, delayed voiding, and straining to void) were positively associated with lower urinary tract symptoms. However, lower urinary tract symptoms were not significantly associated with voiding place or position preference. Among the control variables, being married or having a history of a urinary tract infection was associated with lower urinary tract symptoms. Having a higher income and regular menstrual period were negatively associated with lower urinary tract symptoms. Compared with vaginal delivery, caesarean delivery had a protective association with lower urinary tract symptoms.ConclusionLower urinary tract symptoms among female nurses should not be overlooked, because their prevalence among female clinical nurses exceeded that among the general population of women. These findings highlight the importance of avoiding unhealthy toileting behaviours (especially premature voiding, delayed voiding, and straining to void), as these unhealthy toileting behaviours were significantly associated with susceptibility to lower urinary tract symptoms.     

Discrimination of bladder disorders in female lower urinary tract symptoms on ultrasonographic cystourethrography.

OBJECTIVE: To evaluate morphologic features of bladder disorders in female lower urinary tract symptoms using ultrasonographic cystourethrography and to elucidate the anatomic association of these morphologic characteristics. METHODS: Ultrasonographic cystourethrography was performed in 1049 women with lower urinary tract symptoms and 1 single urodynamic diagnosis, including 764 patients with genuine stress incontinence, 190 with detrusor instability, and 95 with a hypersensitive bladder. Thirty-six women with no lower urinary tract symptoms served as control subjects. Ultrasonographic assessment included measurement of the bladder neck position at rest and during stress and observation of the development of bladder neck funneling and cystocele during the Valsalva maneuver. RESULTS: Hypersensitive bladder and control groups had a significantly higher bladder neck position at rest and during stress, a lesser rotational angle of the bladder neck, a lower prevalence of bladder neck funneling and cystocele formation, and lesser mean bladder wall thickness than the other diagnostic groups. In the study groups, age, parity, and menopause may have effects on the cystourethrographic parameters except rotational angle and funneling of the bladder neck. With control of the confounding factors, bladder wall thickness at the trigone and dome was negatively correlated with the resting bladder neck angle (P = .006 and 0.019, respectively). Bladder wall thickness at the dome was positively associated with the rotational angle of the bladder neck (P = .022). Funneling of the bladder neck and development of cystocele during stress were positively associated with the resting and straining bladder neck angles as well as the rotational angle of the bladder neck. CONCLUSIONS: Ultrasonographic manifestation of a hypersensitive bladder is significantly different from that of genuine stress incontinence and detrusor instability.     

Urinary tract infection in patients with lower urinary tract dysfunction

Lower urinary tract dysfunction (LUTD) is becoming more common in aging societies worldwide. In patients with LUTD, the risk of urinary tract infection (UTI) rises due to several distinct mechanisms, including easy bacterial access to the urinary tract, impaired bacterial washout, and an impaired innate defense system. The pathophysiology of LUTD varies depending on whether it is neurogenic or non-neurogenic, as well as by gender; therefore, the etiology and characteristics of UTI differ according to the type of LUTD. Patients with neurogenic LUTD, especially those with spinal cord injury, have a high risk of febrile UTI, and strict bladder management is required to prevent UTI. Clean intermittent catheterization with or without appropriate pharmacological therapy is also strongly recommended for patients with neurogenic LUTD at risk of febrile UTI, unable to void, or with high post-void residual volume. In contrast, both male and female patients with non-neurogenic LUTD have a lower risk of symptomatic UTI. There is insufficient evidence for non-neurogenic LUTD regarding the association between symptomatic UTI but not asymptomatic bacteriuria and LUTD severity, including the presence of post-void residual volume, or whether therapeutic intervention for LUTS reduces the incidence of UTI, particularly in male patients. In this narrative review, we aimed to highlight the pathogenesis, epidemiology, and management of UTI in patients with LUTD.     

