女性下尿路症状患者的尿动力学分析

目的　探讨女性下尿路症状原因及临床意义。　方法　 72例下尿路症状女性患者 ,年龄 8～ 86岁 ,平均 4 8岁。其中排尿困难 4 6例 ,尿失禁 14例 ,尿频 10例 ,夜间遗尿 2例。患者均行尿动力学检测。　结果　 4 6例排尿困难者膀胱容量 6 0～ 80 0ml,其中 2 0例膀胱逼尿肌收缩力为 0 ,2 6例9～ 16 0cmH2 O(1cmH2 O =0 .0 98kPa)。Linp URR图示为Ⅲ级以上梗阻者 19例。尿道静态分布阻力2 5～ 130cmH2 O。膀胱逼尿肌与尿道外括约肌协调性良好者 5例 ,协同失调者 33例。 10例尿频患者膀胱容量 97～ 4 5 0ml,2例排尿期膀胱逼尿肌收缩力为 0 ,8例 31～ 110cmH2 O。Linp URR图示显示Ⅲ级以上梗阻者 2例。 1例急迫性尿失禁者膀胱过度敏感。 6例压力性尿失禁者腹压漏尿点压力 4 4～76cmH2 O。 3例充盈性尿失禁者排尿期膀胱逼尿肌压力为 0 ,尿道静态分布阻力 32～ 4 2cmH2 O。真性尿失禁 4例尿道外括约肌压力 0～ 16cmH2 O ,平均 (8.5± 5 .7)cmH2 O。 2例遗尿患者存在不稳定性膀胱表现 ,排尿期膀胱收缩乏力。　结论　尿动力学检查对女性下尿路症状疾病诊断、治疗、预后判断具有重要指导意义。     

难治性男性下尿路症状的尿动力学分析

目的：研究难治性男性下尿路症状病因及尿动力学表现。方法：选择24例外院诊断为慢性前列腺炎经反复治疗效果不佳的患者行尿动力学检查。根据膀胱测压、压力-流率、盆底肌电图及尿道压进行诊断。结果：24例中完成检查22例,结果异常18例。顺应性下降并发逼尿肌过度活动1例,逼尿肌过度活动4例,膀胱感觉过敏2例,功能失调性排尿2例,膀胱出口梗阻6例,逼尿肌收缩力下降3例。结论：尿动力学对难治性男性下尿路症状的疾病诊断及治疗具有重要的指导意义。     

尿动力学检查在女性下尿路疾病中的应用（附78例报告）

目的：研究以下尿路症状为主诉的女性患者的尿动力学变化及其临床意义。方法：女性患者,年龄21～86岁,临床表现为储尿期和（或）排尿期症状,采用尿动力学方法检查尿流率,同步膀胱压力容积流率及肛门括约肌肌电图测定。结果：以排尿症状为主者64例,以储尿症状为主者12例,不稳定膀胱2例。下尿路梗阻28例,其中功能性逼尿肌外括约肌协同失调的16例;子宫阴道下垂伴下尿路梗阻21例;压力性尿失禁18例,其中Ⅰ型5例,Ⅱ型3例,Ⅲ型3例,Ⅱ／Ⅲ型7例。正常9例。结论：尿动力学检查能了解膀胱的功能状况,为临床治疗的选择提供了可靠的依据。     

尿动力学检查在下尿路症状患者诊断中的价值（附324例报告）

目的：评价尿动力学在下尿路症状（LUTS）患者病因诊断中的重要价值。方法：对324例不同年龄的LUTS患者行尿流率、压力容积、压力-流率、前列腺压和肌电图检查,根据检查结果,行相应的临床治疗措施,比较治疗前后IPSS、QOL的变化。结果：根据尿动力学结果提示LUTS病因有5种,膀胱出口梗阻55．9％、逼尿肌受损、逼尿肌-括约肌失协调、不稳定膀胱、膀胱容量减少。制定相应治疗方案,取得良好临床效果。结论：尿动力学检查揭示LUTS的深层次病因,在LUTS患者的诊断、鉴别诊断及治疗方式的选择上具有重要的意义,值得临床推广应用。     

尿动力学检查在下尿路症状及良性前列腺增生诊治中的作用

尿动力学对评估前列腺增大 (ＢＰＥ)及下尿路症状 (ＬＵＴＳ)的作用至今尚不清楚。多数学者认为 ,虽然良性前列腺增生 (ＢＰＨ)的症状、尿动力学、病理学及病理生理学之间的关系极为复杂 ,但有证据证明 ,尿流率及压力 /流率测试对膀胱出口梗阻 (ＢＯＯ)的诊断和疗效评估有帮助。临床医师常常对ＬＵＴＳ患者作出最初诊断后 ,就按ＢＰＨ治疗。因此 ,从尿动力学角度探讨ＬＵＴＳ及ＢＰＨ对临床有实际指导意义。一、对单纯尿流率测定的认识尿流率测定不能区分ＢＯＯ及逼尿肌反应 ,但它是最常用的尿动力学检查。第五届国际ＢＰＨ咨询委员会建议Ｂ…     

