尿流动力学在女性尿道综合征诊治中的应用

探讨尿流动力学在女性尿道 诊治中的作用。方法：采用Ｍｅｎｕｅｔ尿流测定仪对２０例女性尿道综合征患者进行尿流动力学检查,并根据检查结果进行分型及相关治疗。结果：不稳定性膀胱６例（３０％）,逼尿肌无力４例（２０％）,远端尿道缩窄１２例（６０％）,膀胱颈梗阻２例（１０％）,低顺应性膀胱１例（５％）,逼尿肌尿道括约肌协同失调１例（５％）其中不稳定性膀胱并发远端尿道缩窄４例（２０％）,不稳定性膀胱并发逼肌无     

男性后尿道横纹括约肌的控尿功能及临床意义

一般认为,男性后尿道的控尿功能由内括约肌和外括约肌来实现.内括肌是一个功能性概念,在解剖形态学上是否真正存在内括约肌,目前尚存有争议.但一般认为内括约肌是平滑肌,位于膀胱颈和后尿道,由膀胱底延续下来的逼尿肌和两侧输尿管延续来的纵行肌以及尿道壁本身的平滑肌构成[1].内括约肌分布有丰富的α-受体,主要受交感神经支配,在控制膀胱排空和尿失禁方面具有重要作用.外括约肌是横纹肌,位于尿生殖膈之中呈环形包绕膜部尿道,由阴部神经(主要是体神经)支配,突然中断排尿由它来实现.在前列腺手术或膀胱颈内切开术后,内括约肌遭受破坏,控尿功能由外括约肌担负,如此时外括约肌也遭受损害或功能不足,即会发生尿失禁.     

人工尿道括约肌治疗尿失禁(附四例报告)

目的　探讨人工尿道括约肌治疗真性尿失禁的效果和安全性。　方法　采用美国AMS公司 80 0型人工尿道括约肌植入治疗 4例真性尿失禁患者 ,记录手术前后的排尿日记 ,尿动力学测定 ,观察其不良反应。　结果　 4例患者人工尿道括约肌植入术后 4～ 6周开通人工尿道括约肌 ,尿失禁得到良好控制 ,恢复自主排尿 ,未出现因感染而取出装置的严重并发症 ;随访 17～ 4 6个月 ,白天或夜间均无漏尿 ,无需尿垫 ,能自主排尿 ,生活质量评分平均 1分。尿动力学测定膀胱顺应性及稳定性良好 ,最大尿道闭合压 8.2～ 9.4kPa ,平均 8.7kPa ,3例无剩余尿 ,1例有少量剩余尿 ,仅 1例曾因机械故障更换控制泵。　结论　人工尿道括约肌植入术治疗真性尿失禁疗效满意 ,手术简单 ,安全可靠 ,无严重并发症。     

精阜增生症尿流动力学检查的临床意义：附21例报告

本文报道21例精阜增生症尿流动力学检查结果。术前最大尿流率、平均尿流率、排尿时间、排尿压和精阜压分别为11.2±3.8 ml/s、6.7±2.3ml/s、42.1±16.3s、78.3±17.4cmH2O和32.4±5.7cmH2O,术后分别为18.9±4.1ml/s、11.6±2.8ml/s、26.6±8.5s、60.9±15.6cmH2O和21.6±4.0cmH2O,手术前后对比差异显著。表明排尿期尿流动力学检查可确定膀胱出口梗阻及其程度,尿道压力图可确定梗阻的部位。     

女性尿道及括约肌重建术二例报告

我们应用重建尿道与重建横纹括约肌术治疗女性尿道缺如患者 2例 ,疗效良好。现报告如下。例 1,2 9岁。因咳嗽、跑步时尿失禁2 0年 ,于 2 0 0 0年 3月在外院诊断为压力性尿失禁行阴道前壁修补、膀胱颈悬吊术 ,术后呈现完全性尿失禁。查体 :完全性尿道下裂、膀胱颈开口于阴道。行阴道黏膜瓣尿道成形术。手术方法 :12F双腔尿管置入膀胱 ,于阴道前壁中线相距 2cm作平行切口 ,近端绕过膀胱瘘口 ,远端达阴蒂下 1cm ,形成长 4cm尿道瓣。将瓣的创缘向中线靠拢围绕导尿管 ,用 5 0可吸收缝线缝合成尿道 (图1) ,同时缩窄膀胱颈 ,用Foley导尿管量取新…     

女性下尿路梗阻的尿流动力学及处理（附42例报告）

１９８５年８月～１９９３年４月对４２例女性下尿路梗阻患者行尿流动力学检查，包括尿流率、膀胱容积压力测定、尿道分布压及尿道外括约肌肌电图，结合Ｂ超及尿道镜观察，全部明确诊断，手术处理及药物治疗，疗效满意。对女性下尿路梗阻的病因，尿流动力学诊断意义及女性膀胱内颈梗阻原因进行讨论。     

