应力性漏尿点压测定在女性真性压力性尿失禁诊断中的应用

背景：尿失禁包括压力性、急迫性以及二者混合型，临床上凭经验很难准确判断其类型和程度，常发生误诊误治。目的：为探讨尿动力学检查，尤其是应力性漏尿点压测定对女性压力性尿失禁的诊断价值。设计：回顾性平行对照观察。单位：解放军第三军医大学西南医院全军泌尿专科中心。对象：选择1996-01／2002-05来第三军医大学西南医院泌尿外科就诊的尿失禁女性患者120例。方法：①膀胱尿道造影：测定患者膀胱尿道后角：〈100&;#176;判定为正常，〉100&;#176;判定为异常。尿道倾斜角：〈45&;#176;判定为正常，〉45&;#176;判定为异常。膀胱尿道连接部（静态时）：无下降判定为正常，下降0.5cm判定为异常。②尿动力学检查：检查项目依次为充盈性膀胱测压，静态尿道压力图测定、漏尿点压测定。③分型标准：膀胱尿道造影分型标准：Ⅰ型：膀胱尿道后角消失，尿道倾斜角〈45&;#176;，最大尿道关闭压〉20cmH2O；Ⅱ型：膀胱尿道后角消失，尿道倾斜角〉45&;#176;，最大尿道关闭压〉20cmH2O；Ⅲ型：膀胱尿道后角正常，尿道倾斜角〈45&;#176;，最大尿道关闭压〈20cmH2O。应力性漏尿点压分型标准：Ⅰ型：应力性漏尿点压〉120cmH2O；Ⅱ型：应力性漏尿点压90～120cmH2O；Ⅲ型：应力性漏尿点压〈60cmH20；Ⅱ／Ⅲ型：应力性漏尿点压60-90cmH2O。主要观察指标：①尿失禁患者尿动力学检查结果。②应力性漏尿点压分型结果及其与膀胱尿道造影分型结果的比较。结果：120例患者均进入结果分析。①尿动力学检查结果：经检查确诊为真性压力性尿失禁患者56例，症状性压力性尿失禁患者64例．其中不稳定膀胱28例，低顺应性膀胱36例。②应力性漏尿点压分型与膀胱尿道造影分型结果比较：56例真性压力性尿失禁患者中Ⅰ型20例；Ⅱ型16例；Ⅱ／Ⅲ型10例；Ⅲ型10例。两种分型在Ⅰ和Ⅲ型上吻合率达到100％，Ⅱ和Ⅱ／Ⅲ型的吻合率分别达到94.1％和90.1％，无显著差异（P〉0．05）。结论：应力性漏尿点压测定能够对女性真性压力性尿失禁进行准确的的分型，并对其治疗有着重要的指导作用。     

超声尿动力学对尿道最大关闭压和腹压漏尿点压及膀胱颈移动度的研究

目的应用超声尿动力学技术研究静态和动态尿道关闭压及膀胱颈移动度的关系。方法对40例真性压力性尿失禁和22例正常入进行超声和尿动力学同步观察,标化测定静态最大尿道关闭压、腹压漏尿点压和膀胱颈移动度。结果真性压力性尿失禁腹压漏尿点压与尿道最大关闭压呈明显的线性相关(r=0.49,P=0.001),其回归方程y=21.90+0.88x。压力性尿失禁尿道最大关闭压、腹压漏尿点压均值显著低于正常组(P＜0.01)。膀胱颈部移动度显著高于正常组(P＜0.01)。腹压漏尿点压＞55cmH     

