女性排尿功能障碍尿动力学检查60例分析

目的探讨女性排尿功能障碍的尿动力学特点和临床意义。方法60例女性患者,年龄19~66岁,平均49岁。其中排尿困难者17例,尿失禁者28例,尿路刺激症状者15例。均行完全性膀胱测压(Micture)检测。结果17例排尿困难者中,1例最大尿流率时逼尿肌压力(Pdet.Qmax)为0,16例为10~135cmH2O,A/G图显示梗阻者11例,A/G值>40者10例。28例尿失禁中,压力性尿失禁18例,Ⅰ型1例,Ⅱ型3例,Ⅱ/Ⅲ型8例,Ⅲ型6例。急迫性尿失禁4例,混合性尿失禁1例,反射性尿失禁3例,充溢性尿失禁2例。15例尿路刺激症状中,逼尿肌不稳定收缩6例。尿动力检查正常者2例。结论尿动力学检查对女性排尿功能障碍疾病的诊断和治疗具有重要意义。     

排尿功能障碍性疾病及尿动力学

收到论文共190篇，其中大会交流3篇，分会场交流36篇，展板交流15篇，书面交流136篇。内容涉及尿动力学理论、基础研究、尿动力学检查方法、新技术新业务等方面。对压力性尿失禁、BPH、神经原性膀胱尿道功能障碍、糖尿病、女性排尿功能障碍、手术前后尿动力学研究等进行了深入探讨。     

尿动力学及排尿功能障碍诊疗新进展研讨学习班通知

为了推广尿动力学新技术的规范化，推广尿失禁诊断治疗新技术的临床应用，华中科技大学同济医学院附属同济医院泌尿外科将于2007年6月6～9日在武汉举办一期尿动力学新技术及尿失禁诊疗新进展研讨学习班。将聘请该领域著名教授和权威专家以专题讲座和现场演示相结合的形式，介绍有关尿动力学检查（含影像尿动力学）的基本原理及操作规范、排尿功能障碍诊疗的最新进展（包括女性压力性尿失禁的手术操作技巧等），并授予国家级Ⅰ类继续教育学分10分。本期拟招收学员20名。     

尿动力学检查在儿童排尿障碍中的应用

<正> 近年来,膀胱尿道测压正逐渐应用于小儿,以了解小儿的下尿路功能,为某些疾病如小儿尿失禁,可凝的膀胱出口梗阻和神经源性膀胱,伴有输尿管返流的上尿路积水,慢性和反复发作的尿路感染等的诊断及鉴别诊断提出新方法,同时可以评估药物和外科手术治疗的疗效。我们对2002年3月～2002年12月32例排尿功能障碍的儿童患者进行尿动力学检查,为临床诊断提供客观诊断依据,现报告如下。 1 资料和方法 1.1 临床资料:选择2002年3月～2002年12月本院因排尿功能障碍行尿动力学检查的32例患儿。男17例,女15例,年龄4月～14岁。采用Dantec公司的Logic四导程尿动力     

影像尿动力学在下尿路排尿功能障碍中的应用进展

正影像尿动力学检查(video urodynamic study,VUDS)是在普通尿动力学测定膀胱压力和记录尿动力学参数的基础上,同时显示膀胱和尿道的X线形态变化,为临床诊断和治疗提供依据。对于复杂膀胱尿道功能障碍、下尿路梗阻及压力性尿失禁等疾病,特别是当患者合并解剖异常时,影像尿动力学检查可更准确的反映下尿路潜在的病理     

排尿功能障碍致上尿路损害的机制及防治策略

排尿功能障碍导致的上尿路损害在泌尿外科临床常见,严重威胁患者生命。尿动力学研究发现3．92kPa（1cmH2O=0．098kPa）是上尿路损害的膀胱压临界值,达到或超过安全压仍继续储尿是导致上尿路损害的最重要原因。因此,无论采用何种治疗手段,将膀胱压降至安全压以下,在安全容量前排空膀胱是保护上尿路的根本原则。     

