膀胱出口梗阻对逼尿肌功能的影响

膀胱出口梗阻 (BOO)常常导致逼尿肌功能改变 ,依膀胱出口梗阻的程度及时间的不同 ,逼尿肌功能变化有所差别 ,但BOO导致副尿肌功能变化的病理生理及最终结果却相对一致 ,包括逼尿肌不稳定 (DI)、逼尿肌收缩功能受损和逼尿肌顺应性改变。本文综合文献 ,对BOO后逼尿肌功能改变及其机制进行综述。     

大承气汤对腹膜炎时肠功能的影响

本研究观察了大承气汤对腹膜炎时血管活性肠肽（ＶＩＰ）的影响、对肠粘膜吸收及分泌功能的影响及对空肠蠕动的影响。结果表明，大承气汤能降低腹膜炎时高水平的ＶＩＰ、促进肠液分泌、对肠吸收功能未发现有明显的作用、促进肠蠕动等作用。从而，进一步探讨了大承气汤的作用机制，为其在临床中广泛应用，提供了理论依据。     

膀胱出口梗阻对逼尿肌功能的影响

膀胱出口梗阻（BOO）常常导致逼尿肌功能改变,依膀胱出口梗阻的程度及时间的不同,逼尿肌功能变化有所差别,但BOO导致逼尿肌功能变化的病理生理及最终结果却相对一致,包括逼尿肌不稳定（DI）,逼尿肌收缩功能受损和逼尿肌顺应性改变,本文综合文献,对BOO后逼尿肌功能改变及其机制进行综述。     

膀胱出口部分梗阻对逼尿肌生物力学特性的影响

目的 探讨膀胱出口部分梗阻(P-BOO)对膀胱逼尿肌生物力学特性的影响及机制.方法 采用Wistar雄性大鼠,膀胱颈不全结扎法建立P-BOO动物模型.依据梗阻时间分为假手术组、梗阻6周组(P-B006W)及梗阻12周组(P-B0012W),其中P-B006W组根据充盈性膀胱测压所示逼尿肌是否稳定分为逼尿肌稳定组(DS)和逼尿肌不稳定组(DI).采用灌流肌槽,以拟胆碱药物(氯化氨基甲酰胆碱)作为刺激因素,用拉力传感器测定离体逼尿肌条的主动收缩功能.充盈性膀胱测压检测最大膀胱容量、膀胱漏尿点压及膀胱顺应性的变化.结果P-BOO模型均成功建立,DI组最大膀胱容量、膀胱漏尿点压、膀胱顺应性[(10.8±3.0)ml,(39.4±7.1)cm H20,(0.27±0.08)ml/cm H20]、DS组[(10.3±1.9)ml,(35.9±6.2)cm H2O,(0.29±0.05)ml/cm H2O]及P-B0012W组[(9.5±2.3)ml,(48.6±9.5)cm H20,(0.21±0.05)ml/cm H2O]均明显高于假手术组[(2.1±0.3)ml,(16.2±2.1)cm H2O,(0.13±0.03)ml/cm H2O],差异有统计学意义(P＜0.05).DI组逼尿肌条拟胆碱药物刺激产生的收缩力显著低于假手术组和DS组.P-B0012W组逼尿肌条均未检测到明确的收缩波(波幅＜0.05 g).结论 P-BOO后膀胱逼尿肌生物力学特性发生了改变:DI组逼尿肌收缩功能受损,DS组发生代偿,但如果梗阻未解除,则逼尿肌收缩性损害,最终导致不可逆的收缩功能丧失;梗阻后膀胱顺应性增大与膀胱容积显著增加密切相关,逼尿肌稳定性对其影响不显著.     

