尿动力学检查术前对BPH患者TVP术后疗效的评价作用

目的：探讨尿动力学检查在术前对前列腺增生（BPH）患者行经尿道前列腺电汽化术（TVP）术后疗效的评价作用。方法：对800例拟行TVP的BPH患者术前行尿动力学检查、国际前列腺症状（IPSS）评分,并于术后随访1年,观察最大尿流率,IPSS评分。结果：800例BPH患者术前最大尿流率均〈15ml／s,IPSS评分平均〉29分。根据术前最大尿道压力、最大尿道压力与充盈时膀胱最大压力的关系、膀胱顺应性及是否存在尿道外括约肌与膀胱逼尿肌压力不协调等指标共分为四组。术后1年最大尿流率平均分别为18．3ml／s、17．9ml／s、9．2ml／s和8．2ml,s,IPSS评分平均分别为12分、11分、23分和26分。其中各组术后最大尿流率〉15ml／s,分别占89．8％、85．5％,29,2％和22．5％。Ⅰ组、Ⅱ组术后各项指标与Ⅲ组,Ⅳ组比较差异均有统计学意义（P〈0．05）。结论：尿动力学榆查对BPH患者行TVP术的疗效有良好的评价作用,可为BPH患者采用何种治疗方法提供重要依据。     

经尿道前列腺电切加膀胱颈内切开治疗小体积前列腺增生

目的：探讨小体积BPH的治疗方法。方法：回顾分析56例小体积BPH患者经尿道前列腺电切（TURP）加膀胱颈内切开的临床资料。结果：最大尿流率（Qmax）治疗前（9．54±1．74）ml／s上升至治疗后的（16．23±4．52）ml／s;国际前列腺症状评分（IPSS）由治疗前（21．58±3．12）分下降至治疗后（10．87±3．42）分。Qmax、IPSS治疗前后比较差异均有统计学意义（均P〈0．01）。结论：TURP加膀胱颈内切开治疗小体积BPH,疗效确切,值得临床推广。     

肠道新膀胱尿动力学检查的临床意义

目的 探讨全膀胱切除肠代膀胱术后患者新膀胱和尿道的尿动力学特点。方法 全膀胱切除回肠原位新膀胱术患者22例，术后6～55个月，平均28个月。尿动力学检查测定尿流率、剩余尿，充盈期、排尿期膀胱测压、直肠测压、括约肌肌电图和尿道压测定。结果 22例患者最大尿流率2．7～22．1ml／s，平均12．9ml／s；排尿时间17～240s，平均66s；剩余尿5～300ml，平均92ml；最大膀胱容量210～650ml，平均426ml；初次尿意膀胱容量137～540ml，平均296ml；急迫尿意膀胱容量200～620ml，平均388ml。充盈末期膀胱内压均〈50cmH2O，顺应性31～35ml／cmH2O，平均33ml／cmH2O。膀胱容量≤50％时充盈期新膀胱不自主收缩平均1．2次，容量〉50％～100％时2．6次。压力流率测定时患者排尿期新膀胱均未见主动收缩，排尿期最大腹压10～105cmH2O，平均64cmH2O。最大尿道闭合压33～114cmH2O，平均69cmH2O。功能性尿道长度17～56mm，平均37mm。结论 回肠新膀胱具有良好的储尿能力，新膀胱排尿主要依靠腹压和尿道的协同作用，保留尿道的控尿能力是保证术后控尿能力的关键。     

膀胱灌注治疗女性OAB疗效分析

目的 探讨自制灌注液膀胱灌注治疗女性OAB疗效及安全性.方法 分析自2007年1月至2011年5月行自制膀胱灌注液膀胱灌注治疗OAB女性患者54例患者的治疗效果及副作用,灌注方法:5％的碳酸氢钠注射液30ml+2％盐酸利多卡因注射液30ml+肝素钠注射液(2ml/12500U)50000U,疗程同其他灌注治疗方法.观察指标有:初尿意膀胱容量、最大膀胱容量、尿频、尿急改善情况,生活质量评分( IPSS)、尿常规变化、肝肾功能等.结果 44例(81％)患者尿频、尿急明显改善;生活质量评分(IPSS)明显好转,治疗前后比较P＜0.05,有统计学差异.初尿意膀胱容量及最大膀胱容量均上升,与治疗前比较差异显著(P＜0.05).尿常规、肝肾功能等方面没有明显改变,治疗前后比较P ＞0.05,没有统计学差异.10例(19％)患者无效,在尿常规、肝肾功能等方面没有明显改变.结论 该方法治疗女性OAB简单有效、安全,可作为女性OAB的可选治疗方法.     

