前列腺增生症453例尿动力学分析

目的 研究尿动力学在前列腺增生症患者的诊断和治疗中的作用。方法 对453例前列腺增生症患者实施尿动力学检测并进行尿动力学评估，为前列腺增生症患者手术治疗提供理论依据。结果 453例皆有膀胱出口梗阻（BOO），单纯（BOO）不伴明显膀胱功能障碍者215例（47．5％），不稳定膀胱86例（18．9％），低顺应性膀胱72例（15．9％），低顺应性伴不稳定膀胱24例（5．3％），逼尿肌收缩乏力77例（17．0％），逼尿肌括约肌功能失调3（0．7％）例。结论 前列腺增生症患者尿动力学检测可同时评估膀胱和尿道功能情况，为前列腺增生症患者的诊断和治疗提供可靠的理论依据。     

影像学尿动力检查对女性复杂性下尿路感染的诊断价值

 目的 探讨影像学尿动力检查(VUD)在女性复杂性下尿路感染病因诊断中的应用价值。方法 应用VUD对126例女性复杂性下尿路感染患者进行检查,分析致病原因及VUD影像学特点,指导进一步治疗。结果 126例患者检查结果:(1)膀胱出口梗阻95例,其中膀胱颈梗阻28例;逼尿肌-外括约肌协同失调(DSD)6例;尿道远端狭窄61例;(2)膀胱外肿块压迫3例;(3)膀胱脱垂18例;(4)尿道憩室10例,憩室伴结石1例。结论 VUD通过尿动力数据与同步影像结合分析,为女性复杂性下尿路感染提供准确的诊断,为进一步治疗提供依据。     

创伤性后尿道断裂术后尿动力学分析

目的利用尿动力学检查方法,探讨创伤性后尿道断裂术后排尿困难和尿失禁的病因及发生机制。方法41例后尿道断裂根据病情不同而采用不同治疗方法,行Ⅰ期、Ⅱ期尿道吻合术18例,后尿道会师术23例,术后拔除尿管1周(近期)及3个月(远期),分别行尿动力学测定。以最大尿流率(Qmax)>12ml/s为正常组(A组),Qmax≤12ml/s为异常组(B组)。结果近期出现排尿困难5例,Qmax为(9.45±2.62)ml/s,其中尿道狭窄2例、前列腺增生2例、膀胱逼尿肌收缩无力1例;远期因尿道瘢痕挛缩继发排尿困难6例,Qmax为(6.28±3.26)ml/s,与正常组尿动力学参数比较,差异均有统计学意义(P<0.01)。尿失禁8例,最大尿道关闭压均低于40cmH2O〔(30.31±7.88)cmH2O〕,其中急迫性尿失禁3例,储尿期最大逼尿肌压力>15cmH2O〔(25.34±4.89)cmH2O〕;压力性尿失禁4例,漏尿点压力测定<60cmH2O〔(43.61±7.89)cmH2O〕;尿道“人工假道”性尿失禁1例。结论创伤性后尿道断裂术后尿动力学检查可以分析排尿困难和尿失禁的病因所在,有效指导临床治疗。     

高位脊髓截瘫患者尿动力学检测指标变异性的研究

目的观察高位脊髓截瘫病人尿动力学检测指标的变异性。方法选择15例高位脊髓截瘫患者在脊髓休克期后行尿动力学检测,在检测中重复膀胱充盈排尿期压力测定及尿道压力测定2次,将检测结果比较。结果前后2次测得的初始逼尿肌收缩容量(P=0.134)、初始逼尿肌收缩最大逼尿肌压(P=0.871)、最大膀胱容量(P=0.774)、最大逼尿肌压(P=0.972)、漏尿点逼尿肌压(P=0.730)、最大尿道压(P=0.870)、最大尿道闭合压(P=0.949)、功能性尿道长度(P=0.844)及膀胱顺应性(P=0.492)的变异性均无显著性差异。结论骶髓排尿中枢在去除脑桥和中脑中枢及脑干上中枢的作用后,膀胱逼尿肌及尿道括约肌具有良好的稳定性。     

