尿动力学检查在尿失禁诊治中的意义

尿动力学检查在尿失禁诊治中的意义金锡御宋波作者单位：４０００３８重庆，第三军医大学西南医院泌尿外科尿失禁是临床常见疾病，发生率较高，尤其是女性、儿童和老年人。国外资料表明，女性３０～５９岁发病率为２５％，６０岁以上者发病率为３８％。尿失禁不仅损害了病...     

女性尿失禁患者尿动力学检查的意义

对６８例女性尿失禁的临床诊断和尿动力学检查结果进行了比较研究。根据病史、主诉、体查和辅助检查而做出的诊断，各型尿失禁之间有１５．０％到２７．８％与尿动力学检查不一致。详细的病史、体检、辅助检查与尿动力学检查结果相结合，才能对尿失禁做出正确的诊断。尿动力学检查对于拟手术的患者或基于临床诊断治疗失败的患者具有重要意义。     

脊髓损伤患者下尿路功能障碍的尿动力学检查

目的提高对神经源性下尿路功能障碍患者的诊断水平,并为针对性选择康复手段提供可靠依据. 方法对220例不同损伤平面和程度的脊髓损伤患者进行尿动力学检查,其中100例患者常规测定膀胱压力容积和尿道压力图,另120例患者采用膀胱-外括约肌压同步连续测定法分别记录膀胱容量为100 ml时的逼尿肌压、反射排尿时的最大逼尿肌压、最大尿道压,并对所得结果进行统计学分析. 结果除圆锥马尾损伤组的最大尿道压(83±38)cm H2O(1 cm H2O=0.098 kPa)和动态逼尿肌压(12±10)cm H2O低于其他各组,其差异有显著意义(t＝2.096～2.656,P<0.05)外,不同损伤组患者膀胱顺应性降低的发生率相似(分别为51.2%,52.4%和50%);同组不同损伤程度患者间各项参数比较差异无显著意义(t＝1.023,P>0.05).120例患者根据膀胱-外括约肌压同步连续测定法记录尿道压曲线发现,其曲线形状大致可分为4型. 结论除圆锥马尾损伤组的最大尿道压和动态逼尿肌压低于其他各组外,其他参数与损伤平面和损伤程度无关.圆锥马尾损伤组多为不完全性损伤,故而逼尿肌括约肌协同失调的发生率较低.尿道压力曲线的表现与外括约肌和尿道周围横纹肌活动有关.     

动态尿动力学与常规尿动力学检查评估女性压力性尿失禁的对比研究

目的 比较常规尿动力学(CUD)和动态尿动力学检查(AUM)对女性压力性尿失禁(SUI)患者膀胱尿道功能异常检出率及尿动力学参数,探讨AUM在评估女性SUI中的应用价值.方法 随机选取门诊女性SUI患者30例.年龄32 ～ 63岁,平均(49.4±9.4)岁.病程1～9年,平均(4.7±2.8)年.行尿失禁问卷表简表(ICI-Q-SF)问卷调查,根据ICI-Q-SF评分将患者分为轻、中、重3组,其中轻度尿失禁9例、中度15例、重度6例.行CUD检查和3个周期的AUM检查,分别记录并进行比较. 结果 30例患者AUM的SUI和逼尿肌过度活动(D0)检出率分别为90％和37％,明显高于CUD的70％和10％(P ＜0.05).对ICI-Q-SF评分为中、重度尿失禁且AUM与CUD同时检出SUI(伴或不伴急迫性尿失禁)的21例患者尿动力学参数进行比较发现,AUM组患者的腹压漏尿点压(ALPP)和排尿量显著低于CUD组(P＜0.05),逼尿肌压力显著高于CUD组(P＜0.05). 结论 AUM较CUD能更容易监测到患者SUI和DO的发生,SUI阳性率增高可能与AUM组患者ALPP值偏低有关.对于有临床症状而CUD检查未见明显异常的患者,可以进一步行AUM检查,降低SUI和DO的漏诊率.     