三磷酸腺苷控制性降压对血尿酸含量的影响

在10例ATP降压成年病人中测量了动脉血ATP代谢产物尿酸的浓度。结果示ATP平均用量324.5士102.25mg时,血尿酸浓度无明显变化。     

勃起神经递质血管活性肠多肽的研究进展

血管活性肠多肽(VIP)是主要的勃起神经递质之一,当阴茎勃起时VIP被释放,参与阴茎勃起调控。随着对VIP调控阴茎勃起机制不断深入的研究,VIP供体、VIP基因转导在治疗勃起功能障碍方面将有巨大的临床应用前景。     

血管活性肠肽(VIP)对单碘醋酸钠诱发关节炎的影响

关节炎性疾病有一个共同的特征就是白细胞迁移到关节滑膜组织.白细胞和滑膜细胞产生各种炎症介质,引起持久的慢性炎症和组织损伤.关节腔内注射单碘醋酸钠,可以诱发关节炎.研究发现血管活性肠肽(VIP)能抑制多种细胞因子的合成与分泌,但VIP在关节炎症中的作用尚不清楚.本研究的目的是要观察VIP对单碘醋酸钠引起关节炎模型及诱发疼痛的影响.研究结果表明10-9摩尔VIP注射入膝关节,可以缓解关节痛觉过敏,延长后肢缩爪反射的潜伏期,增加对刺激足底表面机械压力的耐受.关节腔内注射VIP可导致重量重新分布,减轻因疼痛所致的身体重量偏斜.     

逼尿肌不稳定对老年前列腺增生下尿路症状尿动力学参数的影响

目的探讨老年前列腺增生（BPH）下尿路症状（LUTS）伴逼尿肌不稳定（DI）患者的临床及尿动力学特点。方法对120例患者根据尿动力学检查均诊断为膀胱出口梗阻（BOO）,根据DI的存在与否分为2组,其中DI组63例,非DI组57例。对2组患者前列腺体积（VP）、国际前列腺症状评分（IPSS）、尿流率（Qmax）、残余尿（RV）、PSA和尿动力学参数进行比较。结果 DI组与非DI组年龄分别为（75.5±5.8）和（73.5±4.9）岁,IPSS分别为（28.3±5.1）和（27.9±4.9）,PSA为（4.5±1.8）和（4.2±1.6）ng/mL,Qmax为（5.6±2.8）和（6.0±3.1）mL/s,以上参数2组间无统计学意义（均P〉0.05）;DI组与非DI组VP为（78.2±25.8）mL与（55.5±22.6）mL（P=0.02）,RV为（48.5±26.8）和（140.2±57.3）mL（P=0.018）,初始尿意容量（FUR）为（95.0±25.0）和（135.0±26.0）mL（P=0.001）,最大尿意容量（MUR）为（192.5±50.0）和（328.5±58.0）mL（P=0.005）,梗阻级别为4.6±1.1和3.3±1.8（P=0.015）。结论前列腺体积大、BOO明显的患者易合并DI;DI患者尿动力学特点为膀胱敏感性增加,膀胱功能容量与残余尿量减少;尿动力学检查是准确诊断DI,指导进行临床治疗与预防的前提。     

嘌呤能信号在膀胱功能及相关疾病中的研究进展

嘌呤能信号对膀胱的功能有着重要的调节作用,嘌呤能信号的异常生成、释放和(或)嘌呤能受体的异常表达,导致的嘌呤能信号通路过度激活是许多泌尿疾病的共同特征。目前药物治疗在下尿路症状的治疗中多集中在对储尿期逼尿肌活动的调控,在储尿期感觉传入过敏的症状上存在一定局限性。随着对嘌呤能信号通路研究的深入,发现嘌呤能信号广泛分布于膀胱中,不仅涉及排尿期膀胱传出神经对逼尿肌的调节,还参与储尿期膀胱传入神经对感受刺激的调节,在改善下尿路症状方面更具优势,具有良好的临床应用前景,本文将对嘌呤能信号在膀胱的作用及相关疾病的研究进展进行综述,以期为后续研究提供参考。     