糖尿病性膀胱尿动力学研究

目的为了评价糖尿病患者排尿异常与膀胱和逼尿肌行为间的关系.方法44例糖尿病患者接受影像或普通尿动力学检查及I-PSS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正常的糖尿病患者相比,尿流率中大多数参数具有显著性差异;主观症状评分梗阻指数显著性增高,但刺激症状指数两组无显著性差异.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I-PSS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.     

前列腺移行区与全前列腺体积比和尿动力学的关系

目的:探讨前列腺中央叶和全腺体积比值与尿动力学的关系。方法:采用B型超声横断位、矢状断位检查膀胱充盈及排尿过程中的尿动力学改变,临床诊断为BPH的患者50例。结果:BPH患者的中央叶与全腺体积的比例与尿动力学改变有密切关系,当中央叶和全腺体积的比值增大时,最大流率(Qmax)降低,尿道开放压(Popen)和最大尿流率时膀胱尿道压(Pmax)升高,说明有梗阻的存在,但当中央叶与全腺体积比例超过0.5时,Qmax降低,Popen和Pmax反而降低。结论:中央叶指数与尿动力学梗阻变化的程度成正比,指数超过0.5时,尿动力常表现为逼尿肌代偿功能下降。     

前列腺切除术后排尿困难18例临床分析

目的　探讨前列腺切除术后排尿困难的原因及防治措施。方法　对 18例前列腺切除术后排尿困难患者的临床资料进行回顾分析。结果　膀胱颈部狭窄 10例 ,后尿道狭窄 3例 ,前尿道狭窄 1例 ,腺体残留 3例 ,膀胱逼尿肌功能障碍 1例。尿道扩张联合开放手术或腔内电切术治愈 17例 ,永久性膀胱造瘘 1例。结论　膀胱颈部狭窄、尿道狭窄、腺体残留、膀胱逼尿肌功能障碍是术后排尿困难的主要原因 ,多由医源性因素引起。术前行尿流动力学检查、术中术后操作得当可以避免这些并发症。尿道扩张联合开放手术或腔内电切术是前列腺切除术后排尿困难较为有效的治疗方法。     

经会阴超声与尿动力学评估子宫全切除术后压力性尿失禁的临床价值

目的探讨经会阴超声与尿动力学评估经腹子宫全切除术(TAH)后压力性尿失禁(SUI)的价值。方法选取我院进行TAH治疗的98例患者作为观察组,并根据中华医学会妇产科学分会SUI的诊断标准分为非SUI组(53例)和SUI组(45例),另选取同期在我院进行体检的未进行TAH的健康人群45例作为对照组。根据经会阴超声与尿动力学对SUI的评估标准,并比较其价值。结果 SUI组患者膀胱颈下移距离、膀胱颈口移动度、膀胱颈旋转角度、尿道旋转角度明显高于非SUI组和对照组,非SUI组膀胱颈下移距离、膀胱颈口移动度、膀胱颈旋转角度、尿道旋转角度明显高于对照组,差异均有统计学意义(P0.05)。SUI组患者最大尿流率(Qmax)、尿量、最大尿道闭合压(maximal urethral closure pressure,MUCP)和功能性尿道长度(functional urethral length,FUL)明显低于非SUI组和对照组,尿道开放时逼尿肌压(urethral pressure during urethral opening,UPDUO)明显高于非SUI组和对照组,差异均有统计学意义(P0.05)。结论经会阴超声运用多参数评估TAH后SUI的价值较高,且与尿动力学检查比较无明显差异。     

