重复尿道并泌尿生殖系多发畸形1例报告及文献复习

目的 探讨女性重复尿道并泌尿生殖系多发畸形的临床特征及诊治方法.方法 总结1例女性重复尿道并泌尿生殖系多发畸形的临床资料.检索Pubmed和CNKI数据库相关文献进行复习.结果 病例系临床罕见多系统、器官合并畸形,因生殖器官发育差,诊断欠明确,定期随访.榆索结果表明相似文献报道少见,并多合并其他泌尿生殖系畸形.结论 女性尿道重复在泌尿系畸形中比较罕见.诊断时详尽的体格检查至关重要,在此基础上行针对性辅助检查,检查应以无创检查为主.根据解剖情况及临床表现行相应的治疗.     

膀胱癌患者血红细胞铜锌超氧化物歧化酶活性测定

本文采用邻苯三酚比色法测定20例膀胱癌、7例泌尿生殖系非膀胱肿瘤、20例泌尿生殖系非肿瘤患者和20例健康人血红细胞CaZn-SOD的活性。结果膀胱癌组红细胞CuZn-SOD活性明显低于健康人组和泌尿生殖系非肿增疾病组,其差异有显著性意义(P<0.01)。泌尿生殖系非膀胱肿瘤组中,肾癌患者红细胞CuZn-SOD活性值与健康人有重叠;前列腺癌患者与膀胱癌组中的高值接近;阴茎癌与睾丸癌则与膀胱癌组中的低值相近。若以CuZn-SOD活性值低于929.09u/gHb为诊断标准,则膀胱癌组低于此值的为70％(14例),而健康人组和泌尿生殖系非肿瘤疾患组中无一例低于此标准值。认为可将红细胞CuZn-SOD活性测定作为膀胱癌的一个辅助诊断指标。本文还探讨了CuZn-SOD活性变化的有关临床用途。     

掌握好膀胱镜检查技术

膀胱镜检查是诊断泌尿生殖系疾患的重要方法，泌尿外科医师一般都能熟练掌握。但对初学者说来，还应学习这种检查的基础知识，并积累膀胱镜检查的经验。一、膀胱镜的结构过去膀胱镜的光源来自镜鞘前端内腔的小型钨丝灯泡。镜鞘顶部有一金属小帽，约长１５ｃｍ。小帽内装...     

泌尿生殖系真菌病

近几年来,随着肾移植、糖尿病和导管的使用增多,以及使用强免疫抑制剂使病人存活时间延长,泌尿生殖系真菌病逐渐增多。文献报道在有明确的尿路感染时真菌感染占2%,医源性尿路感染时占11%,败血症时占1.9%。感染途径为全身性真菌病血行播散或尿路上行感染.本病症状无特殊性,依其侵犯的泌尿生殖系部位而异。在泌尿生殖系中,肾真菌病最多见,其次为前列腺和附睾丸。     

泌尿男生殖系统损伤

收到150多篇有关泌尿生殖系损伤方面的文章，从内容可以看出，对于泌尿生殖系损伤的发生、处理较以前有了一些变化。     

《泌尿和男子生殖系创伤》出版

郭应禄任名誉主编、李炎唐主编的《泌尿和男子生殖系创伤》一书于 2 0 0 3年 5月由人民军医出版社出版。全书共分 8章 ,从肾脏损伤、输尿管损伤、膀胱损伤、阴茎损伤、阴茎和阴囊内容物损伤、小儿泌尿生殖学的创伤治疗及泌尿生殖系战伤的处理等方面介绍了泌尿及男子生殖系创伤的原因、临床症状、体征、诊断及治疗措施 ;内容新颖 ,图文并茂 ,重视理论与实践的结合 ,参考了大量文献 ,具有较强的科学性和实用性。定价 2 8元 ,由全国新华书店发行。《泌尿和男子生殖系创伤》出版@李炎唐     

泌尿生殖系平滑肌肿瘤15例临床分析

目的：探讨泌尿生殖系平滑肌肿瘤临床表现，提高对其诊治水平。方法：对15例泌尿生殖系平滑肌肿瘤的临床资料进行回顾性分析，其中平滑肌瘤13例，平滑肌肉瘤1例，混合性平滑肌瘤1例（并发移行细胞癌），分别位于肾、输尿管、膀胱、尿道、附睾。肿瘤均手术切除，并经病理检查证实。结果：15例均获随访，13例平滑肌瘤术后无复发，1例平滑肌肉瘤术后16年无瘤生存，1例混合性平滑肌瘤至截稿时为术后2个月。结论：泌尿生殖系平滑肌肿瘤发生率低，以附睾多发，缺少临床特征，术前确诊困难，主要靠病理检查确诊。手术切除是治疗平滑肌肿瘤最佳方法。     