经尿道前列腺电切术后尿失禁原因的尿流动力学分析

目的 :探讨尿流动力学检查在诊断经尿道前列腺电切术 (TURP)后尿失禁中的作用。　方法 :37例TURP术后尿失禁患者接受了尿流动力学检查 ,包括膀胱压力容积测定 (CMG)、压力 流率分析、静态尿道压力描计(RUPP)及应力性漏点压 (SLPP)测定 ,必要时结合膀胱尿道造影。　结果 :16例患者诊断为运动急迫性尿失禁 ,2例诊断为感觉急迫性尿失禁 ,17例诊断为压力性尿失禁 ,2例诊断为充溢性尿失禁。　结论 :通过尿流动力学能够准确判断TURP术后尿失禁类型 ,从而为选择正确的治疗方法提供客观依据     

Detrusor sphincter dyssynergia,detrusor instability,and urethral sphincter spasticity as the urodynamic findings in the urethral syndrome: Role of treatment with a combined anticholinergic and alpha blocking agent,bladder drill,and antibiotics

The combined effect of isopropamide 5 mg plus trifluoperazine 1 mg (a combined anticholinergic and alpha-adrenergic antagonist) (Smith, Kline and French Canada Ltd, Ontario, Canada), antibiotics, and bladder drill was retrospectively assessed on 100 consecutive women, aged 16 to 47 years, presenting with the signs and symptoms of the urethral syndrome. Assessment included history, physical examination, routine bacterial and chlamydial cultures (cervical, urethral, vaginal, and urine), cystourethroscopy, and urodynamics. Urodynamic diagnoses included detrusor sphincter dyssynergia (n=84), detrusor instability (n =8), external urethral sphincter spasticity (n=4), and sensory urgency (n=1). Three patients with positive urine cultures were excluded. Urethrotrigonitis was visualized at cystourethroscopy in all patients. Only one case of chlamydial urethritis-cervicitis was identified by culture: 82% of patients had a history of prior antibiotic therapy for lower urinary tract symptoms and 21% were being treated with antibiotics at the time of their initial assessment.Following 1 month of treatment, 44 (45%) patients were cured of all symptoms, 49 (51%) were improved, 3 (3%) were unchanged and 1 (1%) was worse. Significant changes in uroflowmetry included a reduction in postvoid residual urine volume from 49 ± 28 ml to 14 ±21 ml (P=0.029) in the unstable bladder group and a conversion from intermittent to continuous uroflow patterns in the detrusor sphincter dyssynergia group (P <0.005, ²) and overall (P <0.005, ²). A statistically significant number of patients (P <0.025, ²) converted from increased to normal tracings on repeat perianal electromyography, suggesting that the pathophysiology of the urethral syndrome is urethral spasticity related to urethral inflammation rather than actual infection.We conclude that detrusor sphincter dyssynergia, bladder instability, and urethral sphincter spasticity are the common urodynamic findings in the urethral syndrome. A combination of anticholinergic and alpha blocking agent, antibiotics, and a bladder drill markedly improved (96%) symptoms in women with the urethral syndrome.     

女性尿道综合征动力学病因分析

对３３例女性尿道综合征患者行尿动力学检查，部分病例同时行雌激素水平测定，结果提示，不稳定膀胱常是本病症状迁延的病理基础，尿道压增高则是诱发不稳定膀胱的病因之一，诊断治疗中尚应重视雌激素水平对女性下尿路功能障碍的影响。     

Electromyography of the female urethral sphincter

Electromyography of the urethral striated sphincter gives information on the function of this muscle which consists of two structures: the intraurethral and periurethral sphincter. The types of electrode used to perform EMG of this sphincter are reviewed. The EMG findings of the peri- and intraurethral sphincters with empty bladder at rest and during maximal voluntary contraction are given as well as during bladder filling. Assessment of the urethral sphincter is described in different pathological situations. Methods and results of evoked potentials and nerve conduction measurements are also described in normal and pathological conditions.     