雌犬压力性尿失禁模型的尿动力学检测与分析

目的:对术前雌犬以及术后尿失禁雌犬进行尿动力学检测,探索合适的尿动力学检测方法并分析检测结果.方法:9只无尿失禁的1岁龄雌性比格犬,术前行尿动力学检测,手术制作压力性尿失禁模型,术后4周再次行尿动力学检测,分析尿动力学结果.结果:术前犬最大尿道关闭压为(47.0±15.6)cmH2O,腹压漏尿点压为(131.9±24.1)cmH2O,尿道关闭面积为(659.6±208.7)cmH2O·mm,术后尿失禁犬的最大尿道关闭压为(28.6±11.9)cmH2O,腹压漏尿点压为(74.0±10.6)cmH2O,尿道关闭面积为(286.5±158.5)cmH2O·mm.结论:对雌犬进行尿动力学检测可行,最大尿道关闭压、腹压漏尿点压和尿道关闭面积的变化反映了压力性尿失禁犬尿控能力的减弱.     

女性压力性尿失禁的超声尿动力学初步分型

目的 对女性压力性尿失禁进行超声尿动力学分型，探讨女性压力性尿失禁的病理生理机制。方法 对64例压力性尿失禁患者和35例正常妇女进行了超声尿动力学检查，测量膀胱颈移动度（UVJ—M）和腹压漏尿点压（ALPP）两个特征性参数。结果压力性尿失禁组ALPP均值显著低于正常组（P〈0．01），UVJ—M显著高于正常组（P〈0．01）。根据UVJ—M和ALPP两个特征性参数，将压力性尿失禁组的64例病例初步分为四型：A型，UVJ—M≤1．5cm，ALPP〉55cm H2O；B型，UVJ—M〉1．5cm，ALPP〉55cmH2O；C型，UVJ—M≤1．5cm，ALPP≤55cmH2O；D型，UVJ—M〉1．5cm，ALPP≤55cmH2O。结论 压力性尿失禁超声尿动力学初步可分为四型，各型可反映尿道、膀胱颈的不同病理生理及形态改变，有助于该病治疗方案的合理选择。     

神经源性膀胱并发上尿路损害患者膀胱漏尿点压测定的意义

目的探讨神经源性膀胱并发上尿路损害患者膀胱漏尿点压的变化。方法对33例神经源性膀胱患者先行泌尿系统的B超或静脉肾盂造影检查,再行尿动力学检查的膀胱漏尿点压测定。结果 21例上尿路损害患者中,20例膀胱漏尿点压〉40cmH2O,明显高于正常值。而12例无上尿路损害患者,膀胱漏尿点压均〈40cmH2O。结论神经源性膀胱患者行尿动力学检查的同时应了解膀胱漏尿点压力和膀胱尿道功能,预测上尿路损害的危险因素,避免上尿路损害。     

成年女性绝经前后发生的压力性尿失禁尿动力学比较

目的探讨在绝经前后发生压力性尿失禁的成年女性患者的不同尿动力学特点。方法对140例经临床确诊的成年女性压力性尿失禁患者(未绝经组71例、绝经组69例)行充盈性膀胱压力测定(FCM)、腹压漏尿点压测定(ALPP)以及尿道压力图测定,比较绝经前后的尿动力学参数和特点。结果未绝经组和绝经组ALPP值分别为(80±28)cmH2O和(64±27)cmH2O(P<0.01);未绝经组有15例(21.2%)ALPP<60cmH2O,而绝经组为26例(37.7%)(P<0.05);未绝经组有21例ALPP>90cmH2O,绝经组为8例(P<0.05)。未绝经组的最大尿道压(MUP)、最大尿道关闭压(MUCP)、控制面积(CA)与绝经组相比有显著性差异(P<0.05);而两组间的功能尿道长度(FUL)、控制带长(CZL)无显著性差异(P>0.05)。未绝经组和绝经组分别有5例(7%)和19例(27.5%)合并不稳定膀胱,两者有非常显著性差异(P<0.01)。结论绝经前后发生的女性真性压力性尿失禁有不同的尿动力学特点,在发生机制上可能存在差异。     