结扎膀胱前列腺侧血管蒂保留尿道前列腺切除65例体会

目的评价结扎膀胱前列腺侧血管蒂改良保留尿道前列腺切除(Madigan)手术的治疗效果。方法对65例有症状的前列腺增生症(BPH)患者行改良保留尿道前列腺切除术,术后随访1月～1年,通过国际前列腺症状评分(IPSS)、生活质量评分(QOL)和最大尿流率观察治疗效果。结果IPSS由术前(25.6±2.1)分降至术后(7.2±1.2)分,Qmax由术前(7.9±2.2)ml/s提高到术后(19.1±2.5)ml/s。结论结扎膀胱前列腺侧血管蒂保留尿道前列腺切除术是可行的,降低了改良保留尿道前列腺切除术的难度。     

女性原发性膀胱颈梗阻诊疗探讨

目的：总结女性原发性膀胱颈梗阻（PBNO）的诊断思路及步骤,以提高对女性PBNO的诊断水平,探讨经尿道膀胱颈切开术（TUIBN）对女性PBNO的治疗效果。方法：于2007年3月～2009年1月期间共确诊女性PBNO患者22例,其中19例通过常规尿动力学检查辅以膀胱尿道造影确诊,3例通过影像尿动力学检查确诊。全部患者均在口服α1-受体阻滞剂保守治疗无效后入院接受TUIBN治疗。收集患者术前及术后最大尿流率、最大尿流率时逼尿肌压、剩余尿量和国际前列腺症状评分（IPSS）指标进行比较,分析TUIBN术对女性PBNO的治疗效果。结果：术后22例随访2～24个月,其中12例随访尿动力学及IPSS评分;9例仅随访IPSS评分;1例失访。21例患者手术前后IPSS评分分别为（27．28±2．42）及（8．22±3．89）（P〈0．001）;复查尿动力学的12例手术前后指标比较,最大尿流率分别为（7．53上3．12）ml／s及（13．62±5．02）ml／s（P=0．017）;剩余尿量分别为（中位数80;QU-QL=155～65）ml及（46．11±19．97）ml（P=0．018）;最大尿流率时逼尿肌压分别为（8．82±3．23）kPa及（6．00±2．58）kPa（P=0．003）。结论：常规尿动力学结合膀胱尿道造影检查能较准确、有效地诊断女性PBNO,并能达到与影像尿动力学检查相接近的诊断水平。对口服α1-受体阻滞剂治疗无效的女性PBNO患者,TUIBN是安全、有效的治疗手段。     

经尿道绿激光分叶汽化剜除术治疗BPH（附80例报告）

目的：评估经尿道绿激光分叶汽化剜除术治疗BPH的安全性及疗效。方法：采用经尿道绿激光分叶汽化剜除术治疗BPH患者80例,观察平均手术时间、绿激光能量消耗、术后膀胱冲洗时间、术后留置导尿管时间、手术并发症,记录并计算手术前后IPSS、QOL、剩余尿量及尿流率等指标的差异。结果：平均手术时间（58．9±7．8）min,平均绿激光能量消耗（156±49）kJ,术后膀胱冲洗（12．8±4．5）h,术后留置导尿管（2．8±0．6）天。无严重并发症发生。IPSS及QOI．评分由术前（25．6±5．4）及（6．8±0．6）分别下降至（9．8±1．7）及（2．8±0．4）,最大尿流率由术前（7．8±2．6）ml／s增加至术后（16．8±4．4）ml／s,剩余尿量由术前（136．8±25．4）ml下降至术后（34．7±6．9）ml,手术前后比较差异均有统计学意义（P〈0．05）。结论：经尿道绿激光分叶汽化剜除术是治疗BPH的一种安全有效的微创手术,与选择性绿激光前列腺汽化术比较具有激光能量消耗低、可以留取标本、手术时间短等优点,对于大体积的前列腺更具有优势。     

