女性逼尿肌活动低下患者自由尿流率曲线形态分析及其临床意义

目的:探讨女性逼尿肌活动低下(DU)患者自由尿流率曲线形态特点及其临床意义。方法:回顾性分析2014年6月至2016年6月因下尿路症状(LUTS)于华中科技大学同济医学院附属同济医院行尿动力学检查的275例女性患者的临床资料。年龄(48.0±13.0)岁；症状主要为尿频、尿急、尿不尽感、排尿费力、尿失禁等。根据尿动力学...

The abnormalities of free uroflow curve in female patients with detrusor underactivity and their clinical significance

Objective To explore the features of free uroflow(FF)curve patterns in female patients with detrusor underactivity(DU)and their clinical significance.Methods Data of 275 adult female patients with lower urinary tract symptoms(LUTS)underwent urodynamic studies(UDS)at urology center of our hospital from June 2014 to June 2016 were analyzed retrospectively.The uroflow curve patterns of patients with DU were classified and analyzed in the context of parameters of FF,cystometry(CM),and pressure-flow study(PFS).The prevalence of each abnormal uroflow curve pattern in DU patients were calculated and compared with those in non-DU patients.Results No bell-shaped curve was found in 141 patients with DU.The abnormal curve patterns can be divided into 5 types:TypeⅠ(bell-shaped curve with saw tooth)in 20 cases(14.2%),TypeⅡ(box-like curve)in 34 cases(24.1%),TypeⅢ(triangle curve with decreasing slop)in 62 cases(43.9%),TypeⅣ(triangle curve with increasing slop)in 4 cases(4.3%),TypeⅤ(tide-wave curve)in 19 cases(13.5%).Maximum flow rate of free uroflow(Qmax.FF)of typeⅠ(28.4±9.7)ml/s]was significantly greater than that of typeⅡ,ⅢandⅤ(17.0±4.1),(15.8±5.4)and(12.9±6.4)ml/s,P<0.05].Flow time of free uroflow(FT.FF)of typeⅢandⅤ(43.7±17.2)and(50.1±28.9)s]were significantly longer than that of typeⅠandⅡ(18.5±7.3)s and(27.2±9.7)s,P<0.05].Post voided residual>50ml was noted in 19 cases(30.6%)of typeⅢ,7 cases(36.8%)of typeⅤ,1 case(2.9%)of typeⅡand no one in typeⅠandⅣ.Abnormal manifestations in cystometry mainly included bladder hypersensitivity,detrusor overactivity,and stress urinary incontinence.Detrusor pressure at Qmax(Pdet.Qmax)of typeⅤ(7.4±5.0)cmH2O]was significantly lower than that of typeⅠ,Ⅱ,Ⅲ(11.8±6.7),(12.0±5.3),(12.1±5.0)cmH2O,P<0.05].Among 134 cases of non-DU,there were typeⅠcurves in 88 cases(65.7%),typeⅡcurves in 4 cases(2.9%),typeⅢcurves in 15 cases(11.2%),typeⅣcurves in 1 cases(0.7%),typeⅤcurves in 7 cases(5.2%).And normal bell-shaped curves in 19 cases(14.2%).The prevalence of typeⅡ,ⅢandⅤin DU patients was significantly higher than that in the non DU patients(P<0.05).Conclusions This study reveals that the characteristics of reduced detrusor contractility and duration,prolonged bladder emptying or incomplete emptying can be reflected in the patterns of free uroflow curve in female patients with DU.The abnormalities of these free uroflow curve patterns,especially typeⅡ,ⅢandⅤwill be helpful in preliminarily screening DU in females.