用自制吊带行经闭孔经阴道无张力尿道中段悬吊术治疗女性压力性尿失禁6例

目的:探讨应用自制吊带系统行经闭孔经阴道无张力尿道中段吊带术(tension-free vaginal tape-obturator,TVT-O)治疗女性压力性尿失禁的临床价值.方法:采用网状疝气补片自制TVT-O吊带,施行TVT-O手术治疗6例女性压力性尿失禁患者.结果:6例患者均顺利完成手术,术后尿失禁消失5例,咳嗽增加腹压后偶有尿液溢出1例.术后1个月复查尿动力学指标,均无剩余尿;腹腔漏尿点压(abdominal leak point pressures,ALPP)为119(106～142)cmH2O,与术前[32(12～57) cmH2O]比较差异有统计学意义(P＜0.05).所有患者术后随访2～6个月,均无排尿困难,亦无尿失禁.结论:应用自制吊带系统行TVT-O治疗女性压力性尿失禁,操作简便、疗效确切、创伤小、患者恢复快,可供临床酌情选用.     

盆底生物反馈治疗前列腺术后尿失禁

目的:探讨盆底生物反馈治疗经尿道前列腺电切术后尿失禁的效果及优点。方法:采用盆底生物反馈电刺激治疗仪治疗12例经尿道前列腺电切术后尿失禁患者,并进行随访。结果:10例Ⅰ-Ⅱ度患者在完成2-3个月的治疗后,可感知的漏尿事件均消失;2例Ⅲ度患者延长治疗时间至6个月,每日仅使用尿垫1-2块或不用。治疗前患者的腹腔漏尿点压力(77.50±18.89)cmH2O,治疗后升高至(110.83±11.39)cmH2O(P<0.05)。结论:盆底生物反馈电刺激治疗尿失禁安全、有效。     

自体脂肪源性干细胞与成纤维细胞联合尿道周围注射治疗大鼠压力性尿失禁

背景：干细胞增殖和分化形成成纤维细胞以及适当的结缔组织,从而实现组织的再生,治疗自体盆腔器官脱垂和压力性尿失禁是目前该领域的一个研究热点。目的：观察自体脂肪源性干细胞与成纤维细胞治疗压力性尿失禁的可行性。方法：建立压力性尿失禁大鼠模型,建模后1个月行自体脂肪源干细胞与成纤维细胞尿道周围注射,细胞移植后1个月测定大鼠腹压漏尿点压力,同时近端尿道组织采用苏木精-伊红染色、弹力纤维染色观察形态学改变。结果与结论：干细胞治疗后的模型大鼠漏尿点压力升高（P〈0.01）,膀胱排空正常。尿道壁肌层增厚（P〈0.01）,弹力纤维、平滑肌含量增多（P〈0.01）。结果证实,自体脂肪源性干细胞与成纤维细胞联合尿道周围注射能明显提高压力性尿失禁大鼠腹压漏尿点压力,增强注射点尿道肌层压力,可用于压力性尿失禁的治疗。     

妊娠晚期漏尿症状诊断压力性尿失禁的临床价值

目的:探讨漏尿症状对妊娠晚期压力性尿失禁的临床诊断价值。方法:选择正常的孕妇33例,于孕38～40周、胎儿先露尚未衔接时行尿动力检查,测量腹压漏尿点压(valsalva leak point pressure,VLPP),同时进行漏尿症状问询记录,分析妊娠晚期漏尿症状与VLPP的关系,Kappa检验漏尿症状与VLPP对妊娠晚期压力性尿失禁诊断的一致性。结果:13例孕妇出现漏尿症状,仅5例VLPP<90cmH2O,20例孕妇无漏尿症状,其中2例VLPP<90cmH2O。漏尿症状诊断的敏感性为71.4%,特异性为69.2%,阳性预测值38.5%,阴性预测值90.0%,Kappa=0.310,P=0.051。结论:妊娠期的漏尿症状可能只是一种功能性的变化,相比于未妊娠女性,漏尿的发生条件和原因更复杂,不能简单根据症状诊断妊娠晚期的压力性尿失禁。     

Transrectal sonographic investigation of urethral and paraurethral structures in women with stress urinary incontinence.