女性下尿路症状调查

目的　调查城市社区女性下尿路症状的发病情况。　方法　采用自我完成的问卷调查,问卷的大部分内容参考BFLUTS问卷,并根据国内具体情况进行调整。社区妇幼保健人员逐户入户调查发卷和收卷,并指导填写。　结果　调查共发出问卷 6066份,回收 5587份。答卷者中>18岁者4745人。其中压力性尿失禁、急迫性尿失禁、尿急、尿频、夜尿的患病数分别为 425例 (9. 0% )、113例(2. 4% )、489例(10. 3% )、72例(1. 5% )、446例 (9. 8% )。总贮尿症状患病率随着年龄增加而增加, 18~27岁患病率为 20. 5% (104 /507), 28~37岁患病率为 19. 1% (332 /1740), 38~47岁患病率为22. 5% (338 /1503), 48 ~57岁患病率为 32. 2% ( 202 /628 ), 58 ~64岁患病率为 41. 2% ( 61 /148 ),65岁以上者发患率为 58. 0% (127 /219),总患病率为 24. 5%。排尿延迟、排尿中断、增加腹压排尿、不能完全排空膀胱、排尿疼痛等症状的患病率分别为 7. 0% ( 330例 )、4. 1% ( 194例 )、4. 6% ( 217例)、4. 9% (233例)、4. 8% (229例)。总排尿症状患病率随着年龄增加而增加, 18 ~27岁患病率为13. 0% (66 /507), 28~37岁患病率为 9. 3% (162 /1740), 38~47岁患病率为 10. 7% (161 /1503), 48~57岁患病率为 13. 2% (83 /628), 58~64岁患病率为 16. 2%     

老年男性下尿路症状伴逼尿肌过度活动患者临床及尿动力学特点分析

目的 探讨老年男性下尿路症状伴逼尿肌过度活动(DO)患者临床和尿动力学特点.方法 中重度下尿路症状老年男性患者227例,根据尿动力学检查将患者分为2组,DO组126例,无DO组101例,对2组患者前列腺体积、PSA、尿流率、残余尿、IPSS和尿动力学参数进行比较.结果 2组患者年龄分别为(71.1±8.9)和(66.3±9.4)岁,DO组高于无DO组(P＜0.05);年龄校正后,2组患者前列腺体积分别为(44.3±18.3)和(46.9±17.5)ml,PSA(2.6±1.5)和(2.9±1.3)ng/ml,最大尿流率(同时用排尿量校正)(6.6±4.3)和(8.1±4.9)ml/s,残余尿为(132.5±114.6)和(142.l±129.7)ml,2组间差异无统计学意义(均P>0.05).尿动力学检查,2组患者膀胱初感觉分别为(105.0±42.4)和(130.6±50.5)ml,膀胱顺应值(25.4±14.3)和(36.7±14.3)ml/cm H2O,最大膀胱容量(262.8±106.7)和(349.1±75.8)ml,单次排尿量(130.3±89.4)和(208±101.4)ml,最大逼尿肌收缩压(66.9±38.1)和(53.3±24.1)cm H2O,LinPURR 3.1±1.7和2.4±1.6,2组间各项指标差异均有统计学意义(均P＜0.05).结论 高龄、严重膀胱出口梗阻患者易出现DO;中重度下尿路症状患者,非侵入性临床参数无法判断患者是否存在DO;DO患者尿动力特点为膀胱敏感性增加、顺应性下降、最大逼尿肌收缩压增高、膀胱功能容量减少和单次排尿量减少.     