膀胱白斑的临床诊断

目的:探讨膀胱白斑的临床特点及诊断方法,提高诊断水平。方法:分析160例膀胱白斑患者的临床资料。结果:诊断膀胱白斑160例,其中增生型147例,增生、萎缩混合型11例,萎缩型2例。患者膀胱镜检、病理检查、电子显微镜检查可见特征性病理改变。结论:膀胱白斑发病率明显高于文献报道,及时对有间断尿频、尿急、尿痛、血尿、下腹部不适、疼痛的患者进行膀胱镜检,病灶活检是早期发现和诊断膀胱白斑的有效方法。电子显微镜检查可进一步了解病变特点,指导临床诊断治疗。     

泌尿生殖系神经鞘瘤(附7例报告)

目的:探讨泌尿生殖系神经鞘瘤的临床、影像学及病理特点。方法:回顾性分析1994～2004年7例泌尿生殖系神经鞘瘤患者的临床资料,包括肾上腺、膀胱、前列腺、精索、阴囊及阴茎的神经鞘瘤,结合文献分析其特点。结果:患者平均年龄42岁,均为偶然发现或体检时发现,通过病理检查确诊。随访2～6年,7例患者肿瘤均经手术切除,病理证实6例良性,无复发;1例恶性睾丸神经鞘瘤,2年后死于肿瘤复发转移。结论:手术切除是目前治疗泌尿生殖系统神经鞘瘤的方法,由于泌尿生殖系神经鞘瘤缺乏典型的临床表现,临床诊断困难,确诊需经病理学诊断。肿瘤特异性标志物S100,Leu7及MBP有助于该病的诊断。     

侵及泌尿生殖系的恶性淋巴瘤

恶性淋巴瘤通常起始于淋巴结,但它可影响到机体几乎所有的器官。曾报导非何杰金氏淋巴瘤影响到泌尿生殖系较多,常为弥散性的肾实质浸润。局限于泌尿道的何杰金氏病报导较少。Watson等在383例何杰金氏病中发现仅5例有各种泌尿生殖系改变。作者回顾了1068例恶性淋巴瘤患者,包括各期淋巴瘤及很多局限性病变者。其中仅72例(6.74％)在尸检,放射照相或手术时有各种与淋巴瘤相关的泌尿系改变。在400例何杰金氏病中有23例(5.8％)、而668例非何杰金氏淋巴瘤中49例(7.3％)在病程的某     

Current and future treatments in multiple system atrophy

Multiple system atrophy (MSA) is an atypical parkinsonian disorder characterized clinically by the development of parkinsonism, autonomic dysfunction, corticospinal degeneration, and cerebellar abnormalities. The cause of MSA is unknown, and progression is usually faster than idiopathic Parkinson's disease. No treatment is currently available to prevent or slow the progression of this neurodegenerative disorder. Available treatments are primarily symptomatic. This article reviews the current treatment options available for MSA in addition to emerging therapies in neuroprotection and neurotransplantation. Research into the neuropathology of MSA is being conducted and could lead to new more effective treatments within the next decade. The management for this disorder currently includes symptomatic and palliative strategies, as well as family education and support; the ultimate goal is to improve the quality of life for patients and their caregivers.     

Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study

Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by parkinsonism and cerebellar, autonomic, urinary, and/or pyramidal dysfunction. Urinary and erectile dysfunction (ED) symptoms are prominent early features in men with MSA. Autonomic failure, considered until recently to be the cause of ED in these men, is commonly expressed through symptoms of orthostatic hypotension (OH). The aim of this retrospective study is to examine the chronological relationship between the development of urogenital symptoms and those of OH in patients diagnosed with MSA and discuss its significance in the aetiology of ED in these patients. A total of 71 male patients, referred to a Uro-Neurology department with a diagnosis of 'probable MSA', were reviewed in terms of 'autonomic' symptoms only--OH and lower urinary tract symptoms, accompanied by ED--present at the time of their referral. Laboratory investigations including anal sphincter EMG and/or autonomic function tests (AFTs) were performed in 75 and 90% of the patients, respectively. At presentation, urinary complaints were recorded in 96% of patients and ED in all patients that this was inquired about. The onset of ED had preceded the onset of bladder symptoms in 58% and the onset of OH symptoms in 91% of these men. Bladder symptoms also preceded symptoms of OH in 76% of patients. Sphincter EMG was abnormal in 91% and AFTs in 77% of the patients tested. Almost all patients with abnormal EMG had troublesome urinary symptoms. AFTs showed similar sensitivity relating to symptoms. At presentation, urogenital symptoms are common in patients with probable MSA and are often not accompanied by symptoms of OH. The earlier occurrence of ED in men with MSA suggests a lack of a causal relationship to hypotension. The notion that MSA possibly affects the dopaminergic mechanism of erectile function is discussed.     