Transrectal sonography of the urethra was used in 14 asymptomatic volunteers, 37 women with frequency-urgency syndrome, 42 patients with mild stress urinary incontinence, and 18 with severe stress urinary incontinence. Transverse scanning over the midurethra was performed and cross-sectional images of the urethral and paraurethral structures were compared among the four groups, with P < 0.05 being considered statistically significant. The total cross-sectional area of the midurethra was significantly smaller in patients with stress urinary incontinence than in those without this disorder (86.7+/-29.9 versus 104+/-35.6 mm2, P = 0.005); this difference resulted from a significantly smaller peripheral striated muscle component in patients with stress urinary incontinence (42.8+/-20.7 versus 58.3+/-27.3 mm2, P = 0.001). The thickness of the urethropelvic ligaments was significantly thinner in patients with stress urinary incontinence than in those without (5.9+/-1.7 versus 8.9+/-2.1 mm, P < 0.001). The distribution of the peripheral striated muscle around the urethra was variable: complete surrounding the urethra was noted in 35.7% of the control women and in 48.6% of frequency-urgency patients, but only in 16.7% of patients with mild stress urinary incontinence and 5.3% of patients with severe disease. Bladder neck incompetence was seen in 42 patients with stress urinary incontinence but in none of the control women. The length of the pubourethral ligaments was similar in the four groups. Our finding showed that stress urinary patients had a smaller striated muscle component in the midurethra and thinner urethropelvic ligaments. These defects in the continence mechanisms might have great implications in the pathophysiology of stress urinary incontinence. Transrectal sonography of the urethra is a valuable investigative tool in assessing urethral and paraurethral conditions in patients with stress urinary incontinence before deciding treatment modality.     

Factors affecting urethrocystographic parameters in urinary continent women

To evaluate the urethrocystographic changes in different conditions, 154 women were evaluated by using introital sonography. Patients were divided into three groups: group 1 (n = 103) normal, including 10 postmenopausal women; group 2 (n = 46) pregnant, including 16 women in the first trimester, 15 in the second trimester, and 15 in the third trimester; group 3 (n = 15) severe genitourinary prolapse. None of the 154 women had a history of urinary incontinence. The following parameters were measured at rest: urethral thickness, uretheral length, urethral inclination, and posterior urethrovesical angle. On maximum straining, urethral inclination, posterior urethrovesical angle, and rotational angle were measured. In general, age, parity, and menopause did not affect the urethrocystographic parameters in Group 1 patients. Postmenopausal women had a significant decrease in the urethral thickness compared with the premenopausal women (p = 0.026). Patients in Groups 2 and 3 had a significantly lower urethral position than those in group 1. However, hypermobility of the urethra was found only in Group 3. Different menstrual ages did not affect the urethral position but could affect the posterior urethrovesical angle at rest in the first trimester. Introital sonography, without the risk of radiation exposure, enables the observation of static and dynamic changes in the lower urinary tract, both repeatedly and reproducibly. © 1996 John Wiley & Sons, Inc.     

压力性尿失禁诊疗135例临床分析(英文)

Objective The purpose of this study is to evaluate and compare the two different treatments by researching 135 cases with stress urinary incontinence.Methods From June 2006 to June 2010,135 patients with stress urinary incontinence were treated in Department of Gynecology and Obstetrics of Peking University Shenzhen Hospital.91 cases of them were treated with low frequency electric stimulation and biofeedback therapy (Group A),and the other 44 cases were treated by improved transobturaor tension-free vagina...     

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。     

Transrectal sonography of the female urethra in incontinence and frequency-urgency syndrome.

