气囊导尿管使用不当致尿道损伤的预防及治疗

目的 探讨气囊导尿管致尿道损伤的原因、预防措施及治疗方法。方法 回顾性分析17例气囊导尿管不当使用导致医源性尿道损伤的临床资料。结果 导致尿道损伤原因分别为导尿管气囊注水量及导尿管型号掌握不佳、不熟悉男性解剖、操作和护理等。尿道损伤多为尿道部分裂伤和粘膜损伤。重新留置导尿管,会阴部持续加压包扎并给予抗炎、止血、通便等方法治疗,全部保守治疗治愈,拔尿管后排尿正常, 未留下后遗症。结论 气囊导尿管使用不当造成的尿道损伤偶有发生,可以保守治疗。合适的导尿管型号及气囊注水量、规范的操作和精心的护理可以预防和减少尿道损伤。     

Clinical importance of urethral pressure variations

The cause of female urethral instability is still controversial. With the help of this retrospective analysis of 1168 continuous long-term recordings of the intraurethral pressure at the maximum point of urethral pressure, the correlation between pressure variations (UPV) and simultaneous bladder instability was investigated. It could be stated that clinically important UPV (more than 15 cmH₂O) are found more often in women who suffer from signs of bladder instability (defined as low bladder compliance combined with uninhibited detrusor contractions and/or urinary leakage) than in patients without signs of unstable bladder.     

Computer assisted pantropic urethral pressure profile

Summary A computerized method for urethral pressure measurement along the whole length and at every angle of the urethra is presented. The main advantage is the exact study of physiological versus artificial factors in pressure distribution in the urethra. Details of the technique are presented.     

尿道会师术后三腔气囊尿管的留置时间探讨

目的:探讨尿道会师术后三腔气囊尿管的合理留置时间。方法:报告65例后尿道断裂患者Ⅰ期尿道会师术后,三腔气囊尿管牵引和留置时间及尿道扩张情况。结果:23例尿道会师术后尿管留置3周,均有不同程度的尿道狭窄,需定期做尿道扩张;其中15例扩张达1年之久,3例行尿道内切开术加定期尿道扩张。20例术后留置三腔气囊尿管3个月,一次治愈7例;6例轻度尿道狭窄者,尿道扩张3～5次痊愈;其余较严重者均需扩张半年以上。22例术后尿管留置6个月,一次痊愈15例;4例轻度狭窄者,尿道扩张3～4次痊愈,其余3例狭窄者,尿道扩张3个月至半年痊愈。结论:尿道会师术后三腔气囊尿管留置时间的长短,将直接影响尿道狭窄的发生率和狭窄程度,较为合理的留置时间以6个月为宜。     

Directional differences in urethral pressure recordings: Contributions from the stiffness and weight of the recording catheter

The difference between urethral pressures measured along the anterior wall and those measured along the posterior wall was found to increase markedly as the stiffness of the catheter was increased and to increase by a greater amount if the weight of the catheter was increased. A method of grading the stiffness of catheters is proposed and the use of stiff catheters in past reports of urethral measurements is discussed.     

Short and long term reproducibility of urethral closure pressure profile parameters

Summary In ten incontinent female patients the reproducibility of urethral closure pressure profile parameters obtained with the Brown and Wickham technique in two consecutive measurements and in measurements after a one month interval was assessed. Variances after one month were statistically signifiantly larger than the variances between consecutive measurements. The mean values obtained with one month interval did not differ significantly.     

微创尿道会师术治疗尿道外伤(附31例报告)

目的:探讨微创尿道会师术治疗尿道损伤的疗效.方法:回顾分析为31例尿道损伤患者用输尿管镜行微创尿道会师术的临床资料,必要时联合应用膀胱造瘘并用金属导尿管辅助.结果:31例均获成功,18例患者经输尿管镜顺利置入斑马导丝及F18尿管,13例合并应用膀胱穿刺造瘘,应用金属导尿管辅助置入斑马导丝后顺利置入F18尿管.随访0.5...     