小儿盆腔及泌尿生殖系横纹肌肉瘤的影像诊断

目的探讨儿童盆腔及泌尿生殖系横纹肌肉瘤(RMS)的尿路造影和CT表现及其诊断价值。资料与方法回顾性分析20例经手术及活检病理证实的原发于盆腔及泌尿生殖系RMS的影像学资料。其中10例经静脉肾盂造影(IVP)检查,3例经膀胱尿道造影(VCUG)检查,10例经CT检查,1例经MRI检查。结果8例膀胱RMS的IVP、CT表现为膀胱内葡萄状充盈缺损,膀胱颈部与耻骨联合间距增宽,VCUG可见肿物延伸至后尿道;4例前列腺RMS表现为后尿道肿物压迫膀胱颈部并使其抬高、环绕尿道的盆底部包块。6例盆腔RMS IVP及CT表现为盆腔包块,压迫膀胱移位、变形,膀胱壁轻度浸润不规则,输尿管下段浸润者可有轻度输尿管及肾盂积水。1例尿道RMS表现为尿道内充盈缺损,1例阴道RMS,IVP表现为膀胱颈部充盈缺损。结论IVP及VCUG能明确诊断原发于膀胱、前列腺、尿道的RMS及上尿路继发病变;CT及MR可进一步了解起自阴道、前列腺、盆腔的RMS及其与周围器官的关系。     

经尿道前列腺电切术后功能锻炼对逼尿肌收缩能力的影响

 目的观察功能锻炼对经尿道前列腺电切(Transurethal resection of the prostate,TURP)术后膀胱逼尿肌收缩能力恢复的影响.方法对42例前列腺增生合并有逼尿肌收缩能力减退的患者,随机分为实验组和对照组.实验组在术后给予规律的功能锻炼,对照组给予常规护理.于9个月后复查尿流动力学,IPSS评分.结果实验组的逼尿肌等容收缩压、排尿期逼尿肌收缩压力,明显高于对照组,差异有统计学意义(P＜0.05).结论规律的功能锻炼对电切术后膀胱逼尿肌收缩能力的恢复有较好的促进作用.     

Accuracy of positional correction for the floor-mounted kV X-ray IGRT system in angled couch positions

Stereotactic irradiation (STI) requires high geometric accuracy. We evaluated the positional correction accuracy after treatment couch rotation for non-coplanar STI with a frameless mask. A steel ball was embedded as a virtual target in a head phantom with a human cranial bone structure, and the head phantom was placed in the isocenter of the treatment-planning system with the image-guide system. The Winston-Lutz test at treatment couch angles of ±90°, ±45°, and 0° was performed, and the amount of displacement from the center position at the treatment couch angle of 0° was calculated. After treatment couch rotation through each treatment couch angle, the amount of center displacement was compared between cases with and without a positional correction by the image-guide system, and then the accuracy of the positional correction after treatment couch rotation was examined. The maximum amount of three-dimensional displacement without and with positional correction after treatment couch rotation was 0.52 mm at a treatment couch angle of –90° and 0.49 mm at a treatment couch angle of –45°. These results indicate that the image-guide system provides accuracy within about 0.50 mm regardless of the positional correction even after rotation of the treatment couch.     

Skin Dose Impact from Vacuum Immobilization Device and Carbon Fiber Couch in Intensity Modulated Radiation Therapy for Prostate Cancer