尿动力学检查对女性压力性尿失禁手术的意义

目的 探讨尿动力学检查对女性压力性尿失禁(SUI)手术治疗的指导价值。方法 16例SUI，尿失禁临床分度：Ⅱ度7例，Ⅲ度9例。根据尿动力学检查：Ⅲ型SUI6例，其中施行改良Gittes术2例，施行M—M—K术加阴道后壁修补1例，施行带涤纶片Sling术3例。混合型(Ⅲ型／Ⅱ型)SUI8例；Ⅱ型或Ⅰ型SUI2例，此10例皆行改良Gittes术。结果 全部病例皆得到随访，随访时间8～40个月，平均31个月。施行M—M—K术加阴道后壁修补1例和施行Sling手术者3例，无复发。施行改良Gittes术者12例，有3例(Ⅲ型1例，混合型2例)于1年左右复发(复发率为25％)，其余无复发。结论 尿动力学检查对SUI的诊断术式选择有指导意义。     

间质性膀胱炎尿动力学检查及其临床意义

有关间质性膀胱炎（interstitial cys- titis,IC）尿动力学研究很少,其价值有待进一步评估。我们对23例IC进行尿动力学检查,现报告如下。     

尿动力学检查在女性压力性尿失禁诊治中的价值(附20例报告)

目的 探讨尿动力学检查对女性压力性尿失禁(SUI)诊断中的价值。方法 对20例SUI，进行全面的尿动力学检查(包括应力性漏尿点压力测定)。20例中不稳定膀胱者6例(30％)。Ⅲ型7例，混合型(Ⅲ型／Ⅱ型)10例，Ⅱ型3例。16例行手术治疗，其中改良Gittes术12例，带涤纶片吊带术3例，MMK术加阴道后壁修补1例。结果 16例手术患者随访8～40个月，平均31个月。MMK术加阴道后壁修补1例和吊带手术者3例均无复发。改良Gittes术12例中3例(Ⅲ型1例，混合型2例)于1年左右复发。结论 尿动力学检查有助于SUI的诊断和鉴别诊断，对SUI的术式选择有指导意义。     

从尿动力学角度谈女性尿失禁

从尿动力学角度谈女性尿失禁张时纯尿失禁是一个困扰病人影响生活质量的常见疾病，据估计美国约有１２００万人患有尿失禁，每年耗资１００亿美元。老年妇女尤为多见。近来由于尿动力学的进步，对女性尿失禁的发病机理与治疗原则有了一些新的认识，介绍于下。一、女性尿失...     

超声尿动力学检查对女性压力性尿失禁行TVT-O手术的指导价值

目的 探讨超声尿动力学检查对女性压力性尿失禁(SUI)的诊断价值及其对经闭孔阴道无张力吊带术(TVT-O)手术的指导价值.方法 对41例SUI患者行超声尿动力学检查,重点了解膀胱尿道连接部活动度( UVJ-M)及腹压漏尿点压力(ALPP),并据此对SUI进行分型,再结合尿失禁临床分度以决定行TVT-O手术.结果 A型,UVJ-M≤l.5cm,ALPP ＞55cmH2O,7例;B型,UVJ-M＞1.5cm,ALPP＞55 cmH2O,11例;C型,UVJ-M≤1.5cm,ALPP≤55cmH2O,10例;D型,UVJ-M＞1.5cm,ALPP≤55cmH2O,13例;其中B型中的Ⅱ度、C型和D型患者共26例行TVT-O手术治疗.术后随访时间3～ 29个月,平均11个月.拔管后除2例重度咳嗽时有漏尿现象外,其余皆尿失禁消失,无一例复发.结论 超声尿动力学检查对SUI患者选择TVT-O手术有客观的针对性,具有重要的指导价值.     

动态尿动力学检查的临床应用

传统尿动力学检查在评估下尿路功能具有重要意义 ,然而其结果的准确性受到各种因素的影响。动态尿动力学检查 (AUM)受精神因素影响较小 ,有一定的优越性。本文就其应用现状作一综述。     

Psychometric validation of the Japanese version of the International Consultation on Incontinence Questionnaire-Short Form

Objective:   To evaluate the psychometric properties of the Japanese version of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).
Methods:   Two study samples of 180 patients with urinary incontinence were used for this psychometric evaluation. Analyses were carried out to examine the instrument's reliability and validity, as well as its responsiveness to change.
Results:   For the ICIQ-SF items and total scores, there was no particular floor or ceiling effect. The internal consistency was sufficiently high, with a Cronbach's alpha coefficient of 0.78. In the analysis of test-retest reliability, high correlations were observed, with Kappa coefficients of 0.61 for item 1 and 0.62 for item 2, and with intra-class correlation coefficients of 0.90 for item 3 and 0.91 for the total score. For the concurrent validity, the ICIQ-SF scores were moderately to highly correlated with most of the King's Health Questionnaire (KHQ) subscales. When the severity groups, divided in quartiles, were compared with respect to the 1-h pad test and the number of daily incontinence episodes, there seemed to be linear trends in most of the ICIQ-SF scores. For responsiveness, changes in the ICIQ-SF after treatment demonstrated statistically significant correlations of more than 0.5 with changes in some of the KHQ subscale scores. All of the ICIQ-SF items and total scores significantly decreased after treatment.
Conclusions:   The Japanese version of the ICIQ-SF is a reliable, valid and responsive measure that performs well among patients with urinary incontinence.     