Urinary and erectile dysfunction in multiple system atrophy (MSA)

Multiple system atrophy (MSA) is a neurodegenerative disease of undetermined etiology that occurs sporadically and manifests itself as a combination of parkinsonian, autonomic, cerebellar, and pyramidal signs. Despite the lack of effective therapies, some of the symptoms may be, at least temporarily, improved with adequate symptomatic therapies. Urinary and erectile dysfunction (ED) symptoms are prominent early features in male MSA patients. Lower urinary tract infections (UTIs) are a major cause of morbidity and mortality in this disorder. More than 50% of MSA patients suffer from recurrent lower UTIs and a significant number (approximately 25%) die of complications related to them. Urogenital symptoms in MSA are usually due to a complex mixture of central and peripheral nervous abnormalities, sometimes superimposed on previous local pathological conditions such as benign prostatic hyperplasia and perineal laxity. There have been instances were MSA-related urological symptoms were confused with symptoms of benign prostatic hyperplasia, leading to unnecessary urological surgery. In this review, we present the phenotypic range and therapeutic approaches for common storage and voiding urological symptoms and ED, in patients with MSA.     

Urinary disturbance in olivopontocerebellar atrophy (OPCA)--changes during the progression of the disease]

PURPOSE: Among spinocerebellar degeneration, syndromes categorized as multiple system atrophy (MSA) are commonly associated with neurogenic bladder, and urinary disturbances change with the disease progression. Accordingly, the changes in the urodynamic findings during the progression of the disease have been studied in the case of Olivopontocerebellar atrophy (OPCA) and OPCA type of MSA. METHODS: Urodynamic study (UDS) was performed more than twice in eight patients (5 males, 3 females, age 48-76, mean 55.0). The interval range between the first examination and follow up examination was 9-93 months (mean 42.4). UDS included cystogram, intravenous pyelography, residual urine volume, cystometry, urethral pressure profilometry, and external sphincter electromyography. RESULTS: The bladder was deformed in almost all patients with the progression of the disease, but the upper urinary tract was properly preserved. Residual urine volume tended to increase, and residual urine rate worsened significantly. The stable detrusor activity seemed to become overactive accompanied by detorusor hyperreflexia, and finally seemed to be acontractile. The normal sphincter activity seemed to become overactive accompanied by detrusor-sphincter dyssynergia, and finally complete relaxation could't be observed. CONCLUSION: These results suggest that urinary disturbance deteriorates together with other neuropathies as the disease progresses in OPCA. These patients should be continuously observed along with proper urinary management depending on the disease progression.     

The value of urethral sphincter electromyography in the differential diagnosis of parkinsonism

A series of 54 patients presenting with parkinsonism underwent clinical assessment and urethral sphincter electromyography (EMG). After clinical assessment, 26 were thought to be suffering from probable multiple system atrophy (MSA), 15 were thought to have possible MSA and 13 were diagnosed as having probable idiopathic Parkinson's disease (IPD). Of those with probable MSA, 16 were found to have an abnormal urethral sphincter EMG. In the group with possible MSA, only 5 patients had an abnormal EMG while in the group with probable IPD, only 1 patient had an abnormal EMG. It was concluded that urethral sphincter electromyography provides a useful method of distinguishing between idiopathic Parkinson's disease and multiple system atrophy. It also provides a means of identifying those patients with parkinsonism whose incontinence may well be worsened, or in whom incontinence may develop following lower urinary tract surgery.     

Micturition disorder as a sequela of sacral autonomic diabetic neuropathy

Diabetic neuropathy may manifest itself also in the autonomous nervous system and thus lead to a functional disorder of the urinary bladder. Urodynamic studies carried out in 11 diabetic patients with unclear bladder dysfunction allowed 2 forms of bladder anomalies to be identified: 1. detrusor hyperreflexia, 2. hyporeflexia and areflexia of the detrusor. Whereas hyperreflexia is clinically characterised by signs of motor urgency, hyporeflexia is mainly identifiable by residual urine formation and recurrent infections of the urinary tract. Therapy depends on the type of dysfunction and consists of physiotherapeutic measures, drug therapy and occasionally surgery.     