To investigate the unexpected skin dose increase from intensity-modulated radiation therapy (IMRT) on vacuum cushions and carbon-fiber couches and then to modify the dosimetric plan accordingly. Eleven prostate cancer patients undergoing IMRT were treated in prone position with a vacuum cushion. Two under-couch beams scattered the radiation from the vacuum cushion and carbon-fiber couch. The IMRT plans with both devices contoured were compared with the plans not contouring them. The skin doses were measured using thermoluminescent dosimeters (TLDs) placed on the inguinal regions in a single IMRT fraction. Tissue equivalent thickness was transformed for both devices with the relative densities. The TLD-measured skin doses (59.5 ± 9.5 cGy and 55.6 ± 5.9 cGy at left and right inguinal regions, respectively) were significantly higher than the calculated doses (28.7 ± 4.7 cGy; p = 2.2 × 10⁻⁵ and 26.2 ± 4.3 cGy; p = 1.5 × 10⁻⁵) not contouring the vacuum cushion and carbon-fiber couch. The calculated skin doses with both devices contoured (59.1 ± 8.8 cGy and 55.5 ± 5.7 cGy) were similar to the TLD-measured doses. In addition, the calculated skin doses using the vacuum cushion and a converted thickness of the simulator couch were no different from the TLD-measured doses. The recalculated doses of rectum and bladder did not change significantly. The dose that covered 95% of target volume was less than the prescribed dose in 4 of 11 patients, and this problem was solved after re-optimization applying the corrected contours. The vacuum cushion and carbon-fiber couch contributed to increased skin doses. The tissue-equivalent-thickness method served as an effective way to correct the dose variations.     

Dosimetric correction for a six degrees carbon fiber couch

We investigated experimentally and clinically the influence of a six degree (6D) carbon fiber couch on conventional radiation therapy. We used 4, 6 and 10 MV X-rays and compared dose distributions based on correction methods, i.e. monitor unit (MU) addition, including computed tomography (CT) couch, and the couch modeling. Additionally, we evaluated the clinical value of dosimetric correction for the 6D couch in 30 patients treated with multi-field irradiation. In the phantom study, the maximum difference of isocenter doses attributable to the 6D couch was 5.1%; the difference was reduced with increasing X-ray energy. Although the isocenter dose based on each correction method was precise within ±1%, MU addition underestimated the surface dose. In the clinical study, the maximum difference of isocenter doses attributable to the 6D couch was 2.7%. The correction methods for the 6D couch provide for highly precise treatment planning. However, the clinical indication of complicated correction methods should be considered for each institution or each patient, because the influence of the 6D couch was reduced with multi-field irradiation.     

Self-introduction of a two-meter nylon string into the urinary bladder: A case report

A foreign body of the urinary bladder can be caused by several factors. Several patients deliberately insert foreign bodies via the urethra due to psychiatric issues to achieve sexual pleasure. Self-inserted urinary bladder foreign bodies remain a significant challenge in the urology field regarding diagnosis and management as patients may be late in seeking medical assistance due to guilt and embarrassment. We aimed to report a 37-year-old man who inserted a two-meter nylon string into his urethra for sexual gratification.     

盆腔脂肪增多症的影像学表现(附六例分析)

目的 报道６例盆腔脂肪增多症的影像表现。方法 ６例患者分别应用多种方法检查,手术证实４例,随访２例。结果 ＣＴ检查６例,示盆腔内大量低密度影并膀胱变形,５例输尿管及肾盂扩张;Ｂ超检查６例,示盆腔内大量强回声光团,膀胱变形,５例肾盂、输尿管扩张;ＭＲ检查３例,示盆腔内大量短Ｔ１、短Ｔ２信号,膀胱变形并肾盂、输尿管扩张;Ｘ线平片４例,显示盆部透亮度增加;静脉肾盂造影４例,示输尿管扩张移位、肾盂积水;钡     

Is early bladder activity in radionuclide cisternography an indirect sign of spontaneous intracranial hypotension or sequence of lumbar puncture?

Spontaneous intracranial hypotension (SIH) is characterized by severe postural headache and low cerebrospinal fluid (CSF) pressure. Radionuclide cisternography (RC) is of some value in diagnosing CSF leakage causing SIH. However, the sensitivity of RC is too low to demonstrate the site of leakage. In these cases, the early appearance of the radioactivity in the urinary bladder has also been used as an indirect finding in the diagnosis of SIH. The aim of this study was to evaluate the diagnostic reliability of early urinary bladder activity as an indirect sign of SIH. We investigated early bladder activity in 21 patients with suspicion of normal pressure hydrocephalus. Of the 21 subjects, 13 (62%) showed early bladder activity. We demonstrated that early bladder activity is observed in patients without CSF leakage such as normal pressure hydrocephalus. Therefore, this indirect finding of RC is not a reliable finding in diagnosing SIH.     

