清洁间歇性导尿术在宫颈癌根治术后膀胱功能快速康复中的应用

目的 探讨清洁间歇性导尿术在宫颈癌根治术后膀胱功能快速康复中的应用效果。 方法 选择72例行宫颈癌根治术后存在膀胱功能障碍的患者,将其随机分为实验组和对照组各36例,实验组采用清洁间歇性导尿术,对照组采用留置导尿,比较2组患者术后1月的尿流动力学检查结果、尿路感染率和自主排尿时间的差异。 结果 术后1月实验组患者尿流动力学恢复正常率高于对照组(χ²=14.961,P<0.001),尿路感染率低于对照组(χ²=4.741,P=0.029),恢复自主排尿时间短于对照组(t=-4.157,P<0.001)。 结论 清洁间歇性导尿能促进宫颈癌根治术后膀胱功能的快速康复,减少尿路感染的发生。     

早期膀胱康复训练对脊髓损伤性截瘫患者排尿功能恢复的影响

目的探讨早期膀胱康复训练对脊髓损伤性截瘫患者膀胱功能恢复的效果。方法选择66例脊髓损伤合并截瘫患者,随机分为康复组和对照组各33例。对照组：膀胱训练和尿管护理方法按常规进行;康复组：进行早期膀胱康复训练。比较2组排尿功能恢复的情况。结果临床膀胱功能恢复情况康复组明显优于对照组。结论对脊髓损伤性截瘫患者进行早期膀胱康复训练,可以促使患者早日脱离尿管,建立规律性排尿习惯,减少并发症。     

Tamsulosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects.

PURPOSE: We systematically reviewed the effectiveness and adverse effects of tamsulosin for lower urinary tract symptoms compatible with benign prostatic obstruction. MATERIALS AND METHODS: Studies were included in analysis when they involved a randomized trial of at least 1 month in duration, men with lower urinary tract symptoms and a comparison of tamsulosin with placebo or an active control. Study, patient and outcome data were extracted onto standard forms using a prospective protocol. RESULTS: Of the series 13 involving 3,418 men with a mean age of 64 years met our inclusion criteria. Study duration was 4 to 26 weeks. Baseline symptom scores and flow rates showed moderate lower urinary tract symptoms. Tamsulosin improved symptoms and peak urine flow compared with placebo. The weighted mean difference in the mean change from baseline for the Boyarsky symptom score for 0.4 and 0.8 mg. tamsulosin versus placebo was -1.1 (95% confidence interval [CI] -1.49 to -0.72 or 12% improvement) and -1.6 points (95% CI -2.3 to -1.0 or 16% improvement), respectively. The weighted mean difference in the mean change from baseline in peak urine flow was 1.1 (95% CI 0.59 to 1.51) and 1.1 ml. per second (95% CI 0.65 to 1.48) for 0.4 and 0.8 mg., respectively. The 0.2 to 0.4 mg. tamsulosin dose was as effective as other alpha-antagonists for improving symptoms and the flow rate, although the doses of all alpha-antagonists evaluated may not have been optimal. Treatment withdrawals and adverse effects increased markedly as the tamsulosin dose increased. CONCLUSIONS: Tamsulosin improves lower urinary tract symptoms and flow. Its effectiveness was similar to that of other alpha-antagonists, increasing slightly at higher doses. Adverse effects were generally mild but the incidence, including treatment withdrawals, increased substantially at higher doses.     

Home uroflowmetry biofeedback in behavioral training for dysfunctional voiding in school-age children: a randomized controlled study

PURPOSE: We studied the added value of home uroflowmetry for biofeedback training compared to added attention and standard therapy in a multicomponent behavioral training program for voiding disorders in school-age children. Little is known about the role of biofeedback by home uroflowmetry for dysfunctional voiding due to NNBSD in children. MATERIALS AND METHODS: A randomized controlled study was conducted at an outpatient pediatric incontinence university clinic from January 2000 to June 2003. A total of 192 children 6 to 16 years old who were suffering from recurrent urinary tract infections with or without urge incontinence were screened for NNBSD. Of 143 eligible patients 44 were randomly allocated to receive 8 weeks of standard therapy (outpatient behavioral therapy), 46 to receive 8 weeks of home video instructions together with standard therapy and 53 to receive 8 weeks of home uroflowmetry biofeedback together with standard therapy. After 8 weeks all treatment groups proceeded with standard therapy for 16 weeks, after which prophylaxis with antibiotics was stopped and patients were followed for another 6 months. Main outcome measurement was total relief of complaints, namely urinary tract infections and, if present, incontinence, at 12 months after randomization. RESULTS: At baseline there was no reason to predict major incomparabilities between the groups. In an intent to treat analysis there was no difference in total relief between standard treatment (44%) and added video instruction (42%, RR 0.96, 95% CI 0.59 to 1.56). Total relief in the added home uroflowmetry group (55%) was higher than with standard therapy (RR 1.24, 95% CI 0.80 to 1.93), although the difference was not statistically significant. A per protocol analysis suggested that the groups with added home uroflowmetry showed better total relief than the pooled groups with standard therapy and those with added video (RR 1.40, 95% CI 0.98 to 2.00). CONCLUSIONS: Home uroflowmetry appears to be a useful adjunctive treatment for the reduction of complaints in children with dysfunctional voiding due to nonneurogenic bladder-sphincter dyssynergia.     