TURis在经尿道前列腺剜除切除术治疗症状性BPH中的应用（附80例报告）

目的：总结TURis双极前列腺电切系统在经尿道前列腺剜除切除术治疗症状性BPH的临床疗效和安全性。方法：回顾性分析自2010年3月～2011年1月采用TuRis系统治疗80例患者围手术期及术后3～6个月随访资料。结果：80例症状性BPH患者均完成双极经尿道前列腺剜除切除术,无中转开放手术,无需输血病例。术前前列腺体积（77．43±26．50）ml,血红蛋白（134．41±13．61）g／ml,IPSS评分（25．10±＋4．81）,QOL（4．16±0．91）,术前Qmax（6．46±3．86）ml／s,手术时间（122．56±36．22）min,术后3天血红蛋白（122．20±13．29）g／L,术后留置尿管时间（76．10±42．51）h,术前与术后血清钠无明显变化,3个月后残余前列腺体积（30．74±6．55）ml,IPSS评分（10．58±3．52）分,QOL（2．31±1．24）分。尿道外口狭窄发生3例,无后尿道及球部尿道发生,无膀胱颈挛缩发生。结论：TURis。系统在经尿道前列腺剜除切除术可安全用于症状性BPH治疗,具有良好的安全性和临床疗效。     

改良双窥镜下尿道会师术治疗男性尿道损伤

目的：探讨双窥镜下尿道会师术治疗男性尿道损伤的疗效。方法：采用软性纤维膀胱镜及硬性尿道膀胱镜（即改良双窥镜）行尿道会师术治疗男性尿道损伤5例。结果：5例手术均一次成功,平均手术时间约1h。术后随访1～6个月,,最大尿流率15．3～22．5ml／s,平均20．7ml／s。结论：采用双窥镜行尿道会师术治疗男性尿道损伤只需膀胱造瘘单孔辅助,可一期完成手术,住院时间短,疗效好。     

经尿道等离子体双极电切术治疗前列腺增生

目的探讨经尿道等离子体双极电切治疗前列腺增生(BPH)的安全性与有效性。方法用经尿道等离子体双极电切法行前列腺切除术(PKVP)81例。结果81例术中出血少,无前列腺电切综合征(TURS)和前列腺包膜穿孔发生。术后随访1-6个月,最大尿流率(Qmax)由术前的(6．2±4．1)ml／S上升至术后的(21．2±4．6)ml／S;国际前列腺症状评分(IPSS)由术前的(25．6±4.8)分下降至术后的(6．8±2．6)分;生活质量评分(QOL)由术前的(5．1±0．5)分降低至术后的(1．8±0．5)分;残余尿由术前的(67±70)ml减少至术后的(15±20)ml。结论经尿道等离子体双极电切治疗前列腺增生疗效确切,安全性好,并发症少。     

Parameters of bladder function in pre-, peri-, and postmenopausal continent women without detrusor overactivity

AIMS: To determine normative data for lower urinary tract function in asymptomatic continent women without detrusor overactivity (DO) across the age span. METHODS: Healthy female volunteers aged > or =20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and video-urodynamics. Continent women without history of frequent urgency and without DO were selected. Data on bladder storage, voiding and urethral sphincter function, urine output and frequency are presented for pre-, peri-, and postmenopausal women. RESULTS: Twenty-four asymptomatic women (mean age 50.2 years, range 22-80 years) met the inclusion criteria, including 7 pre- (29.2 years), 7 peri- (48.8 years), and 10 postmenopausal (66.0 years) women. For all subjects, maximum single voided volume in bladder diary was 500 ml and maximum cystometric capacity was 580 ml (median values). Strong desire to void (SDV) was reported at 287, 366, and 425 ml for pre-, peri-, and postmenopausal groups, respectively. The maximum flow rate was 25, 32, and 23 ml/sec in uroflowmetry and 23, 24, and 18 ml/sec in pressure-flow study, respectively. Median post-void residual volume (PVR) was below 20 ml in all groups. At maximum flow rate subjects voided with detrusor pressures of 29, 26, and 24 cm H(2)O, respectively. Maximum urethral closure pressure was 94, 74, and 42 cm H(2)O, respectively. CONCLUSIONS: We provide normative data on bladder function in asymptomatic, continent, pre-, peri-, and postmenopausal women without DO.     