超声影像尿动力在尿频尿急为主要症状的女性下尿路症状患者中的诊断价值

目的:采用超声影像尿动力检查评估尿频尿急为主要症状的女性下尿路症状(lower urinary tract symptoms,LUTS)患者与无LUTS症状女性志愿者之间的膀胱壁厚度(BWT)及逼尿肌厚度(DWT)之间的差异,探讨超声影像尿动力检查在这类患者的临床诊断价值,并确定膀胱壁、逼尿肌增厚的截断值。方法:回顾性分析2014年1月~2016年12月对146例以尿频尿急为主要症状女性LUTS患者,通过临床症状、尿动力检查、膀胱镜检查等进行临床诊断、分类,分别分为逼尿肌不稳定收缩组、低顺应性膀胱组和出口梗阻组3个亚组,将同期入院无LUTS症状女性志愿者90例作为对照组。所有受试者均行经会阴盆底超声检查,分别测量其BWT、DWT:取膀胱穹顶部及两侧3个点,取平均值并记录结果。对比分析各组年龄、BMI、BWT、DWT等一般资料的差异,将BWT、DWT分别带入受试者工作特征曲线(ROC)进行分析,分别计算膀胱壁、逼尿肌增厚的截断值。结果:研究组中逼尿肌不稳定收缩组、低顺应性膀胱组、出口梗阻组BWT、DWT均显著高于对照组,差异有统计学意义(P<0.05),3个试验组之间BWT、DWT差异无统计学意义(P>0.05)。将试验组中BWT、DWT值对比对照组中BWT、DWT值带入ROC工作曲线进行分析,以BWT增厚为标准判断以尿频尿急为主要症状女性LUTS患者,曲线下面积为0.914,当BWT的截断值选取4.95mm时,对于膀胱壁增厚导致女性LUTS症状诊断价值最大。此时的诊断敏感度为84.8%,特异性为97.3%,约登指数0.821,诊断指数为182.1%。以DWT增厚为标准判断以尿频尿急为主要症状女性LUTS患者,DWT曲线下面积为0.873,当DWT的截断值选取2.49mm时,对于逼尿肌增厚导致女性LUTS症状诊断价值最大。此时的诊断敏感度为72.7%,特异性为94.6%,约登指数0.673,诊断指数为167.3%。结论:超声影像尿动力检查是评估以尿频尿急为主要症状的女性LUTS患者可靠的客观量化手段,值得进一步推广。膀胱壁增厚、逼尿肌增厚与逼尿肌不稳定及膀胱顺应性降低有明显相关性。以BWT=4.95mm,DWT=2.49mm作为截断值诊断膀胱壁增厚、逼尿肌增厚导致女性LUTS症状诊断意义最大。     

老年男性下尿路症状伴逼尿肌过度活动患者临床及尿动力学特点分析

Objective To study the change of clinical and urodynamic parameters in the patients with lower urinary tract symptom (LUTS) caused by detrusor overactivity (DO). Methods Two hundred and twenty-seven patients with LUTS underwent clinical evaluation from October 2006 to December 2008, including Prostate Volume (PV), International Prostate Symptom Score (IPSS), Peak Flow rate (PF) and Residual Urine (RU) measurement. Pressure flow studies were performed. The detrusor overactivity was recorded to classify the patients into 2 groups, DO group and none DO group. The clinical and urodynamic parameters were compared between the two groups. Results Mean patient age was 70 years (range 52 to 89). According to the urodynamic results, there were 126 patients in DO group and 101 patients in none DO group. The mean patients age was older in DO group than the none DO group(P＜0.05). Adjusted by age, the PV, PF, and RU were no different between the two groups(P>0.05). The mean first sensation of bladder, bladder compliance, cystometric capacity, bladder outlet obstruction parameters, single voiding volume and max detrusor pressure during contraction were different between the two groups(P＜0.05). Conclusions The main risk factors of DO are the ageing and BOO. The non invasive parameters such as PV、 PF、 and RU could not be used to judge DO. The changes of urodynamic parameters caused by DO were hyperaesthesia of bladder、lower bladder compliance、 higher max detrusor pressure and lower max cystometric capacity. This study emphasis the importance of the urodynamic studies in the aged patients with LUTS.     

老年男性下尿路症状伴逼尿肌过度活动患者临床及尿动力学特点分析

Objective To study the change of clinical and urodynamic parameters in the patients with lower urinary tract symptom (LUTS) caused by detrusor overactivity (DO). Methods Two hundred and twenty-seven patients with LUTS underwent clinical evaluation from October 2006 to December 2008, including Prostate Volume (PV), International Prostate Symptom Score (IPSS), Peak Flow rate (PF) and Residual Urine (RU) measurement. Pressure flow studies were performed. The detrusor overactivity was recorded to classify the patients into 2 groups, DO group and none DO group. The clinical and urodynamic parameters were compared between the two groups. Results Mean patient age was 70 years (range 52 to 89). According to the urodynamic results, there were 126 patients in DO group and 101 patients in none DO group. The mean patients age was older in DO group than the none DO group(P＜0.05). Adjusted by age, the PV, PF, and RU were no different between the two groups(P>0.05). The mean first sensation of bladder, bladder compliance, cystometric capacity, bladder outlet obstruction parameters, single voiding volume and max detrusor pressure during contraction were different between the two groups(P＜0.05). Conclusions The main risk factors of DO are the ageing and BOO. The non invasive parameters such as PV、 PF、 and RU could not be used to judge DO. The changes of urodynamic parameters caused by DO were hyperaesthesia of bladder、lower bladder compliance、 higher max detrusor pressure and lower max cystometric capacity. This study emphasis the importance of the urodynamic studies in the aged patients with LUTS.     

