女性压力性尿失禁严重程度与尿动力学参数的相关性分析

目的 探讨女性真性压力性尿失禁（GSⅠ）患者临床表现严重程度与尿动力学参数的相关性。方法 50例GSⅠ患者安排填写国际尿失禁咨询委员会尿失禁问卷简表（ⅠCⅠ-Q-SF），依据其评分分为三组，Ⅰ组问卷表评分≤7分。Ⅰ组7分〈评分〈14分，Ⅰ组14分≤评分≤21分。分别记录三组排尿日记并测定其尿动力学参数。结果 功能性膀胱容量和valsalva漏尿点压在Ⅰ、Ⅰ、Ⅲ组之间逐渐降低，具显著性差异（P〈0．05）。Ⅰ组最大尿道压、最大尿道闭合压、最大尿流率时逼尿肌压力和最大逼尿肌压力均显著高于Ⅰ、Ⅲ组（P〈0．05）。三组总排尿量、总排尿次数、最大尿流率、膀胱顺应性、最大膀胱压测定容量和功能性尿道长度无显著性差异（P〉0．05）。结论 有选择地应用排尿日记指标和尿动力学参数可有效地评估女性尿失禁患者的严重程度。     

盆底肌电刺激联合功能锻炼治疗老年女性真性压力性尿失禁60例临床疗效观察

目的 观察盆底肌电刺激生物反馈联合功能锻炼治疗60例老年女性真性压力性尿失禁(GSUI)的临床疗效.方法 依据患者症状分别收集轻度、中度和重度GSUI患者各20例,进行12w治疗.结果 轻度组治疗后总漏尿次数(LT)和国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)评分显著低于中度和重度组,而功能性膀胱容量(FV)、Valsalva漏尿点压(PVLP)和最大尿道闭合压(PMUC)显著高于中度和重度组.结论 盆底肌电刺激联合功能锻炼是治疗轻度老年女性GSUI患者的理想方法.     

盆底肌训练联合胫神经电刺激对老年女性急迫性尿失禁的治疗作用

目的比较单独盆底肌训练和联合胫神经电刺激对老年女性急迫性尿失禁的治疗作用。方法选取47例急迫性尿失禁老年女性病人,随机分为2组:盆底肌训练组(A组,n=23)及盆底肌训练+胫神经电刺激组(B组,n=24)。在治疗前及治疗8周后评估分析病人的排尿日志及生活质量。结果 2组病人日尿次数、夜尿次数、尿急及漏尿次数显著减少(P0. 05),其中B组病人的日尿次数、夜尿次数及尿急次数较A组改善更为明显(P0. 05)。2组病人每日饮水量无明显减少。2组病人治疗后生活质量均有显著提高(P0. 05)。结论盆底肌训练联合胫神经电刺激对老年女性急迫性尿失禁有效,疗效优于单独应用盆底肌训练。     

全程指导盆底肌锻炼治疗儿童神经源性逼尿肌尿道无功能性尿失禁近期疗效观察

目的探讨全程指导盆底肌锻炼（PFMT）治疗儿童神经源性逼尿肌尿道无功能（NADS）尿失禁的近期疗效。方法对45例NADS尿失禁患儿于医生全程指导下行PEMT,30min/次,2次/d,疗程为12周。治疗前后分别记录3d排尿、7d排便情况,填写国际尿失禁咨询委员会问卷简表（ICI-Q-SF）,行尿动力学检查。治疗结束后随访3个月观察疗效。结果治疗后总漏尿事件次数、总大便失禁和污便次数及ICI-Q-SF评分均明显低于治疗前（P均〈0.05）;功能性膀胱容量、功能性尿道长度和最大尿道闭合压均明显高于治疗前（P均〈0.05）。治疗结束时有效率为71%,随访3个月为50%。结论 PFMT是治疗NADS尿失禁的有效方法。     