血管活性肠肽及其受体与胆囊胆固醇结石患者胆囊排空的相关研究

目的　探索胆囊胆固醇结石患者胆囊排空与血浆和胆汁血管活性肠肽 (VIP)的浓度及其胆囊壁VIP受体 (VIP R)表达的关系以及在胆囊结石形成中的意义。方法　采用B超测定胆囊排空功能 ,同时抽空腹静脉血及胆囊结石手术病人胆汁放免测定VIP浓度 ,免疫组化测定VIP R的表达。结果　胆囊结石病人胆囊排空障碍 ;血浆VIP浓度正常人为 ( 8.2 8± 0 .98)ng/L ,胆囊结石病人为 ( 15 .64± 2 .5 1)ng/L ,显著升高 ( P <0 .0 1) ;胆汁VIP高于血浆VIP ;空腹容积越大 ,血浆VIP(P <0 .0 5 )和胆汁VIP(P <0 .0 1)浓度越高 ,VIP R表达越强。结论　胆囊排空功能在胆囊结石形成中起重要作用 ,胆囊结石病人胆囊排空障碍与VIP明显相关 ,空腹容积与VIP及其受体明显正相关     

Urinary ATP as an indicator of infection and inflammation of the urinary tract in patients with lower urinary tract symptoms

Background

Adenosine-5′-triphosphate (ATP) is a neurotransmitter and inflammatory cytokine implicated in the pathophysiology of lower urinary tract disease. ATP additionally reflects microbial biomass thus has potential as a surrogate marker of urinary tract infection (UTI). The optimum clinical sampling method for ATP urinalysis has not been established. We tested the potential of urinary ATP in the assessment of lower urinary tract symptoms, infection and inflammation, and validated sampling methods for clinical practice.

Methods

A prospective, blinded, cross-sectional observational study of adult patients presenting with lower urinary tract symptoms (LUTS) and asymptomatic controls, was conducted between October 2009 and October 2012. Urinary ATP was assayed by a luciferin-luciferase method, pyuria counted by microscopy of fresh unspun urine and symptoms assessed using validated questionnaires. The sample collection, storage and processing methods were also validated.

Results

75 controls and 340 patients with LUTS were grouped as without pyuria (n = 100), pyuria 1-9 wbc μl^-1 (n = 120) and pyuria ≥10 wbc μl^-1 (n = 120). Urinary ATP was higher in association with female gender, voiding symptoms, pyuria greater than 10 wbc μl^-1 and negative MSU culture. ROC curve analysis showed no evidence of diagnostic test potential. The urinary ATP signal decayed with storage at 23°C but was prevented by immediate freezing at ≤ -20°C, without boric acid preservative and without the need to centrifuge urine prior to freezing.

Conclusions

Urinary ATP may have a role as a research tool but is unconvincing as a surrogate, clinical diagnostic marker.     

尿路结构异常儿童合并泌尿系感染的病原菌分析

目的探讨尿路结构异常儿童合并泌尿系感染（UTI）致病菌的分布及药物敏感及耐药情况。 方法收集2012年1月至2016年12月中山大学附属第三医院及汕头市中心医院符合UTI住院患儿476例,分为尿路正常组及尿路异常组,比较两组间病原菌构成比及对抗菌药物的敏感和耐药情况。 结果尿路异常者162例（肾积水最为常见,占43.83%）,尿路正常儿童314例。尿路异常儿童合并感染常见于男性（P<0.05）,共检出致病菌166株,革兰氏阴性菌（G^-）为主（71.08%）,大肠埃希菌占首位（40.36%）,肠球菌属居第2位（22.89%）,粪肠球菌在尿路异常组常见（χ²=4.59,P=0.032）。两组间常见病原菌耐药性差异无统计学意义。 结论尿路结构异常男性儿童易发生泌尿系感染,且肠球菌感染的发生率高于尿路结构正常儿童。     

Sexual activity and lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) have a profound impact on womens physical, social, and sexual well being. The LUTS are likely to affect sexual activity. Conversely, sexual activity may affect the occurrence of LUTS. The aims of the study were to elucidate to which extent LUTS affect sexual function and to which extent sexual function affect LUTS in an unselected population of middle-aged women in 1 year. A questionnaire was sent to 4,000 unselected women aged 40–60 years. All 2,284 women (57.1%) who completed a baseline questionnaire and a similar questionnaire 1-year later were included. Data comprised age, occurrence of LUTS, hormonal status, and sexual activity. A multiple conditional logistic regression model was used to analyze the relationship between sexual activity and LUTS adjusted for age and hormonal status. At baseline and 1-year later, 49 women (2.2%) had no sexual intercourse, and 298 women (13.0%) either ceased or resumed sexual relationship. Compared to women having sexual relationship, a statistically significant three to sixfold higher prevalence of LUTS was observed in women with no sexual relationship. In women who ceased sexual relationship an increase, although not statistically significant, in the de novo occurrence of most LUTS was observed. In women who resumed sexual relationship an insignificantly decrease in LUTS was observed. In women whose sexual activity was unchanged no change in the occurrence of LUTS was observed. Our study confirms a close association between sexual activity and the occurrence of LUTS. A hypothesis that sexual inactivity may lead to LUTS and vice versa cannot be rejected.     