Comparison of voiding parameters in men and women with lower urinary tract symptoms

AIM: The aim of this study was to compare voiding parameters by using urodynamic investigations in men and women with lower urinary tract symptoms (LUTS). METHODS: A total of 164 individuals (76 men and 88 women) completed the International Prostate Symptom Score (IPSS) and underwent a detailed urodynamic investigation. Patients were stratified by voiding function, which included bladder voiding efficiency (BVE) of < 80% and of >or= 80%. RESULTS: IPSSs were similar in the men and women except for voiding symptoms for those with a BVE of >or= 80% (12 for men vs. 9 for women, P=0.016). When voiding parameters were compared according to BVE in men and women, respectively, maximum flow rate (Q(max)) (P=0.002), average flow rate (Q(ave)) (P=0.003), voided volume (P=0.037), post-void residual (PVR) (P<0.001), and bladder outlet obstruction index (P=0.016) were different for men with a BVE of < 80% and men with a BVE of >or= 80%. However, for women with a BVE of < 80% or >or= 80%, PVR (P<0.001), detrusor pressure at maximum flow rate (P=0.022), and opening detrusor pressure (P=0.024) were different. CONCLUSIONS: The voiding parameters of women differ from those of men according to voiding function. The present results show that a pressure-flow study may represent a difference according to BVE in women as well as in men. Our findings suggest that opening detrusor pressure in women reflects the urethral and detrusor during voiding phase accurately as detrusor pressure at maximum flow rate does.     

尿流动力学在女性下尿路症候群诊治中的应用

目的评估尿流动力学在女性下尿路症候群（LUTS）分类和治疗中的作用。方法采用尿动力测定仪对127例女性下尿路症候群患者进行尿流动力学检查,并根据检查结果进行分类及相关治疗,治疗后观察临床症状变化并复查尿流动力学各项参数进行对照。结栗不稳定膀胱30例（26．8％）,低顺应性膀胱10例（8．9％）,逼尿肌无力12例（10．7％）,尿道压增高89例（79．5％）,尿动力学无明显异常15例（11．8％）。112例尿动力学异常患者经相应治疗后有效97例,有效率为86．6％。结论尿流动力学检查在女性LUTS的诊断分型及指导治疗上具有重要意义。     

老年女性下尿路感染362例临床分析

目的探讨老年女性下尿路感染的临床特点,提高临床诊治水平。方法对2002年9月-2008年8月诊治的362例老年女性下尿路感染患者进行回顾性分析。结果本组362例中有明显下尿路刺激症状者仅为38.1％;合并糖尿病131例（36.2％）,合并老年性阴道炎96例（26.5％）,合并尿路梗阻77例（21.3％）,长期卧床31例（8.6％）,合并肾功能不全9例（2.5％）。结论老年女性下尿路感染具有不典型性,患有糖尿病、妇科疾病以及尿路梗阻的老年女性发病率相对较高。     

Pressure flow study: a useful diagnostic test of female lower urinary tract symptoms

AIMS: To compare pressure flow parameters in the different urodynamic diagnoses in women with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Urodynamic traces of women with LUTS were prospectively studied. Detrusor pressures at the start of flow (ODP), detrusor pressure at peak flow rate (PdetQmax), peak flow rate (Qmax) and detrusor pressure at the end of flow (CDP) were measured and compared with different urodynamic diagnoses. RESULTS: Six hundred and twenty one women were prospectively investigated between September 2000 and February 2002. Only 85% (529/621) of women had good quality pressure flow studies and was included in the study. Women with detrusor overactivity have higher ODP, CDP and PdetQmax than women with urethral sphincter incompetence. All these pressure flow parameters are significantly lower in women with urethral sphincter incompetence than continent women (P < 0.05, Bonferroni test). Qmax was significantly greater in women with urodynamic stress incontinence compared to women who had detrusor overactivity (P < 0.05, Bonferroni test). Women with mixed incontinence had pressure flow parameters intermediate between women with detrusor overactivity and those with urodynamic stress incontinence. CONCLUSIONS: Pressure flow parameters appear to be useful urodynamic tools in the evaluation of women with LUTS as they help the clinician in assessing the urethral and detrusor function.