压力性尿失禁患者膀胱充盈前后尿道最大闭合压和功能尿道长度的改变

报告9例压力性尿火禁患者膀胱充盈前后尿道参数的变化,并和正常对照组进行对比分析。结果表明:在同等条件下(膀胱充盈或空虚),压力性尿失禁患者的尿道最大闭合压和功能尿道长度均小于正常对照组;膀胱充盈后尿道最大闭合压和功能尿道长度均较充盈前显著减少,差异有非常显著的意义。提示膀胱充盈后尿道最大闭合压和功能尿道长度减小是压力性尿失禁的重要特点。     

女性尿道综合征动力学病因分析

对３３例女性尿道综合征患者行尿动力学检查，部分病例同时行雌激素水平测定，结果提示，不稳定膀胱常是本病症状迁延的病理基础，尿道压增高则是诱发不稳定膀胱的病因之一，诊断治疗中尚应重视雌激素水平对女性下尿路功能障碍的影响。     

女性尿道综合征诊治10年回顾

对我院１９８２至１９９３年收治的女性尿道综合征６７６例尿动力学资料和１５７例系统治疗和随访资料进行回顾性分析。尿动力学检查显示８０．３％有膀胱尿道功能异常表现。分为四大类，１３种表现，不稳定膀胱和远端尿道缩窄症是最常见的类型。精神因素和非生理性排尿习惯对疾病的发生及治疗有很大的影响。认为对尿道综合征应在排除其它疾病基础上成立诊断。在尿动力学检查基础上分析原因，确定异常类型和有针对性的治疗方法。注重心理和行为治疗。     

我国少数民族成人女性正常尿道关闭压力图

目的 观察我国少数民族成人女性正常尿道关闭压力图探讨各指标与尿道解剖和生理关系。方法 采和国产Nidoc-970尿动力检查仪测定36例少数民族成人女性正常尿道关闭压力图。结果功能性尿道长1.58～3.90cm,平均2.74±1.16cm,控制带长0.86～1.92cm,平均1.39±0.53cm,控制带1/3长度平均0.46cm。P_1压力为1.135～3.612kpa,平均2.37±1.24kpa,P_2压力为3.22～6.29kpa,平均4.755±1.535kpa,最大尿道压4.41～7.69kpa,平均6.05±1.64kpa。结论 测定我国少数民族成人女性正常尿道关闭压力图,对拓宽临床研究尿动力学有重要参考价值。     

女性尿道综合征的尿动力学诊断及治疗

分析８２例女性尿道综合征患者的尿动力学表现，并对５０例患者进行随机分组治疗研究，结果：根据尿动力学表现分６种类型，以远端尿道缩窄症最常见，占７６．８％，膀胱训练加尿动力学指导用药是治疗女性尿道综合征既简单又有效的方法。     

尿动力学检查在女性尿道综合征的应用（附160例分析报告）

为探讨尿动力学检查(UDS)在女性尿道综合征(FUS)的临床价值,应用Laborie公司Encore 5.7尿动力分析仪检查FUS160例。结果发现剩余尿>50ml者占34.4％,初尿意尿量<60ml者28.1％,60～100ml者25.4％,由于有剩余尿和产生初尿意的尿量较少,产生初尿意的实际增加尿量更少,这些都可能是产生尿道综合征症状的部分原因。本组膀胱逼尿肌收缩无力或减弱55例,占34.4％,单纯使用平滑肌兴奋剂,如新斯的明和加兰他敏等提高了疗效。认为尿动力学检查女性尿道综合征患者,有助于了解其病因,分类治疗能提高疗效。     

女性不同类型尿失禁临床及尿动力学特点

目的 探讨女性不同类型尿失禁临床及尿动力学特点，提高临床诊治水平。方法 对76例女性患者常规行尿动力学检查，包括尿流率、压力流率研究、尿道压力测定、漏尿点压测定。结果 76例患者中，压力性尿失禁30例，运动紧迫性尿失禁15例，反射性尿失禁19例，混合型压力性／紧迫性尿失禁2例，不稳定尿道3例，假性尿失禁7例。运动紧迫性尿失禁中，DLPP≥40cmH2O者14例，均有不同程度双肾积水。结论 腹压漏尿点压测定可以协助确定压力性尿失禁的手术方式。神经性膀胱尿道功能障碍和膀胱出口梗阻均可能出现膀胱顺应性下降，逼尿肌漏尿点压可以帮助决定膀胱顺应性下降时手术治疗时机。当逼尿肌漏尿点压≥40cmH2O，或者膀胱充盈200ml时逼尿肌压力≥40cmH2O时，必须进行治疗，否则会导致上尿路损害。     