目标策略性干预在老年女性尿失禁中的应用

目的 探讨目标策略性干预在老年女性尿失禁(UI)患者中的应用效果。方法 选取老年女性尿失禁患者86例随机分为实验组和对照组,每组43例,对照组给予盆底肌肉锻炼,实验组给予生物反馈电刺激疗法联合盆底肌肉锻炼,两组治疗前、治疗后1个月行尿动力学分析仪检测,尿动力学参数主要包括最大尿流率时逼尿肌压力(PQmax)、膀胱顺应性(BC)及Valsalva漏尿点压(PVLP)及1 h尿垫试验、Glazer评估、国际尿失禁问卷调查表(ICIQ-SF)进行评价。结果 两组康复训练后,1 h尿垫漏尿量、ICIQ-SF均下降,但实验组下降程度显著优于对照组(P<0.05);两组盆底肌尿动力学参数均显著提高,且实验组明显高于对照组(P<0.05),实验组治疗前后快肌阶段、慢肌阶段和耐力测试阶段电位信号差值均明显高于对照组(P<0.05)。结论 针对女性压力性尿失禁患者的盆底康复采用目标策略性干预,能够有效提高UI患者盆底肌肌力、改善患者盆底肌功能进而提高盆底康复疗效及其生活质量,促进患者康复目标的实现。     

胰激肽原酶对糖尿病神经原性膀胱的疗效观察

目的探讨胰激肽原酶（PK）对糖尿病神经原性膀胱的疗效。方法40例糖尿病神经原性膀胱女性患者随机分为PK治疗组（PK组）、对照组（Con组）各20例。PK组日1次肌注PK40U；Con组日1次肌注维生素B12 500μg。治疗前及治疗后的1个月、2个月检测尿流率、残余尿、最大尿流率、平均尿流率及排尿期逼尿肌压。结果治疗后PK组残余尿量显著降低，最大尿流率、平均尿流率及排尿期逼尿肌压均显著增加（P〈0.05）。Con组治疗后1个月各项结果较治疗前无统计学差异（P〉0.05）。治疗后2个月残余尿量轻度降低，最大尿流率及排尿期逼尿肌压升高，较治疗前差异有统计学意义（P〈0．05）。PK组与Con组比较，残余尿量更低，最大尿流率、平均尿流率及排尿期逼尿肌压更高，差异有统计学意义（P〈0.05）。结论胰激肽原酶可以作为治疗糖尿病神经原性膀胱的用药之一。     

女性压力性尿失禁的尿流动力学检查及意义

压力性尿失禁（SUI）是妇女（尤其是中老年妇女）的常见疾病，可严重影响患者的生活质量。90％的SUI是解剖型SUI，系指患者腹压突然增高时尿液不自主地自尿道口流出。根据其发病机制，SUI可分为两类、三型：第一类为尿道移动度增加，因盆底松弛，膀胱颈及近段尿道下移，当腹压增高时，压力不能传递到近段尿道，而使原来的尿道膀胱压力梯度不复存在．发生漏尿。此类中根据尿道移动程度又可分为两型：尿道和膀胱颈下降〈2cm为Ⅰ型，否则为Ⅱ型。第二类为尿道内括约肌缺陷（即Ⅲ型），由于盆腔广泛手术、尿道手术或损伤，或神经性病变等。使近段尿道和膀胱颈对合不良而长期处于开放状态，当腹压增高时即致漏尿。尿流动力学检查是通过尿动力学仪检测储尿期和排尿期整个膀胱和尿道的压力、     

