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.     

氯胺酮导致下尿路症状的研究进展

氯胺酮导致下尿路症状是一种由于长期吸食氯胺酮导致的一种以尿频、尿急、夜尿增多伴有耻骨上疼痛的综合征。近几年临床工作者开始重视氯胺酮对于泌尿系统的损害,开展了一系列调查和研究,包括对发病机制、病理特点、治疗方案的研究。但该病的病因、命名和诊断仍不清楚,治疗多为对症治疗。本文检索了近年来发表的相关文献,以探究氯胺酮导致下尿路症状。     

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。     

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。     

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,     

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...     

腔内超声探测技术在女性下尿路病变上的应用

采用腔内超声技术探测５２例女性下尿路疾患，其中尿道肿瘤６例，尿道狭窄６例，尿失禁２８例，尿道旁肿块４例，其它病变或病症８例。结果发现采用该技术可较明确尿道梗阻性为的来源、形态、大小及其和阴道等周围器官的关系；对于区分尿失禁和梗阻性病变的类型有助；尚可用于术中超声监测和术后疗效随访，具较高的临床应用价值。     

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.     

Over-the-counter medication availability could augment self-management of male lower urinary tract symptoms

In this review, we focus on current trends in the management of male lower urinary tract symptoms (LUTS), defined here as LUTS, namely, storage, voiding, and post-micturition symptoms presumed secondary to benign prostatic hyperplasia (BPH), and discuss possible novel approaches toward better care.

According to results of a PubMed database search covering the last 10 years and using keywords pertaining to male LUTS, this condition continues to be globally undiagnosed or diagnosed late, partly because of men’s hesitation to seek help for perceived embarrassing problems or problems considered a normal part of aging. In addition, the prevalence of male LUTS is continually increasing because of a constantly aging population. Male LUTS can be bothersome and affect the quality of life (QoL) and sexual function. Additional effective alternatives for managing this condition need to be identified and incorporated into the current care model.

Considering that most male LUTS such as frequency, hesitancy, urgency, and intermittency are easy to self-identify, a self-management approach toward male LUTS is proposed. Limited evidence supports the efficacy of phytotherapies and herbals as self-management options for male LUTS. However, introducing over-the-counter (OTC) medication with proven efficacy, accompanied by lifestyle and behavioral modifications, may be a promising approach that will encourage more men to treat their symptoms in a timely manner. Formal guidelines, along with appropriate education programs for patients and support from the healthcare community, will be needed to ensure that the promise of this approach is fully materialized.     

Characteristics of circadian change in urinary frequency, bladder capacity and residual urine volume in elderly men with lower urinary tract symptoms

Abstract In order to compare the daily voiding traits of elderly men with those of middle-aged men with lower urinary tract symptoms (LUTS), urinary frequency, bladder capacity at normal desire to void (CNDV), residual urine volume (RUV) and functional bladder capacity were evaluated at home during a 24 h period using a non-invasive method. The results showed that in both groups, urinary frequency was lowest from midnight to 06.00 h. The urinary frequency was the highest from 12.00 to 18.00 h. The CNDV in the elderly group was less than that of the middle-aged group for 1 day. In particular, bladder capacity from 24.00 to 06.00 h showed the greatest difference ( P < 0.05). The RUV in elderly men tended to accumulate more than those in middle-aged men. The findings suggest that the functional bladder capacity of elderly men was lower than that of middle-aged men in the home.     

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.     

Development of a self-management scale for lower urinary tract symptoms in patients with cancer after radical prostatectomy

How can nurses assess the self-management of lower urinary tract symptoms (LUTS) in patients with cancer after radical prostatectomy (RP)? Patients with prostate cancer who have undergone RP experience multiple LUTS. This study aimed to develop a self-management scale for LUTS in patients with cancer following RP (SMS-LUTS-RP), as well as to verify its reliability and validity. LUTS has physical, social, and psychological consequences for patients. As a result, patients are forced to self-manage their LUTS and LUTS-related issues. However, no indicators exist to assess self-management of LUTS. A total of 246 individuals were surveyed. A 49-item scale draft, whose content validity and face validity were confirmed, was used to develop a questionnaire for patients with LUTS after RP. The reliability and validity were determined using by item analysis, exploratory factor analysis, confirmatory factor analysis, and Cronbach's α coefficient. The exploratory factor analysis produced the following 18 items on five extracted factors: ‘monitoring of urinary status,’ ‘coping with daily life difficulties due to LUTS,’ ‘collaboration with medical professionals,’ ‘continued training to improve LUTS,’ and ‘living with LUTS.’ The goodness-of-fit-index (GFI) for confirmatory factor analysis was 0.876, and the root mean square error of approximation was 0.075. Cronbach's α coefficient was 0.754–0.820. SMS-LUTS-RP has desirable psychometric properties and can assess the cognitive and behavioural aspects of self-management of LUTS in patients with cancer who have undergone a RP. This scale can be used to provide individualized self-management support according to living conditions.     

Changes in lower urinary tract symptoms before and after using an indwelling urethral catheter

Aim: The purpose of this study was to clarify changes in lower urinary tract symptoms (LUTS) before and after the use of indwelling urethral catheters. Methods: Subjects were 39 inpatients (13 males and 26 females) who underwent laparoscopic cholecystectomy. Lower urinary tract symptoms was measured by using the International Prostate Symptom Score (IPSS). Demographic variables, abdominal pain, quality of life (QOL), and anxiety were also measured. Results: On admission, 84.6% (n = 36) of subject had LUTS, and 71.8% (n = 28) of subject still had LUTS even after use of the catheter. We found no correlation between LUTS and physical or psychological factors. Quality of life because of urinary symptoms was poor in patients with LUTS. After the use of catheters, IPSS decreased (P < 0.01), and in six cases, subjects exhibited intensified LUTS. Conclusions: The IPSS score significantly decreased in this group of participants after the removal of the indwelling urethral catheter. However, we must assess the LUTS of all patients who did or do not have a chief urinary compliant when the indwelling urethral catheter is/was used because there were many inpatients with LUTS, and the QOL because of LUTS was low in patients. Moreover, there were six patients whose symptoms of LUTS deteriorated after the use of a catheter. We could not find the causes of worsening symptoms of LUTS. It is necessary to investigate the long‐term effects following the use of the indwelling urethral catheter. In future, we have to thoroughly examine patients with severe LUTS and other diseases, which require essential treatment.