圆锥位置正常型脊髓栓系综合征患儿的诊断与治疗

目的了解圆锥位置正常型脊髓栓系综合征(TCS)患儿的临床表现和诊治特点。方法回顾性分析19例(5～8岁)圆锥位置正常型TCS患儿的临床资料,患儿术前均行放射影像学、尿流动力学、肌电图检查,手术方式采用终丝离断加椎板成形术治疗。术后(7±2)个月复查MRI及尿流动力学,比较患儿手术前后脊髓受牵拉情况及尿流动力学各指标的变化。结果术前MRI显示TCS患儿脊髓圆锥末端位置均在L2椎体下缘以上,终丝呈弓弦样紧张。其中4例显示终丝增粗,3例显示终丝轻度脂肪变;术后显示圆锥位置无明显变化,终丝紧张解除。尿流动力学结果显示术前15例患儿存在逼尿肌过度活动,3例逼尿肌收缩乏力,1例逼尿肌部分收缩功能受损伴膀胱残余尿量增多;术后16例患儿取得较好疗效,余3例下肢情况得到改善,但尿流动力学表现改善不明显。结论圆锥末端位置正常型TCS患儿的诊断需综合考虑其临床表现、放射影像学、肌电图及尿流动力学检查结果,而尿流动力学检查是诊断的关键指标,一经明确诊断,应及早行终丝离断术治疗,椎板成形术可维持患儿脊柱正常结构。     

尿畅舒胶囊对绝经后女性膀胱过度活动症尿动力学影响的研究

目的观察尿畅舒胶囊对绝经后女性膀胱过度活动症患者膀胱充盈期尿流动力学指标的影响。方法采用随机对照的方法,选取膀胱过度活动症患者36例,分为治疗组（24例）和对照组（12例）,分别给予尿畅舒胶囊、舍尼亭片治疗8周,观察治疗前后各组患者膀胱容量、膀胱顺应性、膀胱感觉等膀胱充盈期尿流动力学指标的变化。结果治疗组及对照组患者最大膀胱容量、初始尿意容量、膀胱顺应性、膀胱敏感性等膀胱充盈期尿流动力学指标较治疗前均有改善,差异有统计学意义（P〈0.05）;治疗组治疗后各项指标与对照组同期比较,差异无统计学意义（P〉0.05）。结论尿畅舒胶囊能有效增加女性膀胱过度活动症患者膀胱容量,提高膀胱顺应性,降低患者膀胱敏感性,其疗效与舍尼亭相仿。     

“通督益肾”法温针灸联合功能磁刺激治疗脑卒中后尿潴留的临床研究

目的：基于“通督益肾”法探讨温针灸联合功能磁刺激治疗卒中后尿潴留的临床疗效。方法：将70例卒中后尿潴留患者随机分为对照组和观察组,每组各35例。其中对照组给予常规针刺和功能磁刺激,观察组在对照组的基础上另对百会、肾俞（双）、命门（双）、膀胱俞（双）、太溪（双）进行温针灸,2组治疗各30min,均每日1次,共治疗4周。观察2组治疗前后的膀胱尿动力学、排尿情况、导尿次数等指标差异及治疗后的临床疗效。结果：治疗后,2组的最大膀胱容量、最大尿流率、排尿次数、排尿量均较治疗前增加（P<0.05）,充盈期逼尿肌压力、膀胱残余尿量及导尿次数均较治疗前减少（P<0.05）,且观察组均优于对照组（P<0.05）。治疗后,观察组总有效率高于对照组（97.1%,77.1%,P<0.05）;结论：“通督益肾”法温针灸优于单纯针刺,且联合功能磁刺激显著提高了卒中后尿潴留的临床疗效,可以改善患者临床症状,促进神经功能恢复,提高患者的预后。     