神经电调节对老年男性颈脊髓损伤患者膀胱逼尿肌过度活动的影响

目的 通过观察三组神经(胫神经、阴茎背神经、骶神经)电调节对颈脊髓损伤后膀胱逼尿肌过度活动的影响,研究神经电调节疗法在治疗颈脊髓损伤后膀胱逼尿肌过度活动中的作用。方法 选择存在膀胱逼尿肌过度活动的颈脊髓损伤老年男性患者40例,随机分为4组：胫神经电调节组、阴茎背神经电调节组、骶神经电调节组和对照组,分别接受相应的治疗。结果 经过12周试验观察,发现神经电调节组治疗前后膀胱功能均有改善,而对照组未见明显变化;胫神经电调节组静态尿道闭合压变化有显著差异,治疗后静态尿道闭合压降低(P<0.05);阴茎背神经电调节组膀胱内压的变化有显著差异,治疗后膀胱内压降低(P<0.05);骶神经电调节组静态尿道闭合压、初感尿意膀胱容量、无抑制收缩及漏尿时的膀胱容量、逼尿肌压及尿道内压的变化均有显著性差异,治疗后静态尿道闭合压、逼尿肌压、尿道内压、无抑制收缩及漏尿时膀胱容量均降低,而初尿意的膀胱容量增加(P<0.05);三组中以骶神经电调节组的治疗效果最好。结论 神经电调节疗法可改善老年患者颈脊髓损伤后的膀胱功能,经皮骶神经电调节的治疗效果优于经皮胫神经及经皮阴茎背神经电调节。     

芒针针刺疗法联合二氧化碳激光疗法治疗产后压力性尿失禁肾虚证效果观察

目的 观察芒针针刺疗法联合二氧化碳（CO2）激光疗法治疗产后压力性尿失禁（SUI）肾虚证的效果。方法95例产后SUI肾虚证患者随机分为观察组（47例）和对照组（48例），两组均开展Kegel训练，并实施CO2激光治疗，观察组在此基础上接受芒针针刺治疗。比较两组疗效及治疗前后肾虚症状积分、ICI-Q-SF评分、盆底电生理指标（Ⅰ类、Ⅱ类肌肌力）、尿流动力学指标[最大尿道闭合压（MUCP）、最大尿流率（MFR）]。结果 与对照组比较，观察组总有效率高（P<0.05）。与同组治疗前比较，两组治疗8周肾虚症状积分、ICI-Q-SF评分减小及Ⅰ类和Ⅱ类肌肌力、MUCP、MFR增加（P均<0.05）；与对照组比较，观察组治疗8周肾虚症状积分、ICI-Q-SF评分减小及Ⅰ类和Ⅱ类肌肌力、MUCP、MFR增加（P均<0.05）。结论 产后SUI肾虚证患者应用芒针针刺联合CO2激光治疗，其疗效优于单用CO2激光治疗，可明显改善患者盆底肌肌力、尿流动力学，有效控制肾虚症状及尿失禁状况。     

盆底肌电刺激治疗前列腺电切术后早期尿失禁39例

尿失禁是前列腺电切术（TULIP）术后最常见的并发症之一。其原因除手术损伤尿道外括约肌、膀胱出口梗阻外,主要为不稳定膀胱。目前用于本病的治疗方法较多,但疗效均欠佳。我院对39例经尿道前列腺电切术后早期尿失禁的患者行盆底肌电刺激治疗,效果较好。现报告如下。     

Kombinierte Stuhl- und Harninkontinenz

Background: Double (urinary and fecal) incontinence is relatively common in the elderly. 6% of men and 9.5% of women over 50 years suffer from combined urinary and fecal incontinence. 50% of males and 60% of females with fecal incontinence have concurrent urinary incontinence. The high rate of concurrence of urinary and fecal incontinence is due to an almost identical innervation of the urinary bladder and the rectum and the close vicinity and partial identity of the muscular sphincter mechanisms. Classification: There are two causal entities of double incontinence: 1. neurogenic disorders, 2. pelvic floor dysfunction. Neurogenic disorders can be classified in central and peripheral nervous lesions. Pelvic floor dysfunction can be due to nerve injury or direct muscular lesions. According to the International Continence Society, urinary incontinence is classified into five categories: 1. stress incontinence, 2. urge incontinence, 3. reflex incontinence, 4. overflow incontinence, 5. extraurethral incontinence. With respect to anal incontinence, the first four groups are important. Diagnosis: The diagnostic evaluation comprises meticulous history, physical examination including neuro-urological status, rectal and in females standardized pelvic examination, urinalysis, sonography of the kidneys and bladder after voiding (postvoid residual urine). In women, a transrectal ultrasound of the bladder, urethra and the pelvic floor is important and can replace lateral cystourethrography. In complex cases, dynamic NMR imaging is helpful. Functional investigations include urodynamic studies with uroflowmetry, filling and voiding cystometry and urethral pressure profiles and rectomanometry. Conclusion: For optimal therapy of double incontinence, an interdisciplinary approach is necessary.     