Usefulness of classical homeopathy for the prophylaxis of recurrent urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction

Context/Objective: to investigate the usefulness of classical homeopathy for the prevention of recurrent urinary tract infections (UTI) in patients with spinal cord injury (SCI).

Design: prospective study.

Setting: rehabilitation center in Switzerland.

Participants: patients with chronic SCI and ≥3 UTI/year.

Interventions: Participants were treated either with a standardized prophylaxis alone or in combination with homeopathy.

Outcome measures: The number of UTI, general and specific quality of life (QoL), and satisfaction with homeopathic treatment were assessed prospectively for one year.

Results: Ten patients were in the control group; 25 patients received adjunctive homeopathic treatment. The median number of self-reported UTI in the homeopathy group decreased significantly, whereas it remained unchanged in the control group. The domain incontinence impact of the KHQ improved significantly (P?=?0.035), whereas the general QoL did not change. The satisfaction with homeopathic care was high.

Conclusions: Adjunctive homeopathic treatment lead to a significant decrease of UTI in SCI patients. Therefore, classical homeopathy could be considered in SCI patients with recurrent UTI.

Trial registration: ClinicalTrials.gov. (NCT01477502).     

Significance of urinary endotoxin concentration in patients with urinary tract infection

Summary Endotoxin is a component of the outer membrane of gram-negative rods (GNR). Since GNR are responsible for the majority of urinary tract infection (UTI), we measured the concentration of endotoxin in urine using chromogenic endotoxin-specific assay and examined its diagnostic utility in patients with suspected UTI. In all 18 urine samples with an endotoxin concentration exceeding 350 pg/ml and 2 samples with 10–350 pg/ml of endotoxin concentration, GNR were detected at a count of 10⁴ cfu/ml. Negative for endotoxin were 3 samples of culture positive for grampositive cocci (GPC), 2 samples containing various bacterial contaminants and all 37 samples with no growth on culture. Two urine samples collected 5 h after antibiotic dosage showed negative culture for GNR but a significant concentration of endotoxin. In an in vitro experiment, a residual concentration of antibiotic in urine inhibited bacterial growth, leading to a falsenegative culture. These results suggest that chromogenic endotoxin assay is a reliable method for diagnosing UTI caused by GNR and detecting false-negative culture of GNR.     

逼尿肌活动低下在下尿路症状中的临床特征及诊疗策略分析

目的:探讨逼尿肌活动低下(DU)在下尿路症状(LUTS)患者中的流行病学现状、临床特征及诊疗策略。方法:回顾性分析了我院1 019例排除神经源性膀胱及解剖结构异常的LUTS患者的尿流动力学检查结果及随访资料,探讨DU在LUTS中的流行病学及临床诊治特点,并对106例DU患者治疗前后行尿流动力学检查,结合文献进行临床分析。结果:在就诊患者中,储尿期症状最为多见,在男性患者中,排尿期症状稍多于储尿期症状,而女性患者储尿期症状明显多于排尿期症状。男性患者中膀胱出口梗阻(BOO)的患者为57.9%,而女性患者中压力性尿失禁(SUI)患者达到了43.3%。27.4%男性及23.2%女性诊断为DU,男性及女性患病率差异无统计学意义。DU患者与非DU患者的临床表现无明显差异,均以LUTS为主要表现。DU可能合并有逼尿肌过度活动或BOO。DU随着年龄的增加,患病率逐渐增加。106例DU患者经治疗后行尿动力学检查发现逼尿肌收缩力有一定提高,治疗前后逼尿肌肌力差异有统计学意义。结论:DU是LUTS患者的常见病因,并有可能同时合并有逼尿肌过度活动或BOO。目前针对DU患者的治疗有一定效果。     