Transrectal sonography of the bladder and urethra was performed to investigate urethral conditions in 296 women (191 with stress urinary incontinence, 78 with frequency-urgency syndrome, and 27 who were asymptomatic). Patients with stress urinary incontinence showed larger pubovesical angle during both resting and straining states than those with either frequency-urgency syndrome or those who were asymptomatic. Pubovesical length did not vary among the three groups of women. Five types of stress urinary incontinence were classified according to the four findings of transrectal sonography: hypermobility of the bladder neck, bladder neck incompetence, urethral sphincteric incompetence, and the presence of a cystocele. Of the patients with frequency-urgency syndrome, 55.1% showed bladder neck incompetence, whereas only 29.6% of the asymptomatic women did. Of the patients with frequency-urgency syndrome, nine had urethral sphincteric incompetence and one had a cystocele. none of the asymptomatic women had any of these disorders. However, the presence of bladder neck incompetence did not correlate well with the presence of clinical symptoms. Transrectal sonography could not differentiate symptoms caused by the bladder from those caused by the urethra. Although a large overlapping of pubovesical angle size was noted among the groups of women, the angle was largest in those with stress urinary incontinence, second largest in those with frequency-urgency syndrome, and smallest in those who were asymptomatic. These findings held true during both resting and straining. Bladder neck incompetence was often associated with a weak extrinsic continence mechanism, as was demonstrated by pubovesical angle changes in both frequency-urgency syndrome patients and asymptomatic women. Urethral sphincteric incompetence was not present in asymptomatic women but could be found in 12.8% of those with frequency-urgency syndrome.     

56例中年女性尿失禁患者的尿流动力学分析

目的 研究中年女性(35～55岁)尿失禁患者的尿流动力学变化,提高相应诊治水平.方法 对56例尿失禁的中年女性患者进行尿流动力学研究,并与正常对照组(17例)比较.结果 56例患者中压力性(SUI)尿失禁患者为33例(58.93％)(SUI组)、急迫性(UUI)尿失禁患者为9例(16.07％)(UUI组)、混合性(SUI/UUI)尿失禁患者为14例(25.00％)(SUI/UUI组).SUI组患者最大尿流率(Qmax)(27.72±5.21)ml/s高于正常对照组(20.45±7.15)ml/s,差异有统计学意义(P＜0.05);UUI组的膀胱初感容量(FS)、正常排尿感觉(ND)、强烈排尿感觉(SD)、急迫排尿感觉(UD)与正常对照组[(135.65±42.73)ml与(132.70±40.65)ml、(166.24±51.42)ml与(160.70±50.44)ml、(315.75±42.34)ml与(320.75±42.34)ml、(320.24±45.03)ml与(335.75±51.98)ml]比较差异均有统计学意义(P均＜0.05);SUI组及SUI/UUI组患者测得Valsalva漏尿点压力(ALPP)[(62.29±25.40)cm H2O与(88.30±28.54)cm H2O]比较差异有统计学意义(t=13.041,P＜0.05);SUI组患者的最大尿流率时逼尿肌压(Pdet-Qmax)、最大尿道压(MUP)及最大尿道闭合压(MUCP)明显低于正常对照组[(24.29±6.24)cm H2O与(34.45±8.20)cm H2O、(68.20±18.27)cm H2O与(87.14±17.26)cm H2O、(74.24±35.75)cm H2O与(90.66±30.10)cm H2O]差异均有统计学意义(P均＜0.05).结论 中年女性尿失禁患者具有较大患者群体,其分类较为复杂,尿流动力学检查对于明确其诊断及选择正确治疗方法,提高疗效具有重要指导意义.     