女性尿道综合征的尿动力学诊断及治疗

分析８２例女性尿道综合征患者的尿动力学表现，并对５０例患者进行随机分组治疗研究，结果：根据尿动力学表现分６种类型，以远端尿道缩窄症最常见，占７６．８％，膀胱训练加尿动力学指导用药是治疗女性尿道综合征既简单又有效的方法。     

The effects of duloxetine on urethral function and sphincter morphology

The aim of our study was to investigate the effect of duloxetine on urethral function and sphincter ultrasound morphology in 54 women, who were referred to a urogynecology unit, with urodynamic stress incontinence. All completed a King’s Health Questionnaire and a patient global assessment of improvement (PGI-I) question and underwent urethral pressure profilometry, measurement of urethral retro-resistance pressure (URP), and ultrasound of the striated urethral sphincter. The investigations were repeated after 8 weeks of duloxetine 40 mg twice daily in 36 women who continued the medication. After 8 weeks of duloxetine, the mean URP increased significantly compared to baseline (53.8 to 60.8 cm H₂O; p = 0.001), and sphincter thickness was significantly higher (1.8 to 2.0 mm; p < 0.001). There was a significant increase in the maximum urethral closure pressure (MUCP) (52.7 to 59.2 cm H₂O; p = 0.006) but not of functional urethral length. Subanalysis of responders (improved on duloxetine) showed a significant increase in URP (50.3 to 59.1 cm H₂O; p = 0.001), sphincter thickness (1.7 to 2.1 mm; p < 0.001), and MUCP (50.2 to 58.1 cm H₂O; p = 0.03). These changes were not seen in nonresponders. This study has demonstrated objective changes in urethral ultrasound morphology and function after duloxetine therapy, which relate to improved continence. A larger longer term study is required to assess if these changes persist over time. In summary, duloxetine therapy for urodynamic stress incontinence results in an increase in urethral closure pressure, URP measurement, and urethral striated sphincter thickness.     

外伤性尿道狭窄治疗方法分析(附104例报告)

探讨外伤性尿道狭窄的最佳手方法，提高其治疗水平。方法：采用尿道内冷刀切开治疗尿道狭窄１５例，采用尿道狭窄切除端－端吻合治疗尿道狭窄７８例，采用套入法尿道成形术（尿道套入术）治疗尿道狭窄１１例。结果：１５例经冷刀切开治疗者治愈１３例，占８６．７％；７８例经尿道狭窄切除端－端吻合治疗者治愈７５例，占尿道狭窄并直肠瘘者，应选用开放性手术治疗，其中尿道套入术是治疗后尿道狭窄的可靠术式。     

开放手术和内窥镜手术治疗男性尿道狭窄83例报告

目的:总结83例男性尿道狭窄患者的手术治疗体会.方法:对54例≤1.5 cm尿道狭窄者采用内窥镜技术治疗;对29例＞1.5 cm尿道狭窄中的21例行开放手术治疗,其中4例长段尿道狭窄者利用包皮瓣或阴茎皮瓣做尿道成形术,另8例行内窥镜手术治疗,其中5例采用自体包皮片移植术.结果:经6～36个月随访,开放手术排尿通畅者占85.7%,内窥镜手术排尿通畅者为88.7%.结论:临床上应根据尿道狭窄范围及长短选择手术方式,尿道狭窄段≤1.5 cm者适合内窥镜手术,而＞1.5 cm者适合开放手术.而包皮皮片、包皮、阴茎皮瓣是非常好的长段尿道狭窄的替代物.     

尿道口处女膜病的诊断与治疗：附30例报告

报告１９８５年２月－１９９６年１１月经门诊和住院诊断和治疗的尿道口处女膜３０例。志科检查发现所有病例尿道口及处女膜局部均有明显的病理改变；５０％病例合并有不同程度的尿道缩窄。全部病例均采用手术治疗，经３－２０个月的随访，手术有效率为９３．３％，治愈率为７３．３％。认为对反复发作下尿路感染的女性患者，不能盲目给予抗菌药物而忽视必要的专科检查。     

尿道处女膜融合症合并尿道肉阜的诊治

目的：探讨尿道处女膜融事症并尿道肉阜的诊断标准及治疗方法。方法：尿道肉阜患者，若同时阴道口至尿道阜基底部的最短距离〈０．４ｃｍ则诊为此病。共诊治１０７例，采用尿道肉阜缝扎切除，尿道外口阴道口间距延长术，保持尿道外口阴道口间距〉０．５ｃｍ，且使尿道外口的口径〉０．８ｃｍ。结果：痊愈８６例，好转１７例，无效４例。     

带蒂皮瓣尿道成形术治疗前尿道狭窄(附32例报告)

目的:探讨带蒂皮瓣尿道成形术治疗尿道狭窄的技巧。方法:对32例前尿道狭窄患者用带蒂皮瓣尿道成形术一期切开狭窄段同期成形尿道。结果:术后随访,0.5～3年,平均2.2年,25例一次成功,排尿通畅,4例出现狭窄,内切开治愈,3例出现尿瘘,第二次修补治愈。结论:带蒂皮瓣技术对前尿道狭窄,一次完成尿道狭窄切开和尿道成形,成功率高,是一种理想的治疗方法。