Reproduction of Female Lower Urinary Tract Symptoms on Urodynamics

Objectives: Urodynamic testing (UDS) can be a valuable tool in the assessment of urinary incontinence and voiding dysfunction. The success of UDS in reproducing patients' symptoms has not been well defined. We sought to determine the ability of UDS to reliably reproduce various lower urinary tract symptoms and secondarily the ability of UDS to produce disparate findings not associated with patients presenting symptoms. Methods: Following Institutional Review Board approval, patient data was accumulated prospectively over 10 months. Notation was made of primary and secondary symptoms as well as if these stated symptoms were reproduced during the urodynamic procedure. Presenting lower urinary tract symptoms included for analysis were stress, mixed and urge incontinence, urgency, and obstructive symptoms. We also reviewed the number of disparate urodynamic observations that did not correlate with patient history. Results: Over a 10‐month period, 127 women had interpretable data with respect to whether their presenting symptoms were reproduced during UDS. Presenting symptoms were successfully reproduced on 83% of UDS studies. Disparate urodynamic observations were noted in 60% of patients. Conclusions: Reproduction of patient symptoms during UDS occurred in the majority of cases if the patient was queried regarding this association. Additional disparate urodynamic observations were also noted in a majority of patients undergoing UDS. It remains unclear whether reproduction of symptoms during UDS in females ultimately results in improved interventional outcomes. The implications of new or unexpected UDS findings during UDS are unknown.     

Lower urinary tract function in childhood; normal development and common functional disturbances

This review aims to provide researchers and clinicians involved with the adult lower urinary tract with background knowledge regarding the early development of bladder function and its most common disturbances in childhood. Bladder development begins in weeks 4–6 and the detrusor muscle is formed during weeks 9–12 of gestation. Higher CNS centres are involved in micturition at birth, and the infant usually wakes up, at least briefly, to void. Voiding during the first years of life is often incomplete, owing to detrusor‐sphincter dyscoordination, but this disappears when bladder control is attained. Approximately 5–10% of 7‐year‐old children suffer from daytime incontinence and/or nocturnal enuresis, and a few per cent of them will not outgrow it. Daytime incontinence in childhood is usually attributable to detrusor overactivity, although it is unclear to what extent it is the detrusor or the micturition reflex per se that is overactive. Enuresis – nocturnal incontinence – is caused by either nocturnal polyuria and/or nocturnal detrusor overactivity, in both cases combined with high arousal thresholds. Bladder problems in childhood constitute a risk factor for the development or persistence of bladder problems in adulthood.     

前列腺增生致膀胱出口梗阻后逼尿肌功能改变对尿动力学参数的影响

目的探讨良性前列腺增生症（BPH）致膀胱出口梗阻（BOO）后逼尿肌功能改变对尿动力学参数的影响。方法109例具有完整尿动力学结果的BPH患者根据有无B00分为梗阻组和非梗阻组;梗阻组根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级4组;逼尿肌收缩力分为逼尿肌收缩力减弱（DCA）与收缩力正常组;逼尿肌不稳定（DI）分DI与非DI;膀胱顺应性（BC）分高、正常、低顺应性三组;28例患者行经尿道前列腺切除术（TURP）术前及术后尿动力参数对比。结果BOO组的前列腺体积（PV）、国际前列腺症状评分（IPSS）、DI、急性尿潴留（AUR）发生率明显高于非BOO组（P〈O．05）;BOO组的最大尿流率（Qmax）、BC值、DCA发生率明显低于非BOO组（P〈0．05）;逼尿肌收缩力正常组的残余尿（RV）与BC值明显低于减弱组（P〈0．05）,而BOO和DI的发生率明显高于减弱组（P〈0．01）;DI组的年龄、BC值及DCA的发生率明显低于非DI组（P〈0．05）,而B00级别和AUR的发生率明显高于非DI组（P〈0．01）;低BC组IPSS、BOO级别、AUR发生率明显高于正常及高BC组（P〈0．05）,而DCA发生率明显低于正常及高BC组（P〈0．01）;术后Qmax、BC值较术前明显升高（P〈0．05）,RV、IPSS、DI发生率较术前明显减小（P〈0．01）。结论①BOO常与低顺应性膀胱、DI、AUR合并存在;②IPSS评分不能提示是否存在DI,DI的存在不影响IPSS评分;③TURP是治疗前列腺增生的金标准;④尿动力检查能全面了解有无BOO及BOO所致逼尿肌功能改变情况,对BPH的临床鉴别诊断、预后估计及选择恰当治疗方案都具有重要意义。