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。     

Toxic catheters and urethral strictures: A concern about types of catheters used in resource-poor countries

Various reports in the literature have confirmed urethral toxicity caused by the use of catheters, mostly latex catheters and their coated versions, resulting in long-segment urethral strictures or strictures located in multiple areas of the urethra. Most catheters used in resource-poor countries, such as Nigeria, are latex catheters with various coatings, such as silicone. The reasons for the widespread use of these potentially toxic catheters are mainly non-availability and/or the high cost of less toxic catheters. We report three cases of urethral strictures following the use of siliconized latex catheters in order to highlight the potential urethral toxicity associated with the use of latex catheters and to draw the authorities’ attention to the need to regulate the types of catheters used in the country.     

Opening vesical pressure: a new test to discriminate urethral sphincter deficiency?

Urethral sphincter deficiency (USD) is not standardised. Opening vesical pressure could reflect the pressure exerted to overcome urethral resistance during void; thus, we evaluated if it could discriminate USD. Women with urinary symptoms were prospectively assessed with a questionnaire and urodynamics and divided into three groups: urodynamic stress incontinence with USD (group 1), urodynamic stress incontinence related to urethral hypermobility without USD (group 2) and normal urodynamic (group 3). USD was defined as the concomitant presence of severe urodynamic stress incontinence, VLPP <60 cm H2O, MUCP <20 cm H2O and urethral mobility <30°. A total of 145 women were enrolled: 56 in group 1, 50 in group 2 and 39 in group 3. The three groups did not differ for demographics, obstetric and surgical history. The median values for opening vesical pressures were 17.5 (15.6–22.2 95%CI), 30 (27.0–37.3 95%CI) and 30 (30.6–44.2 95% CI) for the groups 1, 2 and 3, respectively. A p value <0.0001 was found when comparing group 1 either with group 2 or 3. Opening vesical pressure is a promising parameter to detect USD.     

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.     

The relationship of urethral resistance pressure and pressure flow parameters in women with lower urinary tract symptoms

This prospective study aims to evaluate the relationship between urethral resistance pressure (URP) and pressure flow parameters in women with lower urinary tract symptoms (LUTS). Consecutive women with LUTS attending three tertiary referral urodynamic clinics were asked to undergo urodynamic evaluation, pressure flow studies and URP measurement. The pressure flow parameters such as detrusor pressures at the start of flow (ODP), detrusor pressure at peak flow rate (PdetQmax), peak flow rate (Qmax) and detrusor pressure at the end of flow (CDP) were measured. The relationship between URP and pressure flow parameters was evaluated as well as differences between each urodynamic group. Two hundred seventy-nine women attended for urodynamic investigations. Two hundred twenty-three (79.9%) women had good quality pressure flow measurements and were included in the study. The mean age was 58 years (range 21–83). Women with urodynamic stress incontinence had significantly lower URP and ODP than those with detrusor over-activity [54.8 (±17.9) and 12.4 (±4.1) cmH₂O, respectively, vs 85.6 (±21.4) and 33.7 (±13.3) cmH₂O, respectively) (p<0.05, Bonferroni test). Furthermore, women with urodynamic stress incontinence have significantly lower PdetQmax values as well as higher Qmax than women with competent urethral sphincters (p<0.05, Bonferroni test). There was a significant correlation between ODP, PdetQmax, Qmax and URP measurements. In urodynamic stress incontinence, both URP and pressure flow parameters are reduced. Although the trend for values of both tests were similar and there was a significant correlation between these tests, we should consider that urethral function at rest differ from that during voiding due to activation of additional mechanisms. Therefore, further study is needed to confirm our results.     

Intentional urethral closure with a TVT (tension-free vaginal tape) for intractable urinary incontinence: a preliminary report of three cases

Bladder neck and urethral closure with urinary diversion is offered as a last resort to patients with intractable urinary incontinence. Various techniques have been described to achieve bladder neck and urethral closure. Most of these are associated with either operative morbidity or long-term complications. A modification of the conventional tension-free vaginal tape (TVT) procedure is described. As the name suggests, during the conventional TVT procedure, the tape is inserted relatively without tension in such a manner that the urethra retains its function and post-operative voiding is possible. In the cases described in this short series, the aim was to achieve urethral and bladder neck closure with minimal operative morbidity. This was achieved by inserting the TVT exactly as in a conventional TVT procedure, but the tape was inserted under greater tension than is normally used to ensure continence. A long-term suprapubic catheter was used for urinary diversion. This procedure is simple to perform, is associated with low operative morbidity [Agostini et al., Eur J Obstet Gynecol Reprod Biol, 124(2):237–239, 2006] and results in functional urethral closure. Results suggest that it may be a useful alternative to other bladder neck and urethral closure procedures in selected patients.     

