隐性脊柱裂排尿功能异常的临床特征

目的：研究伴有排尿功能障碍的隐性脊柱裂患者临床特征。方法：总结41例有明显排尿功能障碍的隐性脊柱裂患者临床资料。以18岁为界，将患者分为儿童组和成人组，所有患者均接受X线检查，除4例儿童外，均接受普通尿流动力学检查。结果：儿童组发病高峰年龄在1～2岁，主要临床表现为持续性原发性遗尿，部分伴有尿频、尿急及轻度急迫性尿失禁现象；成人组发病高峰年龄在18～26岁，主要临床表现为尿频、尿急、排尿前踌躇、排尿困难、遗尿等。结论：隐性脊柱裂患者常有排尿功能异常表现，出现症状的高峰时间为出生后及青春发育期后。X线、CT、MRI和尿流动力学等检查在隐性脊柱裂排尿功能障碍的诊断和治疗方案制定中有重要地位。     

Effects of gonadal hormones on urinary behavior in dogs

The effects of testicular and ovarian hormones on urinary frequency and posture were studied in 8 groups of dogs. Three of the 4 female groups had been exposed to androgenic stimulation in utero, neonatally, or both in utero and in infancy. The fourth group of females consisted of ovariectomized controls. Males were intact or castrated as adults, as juveniles, or as neonates. Frequency of urination was increased in all groups by estrogen and by testosterone. Urinary posture was unaffected in males by castration in the adult or juvenile stages. Neonatal castration of males resulted in periodic regression from the adult male posture to the immature male posture. Control and prenatally androgenized females urinated in the feminine position. Females treated with large amounts of testosterone in infancy showed a limited degree of masculinization of urinary posture. Females exposed to testosterone before and immediately after birth urinated as females about 50% of the time and as adult males for approximately half of their urinations. Exogenous estrogen or androgen administered in adulthood had no effect on posture assumed for urination.     

前列腺增生症术后排尿困难的原因探讨及预防

为了探讨前列腺增生症术后排尿困难的原因及预防方法,对前列腺切除术后27例仍有排尿困难的临床资料进行了分析。结果显示:尿道狭窄14例,尿道内口闭锁2例,膀胱逼尿肌功能紊乱2例,腺体残留3例,后唇瓣膜2例,输尿管间嵴肥厚1例,后尿道狭窄合并结石1例,膀胱颈水肿,前列腺癌1例。由此可见,尿道狭窄是术后排尿困难的主要原因,小前列腺增生或前列腺增生伴炎症宜采用TURP+膀胱颈内切开治疗以减少尿道狭窄。     

低频电刺激联合膀胱功能训练治疗脊髓损伤诱发的神经源性膀胱的效果评价

目的 评价低频电刺激联合膀胱功能训练治疗脊髓损伤(SCI)诱发的神经源性膀胱(NB)的效果。方法 选取2017年5月～2019年2月我院骨科门诊就诊的SCI诱发NB患者90例,随机分为观察组与单纯组,每组各45例。观察组予以低频电刺激联合膀胱功能训练治疗,单纯组予以单纯的膀胱功能训练,两组均治疗6周。评估两组治疗前后排尿情况及尿动力学指标的变化,并比较其临床疗效。结果 治疗6周后,两组日均单次排尿量和日单次最大排尿量较治疗前明显增加,日均排尿次数较治疗前明显下降(P0.05或P0.01),且观察组变化幅度较单纯组更显著(P0.05);两组膀胱内压力和Qmax较治疗前明显上升,RU较治疗前明显下降(P0.05或P0.01),且观察组变化幅度较单纯组更显著(P0.05);同时观察组临床总有效率(95.56%)明显高于单纯组(82.22%)(χ2=4.053,P0.05)。结论 低频电刺激联合膀胱功能训练用于治疗SCI诱发NB患者的效果确切,能更明显改善患者的排尿情况及尿动力学状态。     

经皮肾镜碎石术肾造瘘管拔除后预防漏尿的研究

目的：探讨体位活动指导对经皮肾镜碎石术后拔除肾造瘘管患者漏尿的影响。方法：根据纳入标准，将80例经皮肾镜碎石术的患者，按照入院先后顺序随机分为45°半卧位（对照组）、坐位（实验组），观察两组患者不同时间段漏尿的变化情况。结果：实验组漏尿明显少于对照组。结论：采取坐位按压法对于减少经皮肾镜碎石术后拔除肾造瘘管患者漏尿有着积极的意义，值得在临床上推广。     

