女性原发性膀胱颈梗阻

目的 探讨女性原发性膀胱颈梗阻（ＰＢＮＯ）的临床及尿动力学特点。方法 回顾性分析６１例ＰＢＮＯ及３２例压力性尿失禁患者尿动力学检查资料。结果 ＰＢＮＯ病人分为内括约肌痉挛症（ＩＳＳ）组及膀胱颈梗阻（ＢＮＯ）组,前者４１例,后者２０例,压力流率测定成功率ＩＳＳ组低于ＢＮＯ组及对照组（４９％,８０％,８１％）。ＩＳＳ组及ＢＮＯ组Ｌｉｎ－ＰＵＲＲ ＢＯＯ分级〉Ⅱ级者占９４％,对照组９９％为０～Ⅰ级。ＩＳＳ组及ＢＮＯ组与对照组比较差别有显著性意义的指标为膀胱颈开放逼尿肌压（ＰＶＢ）、ＡＧ数（ＰｄｅｔＱｍａｘ－２Ｑｍａｘ）、剩余尿量及最大尿道闭合压（ＭＵＣＰ）。结论 ＰＢＮＯ诊断的重要参数为Ｌｉｎ－ＰＵＲＲ分级、ＰＶＢ及ＡＧ数,改良苄胺唑啉ＵＰＰ试验是内括约肌功能性梗阻定性定位的良好指标。Ｌｉｎ－ＰＵＲＲ〉Ⅱ级可确定为梗     

Primary bladder neck obstruction in men,women, and children

The understanding of the presentation, diagnosis, and treatment of primary bladder neck obstruction (PBNO) has evolved over the last 20 years. It was first identified 70 years ago, but the etiology is still unclear. There are multiple theories as to the etiology, including muscular and neurological dysfunction and fibrosis. Over the years, many voiding parameters and cut points and nomograms have been presented for diagnosis of nonneurogenic functional bladder outlet obstruction in young men. Until recently, there was a paucity of data on PBNO in women and children. Videourodynamics provide an accurate diagnosis of PBNO but for some patients are an invasive option. Treatments vary from watchful waiting to α-blockade to surgery, depending on the severity of symptoms, urodynamic findings, and response to medical therapy. This paper reviews the theories on etiology, incidence, presentation, and diagnostic evaluation, and briefly discusses treatment options for PBNO.     

The structure of the bladder neck in male bladder neck obstruction

A light microscope and neurohistochemical study is presented of full thickness biopsies from the bladder neck of 10 middle-aged males with urodynamically proven bladder neck obstruction. Apart from varying degrees of collagen deposition in seven cases, no abnormality was present in the detrusor and pre-prostatic components of the bladder neck muscles or in the distribution of cholinergic nerve fibres. The normal noradrenergic innervation to the pre-prostatic sphincter was absent in all specimens; this may be age-related.     

经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察

目的:评估经尿道膀胱颈内切开术治疗女性原发性膀胱颈梗阻(PBNO)的长期疗效。方法:56例女性患者通过排泄性膀胱尿道造影及尿动力学检查确诊为PBNO,在膀胱颈上选取2点及10点位置,所有患者行经尿道膀胱颈内切开术。结果:术后随访6~72个月(平均26.2个月)。56例接受手术的患者中47例(83.9%)术后恢复良好,未见严重并发症。随访过程中,平均国际前列腺症状评分(IPSS)由21.2降至7.6(P<0.05),生活质量评分(QOL)由4.2降至2.3(P<0.05),最大尿流率(Q_max)由8.63ml/s增至17.36ml/s(P<0.05),残余尿量(PVR)由106.32ml降至21.46ml(P<0.05),最大尿流率时逼尿肌压力(Pdet at Q_max)由68.42cmH_2O降至19.86cmH_2O(1cmH_2O=0.098kPa,P<0.05)。术后出现的并发症有血尿、二次行膀胱颈内切开术、压力性尿失禁、尿道狭窄。所有这些并发症按Clavien分类评估为Ⅲa级。3例(5.3%)术后出现出血,经延长尿管留置时间、膀胱冲洗治愈,均未输血治疗;4例(7.1%)出现压力性尿失禁,行经阴道无张力尿道中段吊带术后恢复;4例(7.1%)出现尿道狭窄,间断尿道扩张后好转。结论:PBNO不常见,排泄性膀胱尿道造影及尿动力学检查可确诊,通过经尿道膀胱颈内切开术治疗安全有效。在膀胱颈的2点和10点方向仔细地、足够深度地行颈内切开可以保证手术的成功。     

Functional bladder neck obstruction in women

Symptoms of bladder neck dysfunction in the female are rarely encountered. In 5 females, i.e., 0.6% of the female patients referred for urodynamic investigation, we found parameters consistent with bladder neck dysfunction. Prolonged opening time, slow stream, but otherwise normal voiding reflexes were the main features.     