Effect of thalamic deep brain stimulation on lower urinary tract function

OBJECTIVE: The precise mechanisms underlying cerebral regulation of lower urinary tract function are still poorly understood. In patients with disabling essential tremor (ET) refractory to pharmacotherapy, thalamic deep brain stimulation (DBS) is an effective treatment for tremor control. Here, we evaluated the effect of thalamic DBS on urodynamic parameters in patients with ET. PATIENTS AND METHODS: We investigated seven patients (two females, five males) with ET 15-85 mo after implantation of DBS leads into the ventral intermediate nucleus of the thalamus. We compared urodynamic parameters during thalamic DBS (ON state) and 30 min after turning the stimulator off (OFF state). RESULTS: In the ON compared with the OFF state, there was a significant decrease in bladder volume at first desire to void (median, 218 ml vs. 365 ml, p=0.031), at strong desire to void (median, 305 ml vs. 435 ml, p=0.031), and at maximum cystometric capacity (median, 345 ml vs. 460 ml, p=0.016). No significant differences between the ON and OFF state were detected for changes in detrusor pressure during filling cystometry, bladder compliance, maximum detrusor pressure, detrusor pressure at maximum flow rate, maximum flow rate, voided volume, and postvoid residual. CONCLUSIONS: Thalamic deep brain stimulation resulted in an earlier desire to void and decreased bladder capacity, suggesting a regulatory role of the thalamus in lower urinary tract function. Therefore, the thalamus may be a promising target for the development of new therapies for lower urinary tract dysfunction.     

The impact of detrusor overactivity on bladder function in younger and older women

PURPOSE: We examined the relationship of DO and aging, and bladder function in female volunteers. MATERIALS AND METHODS: We recruited 85 cognitively competent, fully functional female volunteers who were 22 to 90 years old (median age 54) with and without symptoms suggestive of DO. Comprehensive assessment included a bladder diary, uroflowmetry and videourodynamics. We examined predefined urodynamic and diary variables for associations with DO and age, summarizing results in the 3 subgroups no DO, intermediate DO and clinically relevant DO. RESULTS: Compared to women without DO those with DO showed a decrease in maximum cystometric capacity (558 vs 448 ml), mean daytime voided volume (260 vs 175 ml) and volume at strong desire to void (363 vs 283 ml) but an increase in maximum isovolumetric pressure (41 vs 64 cm H2O) and maximum detrusor pressure during involuntary contraction (intermediate and relevant DO 22 and 37 cm H2O, respectively). The positive association between increased detrusor contraction strength and DO was present at younger ages but absent in older subjects. Maximum urethral closure pressure and detrusor contraction strength decreased significantly with age. CONCLUSIONS: From young adulthood to old age DO appears to affect bladder function parameters. It is associated with decreased bladder capacity and increased bladder sensation. Moreover, in younger adults DO is also associated with increased detrusor contraction strength, which is an association not seen in older individuals. This age associated loss of muscle function may be related to sarcopenia, implying that different treatments may be appropriate in older adults.     

Infrequent voiders syndrome (nurses bladder). Prevalence among nurses and assistant nurses in a surgical ward

We evaluated the prevalence of infrequent voiders syndrome (defined as women with a mean voided volume above 400 ml) and predisposing factors among the female nursing staff in a busy 100 beds department of surgery. One hundred and five nurses and assistant nurses were invited to fill in a questionnaire and a frequency/volume chart for a 24-hour period. The infrequent voiders were further studied using uroflowmetry and medium-fill CO2 cystometry. Seventy-two women completed the study. Six (95% c.l. 3%-17%) were infrequent voiders, although fifty women (57%-80%) suppressed the desire to void during working hours. Main reasons for suppression of desire to void were busy work, poor toilet facilities and indolence. The frequency of micturition was higher during evening and night shifts than in the day shift. In the infrequent voiders the functional bladder capacity ranged from 550-1,100 ml, but none had residual urine exceeding 120 ml.     