压力性尿失禁动物模型的建立及效果评价

背景:目前治疗压力性尿失禁的方法有药物治疗、物理-行为治疗及手术治疗等多种,但仍在探索优化中.目的:探索通过截断双侧阴部神经及支配髂骨尾骨肌、耻骨尾骨肌的盆底神经肌友,建立稳定的压力性尿失禁动物模型的方法.方法:6周龄SD雌性大鼠18只,体质量(199.44±8.41)g.随机分为3组,正常组、模型组和假手术组各6只.对模型组大鼠作双侧阴部神经及盆底神经肌支截断,假手术组分离暴露上述神经但不作截断,正常组大鼠不作特殊处理.术后2周测定3组大鼠的漏尿点压力.压力测定后取正常大鼠及模型大鼠的膀胱颈尿道交界部的横截面作组织学分析.结果与结论:假手术组1只大鼠于术后1周死亡.余大鼠皆存活并顺利测定漏尿点压力.与正常大鼠相比,模型组大鼠平均漏尿点压力下降约33%(P＜0.05),而假手术组大鼠与正常组大鼠平均漏尿点压力差异无显著性意义(P＞0.05).组织学检查显示,与正常大鼠比较,模型组大鼠尿道横纹肌排列疏松,而肌纤维也出现一定的萎缩.提示截断双侧阴部神经及盆底神经肌支可建立较为稳定的压力性尿失禁动物模型.     

以Photoshop 8.0图像处理软件定点测量不同骨面型错(牙合)Beta角:乌鲁木齐地区262例患者数据

背景:Beta角是一种新的反映颌骨矢状关系的测量指标,已开始被临床医生所应用.但目前很多医院还应用手工描绘测量,未采用专业测量软件.目的:对乌鲁木齐地区不同骨面型错(牙台)畸形的X射线Beta角头影测量结果进行分析,以期为临床应用提供数据,并验证Photoshop 图像处理软性测量Beta角的可行性.设计、时间及地点:观察性实验,测量设计,于2006-07/2009-05在新疆医科大学第一附属医院口腔正畸科完成.对象:乌鲁木齐地区错(牙合)患者262例,其中男94例,女168例.骨面型分组:骨性Ⅰ类119例,骨性Ⅱ类74例,骨性Ⅲ类69例.方法:拍摄X射线头颅定位侧位片扫描存储,运用Photoshop 8.0图像处理软件定点测量Beta角,对性别、骨面型的测量结果分别进行单因素方差分析及组间t检验.主要观察指标:男、女性Beta角,Ⅰ,Ⅱ,Ⅲ类骨面型Beta角.结果:Beta角在性别间差异无显著性意义(P>0.05).Ⅰ类骨面型Beta角为(34.15±3.88)°,Ⅱ类骨面型Beta角为(26.42±2.65)°,Ⅲ类骨面型Beta角为(42.41±1.88)°,Beta角在不同骨面型组间差异具有显著性意义(P<0.01).结论:Beta角可作为矢状关系的评价指标,乌鲁木齐地区汉族Ⅰ类骨面型人群Beta角参考范围为30～38°.Photoshop 8.0图像处理软件可作为X射线头影测量的另一种手段.     

Ultrasonic evaluation of urethrovesical junction in women with stress urinary incontinence

An ultrasonic evaluation of the bladder base and urethrovesical junction, at rest and during stress, using a transrectal probe, was performed on 24 continent and 67 incontinent patients. Forty-four of the incontinent patients had clinical and urodynamic diagnoses of stress urinary incontinence and 23 patients had detrusor instability incontinence. Thirty-eight of the 44 patients (86%) with urodynamically and urethroscopically proven genuine stress urinary incontinence and a weak urethral sphincter had a urethrovesical junction (UVJ) drop during stress of greater than or equal to 1 cm (mean 1.3 cm +/- 0.6 cm), as demonstrated on transrectal ultrasonic evaluation. All 23 patients with detrusor instability and 22 of the 24 continent (control) patients had UVJ drop on straining of less than 1 cm (mean 0.48 cm +/- 0.23 cm and 0.54 cm +/- 0.29 cm, respectively, p less than 0.05). The sensitivity of ultrasonic evaluation of women with stress urinary incontinence (when 1-cm drop of UVJ is considered as the upper boundary of normal) was 86% and the specificity was 91%. This ultrasound technique is quick, simple, and appears to be accurate. We believe this technique should be considered in the preoperative evaluation of women with stress urinary incontinence.