Effects of Pelvic Organ Prolapse on the Bladder

Purpose of Review

To assess how pelvic organ prolapse (POP) and treatment affect bladder function.

Recent Findings

There is significant overlap between POP and bladder symptoms, including urinary incontinence and overactive bladder. POP may result in bladder outlet obstruction (BOO) secondary to urethral kinking, which may result in overactive bladder (OAB), dysfunctional voiding, and occult or de novo stress urinary incontinence (SUI). Improvements in obstructive symptoms and dysfunctional voiding after POP surgery suggest that pelvic floor reconstruction restores pelvic floor anatomic structure and function. Furthermore, correction of anatomic structure also seems to improve OAB symptoms, although a direct causative link has yet to be established.

Summary

Pelvic floor syndromes should be interpreted as a whole. POP, OAB, urinary incontinence, BOO, and dysfunctional voiding are all part of pelvic floor syndromes, coexisting and interacting to manifest different symptoms before and after POP treatment.

     

Abnormal clinical and urodynamic findings in women with severe genitourinary prolapse

In order to investigate the effects of urogenital prolapse on lower urinary tract function, we studied 61 women with stage III to IV pelvic organ prolapse (prolapse group) and 40 volunteers without prolapse (control group). Each woman underwent urinalysis, urinary questionnaire, pelvic examination, and urodynamic study. The incidence of urinary symptoms, including urinary frequency and urgency, stress/urge incontinence, incomplete emptying, difficult voiding and nocturia, were significantly higher in the prolapse group compared to the control group (p < 0.05). Urodynamic parameters, including residual urine, total bladder capacity, and bladder volume at strong desire to void, were not significantly different between the two groups (p > 0.05). Maximal flow rate, bladder compliance at urgency, functional urethral length, and maximal urethral closure pressure, however, were significantly higher in the control group compared to the prolapse group (p < 0.05). In addition, there was a higher incidence of poor pressure transmission ratio in the prolapse group (p < 0.01). The results indicated that severe urogenital prolapse could produce abnormal clinical and urodynamic results.     

Electrical Stimulation and Pelvic Floor Muscle Training With Biofeedback in Patients With Fecal Incontinence: A Cohort Study of 281 Patients

Purpose Pelvic floor rehabilitation is an appealing treatment for patients with fecal incontinence but reported results vary. This study was designed to assess the outcome of pelvic floor rehabilitation in a large series of consecutive patients with fecal incontinence caused by different etiologies. Methods A total of 281 patients (252 females) were included. Data about medical history, anal manometry, rectal capacity measurement, and endoanal sonography were collected. Subgroups of patients were defined by anal sphincter complex integrity, and nature and possible underlying causes of fecal incontinence. Subsequently patients were referred for pelvic floor rehabilitation, comprising nine sessions of electric stimulation and pelvic floor muscle training with biofeedback. Pelvic floor rehabilitation outcome was documented with Vaizey score, anal manometry, and rectal capacity measurement findings. Results Vaizey score improved from baseline in 143 of 239 patients (60 percent), remained unchanged in 56 patients (23 percent), and deteriorated in 40 patients (17 percent). Mean Vaizey score reduced with 3.2 points (P < 0.001). A Vaizey score reduction of ≥ 50 percent was observed in 32 patients (13 percent). Mean squeeze pressure (+5.1 mmHg; P = 0.04) and maximal tolerated volume (+11 ml; P = 0.01) improved from baseline. Resting pressure (P = 0.22), sensory threshold (P = 0.52), and urge sensation (P = 0.06) remained unchanged. Subgroup analyses did not show substantial differences in effects of pelvic floor rehabilitation between subgroups. Conclusions Pelvic floor rehabilitation leads overall to a modest improvement in severity of fecal incontinence, squeeze pressure, and maximal tolerated volume. Only in a few patients, a substantial improvement of the baseline Vaizey score was observed. Further studies are needed to identify patients who most likely will benefit from pelvic floor rehabilitation. Supported by grant 945-01-013 of the Netherlands Organization for Health Research and Development. Presented at the United European Gastroenterology Week, Copenhagen, Denmark, October 15 to October 19, 2005. Reprints are not available.     