Lower urinary tract symptoms in women and quality of life

Lower urinary tract symptoms (LUTSs) are the most common symptoms in women at all age groups worldwide, and their prevalence is increasing with age. LUTSs have a multifactorial status. The risk factors are age, race, pregnancy, birth, menopause, hysterectomy, obesity, chronic cough, depression, profession and family history. LUTSs have negative effects on women's quality of life, especially on the medical, physical, social, psychological, economical and sexual aspects. Studies report a relationship between the sexual dysfunction and urogynaecological diseases. Although the pathophysiology of high prevalence of sexual dysfunction in women with LUTS is not well known, it is estimated that the LUTS and sexual dysfunction occur due to the effects of low oestrogen levels on vagina, urethra, trigone epithelium and the atrophy of pelvic floor muscles. Especially women, who experience urinary incontinence (UI) and subgroup problems, report more common sexual dysfunctions (hypoactive sexual desire disorder, very urgent need for urination during the sexual intercourse and leakage, lack of sexual arousal, orgasm problems, sexual pain disorders). Despite the high prevalence of LUTS and its negative effects on the quality of life, the help-seeking behaviours of women for overcoming LUTS differ according to the level of disturbance. Nurses should cooperate with other health care personnel in LUTS prevention, diagnosis, treatment/follow-up, in the diagnosis of sexual dysfunction due to LUTS and its management. This article discusses the prevalence of LUTS, the risk factors of LUTS, the quality of life of women with LUTS, the negative effects of LUTS on sexual life and its nursing care.     

Systematic pelvic floor training for lower urinary tract symptoms post-prostatectomy: a randomized clinical trial

Because the majority of prostate cancers are diagnosed in the local or regional stages, radical prostatectomy is a treatment of choice for many patients, particularly men younger than 65 years of age. However, radical prostatectomy carries a significant risk of lower urinary tract symptoms (LUTS) and may also impair quality of life. The aim of the study was to examine the effects of systematic postoperative pelvic floor training (PFT) on LUTS intensity, LUTS distress and health‐related quality of life (HRQL) at 3, 6 and 12 months following radical prostatectomy. This randomized clinical trial was guided by the Theory of Unpleasant Symptoms. All participants (n = 126) received brief instructions for exercising pelvic floor muscles before surgery and the offer of a biofeedback evaluation session 1 month following catheter removal. The intervention group (n = 62) received an additional 4 weeks of PFT immediately following catheter removal. Intervention and control groups both reported steady declines in the intensity and distress associated with LUTS, but no between‐group differences were found. Similarly, no between‐group differences were found in impact on HRQL; however, the pattern of HRQL impact differed by group (p < 0·01) in the direction of greater impairment over time for the control group. LUTS intensity, LUTS distress and negative effects on HRQL decline for many radical prostatectomy patients over the first postoperative year; however, improvement does not occur in all patients. Further research is needed to improve our understanding of factors that influence development, resolution and management of LUTS following radical prostatectomy.     

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: A questionnaire survey

Background

Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL).

Objectives

To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS.

Design

This study was a cross-sectional, questionnaire survey.

Settings

Three medical centers and five regional hospitals in Taipei were selected randomly.

Participants

In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean = 31.02, SD = 6.32), had normal body mass index, and had never given birth. Most nurses’ bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate.

Methods

Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS.

Results

Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS.

Conclusions

Although most of the nurses in this study were young (≦35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses’ possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses’ physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.     

不同拔管时机对全麻术后留置尿管患者下尿路症状和尿控恢复情况的影响

目的探讨不同拔管时机对全麻术后留置尿管患者尿管相关下尿路症状和拔管后尿控恢复情况的影响。方法分层随机选取2018年1月—2019年7月首都医科大学附属北京友谊医院行全麻手术患者术后留置尿管患者198例,采用数字表法随机分为观察组101例和对照组97例。两组患者均采用经过循证护理论证,及院内尿管材质、型号进行的水囊测定试验结果制订的拔管方法。对照组拔管时机为膀胱空虚、患者没有尿意情况下拔除尿管,等尿意出现时,再协助排尿;观察组拔管时机为膀胱处于充盈状态且患者有尿意时,借助腹压使尿管随尿液自然排出。比较两组患者尿管相关下尿路症状和拔管后尿控恢复情况。结果观察组排尿成功率高于对照组,核心下尿路症状评分、尿频、尿急及急性尿潴留发生率低于对照组,差异有统计学意义(P<0.05)。观察组最大膀胱测压容量和残余尿量低于对照组,拔管后72 h控尿率和最大尿流率高于对照组,差异有统计学意义(P<0.05)。结论待全麻术后留置尿管患者膀胱充盈且有尿意时拔管可以降低尿管相关下尿路症状的发生率和严重程度,有助于患者恢复膀胱功能,提高尿控能力。