抗荷正压呼吸时不同囊面积背心代偿性能的比较

目的探讨缩小代偿背心的囊覆盖面积是否仍能保证抗荷正压呼吸（ＰＢＧ）时胸部的代偿性能。方法在离心机上，６名受试者分别穿大囊（Ｌ）、中囊（Ｍ）或胸背囊（ＴＢ）代偿背心、充气，在＋５．５ＧＺ时进行４．８ｋＰａ的ＰＢＧ，在＋６．５ＧＺ进行８．０ｋＰａ的ＰＢＧ；或穿ＴＢ代偿背心、不充气，在＋５．５ＧＺ进行４．８ｋＰａ的ＰＢＧ，在＋６．０ＧＺ进行６．４ｋＰａ的ＰＢＧ。测量的指标包括，抗荷服压（Ｐｓ）、面罩压（Ｐｍ）、胸部代偿压（Ｐｔ）、呼吸频率（Ｒ）、心率（ＨＲ）及主观评分。结果当受试者分别穿Ｌ、Ｍ或ＴＢ这三种代偿背心、充气时，均能很好耐受所进行的ＰＢＧ。各项指标在Ｌ、Ｍ及ＴＢ这三种代偿背心间并无显著性差别（Ｐ＞０．０５）。穿ＴＢ代偿背心、不充气时，受试者对所进行的ＰＢＧ仍可耐受。结论采用囊覆盖面积比较小的Ｍ代偿背心已可满足ＰＢＧ时对胸部实施有效代偿的需要；穿ＴＢ代偿背心、不充气时，受试者也能较好地耐受６．４ｋＰａ的ＰＢＧ。在＋ＧＺ作用时将代偿背心的囊覆盖面积适当缩小是可能的。     

不同抗荷服对下肢血流的影响

为了探讨不同抗荷服、不同充气压力对人体心血管的影响,在＋１Ｇｚ下,用三种囊覆盖面积依次为３０％、６５％、９０％的囊式ＡＧＳ和一种管式ＡＧＳ,ＡＧＳ充气至最大充气压力过程中,观察下肢血流被阻断和重新出现的充气压力以及达到最大充气压力时的下肢血流变化,同时监测心率和血压。结果表明,小腿血流均能被囊式ＡＧＳ阻断,血流阻断的充气压力随囊覆盖面积增大而减小,并呈线性关系：ｙ＝２９．６６－１６．３５ｘ（Ｐ〈０     

医用加速器碳纤维治疗床延长板结合部对放疗剂量的影响

目的：探讨加速器碳纤维治疗床结合部对调强放疗剂量的影响。方法：利用二维平板电离室矩阵,测量6MV X 射线穿射过碳纤维治疗床延长板结合部和避开结合部后的剂量。分析不同机架角度下治疗床结合部对 X 射线剂量的影响。比较实例放疗计划穿射与避开结合部的治疗计划的验证通过率。结果：二维矩阵电离室实测结果显示,射野处于110°～180°机架角范围,穿射结合部位后射线会产生较大衰减,结合部衰减范围集中在延长板分界向床头方向3cm,床尾方向11cm 的范围。116°～180°机架角,部分测量点剂量偏差值超过10％。145°机架角时测量点最大偏差值达24．2％。10例实例测量 VMAT 治疗计划中,射野穿透结合部的 Gamma 通过率较避开结合部显著降低（t ＝4．349,P ＝0．002）。结论：加速器碳纤维治疗床延长板结合部可显著降低放疗剂量。在放射治疗摆位应尽可能避免治疗射野穿射碳纤维治疗床结合部,无法避免时,应将其产生的射线衰减考虑在治疗计划的设计中。