女性压力性尿失禁患者术前尿动力学检查的意义

目的：通过研究临床诊断为压力性尿失禁的女性患者的诊疗资料，探究术前尿动力学检查在疾病诊断和治疗中的作用，分析尿动力学检查的临床意义。方法：收集北京大学人民医院2011年4月至2015年10月间收治的临床诊断为压力性尿失禁并进行术前尿动力学检查的女性患者，排除盆腔脏器脱垂的患者，共计纳入196例进行研究。分析这196例女性患者术前尿动力学检查结果及其对完整诊断和后续治疗的影响，确定术前尿动力学检查的临床意义。结果：根据患者主诉、临床症状和体格检查得出的临床诊断中，有11.73%的诊断结果与尿动力学检查结果不相符。根据尿动力学检查结果，10例患者改变了治疗方法，避免了不适当的手术方式带来的术后并发症，包括3例逼尿肌过度活动的患者，最终采取保守治疗；6例膀胱出口梗阻合并压力性尿失禁的患者，3例采取膀胱颈切开加耻骨后无张力尿道中段悬吊术，2例采取膀胱颈切开术，1例采取膀胱颈切开加经闭孔无张力尿道中段悬吊术；另外1例尿动力检查结果提示膀胱功能未见异常的患者最后证实为间质性膀胱炎，行膀胱内药物灌注治疗。结论：详细的病史、体格检查、辅助检查与尿动力学检查相结合，才能对压力性尿失禁做出正确的诊断。术前尿动力学检查对于临床诊断为压力性尿失禁的女性患者具有重要诊疗意义。尿动力学检查结果可以对临床诊断进行修正，并有助于制定出更个体化的治疗方案。

Significance of preoperative urodynamics for clinical diagnosis of female patients with stress urinary incontinence

Objective:To investigate the impact of preoperative urodynamic study on the diagnosis and treatment for female patients with clinical diagnosis of stress urinary incontinence by studying their diag-nosis and treatment database,and to assess its clinical significance of urodynamic study.Methods:From April 2011 to December 2015,196 female patients diagnosed clinically with stress urinary incontinence underwent preoperative urodynamics study,after excluding pelvic organ prolapse.The preoperative uro-dynamic data of these 196 cases were analyzed and the clinical significance of urodynamics on differential diagnosis and treatment for the female patients with stress urinary incontinence was evaluated.Results:In this study,23 cases (11.73%)changed or amended their diagnoses by the urodynamic study,which were inconsistent with the previous clinical diagnoses concluded by the symptoms,physical examinations, and lab tests.A total of 10 cases underwent a different surgery or conservative treatment instead of the original treatment according to urodynamic study.Of them,3 were diagnosed as detrusor overactive and undertook conservative treatment;3 were diagnosed as bladder outlet obstruction plus stress urinary in-continence and were undertaken the transurethral resection of the bladder neck (TURBN)plus tension free vaginal tape (TVT);2 were diagnosed as bladder outlet obstruction plus stress urinary incontinence and were undertaken TURBN alone;1 was diagnosed as bladder outlet obstruction plus stress urinary in-continence and was undertaken TURBN plus tension free vaginal tape obturator (TOT);1 was found no abnormal bladder function turned out to be interstitial cystitis and went for a bladder instillation of drug. The changed treatments avoided the risk of dysuria or residual urine increased after operation due to inap-propriate surgical methods.Conclusion:In order to make a correct diagnosis and suitable treatment for female patients with stress urinary incontinences,the preoperative urodynamic study is necessary besides detailed medical history,physical examination,and laboratory tests.With the help of the urodynamic study,the concomitant diseases of patients with stress urinary incontinence may be detected,the individualized treatment regimen can be developed,and more importantly,the inappropriate surgical de-cision can be avoided.