小儿尿动力学检查的特殊问题

小儿排尿功能障碍多见.尿动力学检查是确定逼尿肌和尿道括约肌功能及其协调关系必不可少的检查手段.注意小儿尿动力学检查的特殊性和采取相应措施后,小儿尿动力学检查也能取得满意检查结果.小儿尿动力学检查前准备、检查过程、结果分析等方面均有特殊性.这些特殊性与小儿膀胱处于逐渐发育完善过程,许多尿动力学参数的大小与尿龄大小有关.儿童排尿功能障碍分类除了采用国际尿控协会的分类外,常采用病因分类.     

同济医院第七届尿动力学及排尿功能障碍诊疗新进展学习班通知

由华中科技大学同济医学院附属同济医院泌尿外科主办的第七届尿动力学及排尿功能障碍诊疗新进展学习班拟定于2010年3月19-21日在武汉市同济医院开班授课。期间将聘请该领域著名教授和权威专家以专题讲座和现场演示相结合的形式，介绍有关尿动力学检查的基本原理、操作规范和排尿功能障碍诊断治疗的最新进展。     

前列腺增生术后排尿障碍尿动力学检查

目的 分析前列腺增生术后排尿困难的原因,为预防和治疗提供依据。方法 对38例前列腺增生术后仍有排尿障碍的患者,进行全套尿动力学检查。结果 膀胱逼尿肌功能紊乱10例,尿道狭窄9例,膀胱出口梗阻18例。结论 通尿肌功能紊乱、尿道狭窄是引起术后症状无改善的主要原因。尿动力学检查对术前合理选择病例,术后分析症状原因具有重要价值。     

老年男性脑卒中后排尿异常尿动力学检查分析

目的：探讨60岁以上老年男性脑卒中后排尿异常的尿动力学改变。方法：选择50例脑卒中后恢复期或后遗症期排尿异常老年男性患者,其中无BPH脑卒中22例,年龄（69．25±5．78）岁;有BPH脑卒中28例,年龄（71．49±7．65）岁;另选择20例无下尿路异常的正常老年男性[（70．63±6．52）岁]作为对照组,分别进行尿动力学检查,并对各种尿动力学参数进行统计分析。结果：无BPH和有BPH脑卒中组比较,最大尿流率时逼尿肌压为（4．54±0．80）VS．（5．34±0．97）kPa（1cmH2O=0．098kPa）,最大尿道闭合压为（5．45±0．55）VS．（6．99±1．05）kPa,剩余尿量为（9．0±3．4）VS．（12．9±5．3）ml,差异有统计学意义（P〈0．05）。与正常老年组比较,无BPH和有BPH脑卒中组逼尿肌反射亢进发生率均显著增加[72．7％（16／22）VS．75％（21／28）VS．10．0％（2／20）],其最大膀胱容量明显减少[（298．8±112．6）VS．（276．5±132．21）VS．（478．6±92．6）ml]。结论：脑卒中后排尿异常应进行尿动力学检查。有BPH脑卒中患者逼尿肌排尿压、尿道闭合压和剩余尿量变化较无BPH脑卒中患者更为明显,提示应同时治疗BPH。     