The effects on vesicourethral function following laparoscopic hysterectomy

The aim of our study is to determine whether laparoscopic hysterectomy is associated with increased postoperative urinary symptoms and to assess the change in urodynamic parameters after operation. Forty-five women were arranged for laparoscopic hysterectomy (LH). Each patient received urinalysis, interview, and urodynamic study including uroflowmetry, filling and voiding cystometry and urethral pressure profilometry before and after hysterectomy. A total of 27 patients (60%) had urinary symptoms preoperatively. After operation, only 22 patients (48.9%) remained symptomatic. There was no significant change in the number of women with one or more voiding symptoms before and after surgery, but the incidence of urinary frequency and stress incontinence decreased significantly after laparoscopic hysterectomy (P < 0.05). In addition, maximal urethral closure pressure and maximal cystometric capacity showed significant increases after operation. They were 73.1 cm H2O (range: 49-114) vs 104.4 cm H2O (range: 60-147) (P < 0.001), and 363.3 ml (range: 287-423) vs 396.1 ml (range: 265-515) (P < 0.001), respectively. The result indicated that laparoscopic hysterectomy did not significantly increase the subjective or objective incidence of vesicourethral dysfunction. On the contrary, some patients might be cured of urinary frequency or stress incontinence postoperatively.     

妊娠晚期孕妇尿道压力分布及临床意义

目的 探讨妊娠晚期孕妇尿道压力分布情况及功能变化的临床意义。方法 按照国际尿控协会推荐的检查标准对15例志愿孕妇（产前组）于产前行静态及排尿期持续定点尿道压力测定。将结果与14例上尿路疾病（下尿路功能正常）的已婚未育妇女（对照组）比较。结果 产前组静态尿道压力测定时最大尿道压力、最大尿道闭合压力和功能性尿道长度均显著高于对照组（P均〈0．05）。两组排尿期持续定点尿道压力相关指标均无统计学意义,均无膀胱出口梗阻。结论 妊娠晚期孕妇静态尿道阻力增加,孕妇控尿能力增加;排尿期括约肌多代偿性松弛,膀胱排空能力未受到明显影响。     

Lower Urinary Tract Symptoms and Video‐Urodynamic Characteristics of Women with Clinically Unsuspected Bladder Outlet Obstruction

Objective: To analyze the lower urinary tract symptoms (LUTS) and video‐urodynamic characteristics of women with clinically unsuspected bladder outlet obstruction (BOO). Methods: From 1997 to 2010, a total of 1605 women with bothersome LUTS received video‐urodynamic study in our unit. We reviewed the charts of 212 women diagnosed with BOO based on video‐urodynamic criteria and 264 women without abnormal findings. LUTS and urodynamic parameters were compared between obstructed and unobstructed cases and among the BOO subgroups. Results: The mean ages of the BOO (58.2 years) and control groups (58.8 years) were similar. The mean values of detrusor pressure at maximum urinary flow rate (P_detQ_max)/maximum flow rate (Q_max) of the BOO and control groups were 51.83 cm H₂O/10.22 mL/s versus 18.81 cm H₂O/20.52 mL/s. In the BOO group, cinefluoroscopy revealed dysfunctional voiding in 168 patients (79.2%), urethral stricture in 17 (8.0%), and bladder neck dysfunction in 27 (12.7%). Patients with dysfunctional voiding had significantly lower urethral resistance compared with the other two BOO subgroups. Combined lower urinary tract symptoms were present most often in all BOO patients (69.3%), followed by isolated storage symptoms (30.2%) and isolated voiding symptoms (0.5%). Seventy‐seven patients (37.3%) had dysuria and 79 patients (36.3%) had frequency as their main symptom. Conclusion: Women with BOO usually have nonspecific LUTS. Dysfunctional voiding was the most common form among women with clinically unsuspected BOO, but the degree of obstruction was less severe than with primary bladder neck obstruction and urethral stricture.     