Hydrophilic-coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective, randomised, participant-blinded, crossover study of three different types of catheters

OBJECTIVE: To compare two hydrophilic-coated (SpeediCath and LoFric and one uncoated gel-lubricated catheter (InCare Advance Plus) concerning withdrawal friction force and urethral micro trauma. METHODS: 49 healthy male volunteers participated in this prospective, randomised, blinded, crossover study of three different bladder catheters. The withdrawal friction force was measured, and urine analysis of blood, nitrite and leucocytes, microbiological analysis of urine cultures and subjective evaluation of the catheters were performed. RESULTS: 40 participants completed the study and were included in the analysis. SpeediCath exerted a significantly lower mean withdrawal friction force and work than the gel-lubricated uncoated catheter, whereas LoFric exerted a significantly higher mean friction force than both of the other catheters. The hydrophilic catheters caused less microscopic haematuria and less pain than the gel-lubricated uncoated catheter. Furthermore, 93% of the participants preferred the hydrophilic catheters. CONCLUSION: Hydrophilic-coated catheters perform better than uncoated catheters with regard to haematuria and preference. SpeediCath, but not LoFric, exerts less withdrawal friction force than InCare Advance Plus.     

Simultaneous measurement of absolute pressure values in the urethra and bladder

Summary In order to improve the accuracy of bladder and urethral pressure recording, a measurement system has been tested experimentally. It is possible to measure absolute pressure values during withdrawal of the catheter only when the system is constantly perfused. The optimum relationship between catheter diameter, perfusion rate, withdrawal rate, measurement inertia and systemic resistance has been analysed.     

Effects of voluntary pelvic floor contraction and relaxation on the urethral closure pressure

The aim of this study was to assess the effects of voluntary pelvic floor contraction and voluntary pelvic floor relaxation on the urethral closure pressure at rest. In 104 consecutive women, three urethral pressure profiles were performed: standard profile at rest, with voluntary pelvic floor contraction and with voluntary pelvic floor relaxation. A low-pressure urethra was defined as a maximum urethral closure pressure of 20 cmH₂O. The age ranged between 24 and 82 years. The maximum urethral closure pressure at rest was significantly augmented during pelvic floor contraction (mean: 18 cmH₂O). Compared with the first profile, it decreased significantly with pelvic floor relaxation (mean decrement: 8 cmH₂O). A low-pressure urethra was detected in 5 women during the first profile and in a further 11 during pelvic floor relaxation. Because of the significant influence of pelvic floor activity on the urethral closure pressure at rest, the scientific and clinical credibility of urethral pressure measurements remain questionable.Part of the results were presented at the Annual Meeting of the International Continence Society (ICS) 1999 in Denver and at national German and Swiss gynecology meetingsEditorial Comment: This very interesting study on the influence of the pelvic floor muscles on urethral pressure gives basic information about the functionality of the urethra. There is still a great lack of knowledge as we really do not know what exactly we measure when we perform an urethral pressure profile. The study points out that further investigations are necessary that should focus on the different parts of the pelvic floor muscles and their influence on the continence mechanisms. New investigative options such as magnetic nuclear resonance (MNR) and perineal ultrasound should be involved. It would have been even more interesting if the results of the performed perineal ultrasound would have been described beside the palpation of the muscle strength     

尿道置三根硅胶管治疗骨盆骨折后尿道断裂及炎性尿道狭窄

为改进探讨骨盆骨折后尿道断裂、炎性尿道狭窄新的治疗方法,作者对骨盆骨折后尿道断裂会师术后７～１０天患者６６例、炎性尿道狭窄患者１５例强行扩张术后,尿道内置三根２．５ｍｍ硅胶管,留置３个月。结果：骨盆骨折后尿道断裂６６例,治愈率８７．９％,良好率３．０％,失败率９．１％;炎性尿道狭窄１５例,全部治愈。本组８１例总治愈率９２．６％,失败率７．４％。作者认为,该术式操作简单、安全、有效,并且能显著地降低尿道感染及狭窄。     

A comparative study of water perfusion catheters and microtip transducer catheters for urethral pressure measurements