Nocturia and circadian blood pressure profile in healthy elderly male volunteers

PURPOSE: Nocturia is attributed to nocturnal polyuria and/or decreased functional bladder capacity. In this study we elucidated the mechanisms behind circadian fluid regulation and the occurrence of nocturia in healthy elderly males, specifically to determine the role of urine output and regulating hormones, blood pressure, and average voided volumes. MATERIALS AND METHODS: A total of 18 males 55 to 73 years old (mean age 61.1) were included in the study. Voiding habits were assessed by completion of a 7-day frequency volume chart recording all fluid intake and voiding. The subjects subsequently underwent inpatient circadian studies measuring the diurnal rhythm of blood pressure, vasopressin, atrial natriuretic peptide, angiotensin II, aldosterone and urine volume. RESULTS: Of the nightly home recordings 25% showed nocturia, characterized by a higher 24-hour and nighttime urine volume. During the inpatient studies 12 of the 18 participants experienced a nocturnal void. Nocturia nights were characterized by significantly decreased day-to-night ratios in urine output and a higher nighttime mean arterial blood pressure. A circadian variation in plasma arginine vasopressin was seen only in the group without nocturia. The other hormones revealed a circadian rhythm similar in the 2 groups. CONCLUSIONS: In healthy males with occasional nocturia, the occurrence of nocturia seems to be associated with a blunting of the circadian rhythm of diuresis and increased arterial blood pressures during the night. These findings may implicate a role for a baroregulatory related mechanism in nocturia.     

调理脾胃针法配合排尿训练治疗糖尿病神经原性膀胱的临床观察

目的研究调理脾胃针法配合排尿训练治疗糖尿病神经原性膀胱（DBN）的临床疗效。方法将60例DBN患者按随机数字表分为观察组和对照组。观察组选用调理脾胃针法配合排尿训练;对照组采用针刺膀胱俞、肾俞、三焦俞、中极、气海、委阳、阴谷、三阴交、阴陵泉。3个疗程后对两组中医症状评分,综合疗效评分进行对比观察。结果两组治疗前后中医症状评分差异有统计学意义（P〈0.01）,观察组效果更好。观察组治疗3个疗程后综合疗效86.7%（26/30）,高于对照组53.4%（16/30）（uc=2.221,P〈0.05）。结论调理脾胃针法配合排尿训练能通调膀胱经气,健脾化湿,通利水道,提高膀胱张力,改善患者的生存质量。     

腹部手术留置尿管时间的选择

目的 探讨腹部手术围手术期留置尿管的时间.方法 纳入符合入选标准80例全麻下行腹部手术的患者,行术前麻醉后置放尿管,术后麻醉复苏前拔除尿管.术后观察尿潴留及膀胱刺激症状.结果 80例术后患者75例均能自行排尿,仅5例再次置放尿管.x2=3.3,P＞0.05,差异没有统计学意义.术后1d,发生膀胱刺激症状5例,与术前比较...     

留置尿管拔出后自主排尿的最佳方法研究

目的探讨拔除尿管后病人首次自主排尿的最佳方法。方法将502例留置尿管病人采用随机分为三组,常规组（170例）,实验A组（161例）,实验B组（131例）。通过观察是否能首次自主排尿,拔除尿管至首次排尿时间,护士工作量,费用等各项结果以比较三种拔管方法。结果膀胱冲洗后拔管效果明显优于完成当日输液量后和输液过程中随即拔管,差异有显著意义（P〈0.05）。结论提示膀胱冲洗后拔管可有效防止尿潴留的发生,并缩短了拔管后首次排尿时间,该法应作为留置尿管拔出后的首选方法。