The pathology and treatment of incontinence]

In order to understand the pathology of incontinence, it is important to investigate urinary symptoms, urological and neurological examinations and urodynamics. There are two kinds of incontinence. One is true incontinence in which urine passes through urethra, and the other is false incontinence due to the ectopic opening of the ureter, for example to the vagina. The former includes stress incontinence, urge incontinence, reflex incontinence, overflow incontinence and total incontinence. Stress incontinence occurs with the sudden increase of abdominal pressure such as cough, running and exertion. The cause of stress incontinence is thought to be weakening of pelvic floor muscles after delivery or aging. In these patients, the bladder base and urethra move downwards and backwards, which make the posterior vesico-urethral angle more than 120 degrees. Treatment of stress incontinence includes pelvic floor exercise, administration of alpha-stimulants which increase the tonus of the internal sphincter and surgery to elevate the urethra. Urge incontinence is observed when detrusor instability occurs. It is also seen in patients with neurological diseases such as multiple cerebral infarction or with benign prostatic hypertrophy (BPH). Treatment of urge incontinence includes administration of anticholinergics to decrease bladder hyperreflexia. Reflex incontinence is seen in patients with spinal cord disorders. It occurs due to reflex contraction of detrusor and the treatment involves administration of anti-cholinergics. Overflow incontinence is seen in patients with voiding difficulties due to BPH. It occurs when residual urine increases and when the intravesical pressure exceeds urethral pressure on body movement. Treatment for this is intended to improve voiding difficulties. Total incontinence occurs when total sphincter function is damaged.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neuromodulation for the Treatment of Lower Urinary Tract Symptoms

Neuromodulation therapy incorporates electrical stimulation to target specific nerves that control lower urinary tract symptoms (LUTS). The objectives of this article are to review the mechanism of action, the type of neuromodulation, and the efficacy of neuromodulation mainly according to the results of randomized controlled trials. Neuromodulation includes pelvic floor electrical stimulation (ES) using vaginal, anal and surface electrodes, interferential therapy (IF), magnetic stimulation (MS), percutaneous tibial nerve stimulation, and sacral nerve stimulation (SNS). The former four stimulations are used for external periodic (short‐term) stimulation, and SNS are used for internal, chronic (long‐term) stimulation. All of these therapies have been reported to be effective for overactive bladder or urgency urinary incontinence. Pelvic floor ES, IF, and MS have also been reported to be effective for stress urinary incontinence. The mechanism of neuromodulation for overactive bladder has been reported to be the reflex inhibition of detrusor contraction by the activation of afferent fibers by three actions, i.e., the activation of hypogastric nerve, the direct inhibition of the pelvic nerve within the sacral cord and the supraspinal inhibition of the detrusor reflex. The mechanism of neuromodulation for stress incontinence is contraction of the pelvic floor muscles through an effect on the muscle fibers as well as through the stimulation of pudendal nerves. Overall, cure and improvement rates of these therapies for urinary incontinence are 30–50, and 60–90% respectively. MS has been considered to be a technique for stimulating nervous system noninvasively. SNS is indicated for patients with refractory overactive bladder and urinary retention.     

Effect of Urethral Dilatation on Women With Voiding Dysfunction

Despite a lack of evidence for its efficacy in the literature, urethral dilatation (UD) has been used by urologists and urogynecologists for many years to treat a variety of lower urinary tract symptoms in women. Recent surveys of clinical practice suggest that a significant proportion of clinicians continue to perform UD, with it being more commonly used by those trained more than 10 years ago. Recent outcome data on UD in women with overactive bladder and voiding dysfunction have shown poor long-term efficacy, with a 13% risk of de novo urodynamic stress incontinence. Resolution of symptoms is associated with a postprocedure increase in maximum flow rate and a decrease in detrusor pressure at maximum flow. Further studies are needed to delineate the role, if any, of UD in the management of women with overactive bladder and voiding dysfunction.