Ultrastrukturelle Veränderungen der Altersblase

Recent prospective, comparative ultrastructural/urodynamic studies on geriatric voiding dysfunction, including its natural evolution, have revealed that abnormalities of detrusor behavior have specific correlates in detrusor microstructure represented by distinctive electron-microscopic patterns. Each electron-microscopic pattern comprises a constellation of features in two or all three tissue compartments of the detrusor (smooth muscle, interstitium, intrinsic nerves). The pattern characteristic of each dysfunction is the same in detrusors of men and women. The electron-microscopic patterns are additive when multiple abnormalities coexist. All distinctive patterns of various clinical voiding dysfunctions can readily be defined qualitatively in endoscopic biopsies of the detrusor. These observations, including those on material studied for the natural evolution of geriatric voiding dysfunction, have led to the proposal of a clinical/structural definition of the normal aging detrusor and the development of an algorithm for pathologic diagnosis of geriatric voiding dysfunction.     

Sleep Dysfunction in Multiple System Atrophy

OPINION STATEMENT: Sleep disorders in multiple system atrophy (MSA) are common manifestation and include reduced and fragmented sleep, excessive daytime sleepiness, REM sleep behaviour disorder (RBD), and sleep-disordered breathing. Of these, RBD is the most common (affecting 90?%-100?% of patients with MSA) and is regarded as a red flag for MSA. RBD, as well as stridor during sleep, may be the initial manifestation of the disease, occurring several years before the waking motor and dysautonomic onset. Sleep disorders occur in both MSA with predominant parkinsonism (MSA-P) and MSA with predominant cerebellar ataxia (MSA-C). Treatment strategies in patients with MSA presenting difficulties in initiating and maintaining sleep need to be highly individualized. Clonazepam has been found to be successful in treating RBD symptoms at the dose of 0.25 to 2.0?mg given approximately 30?min before bedtime. In case of comorbid obstructive sleep apnea, zopiclone (at the dose from 3.75 to 7.5?mg each night) or melatonin (with a recommended dose of 3 to 12?mg at bedtime) may be alternative treatments. An increased survival in MSA patients with stridor may be obtained both with continuous positive airway pressure (CPAP) and tracheostomy. Since tracheostomy is an invasive surgical procedure, not easily accepted by the patient, CPAP therapy should be considered first. However, tracheostomy is first indicated when stridor is present during wakefulness because of the high risk of respiratory failure and death. In MSA, obstructive sleep apnea (OSA) occurs more frequently than central sleep apnea, ranging from 15?% to 37?% of the cases. CPAP is an effective treatment for eliminating obstructive sleep apnea in MSA patients, even if the adaptation to the device may be difficult in advanced cases.     

The urodynamic aspects of the Guillain-Barré syndrome

A total of 7 patients with the Guillain-Barré syndrome and voiding dysfunction, large post-voiding residuals or urinary retention underwent urodynamic evaluation. Of the patients 4 had detrusor areflexia with a positive bethanechol supersensitivity test, including 3 with electromyographic evidence suggestive of neuropathy. This is the expected pattern in the Guillain-Barré syndrome. However, 3 patients had detrusor hyperreflexia with appropriate sphincteric relaxation, which was associated with Babinski's sign in 2. The presence of detrusor hyperreflexia suggests the possibility of Guillain-Barré pathological conditions involving the central nervous system, although the Guillain-Barré syndrome typically is a disease of the peripheral nervous system. Long-term urodynamic studies may help clarify such issues in future patients.     

Micturitional Reflexes in Chronic Spinalized Cats: The Underactive Detrusor and Detrusor-Sphincter Dyssynergia

We studied micturitional reflexes in 46 unanesthetized adult male cats spinalized at C5-C6 17 to 125 days previously and in eight intact central nervous system chloralosed cats that were used as controls. Urethral pressure profiles, cystosphincterograms with the urethrovesical junction opened and closed, and mechanograms of detrusor and circular and longitudinal urethral muscles were performed. The effect of vesical, urethral, pelvic, or pudendal anesthesia and vesical and urethral mechanical stimulation were studied. Our results suggest that spinalization produces two major types of neurourologic disorders: (1) weakness of detrusor contractor reflexes (vesicovesical and urethrovesical contraction reflexes) and (2) exaggeration of urethral contractor reflexes (urethrourethral contraction reflex, guarding reflex). Secondarily the weakness of detrusor contractions diminishes the efficiency of the urethral reflex relaxation needed for voiding (vesicourethral relaxation reflex). Because of these abnormalities, two main syndromes appear: (1) underactive detrusor function and (2) detrusor sphincter dyssynergia. Isolated peripheral manipulations of the bladder or urethra do not improve micturition: (1) increase in detrusor contraction strength induces detrusor sphincter dyssynergia, and (2) relaxation of the external sphincter facilitates voiding, but urinary retention persists. It is proposed that spinalization produces a central micturitional dysreflexia responsible for the peripheral dysfunction, and treatment must be oriented toward the central dysreflexia rather than the peripheral dysfunction.