脊髓损伤排尿功能障碍患者的尿动力学分析

目的 了解不同节段脊髓损伤后膀胱尿道功能障碍的差异.方法 回顾性分析30例脊髓损伤患者的尿动力学资料.男22例,女8例.年龄17～74岁,平均47岁.病程7～36个月,平均18个月.其中胸腰段脊髓损伤19例,骶髓损伤11例.2组尿动力检查结果行单因素方差分析或秩和检验比较.结果 胸腰段脊髓损伤组与骶髓损伤组自由尿流率参数比较:最大自由尿流率(13.0±5.1)与(13.0±5.8)ml/s,2 s时自由尿流率(6.5±5.1)与(6.9±6.4)ml/s,平均自由尿流率(5.4±2.4)与(3.4±0.5)ml/s,自主排尿量(279.1±131.1)与(450.0±26.6)ml,残余尿量(209.5±180.7)与(434.0±215.0)ml;2组排尿量和残余尿量比较差异有统计学意义(P＜0.05).2组完全性膀胱测压参数比较:最大尿流率(16.0±23.3)与(7.1±3.3)ml/s,平均尿流率(4.6±2.3)与(3.9±2.3)ml/s,排尿后2 s的尿流率(4.6±3.1)与(2.2±3.2)ml/s,排尿量(268.4±113.9)与(129.0±97.9)ml,最大尿流率时的逼尿肌压力(58.8±22.0)与(56.5±14.5)cm H2O(1 cm H2O=0.098 kPa),逼尿肌最大压力时的尿流率(4.8±2.0)与(4.8±4.4)ml/s,逼尿肌最大压力(68.0±31.0)与(54.6±20.2)cm H2O,排尿期平均压力(47.4±20.0)与(42.6±13.9)cm H2O,2组排尿量比较差异有统计学意义(P＜0.05).2组膀胱感觉及膀胱尿道协同性差异无统计学意义(P＞0.05),胸腰段损伤患者中低顺应性膀胱(4/11)发生率较高,骶髓损伤患者中高顺应性膀胱(11/19)发生率较高.结论 骶髓损伤和胸腰段脊髓损伤患者区别主要为膀胱顺应性的差异和膀胱逼尿肌收缩能力的改变,骶髓损伤患者逼尿肌收缩能力降低、高顺应性膀胱发生率较高,胸腰段脊髓损伤患者逼尿肌收缩亢进、低顺应性膀胱发生率较高.

Abstract：

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury.Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group.There were 22 males and 8 females, aged 17 -74 ( mean, 47 ) years, with duration between 7 - 36 ( mean, 18) months.There were nineteen cases of thoracolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group.We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group.They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury.The urodynamic findings of the two groups were comparable.SPSS 16.0 was used to compare the differences between the groups by ANOVA/rank sum test.Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups.The maximum free flow rate was ( 13.0 ±5.1 ) vs ( 13.0 ±5.8) ml/s, the free flow rate at 2 s was (6.5 ±5.1 ) vs (6.9 ±6.4) ml/s, the mean free flow rate was (5.4± 2.4) vs ( 3.4 ± 0.5 ) ml/s, urine output volume was ( 279.1 ±131.1 ) vs (450.0 ± 26.6) ml and the residual urine volume was (209.5 ± 180.7 ) vs (434.0 ± 215.0) ml.The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group (P ＜ 0.05).We also measured the the cystometric parameters.The maximum urinary flow rate was (16.0±23.3) vs (7.1 ±3.3) ml/s, average flow rate was (4.6 ±2.3) vs (3.9 ± 2.3) ml/s, the flow rate after voiding 2 s was (4.6 ± 3.1 ) vs (2.2 ± 3.2) ml/s, urine output volume was (268.4 ± 113.9) vs ( 129.0 ± 97.9) ml, detrusor pressure of maximum flow rate was (58.8 ± 22.0) vs (56.5 ± 14.5) cm H2 O, flow rate of maximum detrusor pressure was (4.8 ± 2.0) vs (4.8 ± 4.4) ml/s,the maximum detrusor pressure was (68.0 ± 31.0) vs (54.6 ± 20.2) cm H2O and the average pressure of voiding period was (47.4 ±20.0) vs (42.6 ± 13.9) cm H2O.The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group ( P ＜ 0.05 ).There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group (P ＞ 0.05).The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients (4/11) was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients (11/19) was higherthan the thoracolumbar group.Conclusions The urodynamics' difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes.Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the cidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher.     