尿路真菌感染（附20例报告）

报告２０例尿路真菌感染，上尿路感染３例，下尿路感染１７例。病原菌为白色念珠菌，酵母样菌，平滑球拟酵母菌和曲霉菌。上尿路真菌感染的治疗以应用抗真菌药嘛康唑或氟康唑获佳良效果。这些新型抗真菌药抗菌谱广，疗效佳，安全而副作用少，下尿路真菌感染应用两性霉素Ｂ或咪康唑滴注膀胱治疗获良好疗效。     

无下尿路症状的女性2型糖尿病周围神经病变患者的尿液菌群特征

目的:探讨无下尿路症状的女性2型糖尿病周围神经病变(DPN)患者的尿液菌群特征。方法:采用横断面调查研究,收集南方医科大学南方医院2017年5月至2018年8月收治的2型糖尿病且无下尿路症状的女性患者30例,17例合并糖尿病周围神经病者为DPN组,13例未合并糖尿病周围神经病变者为nDPN组。两组患者均行神经传导功能检查和美国泌尿外科学会症状指数问卷(AUA-SI)。收集两组患者的清洁中段尿标本并进行DNA提取,采用Illumina测序平台进行扩增和高通量测序,原始数据导入QI-IME软件分析样本微生物的α和β多样性,采用LEfSe软件分析两组间具有显著差异的菌群。结果:DPN组糖尿病病程明显短于nDPN组[(4.12±3.28)年与(8.03±6.11)年,P=0.03]。DPN组视网膜病变例数明显多于nDPN组(6例与0例,P=0.03),两组间其余临床资料及生化指标差异均无统计学意义(P>0.05)。α多样性分析结果显示,与nDPN组相比,DPN组的尿液菌群丰富度显著下降(sobs指数67.24±40.25与108.69±57.18,P=0.03;chao指数81.36±47.99与122.55±55.70,P=0.04;ace指数88.58±55.03与125.78±53.03,P=0.04),但两组间群落多样性差异无统计学意义(shannon系数1.53±1.11与1.91±0.87,P=0.26;simpson指数0.48±0.34与0.34±0.20,P=0.41)。β多样性分析结果显示,DPN组与nDPN组的菌群结构差异无统计学意义(P>0.05)。LEfSe分析结果显示,在菌科水平,DPN组支原体科相对丰度显著高于nDPN组(Metastats值0.52±0.01与0.01±0.00001,P=0.02);在菌属水平,DPN组芽孢杆菌属、杜氏菌属、纤毛菌属、变形杆菌属、丙酸菌属、假黄色单胞菌属、蛭弧菌属、不可培养土壤细菌属等8个菌属相对丰度均降低(P<0.05)。结论:无下尿路症状的女性2型糖尿病周围神经病变患者的尿液菌群明显不同于无周围神经病变患者,其菌群丰富度降低,支原体科细菌可能为DPN患者的潜在生物标志物。     

Symptomatic urinary problems in female genital tract anomalies

Most of urological abnormalities in urogenital anomalies are asymptomatic and need no special treatment; however, a few patients have critical urinary complaints and surgical corrections are required for them. Unfortunately, these coexisting urinary problems are often neglected and failed to be treated. So, it is necessary to delineate the diagnosis and treatment of similar anomalies. Eight typical patients who had urogenital anomalies with urinary discomfort in our institution were excerpted and reported. In this series, the urinary symptoms ranged from cyclical hematuria and urinary incontinence to infection symptom. The involved urological anatomies were generally categorized into three types: abnormal communication of urogenital tracts, malformation of bladder or ectopic ureter, and anomalies of urethral orifice. Surgical corrections were helpful for most cases. For patients with genitalia anomalies, the coexisting urological defects should be highlighted by our gynecologists, especially when they are symptomatic and require surgical correction. Shu Wang and Jing He Lang contributed equally to this article.