女性尿道综合征31例临床治疗分析

目的 探讨女性尿道综合征的治疗效果。方法 31例患者，其中21例进行了尿动力学检查，均有尿动力学异常。治疗上采取心理、行为、药物等方面综合治疗。结果 治疗总有效率为87％。结论 尿动力学检查是女性尿道综合征诊断和治疗依据，女性尿道综合征的治疗应采取综合治疗。     

自制可调TVT吊带术后腹压漏尿点压和最大尿道闭合压变化分析

目的观察自制可调TVT吊带术后腹压漏尿点压(VLPP)和最大尿道闭合压(MCP)变化,探讨自制TVT吊带临床效果。方法女性压力性尿失禁患者134例,术前行尿流动力学检查测定VLPP、MCP,行自制TVT吊带手术治疗后随访患者再次检测VLPP和MCP,分析检查结果。结果按照世界尿控协会(ICS)标准有39例患者未检出VLPP,剩余95例患者VLPP手术前为(77.2±21.6)cm H2O(1cm H2O=0.098 k Pa),手术后为(99.7±26.3)cm H2O,二者比较差异具有统计学意义(P<0.05)。MCP手术前(32.5±14.3)cm H2O,手术后(57.2±13.3)cm H2O,二者差异具有统计学意义(P<0.05)。结论自制TVT吊带术后可以取得较满意的手术效果,并具有灵活的术后调整性,较传统手术具有自身优势。     

Observations on the function of the female urethra: I: relation between maximum urethral closure pressure at rest and urethral hypermobility

AIMS: To study the relation between maximum urethral closure pressure at rest and urethral hypermobility in female patients. PATIENTS AND METHODS: We selected 255 patients aged 20 years and older, with a stable bladder on multichannel urodynamics, without known neurological pathology, and without a history of pelvic or anti-incontinence surgery. A resting urethral pressure profile and the degree of urethral hypermobility were registered. Two-tailed analyses of variance (ANOVA) with Fisher's post-hoc tests were used to detect any statistically significant difference (P < 0.05) in urethral closure pressure between groups with varying degrees of urethral hypermobility. RESULTS: Mean age was 45.6 +/- 12.7 (range 20-77) years. Mean maximum urethral closure pressure for the entire group was 62.7 +/- 29 (range 10-150) cm of water. A statistically significant inverse relationship was found between age and maximum urethral closure pressure (r = 0.489, P < 0.0001) when both analyzed as continuous variables, and with age categorized in 10-year increments (P < 0.0001). When comparing mean urethral closure pressure in each group examined for urethral hypermobility, a statistically significant difference was noted when grades I, II, and III were compared to grade 0 hypermobility. No significant difference was observed when grades I, II, and III were compared to each other. Even if statistically non-significant, there exists an inverse relationship between the degree of urethral hypermobility and the maximum urethral closure pressure: a higher hypermobility is associated with a lesser urethral closure pressure. CONCLUSIONS: Urethral closure pressure falls significantly when urethral hypermobility is present. This decrease is not related to patient's age or parity. Our observations demonstrate an inverse relation between urethral closure pressure and the degree of cysto-urethrocele. As hypermobility increases, closure pressure decreases, even if this decrease does not reach the level of statistical significance.     

Observations on the function of the female urethra: II: Relation between maximum urethral closure pressure at rest and the degree of urethral incompetence

AIMS: To study the relation between maximum urethral closure pressure (MUCP) at rest and the degree of urethral incompetence in the female. PATIENTS AND METHODS: Two hundred fifty five patients aged 20 years or older, with stable bladders on multichannel urodynamics, without known neurological pathology, and with no previous history of pelvic or anti-incontinence surgery were included in the study. Resting urethral pressure profile (UPP) and the grade of urethral incompetence was registered. RESULTS: Mean age of the group was 45.6+/-12.7 years; mean MUCP was 62.7+/-28.5 cm of water. There was a statistically significant difference in the MUCP when the different grades of urethral incompetence were compared to each other, the higher grades being associated with a lower maximal closure pressure. CONCLUSIONS: This study demonstrates that there is a highly significant relationship between MUCP and between all grades of urethral incompetence. This supports previous observations that MUCP decreases when abdominal leak point pressure (ALPP) is low and that this might be secondary to some mechanical failure in the pressure transmission from the abdominal cavity to the urethra. Studies should never compare continent to incontinent cohorts without considering their ALPP because in doing so they are comparing groups that are functionally heterogeneous.     