糖尿病性膀胱IPSS及影像或普通尿动力学研究

目的：评价糖尿病患者排尿异常与副尿肌行为间的关系。方法：对44例糖尿病患者进行影像或普通尿动力学检查及IPSS评价。将糖尿病性膀胱划分为逼尿肌受损型和感觉受损型。结果：17例糖尿病患者诊断为糖尿病性膀胱，27例糖尿病患者尿动力学结果正常。糖尿病性膀胱患者与尿动力学检查正常的糖尿病患者相比，尿流率中大多数参数差异具有显著性意义；主观症状评分梗阻指数显著性增高，但刺激症状指数差异无显著性意义。结论：梗阻指数升高而刺激指数无显著性升高可能是糖尿病性膀胱尿动力学的特征性改变。尽管尿流率和IPSS评价不能特异性区分逼尿肌受损情况，但为进一步进行尿动力学检查提供了有益的参考。     

下尿路排尿功能障碍患者的影像尿动力学评估

目的:研究影像尿动力学检查在下尿路排尿功能障碍患者诊断和治疗中的价值。方法:应用影像尿动力学仪检查64例下尿路排尿功能障碍患者的排尿功能情况。结果:神经原性膀胱(Neurogenic bladder,NB)28例(43.75%),女性压力性尿失禁(Stress urinary incontinence,SUI)15例(23.43%),BPH 12例(18.75%),前列腺切除术(TURP)后排尿障碍4例(6.25%),女性排尿困难5例(7.82%)。发现膀胱输尿管反流5例,膀胱小梁或憩室25例,逼尿肌尿道括约肌协同失调8例,尿道远端狭窄1例。结论:影像尿动力学检查通过同时评估膀胱尿道的功能和形态,为复杂性下尿路排尿功能障碍性疾病的临床诊断和治疗提供可靠的依据。     

Assessment of urinary symptoms in children with dysfunctional elimination syndrome

Objective This study was organized to form a symptom scale for diagnosis and assessment of urinary and bowel symptoms in children with dysfunctional elimination syndrome (DES). Methods The study group included 81 children presented to our clinic with symptoms of DES like enuresis, abnormal voiding, urinary tract infection and urgency, between January 2003 and February 2004. Age matched 102 children with no history of urological complaints were randomly recruited from a public school as control group. Children with isolated, mono-symptomatic nocturnal enuresis were not taken to the study. All children and parents were requested to fill a 35-item questionnaire related to symptoms of DES. After statistical analysis, questions from the initial form that had a P-value <0.05 and an area under curve (AUC) value >0.6 were selected to form a final scale. Results The mean ages for study and control groups were 8.7 ± 2.5 and 8.3 ± 2.2 years, respectively (P = 0.236). The final scale was composed of 15 questions. The cut-off score for the presence of DES was determined as 7.5 (sensitivity 85.2%, specificity 93.1%, AUC value = 0.943) for the total population. When only the male population were concerned the cut-off score was 4.5 (sensitivity 93.8%, specificity 78%, AUC value = 0.913) while the cut-off score for the female population was 7.5␣(sensitivity 87.7%, specificity 94.2%, AUC value = 0.953). Conclusion Providing objective assessment of symptom severity, formation of a validated scoring system for children with DES might be a good tool for diagnosis, confirmation of treatment results and follow up. It might also be useful for screening purposes.     

Female sexual dysfunction, voiding symptoms and depression: common findings in partners of men with erectile dysfunction