Effects of Crede's method on urine voiding within the first 8 h after surgery among post‐haemorrhoidectomy patients: a comparison study

Urinary retention is a common complication among patients after haemorrhoidectomy. Although Crede's method is recommended for urinary retention in nursing practice textbooks, its effects require further examination. The purpose of this study was to investigate the rate of urine voiding within the first 8 h following haemorrhoidectomy and to examine the effects of Crede's method on this postoperative outcome. A two‐group comparison study was conducted. All participants were over 20 years of age, and each had undergone haemorrhoidectomy. Outcome measurements included patients' self‐reported urine voiding within 8 h of surgery, personal demographics and disease‐related data. Before the surgical procedure, participants were divided into Crede's group and non‐Crede's group, and written educational materials were given. Patients in the Crede's group were taught Crede's method for application in the event that they were unable to void urine after haemorrhoidectomy. The non‐Crede's group patients were taught traditional methods without Crede's method. We examined urine voiding within the first 8 h after haemorrhoidectomy. The mean rate of urine voiding within 8 h of surgery was 60·9% overall, with 91·3% (21/23) in the Crede's group and 30·4% (7/23) in the non‐Crede's group reporting successful voiding. After controlling for the two groups' personal characteristics and disease‐related variables, age, educational level and perioperative fluid administration were treated as covariates and included in the multinomial logistic regression model. The odds ratio of urine voiding within the first 8 h after surgery was 52·70‐fold higher in the Crede's group than in the non‐Crede's group (p < 0·01). This study shows that Crede's method is an effective strategy to aid in urine voiding within the first eight postsurgical hours among patients following haemorrhoidectomy. Clear and concise information about urinary retention and related management strategies should be given to patients before haemorrhoidectomy.     

前列腺癌根治切除术中采用神经电调节改善早期排尿功能障碍的临床研究

目的 探讨前列腺癌根治切除术中采用神经电调节改善早期排尿功能障碍的临床效果.方法 2013年8月至2015年4月选择在本院泌尿外科进行诊治的前列腺癌患者120例,根据随机抽签原则分为观察组与对照组各60例,所有患者都给予腹腔镜下前列腺癌根治切除术,对照组在围手术期给予会阴部肌肉常规锻炼,观察组在对照组干预的基础上采用神经电调节治疗.结果 观察组的首次反射排尿时间和平衡膀胱建立时间分别为(7.81±2.14)d和(22.19 ±5.29)d,都明显少于对照组的(9.13±1.49)d和(25.30±6.14)d(P＜0.05).针对术后有效率进行研究发现,对照组和观察组的数据分别为88.3％和98.3％,观察组比对照组明显要高(P＜0.05).观察组术后6个月盆腔血肿、切口感染、吻合口漏、尿失禁、尿潴留等并发症发生情况明显少于对照组(P＜0.05).结论 前列腺癌根治切除术中采用神经电调节治疗可有效缓解患者排尿障碍的症状和体征,减少术后并发症的发生,有很好的临床应用价值.     

The influence of positioning in urination: An electromyographic and uroflowmetric evaluation

PurposeWe conducted a cross-sectional study to evaluate whether the different positions during urination influence the electrical activity of the abdominal and perineal musculature, as well as the uroflowmetric parameters of children with lower urinary tract dysfunction (LUTD).Materials and methodsNinety-four children between the ages of 3 and 14 years with symptoms of LUTD were evaluated. All underwent uroflowmetry and electromyography tests (abdominal and perineal) in two different positions: oriented position (trunk bent slightly forward and feet flat) and atypical position (standing on toes for boys and buttocks not in contact with the lavatory seat and legs flexed in girls). We excluded nine patients due to suspicions of outside interference or elements complicating the analysis of charts.ResultsAmong patients evaluated 55 (64.7%) were girls and 30 (35.3%) were boys with an average age of 8.5 years. Children urinating in atypical position showed higher levels of perineal electrical activity than when they were in normal position (p = 0.018). However, there was no difference in the pattern of the curve if normal or abnormal when comparing the two groups (p = 0.824). When evaluated separately, the boys demonstrated no difference between positions, in relation to perineal electrical activity (p = 0.412) or abdominal electrical activity (p = 0.202).ConclusionsThe electrical activity of the pelvic floor musculature is decreased in the oriented position when compared to atypical positions in female children. Our data suggest that special attention should be given to adopting an adequate posture during urination for girls with LUTD.