The urethral pressure profile at rest: An analysis of variance

Resting urethral pressure protile measurements were carried out by a microtransducer method on 100 women with a variety of urinary symptoms in an attempt to analyse the repeatability and reproducibility of the various protile parameters. The findings were as follows: The repeatability of parameters was shown to have some dependence on the rate of catheter withdrawal. being optiinal at 15 cm per minute. Profiles recorded by microtransducer showed greater consistency than those recorded by a fluid perfusion method. in terms of the parameters of urethral length. Whilst the fluid perfusion method has previously been shown to have a significant component of variance duc to time. no such time-dependent component was found with the microtransducer method. Urethral pressures measured by microtransducer do appear to have a significant time-dependence when recorded during the menstrual cycle in women of reproductive age. These findings suggest that the microtransducer method of urethral pressure measurement has a greater diagnostic reliability than the tluid perfusion method. It also has a greater capacity to assess the effects of drugs. hormones. and surgery on the urethral pressure profile. Care must be takcn. however. in the interpretation of pressure variations noted In women in reproductive age groups.     

Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence

AIMS: To analyze the relation between urethral hypermobility and urethral incompetence, and to summarize the interdependence between maximum urethral closure pressure (MUCP), urethral hypermobility, and urethral incompetence. PATIENTS AND METHODS: A group of 255 patients was selected from a large bank of cases. Inclusion criteria were age 20 years or above, no neurological disease, stable bladder, and no previous incontinence surgery or hysterectomy. The degree of hypermobility (cysto-urethrocele) and the degree of urethral incompetence (abdominal leak point pressure (ALPP)) were determined. Statistical analyses between urethral hypermobility and incompetence were performed with Spearman's correlation and the Jonckherre-Terpstra test. RESULTS: The Spearman's rank correlation test showed a statistically significant relation between urethral hypermobility and the degree of urethral incompetence (P = 0.0049). CONCLUSIONS: The statistically significant relation between urethral incompetence and hypermobility suggests that urethral incompetence will increase as the degree of urethral hypermobility does. Optimal conditions for urinary continence include a high maximum urethral closure pressure, absence of hypermobility, and a low degree of urethral incompetence. This last factor is assured by a strong support underneath the urethra permitting compression of the latter during straining. Failure of the urethral closure mechanism is highly probable with a diminished maximum closure pressure accompanied by urethral hypermobility often associated with a high degree of urethral incompetence. Clinically significant urinary incontinence may appear in many intermediate circumstances between these two extreme states, but stress urinary incontinence is essentially an activity-related phenomenon.     

Fluid perfused urethral pressure profilometry and Valsalva leak point pressure: a comparative study in a biophysical model of the urethra

In patient studies the correlation between maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (LPP) is meagre at best (r = 0.22–0.50). We therefore studied the relation between MUCP and LPP in a flexible and extensible model urethra. We applied differently sized pressure zones and different degrees of resistance to a biophysical model urethra by stepwise inflating three types of blood pressure cuff placed around the model. At each degree of resistance we measured detrusor LPP, an in vitro equivalent of Valsalva LPP. Subsequently, we recorded the Urethral Pressure Profile using a water-perfused 5F end-hole catheter at four withdrawal rates and five perfusion rates and calculated MUCP. We tested the dependence of LPP on pressure zone length and MUCP on perfusion rate, withdrawal rate and pressure zone length using analysis of variance. We tested the correlation between LPP and MUCP using Pearson’s correlation coefficient and Linear Regression. LPP did not significantly depend on the pressure zone length (P = 0.80) and increased linearly with increasing cuff pressure. MUCP also increased with increasing cuff pressure, however, MUCP significantly depended (P < 0.01) on perfusion rate, withdrawal rate and pressure zone length. MUCP increased with increasing perfusion rate, and decreased with increasing withdrawal rate. In our model urethra MUCP only accurately reflected urethral resistance for a very limited number of combinations of perfusion rate and withdrawal rate. LPP reflected urethral resistance independent of the type of pressure zone.     

A comparison of the cough and standing urethral pressure profile in the diagnosis of stress incontinence

Controversy over the accuracy of the urethral pressure profile (UPP) and its role in the diagnosis of stress urinary incontinence (SUI) is unresolved. Different UPP methods and techniques have been introduced. In this study, we examined 78 female patients with mixed symptoms of stress and urge incontinence. Each had a history, physical examination, cystoscopy, and urodynamic assessment, which consisted of a cystometrogram (CMG), UPP (supine and standing), and “cough profile” by the Brown and Wickham (BW) method and also UPP (supine) and “cough profile” with the microtip transducer (MTT). The final diagnosis in 38 patients was SUI (group I) and in 40 patients, no SUI (group II). The maximum urethral closure pressure (MUCP) supine and standing was significantly lower in group I, but there was no significant difference between the two groups in the transmission index (TI) of the “cough profile.” MUCP standing showed the least overlap between the two groups, and with a cutoff point at 40 cm H₂O, the overall diagnostic accuracy was 69%, with 39% sensitivity and 98% specificity. By combining MUCP supine and standing and using cutoff points at 40 cm H₂O and 35 cm H₂O, respectively, the overall diagnostic accuracy was 72%, with 47% sensitivity and 95% specificity. We believe that the UPP is a useful ancillary tool in the assessment of complicated cases of urinary incontinence in the female.