儿童先天性膀胱颈梗阻及其诊治

目的：探讨儿童先天性膀胱颈梗阻的临床特点,提高对先天性膀胱颈梗阻的认识。方法：报告2例先天性膀胱颈梗阻患儿诊治资料,复习有关文献。结果：1例运用尿道镜电切,延期输尿管再植,另1例采用开放手术作膀胱颈增生后唇的楔形切除,同时作膀胱与输尿管再植术,随访3～6个月,均取得了满意效果。结论：儿童先天性膀胱颈梗阻是一种少见的儿童下尿路梗阻,以膀胱颈增生的排列紊乱的平滑肌和弹力纤维为病理特点。可以根据其临床特征、膀胱镜、VCUG、VUDS等作出诊断,尿道内窥镜电切术或开放性膀胱颈成形术可获得良好的治疗效果。     

膀胱颈部梗阻的腔内手术治疗

目的：评价腔内手术治疗膀胱颈部梗阻（BNO）的长期疗效。方法：采用经尿道膀胱颈部切除术（TURN）治疗BNO44例。结果：44例平均随访48个月。1次手术治愈33例；复发4例，经再次或3次手术治愈；无效7例。总有效率84％，复发率11％。结论：TURN治疗BNO远期疗效满意，伴慢性前列腺炎及女性BNO者手术应慎重，部分患者术后需辅以激素补充疗法及长期尿道扩张以预防症状复发。     

女性膀胱颈梗阻的诊断

目的：探讨女性膀胱颈梗阻的诊断方法,提高女性膀胱颈梗阻的诊治水平。方法：对42例女性膀胱颈梗阻患者的临床资料和腔内治疗情况进行回顾性分析。结果：诊断的42例患者行经尿道膀胱颈电切术,效果满意,无尿失禁及尿瘘发生。结论：临床症状结合膀胱尿道镜检查和压力-尿流率测定是该病可靠的诊断手段,经尿道膀胱颈电切术是治疗女性膀胱颈梗阻的首选方法。     

经尿道膀胱颈电切术治疗慢性前列腺炎合并膀胱颈梗阻

目的探讨经尿道膀胱颈电切术治疗慢性前列腺炎合并膀胱颈梗阻的临床效果。方法经尿道膀胱颈部电切术治疗慢性前列腺炎合并膀胱颈梗阻23例,并进行术前术后临床症状和尿流动力学检查及对比。结果所有患者术后排尿通畅,效果满意。随访1～3个月,最大尿流率由（10．78±1．35）mL／s上升至（21．30±0．63）mL／s,差异有统计学意义（P〈0．05）;前列腺液及精液检查正常。结论对于慢性前列腺炎合并膀胱颈梗阻患者经药物治疗无效后,可选用经尿道膀胱颈部电切术治疗膀胱颈梗阻。     

女性膀胱颈部梗阻的诊断与治疗

为探讨女性膀胱颈部梗阻的病因、诊断及治疗方法。总结１９８１年５月～１９９６年６月收治女性膀胱颈部梗阻病例３２例。２９例经手术治疗，其中２例行膀胱颈ＹＶ成形术，２７例经尿道膀胱颈部后唇切除术，效果满意。结果认为，女性膀胱颈部梗阻病因为纤维组织增生和慢性炎症所致；尿流率检查是客观评价排尿状况的指标；膀胱镜检查为可靠的诊断手段；经尿道膀胱颈部后唇切除为有效的治疗方法。     

Diagnosis and treatment of functional bladder neck obstruction

The experience with 32 patients with functional bladder neck obstruction is presented and this condition is discussed. This disease occurred mainly in males from the age of 6 months to 50 years. There was only one female patient. The most important investigations were the micturating cystogram, the flow-rate and the measurement of the residual urine. The bladder neck incision, as proposed by Turner-Warwick, relieved symptoms and obstruction in all patients efficiently.