The aim of this study was to compare the maximum urethral closure pressure (MUCP) measures with two different techniques: water perfused catheter and microtip transducer catheters with respect to reproducibility and comparability for urethral pressure measurements. Eighteen women with stress urinary incontinence had repeat static urethral pressure profilometry on a different day using a dual microtip transducer and water perfused catheter (Brown and Wickham). The investigators were blinded to the results of the other. The microtip measurements were taken in the 45° upright sitting position with the patient at rest at a bladder capacity of 250 ml using an 8 Fr Gaeltec® double microtip transducer withdrawn at 1 mm/s, and the transducer was orientated in the three o’clock position. Three different measures were taken for each patient. Three water perfusion measurements were performed with the patient at rest in the 45° upright position at a bladder capacity of 250 ml using an 8 Fr BARD dual lumen catheter withdrawn at 1 mm/s. The mean water perfusion MUCP measure was 26.1 cm H₂0, significantly lower than the mean microtip measure of 35.7 cm H₂0. The correlation coefficient comparing each water perfusion measurement with the other water perfusion measures in the same patient was excellent, at 0.95 (p?=?0.01). Correlation coefficient comparing each microtip measure with the other microtip measure in the same patient was also good, ranging from 0.70 to 0.80. This study confirms that both water perfusion catheters and microtip transducers have excellent or very good reproducibility with an acceptable intraindividual variation for both methods.     

A comparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women

This study correlated Doppler resistive indices (RIs) with maximum urethral closure pressures (MUCPs) in women with stress urinary incontinence. We hypothesized that urethral blood flow would be inversely correlated to urethral closure pressures. Fifty-three women underwent spectral Doppler waveform analyses of periurethral vasculature to calculate RI. Urethral morphology including pubovesicular length (PVL) with and without cough was measured. MUCPs were obtained according to International Continence Society guidelines. Physical exam and history were also obtained. Correlation coefficients were calculated for comparisons of Doppler measurements and closure pressures. Fifty patients were required to detect a difference between no correlation and a modest correlation of 0.38 with 80% power and alpha of 0.05. Significance is set at p<0.05. Measurements were reproducible between Doppler waveforms and MUCP measurements (all p=NS). RI was not correlated with age, parity, MUCP, Incontinence Impact Questionnaire-7 scores, urethral length, or urethral width (all p=NS). RI and MUCP were likewise not associated with history of diabetes, hypertension, or anterior vaginal prolapse to or beyond the hymen (all p=NS). MUCP was negatively correlated with age (r=−0.33, p=0.01) even when controlled for hormonal status (ANCOVA, p=0.003) and positively correlated with urethral/bladder neck diameter (r=27, p=0.05), PVL (r=0.30, p=0.03), and PVL with cough (r=0.36, p=0.009).     

Telemetric recording of intrapleural pressure

BACKGROUND: Monitoring of intrapleural pressure (IPP) is used for evaluation of lung function in a number of pathophysiological conditions. We describe a telemetric method of non-invasive monitoring of the IPP in conscious animals intermittently or continuously for a prolonged period of time. MATERIALS AND METHODS: After IACUC approval, six mongrel dogs were used for the study. After sedation, each dog was intubated and anesthetized using 0.5% Isoflurane. A telemetric implant model TL11M2-D70-PCT from Data Science International was secured subcutaneously. The pressure sensor tip of the catheter from the implant was inserted into the pleural space, and the catheter was secured with sutures. The IPP signals were recorded at a sampling rate of 100 points/second for 30 to 60 min daily for 4 days. From these recordings, the total mean negative IPP (mmHg), and the total mean negative IPP for a standard time of 30 min were calculated. In addition, the actual inspiratory and expiratory pressures were also measured from stable recording of the IPP waveforms. RESULTS: In six dogs, the total mean +/- SD negative IPP was -10.8 +/- 10.6 mmHg. After normalizing with respect to acquisition time it was -13.2 +/- 11.2 mmHg/min. The actual inspiratory pressure was -19.7 +/- 15.3, and the expiratory pressure was -11.0 +/- 12.9. CONCLUSIONS: Our study demonstrates that telemetric monitoring of IPP can be performed reliably and non-invasively in conscious experimental animals. The values for IPP in our study are compatible with the results of other investigators who used different methods of IPP measurement. Further work may show this method to be helpful in understanding the pathophysiology of various breathing disorders.