Urethral pressure variations in women with neurourological symptoms: I. Relationship to urethral and pelvic floor striated muscle

Simultaneous urethrocystometry and electromyography (EMG) of the urethral and pelvic floor striated muscle were performed in 42 gynecological patients with neurourological symptoms. Their maximum urethral pressure varied between 20 and 124 cm H₂O. A correlation analysis was performed between the maximum urethral pressure and the integrated EMG of the urethral striated muscle and the pelvic floor striated muscle. The analyses were performed on results obtained in 1-min periods during bladder filling before first desire to void was reported, when first desire to void was reported, and when a strong desire to void was reported. In 21 patients no correlation was found between the urethral and pelvic floor striated muscle activity and the maximum urethral pressure at any stage of bladder filling. In the other 21 patients a correlation was found in at least 1 of the 3 stages. At all stages of bladder filling a correlation was found significantly more often between the maximum urethral pressure and the striated urethral muscle EMG than between the maximum urethral pressure and the striated pelvic floor muscle EMG. Thus, activity of the urethral striated muscle cannot be reliably studied in an EMG recording from the pelvic floor striated muscle. In the same patient, periods with a correlation could be succeeded by periods without a correlation. Thus, the urethral pressure variations may in the same patient sometimes be caused mainly by the urethral striated muscle and sometimes mainly by the urethral smooth muscle.     

Funktionelle Ergebnisse nach temporärer Dauerableitung der hypokontraktilen Blase

BACKGROUND: Impaired bladder emptying is a common problem in older people and a challenging task in treatment. Conservative and medical treatment options have shown beneficial effects on micturition; however, in a substantial number of patients the effectiveness of these therapies is disappointing. In the end the decompensated bladder needs indwelling catheterisation. To study the effects on the detrusor function, we analysed the urodynamic data of 31 patients during long-term bladder drainage retrospectively. PATIENTS AND METHODS: All 17 female and 14 male patients showed impaired detrusor contractility, enlarged bladder capacity, decreased sensitivity and a high post-void residual urine volume (PVR). After exclusion of an acute pathology, the patients were treated continously with a suprapubic catheter for an average of 13.1 weeks. By urodynamic measurements before and after the drainage period, we analysed the filling parameters, pressure-flow patterns, PVR and detrusor contractility. RESULTS: At the end of the drainage period, significant changes in the detrusor function were obvious. Compared with the pre-treatment situation, the bladder volume at first desire to void decreased from 306.92 ml to 281.7 ml and the maximum bladder capacity from 691.8 ml to 496.8 ml, respectively. The compliance of the detrusor muscle diminished in the same period of time from 65.6 ml/cmH2O to 51.8 ml/cmH(2)O. The PVR dropped by 227.2 ml in average. The maximum flow rate was 9.4 ml/s, and the maximum detrusor pressure increased slightly up to 23.6 cmH(2)O. CONCLUSION: The continuous drainage of the bladder results in significant changes in the motoric as well as sensoric detrusor function. The reduced bladder capacity and the decreased PVR might be indications of a regenerating process of the detrusor. The long-term drainage of the bladder shows beneficial and therefore therapeutic effects. It still remains to be investigated on a functional as well as structural basis to what extent age, gender and pathogenesis influences the rehabilitation of the detrusor.     

Urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder

Objectives: To investigate the urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder (OAB). Methods: A total of 52 untreated female patients with OAB symptoms were given 5 mg solifenacin once daily for 12 weeks. Before and after treatment, the frequency volume chart, overactive bladder symptom score (OABSS), postvoid residual volume, filling cystometry and adverse events were evaluated. Results: After solifenacin treatment, OAB symptoms were improved, voided volume was increased and voiding number was decreased. Bladder capacities at the first sensation of bladder filling, first desire to void and strong desire to void were significantly increased. Intravesical pressure at the first sensation of bladder filling was significantly decreased. Detrusor overactivity (DO) disappeared in five patients. For 28 patients with persisting DO after treatment, bladder capacity at DO was significantly increased. Both groups with and without DO at baseline had significant improvements of OAB symptoms. Conclusions: Solifenacin urodynamically increases bladder capacity in female patients with symptomatic OAB.     