Correlations between the ICIQ-SF score and urodynamic findings

AIMS: The primary aim of this prospective study was to examine the correlations between "The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)" score and urodynamic findings in patients with urge incontinence. In addition, we aimed to observe the alterations of these parameters with antimuscarinic therapy. METHODS: Between January and December 2005, patients referred to our department with urge incontinence were examined. After taking a detailed clinical history, physical examination, and urinalysis, each patient was asked to complete an ICIQ-SF questionnaire. We carried out subtracted cystometry according to a fixed protocol on all patients. Patients who were defined as detrusor overactivity incontinent were given antimuscarinic therapy for 3 months. Following treatment, filling cystometry and ICIQ-SF scoring were repeated in all patients. All pre- and post-treatment data of 18 male and 42 female patients were transferred to the SPSS 11.0 for Windows program, and statistical analyses were performed. RESULTS: The patients' ages ranged from 28 to 70 (mean 49.8) years. We found statistically significant differences between the pre- and post-treatment parameters (mean ICIQ-SF score, first sensation, cystometric capacity, maximum detrusor pressure, compliance; P<0.01). We found negative correlation between pre-treatment mean ICIQ-SF score and first sensation (correlation coefficient -0.266, P<0.05) and positive correlation between pre-treatment mean ICIQ-SF score and maximum detrusor pressure (correlation coefficient 0.4, P<0.01). CONCLUSIONS: ICIQ-SF scoring is a practical and reliable method for baseline and post-treatment evaluation of patients with urge incontinence. Significant correlation exists between ICIQ-SF score and urodynamic parameters.     

压力性尿失禁患者的尿流动力学研究

目的　了解压力性尿失禁患者的尿流动力学特点,为明确诊断及合理治疗提供参考。方法　对临床诊断为压力性尿失禁的30例患者进行系统尿流动力学研究,并与正常对照组(30 例)比较。结果　两组最大尿流率分别为(30.12±9.81)mL/s、(18.70±8.31)mL/s,平均尿流率分别为(15. 18±7. 22) mL/s、(12. 30±7. 21) mL/s,初感容量分别为(175. 20±57. 34) mL、(165.70±40.65)mL,强烈尿感容量分别为(354.83±52.83)mL、(339.20±50.84)mL,最大尿道闭合压分别为(84.93 ±45.81)cm H2O、(110.23±32.26)cm H2O,压力性尿失禁组测得Valsalva漏尿点压力(73.70±22.61) cm H2O,出现异常尿流曲线7例(23.3%),残余尿 10 例(33. 3%),合并逼尿肌不稳定性收缩 3 例(10%),肌电图协同失调 5 例(16. 7%),正常对照组均无。结论　压力性尿失禁患者是一个复杂的群体,尿流动力学检查对于明确其诊断,选择正确的治疗方法,提高治疗效果有着重要意义。     

Validation of the short forms of the incontinence impact questionnaire (IIQ-7) and the urogenital distress inventory (UDI-6) in a Turkish population

AIM: To validate the Turkish versions of the IIQ-7 and UDI-6 for use in Turkish-speaking populations. METHODS: After establishing the test-retest reliability and internal consistency in a pilot study, 302 patients were enrolled in the study and general and subscale scores of the questionnaires were calculated. All participants underwent an urodynamic assessment. RESULTS: Both instruments showed a high internal consistency (Cronbach's alpha for the IIQ-7 and UDI-6 was 0.87 and 0.74, respectively) and test-retest reliability (Spearman's rho was 0.99 for both of the scales (P < 0.001). 55.6% of the participants showed urodynamic abnormality and/or leakage. 39.7% had urodynamic stress incontinence (USI) and 15.9% had detrussor overactivity (DOA) +/- USI. The mean scores of each IIQ-7 and UDI-6 were significantly higher in the USI, and DOA +/- USI groups compared with normal women. Women with DOA +/- USI scored highest in the IIQ-7 and UDI-6. The irritative subscale scores of the 1st and 2nd items of the UDI-6 were significantly higher in the DOA +/- USI group. The stress subscale scores of 3rd and 4th items of UDI-6 were significantly higher in the USI group. Women with postvoid residual (PVR) urine values greater than 50 ml had significantly higher obstructive subscale scores compared to the ones who had less residual volumes. CONCLUSIONS: The Turkish translated versions of the IIQ-7 and UDI-6 are reliable, consistent and valid instruments for assessing symptom severity and the impact on QOL in Turkish speaking women with urinary incontinence.