The aim of this study was to investigate the prevalence of female sexual dysfunction (FSD), urinary symptoms, and depressive symptoms in female partners of men presenting with erectile dysfunction (ED). A multi-component questionnaire was administered to female partners of men with erectile dysfunction presenting to a urology center. It contained a standardized sexual function component (the Brief Index of Sexual Function for Women), a depression scale (Centers for Epidemiologic Studies-Depression, CES-D), a demographics questionnaire and a general medical questionnaire. A total of 73 consecutive female partners of male patients presenting with ED, were surveyed using the questionnaire at their counterpart’s visit. Fifty-two women responded, of whom 50 filled out the questionnaire adequately for proper evaluation. This indicated a response rate of 68% (50/73). The mean age was 44.8 years (range 20.0–83.0). Thirty-eight of the 50 women (76%) reported being sexually active. A variety of sexual behaviors were reported including 40% (20/50) of women engaging in vaginal intercourse. Sexual dysfunction symptoms included: anxiety/inhibition (26%), hypoactive desire (20%), arousal/lubrication difficulty (30%), orgasmic difficulty (24%), dyspareunia (18%), incontinence during intercourse (8%), and sexual dissatisfaction (34%). Eight women (16%) reported difficulty communicating sexual issues with their partners. Forty-one women (82%) rated sexual activity as an important part of their lives. Urinary symptoms of frequency and urgency were reported by 18/50 (36%). Depressive symptoms were present in 22/50 (44%). FSD disorders, urinary symptoms and depressive symptoms are common in partners of men with erectile dysfunction.     

Development of a validated quality of life tool specific to children with bladder dysfunction

AIMS: To date there have not been any generic or continence-specific measurement tools that allow clinicians to investigate quality of life in children with bladder dysfunction. The aim of this research was to create a cross-cultural tool to assess and measure the wider psychosocial impact of current and new interventions for bladder dysfunction in children. MATERIALS AND METHODS: The study was conducted in three parts: expert consultation with continence clinicians; design and administration of a child-completed international questionnaire; item analysis, validity and reliability testing, and design of a new tool. RESULTS: The need for a pediatric incontinence QoL measure evaluation was strongly endorsed by clinicians. Data from 156 child-completed questionnaires collected in 10 countries was analyzed for item characteristics and found to be free of item correlation and ceiling and floor effects. Factor analysis revealed 2 factors, which were labeled intrinsic and extrinsic. Rasch analyses showed the internal validity of both subscales was reasonable good. Cronbach's alpha for each factor was 0.91 and 0.72. After analysis, items were selected for the new tool, PinQ, and evaluated for ambiguity, clarity, comprehension level required, choice of words and phrases, and age-appropriate concepts. Twenty-one items were finally selected and randomly positioned within the tool. CONCLUSIONS: A cross-cultural tool that quantifies the holistic effect of bladder dysfunction in children has been designed and tested for validity.     

脊髓型颈椎病患者的排尿功能障碍及术后近期效果

目的:探讨脊髓型颈椎病患者产生排尿障碍的影响因素及其术后近期的改善情况。方法:对51例脊髓型颈椎病患者的病程、首发症状、合并症进行分析,并按术前脊髓功能状况评分分组观察术前、术后排尿功能和尿流率改变。结果:51例中术前有排尿障碍者27例（529％）,术后近期症状改善19例（70.4％）;术前尿流率异常者29例（56.9％）,术后最大尿流率较术前显著增加。病程超过1年、以下肢症状起病、合并颈椎OPLL及脊髓功能评分低的患者易出现排尿障碍和尿流率异常。结论:上述因素易造成脊髓型颈椎病患者发生排尿功能障碍;术后近期其排尿功能障碍可获得显著改善。     

小儿神经源性膀胱与上尿路损害

目的：探讨脊髓发育不良致神经源性膀胱造成上尿路损害的尿动力学危险因素,方法：对32例脊髓发育不良患儿行尿动力学和影像学检查。结果：18例（56％）有肾和输尿管积水,其中4例伴IV－V级膀胱输尿管返液,19例逼尿肌漏尿点压力大于等于40cmH2O(1cmH2O=0.098kPa)且膀胱顺应性小于等于40ml/cmH2O的患儿中,17例合并上尿路损害,13例逼尿肌漏尿点压力＜40cmH2O且膀胱顺应性＞40ml/c mH2O的患儿中,仅1例有双侧输尿管扩张,差别有非常显著性意义（P＜0．001）,结论：对脊髓发育不良致神经源性膀胱的患儿应行尿动力学检查,了解逼尿肌漏尿点压力和膀胱顺应性,确定与上尿路损害有关的危险因素,有助于避免上尿路进一步损害。