低张力Roux-y乙状结肠新膀胱在尿流改道中的应用

目的 评价全膀胱切除后低张力抗尿粪逆流Roux-y乙状结肠新膀胱在尿流改道中的疗效.方法 21例患有浸润性膀胱癌的患者施行了膀胱全切、低张力抗尿粪逆流Roux-y乙状结肠新膀胱术,术后随访8～79个月,平均36个月,尿动力学检查包括尿流率、残余尿、膀胱容量和充盈期膀胱压力测定.结果 21例患者最大尿流率21.4～38.4 ml/s,平均28.1 ml/s,排尿时间9～28 8,平均17 s,无残余尿,尿意容量120～410 ml,平均330 ml,膀胱容量350～560 ml,平均480 ml,膀胱充盈期末压力14.2～18.6 cm H2O(1 cm H2O=0.098 kPa),平均16.4 cm H2O,最大排尿压23.6～63.4 cmH2O,平均45.0 cm H2O.结论 低张力Roux-y乙状结肠新膀胱具有良好的储尿功能,是一种有效的可控尿流改道方法.     

采用尿动力学评估TVT—O治疗SUI术后近期疗效

目的：探讨采用尿动力学检查评估经闭孔尿道中段无张力悬吊术（TVT-O）治疗女性压力性尿失禁（SUD近期疗效的作用。方法：选取经TVT-O治疗的女性SUI患者50例．平均年龄（55．1±7．53）岁。全部患者术前和随访时填写国际尿失禁咨询委员会问卷简表（ICI-Q-sF）并行尿动力学检查．比较手术前和随访时各参数的变化。结果：成功随访33例,平均随访1．2．7个月。与术前相关指标比较。术后ICI—Q-sF评分和最大尿流率显著低于术前[术后（0．2±0．1）vs术前（14．6±3．2）。术后（26．4±5．5）ml／sVS术前（30．6±8．1）ml／s,P〈0．05];而术后剩余尿量、最大逼尿肌收缩压、初始尿意、最大膀胱测压容量、膀胱顺应性、最大尿道压、最大尿道闭合压和功能性尿道长度没有显著性改变（P〉0．05）．术中无膀胱及尿道损伤。无闭孔血管神经损伤,无阴道肠管穿孔及血肿等并发症发生;术后并发排尿困难1例（3％）、腹股沟不适2例（6％）及尿急尿频1例（3％）,经对症治疗后好转．手术治愈率和改善率分别为85％（28／33）和12％（4／33）。结论：采用TVT-O治疗女性SUI患者近期效果较好,尿动力学检查是其诊断和疗效评估的有效手段。     

Bladder sensitivity testing using a visual analogue scale: comparative cystometric study on women

AIMS: To obtain improved assessment of bladder sensitivity during cystometry by using a 10 cm visual analogue scale (VAS), and comparing it with the standard method according to the International Continence Society (ICS). METHODS: Twenty-five patients with presumed normal bladder functioning underwent filling cystometries according to the VAS-based method and to the standard method. The order of the cystometries was set by randomization. The relationships between the bladder sensation using the VAS-based method and the volume of bladder perfusion were analyzed graphically. Various parameters were abstracted and compared to those obtained by the standard method. Correlations were searched for by principal component analysis. RESULTS: All the curves showed continuous progression of the desire to void. Eighteen of the 25 curves (72%) had a characteristic appearance, showing a latency phase with no perception of any bladder sensation, then a second phase with linear increase of the desire to void. The latency phase corresponded to the first sensation of bladder filling (226.3 ml +/- 169.1 vs. 200.0 ml +/- 143.1, r = 0.9). The progression in desire measured by the VAS method culminated in a sensation of maximum tolerable desire to void, which corresponded to the maximum cystometric capacity (MCC; 497.3 +/- 191.2 vs. 517.4 +/- 196.7, r = 0.9). The slope of the linear regression line for the desire to void constitutes an independent parameter. CONCLUSIONS: VAS reveals that the distinct sensations with the standard method are in fact a single sensation of a desire to void that increases continually during filling.