使用新型倒刺电极的骶神经调节治疗神经源性膀胱的初步临床结果

目的探讨应用新型倒刺电极（Tined-lead）对神经源性膀胱患者行S骶神经调节（SNM）的初步疗效。方法对5例神经源性膀胱患者采用新型倒刺电极，在X线监测下将电极植入S3骶神经孔，进行SNM。术前、术后详细记录排尿日记，用影像尿动力学方法评估患者的膀胱尿道功能。结果患者1（隐性骶裂）术后排尿次数和排尿量分别改善22％和49％；患者2（隐性骶裂）术后排尿次数、排尿量和残余尿量分别改善0．7％、11％和46％；患者3（隐性骶裂）术后排尿次数、排尿量和残余尿量分别改善0．4％、18％和44％。患者4（脑外伤）术后漏尿次数和漏尿量分别改善36％和54％。患者5（高位截瘫）术后间歇导尿次数和导尿量分别改善42％和54％，尿动力学参数改善37％～45％。结论用新型倒刺电极进行SNM为神经源性膀胱的治疗提供了一条新的可供选择的微创方法。     

Perugia urodynamic method of analysis (PUMA): a new advanced method of urodynamic analysis applied clinically and compared with other advanced methods.

AIMS: The aim of this study is to compare PUMA curves with different pathologic conditions causing bladder dysfunction in 158 men and 83 women. METHODS: PUMA results in terms of bladder outlet obstruction and detrusor contractility were compared in 92 men with benign prostatic hypertrophy (BPH) and p(ves) congruent with p(det) (i.e., p(abd) congruent with 0) with the results of the urodynamics operator's opinion, the provisional International Continence Society method, Abrams and Griffith's diagram, urethral resistence factor (URA), Sch?fer's diagram, and Watt factor. PUMA curves correlated reliably with different pathologic conditions such as obstructive BPH, orthotopic bladder, cystocele, the neurological bladder, and bladder diverticulum. Statistical analysis indicated excellent agreement between PUMA and URA; agreement with other methods was good in cases of obstruction and nonobstruction. In doubtful cases, as diagnosed by standard methods, PUMA agreed only with the Abrams and Griffith's diagram. PUMA and Wmax were in good agreement on detrusor con traction force. Agreement between PUMA and Sch?fer's diagram was excellent for patients with detrusor hypercontractility and good for patients with detrusor hypocontractility and normocontractility. PUMA is the only method applicable to women. It is easy to perform. When integrated with other diagnostic tests, it provides realistic data for diagnosis, medical or surgical therapy, and outcome.     

经尿道电气化手术治疗112例膀胱肿瘤的临床分析

目的 :探讨经尿道电气化手术治疗病变局限于膀胱壁内肿瘤的治疗方法。方法:综合采用套切、勾切、气化、凝切及电凝、封闭闭孔神经等技术 ,经尿道根治性电气化手术切除膀胱肿瘤 112例。结果:2例因膀胱穿孔改行开放手术 ,7例需 2次手术完全切除肿瘤 ,全部病例均达到根治性切除目的 ,术后平均留置尿管 3～ 7d。结论 :经尿道电气化切除手术适宜病变局限于膀胱壁内肿瘤的根治性治疗。     

尿干化学法检测阴性不可偏废沉渣镜检

通过对 5 0 0例经尿 11项试纸检查阴性的标本 ,沉渣镜检发现尚有 6 7例阳性 ,阳性率为 13.4 %。提示尿沉渣镜检 ,不失为泌尿系统疾病检查的必要手段不应忽视及偏废     

Comparative genomic hybridization (CGH) of augmentation cystoplasties

OBJECTIVE: Tumors arising within augmentation cystoplasties are aggressive, have poor prognosis and the majority are not detected at follow-up cystoscopy. Genetic changes in tumors precede morphological abnormalities. Therefore, the aim of this study was to investigate whether genetic abnormalities detected by comparative genomic hybridization (CGH) could be used to identify those patients with augmentation cystoplasties at increased risk of tumorigenesis. METHODS: Bladder biopsy samples were obtained from 16 augmentation cystoplasty patients both distant from and near to the enterovesical anastomosis. CGH was used to detect genetic abnormalities in DNA extracted from the biopsies, archival specimens of two augmentation cystoplasties and two de novo bladder adenocarcinomas. RESULTS: A greater number of amplifications on 2p, 3q, 8q, 9p, 17p, 18pq and 20pq, were observed in bladder biopsies obtained near to the enterovesical anastomosis compared to those taken distant to the suture line. CGH of archival augmentation cystoplasty tumor DNA indicated abnormalities at several loci with amplifications at 2q, 5q, 10p and 21pq, while deletions occurred at 5p and 16p. CONCLUSIONS: The results of this study suggest that the urothelium adjacent to the bladder and/or bowel anastomosis in augmentation cystoplasties is genetically unstable. Furthermore, longitudinal studies are required to establish whether or not patients exhibiting genetic instability following augmentation cystoplasty are at greater risk of developing tumors than those with genetically stable epithelia.     

Case of acute urinary retention as a result of non-steroidal anti-inflammatory drugs

Abstract:   A 19-year-old woman presented at our hospital with acute urinary retention in September 2005. She had experienced the same chief complaint twice previously. She had used non-steroidal anti-inflammatory drugs before acute urinary retention. The results of physical examinations were unremarkable, and her neurologic signs were not remarkable. The basic laboratory test values were all normal and a psychiatric assessment indicated that her symptoms were not psychogenic. Magnetic resonance imaging was carried out, but revealed only a slight bulging in the L3/L4/L5 disk. Water cystometry showed acontractile detrusor. We made a diagnosis of acute urinary retention as a result of non-steroidal anti-inflammatory drugs because of her use of such drugs before the development of symptoms on multiple occasions. This patient was regularly followed up as an outpatient, and she could void smoothly in February 2006. This is the first report which acute urinary retention associated with non-steroidal anti-inflammatory drugs in Japan.